Be like a kid.

Sometimes the best advice comes from the least expected places. This week, I bring you wise words from my seven year old, as she taught me how to ‘relax’ by dancing on our back deck:

 “Let me show you how to be a kid. You just do the things your body tells you to do - the fun things!”

Healthy kids don’t have to set aside time to exercise, because exercise is simply part of their everyday life. They move constantly. They fidget, they chase their friends, they play sports and take gymnastics classes and dance. 

As adults, sometimes, we too often stop doing all the ‘fun things’ our body tells us to do. We replace the fun things with work, and stress, and sitting and to-do lists. We have to schedule exercise in, just to get it done.

But what if we started looking at exercise like a kid again? 

Did you know that most of the things to do count as exercise - even some of the things you do for fun? Anytime you are up and out of your chair, you are burning energy. Self-care, household tasks and leisure activities and hobbies - they all require movement. The intensity of each activity varies, but the concept is very much the same - and becomes even more important, for older adults. Older adults spend as much as 7-10 waking hours a day sitting. Have you ever seen a kid sit for 7 hours straight without being duct taped to a chair? (I know I haven’t..)

 If we all choose to incorporate movement throughout our days, we wouldn’t have to stress so much about ‘exercising’ or getting your steps in or whatever else we’re doing to cross it off our to-do lists. It all counts and it all helps you be a healthier, more active person. Many of these activities even has an assigned ‘MET’ (metabolic equivalent) designed to help us understand how much energy it typically burns - and how much it ‘counts’ towards your daily exercise:

I’m not sharing these to give you something else to calculate each day, but to help you understand that any and all movement COUNTS and is GOOD FOR YOU. Want an even easier way to understand how much your activity counts towards exercise? Next time something you are doing that requires movement, try using this Rate of Perceived Exertion scale. The beauty of this scale is that it takes into account that what might be challenging to one person may be less challenging to the next. We all start from different places and our levels of reserves (physiological and functional) vary and using this scale helps to reflect this:

If you find yourself working between a 0-3, you are performing light exercise. If you are feeling a 4-6, you are performing moderate intensity exercise. If an activity has you pushing 7-9, you are working at a vigorous level. Long story short, if you garden for 30 minutes and FOR YOU, this feels like a 5/10 - you just completed 30 minutes of moderate intensity exercise. THIS is how we get healthy.

Move like a kid. Do things you enjoy. Listen to your body. Exercise is Medicine - and all Movement is Exercise. 

#haept #stronger #fitter #functional #fallprevention #balance #neuro #geriatrics #physicaltherapist #physicaltherapy #doctorsofphysicaltherapy #mobilePT #geros #olderadults #healthyaging #optimalaging #successfulaging #exerciseismedicine #movementisexercise

Have an (Exercise) Snack..

If you’ve met me, been treated by me or ever visited my social media, you’re probably already aware that I strongly believe that Exercise is Medicine and that every adult should strive to meet the recommended 150-300 minutes a week of moderate intense exercise to prevent disease and better manage chronic conditions. However, only 1 of every 3 American Adults meet this recommendation, the rest, achieving less than that recommended dosage on a regular basis and placing themselves at increased risk for cardiovascular disease, diabetes and more. 

A new study, published by Preventative Medicine Reports looks at a new approach to encouraging regular exercise in older adults. Given many older adults cite lack of time as a prohibiting factor, this study looked at prescribing exercise ‘snacks’ or small bouts of regular exercise every day. Participants in this study completed one minute of functional exercise (30 seconds of body-weight push ups and 30 seconds of squats), each and every day for 24 weeks. 75% of these of this group completed at least half of the sessions, and as a group, significant improvements were noted at the end of the trial in maximal push-up and squat performance.

You can read this study in it’s entirety here: 

Feasibility and impact of a 1-minute daily functional exercise regimen prescribed to older adults by their primary care physician - ScienceDirect

Take-home message? Even a little effort can yield positive results. Every day, I work with people limited by pain, disability and fear. Issuing an exercise program, and expecting compliance, to an older adult who hasn’t participated in regular exercise since they were young or who associates exercise with pain, fatigue or fall risk is one of the biggest challenges faced by Physical Therapists on a daily basis. 

I frequently apply this idea of exercise ‘snacks’ to my patients, to help them gradually adjust to a more active lifestyle and too help them learn to see that exercise doesn’t have to be painful, exhausting or scary. I try to link these small bouts of exercise with everyday habits to make  remembering to exercise second nature, and improve compliance. Whether you’re older and trying to get more active, or a therapist or other healthcare professional trying to help your client become healthier, you can try my top five favorite exercise snacks to get the ball rolling.

1. Sit to Stands - Every time you stand up off a chair, do it 5 times instead.

2. Counter Push Ups - Every time you walk by the kitchen sink, do 10 Counter Push Ups.

3. Single Leg Stand - Every time you brush your teeth, try to stand on one leg as long as you can.

4. Loaded Carries - After each meal, carry a soup cans in each hand and walk 5 laps back and forth across the kitchen.

5. Wall Angels - Put a post it note on a spot in the hallway and every time you pass it, perform 5 Wall Angels.
   

#haept #stronger #fitter #functional #physicaltherapist #physiotherapist #physicaltherapy #physiotherapy #doctorofphysicaltherapy #exercise #health #wellness #aging #healthyaging #optimalaging #successfulaging #exerciseismedicine #functionalstrength #balance #fallprevention #strengthtraining #freetalks #knowledgeispower #exercisesnacks

the HAE series: the Pulmonary system part III

Part III, and my favorite part to write, reviews the concrete steps we can take to prevent pulmonary disease and slow age-related changes to the lungs.

Lifestyle Factors

First and foremost, cessation of smoking and avoidance of second hand smoke is, of course, the number one lifestyle modification you can make to protect your pulmonary system. Smoking is the greatest risk factor for developing COPD. Those who smoke more than 10-15 ‘pack years’ (1 pack of cigarettes per day for a year is ‘1 pack year;’ 2 packs of cigarettes for 1 year is ‘2 pack years.’) are at higher risk to develop COPD and the exposure to secondary hand smoke and other environmental irritants and air pollution can also increase your risk. Visit SmokeFree.org for some amazing tools to help you or your loved one quit.

Exercise and the Pulmonary System

Exercise also can have significant impact on the risk of developing, and the management of, pulmonary disease. Both aerobic exercise and strengthening activities play a role in your pulmonary health. Participating in the recommended 30 minutes of moderate exercise most days of the week works to improve the way the body is able to access and utilize oxygen. Aerobic exercise strengthens the cardiovascular system; with a stronger heart and healthier vascular system, the blood stream can transport the oxygen-rich blood with increase ease and efficiency. Participation in a regular strengthening program improves gas exchange within the musculoskeletal system. When the blood stream reaches the muscle, a stronger muscle is able to more quickly and efficiently extract the oxygen, which it can then use to make energy and contract more successfully.

Lastly, focused breathing exercises can improve the muscle function of the structures responsible for the act of breathing. These include the diaphragm, located under the lung set, the intercostal muscles found between the ribs and the accessory breathing muscles, located throughout the neck and abdomen that help with the work of breathing. These muscles, in particular, tend to become overused and overdeveloped in pulmonary disease states that frequently lead to dyspnea or shortness of breath. Physio-pedia has an excellent set of videos that illustrates how these muscles work together to support the cycle of breathing here if you want to check it out.

Respiratory Training

There are three exercises I typically take my patients through to strengthen both breath control and respiratory strength. Pursed lip breathing, belly breathing and straw breaths all work to teach proper breath sequence, timing and help to strengthen the muscles responsible for the cycle.

To perform pursed lip breathing, try following these steps:

1. Take a slow inhale through your nose, counting to 3-4 seconds as you go.

2. Pause, then exhale this breath through pursed lips (like you’re holding a straw) trying exhale slowly, doubling the time you spent on the inhale. If you inhaled for 2 seconds, exhale for 4. If you made it 4 seconds, exhale for 8.

This exercise can be used proactively to strengthen, and also reactively, to address shortness of breath. You can watch a video of pursed lip breathing here. Pursed lip breathing is especially important to people with COPD; this extended exhale allows the breather to exhale trapped carbon dioxide more effectively, further normalizing the breathing pattern and improving the associated feeling of shortness of breath.

Diaphragmatic breathing, or belly breathing, helps to normalize the breathing pattern, and better utilize the diaphragm, leading to deeper and more effective breathing patterns. In states of respiratory distress, instinct tends to trigger short, quick, repeated breathing. However, this pattern is less effective than deeper, diaphragmatic breathing and tends to exacerbate the shortness of breath instead of alleviating it. Practicing this technique at rest is helpful, so it can be used more effectively in states of dyspnea with less effort and more ease. To perform a proper diaphragmatic breath, follow these steps.

1. Sit comfortably with feet flat on the floor, or lay down flat in bed. Place hands on your belly and try to relax your body.

2. As you breathe in slowly through your nose, imagine filling your lungs to the very bottom and watch your hands rise as your belly expands.

3. As you exhale, watch your hands fall back down and your belly return to resting state.

This video link will show you diaphragmatic breathing in action.

The third exercise worth mentioning is straw breathing. It is similar to the pursed lip breathing above, but can sometimes be a little easier to coordinate. To perform, find a plastic straw and sit comfortably in a chair. Breathe in slowly through your nose, then exhale fully with lips wrapped tightly around the straw. Try to repeat 5 times and rest.

All three of these exercises are best performed when you are calm and at rest. Try to choose a time to perform them each day to create a habit; spending 5 minutes focused on each one 3-5 times a day can be extremely beneficial and will make using these strategies with the onset of shortness of breath more automatic and let you return to a resting state with increased ease.

the time I had to participate in family yard work day…

totally not my house, but the weeds were the same…

I’m not a fan of yardwork. I won’t go so far as to say I hate it, but I don’t get any joy from it. I don’t love the dirt, I’m not a huge fan of the bugs and every time I’ve ever put effort into creating a garden, it has become absolutely decimated by hungry rodents in less time than it took to plant the stupid thing. But lo and behold, last week, I found myself begrudgingly taking part in family yard clean up day. And by ‘family’, I mean me and my husband weeding and raking and mowing and scooping and wheel-barrowing for 6 hours straight after my kids pulled weeds for 10 minutes declared it was too hot and went inside for popsicles. But I digress.

‘So, Katie, why are you posting about yard work in your PT blog?’ Welllll…during the 6 lovely hours I spent weeding and raking and mowing and wheelbarrow pushing, I had a lot of time to think. And I thought a lot of about functional strengthening. I’ve been on a functional strengthening kick lately. I’ve come to love how it feels in my own body to focus on functional strengthening exercises, and have begun to utilize this form of exercise more and more often into my therapy sessions with my patients. I love it because it just plain makes sense. Why work a one single plane exercise, when you can use a movement, that not only involves all the major muscle groups, but mimics every day movements to encourage carryover to function? If I’ve already started to lose you, you may want to take a moment and read back to my initial post on functional strengthening What is ‘Functional Strengthening' and Why Does it Matter?'

Now I’m not sure what your weeds are like, but let me tell you, our yard has been overrun by some monsters lately. These things have vines and flowers and they are expansive. It took some serious effort to get these bad boys out of the ground and I soon found myself doing what felt like weighted squats and deadlifts and before I knew it, I was involved in a complete functional strengthening workout - right in the middle of my front yard. I spent the next few hours analyzing each task and found myself in awe and wonder of how much each yardwork task involved the six primary functional movement patterns. These movements, the squat, the lunge, push, pull, hinge, and twist were involved in every task I completed - and the workout I got was pretty damn impressive considering it didn’t involve a single weight, band, or kettlebell or anything else I normally use to get my strengthening done.

Functional Movement Patterns

◦The Squat

◦The Lunge

◦Push

◦Pull

◦Hinge

◦Twist

Without further ado, I present to you, a full yard cleanup workout plan:

Squat: Instead of sitting to weed, squat and pull, squat and pull, squat and pull and repeat. Take two steps to the right and perform your second set.

Lunge: Find a large hill. Push the mower up said hill and enjoy endless alternating forward lunges. You’re welcome.

Push: Put aside the ride-along and push a mower across your yard. Bonus points if it isn’t self-propelling. Load a wheelbarrow with weeds, then push to dump them behind your fence for the sled-push version of this exercise.

Pull: Rake. Rake. Then rake some more. This exercise can also be used in fall to get rid of excess leaves.

Hinge: Once you have completed your raking super-set, keep your back straight and hinge at the hips to pick up the piles of your yard crap.

Twist: Twist to load these piles into your wheelbarrow, then return to your Push set as a finisher.

Be sure to tune in next week for my next installment of things I think about when I’m bored ‘How to Workout While Also Getting your Laundry Done.’

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Benefits of Physical Activity, some thoughts about Intensity and How to Cut Your Risk of Premature Death by 33%

So I’ve been researching the benefits of physical activity on healthy aging a lot lately. Of course, as a PT, I’m well-aware that exercise is good and we should all be doing it, but I’ve been doing a deeper dig lately into the actual specific effects on our health as I develop my therapy programs. Beyond identifying the benefits, the next step is learning how acheive them. This has led me to topic of intensity. Yes, for those of you who know me, you can stop your snickering, I’m aware I can be a *little* intense sometimes and you may find the idea of me actually having to put research into this topic a little amusing. But in reality, the topic of intensity is actually quite pertinent to healthy aging. You see, the older adult is chronically underdosed in exercise intensity by well-meaning therapy clinicians and the medical profession in general when it comes to exercise prescription. Underdosing translates into wasted efforts, and poorer health outcomes. I want better for my patients.

The first step in understanding how to better prescribe exercise to promote health and wellness in the older adult is to understand what is required to achieve said benefits. The CDC issued a well-researched and thoroughly detailed 117 page document in 2018 entitled ‘Physical Activity Guidelines for Americans,’ and after reading all 117 pages, I started wondering if I am I even getting enough exercise at an adequate intensity. While you’re more than welcome to read the document in it’s entirety yourself, for those of you satisfied by a summary, I’ll share a brief cliff-notes of the relevant details here.

• Americans do not exercise enough. The average American sits for 55% of their waking time, or around 7.7 hours hours per day. This number only increases in the older adult. The average 70-85 year old American sits for 9 hours per day. This doesn’t take into account time spent SLEEPING.

• 28% of adults over the age of 50 are physically inactive. Physical activity levels are graded from Inactive, to Insufficiently Active, to Active, to Highly Active. Adults who are physically inactive do not get any moderate or vigorous physical activity beyond the basic movements involved with daily life. Insufficiently active adults exercise, but at less than the recommended amount. Active adults hit their target movement goals and Highly Active adults surpass them.

• Inactivity is 30% higher in those with a chronic disease. 6 in 10 Americans live with at least 1 chronic disease. 4 in 10 have two or more.

• To qualify as Active, you must regularly participate in the recommended level of exercise as described in the Physical Activity Guidelines for Americans. These guidelines state that to get optimal health benefits from physical activity, you should:

  • Perform 150 to 300 minutes of moderate intensity physical activity per week.

  • Participate in regular moderately challenging strengthening activities at least twice per week that target all the major muscle groups.

  • For older adults, the Guideline goes on to suggest every older adult should include balance training as part of their regular, weekly multicomponent exercise routine.

Where do you fall ? Are you Inactive, Insufficiently Active, Active or Highly Active? Could you do better?

And now for the good news. IF you are able to participate in this level of activity, you will not only be 33% less likely to die of unnatural causes, but you also reduce your chances of developing or experiencing:

• Dementia, by 30%

• Hip fractures, by 68%

• Cardiovascular disease, by 35%

• Type II diabetes, by up to 40%

• Colon cancer, by 30%

• Breast cancer by 20%

If this isn’t enough to convince you, regular physical activity has further health benefits on your cardiovascular system, pulmonary system, muscle, joint and bone health, neurological function and emotional health, helps you sleep, has a large role to play in weight management and can reduce your risk of falls, and falls-related injuries significantly. And also, it improves your quality of life. Yes, this has actually been proven.

So back to the question I found myself posing earlier. Am I getting enough physical activity to garner me all of these health benefits? I mean, I’m an active person, and I pretty much never sit still. I try to exercise throughout the week, though some weeks I’m better than others. Some days I cycle, but others I just feel like taking a walk or doing some yoga, and I try to respect what my body tells me I need. Before you, too, try to figure out whether you getting enough exercise, I want to take a moment to explain the concept of Intensity. What is ‘moderately intense’ physical activity anyways?

Exercise Intensity

A general description of exercise intensity is how hard you have to work to perform an activity. It can be further broken down system-specifically, in regards to how hard you heart has to work, how hard your lungs have to work and how hard your muscles have to pump to make the activity happen, but in a general sense, exercise intensity refers to how taxing the activity is on your body. The most specific way to measure intensity (without a whole bunch of treadmills, EKG tabs and pulmonary function tests) is to determine the percent your heart is working of its maximum capacity. You can use an online calculator, or do some simple math (220-your age) to determine your maximum heart rate, then multiply by the desired intensity to calculate your intensity range. Per the CDC, intensity ranges per percent of heart rate maximum are as follows:

• Light Intensity is activity that places you at 50-64% of your heart rate maximum.

• Moderate Intensity is activity that places you at 64-76% of your heart rate maximum.

• Vigorous Intensity is activity that places you 77 - 93% of your heart rate maximum.

Now of course, there are all sorts of variables that go into your true heart rate maximum, and your ability for your body to reach these levels (use of beta blockers is a big one!), but to give you a sense of what this translates to, for an average 50-year old, the heart rate range for light intensity is 85-106 beats per minute, for moderate intensity is 109-129 beats per minute, and for vigorous intensity is 130 - 158 beats per minute. For a 75 year old, these values drop; for light intensity the range is 72-92 beats per minute, for moderate intensity the range is 93-110 beats per minute and for vigorous activity the range is 111 - 134 beats per minute. As you would expect, this means that the same active I perform at 37 years old, would likely be more taxing for someone who is 50, and even more taxing for someone who is 75. This means exercise prescription for the older adult cannot be a simple cookie-cutter exercise class or online program. It requires an educated health profession (a PT perhaps…) to take into account all the health variables that may determine what your personal exertion ranges can and should be.

There are also a few subjective, but frequently, more useful measures to gauge intensity. The measure I use most frequently is called the Rate of Perceived Exertion Scale, or RPE. While the original tool used a 6-20 scale to self-report level of perceived exertion, a modified version has since been validated and uses instead self-rating on a 0-10 scale. I find this is more user-friendly for my patients, and I use it more often. When I use this scale, I explain 0/10 is when you are completely at rest, and 10/10 is running a marathon and you couldn’t possibly take another step. 5/10 is working hard, but you can maintain this level of exertion. This scale has been validated to correlate well with intensity as measured by heart rate ranges as above, and can be used in lieu of this measure of intensity for general purposes. To gauge how intense your physical activity with this modified RPE scale:

• 0-3 reflects a subjective experience of light intensity (rest, little to no fatigue or comfortable level of activity with slightly evaluated breathing rate - you should still be able to carry on a regular conversation)

• 4-6 reflects a subjective experience of moderate intensity (moderate, walking a brisk to rushed pace, breathing more deeply and level of activity more difficult to maintain - you should be able to talk, but not sing)

• 7-10 reflects a subjective experience of vigorous intensity (very strong, difficult to maintain level of activity, could not sustain for long, can barely talk)

So, if you find yourself in a session with me, wondering why the heck this PT lady is making you run around your house or get up and down from your chair so many times in a row, or even *gasp* lift weights (‘I’m 80-years old, why in the world does this chick have me deadlifting?’) it is because I am trying to get you what you deserve - the benefits of moderately intense physical activity and the most effective therapy treatment possible. The days of ankle pumps and seated exercise are behind us. We know better. You deserve therapy that not only fixes your pain and dysfunction, but helps you adopt a lifestyle that promotes health and wellness in more meaningful ways. And that takes participation in moderately intense, multicomponent regular physical activity. But your hard work will pay dividends; you will decrease your chances of developing disease and can increase your lifespan. Seems like a fair trade, right?

Getting your 150…

So back to me. With these thoughts in mind, I decided to check myself and see whether I am actually getting the recommended level of physical activity each week. I mean, if I can’t practice what I preach, what business do I have giving other people health and fitness advice? While I track my activity on my Apple Watch intermittently, I don’t often circle back to see what my weekly numbers are. I decided last week track my activity each time I exercised, and see where I wound up for the week. While I got plenty of exercise minutes, I was surprised to see how many of them didn’t qualify as moderately intense physical activity. Now, fortunately, this is likely reflective that I am in good cardiovascular health, and my never-stop-moving baseline level of activity doesn’t pose a physical challenge for me beyond light intensity. But that said, level of physical activity is person-specific; even if I’m active for the recommended number of minutes per week, if they aren’t at ‘moderate’ or higher level of intensity, I’m not going to get health benefits associated with an ‘Active’ lifestyle. All said and done, last week I worked out for 222 minutes. I only tracked my specific work out times, as I assumed none of my busy-body daily movements would be high enough to register as moderate activity. Of those 222 minutes, 155 of them qualified as moderately intense, while 68 of them registered as light. 2 of my workouts were bike rides, 2 of them were strengthening sessions and 1 was a 3 mile brisk walk around a local state park. So what did I take from my experiment? Of my five workout sessions, 30% of the time spent was not intense enough to garner the health benefits I am striving to achieve. And this is not to say that the light exercise I performed wasn’t worthwhile - some of was time spent in warm up, some of was walking that I do just to relax and some if it is the stretching and flexibility work I use to keep my back from bothering me. But, on the other hand, I barely broke the recommended minimum for moderate physical activity! I could absolutely be doing more. And I know I’m not the only one who struggles with this. I’ve heard from so many friends, colleagues and acquaintances that this year in particular, has made getting adequate levels of physical activity even harder. Many of us rely on getting out and going to work for our regular physical activity. Staying home has had a tremendous impact on all our our lives and daily rhythms. But with the stress of pandemic life higher than ever (oh dear god...school starts next week), it is even more important that we prioritize ‘getting our 150’ to help balance out the chronic stress and immobility that has unfortunately, become part of this pandemic life.

If someone told you there was a way to reduce your risk of dying early by 33%, wouldn’t you take it???

So back to you. How are you going to get your 150 this week? Do you need help? Extra motivation? Guidance? Have questions? I’ll post how I get my 150 each week if you post me yours. Keep an eye on my Facebook each week for a Getting Your 150 thread and share with me your plans, workout pictures and stats and lets celebrate together when we hit our goals. But don’t forget - something is better than nothing, so even if you start small, share your victories with me and I’ll root you on.

Need some extra help? Exercise is for everyone, even if you’re young, old, limited or living with a disability. My job as a physical therapist is to make exercise accessible. I am an expert at making exercise safe and efficient and enjoyable for people of all ages and abilities. I offer 1:1 Wellness Training and ongoing community education as part of my efforts to offer health promotion on a greater scale than I can with physical therapy alone. Check out these links to learn more.

HAE/FIT 1:1 Fitness Training

HAE/ED Community Seminars

Coffee Talks with Katie (Doctor of Physical Therapy)

References:

CDC Physical Activity Guidelines 2018

CDC Physical Activity Guidelines Executive Summary

ncbi.nlm.nih.gov/pmc/articles/PMC3527832/

CDC Physical Inactivity Among Adults