Exercises for Older Adults

johnnysfit ohana reports and opinions are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provideruct

JULY 12

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592)

More New Studies on Muscle Growth for Older People
Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).
Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).
High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).
Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program
The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging
Preventing Muscle Loss

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger
Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations
Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

JULY 4

Heat Stroke

Nobody should ever die of heat stroke, a rapid uncontrolled rise in body temperature that causes you to pass out. Your body sends you warning signals as your temperature rises.

In 1965, I almost died from heat stroke in an unimportant local race in Arlington, Virginia. I passed out during the race and lay unconscious for a while. I am still embarrassed by the stupidity that I showed when I ignored all the warning signs as my temperature continued to climb. First your muscles are affected, then your lungs and then your brain.
Muscles: As your temperature starts to rise, your muscles feel like a hot poker is pressing against them. It is normal for intense exercise to make your muscles burn, but hard exercise does not cause painful burning that feels like fire. Furthermore, the burning of hard exercise is relieved by slowing down, while the muscle burning of impending heat stroke does not go away when you slow down.
Lungs: As your temperature rises further, the air that you breathe feels like it is coming from a furnace and no matter how rapidly and deeply you try to breathe, you can’t take in enough air. When you exercise intensely, you can become very short of breath, but the air you breathe will not burn your lungs. Burning in your lungs, not relieved by slowing down, signals impending heat stroke. When you feel that the air is so hot that it burns your lungs, stop exercising. This sign means that your heart cannot pump enough blood from your exercising muscles to your skin so heat is accumulating and your temperature is rising rapidly. Your temperature is now over 104 degrees F. and continuing to exercise will raise your body temperature even further so it will start to cook your brain• Brain: When heat stroke begins to affect your brain, your head will start to hurt, you may hear a ringing in your ears, feel dizzy and have difficulty seeing. Then you will end up unconscious. Your temperature is now over 106 and your brain is being cooked just like the colorless portion of an egg that turns white when it hits a hot griddle.

Mechanism
During exercise, more than 70 percent of the energy used to drive your muscles is lost as heat, so your heart has to pump the heat in your bloodstream from your hot muscles to your skin where you sweat and the sweat evaporates to cool your skin to dissipate the heat. The harder you exercise, the more heat your muscles produce. Everyone who exercises, particularly in hot weather, has to sweat to keep their body temperatures from rising too high.

Risk for heat stroke is increased by:
• any pre-existing illness
• heart disease
• use of various recreational drugs such as cocaine, and some prescription drugs
• lack of fitness
• not drinking enough fluid
• exercising for extended periods without eating
• wearing excess clothing that traps heat in your body
• not listening to your body when you feel the warning signs described above

Many cases of heat stroke during exercise occur when a person suddenly increases the intensity of exercise, such as a sprint at the end of a long distance running or cycling race, or an intense run down the field in soccer.

Treatment
When a person passes out from heat stroke, get medical help immediately. Any delay in cooling can kill the person, and you may need an expert to help decide if the person has passed out from heat stroke or a heart attack.

Carry the victim rapidly into the shade and place him on his back with his head down and feet up so blood can circulate to his brain. Once it has been established that the person is not having a heart attack, he or she can be cooled by pouring on any liquids you can find. Evaporation of any liquid cools. As you cool him, he may suddenly wake up and talk to you and act like nothing has happened. Don’t stop cooling him, because while he’s sitting or lying there, his temperature can rise again and he can go into convulsions or pass out again. He must be watched for several hours after he is revived.

Prevention
When you exercise in hot weather, stop exercising when you start to feel any of the symptoms described above and find a shady spot to recover. Stay well hydrated, but realize that too much fluid (Hyponatremia) can also be harmful.

June 16

How to Get My Body in Shape at 60-Years-Old

SHARIN GRIFFIN

June 7

Osteoarthritis Linked to Inflammation

Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant joint pain. Recent research suggests that osteoarthritis may be caused by inflammation, the same overactive immunity that causes heart attacks and auto-immune diseases. Your immunity is good for you because it kills germs that try to invade your body. However, after the germs are gone, your immunity is supposed to slow down. If your immunity remains active, it can use the same chemicals and cells that attack germs to attack any part of your body, and that includes destroying the cartilage in your joints. Here are some of the recent studies linking osteoarthritis with other diseases of inflammation:

• People with osteoarthritis have high blood levels of galectins that turn on a person’s immunity to cause inflammation, just as in rheumatoid arthritis and reactive arthritis (The Journal of Immunology, February 15, 2016;196(4):1910-1921).
• People who eat an anti-inflammatory Mediterranean-type diet (high in plants, low in red meat and other pro-inflammatory foods) are at reduced likelihood for getting osteoarthritis (Clin Nutr, Oct 8, 2016. S0261-5614(16)31279-1).
• Factors associated with increased diabetes risk are increased in people who have osteoarthritis (Br Med Bull. Sept 2015;115(1):111-21).
• Overweight women are at increased risk for osteoarthritis (Osteoarthritis Cartilage, Oct 27, 2015. S1063-4584(15)01364-3). See How Excess Weight Can Cause Arthritis.
• Taking sugared drinks increases risk for osteoarthritis and the more a person drinks, the greater the risk (BMJ Open, July 18, 2013;3(7):e002993).
• Osteoarthritis is associated with high cholesterol (Osteoarthritis and Cartilage, Feb 9, 2017).

Types of Arthritis
Doctors classify arthritis into several types, including:
• degenerative arthritis (following trauma. work-induced injury or repetitive motion injury)
• various kinds of reactive arthritis, such as rheumatoid arthritis, in which a person’s immunity is overactive
• infections in joints
• crystal diseases, such as gout, in which crystals form in joints
• osteoarthritis, by far the most common type, where cartilage is worn away and there is no history of trauma or other known explanation. When there is no known cause, treatments are just guesswork. Osteoarthritis is usually treated with non-steroidal drugs (NSAIDs) that help to block pain but do nothing to slow down the destruction of cartilage.

Symptoms of Osteoarthritis
People are usually diagnosed as having osteoarthritis if they:
• have gradually increasing pain in their knees, hips, hands or spine
• are age 40 or older
• have negative results in the standard blood tests for an overactive immunity
• have swelling of the knuckles and joints on the ends of the fingers next to the fingernails, not in the middle finger joints, and at the base of the thumb (Rheumatoid arthritis usually affects the middle joints of the fingers and the joints where the fingers attach to the hand)
• have pain that is usually worse in the morning when a person first gets up. In osteoarthritis, the pain usually lessens as the person keeps moving.

Exercise Treats Osteoarthritis
• A reviews of 55 studies showed that weight bearing exercise reduces pain and improves joint function in osteoarthritis (British Journal of Sports Medicine, September 24, 2015). Exercise helps to reduce inflammation.
• Aerobic and strength training for 20 weeks markedly decreased knee pain and increased mobility (Arthritis Care & Research, 08/30/2016). No serious side effects occurred from the knee strength and conditioning program.
• A review of six studies of a total of 656 men and women with knee osteoarthritis found that exercise improves symptoms of knee pain in osteoarthritis and that it did not make much difference whether the knee exercise program was of low or high intensity (Cochrane Database Syst Rev, 2015 Oct 29;(10):CD010203).
See Treat Osteoarthrits with Exercise
Exercise for Osteoarthrits

Little Evidence That Any Type of Surgery Helps to Treat Knee Osteoarthritis
Removing damaged attached cartilage offers little or no benefit (Br J Sports Med, 2016;50:1473-1480). Exercise is more effective than surgery (arthroscopic partial meniscectomy) in treating people with knee pain and degenerative meniscal tears (British Medical Journal, July 20, 2016). Surgery has not been shown to be more effective than exercise in treating knee osteoarthritis (N Engl J Med, 2013;368:1675-84) and arthroscopic partial meniscectomy is not more effective than sham placebo surgery for a degenerative meniscal tear (N Engl J Med, 2013;369:2515-24). An editorial in the same issue of the journal states: “The surgery is a highly questionable practice without supporting evidence of even moderate quality . . . the latest nail into what should be a sealing coffin” (BMJ. July 20, 2016).

Why So Much Surgery?
In the United States, medicine is a business and the bottom line of a business is profit. Fifteen years ago, the first of many studies showed that arthroscopic partial meniscectomy is no more effective than a placebo (N Engl J Med, 2002;347:81-8). Yet arthroscopic partial meniscectomy to trim a torn knee meniscus is one of the most common surgical procedures, with more than 750,000 knee arthroscopies done in the United States each year.

My Recommendations
If your joints hurt, check with your doctor to see if you have a known cause. If you have sudden locking of a joint and it gets better but then recurs, you may have “joint mice”, loose pieces of cartilage that slip between the cartilage to cause horrible pain. Your doctor can usually fix this by removing the loose pieces by arthroscopy. If your doctor cannot find a cause for your pain, you will probably be told that you have osteoarthritis. Everything you can do to reduce inflammation will help you to combat the pain of osteoarthritis:

• Lose weight if you are overweight. I recommend Intermittent Fasting.
• Eat an anti-inflammatory diet that includes lots of fruits, vegetables, whole grains, beans, nuts and other seeds, and severely restrict red meat, all foods with added sugar, all sugared drinks including fruit juices, and fried foods.
• Keep blood levels of hydroxy vitamin D above 30.
• Exercise and keep moving. Osteoarthritis always worsens with inactivity. However, you must be guided by pain and stop when the pain worsens.
• Avoid sports that involve impact, since the force of your foot hitting the ground can break off cartilage. Do not run, jump or participate in exercise that involves impact of your feet hitting the ground. You can cycle since your feet never leave the pedals, so pedaling is not an impact sport. Swimming is also a good non-impact sport.
• Use non-steroidal anti-inflammatory drugs as needed to control pain, but realize that they do nothing to cure the problem. Take the lowest dose possible to relieve pain.
• If knee pain becomes so unbearable that it keeps you awake at night, you may want to consider a knee replacement. However, replacing your joint requires driving a spike into the middle of the bones of your knee and that pushes aside the shock-absorbing marrow and weakens the bone to increase your chances of breaking the bones if you fall. If that happens, the knee cannot be replaced again until the broken bones heal.

May 24

Weight Lifting for Middle-Age and Beyond

Many middle-aged and older people have started to lift weights, since extensive data show that lack of muscles increases risk for diabetes, heart attacks and premature death (British Medical Journal, September 2009; Journal of Physiology, September 2009). However, within the first few weeks of their new weight-lifting programs, most get injured and quit.

Often they get injured because they try to train like younger me, by picking the heaviest weight that they can lift ten times in a row, resting and repeating that set two more times. Then they feel sore for the next few days and when the soreness lessens, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program.

The safest way for most older men and women to start a program to gain strength and increase muscle size is to join a gym and try to use 15 to 20 Nautilus-type machines every day or every other day. On each machine they should pick the weight that they can lift and lower 10 times in a row comfortably, without straining or damaging their muscles (which would make their muscles feel sore on the next day). If they feel the least bit sore, they should take a day or days off until the soreness is gone. As they become stronger and the weights feel very easy for them, they should try to lift 15 times in a row, then perhaps 20 times.  Only when they can lift that weight at least 20 times in a row and not feel sore the next morning, should they try to increase the resistance by going to the next heavier weight.

The key to this program is to avoid injuring their muscles by lifting weights in a single set and increasing the number of repetitions gradually so they do not cause next-day muscle soreness. They should not increase the weight (resistance) until they can lift a set of at least 20 daily and not feel sore the next day.

Before any older or out-of-shape person starts an exercise program, he or she should check with a physician to rule out serious problems that might be aggravated by weight lifting.

This program is for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles. It will, however, increase strength and provide the other benefits of a weight training program. After many months (injury-free) on this program, if a person wishes to build larger muscles, he or she can transition to a more traditional weight training program.  

MAY 21

Exercise Keeps You Younger

The decline in brain and body function with aging is caused more by inactivity than it is just by aging. A study of 85 male and 41 female fit amateur cyclists, aged 55 to 79, found that most of them were physically much younger than most people of the same age (The Journal of Physiology, published online January 6, 2015;593(1)). All rode their bikes for recreation and none were serious competitive athletes. The men had to be able to ride a metric century (62 miles)averaging only 10 miles per hour, and the women 60 kilometers (37 miles), averaging a slow 6.7 miles per hour.

The older bicyclists’ test results were close to those for younger people for:
• endurance,
• pedaling power,
• metabolic health (control of blood sugar levels),
• balance,
• memory function,
• bone density and
• reflexes.

The single best test that correlates with aging is called V02max, the maximal amount of oxygen that a person can take in and use during a given time period. Many population studies show that VO2max drops significantly with aging. In this group of older bicyclists, VO2max was just a little lower than the results in the younger ones.

Incredibly, the older cyclists had test results similar to younger cyclists for lung power and exercise capacity; and even more incredibly, the memory of the older cyclists was just as good as the memory of the younger cyclists. This confirms many other studies that show that a high level of regular exercise prevents your brain from deteriorating. Several thousand years ago, the Romans knew that when they greeted each other with “Mens sana in corpore sano” (a healthy mind in a healthy body).

Older Bicyclists Did Lose Strength
By studying only older men and women who are very active and ride bicycles most days, the authors were able to select a group of older people who are not like the general population in England. Thus this study shows that older people who exercise regularly have bodies and minds that are similar to those of much younger people. The conclusion is that the rapid decline in mind and body with aging is caused far more by inactivity than by aging.

The oldest cyclists were stronger than non-exercisers, but they had much smaller and weaker muscles than cyclists in their 50s and early 60s. This shows that aging makes you weaker, no matter how much you exercise. However, other studies show that while you lose strength rapidly with aging, you lose endurance and recovery time from intense exercise far more slowly.

What You Should Learn from This Study and Others Like It
If you want to be able to run, cycle or walk long distances fast as you grow older, you should try to exercise every day and try to go a little faster on some days. The majority of older people have chosen to be frail, weak and uncoordinated because of their lifestyles, not their ages.
• If you have never exercised, start now.
• If you exercise regularly, continue to do so.
• Find an exercise in which you can keep moving almost every day: dancing, walking, various exercise machines, cycling, skiing, and so forth.
• Those who choose to ride a bicycle should worry more about being hit by a car than about the disabilities associated with aging.
• In our modern societies, people are living longer and often spend many years suffering terrible disabilities of both mind and body. Most North Americans over 70 cannot walk fast. One in eight people over 70, and one in two over 85, suffer from dementia. Exercise helps to slow damage to your mind and body associated with aging.
• Lack of exercise is associated with increased risk for overweight, diabetes, heart attacks, strokes, many different cancers, and premature death.

Caution: People with blocked arteries leading to their hearts are at increased risk for heart attacks when they start to exercise or increase the speed or amount of exercise. Check with your doctor.

MAY 15

New Research on Intense Exercise
The more intensely you exercise, the less likely you are to suffer a heart attack, even though heart attacks can be caused by intense exercise in some people who already have irregular heartbeats or blocked arteries leading to their hearts.

• Researchers had 4582 men and women, average age 46, wear mechanical accelerometers to measure their intensity of exercise. After ten years, they found that the more they moved about and the less time they sat without moving around, the less likely they were to develop heart disease and the higher their blood levels of the good HDL cholesterol (Preventive Medicine, published online May 02, 2019). Also, the women who were even moderately active had lower total cholesterols.

• The HUNT study from Norway followed 26,163 healthy men and women, average age 55.7, for an average of 13 years and found that the more fit they were, the less likely they were to develop a first heart attack (Journal of the American Heart Association, April 19, 2019). They found that a high level of fitness was even more protective in the women than in the men.

• The SUN study from Spain followed 18,737 men and women, average age 38, for six years. The researchers found lower rates of heart attacks in those who exercised intensely as opposed to those who exercised at low intensity (American J of Cardiology, Dec 1, 2018;122(11):1871–1878). They used intensity of exercise per time spent exercising to show that those who exercise intensely had half the heart attack rate, compared to those who did the same amount of exercise less intensely.

Exercise to Prevent a Heart Attack
The association between a regular exercise program and improved health is unquestioned (J Clin Prev Cardiol, 2017;6:109-14; Am J Lifestyle Med, July 1, 2009;3(1 Suppl):44S–49S), and a healthful diet in addition to exercise helps even more to help prevent heart attacks and many other diseases (Eur J Prev Cardiol, Jul 2018 ;25(11):1186-1197).

Intensity makes all muscles stronger including your heart muscle. All people lose heart muscle as they age, which increases risk for frailty and heart failure. Strengthening your heart muscle helps you to live a more vigorous lifestyle and to protect you from heart failure. Intense exercise stabilizes plaques in arteries and widens heart arteries to help protect you from a heart attack. Men with the highest ability to take in and use oxygen (VO2max) have the least high blood pressure, high HBA1C (a test for diabetes), high fasting blood sugar levels, obesity, coronary calcium scoring, abnormal treadmill exercise test, and calculated 10-year risk for heart attacks (American J of Cardiology, March 2012;109(6):839-843).

Preventing heart attacks involves both exercising and eating healthfully. Since exercise helps to stabilize plaques to help keep them from breaking off from arteries, exercise should be part of any heart-attack-prevention program. Dedicated exercisers who need to eat large amounts of food to meet their caloric needs should choose healthful, anti-inflammatory foods to avoid forming more plaques in their arteries. Check with your doctor if you have evidence of heart disease caused by a faulty diet: high blood pressure, high blood cholesterol, high triglycerides, high blood sugar, high CRP (c-reactive protein, a measure of inflammation), an abnormal EKG, or chest pain, particularly with exercise.

Can Intense Exercise Be Harmful?
Exercisers live longer and have far less heart damage than non-exercisers. However, elite athletes may be at increased risk for irregular heartbeats, increased arterial plaque size or thickened heart valves.

• Even though master athletes may be at increased risk for irregular heartbeats (atrial fibrillation), they can still benefit from continuing to exercise. Compared to non-exercisers with atrial fibrillation, they appear to be at reduced risk for suffering from serious side effects such as clots. See Irregular Heartbeats in Senior Athletes and Exercisers.

• Elite athletes may be at increased risk for larger plaques in their arteries than non-exercisers, but narrowing of arteries by plaques does not cause a heart attack. Heart attacks are caused by plaques breaking off from arteries, and exercise helps to prevent heart attacks by making plaques more stable and less likely to break off. See Exercisers Have More Stable Plaques.

• Vigorous exercisers may be at increased risk for thickened heart valves, but compared to non-exercisers, athletes with thickened heart valves still have stronger heart muscles so that they are less likely to suffer heart failure. See Exercise to Prevent a Heart Attack

My Recommendations
I think everyone should have a regular exercise program, and it is never too late to start. See How to Start an Exercise Program.
• Before you try to increase the intensity of your exercise program, you should have exercised regularly for many months, be in good shape and not have any health conditions that can harm you. Because intense exercise can cause heart attacks in susceptible people, you may want to check with your doctor before increasing the intensity of your workouts.
• Try to set up your exercise program so that you increase the pace enough on an intense day to feel mild muscle soreness on the next day. Then take easy workouts for as many days as it takes for the soreness to go away. Only then should you take your next hard workout.
• When you are training properly, your muscles can feel sore every morning. If they don’t feel better after a 10 minute warmup, take the day off.
• If you feel pain in one spot that does not go away after you slow down, stop that workout immediately for that day. Otherwise you are likely to be headed for an injury.

CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or increase the intensity of your existing program.

APRIL 25

.Water-Based Exercises Help Relieve Arthritis Pain

Water exercise is a great option for painful joints and arthritis pain relief.

As a kid I loved to swim. In fact, you couldn’t keep me out of the water. The old swimming hole near my home was a summertime place of fun for me and my friends. Even in this day and age you still can’t keep most people out of the water. According to the Centers for Disease Control and Prevention, swimming is considered the fourth most common sports activity. It is also an excellent way to get in some aerobic exercise.

Many older people can certainly benefit from water-based exercises, such as swimming, or other water activities that require equipment. Besides the benefit to the joints and inflammatory pain, exercising in the water has been found to benefit those who are overweight or suffering from injuries or lower back pain. Water exercise can also improve muscular and cardiovascular strength.

Now that I’m getting older, jumping back in the swimming pool may not be such a bad idea, especially since I’m starting to develop joint and arthritis pain in my knees, hips, spine, and hands.

Water-Based Exercises Help Relieve Arthritis Pain

Osteoarthritis is an extremely common condition. In the U.S. it affects over 50 million people and 80% of those are over 50-years-old. Although autoimmune disorder rheumatoid arthritis is less common, it still affects two percent to three percent of the population at any age.

I’m starting to experience many of the common symptoms associated with arthritis, including morning stiffness, and painful and swollen joints. I also seem to have a restricted range of motion overall and I could benefit from losing a few pounds! Since activities like running and walking can also be painful on the joints, my physiotherapist recommended water exercises.

Water exercise eases arthritis pain and can actually help protect the joints. Some people with arthritis prefer swimming in cold water, whereas others find comfort in warmer water. Research is also very supportive of water exercise to treat arthritis relief. In a 1987 study published in the Scandinavian Journal of Rehabilitation Medicine, eight chronic rheumatoid arthritis patients performed water exercise therapy in a heated swimming pool. After two months of participating in the water exercise program, the patients’ maximal isometric and isokinetic quadriceps strength had increased by 38% and 16% respectively. A more recent review published in the journal Musculoskeletal Care in 2012 found that a warm water exercise called hydrotherapy reduced joint tenderness and pain in rheumatoid arthritis patients. It also increased grip strength and improved mood and overall wellbeing.

In regards to osteoarthritis, a 12-week study published in the Journal of Advanced Nursing in 2007 found that aquatic exercise could significantly improve knee and hip flexibility, strength and aerobic fitness in osteoarthritis patients. For the study, data was collected from 38 patients at the beginning of the study, and at weeks six and 12 during 2003 and 2004.

Getting Started With Water-Based Exercises and Relieving Joint Pain

Do you want to learn how exercise can reduce arthritis and joint pain? Water exercise for arthritis relief is a good place to start. It can be a simple exercise, such as water walking. Water is thought to provide 12 times the resistance of air. In other words, as you walk you are building and strengthening your muscles. Water walking as therapy helps relieve osteoarthritis pain and joint damage. The water’s buoyancy can also decrease the impact on your joints. There are a few key points to keep in mind when you are getting started with water-based exercises to treat joint pain:

  • It is important to start slow if you have arthritis but currently don’t exercise.
  • Use a flotation belt to stay upright when doing deep-water walking.
  • Avoid water exercises if you are experiencing a severe rheumatoid arthritis flare-up. Some downtime may be needed until the pain eases up. If your joint pain, stiffness, or swelling continues to increase, consult your doctor.
  • It is advised that people who experience heavy swelling related to knee osteoarthritis wait to attempt swimming or any other water exercise that would put the joints through a lot of movement.
  • An aquatic center or community center with pools will have programs geared toward people with arthritis.
  • Heated pools with temperatures that reach between 82 to 88 degrees Fahrenheit will help relieve arthritis pain.

Examples of Warm Water Exercises

It is important to relax and enjoy the soothing warm water from the pool when conducting the exercises, just make sure to choose a warm water exercise that best suits your capabilities and fitness level. The following are examples of warm water exercises that can reduce arthritis and joint pain:

  • Pool walking exercise or jogging: The water exercise eases arthritis and joint pain as well. You can try it for yourself. A good place to start is in chest high water. Walk about 10 to 20 steps forward and then about the same amount of steps backward. Eventually you will increase you speed and your difficulty level. Jogging will also increase your intensity. It is good practice to alternate between water walking and jogging for 30-second intervals for at least a five-minute period.
  • Water aerobics: Water aerobics (also known as waterobics, aquafit, or aquatic fitness) includes water yoga, aqua aerobics, or aqua Zumba. Water aerobics tend to be strenuous by nature. Examples of water aerobic exercises include strengthening or resistance exercises and range of motion workouts that prevent joint stress.
  • Hydrotherapy: Hydrotherapy is part of physiotherapy, occupational therapy, and naturopathic medicine. It is used to treat rheumatoid arthritis and osteoarthritis. This therapy is different from swimming since it involves water exercises in a warm water pool. The temperatures are usually warmer than a normal swimming pool at 33 to 36 degrees Celsius. The exercises tend to focus on slow and controlled movements and relaxation.
  • Side and forward lunges: Side and forward lunges are among the most effective pool exercises for joint pain. It is a great way to strengthen the muscles and improve the range of motion of joints. To perform the exercise, stand near the pool wall for support and take a large lunge forward; however, avoid letting the knee go past your toes. Return your leg to the starting position and then repeat on the other side. Side lunges are a little different. Face the pool wall and take a large step to your side with your toes facing forward. Repeat on the other side. Try doing three sets of 10 lunges and side steps.

Precautions to Take With Water Exercises

Water exercise is a great option for arthritis pain relief; however, there are a few precautions you should take before you perform water exercises for arthritis pain relief:

  • Consult with a doctor before participating in water-based exercises to make sure they are safe for you, especially if you have certain medical conditions such as diabetes, multiple sclerosis, thyroid disease, heart or lung disease, circulatory problems, low or high blood pressure, skin problems, or any other serious health condition.
  • Everyone reacts differently to heat. People who feel nauseous or lightheaded should get out of the pool immediately.
  • Avoid using pools or spas after drug or alcohol use. They may increase or reduce blood pressure, or cause drowsiness or sleepiness.

Sources for Today’s Article:

Danneskiold-Samsoe, B., et al., “The effect of water exercise therapy given to patients with rheumatoid arthritis,” Scandinavian Journal of Rehabilitation Medicine, 1987; 19(1): 31-35, http://www.ncbi.nlm.nih.gov/pubmed/3576139.

Al-Qubaeissy, K.Y., et al., “The Effectiveness of Hydrotherapy in the Management of Rheumatoid Arthritis: A Systematic Review,” Musculoskeletal Care, 2013; 11(1): 3-18, doi: 10.1002/msc.1028, http://www.ncbi.nlm.nih.gov/pubmed/22806987.

Wang, T.J., et al., “Effect of aquatic exercise on flexibility, strength and aerobic fitness in adults with osteoarthritis of the hip or knee,” Journal of Advanced Nursing, 2007; 57(2): 141-152, http://www.ncbi.nlm.nih.gov/pubmed/17214750.

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APRIL 23

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People
Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).
Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).
High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).
Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program
The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging
Preventing Muscle Loss

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger
Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations
Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

CAUTION: People with blocked arteries leading to their hearts can suffer heart attacks with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

APRIL 14

A Little Vigorous Exercise Yields Big Fitness Gains

If you want to get in shape, you will become far more fit in far less time if you include some vigorous exercise. A new study showed that one intense exercise session plus four relaxed sessions per week improves fitness almost three times more than five relaxed exercise sessions per week (J Sports Sci Med, September 2014;13(3):702-7).

Twenty nine sedentary and out-of-shape men and women, average age 36 years, started a 12-week treadmill and stationary bicycle exercise program. They were put into one of three groups:
• Low Intensity: Five days a week of 30 minutes of exercise at 45-60 percent oxygen consumption reserve.
• High Plus Low Intensity: Four days a week of the above program plus one session of high-intensity intervals: 8 to 12 repeats of 60 second efforts at 100 percent of their maximum oxygen capacity (VO2max), with a 2.5 minute recovery between each interval.
• No Exercise at all.
In just twelve weeks the High Plus Low Intensity group increased their VO2max (the best measure of fitness) by more than 10 percent over the No Exercise group, and 3.9 percent more than the Low-Intensity group.

Why Intense Exercise Makes You More Fit than Just Exercising
To strengthen a muscle, you have to exercise intensely enough to damage it and when it heals, it will be stronger. To have greater speed and endurance, you have to increase your ability to take in and use oxygen. You do this only with intense exercise. Whatever your level of fitness, short bouts of working at YOUR maximum will do more to make you stronger and faster than any amount of casual exercise. Athletes call these repeated short bouts of vigorous effort “Intervals”.

Introducing Intervals in Your Exercise Program
Start out in your chosen activity by pedaling, walking or jogging at a slow pace for at least 10 minutes just to warm up. When you feel that your legs are ready, pick up the pace for 10 seconds and then slow down. It is irrelevant how long you take to recover for your next interval. Repeat these 10-second intervals until your legs start to feel heavy or hurt or you feel any discomfort whatever. Then quit for the day.

On the next day, you can go at a slow pace or take the day off if you are sore. The following day you can try intervals again provided that your legs feel fresh and are not sore. Repeat the 10 second intervals until your legs start to feel heavy or hurt. Continue this program of intervals and try to increase your intervals until you can sustain 30 seconds for each interval with any recovery time that feels comfortable to you. You will probably feel best with a 30-second interval followed by a one-to-two-minute recovery between each interval.

Doing intervals once a week will get you in great shape. You can do them more often but do not plan to do intervals more than every other day. Do not do intervals when your legs feel heavy or sore. Intense workouts when your muscles are sore markedly increase your chances of injuring yourself.

If You are Starting a New Exercise Program
If you have not exercised in a long time and are out-of-shape, or if you want to start a new sport, do what athletes call “Background before Peaking”. Take it very easy on the first day; muscle soreness does not show up for several hours. Go out and pedal on your bike or walk or jog at a very slow and comfortable pace until your legs start to feel tired or hurt. Then stop, even if you have only done a few minutes. Do that every day until you can exercise at a slow relaxed pace for 30 minutes. Most people will take six weeks or more of this background work to be able to do 30 minutes consistently. Then you are ready to start your intervals.

CAUTION! If you are out of shape, or if you are a regular exerciser but have never tried to exercise intensely, check with your doctor to make sure that you do not have a medical condition that will be aggravated by vigorous exercise. Heart attacks during exercise often occur in peop

APRIL 1 

How does exercise make bones stronger?

Bones are not static. Certain cells called osteoblasts constantly bring calcium into bones to make them stronger and osteoclasts take calcium from bones. Exercise increases the rate that osteoblasts strengthen bones. Inactivity slow osteoblastic activity to weaken bones. So any exercise that places force on a bone will strengthen that bone.

If they live long enough, every woman and most men will suffer from osteoporosis. Women who break their hips from osteoporosis must have a hip replacement immediately. Otherwise, they have a 20 percent chance of dying from complications within a year. A study from Australia shows that running strengthens the leg bones of both older and younger women (Medicine & Science in Sports & Exercise, October 2005.) However, the research shows that bones used in an exercise are the only bones that are strengthened by that activity. So running strengthens leg bones, rowing strengthens arms and back, and lifting weights strengthen bones that are used for each lift.

MARCH 30

Helicobacter and Stomach Ulcers
If you belch or have burning in your stomach or chest, particularly when your stomach is empty, you probably have either an infection, a tumor, or a condition called GERD (reflux or regurgitation). Infection with bacteria such as helicobacter pylori is by far the most common cause.

Your doctor will probably order an upper GI series X ray to rule out a tumor. That almost always comes back negative to tell you that you do not have tumor. Then you get a blood test for bacteria called Helicobacter pylori and you should be treated with antibiotics even if the blood test is negative, because there are at least 23 other species of bacteria that this test does not detect. Your gastroenterologist will want to put a tube down your mouth and into your stomach, but the biopsy that he will do to find the Helicobacter can often miss the germ even when it is there (11). If your doctor does not offer the antibiotic treatment (see below), you will be stuck with a diagnosis of regurgitation, called GERD, which means you have pain and no one can tell you why. You will need to take medication for the rest of your life.

An article in the medical journal GUT reported that at least 24 different bacteria have been shown to cause stomach ulcers (16). Since doctors do not have any way to check for all 24 different bacteria (10), all people with belching and burning in the stomach should be given a one-week course of antibiotics that are used to treat the most common cause of stomach ulcers, called Helicobacter Pylori.

Twenty years ago, stomach ulcers were treated by drinking cream. Today, almost everyone with belching and burning in the stomach should be treated with antibiotics. In 1983 they laughed at Dr. Barry Marshall when he reported that stomach ulcers were caused by infection with helicobacter pylori and could be cured with antibiotics. Fellow physicians were so mean to him that he responded by swallowing a vial of helicobacter and almost died. He recently received the Nobel Prize for his pioneering work.

Now almost every reasonable physician agrees that all people who have belching and burning in the stomach and a positive blood test for helicobacter pylori can be cured with antibiotics, but many gastroenterologists stubbornly refuse to treat patients with ulcer symptoms and a negative blood test or biopsy for that germ. They are clearly wrong because literature shows that at least 24 germs cause an irritation in the stomach (9), including H. helmannii (13), H. felis, H. rappini, H. cinaedi, H sp. Strain Mainz (14) H. fennelliae and H. pullorum, H. hepaticus, H. Billis, H. canis, H. Hills (15), cytomegalovirus and mycoplasma (1,2,3,4,5,6,7,), and Helicobacter mesocricetorum sp nov (12).

Helicobacter species have been isolated from the stomachs of dogs, cats, ferrets, pigs, monkeys and cheetahs, birds, mice, chickens. The standard treatment of one week of clarithromycin 500 mg twice a day, metronidazole 500 mg twice a day and omeperazole 20 mg once a day is safe and effective. These germs also grow in saliva, so they can be transmitted between family members and pets. So some doctors prescribe antibiotics to all people with belching and stomach burning, and check the other members of the household for symptoms.

At least 12 weeks later, you need a follow up blood test for helicobacter. If your symptoms are gone and the titre drops, you are probably cured. If your helicobacter titre is still high, your helicobacter is probably resistant to metronidazole and you need to be treated for at least ten days with amoxacillin 500 mg four times a day, tetracycline 500 mg three times a day and omeperazole 20 mg once a day (1). If you still have symptoms, you may need to have a tube put down your throat by a gastroenterologist. If you have regurgitation of stomach acid into your esophagus (reflux, hiatal hernia), you may need to be treated with 20 mg omeperazole once a day. Some people who are not infected with helicobacter may benefit from taking clarithromycin or other antibiotic for a longer period of time.

Helicobacter may also cause liver disease, blood vessel diseases such as clotting and heart attacks, and certain skin conditions such as rosacea.

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10) Monkeys have so many different bacteria in their stomachs that nobody can tell what belongs there or is causing stomach symptoms . The bacteria that were found were susceptible to the following antibiotics: amikacin, ciprofloxacin, gentamicin, cefoperazone, tobramycin, imipenem, and trimethoprim/ sulfamethoxazole. SS KhanolkarGaitonde, GK Reubish, CK Lee, CTKH Stadtlander. Isolation of bacteria other than Helicobacter pylori from stomachs of squirrel monkeys (Saimiri spp.) with gastritis. Digestive Diseases and Sciences, 2000, Vol 45, Iss 2, pp 272-280.

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58) S Tsuji, M Tsujii, WH Sun, ES Gunawan, H Murata, S Kawano, M Hori. Helicobacter pylori and gastric carcinogenesis. Journal of Clinical Gastroenterology. 25: Suppl. 1(1997):S186-S197.

59) R Cheli, M Crespi, G Testino, F Citarda. Gastric cancer and Helicobacter pylori: Biologic and epidemiologic inconsistencies. Journal of Clinical Gastroenterology 26: 1 (JAN 1998):3-6.

60) V Pasceri, G Cammarota, G Patti, L Cuoco, A Gasbarrini, RL Grillo, G Fedeli, G Gasbarrini, A Maseri. Association of virulent Helicobacter pylori strains with ischemic heart disease. Circulation 97: 17 (MAY 5 1998):1675-1679.48-51. J Danesh. Helicobacter pylori infection and gastric cancer: systemic review of the epidemiological studies.Alimentary Pharmacology & Therapeutics, 1999, Vol 13, Iss 7, pp 851-856.

61) K Haruma, K Komoto, T Kamada, M Ito, Y Kitadai, M Yoshihara, K Sumii, G Kajiyama. Helicobacter pylori infection is a major risk factor for gastric carcinoma in young patients. Scandinavian Journal of Gastroenterology, 2000, Vol 35, Iss 3, pp 255-259.

62) JW Konturek, A Dembinski, SJ Konturek, J Stachura,W Domschke. Infection of Helicobacter pylori in gastric adaptation to continued administration of aspirin in humans. Gastroenterology 114: 2 (FEB 1998):245-255.

63) RI Russell. Helicobacter pylori eradication may reduce the risk of gastroduodenal lesions in chronic NSAID users. Italian Journal of Gastroenterology and Hepatology. 29: 5 (OCT 1997):465-469.

64) CY Wu, SK Poon, GH Chen. Is Helicobacter pylori a risk factor for NSAID- associated gastric ulcer bleeding? A sex- and age-matched case-control study. Advances in Therapy 15: 2 (MAR-APR 1998):85-91.

65) M Stolte,G Kroher,A Meining,A Morgner,E Bayerdorffer,B Bethke. A comparison of Helicobacter pylori and H-heilmannii gastritis-A matched control study involving 404 patients. Scandinavian Journal of Gastroenterology 32:1(JAN 1997):28-33.

66) MJ Blaser. Hetero- geneity of Helicobacter pylori. European Journal of Gastroenterology & Hepatology. 9:Suppl.1 (APR 1997)S3-S6.

67) C Seidl,V Grouls,HJ Schalk.Bulboduodenitis associated with Helicobacter heilmannii (formerly Gastrospirillum hominis) infection. A rare cause of duodenal ulcer. Leber Magen Darm 27: 3 (MAY 1997):156-159.

68) H Yoshida,K Hirota,Y Shiratori,T Nihei,S Amano, A Yoshida,O Kawamata,M Omata. Use of a gastric juice-based PCR assay to detect Helicobacter pylori infection in culture-negative patients. Microbiology 36:1(JAN1998):317-320.

69) D Scott, D Weeks, K Melchers, G Sachs. The life and death of Helicobacter pylori. Gut 43: Suppl. 1 (JUL 1998):S56-S60. In the absence of division, antibiotics such as clarithromycin and amoxycillin are ineffective. Proton pump inhibitors, by elevating gastric pH, would increase the population of dividing organisms and hence synergise with these antibiotics.

Checked 3/16/19

January 1st, 2015

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MARCH 22

Stress Fractures – Prevention and Treatment
 
If you are an exerciser and develop a sharp pain on a bone that hurts when you press directly on that spot and does not hurt to touch an inch away, you probably have a stress fracture. Stress fractures are very common injuries, particularly in runners. In one study, 69 percent of the stress fractures occurred in runners, eight percent in fitness class participants, five percent in racket sports, four percent in basketball players and the remainder from other activities (Clin Sports Med, 1997;16:179–196). Runners are at high risk for stress fractures of the lower legs because running fast causes the foot to hit the ground with tremendous force that can shatter bones.

X-rays Often Miss a Stress Fracture
A stress fracture is not a broken bone; it is a small crack on the surface of a bone, like a crack on an egg shell. Most of the time you do not need an X-ray or MRI to diagnose a stress fracture. X-rays usually are not sensitive enough to show the surface crack until you have had it for a week or more. After a couple weeks, an X-ray can pick up the callus that forms over the crack. An MRI (which is much more expensive) can usually pick up an early stress fracture.

Healing a Stress Fracture
Stress fractures usually start out as minor discomfort in the foot, lower leg or pelvis, and they often occur for the first time near the end of a long run. Usually the pain goes away as soon as you stop exercising. On the next day, it hurts in the same spot earlier in the run. Most of the time, you don’t need a cast or brace for a stress fracture to heal, but you should stop the exercise program that caused the problem until you can exercise without pain — usually three to six weeks. Meanwhile, you can probably switch to a non-impact exercise that does not hurt, such as cycling or swimming. If you are a competitive runner, you may be able to run in water, because the water absorbs most of the foot-strike force.

Risk Factors for Stress Fractures
• Small, thin bones: The largest bones are usually the strongest, so people with smaller bones are at increased risk for stress fractures.
• Smaller muscles: people with the largest muscles usually have the strongest bones, so people with small leg circumference at the calf muscles are more likely to suffer stress fractures.
• Weaker calf muscles: Women with stress fractures often have weaker calf muscles (Med & Sci in Sprts & Ex, December 2009). Having strong muscles can help to prevent stress fractures by absorbing more force from the foot hitting the ground during running. Distance runners often work to strengthen their calf muscles by running up hills no more than three times a week.
• Longer stride length: Taking long strides causes the greatest foot strike force, which increases stress fracture risk. Reducing stride length by ten percent reduces the force of the foot striking the ground and therefore reduces force on the lower leg bones. Shortening your stride usually will not slow you down. When your foot hits the ground, your Achilles tendon contracts to store up to 60 percent of your foot strike force. Then when you step off that foot, your Achilles tendon releases the stored energy to drive you forward. Over-striding deprives you of some of this stored energy. Since many runners take strides that are too long for them to be efficient, shortening stride length usually allows them to increase cadence, helps them to run faster and longer, and reduces risk for stress fractures.

My Recommendations
If you develop a pain anywhere in your body that does not go away when you slow down, stop exercising immediately. Most wear-and-tear injuries of any sort give you plenty of warning and become long-term only because you continued to exercise when your body was telling you to stop for that day.

Most runners who have had a stress fracture can resume running after they heal. Most will benefit from:
• taking shorter strides at an increased cadence,
• doing some hill training to make their muscles stronger, and
• stopping a workout when they develop pain in one spot that doesn’t go away when they slow down or stop.

People with recurrent stress fractures need to be evaluated for osteoporosis and its many causes. If a bone density test shows that you have osteoporosis, your doctor may recommend bone strengthening medication (Clin J Sports Medicine, Oct 1995;5(4):246-250).

People with recurrent stress fractures should also be evaluated for:
• Overtraining syndrome,
• Vitamin D insufficiency,
• Calorie insufficiency (not eating enough food),
• In females, the triad of irregular periods, weight loss and overtraining, and
• Other medical conditions (J Orthop Surg Res, 2016;11(1):98).
If pain persists for several months, or if stress fractures continue to recur, they may need to switch to a low-impact sport such as swimming or cycling. Cyclists usually do not suffer stress fractures but they can break bones if they get hit by a car or another cyclist.

MARCH 13

How Exercise Prolongs Your Life
Several recent studies show that exercise helps to prolong your life by:
• strengthening heart muscle,
• increasing the ability of the heart to pump increased amounts of oxygen through the body,
• reducing belly fat, and
• increasing the diversity of bacteria in your colon.

We have abundant data to show that people who exercise live longer than those who do not exercise. Now we have the Copenhagen City Heart Study which begins to examine which sports are associated with living the longest (Mayo Clinic Proceedings, Sept 2018;93(12)). People who played tennis lived an average 9.7 years longer than people who do not exercise, compared to badminton (6.2 years), soccer (4.7 years), cycling (3.7 years), swimming (3.4 years), jogging (3.2 years), calisthenics (3.1 years), and health club activities (1.5 years). This study followed 8,577 people for up to 25 years. Twelve percent were primarily sedentary while 66 percent reported exercising regularly. Those who exercised only occasionally were not included in the data.

Interestingly, longevity did not correlate with the amount of time spent exercising. Those who worked out in health clubs (treadmill, elliptical, stair-climber, stationary bikes, and weightlifting) averaged 2.5 hours per week, while the longest-living group, tennis players, played only 1.7 hours per week. Cyclists who averaged the most time exercising per week (6.4 hours) lived six years less than the tennis players.

The authors report that the sports that were associated with living the longest are the ones that require interval training of some sort: short bursts of exercise using large muscle groups and full body movement. Another factor associated with increased longevity appeared to be the amount of social interaction of group sports (tennis, badminton, and soccer) compared to more solitary exercise (jogging, swimming, and cycling).

Exercise Strengthens the Heart
Another study showed that older men who exercise have stronger and larger hearts that supply more oxygen to their bodies (Sports Medicine, February 2019;49(2):199-219). The authors reviewed 32 studies of men over 45 years of age, comparing 644 athletes to 582 non-exercising controls. Echocardiograms showed that the athletes’ hearts had far more muscle. The stronger and bigger hearts pumped more blood and oxygen with each beat and had more beneficial heart rhythms. The older athletes maintained these heart benefits as they aged. Having the ability to supply more oxygen to your heart muscle is a major factor that helps to prevent heart attacks.

Sedentary People Have More Belly Fat
Compared to people who exercise, those who do not exercise regularly have much higher levels of fat in their liver and that fat markedly increases risk for heart attacks, diabetes, certain cancers and premature death (Obesity, Dec 20, 2017). The authors used MRI scans on 124 participants to show that the more time a person spends sitting down, the more belly and liver fat he has. They used history and mechanical accelerometers to measure how much time a person spends sitting down. See my report on liver fat below.

Exercise Increases Bacterial Diversity in your Colon
Of 37 breast cancer survivors, those with the highest level of fitness (endurance and maximal ability to take in and use oxygen) had the most different types of bacteria in their colons (bacterial diversity), regardless of how much fat they had in their bodies (Exp Physiol, Feb 14, 2019). The authors suggest that exercising regularly and more intensely can increase the efficiency with which your heart transports oxygen to your tissues, which, in turn, encourages a greater diversity of bacteria to grow in your colon. Having more and different types of bacteria in your colon is associated with increased lifespan and freedom from diseases such as heart attacks and certain cancers (Int J Mol Sci, Apr 2015;16(4):7493-7519). Healthful bacteria turn soluble fiber into short chain fatty acids that lower high cholesterol and high blood pressure and reduce inflammation that can cause diabetes, heart attacks and certain cancers. The more different types of bacteria you have in your colon, the longer you can expect to live. The authors tested 37 non-metastatic breast cancer survivors who were at least one year post-treatment. Those who had the highest heart and lung fitness levels (most intense exercise capacity) had significantly greater numbers of different types of gut bacteria compared to less fit participants. This shows that the people who exercise at the most intense levels have more varied colon bacteria.

My Recommendations
Every week, studies are published that show that exercise prolongs lives, and now we are seeing studies that show the advantages of intense exercise over less-intense exercise. However, people with blocked arteries can suffer heart attacks with more intense exercise, so it is a good idea to check with your doctor before starting an exercise program or increasing the intensity of your present exercise program.

March 1 

Irregular Heartbeats in Lifelong Exercisers

Many studies show that a lifetime of vigorous exercise makes the heart stronger and healthier and does not harm it. However, as I reported last year, a few studies that got a lot of media attention suggested that chronic intense exercise can damage the heart to cause irregular heartbeats.

Now a new study of elite lifetime endurance athletes has found no evidence of irregular heartbeats from damage to the right ventricular heart chamber (Circulation, May 17, 2016;133(20):1927-35). Thirty-three world-class endurance athletes, 30 to 60 years old and training for more than 15 hours per week, received extensive heart function tests that were compared to the same number of healthy men who did not have a regular exercise program. Of course the athletes had larger and stronger right ventricles, and there was no evidence of damage or potentially harmful effects. Their hearts pumped more blood, beat at a much slower resting rate, and most importantly, had no evidence of irregular heartbeats called atrial fibrillation that had been reported in an earlier study. Note that the tests in this study were not done immediately after racing, while a previous study (see below) tested the athletes right after a race. This new study shows that athletes with lifelong high volumes of training seem to be very unlikely to suffer from heart disease.

Why the Earlier Studies May Not Show Heart Damage

Forty athletes were tested immediately after a three-to-11-hour cross country ski race and were found to have right ventricular abnormalities (Eur Heart J, Apr 2012;33(8):998-1006). However, the abnormalities returned to normal when the athletes were retested at a later date. This shows that the reported short-term heart muscle damage may really not have been heart damage at all. It could be the same changes that occur after vigorous exercise in all muscles that are exercised vigorously. Your skeletal muscles are supposed to feel sore after vigorous exercise because all muscles in your body show signs of damage after being vigorously exercised, and that can also apply to your heart muscle. All competitive athletes learn very quickly that to be competitive, they have to exercise very intensely. To make a muscle stronger, you have to exercise so intensely that you damage the z-lines that join the sarcomere blocks in muscle fibers. You can tell you are doing this when you feel a burning in muscles during exercise and delayed onset muscle soreness (DOMS) several hours afterwards. When the Z-lines in a muscle heal, the muscle is stronger.

More Evidence that Vigorous Exercise Strengthens the Heart

In another study, male participants in a 54 mile (90 km) cross-country skiing event were followed for several years. Those who skied faster and in more events had slow resting heart rates and had increased rates of atrial fibrillation (European Heart Journal, June 11, 2013;34(47):3624-3631). However, they were not at increased risk for the types of irregular heartbeats in the lower heart chambers that are more likely to kill them: ventricular tachycardia and ventricular fibrillation. Many other studies show that regular exercise is associated with a reduced risk of atrial fibrillation (Heart, 07/27/2015). Olympic endurance athletes, followed for up to 17 years, had no evidence of any damage whatever to the size, shape and function of their main pumping chambers (left ventricles) and suffered no evidence of heart damage or disease (J Am Coll Cardiol, 2010;55(15):1619-1625).

Lack of Exercise Increases Risk for Irregular Heartbeats

Not exercising is a risk factor for atrial fibrillation (Am J Cardiol, 2012 Aug 1;110(3):425-32). A slow resting heart rate in an athlete generally indicates a strong heart, but apparently healthy men who do not exercise and have slow resting heart rates are at increased risk for atrial fibrillation (Circ Arrhythm Electrophysiol, Aug, 2013;6(4):726-31). Obesity is also a major risk factor for atrial fibrillation (J Am Coll Cardiol, Jul 7, 2015 and JAMA, 2004 Nov 24;292(20):2471-7). Elite endurance athletes are virtually never obese and they are unlikely to have high blood pressure, which is a major risk factor for atrial fibrillation (J Am Soc Hypertens, Mar 2015;9(3):191-6).

Most Studies Associate Vigorous Exercise with Increased Longevity

A review of fourteen articles on the life spans and death rates of elite endurance athletes shows that they live longer than the general population, and suffer far less from heart disease (J of Sci and Med in Sport, July 2010;13(4):410–416). Another review of 174 studies shows that even activities such as gardening and household chores are associated with a lower risk of stroke, breast cancer, colon cancer, diabetes and heart disease. Larger risk reductions came with increasing intensity and duration of exercise (British Med J, August 9, 2016). However, one study reported that intense exercise could cause scarring in the heart that may increase the risk of death from heart disease (Mayo Clinic Proc, June 2012;87(6):587–595), and another article questioned the safety of exercising for more than an hour a day (Mayo Clinic Proc, 2014;89(9):1171-1175).

My Recommendations

The existing evidence is that intense exercise is good for you, provided that you have a normal heart and do not have any underlying disease. Of course, if you have chest pain or any questions about your health, you should check with your doctor.

Many different factors can damage your heart. While vigorous exercise can help to prevent heart disease and long-term heart damage, it does not guarantee protection against irregular heartbeats and heart damage.

FEB 26

Testosterone for Older Men

Medical journals have reported trials that examine the benefits and harms of taking testosterone for men over 65 with low blood levels of testosterone (less than 275 ng/dL). At 12 study sites across the country, a total of 790 participants were given testosterone gel or a placebo applied daily to the skin. Most of these men had low testosterone due to aging, not due to damage to the testicles or brain where testosterone levels are controlled. Over a year, investigators measured the effects of testosterone on:

• bone density and strength

• anemia

• heart health

• cognitive function

• sexual function

Bone Density and Strength: Testosterone increased bone density and strength in 200 older low-testosterone men (JAMA Intern Med, February 21, 2017). These increases were greater in the spine than in the hips.

Anemia: Testosterone raised hemoglobin levels by at least 1 g/dL in nearly 130 men with anemia (JAMA Internal Medicine, Feb 21, 2017).

Heart Health: Testosterone increased plaques significantly in the arteries leading to the heart likely to increase risk for heart attacks (JAMA, 2017;317(7):708-716). However, another study of more than 44,000 men with low testosterone showed that three years of testosterone gel reduced heart attack rate by 25 percent compared to those given placebos (JAMA Internal Medicine, Feb 21, 2017). The effects of testosterone on heart attack risk are controversial.

Cognitive Function: Testosterone did not improve memory or other brain functions including verbal memory, visual memory, executive function or spatial ability in 500 men with age-associated memory loss (JAMA, 2017;317(7):717-727).

Sexual Function: Improvement in sexual function is the benefit most strongly supported by research studies. However, having low testosterone levels does not determine whether a man will respond to erection-increasing drugs such as tadalafil in older men with enlarged prostates and erectile dysfunction (J Sex Med, May 2016;13(5):843-51).

A review of several other studies showed that testosterone gel can improve depression, bone mineral density, energy, libido, erectile function, muscle mass, insulin resistance, and lower urinary tract symptoms (Curr Opin Urol, Mar 2016;26(2):152-7). Testosterone treatment did not appear to increase a man’s risk of developing an enlarged prostate.

Testosterone Is Often Given to Men Who Will Not Benefit from its Use

A study from Baylor Medical School shows that more than 85 percent of men treated with testosterone do not have any disease caused by low testosterone. Most of the men suffer from adult-onset hypogonadism associated with chronic medical conditions such as diabetes, metabolic syndrome, arteriosclerosis and obesity. They do not have a deficiency of testosterone caused by damaged testicles or brain hypothalamic and pituitary glands that cause low testosterone. They should be treated for these conditions and not take testosterone, which may increase their risk for future heart attacks (Mayo Clinic Proceedings, June 24, 2016).

My Recommendations

• Men with normal blood levels of testosterone (>300) should not take testosterone since it may increase risk for heart attacks, liver damage and shutting down their own natural production of testosterone.

• Older men with normal testicles and brain hormones should not take testosterone unless their testosterone is very low (below 150).

• Usually men should take testosterone if they have low levels of the brain hormones that stimulate the testicles to produce testosterone or testicles that are damaged so they cannot make testosterone.

• Most men who suffer from poor sexual function because they have conditions that damage their sexuality, such as overweight, diabetes, arteriosclerosis or other life-shortening conditions that affect sexual function, should work to reverse those conditions rather than resorting to testosterone.

• Testosterone pills can damage the liver, so if a man chooses to take testosterone, the form of choice is a gel that is absorbed through the skin so it avoids the liver.

FEB 20

Even a 100-Year-Old Can Improve with Training

You can improve athletic performance at any age with proper training, even if you are over 100 years old. Traditional feeling among scientists is that aging is progressive and inevitable, and that your genetic programming causes you to age no matter what you do. This paper shows that physical training can reverse established markers of aging (J Appl Physiol, February 15, 2017).

I have reported on Robert Marchand, the 105-year-old cyclist who had improved his world record for how far he could ride a bicycle in one-hour from 15.07 miles (24.25 kilometers) at age 101 to 16.73 miles (26.92 kilometers) at age 103. That is an 11 percent improvement in a world record after just two years of serious training, an impressive accomplishment at any age.

Marchand’s Training Program

For two years, from age 101 to 103, Marchand trained by riding 3000 miles (5,000 km) per year, with 20 percent of his workouts doing hard, intense riding and 80 percent doing slow recovery riding. He spun his pedals at a cadence between 50 and 70 rotations per minute.

The newer study documents his training program and the improvements in his markers of aging. Athletes can run, ride, swim or ski faster if they improve their maximum ability to take in and use oxygen (VO2max) and their peak power output (strength). These same measurements are used by scientists to track aging in non-athletes. Marchand’s VO2max (maximal ability to take in and use oxygen) increased 13 percent, from 31 to 35 ml.kg-1.min-1, and his peak power output increased by 39 percent, from 90 to 125 watts.

These factors improved in Marchand because he was able to increase his maximal pedaling frequency by 30 percent, from 69 to 90 rotations per minute, and his ability to take in air through his lungs by 23 percent, from 57 to 70 liters per minute. His maximum heart rate and body weight did not change.

Training That Reduces Measures of Aging

Here is a program of training that is typical of the way competitive athletes in endurance sports work to become faster.

Muscle-sugar-depleting workout (one per week): You must exercise long enough to use up most of the sugar stored in your most-used muscles. Muscles use primarily fat and sugar for energy. You have an almost infinite amount of fat stored in your body, but only a very limited amount of sugar stored in the liver and muscles. Sugar requires less oxygen than fat to fuel your muscles, so when you run out of sugar stored in your muscles, you have to slow down. Exercising long enough to deplete muscles of their stored sugar supply increases the amount of sugar they can store and also increases your ability to move faster longer. The faster you move, the quicker you use up your muscles’ stored supply of sugar. The average runner can use up most of his stored muscle sugar supply while running fairly fast for two hours, and the average bicycle rider can use up his stored muscle sugar in three hours.

Intense oxygen deficit workout (two per week): The limiting factor to how fast you can move is the time it takes to move oxygen into muscles. You can increase your ability to take in and use oxygen by using interval workouts in which you run up severe oxygen debts and gasp for breath. You also have to damage muscles so that when they heal, they become stronger. To do this you must put great pressure on your muscles by moving very fast.

Type of Intervals: A short interval lasts less than 30 seconds. You can do lots of them in a single workout because in less than 30 seconds, you do not build up much lactic acid and do less muscle damage. A long interval lasts longer than two minutes and you should do only a limited number of these intervals because they cause considerable muscle damage and can take a long time for muscles to heal and recover.

Recovery workouts (at least four per week): Intense interval workouts cause considerable muscle damage, and it usually takes at least 48 hours for muscles to heal, so each intense workout requires easier workouts on the following day. If you are training twice a day, each intense workout is usually followed by three recovery workouts.

Example of a Weekly Training Program

Sunday: race or depletion workout

Monday: recovery workout

Tuesday: short intervals

Wednesday: recovery workout

Thursday: long intervals

Friday: recovery workout

Saturday: recovery workout

How to Apply These Concepts to an Ordinary Exercise Program

While exercisers who are not competing are likely to spend far less time in their sport, they can still benefit from following the same training principles. Increasing evidence shows that intense exercise is more effective than casual exercise, so plan to introduce at least some intense intervals into your program. You can gain the health benefits and help to prevent injuries if you:

• Plan to exercise every day

• Realize that if you are training properly, your legs are likely to feel sore every morning. If your legs do not feel fresh after a 5-to-10-minute warm up, take the day off.

• Stop your workout immediately if you feel a tightness, discomfort or pain in one area.

• As soon as your legs start to feel heavy during a workout, stop for the day.

Caution: People with blocked arteries leading to their hearts can be harmed by intense exercise, so check with your doctor if you have any questions.

FEB 14

Why Ice Delays Recovery

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94). Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.

In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261).

Healing Requires Inflammation

When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.

The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010).

Ice Keeps Healing Cells from Entering Injured Tissue

Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.

Anything That Reduces Inflammation Also Delays Healing

Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:

• cortisone-type drugs,

• almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),

• immune suppressants that are often used to treat arthritis, cancer or psoriasis,

• applying cold packs or ice, and

• anything else that blocks the immune response to injury.

Ice Also Reduces Strength, Speed, Endurance and Coordination

Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.

My Recommendations

If you are injured, stop exercising immediately. If the pain is severe, if you are unable to move or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.

If the injury is severe, follow your doctor’s advice on rehabilitation. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain.

FEB 12

Added Sugars Linked to High Blood Pressure

A review of studies on sugar-added foods shows that people who take in 10-25 percent of their calories from sugared beverages and foods suffer a 30 percent higher risk for heart attacks, compared with people who take less than ten percent of calories from added sugars (British Medical Journal: Open Heart, Dec. 11, 2014). The review also found that:

• higher added-sugar intake was associated with increases in systolic and diastolic blood pressure of 6.9 and 5.6 mm Hg.

• the more sugared foods you eat, the higher your bad LDL cholesterol.

• sugars occurring naturally in foods, such as fruit, did not appear to increase risk for high blood pressure or heart attacks.

Another review of twelve scientifically-dependable studies involving 409,707 participants showed that sugar-sweetened beverages are associated with increased risk for high blood pressure, a major risk factor for diabetes and heart attacks (The American Journal of Cardiology, February 2014).

What is High Blood Pressure?

You have high blood pressure if your systolic blood pressure is greater than 120 before you go to bed at night and just after you wake in the morning. That is when your blood pressure is at its lowest level. You may also have high blood pressure if your systolic pressure is greater than 140 after resting for 5 to 10 minutes during the day.

What Causes High Blood Pressure?

More than 90 percent of North Americans will develop high blood pressure. Kidney damage or an overactive adrenal gland can cause high blood pressure, but these causes occur so rarely that most doctors do not even order a renin level to look for kidney damage, or an aldosterone level to look for adrenal problems.

Many doctors believe that a high-salt diet is a major cause of high blood pressure, but low-salt diets reduce systolic blood pressure by less than 5 mm Hg in most adults with hypertension, and the average reduction in diastolic blood pressure associated with a low-salt diet among adults with high blood pressure is 2.5 mm Hg (JAMA Intern Med, 2014;174(4):516-524). Low-salt diets are associated with increased risk for death in people who also have diabetes.

The people who are most likely to get high blood pressure from taking in too much salt are those whose cells are insulin resistant. Their cells do not respond well to insulin (Hypertension, Jan 2013), so the pancreas keeps on releasing large amounts of insulin to try to lower high blood sugar levels. High levels of insulin constrict arteries to cause high blood pressure. People with high insulin levels are the ones who get high blood pressure when they take in too much salt (Am J Hypertens, 1998 (Apr);11(4 Pt 1):397-402). For them, a high salt intake increases blood pressure, insulin and blood sugar.

How Sugar-Added Foods Can Cause High Blood Pressure

More than 80 percent of people who have high blood pressure also have insulin resistance, an inability to respond normally to insulin. This means that when they eat or drink sugar-added foods, their blood sugar levels rise, causing their insulin levels to rise which constricts arteries to cause high blood pressure (British Medical Journal: Open Heart, Dec. 11, 2014).

How Can You Tell if You are Insulin Resistant?

People who are insulin insensitive usually have what is called metabolic syndrome. You probably have metabolic syndrome if you have any three of the following:

• storing fat primarily in your belly

• having small hips

• being overweight

• having blood triglycerides (>150)

• having blood HDL cholesterol (<40) • having high blood pressure • having a fatty liver • having a fasting blood sugar >100 (HbA1c> 5.7)

• having high insulin levels

Lifestyle Changes, Not Drugs, Can Cure High Blood Pressure

You cannot cure high blood pressure with drugs; you can only control it as long as you continue to take drugs (Hypertension, 2002;40(5):612-618). Most of the time, your blood pressure cannot be controlled with just one drug and most people end up with three or more drugs to treat their high blood pressure.

Lifestyle Changes to Lower Blood Pressure

• Restrict sugared drinks and sugar added to foods.

• Restrict refined carbohydrates. Whole grains are seeds with a fiber coating that forms a thick capsule which cannot be broken down efficiently in your intestines, so blood sugar and insulin levels barely rise after you eat them. However, when you grind whole grains into flour, you break the capsule so the starches can be absorbed quickly. Foods made from flour, such as bakery products or pasta, cause a high rise in blood sugar and insulin.

• Eat large amounts of fruits, vegetables and seeds. Unprocessed vegetables, whole grains, nuts, other seeds and most fruits contain complex carbohydrates and fats that are not released rapidly into the bloodstream. These nutrient-rich foods do not cause a high rise in blood sugar and insulin.

• Exercise. Resting muscles draw no sugar from the bloodstream. On the other hand, contracting muscles draw sugar rapidly from the bloodstream and don’t even need insulin to do so. The more intensely you exercise, the less insulin is needed by muscles to withdraw sugar from the blood and this effect lasts for up to 17 hours after you finish exercising.

• Avoid overweight. Your liver controls blood sugar levels. When blood sugar levels rise, insulin drives sugar from the bloodstream into the liver. However, the more fat you have stored in your liver the harder it is for sugar to enter liver cells in response to insulin. A fatty liver will raise blood sugar levels even higher by releasing stored sugar from its cells into the bloodstream.

• Avoid smoking. Smoking damages every cell in your body.

FEB 9

If you’ve been training for some time now and have gotten the body you want, keep moving forward and don’t give up.

I know how it is.

Life happens; marriage, kids, new career, the list goes on.

And you’re probably wondering what’s going to happen to your body and all your gains.

If you’re just starting out, you may be afraid and concerned to train hard because you’ve heard that the harder you train, you can’t stop or slow down as your muscles will turn into fat.

When you stop training, there are 3 main things that’s going to happen.

#1: Your muscles will start wasting away (atrophy) and will be covered in fat.

#2: If you’re eating well and you have high protein foods in every meal like fish, eggs, chicken breast, lean beef and you’re not taking any protein supplements, you’d probably still get muscle gains and a good body.

#3: If you keep taking protein shakes but you’re not having a good solid meal, and you don’t have enough of good protein sources for your body, the chances of maintaining and gaining muscles is very low.

FEB 1

Daily Aspirin May Not Save Lives
 
Just about everyone agrees that aspirin can help to prevent heart attacks by keeping clots from forming, but a major side effect of daily aspirin is increased risk for bleeding.  Almost all heart attacks are caused by clots blocking blood flow to the heart. However, a review of 13 studies on nearly 165,000 adults without heart disease and a mean age of 62, showed that five years of taking aspirin every day increased virtually the same percentage of major bleeding episodes as it reduced the incidence of heart attacks (JAMA, Jan 22, 2019;321(3):277-287).
This means that the number of lives that were saved by aspirin decreasing clotting that can cause heart attacks was no better than the number of lives that were lost by aspirin causing bleeding that can cause strokes and stomach bleeds.  The researchers showed that they would need to treat 265 people with daily aspirin to prevent one heart attack, while they needed to treat only 210 people with daily aspirin to cause a major bleed into the brain or gastro-intestinal tract.  The absolute risk reduction of fatal and non-fatal heart attacks and strokes was 0.38 percent, compared to the increased risk of 0.47 percent for a major bleeding into the brain or gastrointestinal tract.
Another study found that the number of diabetic lives saved from heart attacks and clotting strokes was offset by the number of diabetics who died from major bleeding into the brain, eyes, stomach, and other places (N Engl J Med,  Oct 18, 2018; 379:1529-1539).  Diabetes is among the strongest risk factors for suffering heart attacks in North America today, with more than 68 percent of diabetics, age 65 or older, dying from some form of heart disease and 16 percent dying of stroke.  The 15,480 adult diabetics who had no obvious heart disease were placed on either 100 mg of aspirin per day (a little more than one baby aspirin) or a placebo. Over the next 4.7 years, a heart attack or clotting stroke occurred in 8.5 percent of the aspirin group, compared to 9.6 percent of the placebo group. This appears to be a significant protection, but major bleeding occurred in 4.1 percent of the aspirin group, compared to 3.2 percent in the placebo group. This is a also a significant difference and shows that whatever advantage was gained by the anti-clotting benefit of aspirin was offset by the bleeding that aspirin can cause.

Data on Aspirin Preventing Heart Attacks

Taking aspirin daily for three years is associated with a small reduction in heart attacks only in people who have had previous heart attacks, but not in those who had not had a previous heart attack, and the people most likely to benefit from taking aspirin daily are those 50 to 70 years old (Clin Cardiol, May 2017; Am J Med, Feb 2015;128(2):137-43). The American Heart Association recommends that you take daily aspirin only if your chance of developing a heart attack in the next 10 years is greater than five percent (Ann Intern Med, June 21, 2016;164(12):826-35). They do not recommend that most people over 70 take aspirin regularly because of the increased risk for bleeding.

Factors that put you at high risk for a heart attack include:

• A previous heart attack or stroke

• Previous heart bypass surgery

• Angina (chest pain due to coronary artery disease)

• Diabetes and at least one other heart disease risk factor such as smoking or high blood pressure

• A stent in the arteries leading to your heart. Stents increase risk for clots for the rest of a person’s life. Almost all patients with stents are prescribed some type of anti-clotting medication.

How Aspirin May Help to Prevent Heart Attacks

A heart attack and most strokes are not caused by narrowed arteries. They are caused by a sudden complete blockage of blood flow to the heart or brain. First a plaque breaks off from the inner lining of an artery leading to your heart or brain. Then that spot bleeds and a clot forms. Then the clot extends to block completely all blood flow to the heart or brain. The heart muscle then suffers from lack of oxygen and dies. Aspirin helps to prevent blood clots from forming and therefore helps to prevent heart attacks and strokes. When a patient is at very high risk for forming clots, doctors often prescribe other drugs with aspirin such as clopidogrel, prasugrel or ticagrelor.

If you have sudden chest pain or headache and think that you may be having a heart attack or stroke, dial 911. You are likely to need far more treatment than just taking aspirin. Often emergency technicians do give aspirin while they are rushing you to a hospital or after you enter an emergency room with a suspected heart attack. If you are having a stroke, aspirin can harm you because some strokes are caused by bleeding and aspirin increases bleeding.

People Who Should Not Take Aspirin

You should not start aspirin therapy without first consulting your doctor. You should not take aspirin if:

• You are at increased risk for bleeding for any reason, particularly to the stomach, intestines or brain

• You drink alcohol regularly. Taking aspirin and drinking alcohol markedly increases risk for stomach and intestinal bleeding.

• You engage in activities in which you are at risk for banging your head, which could result in bleeding into your brain

• You are allergic to aspirin

Caution About Stopping Aspirin

Never stop taking aspirin suddenly. You can suffer rebound from stopping aspirin which increases risk for clots that can cause a heart attack. If you are going to stop taking aspirin after taking it for a while, your doctor will tell you how to gradually taper your dose of aspirin.

Lifestyle Factors that Decrease Risk for Clots

What you eat and what you do influence your susceptibility to forming clots. You can decrease your risk for clotting by:

• losing excess weight

• exercising

• avoiding smoking and smokers

• keeping diabetes well controlled

• lowering high blood pressure

• lowering high cholesterol

• limiting salt

• following a heart-healthy diet with plenty of vegetables, fruits, whole grains, beans, nuts and other seeds

JAN 16

Kettlebell fans love the heavy, round-shaped weights for a reason — kettlebell exercises combine cardio and strength training for a time-saving calorie burn. The amount of calories you can burn using kettlebells can be amazingly high: a study by the American Council on Exercise found that the average person burns 400 calories in 20 minutes when doing kettlebell exercises. More research has found that regularly exercising with kettlebells significantly reduces back, neck, and shoulder pain by strengthening core and upper body muscles

JAN 5

How Exercise Reduces Dementia Risk

Almost 50 percent of North Americans over 85 and 13 percent of those over 65 suffer from Alzheimer’s disease (Alzheimer’s Assoc Facts and Figures, 2018). We know that you lose brain cells as you age, and scientists used to think that you could not make new brain cells. However, an exciting new study from Columbia University suggests that you can make new brain cells as you age, and that loss of brain function may be caused by lack of adequate blood flow and nourishment of brain cells (Cell Stem Cell, April 5, 2018;22(4):589–599).

The authors found that all age groups, from young to old, have the same number of neural progenitor cells and immature neurons that make new nerve cells in the hippocampus, the part of the brain that governs memory. Contrary to a previous study that showed no new nerve growth with aging (Nature, March 2018), this new study suggests that the brains of older people have progressive loss of new blood vessels with aging and with that, the loss of ability of brain cells to connect with each other. If lack of blood flow to brain cells can cause dementia, its prevention should include exercise — the most effective way to increase growth of new blood vessels. Many previous studies show that exercise:

• increases blood flow to the brain, and

• reduces risk for diabetes and obesity which can damage the brain.

This new study suggests that anything that increases blood flow to the brain may stimulate growth of new blood vessels and brain cells.

Studies Showing that Exercise Reduces Risk for Dementia

A study of 1,462 women, ages 38 to 60, followed for 44 years, showed that those who exercised regularly were one tenth as likely to suffer dementia with aging as those who did not exercise (Neurology, March 14, 2018). In another study, 6500 older people wore exercise trackers. After three years, those who exercised regularly had a 36 percent lower risk of memory loss as well as better memory and executive function (Medicine & Science in Sports & Exercise, January 2017;49(1):47–53).

A third study of 81 older adults used VO2 max, a test of maximal ability to take in and use oxygen, to give a dependable measure of fitness. Those who were less fit had an increased rate of dementia and of losing the white matter in their brains that helps them to retain memory and make wise decisions (Journal of Alzheimer’s Disease, Dec 19, 2017;61(2):729-739). An earlier review of hundreds of articles showed that older people who exercise have far less loss of brain function with aging, less brain blood vessel damage, larger hippocampal brain size for better memory, less loss of brain tissue with aging, better spatial memory, better communication between brain nerves and improved ability to learn new facts (Mayo Clin Proc, 2011 Sep; 86(9): 876–884).

JAN 1 2019

How to Start an Exercise Program

If you want to become fit and use exercise to help prevent a heart attack, first check with your doctor to make sure that you do not have anything wrong with your heart or blood vessels. Intense exercise can increase your risk for a heart attack if you already have a damaged heart.

Pick any sport or activity that uses continuous motion (such as running, cycling, swimming, skating, rowing, dancing) that you think you might enjoy. Start out at a relaxed pace until your muscles feel heavy and then stop. For the first several days or weeks you may be able to exercise only for a few minutes. If your muscles feel sore the next day, take the day off. Increase the amount of time gradually until you can exercise 30 minutes a day at a relaxed pace and not feel sore. Then you are ready to begin your training for fitness. Try to increase the intensity of your exercise once a week. Do your jogging, cycling or whatever you have chosen as your sport at a slow pace to warm up. Then gradually increase the pace until you start to feel short of breath and your muscles start to feel sore, and then slow down. Then when you recover, pick up the pace again. Repeat these surges until your muscles start to stiffen and then quit for the day. Take the next day off and go easy the rest of the week. Then once a week, keep on making your one-day-a-week hard workout harder and harder. You will be continuously increasing your level of fitness.

The only way to strengthen any muscle is to contract the muscle against increasingly greater resistance. Your heart is a muscle, so the only way to make your heart stronger is to contract it against greater resistance. When you exercise, you alternately contract and relax your skeletal muscles. This alternate contraction and relaxation squeezes the veins near the muscles to pump blood toward the heart. Your heart is muscular balloon. The increased flow of blood returning to your heart goes inside the heart to stretch the balloon and the heart has to contract with greater force to pump the blood from inside the heart toward the body. The increased amount of blood inside the heart stretches the heart muscle to make it stronger.

The harder you contract your skeletal muscles, the more blood you pump toward your heart, the greater the stretch on the heart to make it stronger. So fitness is determined more by how hard you exercise than by how much you exercise because the harder you exercise, the stronger your heart muscle becomes. Going out and running 100 miles a week slowly does not make you very fit because you are not strengthening your heart very much with a little increase in circulation of blood, no matter how long you do it. Compare lifting a very light weight a thousand times in a row to lifting a very heavy weight 10 times in a row. The person lifting the heavy weight 10 times will become stronger than the person lifting a light weight a thousand times.

Caution: Exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program.

DEC 23

Listen to Your Body

The best way to achieve a high level of fitness without injuring yourself is to listen to your body. Don’t depend on heart rate monitors, fitness trackers or other gadgets. The most sophisticated fitness tracker and injury-avoider is your brain. Training to achieve a high level of fitness requires intense exercise and most exercise injuries are caused by continuing to exercise intensely when your body tells you to take the day off.

A fascinating study from Boston University showed how rats’ brains automatically record both time and distance. The researchers had rats run on treadmills with brain implants to measure brain function during exercise (Neuron, November, 2015). The treadmills forced the rats to run in the same place so they were not distracted by different visual effects. Their brains generated electrical impulses that fired off regularly at repeatable specific distances and times. Some repeatable electrical brain waves were recorded every eight seconds. Some were recorded every 400 centimeters. We can assume that the human brain functions in a similar way.

You Don’t Need Electronic Devices to Track Exercise

You can buy sophisticated gadgets to monitor your:

• heart rate,

• variability of heart rate,

• blood lactic acid, carbon dioxide, sugar and oxygen levels,

• speed or cadence,

• number of steps, breaths or arm motions that you take,

• stride length, and so forth.

However, these devices cannot tell you whether you are exercising intensely enough to gain your maximum improvement in ability to take in and use oxygen or to damage your muscles enough for maximum strength gain. Only your brain can tell you whether you are at your maximum, if you need to take off because you are about to injure yourself, or when you need to slow down because you are exhausted.  Fitness gadgets can help to motivate you and can be fun to use, but do not count on them to tell you how intensely you should exercise or when you are at the edge of an injury.

A report from Deakin University in Australia reviewed 56 studies that compared the way that electronic devices and your brain tell you when to slow down or stop exercising (Br J Sports Med, September 29, 2015). Half of these studies showed that the brain and sophisticated machines were equally effective in telling you that you are training too intensely and need to reduce your training. The other half of the studies showed that 85 percent of the time, the brain was a better gauge of over-training than sophisticated machines.

Your Brain Talks to You

Your brain can tell you when you are tired, short of breath and your muscles hurt. All you have to do is to ask, “How do I feel?” Researchers can measure signs of fatigue such as lactate levels, VO2max, heart rate, heart-rate variability, rapid morning heart rate, recovery heart rate, hormone levels (cortisol, testosterone, etc.), red cell counts (hemoglobin, hematocrit, red cell indices), immunity (white blood cells, interleukins, inflammation), muscle damage (creatine kinase, oxidative stress), blood pressure, and much more. But in the real world for athletes and regular exercisers, all you need to do is listen to your body.

For example, the test called VO2max measures the major limiting factor to how fast you can move over distance: the maximum amount of oxygen you can take in and use over time. However, you do not need to monitor VO2max with a machine; you can increase VO2max just by becoming short of breath in your training. To make muscles stronger, you have to exercise intensely enough to damage muscles so that when they heal, they will become stronger.

Stress and Recover

Almost all competitive athletes use the training principal of “stress and recover”:

• On one day they take an intense workout to damage their muscles.

• On the next day they feel sore and go less intensely to allow their muscles to heal.

• Then when their muscles feel fresh again, they take their next very intense workout.

Running causes tremendous muscle damage, so runners usually run very fast only two or three times a week, long once a week and have three or four slower recovery days, even if they are working out twice a day. Competitive swimmers are different. The water seems to protect their muscles so they usually try to take one hard and one easy workout every day. Pedaling causes less muscle damage than running, so bicycle racers do some fast riding on most days, and have to learn when to slow down.

Rules to Prevent Injuries

1. When you are training properly, your muscles will feel sore when you get up almost every morning. If you warm up for a workout and your muscles don’t recover and feel fresh after 10 minutes, take the day off or go very slow. It doesn’t matter what workout you have planned for that day.

2. If you are training and you feel a soreness or pain in one area that worsens as you continue to exercise, take the day off. You are headed for an injury. Wear-and-tear injuries are usually not symmetrical. One side of your body will feel far more uncomfortable than the other. Wear-and-tear injuries don’t just happen, they give you plenty of warning.

3. Stop your intense workouts immediately when your legs start to feel heavy or hurt.

4. You recover faster from workouts by eating food and drinking fluids immediately after you finish a workout and getting off your feet as much as possible. You recover faster by lying instead of sitting and sitting instead of standing.

What Does This 80-Year-Old Bicycle Rider Do for Training?

I spent my entire competitive running career injured because I thought that the runner who does the most miles is the best. Of course, that is ridiculous. It took me 60 years to learn when to take off and I have not been injured in the last six years. That means that I hope that I have finally learned when to take days off.

Remember, I am no longer a runner. Running causes so much muscle damage that runners must go much slower three or four days a week. Bicycle riding is done in a smooth rotary motion with no road shock, so cyclists can test their legs every day. Diana and I ride very fast in a tandem bicycle group of couples in their 40s to 80s. We usually ride about 30 miles on Tuesday, Thursday and Saturday. After these hard rides, my legs are always sore when I get up the next day. I take a very slow 10-minute warm up. If my legs still feel tired or stiff or I have localized pain after the warm up, I take the day off. If my legs recover during the warm up, I then do a series of standing 50-pedal-stroke intervals fast enough to make me short of breath each time, followed by a slow recovery of however long it takes to get my breath back and for my muscles to feel fresh again. I do not time recoveries, since starting an interval before full recovery would slow down my next interval. As soon as my legs start to feel heavy, I stop the interval workout and start my slow and short cool down.

See Rests Between Intervals Should Not Be Too Short

Interval Workout Rest Periods

I am riding about 125 miles a week (30-mile fast group ride three times a week plus about 12 miles of warm up and intervals three times a week). My 30 mile rides are close to as fast as I can go, depending on how I feel. Of course I go slower on some days. I do 21 to 24 fifty-pedal-stroke intervals on my average interval workout, which takes about 40 minutes. I always stop my interval workout when my legs start to feel heavy. I am usually forced to take off or go very slow at least one day and perhaps two days a week.

Caution: People who have narrowed arteries leading to the heart can suffer heart attacks when they exercise intensely. All vigorous exercisers must learn when to back off of training because not allowing enough time to recover from hard exercise can damage your heart muscle as well as your skeletal muscles. Check with your doctor before beginning an exercise program or making a sudden change in the intensity of your existing program.

DEC 20

NSAIDs Interfere with Exercise Training
To strengthen a muscle, you have to take an intense workout that damages muscle fibers to make them feel sore on the next day. This is called Delayed Onset Muscle Soreness (DOMS). Then you take easy workouts for as many days as it takes for the soreness to lessen before you take your next intense workout. Even if you do not compete in sports, you should use some form of “stress and recover” to strengthen your muscles and keep them strong. You can tell that you are damaging muscles when you exercise vigorously enough to feel burning during exercise and DOMS in those muscles 8-24 hours later (Str & Condit J, October 2013;35(5):16–21). Only when the soreness decreases should you take your next intense workout. The soreness is caused by injury to the muscle fibers themselves and when muscles heal, they are stronger than they were before the soreness occurred (J Strength Cond Res, Feb 2003;17(1):197–208).Non-Steroidal Pain Medications (NSAIDs)Some athletes and exercisers use pain medication, such as ibuprofin (Advil, Motrin) and other non-steroidal anti-inflammatory drugs (NSAIDs), because they think it will help them to recover faster from muscle soreness so they will be able to do more training and become better athletes. NSAIDs do not prevent DOMS (Brain Behav Immun, Nov 2006;20(6):578–84). Even if they did prevent DOMS, using them would increase your chance of injuring yourself because you should use DOMS as a signal to tell you when you can safely exercise intensely again (Clin J of Sprt Med, 2002;12(6):373-378). A review of 41 research papers showed a slight association between the use of NSAIDs and reduction of injuries, but the difference was nearly the same as what you would expect from use of placebos (Am J Sports Med, Mar 2017:363546517697957).Reasons for Not Taking NSAIDs for DOMSNSAIDs are supposed to reduce pain by blocking inflammation, and inflammation is unlikely to be a cause of DOMS since it does not decrease in any way after years of exercising (Front Physiol, 2015;6:424). Earlier studies have shown that NSAIDs:• do not significantly prevent DOMS (Brain Behav Immun, Nov 2006;20(6):578–84)• may not block DOMS at all (J Sports Sci, Mar 1999;17(3):197–203)• do not help muscles to recover faster (Appl Phys Nutr and Metab, 2008, 33(3): 470-475)• may delay muscle recovery (J Bone Joint Surg Am, 77:1510-1519, 1995)• may block some of the muscle growth that makes muscles stronger in the short term (American Journal of Physiology, 2002;282:E551-556; 2011;300:R655-662)• may cause short-term weakening of bones and tendons (J Bone Joint Surg Am, 77:1510-1519, 1995)What to Do When You Have DOMSYou can stop exercising when you have DOMS if you want, but you will become stronger if you take easy recovery workouts while your muscles are still sore. Athletes do not usually plan to take off workouts during recovery, even though resting when the muscles feel sore will allow muscles to heal faster than if you exercise at low intensity. Exercising at low intensity during recovery will cause your muscles to become more fibrous and resistant to injury when you stress them in your next intense bout of exercise. If you are a runner, run faster two or three times a week and much more slowly when you feel soreness on the days after running fast. If you are a weightlifter, lift heavy weights once or twice a week and much lighter ones on the following day or days when your muscles feel sore.What Does Not Decrease DOMS

• cryotherapy, homeopathy, ultrasound or electrical current devices (Sports Med, 2003;33(2):145–64; Phys Ther Sport, May 2012;13(2):101–14)

• glutamine or arginine supplements

• stretching (Cochrane Database Syst Rev, 2011;(7):CD004577)

• Epsom salts

• drinking extra water

• compression garments

• massage therapy (J Orthop Sports Phys Ther, Feb 1997;25(2):107–12)

• vitamin D supplementation, unless a deficiency needs to be corrected (hydroxy vitamin D below 20 ng/ml)

How to Prevent Injuries

Before you start an intense exercise program, you should have exercised regularly for many months, be in good shape and not have any health conditions that might cause exercise to harm you.

• Try to set up your exercise program so that on one day, you take a hard workout that damages your muscles so they feel sore on the next day. Then take easy workouts for as many days as it takes for the soreness to go away, and then take your next hard workout.

• When you are training properly, your muscles will feel sore every morning. If they don’t feel better after a 10-minute warmup, take the day off.

• When your muscles start to feel heavy or hurt, stop the workout.

• If you develop a localized pain (one side only) that worsens as you exercise and does not go away when you slow down, stop the workout immediately.

Tips for Recovery from a Hard Workout

• Eat as soon as possible after an intense workout (J of Sports Science, Jan 2004). It doesn’t matter what you eat (Am J Clin Nutr, Jan 2017).

• Go to sleep for 1-3 hours as soon as possible after an intense workout. Muscles recover faster when you are asleep.

• Avoid NSAIDs; they may ease pain but will not help you to recover faster (PNAS, June 27, 2017;114(26):6675 – 6684).

See Recovery: The Key to Improvement in Your Sport

CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or make a sudden increase in the intensity of your existing program.

DEC 15

Calculate Your Fitness Age

VO2max can be used to predict a person’s risk of premature death from a heart attack. Researchers at the Norwegian University of Science and Technology have developed a simple way to estimate a person’s VO2max, his maximal ability to take in and use oxygen (Med Sci Sports Exerc, November 2011;43(11):2024-30).

The researchers had 4637 healthy adults, average age near 50, run to exhaustion on a treadmill and measured their VO2max (a complicated test that measures oxygen and carbon dioxide concentrations). They then developed a formula that correlated very well with the subjects’ actual VO2max, based on their

* sex and age,

* exercise habits,

* resting heart rate and

* waist circumference.

VO2max Predicts Fitness Age

Now the researchers have figured out the average VO2 max for a healthy person at every age from 20 to 90 and used these numbers to calculate fitness age which predicts how long a person is expected to live. Their Fitness Calculator is available (free) at http://www.ntnu.edu/cerg/vo2max

Enter your answers to the simple questions: How often do you exercise? How long? How hard? Your age? Waistline? Resting heart rate?

The calculator quickly gives you your estimated VO2max and your fitness age.

How We Fared

Gabe at 78 had an 81 cm. abdominal circumference and a resting heart rate of 48. His estimated VO2max was 50 and fitness age was 35.

Diana at 71, had a 65 cm. abdominal circumference and a resting heart rate of 50. Her estimated VO2max was 50 and fitness age was 23.

Here is our exercise program: we exercise every day for two to three hours. On Tuesdays, Thursdays and Saturdays, we race flat out on a tandem bicycle for 25 miles. On the other four days Gabe does 30-second intervals with two-minute recoveries until his legs start to stiffen. Diana takes a longer ride with some intervals interspersed.  We cycle an average 150 miles per week and go to the gym 3-4 times a week to use the strength-training machines.

Vigorous Exercise Slows Aging

Studies from all over the world show that intense exercise maintains fitness. People who do not exercise lose 15 percent of their fitness per decade, those who exercise at low intensity lose nine percent, while those who exercise intensely barely lose any fitness at all.

Increasing intensity makes you more fit. If you go out and jog the same two miles at the same pace every day, you will not improve and you will not be very fit. However, if you go faster on one day, feel sore on the next day, go slowly until the soreness disappears, and then go fast again, you will become more fit on every measure of fitness, and also perform better on the tests that measure aging.

However, with increased intensity comes increased risk of injury. Before you start an intense exercise program, and before you start lifting heavier weights, running faster, jumping higher, throwing further, hitting a tennis ball harder, or doing anything that requires increased intensity, check with your doctor. The only problem with this recommendation is that the odds are overwhelming that your doctor won’t know very much about sports, training, or improving physical fitness. But you should at least check with him or her to see if you have any condition that could be aggravated by hard exercise.

DEC 12

Exercise Wins: Fit Seniors Can Have Hearts That Look 30 Years YoungerDecember 10, 2018 5:03 AM ET

Heard on Morning Edition

pneighmond.150_sq-4476ec103a87e65492a18dac755e8a521780c343-s100-c85.jpg

PATTI NEIGHMOND

Twitter

The people who got caught up in the exercise boom of the 1970s and stuck with it into their senior years now have significantly healthier hearts and muscles than their sedentary counterparts.

David Trood/Getty Images

We know we need to exercise for our health, but a lifelong exercise habit may also help us feel younger and stay stronger well into our senior years. In fact, people in their 70s who have been exercising regularly for decades seem to have put a brake on the aging process, maintaining the heart, lung and muscle fitness of healthy people at least 30 years younger.

Take 74-year-old Susan Magrath, a retired nurse practitioner who lives in Muncie, Ind. Magrath has been running almost daily for 45 years. She often runs outdoors and describes it as addictive. “It’s just such a release, just a wonderful release,” she says. “I ran today and there were little snowflakes coming down, and I was down by the river and it’s just wonderful. And I think it’s become more of a contemplative meditative process for me.”

Magrath may be living proof that lifelong exercise helps with cardiovascular and muscle health. She recently took part in a study at the Human Performance Laboratory at Ball State University, also in Muncie, headed by exercise physiologist Scott Trappe. Trappe is among the first to study the enticing new population of lifelong exercisers.

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After the running and aerobic boom of the 1970s, large numbers of septuagenarians stuck with it and have been exercising regularly for the past 50 years. In this population, Trappe says, “We were interested in basically two questions: One, what was their cardiovascular health? And two, what was their skeletal muscle health?”

What he saw surprised him. “We saw that people who exercise regularly year after year have better overall health than their sedentary counterparts. These 75-year-olds — men and women — have similar cardiovascular health to a 40- to 45-year-old.”

” ‘Exercise wins’ is the take-home message,” he says.

In the study, Trappe divided 70 healthy participants into three groups. Those in the lifelong exercise group were on average 75 years old and primarily kept their heart rates up through running and cycling. They had a history of participating in structured exercise four to six days a week for a total of about seven hours a week.

The second group included individuals who were also, on average, 75 years old but did not engage in structured exercise regimens, although they might have participated in occasional leisure walking or golf.

The third group consisted of young exercisers who were, on average, 25 years old and worked out with the same frequency and length of time as the lifelong exercisers.

All participants were assessed in the Human Performance Laboratory at Ball State University. Cardiovascular health was gauged by having participants cycle on an indoor bike to determine VO2 max, also known as maximal oxygen uptake, which is the measurement of the maximum amount of oxygen a person can use during intense exercise and is an indicator of aerobic endurance. During the cycling test, which became increasingly challenging, individuals exhaled into a mouthpiece that measured oxygen and carbon dioxide levels.

The aerobic profile of the participants’ muscles was measured by taking a sample via a biopsy about the size of a pea, says Trappe. Then in the lab, researchers examined the micro vessels, or capillaries, that allow blood to flow through the muscle itself.

They also looked at specific enzymes that provide fuel to the working muscle and help break down carbohydrates and fats.

Although the study was relatively small, the findings, which were published in the Journal of Applied Physiology in August, suggest a dramatic benefit of lifelong exercise for both muscle health and the cardiovascular system.

“Lifelong exercisers had a cardiovascular system that looked 30 years younger,” says Trappe. This is noteworthy because, for the average adult, the ability to process oxygen declines by about 10 percent per decade after age 30.

“It’s kind of a slow decay over time that’s probably not so noticeable in your 30s or 40s,” says Trappe, but eventually as years go on, becomes apparent. People can get out of breath more easily and may have difficulty pushing themselves physically.

The age-related reduction in VO2 max is directly associated with an increasing risk of multiple chronic diseases, mortality and loss of independence. Maintaining a strong heart and lung system has been shown to decrease these health risks.

As for muscle health, the findings were even more significant, says Trappe. Trappe says researchers were surprised to find the 75-year-old muscles of lifelong exercisers were about the same as the muscles of the 25-year-olds. “If I showed you the muscle data that we have, you wouldn’t know it was from an older individual. You would think it’s from somebody that’s a young exerciser,” he says.

David Costill, 82, was not part of the study but is a former colleague of Trappe’s and professor emeritus of exercise science at Ball State University. As an exercise physiologist, he has always known about the benefits of exercise and has been committed since high school.

He says he has spent about “60 years actively exercising.” Costill ran marathons for about 20 years until his knees started to bother him, so he headed to the pool. “And I’ve been swimming for the last 35 years.”

When Costill looks at his friends, he says he finds he can do a lot more physically than they can. “If I’m out with a group of my peers, guys who are near 80, and we’re going someplace, it seems to me they’re all walking at half speed.”

Trappe says the findings are clear: 30 to 60 minutes of exercise a day may be the key to a healthy life. But you don’t have to run marathons or compete in cycling events. “If you want to do 30 to 45 minutes of walking a day, the amount of health benefit you are going to get is going to be significant and substantial,” he says. “Will it equal the person training for competitive performances? No. But it will outdo the couch potato.”

Unfortunately, couch potatoes are the norm. Federal guidelines recommend two hours and 30 minutes of moderate exercise a week, or one hour and 15 minutes of vigorous exercise per week. Yet 77 percent of Americans do not come close to getting that amount of exercise.

Dr. Clyde Yancy, spokesperson for the American Heart Association and chief of cardiology at Northwestern University Feinberg School of Medicine, says the findings suggest “a lifelong investment in health and fitness appears to be associated with a really sustainable benefit out until the outer limits of life.”

Since we are living longer, maintaining a good quality of life is more important than ever. While the study was small and the findings need to be confirmed, they present a “strong argument” for lifelong exercise that is inexpensive and accessible for everyone. “If you can swim, do yoga, cycle, or walk,” you can benefit,” Yancy says.

DEC 11

Inactivity Linked to Arthritis

The majority of people with arthritis are inactive, overweight, diabetic or pre-diabetic. The CDC Morbidity and Mortality Weekly Report (November 9, 2018; 67(44);1238–1241) found that 32 percent of adults with arthritis have pre-diabetes or diabetes, 56.5 percent are physically inactive and 50.1 percent are obese.

Osteoarthritis affects more than 30 million North Americans, making it the most common joint disease. Anything that causes inflammation can damage joints (Nature Medicine, published online Nov. 6, 2011), and inflammation is a more common cause of arthritis than wear-and-tear injuries (Bone, 2012;51:249–257). Everything that helps to reduce inflammation also helps to reduce pain and joint damage: lose excess weight, eat an anti-inflammatory diet, exercise, lower high blood sugar levels and so forth (Ther Adv Musculoskelet Dis, 2013 Apr; 5(2): 77–94).

Inflammation Harms Joints

Your immune system attacks and destroys germs that invade your body because it can tell that germs have different surface proteins than you do. However, if your immune system stays on all the time, it will use these same cells and chemicals to attack and destroy your own tissues. This is called inflammation and anything that causes your immune system to stay active all the time can damage the cartilage in your joints. See Osteoarthritis Linked to Inflammation

Osteoarthritis Probably Caused by Inflammation

Diabetes, Pre-Diabetes and Arthritis

A high rise in blood sugar can cause sugar to stick to the outer membranes of cells. Once there, sugar cannot get off and is eventually converted to sorbitol that destroys that cell. Your immune system responds to these damaged cells in exactly the same way it works to attack invading germs, so high blood sugar is a constant source of inflammation that specifically damages joints (Osteoarthritis Cartilage, Jun 2015;23(6):841–850).

Obesity and Arthritis

Obesity turns on your immune system to raise blood levels of cytokines that can damage joints (Clin Chem Lab Med, 2010;48:1141–1145), and high levels of these cytokines predict the onset and progression of osteoarthritis (Clin Immunol, 2012;144:228–236). More than 80 percent of obese people suffer some form of joint disease, most often because having muscles and liver full of fat is associated with inflammation that can damage every cell in your body including the cartilage in joints. Obesity is frequently associated with both osteoarthritis and rheumatoid arthritis, and losing excess weight can reduce joint damage and disability and improve quality of life (PMR, May 1, 2012;4(5 0):S59–S67).

• Obese people are seven times more likely than normal-weight people to suffer osteoarthritis of the knee (Joint Bone Spine, 2011; 78(2):150-5).

• The more overweight you are, the greater your chance of suffering from osteoarthritis of the knee and hip (Joint Bone Spine, 2012; 79(3):291-7).

• Obesity is a potent trigger to develop rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis (RMD Open, June 29, 2015;1(1): e000012).

• In just 16 weeks, weight loss lowered high markers of inflammation in people with osteoarthritis (Osteoarthritis Cartilage, 2014;22(11):1817–25) and losing weight markedly reduced pain and limitation of movement in patients with osteoarthritis (Arthritis Care Res, 2013;65(1):15–22).

Inactivity and Arthritis

You may believe that people with arthritis don’t exercise BECAUSE of the pain, but osteoarthritis always worsens with inactivity. If you have joint pain, keep on moving but be guided by the pain and slow down or stop when your pain worsens. Avoid sports that involve a lot of impact, because the force of your foot hitting the ground can break off cartilage. Good non-impact sports include cycling, swimming and water aerobics.

A study that followed more than 6500 women for 12 years showed that those who exercised regularly had far fewer complaints of joint pain than those who did not exercise or who exercised only a little bit (Arthritis Care & Research, Dec 5, 2017;69(12)). The women who were overweight and did not exercise had the highest incidence of joint pain. See Knee Osteoarthritis: Exercise Therapy More Effective than Surgery

NOV 30

Retaining Strength with Aging

If you don’t exercise regularly and vigorously, expect to lose a significant amount of muscle strength as you age, and expect that loss of strength to reduce the quality of your life. A 15-year follow-up study showed that older people who lift weights at least twice a week had a 46 percent lower death rate within the study period, a 41 percent lower death rate from heart attacks, and a 19 percent lower death rate from cancer, compared to the control group that did not lift weights (Preventive Medicine, June 2016;87:121-127).

• In one study, older people with the highest loss of muscle strength were four times more likely to be disabled, have difficulty walking and need walkers or other mechanical devices to help them walk (Am J Epidemiol, 1998; 147(8):755–763). The authors of this study said, “Exercise decreases body fat and obesity, increases muscle strength, improves balance, gait, and mobility, decreases likelihood of falling, improves psychological health and reduces arthritis pain, heart attacks, osteoporosis, cancer and diabetes.”

• Strength training can significantly reduce heart attack risk factors in older people (Clin Geriatr Med, Nov 2009;25(4):703-14).

• Just eight weeks of lifting weights increased muscle strength in a group of men 80 to 88 years old (Aging Clin Exp Res, April 2010;22(2):134-40).

Exercise Reduces Loss of Muscle

Muscles are made up of thousands of individual muscle fibers. Each muscle fiber is innervated by a single nerve. With aging, humans lose the nerves that innervate muscle fibers and with each nerve loss, they lose the associated muscle fiber. For example, the vastus medialis muscle in the front of your thigh contains approximately 800,000 muscle fibers when you are 20 years old, but by age 60, it will have only about 250,000 fibers. The average person loses about eight percent of muscle size in the decade between 40 and 50 years of age, and the rate of loss increases to 15 percent per decade after age 75 (J Am Geriatr Soc, March 2003;51(3):323-30). You can slow the loss of muscle fibers as you age and can enlarge the remaining muscle fibers by exercising against resistance, but you cannot increase the number of fibers once they are lost (The Journals of Gerontology, August 2012).

Resistance exercise increases muscle size and strength in older people (Med. Sci. Sports Exerc, 2011; 43 (2): 249–58), but with aging you need to work much harder to gain the amount of strength that a younger person would get with the same program. In older people, resistance training can enlarge the remaining muscle fibers, but it does not increase the number of fibers in a muscle (Med Sci Sports Exerc, July 2011;43(7):1177-87).

How to Grow Larger Muscles As You Age

The stimulus to enlarge a muscle is to exercise against resistance vigorously enough to damage your muscles. Muscles grow when they heal from muscle damage. You can tell that you are causing muscle damage because of the burning you will feel in muscles when you are exercising and the delayed onset muscle soreness (DOMS) that you feel 8 to 24 hours after you finish exercising. Then you take easier workouts until the soreness goes away, usually in 24 to 48 hours. If you take hard workouts when muscles are sore, you are likely to tear them and not be able to exercise again until your injuries heal.

Taking in extra protein without doing resistance exercise will not increase muscle size or strength; see my report on Extra Protein Does Not Enlarge Muscles.  However, eating foods that contain both protein and carbohydrates after a workout can help muscles to heal faster and grow stronger.

Lifting Lighter Weights with More Repetitions

In one study, older men gained more muscle strength by spending more time lifting lighter weights, whereas younger men gained more muscle strength by lifting heavier weights. In younger men, doubling exercise volume by spending more time lifting weights produced limited added muscle enlargement. In older men, it resulted in much larger muscles and far more strength (The Journals of Gerontology, August 2012).

Exercising as You Age Keeps More Fast-Twitch Fibers

Muscles are made up primarily of two types of fibers: fast twitch fibers that govern strength and speed, and slow twitch fibers that govern endurance. Inactivity causes a far greater loss of the fast twitch muscle fibers that govern strength and speed (J Cell Mol Med, Sep 2009;13(9B):3032-50), so exercise makes you stronger by causing your muscles to retain more fast twitch fibers.

Benefits of Life-long Exercise

Inactivity at any age causes tremendous loss of muscle size and strength. If you inactivate a leg by putting it in a cast, you lose a large amount of muscle size in just four days. However, if you make the inactivated leg muscles contract by stimulating them with an electric current, some of the loss of muscle size is prevented (Nutrition, Acta Physiol (Oxf), March 2014; 210(3):628-41).

Life-long competitive athletes over 50 who train four to five times per week do not lose as many of the nerves that innervate muscles, so they retain more muscle size and strength with aging (The Physician and Sportsmedicine, Sept 2011;39(3):172-8). Other studies show that life-long competitive runners over 60 had almost the same number of muscle fibers as 25-year-olds. If you are not a life-long exerciser, there is still plenty of benefit from exercise no matter when you start.

Join a Gym

First check with your doctor to make sure you do not have any condition that will be harmed by vigorous exercise. Then join a gym and ask for instructions on how to use the weight-training machines. As a general rule, on each machine, you will try to move a weight 10 times in a row, rest a minute, and then do two more sets of 10. In the beginning, you should lift very light weights and go home without sore muscles. After a few weeks of lifting weights three times a week, not on consecutive days, you can gradually try to add more weight on your machines. Older people are at increased risk for injuries, so always stop a lifting workout when you feel pain in one spot that worsens as you continue to lift a weight. 

NOV 9

Irregular Heartbeats in Senior Athletes and Exercisers

Virtually all doctors agree that exercise helps to keep you healthy and to prolong your life. People who exercise into later life live longer than non-exercisers and are at reduced risk for high blood pressure, heart attacks, premature death, diabetes, strokes and even some cancers. Endurance bicycle racers who participated in the Tour de France from 1947 to 2012 live an average of five years longer than their countrymen (European Heart Journal, 2013, 34 (40):3145-3150). Fit people are less likely to suffer a particular form of irregular heartbeat called atrial fibrillation, and a regular exercise program reduces a person’s chances of developing atrial fibrillation (Circulation, April 22, 2015). More than 36,000 middle-aged women were followed for 10 years, and those who exercised regularly were far less likely to develop atrial fibrillation (Heart, May 27, 2015).

However, extreme endurance exercisers such as bicycle racers, cross country skiers and long-distance runners who compete into their 40s and beyond may be at increased risk for atrial fibrillation (American Journal of Cardiology, October 15, 2014;114(8):1229–1233). The incidence of atrial fibrillation appears to be more common in older athletes than in the general population (J Am Coll Cardiol, 2005;46:690–6). Recent articles in the Wall Street Journal, the New York Times and other popular media have suggested that athletes who continue to do extensive fast mileage or train for extreme endurance events in later life may be doing more harm than good. I feel that these articles have caused a tremendous amount of harm in the exercising community.

What is Atrial Fibrillation?

Each heartbeat starts when a “battery” in the upper heart (atrium) sends an electrical impulse through the upper heart to make it contract to squeeze blood toward the lower heart (ventricle). Then the electrical impulse reaches another “battery” in the lower heart to make the lower heart squeeze blood forward. Atrial fibrillation means that the upper heart quivers and does not push blood forward, while the lower heart beats independently.

Some people with atrial fibrillation have no symptoms and do not know that they have this condition until it is discovered during a routine physical examination. Symptoms may include:

• Palpitations (a feeling that the heartbeat is racing, uncomfortable, or irregular)

• Muscle weakness

• Reduced ability to exercise

• Fatigue

• Lightheadedness

• Dizziness

• Confusion

• Shortness of breath

• Chest pain

These symptoms are usually harmless, but on rare occasions an irregular heartbeat can cause sudden death by stopping the heart from pushing blood through your body.

Atrial fibrillation is the most common irregular heartbeat. It occurs in 1.5 to 2 percent of the general population and risk increases with age. It affects 10 percent of 75-year-olds and 20 percent of those over 85, because aging increases the risk factors for atrial fibrillation such as blocked arteries, high blood pressure or diabetes.

How Atrial Fibrillation Can Harm You

When a person has an upper (atrial) heart that is fluttering, a clot can collect there and pass to the brain to cause a stroke, or to the lungs to block blood flow through the lungs. This is so dangerous that most doctors prescribe anti-clotting agents to everyone with atrial fibrillation. I believe that athletes with atrial fibrillation are far less likely to suffer clots that cause strokes than non-athletes with atrial fibrillation, but I have not seen any studies to support my belief. Healthy athletes can have occasional irregular heartbeats that will not harm them, but at this time, doctors treat atrial fibrillation in athletes the same way they treat their other patients.

Extreme Exercise May increase Atrial Fibrillation Risk

Two studies raised the concern about extreme amounts of exercise in older athletes. In the first study, 29 elite athletes were given MRIs to look for heart muscle scarring that increases risk of atrial fibrillation. They were Olympic or national team runners and rowers who had competed throughout their lives, including some who had completed more than 100 marathons. In the older group of 12 athletes ages 50 to 67, half showed some heart muscle scarring (J Appl Physiol, June 2011;110(6):1622-6). Those who had trained the longest and hardest had the most scarring. None of the 17 younger athletes (20-42) or the control group of 20 older non-athletes showed this heart muscle scarring.

In the second study, on rats, a 16-week program of daily one-hour treadmill running caused widening of the upper part of their hearts and scarring in the heart muscle that could increase risk for irregular heartbeats (J Am Coll Cardiol, July 2013;62(1):68-77). The scars in the upper heart remained after the rats stopped exercising.

Risk Factors for Atrial Fibrillation

• High blood pressure is the most significant risk factor for atrial fibrillation (Hypertension, 2012 Feb;59(2):198-204). Blood pressures greater than 140/90 significantly increased risk (J Am Soc Hypertens, 2015 Mar;9(3):191-6).

• Diabetes

• Overweight (J Am Coll Cardiol, Jul 7, 2015). A program getting people to reduce their excess body weight markedly reduced symptoms in patients who already had atrial fibrillation (JAMA, 2013;310(19):2050-206).

• Alcohol

• Smoking

• An over-active thyroid

• A very low heart rate, below 50 beats per minute (Circ Arrhythm Electrophysiol, 2013, Aug;6(4):726-31).

• Abnormal coronary artery calcium score, even with no heart symptoms (Am J Cardiol, 2014 Dec 1;114(11):1707-12). This test can be ordered by any doctor.

• Lack of exercise. Exercise helps to prevent atrial fibrillation; fit men had a 23 percent lower susceptibility for atrial fibrillation (Am J Cardiol, 2012 Aug 1;110(3):425-32).

• Aging. The older you are, the more likely you are to suffer atrial fibrillation. Walking or cycling is associated with a decreased risk in older people (Heart, 2014 Jul;100(13):1037-42).

• Possibly extreme ultra-endurance exercise.

My Recommendations

Exercise reduces the chances of a person developing atrial fibrillation. Nobody has shown that exercise in itself causes atrial fibrillation, and it is only extreme ultra-endurance exercise that some doctors believe may increase risk for atrial fibrillation. I think that nutrition, exposure to pollutants and other lifestyle factors are also important. I do not believe that just exercising will give you adequate protection from heart disease. To protect your heart, you should follow all of the rules that apply to everyone whether you compete in ultra-endurance events, exercise moderately or just sit on a couch.

• eat lots of fruits and vegetables

• severely restrict sugar-added foods and drinks

• restrict red meat and fried foods

• avoid smoking, second-hand smoke and third-hand smoke

• restrict alcohol

• avoid overweight

• exercise

However, some doctors disagree with me. Even if you are healthy and do not have any heart problems, your doctor may recommend that you avoid strenuous workouts. If you have atrial fibrillation or other heart problems, some doctors will even tell you to stop exercising altogether. After all, on rare occasions irregular heartbeats can kill you. If you already suffer from atrial fibrillation, or you already have blocked arteries leading to your heart, you have to depend on your doctor’s advice.

One Senior Athlete’s Exercise Program

I am 80 years old and do not have atrial fibrillation or known heart disease. I race with others 20 to 30 miles on my bike three times a week and know that I have to back off when my leg muscles start to feel stiff and heavy. I race for the sheer pleasure of riding fast. There are no trophies or financial rewards. On my other four days, I try to do controlled 50-pedal-stroke intervals until my legs feel heavy or hurt.

For most of my life, first as a marathon runner and then as a cyclist, I had exercise-induced injuries all the time. It took me more than 70 years to learn when to go slow and when to take a day off. Most mornings, my leg muscles feel heavy and ache from my previous day’s work out. If my legs do not feel better after riding my bike for 10 minutes, I take the day off or ride very slowly. I do not ever plan to do slow junk miles and I do not care how few miles I put down in my diary. I usually have to take off one day a week and go slowly one day a week. I also follow all of the rules I have listed for a healthful lifestyle.

NOV 6 ARE YOU OVER 40.50,60,or 70 GOOD WORKOUT 

NOV 05

Healthful Lifestyle Reduces Risk of Dying from Prostate Cancer

Almost all North American men will develop prostate cancer if they live long enough. However, fewer than five percent of men diagnosed with prostate cancer will die from that disease and the 15-year survival rate is 96 percent.

Data from the Health Professionals Follow-Up Study show that men who participated most frequently in vigorous exercise had a 30 percent reduced risk of developing advanced prostate cancer and 25 percent reduced risk of dying from prostate cancer than those who exercised the least (European Urology, October 22, 2018). Men in the highest group of intense exercisers did the equivalent of 25 minutes of running daily in various activities including bicycling, swimming, heavy outdoor work or playing sports such as tennis or racquetball.

Nearly 50,000 men, 40-75 years old, were followed for 26 years, during which 6,411 developed prostate cancer and 888 developed the aggressive type that can kill. Half of all prostate cancers contain the gene, TMPRSS2:ERG. If you have this gene, insulin, certain growth factors and other metabolic factors increase your risk for developing prostate cancer. This could explain the link between physical activity and reduced risk for developing or dying from prostate cancer. This genetically-driven prostate cancer now appears to be a metabolic disease and all the rules for preventing and treating diabetes and heart attacks also may help to prevent and treat these cases of prostate cancer.

The same group of researchers published a paper in the same journal issue showing that measuring PSA levels in mid-life can predict the likelihood to develop aggressive prostate cancer later on in African-American men (European Urology, October 22, 2018). The group reported earlier that PSA screening in mid-life can also be used to predict aggressive prostate cancer in Caucasian men.

Lifestyle Factors that Increase Risk for Prostate Cancer

• Most risk factors for diabetes and heart attacks are also risk factors for developing prostate cancer: high blood sugar, high insulin levels, high cholesterol, and diabetes (Horm Cancer, April 2016;7(2):75-83).

• Prostate cancer is six times more common in Western than non-Western countries and in countries that are richer rather than poorer (Eur Urol 2012, 61:1079-1092).

• Obesity is associated with increased death rate, more advanced stage disease, and higher Gleason scores once a man has prostate cancer (Int J Oncol, Mar 2006;28(3):737-45). Doctors look at prostate cancer cells under a microscope and use the characteristics of the cells, called the Gleason score, to predict how likely the cancer is to spread through the body.

• Full fat cells produce high levels of potential cancer causing leptin, interleukin-6 (IL-6), heparin-binding epidermal growth factor-like growth factor (HB-EGF), vascular endothelial growth factor (VEGF) and adiponectin that can cause cancer cells to spread through your body (Int J Oncol, Mar 2006;28(3):737-45 and J Clin Endocrinol Metab, Mar, 2001;86(3):1341-5).

• High blood sugar (fasting sugar over 100) in men diagnosed with prostate cancer markedly increases risk of them dying from prostate cancer (Prostate Cancer Prostatic Dis, June 2013;16(2):204-8).

• Eating a diet that has a high glycemic load (foods that cause a high rise in blood sugar) increases risk of developing prostate cancer by more than 26 percent (Ann Oncol, Jan 2013;24(1):245-51).

• Exercise is associated with reduced risk for both slow growing prostate cancer and the type that can kill (Journal of Urology, November 2009;182(5):2226-2231).

If You Already Have Prostate Cancer

After a man is diagnosed with prostate cancer, the same risk factors associated with the disease also increase risk for the prostate cancer progressing and being fatal. Men diagnosed with prostate cancer are less likely to have the prostate cancer spread and kill them if they:

• avoid smoking, maintain a healthy body weight, exercise regularly and intensely, and eat a high vegetable diet that includes tomato sauce (lycopene), cruciferous vegetables, non-saturated vegetable fats and coffee (World J Urol, 2017 Jun; 35(6): 867-874).

• restrict eggs, red meat and poultry (American Journal of Clinical Nutrition 2010; 91(3): 712-21; American Journal of Clinical Nutrition 2012; 96(4): 855-63; Cancer Prevention Research (Phila) 2011; 4(12): 2110-21). These foods are sources of choline that colon bacteria convert to TMAO, which is a carcinogen.

• restrict saturated fat in meat and eat polyunsaturated fats in vegetables (annual meeting of the American Association for Cancer Research. April 19, 2016).

My Recommendations

Most risk factors for heart attacks are also risk factors for prostate cancer (Journal of the American College of Cardiology: Cardiovascular Imaging, December 2015). I believe that the most beneficial diet to prevent and treat prostate cancer includes eating lots of fruits and vegetables, and restricting refined carbohydrates, red meat and processed meats, and fried foods (BMC Medicine, March 24, 2015;13:3). I also recommend that you try to exercise every day and work to lose excess weight if you are overweight.

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NOV  01

Exercises for Seniors to Improve Strength and Balance

In Canada and around North America, falls are one of the leading causes of injury and death for senior citizens. However, you don’t have to fall prey to slops & falls  By exercising, you can improve your balance and your strength, so you can stand tall and feel more confident when walking.

Read on to find 14 exercises seniors can do to improve their balance.

Exercise 1: Single Limb Stance

It’s best to start off with a simple balance exercise for seniors. Here’s how you do this one: stand behind a steady, solid chair (not one with wheels), and hold on to the back of it. Lift up your right foot and balance on your left foot. Hold that position for as long as you can, then switch feet.

The goal should be to stand on one foot without holding onto the chair and hold that pose for up to a minute.

Exercise 2: Walking Heel to Toe

You might read this and wonder, “How is walking an exercise to improve balance?” This exercise makes your legs stronger, which enables you to walk without falling.

Put your right foot in front of your left foot so that the heel of your right foot touches the top of the toes of your left foot. Move your left foot in front of your right, putting your weight on your heel. Then, shift your weight to your toes. Repeat the step with your left foot. Walk this way for 20 steps.

Exercise 3: Rock the Boat

Stand with your feet apart, so that the space between them is the same width as your hips. Make sure both feet are pressed into the ground firmly. Stand straight, with your head level. Then, transfer your weight to your right foot and slowly lift your left leg off the ground. Hold that position for as long as possible (but no more than 30 seconds).

Slowly put your foot back onto the ground, then transfer your weight to that foot. Slowly lift your opposite leg. Start by doing this exercise for balance five times per side, then work your way up to more repetitions.

Exercise 4: Clock Reach

You’ll need a chair for this exercise.

Imagine that you are standing in the centre of a clock. The number 12 is directly in front of you and the number 6 is directly behind you. Hold the chair with your left hand.

Lift your right leg and extend your right arm so it’s pointing to the number 12. Next, point your arm towards the number three, and finally, point it behind you at the number 6. Bring your arm back to the number three, and then to the number 12. Look straight ahead the whole time.

Repeat this exercise twice per side.

Exercise 5: Back Leg Raise

This strength training exercise for seniors makes your bottom and your lower back stronger.

Stand behind a chair. Slowly lift your right leg straight back – don’t bend your knees or point your toes. Hold that position for one second, then gently bring your leg back down. Repeat this ten to 15 times per leg.

Exercise 6: Single Limb Stance with Arm

This balance exercise for seniors improves your physical coordination.

Stand with your feet together and arms at your side next to a chair. Lift your left hand over your head. Then, slowly raise your left foot off the floor. Hold that position for ten seconds. Repeat the same action on the right side.

Exercise 7: Side Leg Raise

You’ll need a chair for this exercise to improve balance.

Stand behind the chair with your feet slightly apart. Slowly lift your right leg to the side. Keep your back straight, your toe facing forward, and stare straight ahead. Lower your right leg slowly. Repeat this exercise ten to 15 times per leg.

Exercise 8: Balancing Wand

This balance exercise for seniors can be performed while seated. You’ll need a cane or some kind of stick. A broomstick works well for this – just remove the broom’s head before you start.

Hold the bottom of the stick so that it’s flat on the palm of your hand. The goal of this exercise is to keep the stick upright for as long as possible. Change hands so that you work on your balance skills on both sides of your body.

Exercise 9: Wall Pushups

As long as you’ve got a wall, you can do this strength training exercise for seniors.

Stand an arm’s length in front of a wall that doesn’t have any paintings, decorations, windows or doors. Lean forward slightly and put your palms flat on the wall at the height and width of your shoulders. Keep your feet planted as you slowly bring your body towards the wall. Gently push yourself back so that your arms are straight. Do twenty of these.

Exercise 10: Marching in Place

Marching is a great balance exercise for seniors. If you need to hold onto something, do this exercise in front of a counter.

Standing straight, lift your right knee as high as you can. Lower it, then lift the left leg. Lift and lower your legs 20 times.

Exercise 11: Toe Lifts

This strength training exercise for seniors also improves balance. You’ll need a chair or a counter.

Stand straight and put your arms in front of you. Raise yourself up on your toes as high as you can go, then gently lower yourself. Don’t lean too far forward on the chair or counter. Lift and lower yourself 20 times.

Exercise 12: Shoulder Rolls

This is a simple exercise for seniors. You can do it seated or standing.

Rotate your shoulders gently up to the ceiling, then back and down. Next, do the same thing, but roll them forwards and then down.

Exercise 13: Hand and Finger Exercises

The following are exercises to improve flexibility. You don’t need to stand for these.

In the first exercise, pretend there’s a wall in front of you. Your fingers will climb the wall until they’re above your head. While holding your arms above your head, wiggle your fingers for ten seconds. Then, walk them back down.

During the second exercise, touch your hands while they’re behind your back. Reach for your left hand while your right hand is behind your back. Hold that position for ten seconds, then try with your other arm.

Exercise 14: Calf Stretches

These strength training exercises for seniors can be performed sitting or standing.

To do calf stretches while standing, find a wall with nothing on it. Stand facing the wall with your hands at eye level. Place your left leg behind your right leg. Keep your left heel on the floor and bend your right knee. Hold the stretch for 15 to 30 seconds. Repeat two to four times per leg.

If you want to stretch your calves while sitting, you’ll need a towel. Sit on the floor with your legs straight. Put the towel around the soles of your right foot and hold both ends. Pull the towel towards you while keeping your knee straight and hold it for 15 to 30 seconds. Repeat the exercise two to four times per leg.

OCT 30

You Can’t Exercise Too Much

Dramatic results in a new study from the Cleveland Clinic show that:

• You can’t exercise too much: Elite athletes who do tremendous amounts of exercise have a much lower risk of dying than non-athletes.

• Exercise is healthful: Not exercising is worse for your health than smoking, diabetes or heart disease. The vigorous exercisers had nearly a 500 percent reduced risk of death during the study period, compared to the non-exercisers (JAMA Network Open, Oct 19, 2018;1(6):e183605).

More than 120,000 patients, average age 53, were given an exercise stress treadmill test between 1991 and 2014 and were followed up at the Cleveland Clinic. The researchers used the stress test results to classify their fitness level as low (the bottom 25th percentile), below average (25th to 49th percentile), above average (50th to 74th percentile), high (75th to 97.6th percentile), and elite (above 97.7th percentile). By January 1, 2018, 13,637 of the participants had died.

The study results were overwhelming. The more fit a person was, the less likely he was to die. There was no limit to the increase in benefits from improving fitness to very high levels. The elite athletes had an 80 percent reduction in risk for death. The greatest differences were seen among patients who had high blood pressure in the high and elite groups compared to those in the low fitness group. The lead researcher concluded, “We found that there was no ceiling for benefit . . . with no toxicity at the higher end.”

Can Extreme Amounts of Exercise Be Harmful?

This new study counters the findings of earlier studies on elite athletes that suggested they are at increased risk for irregular heartbeats, increased arterial plaque size or thickened heart valves.

• Even though master athletes may be at increased risk for irregular heartbeats (atrial fibrillation), they can still benefit from continuing to exercise. Compared to non-exercisers, they appear to be at reduced risk for suffering from serious side effects such as clots. See Irregular Heartbeats in Senior Athletes and Exercisers.

• Elite athletes may be at increased risk for larger plaques in their arteries than non-exercisers, but narrowing of arteries by plaques does not cause a heart attack. Heart attacks are caused by plaques breaking off from arteries, and exercise helps to prevent heart attacks by making plaques more stable and less likely to break off. See Exercisers Have More Stable Plaques.

• Vigorous exercisers may be at increased risk for thickened heart valves, but compared to non-exercisers, athletes with thickened heart valves still have stronger heart muscles so that they are less likely to suffer heart failure. See Exercise to Prevent a Heart Attack

Exercise Reduces Inflammation

Aging is associated with inflammation, an overactive immune system. Your immune system is supposed to kill germs when they attack you, but as soon as the germs are gone, your immunity is supposed to dampen down. However if your immunity stays active all the time, it attacks you in the same way that it kills germs. It can punch holes in arteries to cause plaques, break off the plaques to cause heart attacks, destroy your DNA to cause cancer, cause various auto-immune diseases and so forth. As you age, inflammation increases to cause loss of muscles and bone, osteoarthritis, loss of cell function associated with aging, and other harmful effects. Exercise helps to dampen down inflammation, and thus helps to prevent diseases and prolong life. One study of 111 women, ages 65 to 70, showed that replacing 30 minutes of sitting time with the same amount of time in light or moderate exercise very significantly reduced markers of inflammation (C-reactive protein and fibrinogen) and diabetes (Medicine & Science in Sports & Exercise, July 2018).

Intense Exercise is More Beneficial than Casual Exercise

This new study agrees with many earlier studies that have shown greater benefits from vigorous exercise than from low-intensity exercise:

• The SUN Study on 18,737 middle-aged people showed that those who exercise intensely have half the rate of heart attacks as those who did the same amount of exercise less intensely (Am J of Cardiology, Sept 11, 2018).

• Increased time spent exercising intensely gives adolescents a healthier metabolic profile than more time spent just exercising (PLOS Medicine, Sept 2018; 15 (9): e1002649).

• Vigorous exercise is associated with a much lower rate of metabolic syndrome and diabetes, compared to low-intensity exercise (American J of Prev Med, April 2017;52(4):e95–e101).

My Recommendations

I think everyone should have a regular exercise program, and it is never too late to start. See How to Start an Exercise Program. Do not start an intense exercise program until you have spent several months exercising at a casual pace.

Socialization usually improves the length of time, intensity and enjoyment of exercise, so it is best to join a group, exercise with your mate, or do your exercise regularly with friends (Am J Alzheimer’s Dis Other Demen, June 2014; 29(4): 372–378).

CAUTION: Intense exercise can cause a heart attack in a person who has blocked arteries or heart damage. Check with your doctor before you start a new exercise program or make a sudden increase in the intensity of your existing program.

OCT25

Swimming May Slow Down Aging By Decades

From cradle to grave, swimming might just be the best exercise ever. Here, eight health benefits of taking a lap or two. 

Swimming is good for just about everyone. It accommodates all ages, stages, abilities and disabilities.

There’s also evidence it can slow down the aging process.

A long-term study at Indiana University Bloomington’s Counsilman Center for the Science of Swimming found that Masters Swimmers (over age 35) who swam roughly 3,200 to 4,500 metres (about 3.2 to 4.8 kilometres) three to five times a week, postponed the aging process. And not just for a few years but for decades, according to traditional age markers like muscle mass blood pressure and lung function.

But you don’t have to be a Masters Swimmer to benefit from swimming. Far from it.

“The health and well-being benefits start with a minimal amount of swimming,” Counsilman Centre Director Joel Stager is quoted as saying in the university’s newsletter. “If you want the fitness effect, you’ll need to look at getting your heart rate up and boosting the intensity.”

Another study, by Dr. Steven Blair at the University of South Carolina, has shown swimming dramatically reduces the risk of dying. The study spanned 32 years and followed 40,000 men, aged 20 to 90. Those who swam had a 50 per cent lower death rate than runners, walkers and those who didn’t exercise at all.

Here are some other known benefits to swimming:

1. It’s kind to your joints and improves flexibility: “Swimming is a form of exercise that’s suitable to people of all ages because it’s so easy on the joints,” says Belgium-based Christophe Keller, who so loves the sport he created a website solely devoted to it, called enjoy-swimming.com. “The water supports the body so only a fraction of your weight has to be supported by your limbs. It also favours smooth circular movements rather than quick jerky movements that can strain joints.”

2. Helps you lose weight: Swimming for half an hour can burn as much as 250 calories. Even a gentle swim can burn 200 calories. Since water is about 800 times denser than air, your body has to work harder in the pool, even though it might not feel like it is. Gliding through the water can be a glorious feeling.

3. Improves mental health: The British website swimming.org reports that swimming promotes feelings of well being, something the Centres for Disease Control and Prevention confirms. “For people with fibromyalgia it can decrease anxiety, and exercise therapy in warm water can decrease depression and improve mood.”

Article Continued Below

4. It’s a great aerobic exercise: Swimming increases your lung capacity and gives them a solid work-out. It’s also been identified as a good form of exercise for people with asthma.

5. Choose where you want to tone up: Since swimming involves a variety of strokes that use different muscles, you can target the areas you most want to tone – be it legs, upper arms, or stomach muscles. Keller’s website includes techniques for doing each stroke.

6. It’s cheap: Unlike some sports which require a lot of equipment, swimming just requires a swim suit, bathing cap and a pair of decent goggles and of course a pool, which most cities and mid-size communities have. It’s also a great summer exercise since you can cool down and work out at the same time.

7. Suitable for all ages: That’s why they say swimming is ‘cradle to grave.’ You simply adjust the pace to your age and ability.

8. It’s social: “If you swim regularly you’ll most likely make new friends of all ages,” says Keller, “since people not only swim at the pool but also like to relax, socialize and talk. My impression is that swimmers are usually positive and in a good mood.”

If you aren’t already a swimmer, but think you might like to start, first check with your doctor to make sure there aren’t any health issues to take into account. You might even want to enroll in swim lessons. An instructor can not only help build swimming skills, but alleviate any fears you might have about the water.

“Take it slow in the beginning and progress at your own pace,” suggests Keller. “Don’t try to measure up to a 20-year-old speeding through the water. Instead, enjoy the experience of swimming – of floating and moving through the water.”

OCT 18

Cooling Down After Intense Exercise

“Cooling down” means that after you exercise intensely, you slow down and exercise at low intensity for a while before you stop exercising for that session. The scientific literature is controversial on whether cooling down helps to reduce next-day muscle soreness to help muscles to recover faster. I believe that cooling down may help you to heal faster from muscle soreness after intense exercise, which allows you to recover faster from intense workouts. There is some evidence that cooling down augments your immune system response to help muscles fibers heal faster from the Z-line damage caused by hard exercise (Sports Med, July 2018;48(7):1575-1595; Nat Rev Immunol, 2011;11:607-615).

You can tell you are damaging muscles when you exercise vigorously enough to feel burning during exercise and when you get soreness in those muscles that develops 8-24 hours later (Strength & Conditioning Journal, October 2013;35(5):16-21). This is called Delayed Onset Muscle Soreness (DOMS); see my report on DOMS below. The old explanation that cooling down helps muscles recover faster by ridding them of lactic acid does not adequately explain any improvement in recovery time after intense exercise. Lactic acid build-up from intense exercise lasts, at most, for only a few minutes even if you do not cool down. Muscle soreness that starts more than four hours after stopping exercise is not caused by lactic acid accumulating in muscles; it is caused by damage in the muscle fibers.

Cooling Down May Help You Recover Faster

Many coaches and athletes believe that cooling down helps muscles heal so the athlete can resume intense workouts sooner and thus become a stronger athlete. However, there is conflicting scientific evidence whether cooling down helps to prevent DOMS. There is some evidence that cooling down does help to relieve DOMS three days after intense exercise (J Strength Cond Res, Oct, 2012;26(10):2777-82), but smaller studies on non-competing athletes fail to show that cooling down reduces next-day muscle soreness (J Hum Kinet, Dec 2012;35:59-68; Aust J Physiother, 2007;53(2):91-5), or helps athletes to recover faster (J Hum Kinet, Mar 2012;31:121-9). There is data to show that cooling down reduced pain when pressure was applied to muscles with DOMS 48 hours after intense exercise, more so than on the muscles of those who did not cool down (J of Human kinetics, Jan 26, 2013;35(1):59-68). A recent review of the scientific literature concluded that cooling down does not enhance same-day or next-day sports performance, even though it may help to clear lactic acid in blood faster, but cooling down may partially prevent immune system depression and promote faster recovery of the heart and lungs (Sports Med, Jul 2018;48(7):1575-1595).

Known Benefits of Cooling Down

• Cooling down can help to keep you from feeling dizzy or passing out after very vigorous exercise (Medicine and Science in Sports and Exercise, Sept 1994;26(9):1095-1101). Most people who pass out in races do so after they stop running suddenly at the finish line. In one study, all of the runners who collapsed had an excessive drop in blood pressure when they went from lying to standing, and the few cases of collapse away from the finish line were far more serious and were often caused by diseases such as asthma, heart damage or heat stroke (Physician and Sportsmedicine, 2003;31(3):23-29).

• Cooling down can help to clear lactic acid and relieve oxygen debt after intense running (J of Applied Physiol, Nov 6, 1966;21(6):1767-1772).

Cooling down has NOT been shown to improve fitness level, make you stronger (J Strength Cond Res, Nov 2012;26(11):3081-8), or to prevent injuries.

My Recommendations for Recovery After an Intense Workout

• Before every intense workout, warm up by going slowly until your muscles feel fresh.

• After every intense workout, do a prolonged cool down of at least 10 minutes (Sports Science Exchange, 87:15, 2002; J Sports Sci Med, 2004 Sep; 3(3):131-138).

• Drink fluids for a faster recovery (Journal of Sports Sciences, January 2004).

• Add salt on hot days if your muscles feel excessively fatigued or if you develop cramps (Can J Appl Physiol, 2001;26 Suppl:S236-45).

• Eat as soon as you finish your intense workout (J Sports Sci Med, 2004 Sep; 3(3): 131–138). It doesn’t matter what you eat in your post-intense-workout meal, as long as it contains lots of protein and carbohydrates (Am J Clin Nutr, Jan 2017; Med Sci Sports Exerc, Oct 2008;40(10):1789-94). In one study, fast foods such as French fries, hash browns and hamburgers helped athletes recover just as quickly from hard workouts as sports nutrition products such as Gatorade, PowerBars and Clif Bars (International Journal of Sport Nutrition and Exercise Metabolism, March 26, 2015).

• After each intense workout, get off your feet and do as little walking as possible.

• Try to sleep within a few hours after your intense workout as you may recover faster by sleeping than remaining awake (South African J Research in Sport, Physical Education and Recreation, Jan 2012;34(1):167 – 184). Loss of sleep can impair exercise performance (European Journal of Applied Physiology, April 2017;117(4):699-712).

• Do not take non-steroidal anti-inflammatory drugs (NSAIDs) to relieve muscle soreness. NSAIDs can block gains in strength and endurance (

OCT 11

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592)

More New Studies on Muscle Growth for Older People

Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).

Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).

High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).

Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program

The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone and Muscle Strength with Aging

Preventing Muscle Loss

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger

Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations

Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

OCT 1

Should You Breathe Through Your Nose?

People who exercise with their mouths closed aren’t working very hard. You can’t get enough air through your nose to meet your needs for oxygen when you exercise vigorously. The cross sectional area of the openings in your nose is less than one tenth the opening in the back of your mouth. That space is so narrow that when you pick up the pace, you could turn blue.

You don’t need to breath through your nose when you exercise in very cold weather. Your nose warms the air much more than your mouth does, but exercise causes your body to produce such large amounts of heat that air taken through your mouth at 40 degrees below zero Fahrenheit during exercise will be warmed almost 100 degrees before it reaches your lungs. Breathing air that cold hurts so much that you lose interest in exercising and seek shelter.

Your nose clears pollutants far more efficiently than your mouth does, but people with healthy lungs can exercise safely on polluted days. Pollutants that you breathe in through your mouth can be quickly cleared from your lungs. Your air tubes are lined with small hairs, called cilia, that sweep pollutants towards your mouth where you swallow them with your saliva and they pass from your body.

Lifter-for-life-1

SEPT 22

Weight Lifting for Middle-Age and Beyond

Many middle-aged and older people have started to lift weights, since extensive data show that lack of muscles increases risk for diabetes, heart attacks and premature death (British Medical Journal, September 2009; Journal of Physiology, September 2009). However, within the first few weeks of their new weight-lifting programs, most get injured and quit.

Often they get injured because they try to train like younger me, by picking the heaviest weight that they can lift ten times in a row, resting and repeating that set two more times. Then they feel sore for the next few days and when the soreness lessens, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program.

The safest way for most older men and women to start a program to gain strength and increase muscle size is to join a gym and try to use 15 to 20 Nautilus-type machines every day or every other day. On each machine they should pick the weight that they can lift and lower 10 times in a row comfortably, without straining or damaging their muscles (which would make their muscles feel sore on the next day). If they feel the least bit sore, they should take a day or days off until the soreness is gone. As they become stronger and the weights feel very easy for them, they should try to lift 15 times in a row, then perhaps 20 times.  Only when they can lift that weight at least 20 times in a row and not feel sore the next morning, should they try to increase the resistance by going to the next heavier weight.

The key to this program is to avoid injuring their muscles by lifting weights in a single set and increasing the number of repetitions gradually so they do not cause next-day muscle soreness. They should not increase the weight (resistance) until they can lift a set of at least 20 daily and not feel sore the next day.

Before any older or out-of-shape person starts an exercise program, he or she should check with a physician to rule out serious problems that might be aggravated by weight lifting.

This program is for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles. It will, however, increase strength and provide the other benefits of a weight training program. After many months (injury-free) on this program, if a person wishes to build larger muscles, he or she can transition to a more traditional weight training program. 

SEPT 20

Exercise for Arthritis

When you have arthritis, your joints hurt every time you move. When you wake up, your muscles and tendons are so stiff that you can barely get out of bed, but you force yourself to get up and as you keep on moving, the pain lessens and you can move a little faster.

Is your body trying to tell you something when you muscles and joints feel better after you start to move? Dr. Ronenn Roubenoff of Tufts University Medical School published a paper in the Journal of Rheumatology showing that rest worsens arthritis, and strength training helps to control the pain of arthritis.

Most people think that when they have arthritis, they are supposed to rest their muscles and joints, but resting is the worst thing that a person with arthritis can do. Arthritis means that the gears that are formed by cartilage in your joints are damaged, causing your joints to hurt. Resting weakens your muscles and makes your joints wobble even more when you walk. Your car works in a similar fashion. When your car goes over a bumpy road, the shock absorbers dampen the shock of each bump. When you walk or run, the cartilage in your joints act like rubber to absorb the shock. Resting weakens cartilage and increases its likelihood to break. Resting weakens muscles so they can’t control the joint, allowing more wobble of the joints with each movement and therefore increasing cartilaginous damage.

People with arthritis should exercise, but they should not walk fast or run. When you walk or run, your foot stops moving suddenly when it hits the ground with a force that is transmitted up your leg to your knees and hips. This force can break cartilage. So people with arthritis should not run, walk fast, jump, or play tennis or basketball because the jarring breaks joints. On the other hand, these people can pedal a bicycle because pedaling is done in a smooth rotary motion that does not stop suddenly to jar and break the cartilage in joints.

People with arthritis should also lift weights because this strengthens muscles to stabilize joints, and strengthens cartilage to protect it from breaking. Ideally, everyone with arthritis should gain access to weight machines and be taught how to lift weights with proper form, in sets of ten, two or three times week. They should also pedal a bicycle several times a week. The combination of smooth continuous exercise on a bicycle and supervised weight lifting on a machine can help protect people with arthritis from further joint damage and reduce pain. Swimming, rowing or any other activities that use smooth motions can be substituted for cycling.

SEPT 5

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People

Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).

Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).

High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).

Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program

The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). See Slowing Loss of Bone 

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger

Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations

Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

CAUTION:People with blocked arteries leading to their hearts can suffer heart attacks with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

AUG 31

Even a 100-Year-Old Can Improve with Training

A new research report shows that you can improve athletic performance with proper training, even if you are over 100 years old. Traditional feeling among scientists is that aging is progressive and inevitable, and that your genetic programming causes you to age no matter what you do. This paper shows that physical training can reverse established markers of aging (J Appl Physiol, February 15, 2017).

A few weeks ago I reported on Robert Marchand, the 105-year-old cyclist who had improved his world record for how far he could ride a bicycle in one-hour from 15.07 miles (24.25 kilometers) at age 101 to 16.73 miles (26.92 kilometers) at age 103. That is an 11 percent improvement in a world record after just two years of serious training, an impressive accomplishment at any age.

Marchand’s Training Program

For two years, from age 101 to 103, Marchand trained by riding 3000 miles (5,000 km) per year, with 20 percent of his workouts doing hard, intense riding and 80 percent doing slow recovery riding. He spun his pedals at a cadence between 50 and 70 rotations per minute.

This new study documents his training program and the improvements in his markers of aging. Athletes can run, ride, swim or ski faster if they improve their maximum ability to take in and use oxygen (VO2max) and their peak power output (strength). These same measurements are used by scientists to track aging in non-athletes. Marchand’s VO2max (maximal ability to take in and use oxygen) increased 13 percent, from 31 to 35 ml.kg-1.min-1, and his peak power output increased by 39 percent, from 90 to 125 watts.

These factors improved in Marchand because he was able to increase his maximal pedaling frequency by 30 percent, from 69 to 90 rotations per minute, and his ability to take in air through his lungs by 23 percent, from 57 to 70 liters per minute. His maximum heart rate and body weight did not change.

Training That Reduces Measures of Aging

Here is a program of training that is typical of the way competitive athletes in endurance sports work to become faster.

Muscle-sugar-depleting workout (one per week): You must exercise long enough to use up most of the sugar stored in your most-used muscles. Muscles use primarily fat and sugar for energy. You have an almost infinite amount of fat stored in your body, but only a very limited amount of sugar stored in the liver and muscles. Sugar requires less oxygen than fat to fuel your muscles, so when you run out of sugar stored in your muscles, you have to slow down. Exercising long enough to deplete muscles of their stored sugar supply increases the amount of sugar they can store and also increases your ability to move faster longer. The faster you move, the quicker you use up your muscles’ stored supply of sugar. The average runner can use up most of his stored muscle sugar supply while running fairly fast for two hours, and the average bicycle rider can use up his stored muscle sugar in three hours.

Intense oxygen deficit workout (two per week): The limiting factor to how fast you can move is the time it takes to move oxygen into muscles. You can increase your ability to take in and use oxygen by using interval workouts in which you run up severe oxygen debts and gasp for breath. You also have to damage muscles so that when they heal, they become stronger. To do this you must put great pressure on your muscles by moving very fast.

Type of Intervals: A short interval lasts less than 30 seconds. You can do lots of them in a single workout because in less than 30 seconds, you do not build up much lactic acid and do less muscle damage. A long interval lasts longer than two minutes and you should do only a limited number of these intervals because they cause considerable muscle damage and can take a long time for muscles to heal and recover.

Recovery workouts (at least four per week): Intense interval workouts cause considerable muscle damage, and it usually takes at least 48 hours for muscles to heal, so each intense workout requires easier workouts on the following day. If you are training twice a day, each intense workout is usually followed by three recovery workouts.

Example of a Weekly Training Program

Sunday: race or depletion workout

Monday: recovery workout

Tuesday: short intervals

Wednesday: recovery workout

Thursday: long intervals

Friday: recovery workout

Saturday: recovery workout

How to Apply These Concepts to an Ordinary Exercise Program

While exercisers who are not competing are likely to spend far less time in their sport, they can still benefit from following the same training principles. Increasing evidence shows that intense exercise is more effective than casual exercise, so plan to introduce at least some intense intervals into your program. You can gain the health benefits and help to prevent injuries if you:

• Plan to exercise every day

• Realize that if you are training properly, your legs are likely to feel sore every morning. If your legs do not feel fresh after a 5-to-10-minute warm up, take the day off.

• Stop your workout immediately if you feel a tightness, discomfort or pain in one area.

• As soon as your legs start to feel heavy during a workout, stop for the day.

Caution: People with blocked arteries leading to their hearts can be harmed by intense exercise, so check with your doctor if you have any questions.

AUG 11

Exercise Keeps You Younger

The decline in brain and body function with aging is caused more by inactivity than it is just by aging. A new study of 85 male and 41 female fit amateur cyclists, aged 55 to 79, found that most of them were physically much younger than most people of the same age (The Journal of Physiology, published online January 6, 2015;593(1)). All rode their bikes for recreation and none were serious competitive athletes. The men had to be able to ride a metric century (62 miles)averaging only 10 miles per hour, and the women 60 kilometers (37 miles), averaging a slow 6.7 miles per hour.

The older bicyclists’ test results were close to those for younger people for:

• endurance,

• pedaling power,

• metabolic health (control of blood sugar levels),

• balance,

• memory function,

• bone density and

• reflexes.

The single best test that correlates with aging is called V02max, the maximal amount of oxygen that a person can take in and use during a given time period. Many population studies show that VO2max drops significantly with aging. In this group of older bicyclists, VO2max was just a little lower than the results in the younger ones.

Incredibly, the older cyclists had test results similar to younger cyclists for lung power and exercise capacity; and even more incredibly, the memory of the older cyclists was just as good as the memory of the younger cyclists. This confirms many other studies that show that a high level of regular exercise prevents your brain from deteriorating. Several thousand years ago, the Romans knew that when they greeted each other with “Mens sana in corpore sano” (a healthy mind in a healthy body).

Older Bicyclists Did Lose Strength

By studying only older men and women who are very active and ride bicycles most days, the authors were able to select a group of older people who are not like the general population in England. Thus this study shows that older people who exercise regularly have bodies and minds that are similar to those of much younger people. The conclusion is that the rapid decline in mind and body with aging is caused far more by inactivity than by aging.

The oldest cyclists were stronger than non-exercisers, but they had much smaller and weaker muscles than cyclists in their 50s and early 60s. This shows that aging makes you weaker, no matter how much you exercise. However, other studies show that while you lose strength rapidly with aging, you lose endurance and recovery time from intense exercise far more slowly.

What You Should Learn from This Study and Others Like It

If you want to be able to run, cycle or walk long distances fast as you grow older, you should try to exercise every day and try to go a little faster on some days. The majority of older people have chosen to be frail, weak and uncoordinated because of their lifestyles, not their ages.

• If you have never exercised, start now.

• If you exercise regularly, continue to do so.

• Find an exercise in which you can keep moving almost every day: dancing, walking, various exercise machines, cycling, skiing, and so forth.

• Those who choose to ride a bicycle should worry more about being hit by a car than about the disabilities associated with aging.

• In our modern societies, people are living longer and often spend many years suffering terrible disabilities of both mind and body. Most North Americans over 70 cannot walk fast. One in eight people over 70, and one in two over 85, suffer from dementia. Exercise helps to slow damage to your mind and body associated with aging.

• Lack of exercise is associated with increased risk for overweight, diabetes, heart attacks, strokes, many different cancers, and premature death.

Caution: People with blocked arteries leading to their hearts are at increased risk for heart attacks when they start to exercise or increase the speed or amount of exercise. Check with your doctor.

AUG 4

Weight Lifting for Middle-Age and Beyond

Many middle-aged and older people have started to lift weights, since extensive data show that lack of muscles increases risk for diabetes, heart attacks and premature death (British Medical Journal, September 2009; Journal of Physiology, September 2009). However, within the first few weeks of their new weight-lifting programs, most get injured and quit.

Often they get injured because they try to train like younger me, by picking the heaviest weight that they can lift ten times in a row, resting and repeating that set two more times. Then they feel sore for the next few days and when the soreness lessens, they lift heavy weights again, usually two or three times a week. This type of training almost always injures older novice weight lifters and ends their training program.

The safest way for most older men and women to start a program to gain strength and increase muscle size is to join a gym and try to use 15 to 20 Nautilus-type machines every day or every other day. On each machine they should pick the weight that they can lift and lower 10 times in a row comfortably, without straining or damaging their muscles (which would make their muscles feel sore on the next day). If they feel the least bit sore, they should take a day or days off until the soreness is gone. As they become stronger and the weights feel very easy for them, they should try to lift 15 times in a row, then perhaps 20 times.  Only when they can lift that weight at least 20 times in a row and not feel sore the next morning, should they try to increase the resistance by going to the next heavier weight.

The key to this program is to avoid injuring their muscles by lifting weights in a single set and increasing the number of repetitions gradually so they do not cause next-day muscle soreness. They should not increase the weight (resistance) until they can lift a set of at least 20 daily and not feel sore the next day.

Before any older or out-of-shape person starts an exercise program, he or she should check with a physician to rule out serious problems that might be aggravated by weight lifting.

This program is for beginners and is intended to prevent injuries that plague older people when they first try to lift weights. It will not build very large muscles. It will, however, increase strength and provide the other benefits of a weight training program. After many months (injury-free) on this program, if a person wishes to build larger muscles, he or she can transition to a more traditional weight training program.  

AUG 2

Weak Muscles Increase Risk for Dementia

Many studies show that having excess fat in your belly is associated with increased risk for dementia, but a new study shows that as a person ages, lack of muscle size and strength appears to be an even stronger predictor of dementia than having excess belly fat (Clinical Interventions in Aging, July 5, 2018;13).

The authors followed 353 men and women, average age 69, and found that those who had both excess body fat and small, weak muscles had the worst memory, speed in answering questions and executive function such as making intelligent decisions. Those who had the weakest and smallest muscles had even worse mental function than those who were just obese and did not have excessive muscle weakness. Another well-performed study of more than 5000 people, with an average age over 70, also found that low muscle size is associated with increased risk for dementia (Age and Ageing, March 2017;469(2):250–257).

Significance of “Skinny Fat”

This new study found that many people who do not have conventional measures of obesity such as excess weight or a high BMI (Body Mass Index) can still be at high risk for obesity-related diseases such as dementia, heart attacks, strokes, diabetes, certain cancers and premature death. The authors call this “skinny fat,” a combination of low muscle size and strength and high fat mass that significantly increases risk for dementia. Sarcopenia (loss of muscle size and strength) and obesity are part of the aging process for many people, and can both be used to predict potential mental decline, dementia, and diseases associated with aging. These conditions can be caused by sedentary behavior, weight gain and an unhealthful diet.

Testing and Treating People with “Skinny Fat”

Strength testing can be as simple as measuring a person’s grip strength with a simple inexpensive hand-held dynamometer. Excess fat can be measured with belly circumference or thickness of the fat layer underneath the skin near the belly button. An MRI of the body will be more accurate but is far more expensive and time consuming. People with weak grip strength or high belly fat are at increased risk for dementia with aging, even if they appear otherwise to be thin and healthy. An earlier study showed that a program of strength training and aerobic exercise and a healthful diet can help slow the frightening loss of muscle size and strength and increase in body fat in people as they age (Clinical Interventions in Aging, August 6, 2015;1267—1282). A recent review of many studies showed that the typical Western diet (high in sugar, red meat, processed meat and fried foods) is associated with a marked increase in the incidence of mental decline and dementia throughout the world (presented at the 2018 Alzheimer’s Association International Conference, July 22, 2018 in Chicago, Illinois). Another study of 2200 people, presented at this same conference, shows that people who consume the equivalent of two-and-a-half teaspoons or more of added sugar a day have a 54 per cent increased risk for developing Alzheimer’s disease. A high rise in blood sugar can damage every cell in your body, particularly your brain.

To prevent blood sugar levels from rising too high, your pancreas releases insulin which lowers blood sugar by driving sugar from the bloodstream into the liver. However, if you have a lot of belly fat, you are also likely to have a liver full of fat, and a fat-filled liver cannot accept sugar from the bloodstream. Contracting muscles can lower blood sugar just by pulling sugar from the bloodstream without even needing insulin. A single bout of exercise will allow your muscles to pull sugar out of your bloodstream without needing insulin for up to 17 hours after you finish exercising. Lack of exercise and low muscle size are associated with high blood sugar levels and increased risk for both diabetes and dementia.

My Recommendations

A high rise in blood sugar after meals is a major risk factor for dementia. You will help to prevent dementia by preventing high rises in blood sugar if you:

• grow larger and stronger muscles

• avoid foods that cause high rises in blood sugar

• avoid having excess belly fat that specifically causes high rises in blood sugar

july 30

More Reasons to Exercise as You Grow Older

Muscles are made up of thousands of muscle fibers just as a rope is made up of many strands. Each muscle fiber has a nerve that innervates it. With aging you can lose nerve fibers that, in turn, cause you to lose the corresponding muscle fibers, but exercising against resistance will make the remaining muscle fibers larger so they can generate more force.

A recent experiment measured the force that a rat’s muscle fiber generates when it is electrically stimulated at the nerve or at the muscle. Electrically stimulating the muscle directly showed that the muscles of young rats generated 40 percent more force than those of old rats. On the other hand, when the nerve endings were stimulated electrically for five minutes, the muscles of the old and young rats generated the same amount of force. The authors suggest that loss of strength with aging is primarily due to loss of nerve function rather than just muscle function (Experimental Gerontology, March 2018). The repetition of a regular and consistent training program teaches your brain how to contract your muscles more efficiently.

Researchers at the University of Guelph have another explanation why people, even those who exercise regularly, lose muscle size and strength as they age. They showed that aging causes loss of mitochondria, the tiny furnaces in cells that turn food into energy (Cell Reports, March 13, 2018). This causes the accumulation of breakdown products called Reactive Oxygen Species (ROS) that delay healing and weaken muscles (Cell Metabolism, March 2017;25(3):581–592).

More New Studies on Muscle Growth for Older People

Osteoporosis: Lifting weights helps to strengthen bones of postmenopausal women who suffered from osteoporosis (J of Bone and Min Research, February 2018;33(2):211-220).

Protein Intake: Several studies show that older people do not gain any additional muscle size or strength from increasing their intake of protein above the current RDA (recommended dietary allowance) of 0.8 gm/kg of body weight/day. Even older men who are taking extra testosterone do not gain any extra strength or muscle growth from increasing their intake of protein to 1.3 g/kg/day (JAMA Internal Medicine, April 2018).

High-Plant Diet after Menopause: Older women who follow a Mediterranean-type diet (based on plants, with fish but restricting red meat and added sugars) have larger muscles and bones after the menopause than women who eat the typical Western diet (ENDO 2018, the Endocrine Society annual meeting in Chicago, March 19, 2018).

Recovery Time: Older people who do strength training need to realize that their muscles will not heal as fast from workouts as muscles of younger people because aging causes their mitochondria to become smaller in number and size (Cell Metabolism, March 2017;25(3):581–592).

Starting a Resistance Program

The most effective way to slow down the loss of muscle strength with aging is to start a resistance exercise program that includes using strength training machines or lifting weights. A review of 25 well-designed and performed scientific studies shows that resistance training can grow larger and stronger muscles in older men and women (Sports Med, Dec 2015;45(12):1693-720). Older people who use strength training machines two or three times a week can make themselves stronger to decrease their risk for falling, breaking bones, and suffering osteoporosis, arthritis, heart attacks, diabetes, and premature death (Am J Prev Med, Oct 2003;25(3 Suppl 2):141-9). 

Before you start a new weight training program, check with your doctor and get expert advice from a trainer so you can learn proper lifting techniques for the equipment you will be using. Most beginners will be far more successful on weight lifting machines, rather than using free weights. The machines are safer because they can guide the way you move the weights with the specific muscles for each machine.

How to Make Muscles Stronger

Just exercising does not make a muscle stronger. The stimulus to make a muscle larger and stronger is to exercise that muscle against resistance to the point where you feel a burning in that muscle. However, if you continue to exercise after you start to feel that burn, you run the risk of injuring the muscle, so most older people can prevent injuries by stopping each set of lifting as soon they feel a burn in their muscles. You can exercise to the burn by using heavy weights with few repetitions or by using lighter weights with more repetitions. Older people gain the most strength by doing more sets of lower repetitions per set than using fewer sets with higher numbers of repetitions per set (Experimental Gerontology, March 29, 2018;108:18-27). The lighter the weight you use, the more repetitions you have to do to feel the burn. For example, several sets of three repetitions each is safer than performing fewer sets of the same weight with sets of 10 repetitions. For more detailed suggestions see Strength Training Guidelines from Dr. Richard Winnett of Virginia Tech.

My Recommendations

Aging can take away much of your quality of life unless you keep your muscles strong enough to perform all of your daily activities. A regular strength training program will help you to move faster, walk with more security, be less likely to fall and hurt yourself, and have more confidence in every movement of your body.

CAUTION:People with blocked arteries leading to their hearts can suffer heart attacks with exercise. Check with your doctor before starting a new exercise program or increasing the intensity of your current program.

JULY 18

Update on Aging

By Dr. Phil Maffetone

It’s more than immunity and hormones, posture and gait play key roles too.

The ageless Hall of Fame baseball pitcher Satchel Paige said it best: “How old would you be if you didn’t know how old you were?” Too many people would say they feel or look older than they are. If that is the case, change it!

We can all update our age, and always strive to be younger. While we know that most debilitating chronic illnesses are preventable, including heart disease, cancer and Alzheimer’s, so is poor aging. Large numbers of today’s elderly are living longer through heroic measures such as heart, lung and liver transplants, around the clock care and other medical means. For most, those ‘extra years’ come at the end of the lifespan, unfortunately, when life is less vigorous and productive. But we can significantly control what may be the most important factor of aging—quality of life. And the sooner we start the better.

All humans do it. The months and years pass and we get less efficient with our bodies and brains. We slow down, and it happens whether we are couch potatoes or Olympians. There is no stopping it—anti-aging is a myth. We can, however, significantly control the pace at which aging occurs by being healthier and more fit. The difference is physiological versus chronological aging.

A normal, healthy life includes aging. And while some illness and death may come from factors beyond our control, most unhealthy conditions that slow people down, or kill them at too early an age, are avoidable. This means we control aging to a great degree by choosing a lifestyle that allows us to be more like an average 40-year old even if we were born 50 years earlier, or a 45-year old even though our driver’s license says 1953.

Chronological age refers to the years that have passed. But when we are healthier and more fit, we function like someone younger. That is our physiological age. It’s related to better blood sugar regulation, brainpower, endurance and strength, and other lifestyle features we influence. This also includes our posture, gait and how we physically move.

While the whole body plays a role in graceful aging, three areas in particular do much of the work: the brain and neuromuscular mechanism, hormones, and the immune system. These areas of the body are continuously repairing and replacing themselves, relying on raw materials from the foods we eat. Adelle Davis’ 1950s mantra, “you are what you eat” still holds true today.

These and other aging factors are so integrated into our whole body that it is difficult to discuss each one in isolation. For example, hormones are an essential part of immunity, and muscle function reflects physical, chemical and mental health. In particular, one of the most common images of aging—posture and gait—is also a sign of how well we are doing it.

The Bent Spine Syndrome

Among the most common images of poor aging are people who do not stand erect. On closer examination, they don’t sit or move that way either, especially when walking. Their lower (lumbar) spine is flexed, and they are “bent” forward having lost their natural spinal curve, which usually helps maintain a healthy-looking upright posture. With a “bent” spine, individuals become shorter. While this typically occurs in the elderly, younger people can begin developing it too. This condition is well recognized by clinicians and researchers, and is called the bent spine syndrome, BSS, originally referred to as camptocormia, derived from the Greek camptos (bent) and kormos (trunk). (See “Camptocormia: the bent spine syndrome, an update.” European Spine Journal. 2010 Aug;19(8):1229-37.)

The BSS is a spectrum disorder, going from mild and moderate to a more severe condition depending on a person’s level of health. Two common causes of BSS include muscle imbalances, often a reflection of various neurological and biochemical problems, and psychological disorders.

The BSS affects the whole body, not just the spine. An example is how proper spinal function can help balance a key component of the body, the autonomic nervous system, which regulates many aspects of health from blood pressure, heart beat and breathing, to gut function, sexual arousal and controlling all stress.

As a functional problem for most individuals, BSS is rarely due to permanent changes in the bones or discs of the spinal column. This is evident when lying down—in this relaxed position people with BSS have relatively straight spines.

In addition, BSS may or may not be associated with pain, but the posture and gait are typically irregular, with related body-wide function that can be significantly reduced. The result is poor aging.

Physical and Chemical Causes

There are a number of physical causes of BSS, perhaps the most common one being muscle imbalance (muscles directly control the skeleton, especially the spine). In most cases, these imbalances are due to some type of neurological dysfunction between the brain and muscle. These weaknesses are not only in muscles directly controlling the spine, but throughout the body too, including those in the feet, pelvis, abdomen, and neck—areas that can significantly affect spinal posture and movement.

Another aspect of muscle dysfunction is reduced energy due to chemical imbalance. Muscle fatigue develops quickly in those with BSS during standing, walking, and even easy physical activities. This is typically due to poor aerobic metabolism.

Other biochemical factors include abnormally high levels of fat found in the muscles of those with BSS. The cause of this may be of hormonal, primarily high insulin due to the ingestion of too much refined carbohydrate. Higher levels of the stress hormone cortisol also can influence the brain, often significantly. This is typically due to the combination of physical, chemical and mental stressors, which, in turn, can affect muscle balance.

At any age, BSS is associated with, often caused by, other chemical disorders that include chronic inflammation. This is usually directly associated with the balance of fat in the diet. The ongoing inflammatory disorder is the first stage of many chronic diseases.

Other hormonal imbalance can play a role too. Especially important are conditions of low testosterone and low thyroid function—both can occur in men and women. In addition, low levels of vitamin D, typically from inadequate sun exposure, and sarcopenia, the loss of muscle during aging, are both very common problems of epidemic proportion that can speed up the aging process.

More severe cases of BSS are often seen in patients with Parkinson’s disease, multiple sclerosis, or other neurological diseases.

Psychology

It has long been know that posture and gait, in addition to being a manifestation of physical and chemical dysfunction affecting muscle contraction, can also reflect ones psychological state. Bent spine syndrome was first observed and researched in young soldiers psychologically affected by war. Whether old or young, images of an aging spine can reflect mental and emotional states.

Growing Younger

Just being aware of ones posture is the first step to improved function. By avoiding the common age- or fatigue-related slumping and making sure the lower spine is not slowly losing its natural curve, one can keep the body healthier and not only more youthful looking, but physiologically younger. By simply sitting up straight, standing, walking and running more erect, we can maintain better balance, and our bodies will function better.

In addition, yoga, tai chi, respiratory biofeedback and other self-therapies can be very effective in maintaining good posture when practiced properly.

Regardless of how much or little you run, bike or lift weights, walking can also do wonders to help train the brain to better maintain proper postures. Walking erect is part of an optimal walking gait. In order to do this effectively, the knees must be gently locked as you land more on the front of your heels. This is different from the running (or jogging) gait, where knees should never lock and landing on the foot is farther forward. (By striking on the back of the heels, often encouraged by wearing thicker shoes, many runners do lock their knees, which can directly cause knee and other physical impairments, poor gait, and wasted energy.)

While most of us are too familiar with the images of aging, we sometimes don’t see it in ourselves. We can control the process significantly. With increased health and fitness we can age more gracefully and have additional active years at the end of our natural lifespan.

july 13

Knee Cap Pain

The most common long-term running injury is called runner’s knee. It is caused by the back of the knee cap rubbing against the femur, the long bone behind it.

When you suffer from runner’s knee, the back of the kneecap hurts when you walk or run, particularly when you walk down stairs. It usually does not hurt to pedal a bicycle. If it hurts to push the kneecap against the bone behind it, you have runner’s knee.

The back of the kneecap is shaped like a triangle with the point fitting in a grove in the lower part of the bone behind it. During running, the knee cap is supposed to move up and down. If it moves from side to side, the back of the kneecap will rub against the front of the bone behind it and hurt. Treatment is to stop the kneecap from touching the bone behind it which is usually caused by the knee cap being pulled toward the outside (laterally), while the lower leg twists the bone behind it inward (medially). When you run, you land on the lateral bottom of your foot and roll inward, causing the lower leg to twist inward. At the same time, three of the four quad muscles attached to the kneecap pull the kneecap outward and cause the knee cap to rub against the bone behind it.

People with runner’s knee usually can pedal a bicycle with their seats set lower than normal to prevent their knees from straightening completely. Orthotics, custom- fitted inserts in the shoes that restrict pronation, may help. They can also use special exercises that strengthen the vastus medialis muscle above the kneecap that pulls the knee cap inward when they run or pedal. Running backward may also help (1).

july 11

Repairing Damaged Knee Cartilage

The ends of bones are soft, so they must be covered with a thick white gristle called cartilage. Once damaged, cartilage can never heal. When knee cartilage is damaged, the person spends the rest of his life losing more cartilage until it is completely gone and the knee hurts 24 hours a day.

If only a small area of the cartilage is damaged, it may be treated with cartilage extracted from your own body. (If cartilage is taken from someone else, your immunity will try to kill it, but it does not try to kill your own cartilage.) Your extracted cartilage is grown in special culture dishes and then injected into a hole in your own cartilage and secured in place. This procedure works very well if you have only a small piece of cartilage missing. The doctors just fill the hole. However, unless they can enclose the entire area for the donor site, the cartilage will not stay where it was put and will not be beneficial. That is why this procedure cannot be used to treat a cracked cartilage in the knee. Remember they have to cover the articular surface that meets the cartilage from the other side of a joint.

When all the cartilage in your knee is gone, the only effective treatment is to replace the whole knee. Knee replacements are now lasting for twelve to twenty years or more, and most remain pain-free.

If you have damaged cartilage in your knee, you should protect that knee for the rest of your life. Running, fast walking and jumping cause further damage, while pedaling and swimming usually do not. When the knee hurts all the time, your doctor will check to see how much cartilage is left. If it’s gone, you will probably be told that you need a knee replacement.

JULY 11

Strengthen Quad Muscles to Help Your Knees

Doctors have known for many years that having weak quad muscles (in the front of your upper legs) increases risk for damage to the cartilage in your knees. A study from Purdue University showed that strengthening these muscles slows down knee cartilage damage and may even improve knee function (Arthritis & Rheumatism, October 2006). The researchers placed 221 adults in their sixties and seventies either on a program of strengthening their muscles in their upper legs or just moving their knees in a series of range-of- motion exercises. The subjects exercised three times per week (twice at a fitness facility and once at home) for 12 weeks. This program was followed by a transition to home-based exercise for 12 months. Older people weaken naturally with aging, but the range of motion exercisers lost more strength than those who exercised against progressive resistance. The strength training helped retain joint space, signifying that this group had less loss of cartilage.

The knee is like two sticks held together by four bands called ligaments. Strength training stabilizes the muscles that support the knee and helps to prevent loss of cartilage with aging. People with knee pain should get a diagnosis from their doctors. Most will be advised to do exercises that strengthen the knee, such as pedaling a bicycle or performing knee strengthening exercises that involve bending and straightening the knees against resistance. People with knee pain should avoid exercises that jar the joints, such as jumping or running.

july 1

Kettlebells Build Hard Bodies

Kettlebells (or girva, as they are called in Russian) are traditional Russian cast-iron weights that look like a cannonball with a handle. They have become a popular exercise tool in the United States largely because of the enthusiasm and effective marketing by strength and flexibility coach Pavel Tsatsouline and kettlebell lifting record holder Valery Fedorenko.

Though kettlebell lifting competitions are relatively new in the United States, they have historical significance in other parts of the world. Recently, kettlebell training has been “discovered” by U.S. athletes and particularly mixed martial arts fighters.

Kettlebell workouts are designed to increase strength, endurance, agility, and balance. Both the muscle and cardiovascular systems are challenged through dynamic total-body movements. They are used by both men and women.

Commonly asked questions are . . .

What makes kettlebells different than dumbbells or barbells?

Why has kettlebell training become so popular with women?

Are they safe?

Are kettlebells appropriate for seniors?

What sizes do they come in?

What weight should a beginner buy?

What is good kettlebell design?

What makes kettlebells different than dumbbells or barbells?

All are free-weights used for strength training, muscle building, and all-around fitness. However, since practically any KB exercise can also be executed with a dumbbell, it is reasonable to ask why you should use a kettlebell instead?

The kettlebell shape (remember the “cannonball with a handle” description) makes the weight displacement different from a dumbbell’s. The off-center weight of a kettlebell makes it more unwieldy, requiring the use of more stabilizing muscles to control it. By the nature of their design, nearly all kettlebell lifts are compound movements that work the body as a whole, rather than isolating muscles. Common kettlebell lifts also tend to work muscles through a longer range of motion, which improves flexibility.

So while barbells and dumbbells are certainly good free-weights, keep in mind that the unique unwieldiness of kettlebell training is precisely the reason many athletes use them today. When comparing dumbbells to kettlebells, it really comes down to being a matter of personal preference.

Why has kettlebell training become so popular with women?

Many of the most common kettlebell exercises, such as swings, cleans, windmills, and snatches, really work the hips, hamstrings, glutes, and waistline. And when done in higher repetitions they are great cardiovascular exercise. Combined with proper nutrition, KB workouts will burn off fat better than almost anything you can think of. And they are fun to use.

Are they safe?

Get some instruction from a good DVD video or coach/teacher. Kettlebell lifting is somewhat different than lifting other free-weights. I am not aware of any reported serious injuries, but you sure wouldn’t want to bonk yourself on the head or drop one on your foot. Ideally, some sessions with a competent instructor is a good way to go, although I’ve seen some excellent video instruction, too. Either way, once you know and practice proper form, kettlebells are certainly no riskier than lifting other free weights such as barbells and dumbbells.

Are they appropriate for seniors?

 

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Used properly, all free weights are senior friendly. Good judgment is the key to safe, successful kettlebell training, just as it is with barbells and dumbbells. But always consult with your doctor before starting any exercise/fitness program. Then begin with modest efforts, perfect your form, and gradually work up. If a particular lift or exercise irritates an existing problem area – don’t do that exercise. It is really a common sense issue.

What sizes do they come in?

The common kettlebell weights follow:

8 lbs

12 lbs

18 lbs

26 lbs

35 lbs

44 lbs

53 lbs

70 lbs

80 lbs

88 lbs

97 lbs

105 lbs

What weight should a beginner buy?

Most kettlebell exercises can be done with a single bell. Or they can be done with a pair of bells of the same weight. Most people start with a single KB and many continue lifting singles.

Next, you must consider your present strength and fitness level when deciding what weight to start with. A rule of thumb is that handling a kettlebell will be more challenging than a dumbbell of the same weight. Most of the companies selling KBs offer beginner guidelines for what weight(s) to buy. I would rely on their advice.

As your strength grows you can buy a heavier bell and sell the lighter one or keep it for higher repetition work.

Best of all, if you can attend a KB training workshop before you buy, or find a trainer nearby, you can try out different weights at the same time you are receiving some coaching.

JUNE25

Senior Exercises for Slenderizing the Waistline

The best approach for you to slenderize their waistline is a healthy diet, 150 minutes of cardio and two strength training sessions each week. Including abdominal exercises in strength training sessions will tone the stomach muscles, which will become visible after overall weight loss occurs. A strong core contributes to good posture and eases the challenge of standing for extended periods of time. In addition, becoming physically fit can make daily tasks, such as showering or carrying objects, easier for older adults. You should consult with your physician before starting an exercise program.

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Burn Calories

Burning calories and expending more than you consume is the only way to lose weight. Mowing the lawn, climbing stairs or going on a walk with friends are all examples of cardio exercises that contribute to weight loss, including the stomach area. The treadmill, elliptical and recumbent bike are all cardio machines available at most gyms. The rowing machine is a good option if you want to challenge your midsection while doing your cardio. Water aerobics and swimming are non-weight bearing cardio workouts that don’t strain the joints, making them a good option if you have joint problems or arthritis. Complete at least 10 minutes of cardio exercise during a session to ensure benefits and contribute to your weekly goal of 150 minutes.

Make a Bridge

The bridge is an abdominal exercise that strengthens the glutes, lower back and stomach muscles. Lie on your back, bend your legs and place your feet on the floor, directly under your knees. Tighten your abdominal muscles and rest your arms on the floor, next to your hips. Push through your heels and lift your hips and lower back off the floor. Align your knees, hips and shoulders. Squeeze your glutes and hold this position for 20 to 60 seconds.

Twist and Turn

Trunk rotations tone the abs while strengthening the arms. Hold a light weight with both hands. Stand up straight, bend your knees and position your feet shoulder-width apart. Lift the weight in front of your waist, straighten your arms, then slightly bend your elbows. Tighten your stomach muscles. Twist your torso and rotate your trunk and arms to your right. Do this without moving your hips or lowering your arms. Twist back to the center, pause, then rotate to your left to complete your first repetition. Complete eight to 10 reps, stopping when your stomach and arms fatigue.

Tighten Your Abs

Pelvic tilts tighten and tone the abdominal muscles. Lie on your back, bend your legs and place your feet on the floor, under your knees. Squeeze your stomach muscles. Throughout the exercise, imagine that you are trying to balance a grape in your belly button. This will help you maintain the contraction. Simultaneously, push your lower back against the floor and slightly lift your hips off the floor. Hold for six to 10 seconds, then release. Complete eight to 10 repetitions.

JUNE 23

The Best Kettlebell Workout for Women Over 50

Women in their 50s often gain weight, experience changes in posture, and lose muscle mass because of menopause. Doing two to three kettlebell sessions a week can help combat some of those physiological changes. Kettlebells increase muscular strength and endurance, and improve balance, core strength, coordination and posture. The workout has cardiovascular benefits as well. Most of the exercises are functional and incorporate the entire body, which makes the workout more efficient and less time consuming than traditional strength training with free weights.

Program Design

Pay careful attention to form and technique when learning how to use kettlebells. It is better to begin with a light weight to master form to prevent injury to the back, shoulders and knees. If you work out regularly, begin with a 10- to 15-pound kettlebell. Try a routine two to three days a week that consists of two to three sets of eight to 10 exercises. Cross train on alternate days with Pilates, yoga or a moderate-intensity cardiovascular activity.

Short Circuit

A circuit kettlebell routine can help banish the excess adipose tissue that accumulates around the midsection during menopause. Include two to three sets of 10 to 15 squats, deadlifts, snatches and swings. Rest 30 to 60 seconds between each exercise before continuing. Finish with two to three bodyweight planks before you stretch. The moves can help you burn calories, aiding in fat loss and increased lean muscle mass.

Muscle Up

You may be dismayed as you progress through your 50s to realize that you are losing tone in your lower body, particularly in the derrière. A kettlebell routine that targets the lower body can prevent things from going further south. Warm up with joint mobility exercises. Perform two to three sets of walking lunges, single-leg squats, figure eights between the legs, single-leg deadlifts and single-arm swings for 15 to 60 seconds. Rest 30 to 60 seconds between exercises.

Upper Body Training

Banish batwing arms with upper-body exercises involving 5- to 8-pound kettlebells, such as snatches, high pulls, bentover rows, alternating shoulder presses, farmer’s walks and overhead triceps extensions. Consult a certified fitness professional to watch your form when you are learning how to use kettlebells.

june 19

Kettlebell Exercises for Seniors

Kettlebells are traditional Russian weights that look like a cast-iron cannonball with a handle. Used properly, they are senior friendly and can be used for maintaining and increasing muscle strength and bone density, and for a cardiovascular workout. They are available in weights from 2 lbs to over 100 lbs. Women should start with about 8 lbs, while men can begin at 16 lbs. Use common sense: If a particular exercise aggravates an existing problem or injury, don’t do that exercise.

Two-Arm Swing

The two-arm swing is the most basic kettlebell exercise and should be mastered before moving to other exercises. Use an overhand grip with both hands on the handle and allow it to hang between your legs. Stand with feet slightly wider than hip-width apart. Start swinging by rocking your hips rather than using your shoulders and use momentum to raise the bell so that it swings to about shoulder height, then back between your legs. Perform for at least one minute, or for a desired number of repetitions.

Single-Arm Swing

The single-arm swing uses the same basic movement as the two-arm swing, but only one hand is used. Remember to swing upward by thrusting the pelvis forward rather than lifting from your shoulders, and allow gravity to bring the kettlebell down in a smooth, controlled movement. Keep the free arm at the side of the body. Perform for one minute or a desired number of repetitions, then change arms and repeat.

Body Pass

Begin in the same body position as for the two-arm swing. Release one hand from the bell, and swing the bell behind your back with the other hand. Grasp it with the free hand at the back and bring it back around the other side to the front again. Make sure you grasp it firmly and breathe throughout the movement. As the weight moves from hand to hand, your arms will loosen and tighten. After the required number of repetitions, repeat in the opposite direction.

Figure Eight

The figure eight is an advanced version of the body pass and should not be done until you have mastered that move. Instead of passing the kettlebell around your body, you pass it from one hand to the other between your legs from the front of the body to the back and from side to side, so that it creates a figure-eight pattern. This gives you an excellent workout. After the required number of repetitions, repeat in the opposite direction.

june 15

Kettlebells for the Aging Population

Swinging and lifting kettlebells may sound like a form of training best left to weightlifters, hardcore athletes, and members of the younger generations. But the reality is that everyone, especially seniors, can benefit from properly training with kettlebells. In 2010 the American Council of Exercise (ACE) at the University of Wisconsin conducted a survey about kettlebell training and its effects on individuals. Researchers found evidence supporting the positive implications of kettlebell training’s potential to strengthen the core muscles by 70 percent, especially for elderly people. One of the research leaders, John Porcari, Ph.D. says, “I think that’s huge because the stronger people are through the core, the less low-back pain they are going to have.” He also pointed out the importance of how working out with the unique weights can affect and improve balance for older kettlebell users. “Older people who are doing some sort of kettlebell-like training are going to be more likely to avoid dangerous falls,” he says.

Kettlebells training can also improve bone density (preventing osteoporosis), combat against age-related muscle atrophy, and help control blood pressure, blood sugar, and cholesterol levels among the older generations.

Due to the many health benefits and quality of life improvements associated with kettlebell training, kettlebell classes and workout videos for older age groups are cropping up all over America. Of course, as with any other type of workout program for the elderly involving weights, the key to getting a safe workout is using wise judgment. It is also advised to consult with a physician before starting any kettlebell training, to begin slowly and gradually increase intensity and weight, and to pay close attention to proper form to avoid injuries. 

Here are just a few typical activities you regularly engage in that require some form of pulling, pushing, lifting, and/or balancing objects that have a displaced center of gravity (meaning they’re not centered and balanced in your hand):

picking up a child or pet

mowing the lawn

operating the vacuum cleaner

toting bags of groceries

catching your balance when you start to slip or fall

walking your dog

playing a sport

carrying a full laundry basket

lifting a suitcase or gym bag

Beginner Kettlebell Exercises for Older Adult

Kettlebells are a centuries-old exercise tool originally used by Russians to develop strength, stamina and endurance with a single piece of equipment. Seniors can use these weights to perform exercises that build muscular strength, improve heart health and increase bone density. Limit your use of a kettlebell to simple exercises using a light weight as you begin to learn how to use this increasingly popular piece of fitness equipment.

Step 1

Perform biceps curls, a simple exercise you can do standing or sitting, to work the muscle on the front of your upper arm. Start with the kettlebell hanging at your side with your palm facing forward. Bend your arm at the elbow, bringing your palm and the kettlebell toward your shoulder. Hold for one or two seconds, then lower the kettlebell. Perform this exercise one arm at a time or using two kettlebells at once. If you can stand while you perform the exercise, curl the kettlebell across your stomach instead of up to your shoulder. Balance yourself with one hand against a chair or wall if you exercise standing up.

Step 2

Perform triceps extensions using a kettlebell to work the upper backs of your arms. Without using the weight, practice putting your hand behind your head with your palm facing your back. Extend your arm at the elbow, turning your hand outward so your palm faces forward when you’re finished. Decide if you can perform this exercise with the weight of kettlebell you have chosen without losing your balance or straining your back. If you can safely perform the exercise, add the weight of the kettlebell.

Step 3

Perform rows, a simple exercise you can do while kneeling on a bench. Place one knee on the bench and one hand on the seat in front of you for support and hold the weight straight down with your palm facing your body. Raise and lower the weight to your chest, bending your arm at the elbow. Keep your elbow tucked into your side and squeeze your shoulder blades together as you raise the weight. This exercise will work your biceps and the fronts of your shoulders as well. Change positions to work your other arm.

Step 4

Add kickbacks to your workouts, which start from the same position as rows, using a slightly different movement to emphasize your triceps and rear shoulder muscles. Raise the kettlebell to your chest, bringing your elbow back behind you with your palm facing your body for your starting position. Extend your arm at the elbow, bringing the weight backward without changing the position of your elbow and upper arm. Return to the starting position by bending your elbow. Switch positions to work the other arm.

Step 5

Work your forearms, chest and the fronts of your shoulders with arm raises. Hold the kettlebell at your side with your palm facing behind you while you are in a standing or sitting position. Raise your arm straight ahead, up to shoulder level. Hold the weight still for two seconds, then slowly lower it. Switch sides.