Diabetes 101

November is National Diabetes Awareness Month. To do my part, I’ve been sharing information each week about Diabetes - symptoms, causes, impact on the body and most importantly, about prevention. To wrap up the month, I’m putting it all together here on the website, in Diabetes 101.

Diabetes 101

Diabetes is the 7th leading cause of death in the United States, and the numbers of people living with Diabetes are increasing. Since I’ve been alive (I’m under 40, but over 35 for those of you wondering..), the number of cases of diabetes have QUADRUPLED. Trends project that by 2050, 1 out of ever 3 American adults will have Diabetes. 

While there are different types of Diabetes, the vast majority, 90-95%, have Type 2. While Type 2 Diabetes does have some genetic component, this is a preventable type of Diabetes. And for the folks in the back - THIS IS A PREVENTABLE DISEASE! Not only is it preventable, but people typically are often made aware by their doctors that they are developing it, and there are concrete ways to reverse course and normalize your blood sugar regulation to prevent progression to full course diabetes. Of the 86 million adults in the United States who are prediabetic, 15-30% will go on to develop full Type 2 Diabetes within 5 years. The key to prevention? Changing your habits and lifestyle to foster healthy eating habits, weight management and regular physical activity, But before I go on, and on and on, about the benefits of physical activity (have you heard this one before?), here is a quick primer on Diabetes.

Diabetes Is:

Diabetes is: a group of metabolic diseases that cause unmitigated blood sugar (hyperglycemia). While the body relies on sugar for energy production, too much free floating, unstored sugar, can wreak havoc and cause damage and dysfunction, and eventual failure, of organs throughout the body. Diabetes most commonly affects the eyes, kidneys, nerves, heart and blood vessels. Long term effects of Diabetes can include:

• Retinopathy

• Nephropathy

• Peripheral Neuropathy (leading to skin breakdown, foot ulcers and often amputations)

• Autonomic Neuropathy (leading to gastrointestinal, genitourinary and cardiac symptoms)

• Atherosclerosis

• Cardiac Artery Disease

• Peripheral Artery Disease

• Cerebrovascular Disease

• Hypertension

• Abnormal Lipid Metabolism

There are a few different types of Diabetes. Type 1, or what used to be referred to as Juvenile Diabetes, is not preventable. This form is an autoimmune disorder where the body attacks the insulin-producing Beta cells in the pancreas, thereby preventing insulin formation. Without insulin, the body cannot break down sugar effectively leading to diabetes. People with Type 1 Diabetes rely on careful diet and exogenous insulin (injections) to manage their blood sugar, and while healthy diet and exercise is still important for someone with Type 1, it will not prevent Diabetes in this case. Type 1 Diabetes accounts for about 5% of Diabetic cases.

Type 2 on the other hand, develops over time, most frequently as a result of lifestyle choices. In the case of Type 2 Diabetes, insulin deficiency is relative, and due instead to insulin resistance. Between overexposure to sugary foods and carbohydrates, and lack of physical activity, more and more insulin must be produced to have the same effect, leading the body to become less sensitive to this hormone and leading to this state of insulin resistance. While Type 2 Diabetics may require pharmacological management (medications that improve insulin sensitivity) or exogenous insulin (injections), many can manage their disease with diet and exercise alone.

Symptom Presentation:

Whether you are experiencing Type 1 or Type 2 Diabetes, the symptoms that you experience are a result of either blood sugar that is too low (hypoglycemia) or too high (hyperglycemia). Symptoms of hypoglycemia include hunger, nervousness, shakiness, perspiration, dizziness, lightheadedness, sleepiness and confusion. Symptoms of hyperglycemia include frequent urination, increased thirst, sweet smelling breath and when progressed too far, ketoacidosis and coma. Initial signs of Diabetes can be a mix of these. Typically, the first signs of Diabetes include:

• Blurred vision

• Polyuria (Increased Urination) and Nocturia (nightime urination)

• Neuropathy (pain, tingling and numbness in hands and feet)

• High blood prssure

• Fatigue

• Confusion

• Itchy, dry skin

• Slow healing wounds and recurrent infections 

Diagnosis:

So how do you know if you are diabetic? There are two primary tests used to screen for, and diagnose Diabetes. Most commonly, if you are at risk or over a certain age, your primary care physician will order an A1C check. This provides an average of your blood sugars over the prior 2-3 month period. A normal value is under 5.7%; a prediabetic reading falls between 5.7 and 6.4%; and a test over 6.5% indicates Diabetes. If you have fasted, your doctor may take fasting blood sugar reading. This reflects your blood sugar, at the current place in time and results under 100 mg/dl indicate you fall in the normal range. Results between 100-125 mg/dl indicate you are prediabetic, and values over 126 mg/dl indicate Diabetes.

Concerned you may be at risk? There is a great resource available on the American Diabetes Association Website that helps you calculate your risk of developing this disease. You can access it here:

When in doubt, simply ask your doctor at your next visit about your risk of Diabetes, and what you can do to prevent it.

Prevention and Management:

Whether you find yourself at risk, diagnosed with Prediabetes or living with Type 2, lifestyle intervention can prevent or stop the progression of this disease. There are three keys to the prevention of Diabetes: Weight Management, Healthy Diet and Physical Activity.

While focusing on a healthy diet is important for everyone, weight management is a particularly important step for people who are overweight or obese. Eating a balanced, healthy diet, while increasing activity and energy expenditure should help to balance out your energy intake and improve your weight management. While I won’t go into too much detail here, the important thing is to identify if this is an issue for you and if so, seek support. A nutritionist, diabetic educator or the Dietary Guidelines for Americans are all great places to start. Choose My Plate.gov offers great online tools you can access here: 

I will, however, go into more detail about physical activity. If you’ve been on the HAE website before, I’m sure you’ve already heard that getting 150 minutes each week of moderately intense physical activity (plus strengthening twice a week) is incredibly beneficial and is THE most effective way to promote healthy aging. This is the same for Diabetes. Not only does regular physical activity help with weight management, but it lowers blood sugar, lowers cholesterol, improves blood pressure, and lowers stress, anxiety and improves mood. While counseling for patients found to be prediabetic includes encouraging increased physical activity, in my experience, there is a reason inactive people aren’t active in the first place. If it were that easy to simply start being active, chances are, they would have done it years ago. But pain, fear, inexperience, lack of time, lack of knowledge...these factors, unaddressed, are all barriers to exercise. 

Role of Physical Therapy in Diabetic Prevention and Management:

Physical Therapists are physical activity and exercise experts. We are experts at finding ways for everyone, in every shape, to become ACTIVE, safely and effectively. Exercise and physical activity can be life changing. It can ward off depression, manage anxiety, improve sleep, prevent disease like heart disease and some cancers. And it can reverse prediabetes and PREVENT DIABETES. 

Exercise lowers blood glucose and improves insulin sensitivity. It improves body composition and reduces adiposity (fat tissue), which when increased, is in itself a risk factor for development of Diabetes. It aids in weight management and makes you FEEL BETTER, and often, that alone, can help with making better food choices. 

So, climbing off my soapbox: this was my long-winded way of saying, good grief, if you have been told you are prediabetic, or had an impaired fasting glucose reading, now is the time to get ACTIVE! And if you need help, ask a PT:)

In summary, Diabetes is a quickly growing problem in the US. However, for the vast majority, this is a preventable disease! Learn about it, make healthy choices and get active. Great resources exist on the internet (ADA), but as always, your primary care physician is the best place to start. Ask the questions, make the changes and get stronger, fitter and healthier! 

STRESS!!! Three Easy Changes You Can Make Today to Decrease your Stress and Improve Your Health

Anyone out there feeling extra stressed lately? No? Just me? Great…

In reality, I think I’d be hard pressed to find someone who hasn’t been unusually stressed out this year. 2020 has been a veritable buffet of stressors - there’s been something for absolutely everybody. Job insecurity? Check. Overworked and underprotected? Check. Fear for your children? Check. Fear for your aging parents? Check. Fear of death or disability from a mysterious illness no one fully understands that is spreading like wildfire through the world? CHECK!  Loneliness, isolation or stuck in the house with your entire family for months on end? Check, check and check. For even the most stoic of individuals, 2020 has shaken us to our core, and more than likely, given each of us more than our fair share of things to worry about. 

Stress is a fact of life. In fact, some stress is actually helpful. Our bodies are designed to respond to stress in a way that keeps us safe in the presence of impending threat or danger. But while the experience of stress is natural and unavoidable, stress is meant to be experienced in the acute state: ‘Oh, is that a bear? I better prepare to run. Body: Send blood to my extremities, shut down my immune system and digestion. Get my heart pumping and let’s get some extra glucose circulating so I can move even faster.’ However, the body is not designed to react in an adaptive way to chronic stress. All the physiologic reactions to stress (increased cortisol, glucose and adrenaline release) act to shunt resources away from non-essential functions like the immune and digestive systems, to redirect the body’s resources to systems involved in response to the present physical threat. The cardiorespiratory system revs up, increasing the heart rate to pump more blood into circulation and triggers you to breathe faster to increase oxygen uptake to respond to increased energy demands. Blood (and the oxygen and glucose circulating within the blood) is sent to the extremities and large muscle groups to prepare to run or fight. While these physiologic reactions are super helpful when you’re face to face with a bear, they can be quite maladaptive and destructive to your body when they don’t shut off after the source of stress has been resolved (like in response to chronic anxiety) - or in the case of 2020, if the stressors just keep coming. 

Exposure to chronic stress results in an increased state of systemic inflammation. And again, while inflammation can be a good thing (it is how we heal from a cut or virus or other invading pathogen), chronic inflammation is associated with nothing but bad outcomes. Chronic systemic inflammation has been linked to increase risk of cardiovascular disease, metabolic syndrome, diabetes and cancer. It is associated with the development of arthritis, Alzheimer’s, IBS and a host of other bodily dysfunctions. It is one of the primary theories linked to aging in general. And also, it makes you feel like crap. Chronic inflammation increases aches and pains, disrupts your sleep and increases anxiety and depression. So, if you haven’t been feeling yourself this year, you can probably chalk it up to chronic stress, systemic inflammation and the fact that your entire life and physiologic sense of homeostasis is TOTALLY OUT OF WHACK. 

Now, (and I say this with total lack of judgement because I 100% fall into this camp) some of us think that ‘we can handle it’ or that living a busy, stressful life is simply your status quo. While this may be true, this doesn’t mean your body is handling it any different then the rest of us frazzled, stressed out hot-messes (I also fall into this camp sometimes, too. Lucky me.) Whether you’ve got your make-up on, kids out the door (or at their zooms) and to-do list half finished by 7am, or you’re simply struggling to find the motivation to pour a cup of coffee and deal with the mess you’ve left from the night before, under the surface, we are all the same. When we don’t address how we respond to stress, our body experiences inflammation. No matter what. And as I briefly explained before, inflammation causes disease and dysfunction. So what do we do about this? How do we stop the cycle?

Personally, (and I’m writing this partly to give myself a concrete stress-reduction plan) I suggest trying to reduce stress in two ways. First, I think it is critical to find ways to interrupt the stress-response cycle. This requires two steps - learning to identify when you are experiencing stress, and making the choice, then and there, to ‘change the story’. Second, it is important to minimize the state of systemic inflammation throughout your body, not only to promote improved health, but also to set yourself up to better respond to stress in the first place.

Interrupting the stress-response cycle:

The first step in interrupting the stress-response cycle is to identify that you’ve begun to feel a reaction to stress. Note that I didn’t say identify the stress. The stressor itself is immaterial, it doesn’t matter if it’s a bear or a work deadline. Your body responds in the same exact way (though in variable degrees of severity). Try to notice next time you encounter a stressor what happens in your body. Do you get tense and find your shoulders riding up to your ears? Does your heart race? Do you get a headache or experience nausea? Some people get strong somatic responses - increased heart rate, flushing, muscle tension, headaches or other bodily responses. Other people (myself included) experience more emotional responses. You may feel angry, overwhelmed, irritated or worried. Try to make a list of your specific stress responses and then try to be mindful of these throughout the day. The first step in interrupting the stress-response cycle is simply identifying when you are experiencing it. 

The second step is to change the story. In my experience, this is the most helpful thing you can do right now to reduce the effect of stress on your body. By consciously changing the way you react to the stressor, you change the way your body perceives it. This is the key to stopping the cascade of the physiological responses that lead to systemic inflammation and the physical effects of stress. I learned to use this technique when I experienced sudden onset tinnitus last year. Everytime my ears would start to ring, I’d panic. The anxiety and panic would worsen the experience of the tinnitus, and the worsening of tinnitus would increase the feelings of anxiety. See the problem here? The key to curbing my tinnitus was not getting rid of the stressor (as often, we can’t), but changing my reaction to it. When I would notice the ringing, I taught myself to stop and listen to it. I’d simply identify it for what it was, literally tell myself this is a symptom, not a crisis. This is a sound, not a bear. Then, I’d take a few minutes to listen to the ringing while taking slow deep breaths. Within a few days of practicing this behavior, the ringing didn’t trigger the panic response anymore, and eventually, the tinnitus improved. Even though I still am aware of the tinnitus at times,  it no longer initiates the stress, panic, inflammatory cycle for me, it’s just simply ‘there.’

You can adopt this two-step stress reduction plan to address any stress you encounter. Whether it’s pain, background noise, or demanding coworkers or children - when you identify the onset of the physical effects of stress, stop. Stop and identify the stress for what it is and remind yourself this is not a crisis, or a threat or an oncoming train. Then, take whatever actions best help you retrain your body to enter a state of calm, instead of a state of fight or flight.  If the deep breathing works, great. If you respond well to meditation, use that. Take a walk, go outside, read a book, write in your journal. Whatever you associate with calm, substitute that behavior for your instinctual response to the stressor. It takes practice, but your body will adapt and you can extinguish this response, despite how automatic it may initially be.

Decreasing systemic inflammation: 

Lastly, find ways to lower your systemic inflammation. According to the American College of Sports Medicine, there are four methods to decrease systemic inflammation. First is to take anti inflammatory medications. Second is to ingest antioxidant foods and supplements. Third is by caloric restriction. And the fourth is to exercise. Guess which is the most effective? Exercise. No joke. How great is that? The most effective solution to reduce inflammation is something you can do on your own, for free, right now. It doesn’t even need to be aggressive exercise! Low impact steady state cardio has been shown to reduce cortisol levels and is great for stress-reduction. More moderately intense exercise has even greater benefits on your mental and physical health. Effects start right after you exercise and last hours, and are cumulative over time. There is literally no downside to making exercise part of your regular routine. There is also substantial evidence there are benefits in following an anti-inflammatory diet (like the Medeterranean diet), getting adequate sleep and practicing habits like gratitude, yoga and other mindset-shifting activities daily. You don’t need to follow a guru or pay thousands to a health coach to get in these habits either. Just sit down, in the morning, and try to write a few things you’re grateful for. Make time to exercise. Drink plenty of water. Go to sleep on-time. 

So, am I writing about this because I am a stress-management expert? No. I’m writing this because I’m a frazzled, stressed out control-aholic trying to manage my home, my children, my career and my life in the middle of a dumpster fire of a year. I’ve turned to my vices more often than I’d like to admit, found myself grumpy, irritable, achy and run down and I know perfectly well that this is because I’ve been letting my reaction to stress run the show, instead of using these strategies to change the story. 

I hope you find this information useful and these strategies helpful. Not only do I find that these techniques help me, but these are skills I teach to my patients who struggle with pain management and anxiety related to physical dysfunction and disability. Of course, my advice does not take the place of the advice of your doctor or other clinical professional, and if you feel like your level of stress is unmanageable, please reach out to those individuals for help. And if you see me somewhere staring off into space taking nice slow breaths, now you know why:)

#justtryingtokeepmyishtogetheroverhere

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

the HAE Senior Fitness Assessment

Curious how you stack up against the competition or just want to find out if there are areas you could improve on. Sign up for a HAE Senior Fitness Assessment. On the day of your assessment, I will meet with you in your home to discuss your goals, your health history and will perform a thorough physical fitness assessment that day.  Here are some of the areas I will be assessing:

Past Medical History and Current Conditions: I will review your pertinent health history, discuss with you any concerns you have about your current medical conditions, within the scope of my practice, and provide education on conditions that you may benefit from understanding better. If I feel like you could benefit from any specialist referrals, I will provide this feedback to you and your medical team.

Assessment of Goals: For your Wellness plan to be effective, it must start with you. We will discuss what your goals are at present and for the future. These goals can be anything from being able to get up from the ground with more ease, to participating in your favorite hobbies and leisure activities with less limitation. I will use this information to help with development of your Wellness plan and our success together is measured by your progress in these areas.

Clinical Assessment: I will then perform a thorough physical assessment of your areas of strength and any areas of potential weakness. I will perform tests and measures to assess the following areas:

o   Cardiovascular and Pulmonary Health

o   Functional Strength, Power and Muscle Endurance

o   Flexibility and Range of Motion

o   Aerobic Capacity and Activity Tolerance

o   Balance and Coordination

Functional Outcome Measures: By utilizing outcome measures with predetermined age-matched norms and cut-off scores that indicate associated fall risk and other functional outcomes, I can better gauge where you are at present, and where I hope you will be when by the time we finish. I use tests like the 6 Minute Walk, 2 Minute Step, Berg Balance Scale, Functional Gait Assessment, 30 Second Sit to Stand, Arm Curl Test, and the Activities Specific Balance Scale among others to help me set more specific goals for you, and to help illustrate for you where you land currently on the spectrum of health and fitness. I will provide you with your scores, and we will reassess these as you progress with your Wellness program.

Development of Your Wellness Plan

After careful review of your medical history, and after we address any pertinent current medical issues, I will review specific guidelines for physical activity and provide you with education on any relevant precautions or contraindications for exercise. I will then review your individualized Wellness plan and we will determine together how you would like me to help you along your journey. Visits can be made in person or virtually, and at a frequency that you and I decide together would be most beneficial.

While our routine may vary, and all Wellness programs are individualized, there are certain types of workouts I find most beneficial to my clients. All of your workouts can be done in your home with whatever equipment you have on hand, or no equipment at all. Here is an overview of some of the different types of workouts you can expect to try:

Functional Strengthening: I believe in performing exercises and activities that are designed to directly improve your ability to function. This means choosing activities that strengthen your body in ways it must move to perform functional mobility and everyday activities. Typically, these movements fall into seven categories: Pushing, Pulling, Hinging, Squatting, Lunging and Core Work and Twists. While these are the same types of patterns you may expect to see heavy weightlifters performing, I modify these to reflect the types of activities you perform during your everyday life. You perform a squat every time you get up and down from a chair or the toilet. Stairs require a form of lunging and you hinge every time you must retrieve an item from the ground.  Pushing happens when you rise from bed, and you pull often when get in and out of the car. Your core is active during every one of these activities and twisting is a part of everything you do – rarely do these actions happen in isolation or as straight plane. By getting away from the traditional single limb strength protocols (bicep curls, knee extensions) and focusing on the multi-body part, big muscle group motions that translate to increased function, your workouts will not only be more effective, but more efficient. To read more about the benefits of functional strengthening, check out this blog post I wrote about it here.

High Intensity Training and EMOM-Style Workouts: To get maximum benefit from your workouts, you must be working intensely. And while this doesn’t necessarily mean you have to be dripping sweat or exhausted, it does mean I will find ways to get you moving and keep you moving so your heart rate stays up and you get a cardiovascular benefit even during your strengthening. I do this frequently by incorporating low impact aerobic intervals into your strength sessions, or using Every Minute on the Minute (EMOM) style workouts that use strength activities performed at more intense speeds and efforts to achieve the same effect. 

Low Intensity (LISS) and Moderate Intensity (MISS) Steady State Cardio: While it may sound simple, there are so many benefits from participating in regular low to moderate intensity aerobic exercise, that it has a role in a every Wellness program I create. This is the place where you get to choose how you move; if you like to walk, I will help you create a walking program. If you like to dance, we will find a way for you to find your groove. If you want to get on a bike, we can do that too. The only guideline I have your LISS or MISS workouts is you pick something you like to do, that feels good for your body.

Balance, Coordination and Agility:  I rarely meet someone who couldn’t benefit from work on their balance. I will create a balance program specifically for you that starts with the areas I find deficit during your assessment. It will start easy, and progress to keep you challenged, with activities modified to present challenges to your static, dynamic and walking balance all designed to encourage more instinctive and effective use of your balance strategies when needed.  

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What is ‘Functional Strengthening?’ And Why You Should Care About It.

Think for a minute, then tell me what the most difficult thing you do in your house is each day? Is it taking out the trash? Or getting in and out of the shower? Of lifting that heavy jug of water? Now think about that task, and try to tell me what makes it so hard. Does it challenge your strength? Your endurance? Your balance? Maybe all of the above?

Fitness is a combination of all of these things - strength, power, speed, endurance, agility, flexibility, coordination and balance. And your ability to continue to perform everyday functions as you get older relies on competency in all of these areas. Getting out of bed in the morning? That is a feat of strength. Completing your daily shower? It’s a true test of endurance. Leaning forward to tie up your shoes? You’ll have to keep your balance. Taking out the trash? It’s a combination of all three. You need the strength to lift the bag, the coordination to maintain your balance while carrying it and the endurance to make it outside to the barrel. 

This is why working on your functional strength is so important. While strength alone is a simple measure of how much load a single muscle group can bear, functional strength is how well all of your muscles work together to perform a complex movement. These multi-muscle group, multi-joint movements enable you to move through a functional pattern - a pattern that translates to your ability to perform a real-life functional task. 

In exercise terms, functional movement patterns are broken up into six categories; the squat, the lunge, the hinge, the push, the pull and the carry. The twist is also included, but is used in combination. If you take a closer look at the tasks you perform on a day to day basis with your home and in your community, you’ll find these movements are part of everything you do. Reaching down to pick up the paper? There’s your squat. Walking up a hill, or taking the stairs are lunge patterns. Every time you pick up up an object up off the ground, you’re moving through a hinge. Push, pull and carry? You’ll find yourself doing these getting out of bed, pulling yourself into the car and simply walking around!

One of the most important foundations of exercise training science is the principle of specificity. Specificity dictates that in order to make progress in a sport or activity, you must practice and strengthen the skills required to perform that specific activity. You could do bicep curls every day, and while you may end up with stronger biceps, you aren’t going to get any better at tennis. If you’ve ever found yourself wondering what good these ridiculous ankle pumps are doing for you - then good! Because they probably aren’t doing much. If you want the things you struggle with every day to get easier (lifting those groceries, climbing those stairs, getting out of bed in the morning) - then you have to practice those skills. And you have to practice those skills repetitively, intensely and with purpose. 

A good functional strengthening program will help you get stronger in the whole-body movement patterns that you need to use to perform everyday activities with increased ease. When I design a functional strength program for you, it starts with an analysis of what activities you struggle with. We then work on exercises that mimic those movements - scaled first to your present ability then with progressive challenge. This may look like a sit to stand exercise from progressively lower surfaces, or hinge lifts with a weighted ball or bag first from a counter, then a chair and eventually from the floor. What will feel difficult initially, will soon start to get easier - and you’ll see the results carryover at home home. Whether you’re a seasoned athlete or an eighty five year old woman just trying to get through the day, functional strengthening is a more effective and enjoyable way to exercise - and will help you make specific improvement on the things that matter to you.

Wondering how you stack up? Sign up for a Senior Fitness Assessment and learn how a functional strength program can help you.

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