Fitness Training for Seniors: From Frail 2 Fit

This month I would like to write about fitness for the aging population.  More than half of our clients at BACK IN FORM are 60 years of age or older. We truly cherish this group and love working with them. We offer a program called “Frail-2-Fit” that suits every Senior no matter what stage of life or what level of physical ability he or she is in. Today's blog will explain how aging affects us physically, and how exercise and fitness training can help slow down the process of aging.

It is a well-known fact that there are individuals who live abusive lifestyles and exercise very little if at all, but live to celebrate their 107^th birthdays, think Winston Churchill or George Burns.  Understand that this is the exception and not the norm.  For most of us, exercise is the key to maintaining a high quality of life and preventing the physical decline that often ends in assistant living or nursing care at a very high price. (See also my previous blog: "Your greatest financial asset is you")

According to statistics the US population over the age of 65 will reach 70 million by 2030, with the group of those 85 and older growing faster than any other segment. Unless Seniors adopt healthy living standards that include physical activities and balanced nutrition, the US could experience unprecedented growth in health care cost. 

The physical effects of aging and the counter effects of fitness training

Endurance,
is reflected by the level of cardio-respiratory fitness (CRF) which is being measured and expressed through the VO2max (maximal Oxygen uptake). CRF declines at a much greater rate after age 45 in both men and women depending on exercise habits, Body Mass Index and smoking. Those leaner, trained and non-smoking experienced in many different studies far lower declines in CRF than their untrained, overweight and smoking counterparts.However even those who smoked or were overweight were protected from early death if they exercised/walked at least 30 minutes per day, reinforcing the importance of exercise.

Strength,

loss, outside of a stroke or accident, is the leading cause of immobility and loss of independence. We tend to lose about 3%-5% per decade starting in our 40's and that loss increases often by 1%-2% per year after age 50. However, the good news is that hypertrophy and improved neuro-muscular adaptation can be achieved at any age. That means strength can be regained and maintained after loss, by increasing muscle mass and fine tuning the communication between the Brain/Spinal Cord and the muscle. Strength increases of up to 200% in lower extremities and well above 100% in upper extremities have been found in many case studies with weight and resistance training.

Flexibility,

decreases with age because of reduced movement and the natural reduction in soft tissue elasticity due to the inability of cells in the aging body to retain water in an sufficient manner. There is no clear science as to how much stretching should be described. However regular stretching can help preserve functional range of motion and joint health preventing increased wear and tear (Osteoarthritis).

Balance,
depends on several physical abilities that all decline with age, such as strength, mobility, neuron-transmission speed, eye sight, proprioceptive information flow, depreciation of vestibular system etc. Many of these physical abilities can be corrected and/or their regression slowed through adequate fitness training. For example: A loss of strength and decreased mobility and flexibility commonly effects posture negatively increasing the challenge to maintain the body's center of gravity over the base of support. Exercises geared to correct postural deficiencies can reduce the negative impact on balance.Another example: Reducing physical activities such as golfing, tennis or dancing reduced the stimulus for the proprioceptors, starting up a fitness program and reintegrating some of the activities done earlier in life will awaken those receptors and can reverse the negative effect on balance.

Bone density,

decreases as we age. Significant decreases are more common in women than in men and more prevalent in post menopausal women. Moderate bone density losses are referred to as Osteopenia, the severe form is called Osteoporosis. US wide more than 40 million Americans (female and male) are affected by severe bone density loss. This disease causes roughly 1.5 million fractures in the US annually. Exercises such as lifting weights places stress on the bone as muscles contract causing the bone to thicken. Weight bearing exercises such as walking compressing bone structures in vertical direction which improves the nutritional situation inside the bone and helps repair bone density loss in lower extremities and spine. Please see also my previous blog: "Osteoporosis: maintain and recreate bone density"

Joint health,
is diminished in almost all older adults. Over time the cartilage that protects the bones inside the joints starts to degenerate and eventually bone starts to grind on bone. This degenerative condition is known as Osteoarthritis and affects nearly 27 million Americans. It leads to pain and joint stiffness and often results in joint replacement. Studies have shown improvements in joint function and joint pain in those who exercise regularly choosing low impact aerobics and light to moderate weight lifting. The Arthritis Foundation has created an exercise program called PACE (People with Arthritis Can Exercise) that offers tips and instructions for land and water based exercising with Osteoarthritis.

Cognitive functions,
can become impaired as we age. Studies have shown that adults ages 55 and older showed in MRI testing substantial declines in brain tissue density in areas associated with memory and thinking. Those who were actively involved in regular cardiovascular fitness training showed significantly lower losses. Another study showed that individuals 65 and older, who walked at least 3 days per week had a 35% lower incident rate of dementia than those who walked less or not at all. These results are very encouraging and should be taken into serious consideration when battling Alzheimer's Disease and other forms of dementia.

Mental Outlook
In the US about 14% of males and 18% of females over the age of 55 struggling with some form of depression or another. There is unfortunately very little research on exercising and depression in older adults. It is however safe to assume that it shows similar results as we see in younger adults with depression. Even if it's not a depression cure for Seniors aerobic exercises can at least help alleviate the negative impacts of depression and enhance the mental outlook.


Conclusion
It doesn't come as a surprise that exercise is a great tool to improve quality of life, stave off disease and the negative effects of aging as it has made it's way into almost every therapy protocol known to men. There is no age limit on when to start, and there is no success limit due to age as long as we take preexisting conditions that require changes to an exercise routine and the slower adaptation to training into consideration. I recommend you start by discussing your training plan with your physician and let a fitness professional guide you in the set-up of a program that takes your individual situation into account.

A Sante,
Hartmut



Sources:
Andrew S. Jackson; Xuemei Sui; James R. Hébert; Timothy S. Church; Steven N. Blair. ” Role of Lifestyle and Aging on the Longitudinal Change in Cardiorespiratory Fitness.”  Arch Intern Med. 2009;169(19):1781-1787
http://www.acsm.org/docs/current-comments/resistancetrainingandtheoa.pdf
http://www.medicinenet.com/senior_exercise
http://www.arthritis.org/what-is-osteoarthritis.php
http://www.ncbi.nlm.nih.gov/pubmed/19363089

Osteoporosis: maintain and recreate bone density

This blog is focusing on one of the most common health problems among my older female clients/patients, Osteoporosis.


Overview
Osteoporosis is the most common bone disease in women over 50 in the US. A loss of bone density occurs when the body doesn't form enough new bone or reabsorbs too much old bone or both. This is caused by a lack of calcium and phosphate, two minerals vital to bone formation. Other causes include:

• chronic rheumatoid arthritis
• corticosteroid use
• Hyperparathyroidism
• bed confinement
• Vitamin D deficiency
• alcohol abuse and more

Symptoms include bone pain, fractures without or little impact/trauma, stooped posture (hyper kyphosis) and significant loss in height (6 inches or more).

Bone density loss is commonly diagnosed by performing a bone density test. The dual energy x-ray absorptiometry scans are comparing the patients levels with those of a healthy young woman (T Score) and with those of the patient's peers (Z Score). Negative T-Scores indicate the loss of bone mass with values from -1.0 to -2.5 being diagnosed as Osteopenia (milder form) and values of -2.5 and lower being considered Osteoporosis.

A treatment plan is trying to stop further bone density loss, increase bone density and manage the associated pain. The patient is typically using calcium and vitamin D supplements and medications such as Fosamax, Actonel, Boniva, and Reclast that are designed to increase bone density. In addition patients with low bone densities need to be educated on the importance of impact exercising and be put on an appropriate exercise program


Why is weight bearing and loaded exercising important? Bone is considered a bradytrophic tissue, meaning it has very little or no direct blood supply. It absorbs nutrition like a sponge absorbs water. You squeeze the sponge for maximum absorption. Compressing the bone through weight bearing- and impact exercises accomplishes the same. Studies performed among women with Osteoporosis and Osteopenia showed significant better outcomes in those that were involved in exercise programs involving weight bearing exercises and loading stresses. It needs to be mentioned though that patients with severe Osteoporosis are at a very high risk for hip, wrist and vertebra fractures. High impact exercises have to be avoided at this stage. Exercising under the supervision of an experienced trainer or Physical Therapist is highly recommended.


Exercises I recommend to my patients include but are not limited to:

• Lunges
• Squats
• Step-ups
• Jumps (milder stages)
• Hip Abduction (short lever in severe cases)
• modified Push-Ups
• Supine Posterior Pelvic Tilts
• Supine Bridging etc.

I hope this blog is offering some insights into the problem of bone density loss and the importance of exercise to treat this disease. As always, please feel free to contact me with questions and comments. Please like BACK IN FORM on Facebook (www.facebook.com/backinform) and follow our tweet on Twitter.

A sante,

Hartmut

Piriformis Syndrome or Sciatica?

Many of my clients come to me asking for help after having been diagnosed with Piriformis Syndrome (PS) aka "Pseudo Sciatica". PS is caused by either a tight piriformis muscle or a spasm of the same causing irritation to the underlying Sciatic nerve. The term "Pseudo Sciatica" already indicates that it is hard to differentiate between true Sciatica and PS, as both cause the same symptoms (pain, tingling, burning, "electrical shock" sensations, and/or numbness down the leg, often all the way to the foot). Some recent studies contribute a tight piriformis or a piriformis spasm to the fact that the muscle is overworked due to weakness in gluteus medius and maximus (buttock muscles). True Sciatica is most commonly caused by the compression of one or more of its component nerve roots due to disc herniation or spinal degeneration in the lower lumbar region.

How can you actually tell the difference? There are two simple diagnostic exercises that give you a very good idea whether you are dealing with Sciatica or PS. If from a sitting position the patient/client straightens his/her painful leg and experiences an increase in pain you very likely are dealing with true Sciatica. If your client/patient pulls up his/her knee (painful side) from sitting position towards the same-side shoulder an increase in pain is only likely in severe Sciatica cases. If the same maneuver is performed towards the opposite shoulder and causes an increase in pain you most likely are looking at a client/patient with PS.

Can Exercise Therapy reduce the symptoms of Piriformis Syndrome?

Unfortunately there are no real scientific studies available that address this particular question. Treatment for PS has traditionally included physical modalities like heat, ice and ultrasound, stretching, and a combination of local anesthetic, corticosteroid and botulinum toxin injections into the piriformis muscle, muscle sheath, or sciatic nerve sheath. Furthermore Physical Therapy included soft tissue mobilization, positional release, and joint manipulation, performed two to three days per week over a three months period.

Recent case studies suggest that exercises strengthening the gluteus maximus and medius and help with movement reeducation can reduce PS symptoms dramatically and in some cases lead to a full symptom resolution within a couple of months.

Exercises recommended in these case studies and have shown improvement in my own PS clients included:

• Piriformis Stretches
• Resisted Side Step Abduction
• Supine Bridging
• Resisted Clam Shells
• Myofascial Release of Piriformis with Foam Roller
• Clock Lunges
• Clock Single Leg Hops

I hope I was able to shed a little light onto the problem of Piriformis Syndrome vs. Sciatica and my tips prove to be helpful to you or people you might train.

A Sante,
Hartmut

Summer Round-Up

Dear Friends,

Each year during the summer time Back In Form is asking friends, colleagues as well as previous and current clients for their help with our "New Client Round-Up".

Our services include:
Personal Fitness Training
Rehab Exercises (Neurology, Orthopedics, Internal Medicine)
Fitness for Seniors (any level, fit to frail or healthy to ill)
Yoga
Pilates
Massage Therapy
Variety of Fitness Classes
Brown Bag Lectures

We offer our services to private individuals as well as companies and residential communities of any size. All services are conveniently offered at the clients home or work-site.

If you know of any friend, neighbor, relative or colleague that could be interested and benefit from our services please pass this information on and claim your reward.

REWARD: $50.00 to the referral source and the new client. Simply have the new client provide your name when signing a contract with BACK IN FORM and we will send you a check for $50.00 in the mail.

Thank you so much for your time and help!

 

Hartmut Broring -- M.S. Exercise Therapy
Founder & President
BACK IN FORM, Inc.
(408) 455-2887