Getting a Grip

hand holding ballHi Chris,

My Dad, age 84, has had peripheral neuropathy for a few years now. He walks unsteadily, even with a cane, and has minimal feeling in his arms and legs.

He lives in a retirement home where a daily exercise programme is in place. Dad participates actively and willingly in this regimen, and can do most of the exercises the other folks do.

The one thing he is really terrible at is working with a tennis ball. They don’t throw it or anything, just pass it from one hand to the other, but Dads drops his often and of course getting up to chase it is impossible. Can you suggest anything that he might be able to use instead of a tennis ball to help achieve the same goal with less frustration?

Joan, Toronto

Dear Joan,

Ah, the old tennis ball trick! I find those darn things hard to hold onto and I’m 40 years younger than your dad and don’t have peripheral neuropathy. They’re fuzzy and they’re slippery! Do your Dad a favour, go to a dollar store and pick up a kid’s rubber ball. They have a variety of different sizes and textures. You might want to pick up a few different types and let him experiment. You’ll want to get him something that he can grip, which won’t slip, and that he can apply some pressure to. Squeezing the ball will help with his peripheral neuropathy as he concentrates on the sensations of applying pressure to the ball. Tennis balls are too stiff and light for this.

Next time you’re with your Dad, how about doing some extra therapy with him? Get him to hold a scarf or resistance band in his hand and scrunch it up until he gets all of it into his palm like a ball, release then repeat. Work up to 5 repetitions.

To your health

Chris


Information on stayingstrong.ca should not be used for diagnosis, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.

Pool Pain

Hi Chris,

I am 65 years old, in pretty good condition, retired recently, trying to keep trim swimming, the only exercise I enjoy. Are there specific exercises one can do to lessen lower back pain, while in the pool? It is a chronic condition and has been checked by several doctors.

Thanks!

“Esther Williams”

Dear “Esther”

Good for you for being recently retired. I envy you. Well, it looks like you are off to a good start by being active and swimming is a great exercise. I don’t have a background in aqua fitness so can only speak from limited knowledge and from my own past experience of back pain. I’m going to assume that you experience most of your pain on forward bending. There are three good things to do for that kind of pain. (If you have a different kind of pain, send me another letter!)

The first is back extension exercises. While lying face-down, do a half-push up (also known as thecobra or “sloppy” pushup). If you like, you can also do this from a standing position in the water. Place your fingers on the small of your back and reach your thumbs forward to those two bony bumps on your hips (called the iliac crest). Then lean back into the stretch while exhaling. Do this slowly ten times. That should help to alleviate pain.

The second thing is to strengthen the segmental stabilizer muscles. These deep muscles stabilize the vertebrae of the spine. The easiest ways to strengthen the front stabilizers is to perform Kegel exercises, which are usually prescribed for other reasons but have been shown to be helpful for this. To strengthen the back stabilizers, do a slight lower back extension. While lying face-down, slightly tilt your tailbone towards the ceiling (i.e. stick your butt out). I would practice these out of the water, however.

The third thing you can do is keep your abdominal muscles tight while swimming. To do this, draw your navel towards your spine. Keeping your abs tight will not only strengthen them but will also help strengthen the muscles that run along the length of the spine (these and the abs are both part of the global stabilizers). This will go along way to relieving lower back pain.

If you continue to have problems, consider making an appointment to see a physiotherapist. Look for one who does athletic or sports therapy. There are many good ones around. He or she should be able to recommend other specific exercises to do while in the pool. You might also consider attending an aqua-fit class and speaking with the instructor beforehand about your back condition.

To your health

Chris


Information on stayingstrong.ca should not be used for diagnosis, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.

Too Tired to Exercise

Dear Chris,

I have had blood pressure problems for the last 10 or so years and my doctors have had a difficult time to find a blood pressure medication regimen that works. In May my doctor prescribed “Altace” as the fourth of a set of pills that I have to take (the others are Norvasc, Atenolol, and Hydrochlorothiazide). In August my doctor referred me to a specialist and he has doubled the “Altace” with me taking one at night as well as in the morning.

I know that I need to get out and get exercising but it is such a struggle since I feel exhausted all the time. I still work. I leave for work at 7:30 am and usually get home by 6:00 pm. I need to find the time and energy to at least go for walks but by the time I get something to eat, I am beat.

What do you think? Any suggestions? I have complained about having no energy and feeling tired all the time but so far to no avail.

Downtown Dilemma

Dear Downtown

Unfortunately, three out of the four medications you are taking list fatigue as one of the side effects. For a complete list of side affects be sure to read the literature your pharmacist has provided for you. There are also excellent on-line resources to consult, such as www.drugs.com. I encourage you to speak with your pharmacist. Don’t just treat him as a pill counter. They generally have more time to spend with you than your doctor and they are well versed in pharmacology, contraindications, and the potential side effects from being on multiple medications. Be sure to tell your pharmacist everything that you are taking, even if you haven’t purchased all your medication from the same store.

The other thing I would encourage you to do is to tell your doctor that you are interested in making lifestyle changes to help with your hypertension. I’m assuming that you are open to the idea of taking an active role in managing your condition, otherwise you wouldn’t even consider exercise. Be aware that many people are not and doctors may assume that you’d rather just take medication without making any lifestyle changes.

Apart from the medications you are on, three things you should consider and talk to your doctor about: exercise, which you mentioned, diet, and stress reduction. All three of these factors can go along way to helping you control your high blood pressure and if you choose to go that route, your doctor may need to adjust your medication dosages.

Ask your doctor about referring you to a clinical dietitian if you want to make changes to your diet. Although you can make healthy food choices by following Canada’s Food Guide, your particular medication might warrant talking to a professional who has an understanding of food and drug interactions and understands the side affects of your medication, especially those which affect your electrolyte balance.

As for meditation and relaxation, there are numerous resources out there, ranging from spiritual practices to doctor supervised breathing classes. Learning to relax will go a long way to helping you reduce your high blood pressure.

Last but not least is exercise. I am glad that you recognize the positive contribution exercise will have on your high blood pressure. It is well documented. Your problem is your lack of time and energy. As to your lack of time, all I can do if offer some suggestions:

Can you add exercise to your commute? If you take local transit, can you get off the subway or bus a stop or two earlier and walk the rest of the way home?

Can you make the most use of your commute to free up time for exercise when you get home? If you take public transit, use the time to get caught up on your reading or listen to audiobooks? That way, you can lop those activities off your precious free time and add in exercise. Better still can you listen to a meditation tape or CD while commuting?

How about doing all of your cooking on the weekend and store your week’s supply of dinners in your freezer. I’ve been known to make three of four dishes on a Sunday afternoon and have plenty of food available that can easily be reheated. Cooking without being in a hurry or being hungry is also kind of fun. Put on some old tunes and enjoy your afternoon.

As to your lack of energy, all I can say is that once you start making exercise a habit, you will find that you have more energy. The trouble is that your medication is making you feel tired all the time. However, I encourage you to push past that by going for a brisk walk or go on a treadmill at your local gym. Just do that for now. Don’t take on the world all at once but add a brisk walk into your daily routine. Start slowly and build up.

When you are doing any aerobic activity, such as walking or running, keep in mind that beta blockers (like Atenolol) will lower your heart rate. So when you measure your level of exertion, do not rely on your pulse. Instead, you should judge your level of exertion by how you feel. You should be able to talk out loud without gasping for breath. Consider hiring a personal trainer to coach you on alternative ways to measure your exertion or attend a walking clinic in your neighbourhood.

I wish you success. Please let me know how you are making out. I’d encourage you to do other exercises and I can give you some advice on that but leave that until later. For now, free up some time, go for a walk even if you don’t feel like it, just be sure to keep your doctor informed of your intentions.

To your health

Chris


Information on stayingstrong.ca should not be used for diagnosis, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.

Feeling Delicate

Dear Chris,

I’d like to work out more, but I’m very afraid I may break something. My mother had osteoporosis, and I worry that I might be getting it, too.

Brittle in Burlington

Dear Brittle,

Some decrease in bone density is a normal part of aging. Osteoporosis is a disease where the bone loss is excessive and can lead to pain, fractures, and loss of independence. Although having a family history of the disease is a risk factor, it is only one. Excessive alcohol and caffeine intake, smoking, insufficient dietary calcium and a sedentary lifestyle are all risk factors you can control. Because there is a higher chance of bone fractures, pain, and fragility, people with osteoporosis often shy away from physical activity. However, we know that inactivity will lead to de-conditioning of muscles and loss of bone mass.

If there is osteoporosis in your family, then that is even more reason for you to exercise. Studies have shown time and again that performing load-bearing exercise will actually make your bones stronger by increasing bone mass, as well as your muscles, which will support your frame and help reduce the incidence of falls that can cause fractures and loss of independence.

Your program should include cardio-respiratory exercises which are also weight-bearing (such as brisk walking), resistance training, balance, and flexibility exercises. When bones feel a steady force on them such as that done by a rigorous walk or by contracting muscles in resistance training, they respond by increasing their mass to better tolerate the force placed upon them. The increase in bone mass and density will go a long way to protect you from things like hip fractures should you suffer a fall. Hip fractures are one of the main causes of loss of independence and having to be admitted into a long term care facility (or “nursing home”).

While it is safe for you to exercise, there are a couple of things you should remember: Avoid bending your spine too far forward or sideways. In other words, you should not do toe touching exercises, abdominal crunches or deep side bends. However, you can still tighten your abdominal muscles and strengthen your lower back through isometric and extension exercises. A personal trainer who understands how to modify exercises for osteoporosis will be able to help you if you have questions.

For more information on osteoporosis, contact the Osteoporosis Society of Canada.

Chris


Information on stayingstrong.ca should not be used for diagnosis, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.

Gyms Intimidate Me

Dear Chris,

I’ve heard what you’ve said before about the importance of exercise and I find that the only way for me to stay motivated is to go to a gym. However, whenever I go into one, I cringe. It seems that everyone in there is trim, buff, and young. I am a retired woman living in the Toronto area and would like to find a gym where I feel comfortable. Do you have any suggestions?

Shy in Spandex, Scarborough

Dear Shy,

In the Toronto area, there are several women-only gyms as well as gyms that have women-only exercise classes, or women-only exercise rooms. You might feel more comfortable there. Alternatively, many churches, community centres, and seniors’ day centres hold regular group exercise classes. You may also want to hire a personal trainer to help get you motivated. I offer this service in client’s homes and also offer small group sessions.

Another possibility is to go with a friend. But you really don’t need to worry — I guarantee you that all of those buff young things you see at the gym are also shy about how they look.

Chris


Information on stayingstrong.ca should not be used for diagnosis, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.

Hard to Stomach

Dear Chris,

Can I eat before I have a workout? Or do I have to wait an hour, like they say for swimming? If so, why?

John in Toronto

Dear John,

The short answer to your question is it depends on what you eat and how much.

Your body needs energy to carry on its basic functions and this is especially true when you exercise. Your body breaks down carbohydrate into the simple sugar glucose and uses some of it immediately (as blood glucose) and stores some of it for later (mainly as the complex sugar glycogen). When you exercise, your muscles use both glucose for immediate energy and glycogen for longer lasting energy.

Generally it takes 3-4 hours to digest a large meal, 2-3 for a small meal, and an hour for a snack so time your workout with the type of meal or vice versa. You’ll want to have a quick source of energy for your workout so it’s best to have a light snack which is high in carbohydrate and low in fat up to an hour before. Eating a large meal, especially one high in fat or protein, just before you workout will make you feel sluggish and may give you indigestion or nausea because during exercise, blood moves away from the digestive tract to the working muscles.

So much for pre-exercise eating. What about eating after you exercise?

Studies suggest that if you are a moderate exerciser and only work out a few times per week, you need not worry about having a post-exercise meal. Your body will have plenty of time to recover from the exercise since you are leaving a couple of days in between sessions. If you exercise intensely and daily, you should eat within an hour after exercising because you need to replace the muscle glycogen you will have depleted. In this case, you should consume both carbohydrate and protein.

And remember, whether you exercise a few times a week or every day, moderately or intensely, be sure to drink plenty of fluids.

Chris


Information on stayingstrong.ca should not be used for diagnosis, nor should it be considered a replacement for consultation with a healthcare professional. If you have questions or concerns about your health, please contact your healthcare provider.

Reducing Falls

Banana PeelAccording to a recent study, one third of adults 65 years of age and older suffers at least one fall each year. And nearly half of these people fall more than once. Falls are the leading cause of injury-related deaths. But even when the fall is less serious, it can still cause pain and suffering, and bring a tragic loss of independence. For many older adults, suffering a fall can mean the difference between remaining in your own home and having to go to a long-term care facility.

But there’s good news along with the bad. Studies have also shown that many falls can be prevented by a few simple changes you can make in your life. And it turns out that exercise is the most important thing you can do to help prevent falls.

How Not to Fall

Have you ever tried to stand a chair on two legs? It isn’t easy. But our bodies stand us up on two legs all the time, without our having to think about it. As it turns out, there is a lot happening.

Three systems have to be working properly to keep us balanced:

  • Our eyes tell the brain where we are in relationship to our environment and identify obstacles.
  • Our inner ears have special organs (the vestibular system) that tell the brain about the movement of our head in space.
  • Our muscles have special receptors (the somatosensory system) that tell the brain what position our body is in, and detect movement and contact with other objects (such as our feet on the floor).

With all this information, our brains send constant signals to our muscles that keep us standing in balance and that help us react to changes when we move around. So even with all the right information, we still need muscular strength to keep our balance.

Why does getting older increase our risk of falling?

Some age-related changes are inevitable, and ones that affect our vision, inner ears, receptors, brain, or muscular strength will of course affect our balance.

Vision can be affected by glaucoma, age-related macular degeneration, and cataracts. These compromise our ability to perceive hazards and anticipate changes in surfaces when walking. The inner ear starts to lose its motion-sensing “hairs” as early as age 30. Losing too many can result in postural sway. The receptors in our somatosensory system also decline with age, making it harder to sense contact and body position. The brain’s ability to control our muscles declines with age. We don’t react as fast to changes. Finally, our muscles can get weaker as we age, making it harder to recover balance when we lose it.

Can we reverse some of these changes, which increase our risk of falling?

The answer is yes!

Doing the right kinds of exercises — ones geared specifically for balance, strength, endurance, and flexibility — can improve balance, increase mobility, and reduce falls. Programs such as FallProofTM and Standing StrongTM target the sources of the impairments, which contribute to postural instability. However, there are a number of exercises you can do on your own, with a trainer, or in a class that can also help.

These should include balance specific exercises, which train your centre of gravity, the three sensory systems, posture, and gait to help maintain and improve your balance.

  • Centre of Gravity Training will reduce your body sway and help you move more quickly. Some of the exercises are done while seated on a stability ball while others are done standing on the floor, a step, a foam pad, or an uneven surface.
  • Multi-sensory training will help each of the sensory systems to work more efficiently: the eyes, inner ears, and muscle receptors. Some of these exercise are performed standing, while other are performed sitting on a stability ball or a chair.
  • Postural Training will help to improve the strategies you use subconsciously to correct your posture while you are moving such as ankle and hip correction and your ability to step out quickly to prevent a fall. These exercises are done standing and require a trainer to support you or move you through space using resistance bands placed around your waist.
  • Gait Training will help improve your walking gait pattern so that it is more efficient, flexible, and adaptable to environmental changes. The exercises are designed to increase the length of your stride length and help you get around obstacles better.

No exercise program is complete without including strength, endurance, and flexibility training. Of all of the systems that decline with age, the musculoskeletal system is one which benefits the most from exercise and can be improved at any age.

Muscles are made stronger by resistance training. You don’t have to lift heavy weights, operate complicated machinery, or join a gym. You can strengthen your muscles with simple exercises using everyday props, stability balls, and elastic bands or tubing in the comfort of your own home. Strong muscles will cause your bones to become stronger as well and reduce wear and tear on your joints. A strong musculo-skeletal system will serve you well in reacting and responding to a situation that may otherwise cause you to fall.

Your muscles don’t just need to be strong, they must also be kept supple and flexible. Any falls reduction program must also include flexibility training to stretch muscles that have been worked. This will allow you to reach and move with ease without pulling a muscle or causing a painful spasm.

A strong heart is also important by giving you the energy you need to react and move quickly in order to avoid falling when something startles you or you trip and lose your balance. So, aerobic activity should be included in any falls reduction program.

I highly recommend that you begin a falls reduction program that you can do at home, with a friend, or at a gym or recreational facility. If you decide to work with a trainer, make sure he or she is qualified to prescribe a falls prevention program. Many recreation facilities and gyms offer programs. Whatever you decide to do, remember that through exercise you can help reduce the risk of falling and the number of falls you experience. Having a strong body, good posture, and balance will go a long way to help keep you on your feet and not on your rear-end!

To your health,

Chris

References:

Belfry, S. et al. (2004). The project to prevent falls in veterans: a multifactoral risk factor screening and intervention study. Scientific Proceeding from the 6th World Congress on Aging and Physical Activity. London, ON: Canadian Centre for Activity and Aging, 157-164.

Brown, R. (2004). How to start and sustain a falls prevention program for seniors led by seniors.Scientific Proceeding from the 6th World Congress on Aging and Physical Activity. London, ON: Canadian Centre for Activity and Aging, 147-149.

Freiberger, E. (2004). Prevention of falls – an ongoing longitudinal research project. Scientific Proceeding from the 6th World Congress on Aging and Physical Activity. London, ON: Canadian Centre for Activity and Aging, 150-153.

Islam, M.M., et al. (2004) Improvement in body sway after 12-wk of customized balance training versus tai chi exercise in older adults. Scientific Proceeding from the 6th World Congress on Aging and Physical Activity. London, ON: Canadian Centre for Activity and Aging, 57-64.

Islam, M.M., et al. (2004) Improvement in fitness after 12-wk of well-rounded exercises in older adults. Scientific Proceeding from the 6th World Congress on Aging and Physical Activity. London, ON: Canadian Centre for Activity and Aging, 78-81.

Rogers, M.E. & Page, P. (2005). Standing StrongTM: a strength and balance program for older adults. Can-Fit-Pro Annual Conference, August 18-21. Toronto, ON (unpublished paper).

Rose, D. (2003). Fall Proof!: A Comprehensive Balance and Mobility Training Program. Champaign, IL: Human Kinetics.

Westlake, K.P. & Gulham, E.G. (2004) Activity level, proprioception, postural sway, and fear of falling in older adults. Scientific Proceeding from the 6th World Congress on Aging and Physical Activity.London, ON: Canadian Centre for Activity and Aging, 43-57.