5 Tips for Preventing Dehydration and Low Blood Pressure in the Summer:

Summer is here…

Summer came in with a bang this year - a hot bang - and Boston made records for the warmest June on record.

And while summer comes with it’s shares of highs, it also comes with it’s share of lows - Low Blood Pressure, that is!

Here are a couple tips for keeping your blood pressure regulated in the heat:

How do I know if my blood pressure is too low?

1. Know the Signs: Be familiar with signs of hypotension (low blood pressure). Feeling dizzy or woozy, having tingling in your lips, blurred vision or nausea can all be signs of dropping blood pressure. When blood pressure drops too low, especially when you stand up, can cause you to pass out - or experience Syncope. If you feel any of these symptoms, stop what you are doing and GET LOW. This may mean sitting back down if you have just stood up, or finding a way to lower down to the ground safely.

   What do I do if my blood pressure is too low?

2. Have a Plan: The first thing to do if you feel the signs of low blood pressure is to quickly drink 16 ounces of water. This can help improve your blood pressure by improving your blood volume. The second thing to do is squeeze your muscles. When you do things like ankle pumps, calf raises or squeezing a ball between your thighs, the muscles in your legs put pressure on the veins and help to push the blood back up to your heart. Taking deep, diaphragmatic breaths, also helps to improve blood pressure, so try to take a few of these nice and slow belly-breaths before you stand back up.

   How do I keep my blood pressure from getting too low?

3. Stay Hydrated: Ideally, we should all be drinking about about 3-4 Liters - or about 12-16 cups of water, each day. Our bodies are made up of 70% water and every single system we have relies on water to function properly. Without enough water, we can’t think clearly, may experience muscle cramping and joint pain, and hypotension. Try to drink 1 cup of water when you first wake up, then make sure you have a bottle to sip on throughout the day. Make sure to add extra if you do things that make you sweat, or urinate more (coffee, alcohol, exercise). Don’t be afraid to change it up - if water doesn’t appeal to you, add fruit or other low-sugar flavoring, or try to add more fluid-filled foods like fruit or soups.

4. Stay Cool: Make sure your home is well-ventilated, using fans or air conditioning as needed. When you go outside, wear loose, breathable clothing, wide-brimmed hats and choose shady, cool spots to spend time in , when you can. Avoid being outdoors in extreme temperatures. Bring water! Sweating can alter your electrolyte balance (sodium and potassium) so make sure to drink even more water if you find yourself sweating outdoors. Wearing things like ice necklaces and personal fans can further help you stay cool in the summer.

5. Eat Smart: When you eat, your body shunts blood away from your extremities and into your stomach to aid in digestion. The larger the meal, the more blood gets sent that direction. Try to eat smaller, more frequent meals in the summer, focused on proteins, vegetables and fruits when you can. Make sure you get plenty of B-12 rich foods (meats, eggs, fish) which can help improve your iron levels, prevent anemia and keep your blood pressure regulated.

About the Author:

Dr. Katie Wadland, PT, DPT is a Board-Certified Geriatric Clinical Specialist and the Owner and Primary Physical Therapist at Healthy Aging Physical Therapy. Healthy Aging Physical Therapy offers in-home Physical Therapy for older adults living in Melrose, Medford, Arlington, Stoneham, Winchester, Reading, Wakefield and Lynnfield, Massachusetts. She is licensed to practice Physical Therapy in the State of Massachusetts (License #18193). She has over fourteen years of experience working with older adults with musculoskeletal and neurological impairments and advanced training in the care of people with Parkinson’s Disease, Spinal Cord Injury and Stroke.

Click here to learn more about Dr. Katie Wadland, PT, DPT or here to request an evaluation.

How Can Physical Therapy and Regular Exercise Help Older Adults?

People often think of physical therapists as the go-to people to treat musculoskeletal pain, but physical therapy has much to offer beyond pain management, especially when it comes to the older adult. Read on for 5 Ways Physical Therapy can help you live your best life as you age.

Why is exercise important for older adults?

Inactivity is associated with most of the diseases we commonly associated with getting older. Inactivity increases your risk of diseases like heart disease, stroke and dementia. It also increases your risk of fall and resulting hip fracture - a major concern for many older adults! However, only 20% of older adults participate in adequate amounts of regular exercise. A Physical Therapist who specializes in Geriatrics can help you learn how to exercise safely - and use exercise to stay healthy and active as you age. Regular, moderately-intense exercise can reduce your chance of a premature death by up to 30%! Exercise is safe and beneficial for adults of all ages and in all conditions.

How does exercise reduce the risk of falls in the elderly?

Regular exercise can reduce the risk of falls in older adults by up to 20%. Participation in Evidenced-based balance programs (like the Otago Program offered by Healthy Aging Physical Therapy) can bring that risk down even more to 30-40%.

Physical Therapy can help you improve your strength, your endurance, help you mange pain, and improve your balance. We can help you if you’re dizzy or experiencing vertigo (Vestibular Rehabilitation). We can help you make your house a safer place to live and teach you ways to modify your movement and mobility to make moving around your home and community safer and easier.

However, falls are an unfortunate reality for many older adults, so it’s also important to be PREPARED for falls. Around 36 Million adults fall in the US each year. Learning to fall safely, what to do after you fall and how to get back up is just as important as working to prevent them.

How can Physical Therapy help me stay Independent?

By helping you manage all areas of your health and wellness, we can help you stay strong and fit so you can stay living in your home and be as independent as possible. Physical Therapy and exercise improves your cardiovascular, pulmonary, neurological, metabolic, musculoskeletal and psychological health. The stronger and fitter you are, the better your resilience to disease, decline and disability. If you do need help, we can help you find it, or teach your loved ones how to care for you - while making sure they also take care of themselves. This balance of keeping you as independent as you can, with guiding you towards the support you need is how physical therapy can help you age in place and remain active as you can within your home and your community.

How can Physical Therapy and Exercise help me Walk and Move better?

Physical Therapists are Movement Experts and as you age, it can be harder to get up and down from chairs or the toilet, to walk around the house, access your community or use the stairs. Through movement and mobility assessment, we can identify limitations in your range of motion, strength or muscle balance that may be making these tasks more difficult for you. We help you develop the strength and skills you need to make tasks like walking, using the stairs and getting off low surfaces like the toilet easier - and safer.

Can Physical Therapy and Exercise improve my Quality of Life?

Getting older doesn’t have to be painful, exhausting or depressing. Learning to care for your body better as you age and use Movement as Medicine can help you feel your best, move your best and live your best life. Regular exercise improves your sleep, reduces depression and anxiety and can help you be strong enough to continue living a life full of family, fun and purpose. To quote George Burns, “you can’t help getting older, but you don’t have to be old.“

A Physical Therapist who specializes in working with older adults has the skills necessary to help you live your Best Life, no matter what diseases or disabilities you may be living with - and no matter how old you may be.

Click Here to Request a Physical Therapy Evaluation

About the Author:

Dr. Katie Wadland, PT, DPT is the Owner and Primary Physical Therapist at Healthy Aging Physical Therapy. Healthy Aging Physical Therapy offers in-home Physical Therapy for older adults living in Melrose, Medford, Arlington, Stoneham, Winchester, Reading, Woburn, Wakefield and Lynnfield, Massachusetts. She is licensed to practice Physical Therapy in the State of Massachusetts (License #18193). She has over fourteen years of experience working with older adults with musculoskeletal and neurological impairments and advanced training in the care of people with Parkinson’s Disease, Spinal Cord Injury and Stroke.

Click here to learn more about Dr. Katie Wadland, PT, DPT or here to request an evaluation.

Walking Speed - the Sixth Vital Sign

😳Did you know that simply being the SPEED that you walk can predict whether you still stay ACTIVE and INDEPENDENT - or whether you will be at increased risk for FRAILTY and FALLS? In fact, walking speed has been referred to as the ‘6th vital sign’ because it so highly correlated with over function. 🚶‍♀️🚶‍♀️🚶‍♀️

➡️ Here are some general guidelines what you can learn about what your walking speed might tell you:

🌟.4-.8 miles per hour: Walking at this speed should enable you to walk comfortably within your home setting. It will likely also mean you may struggle to walk outdoors or walk safely or easily in your community. Unfortunately, gait speeds under 1 mile an hour are also predictive of falls, so while walking this speed may enable you to move around at home, this can lead to isolation, decreased overall activity and a progression to frailty.

🌟Faster than 1.4 miles per hour: This is the cut-off for being able to care for yourself and do all the activities required on an average day to clean, bathe, toilet and dress. It will also likely mean you can get around your house safely and likely move around your community in a limited way.

🌟Faster than 2 miles per hour: If you are able to walk slightly faster, you can also likely continue to take care of your home, cook for yourself and complete other activities of daily living. People who walk at this speed can also usually get around their communities with relative ease, helping them to stay independent and active.

✳️Fast walking is healthy walking! Your brain has a special place designated just to control walking and it works best when walking speed is fast! When you walk slower, or outside of your normal pattern (limping, using a cane, crutch, walker etc), your body can no longer rely on automatic reflexes and brain patterns to control your movement. Instead it requires MORE brain power, MORE energy and is LESS efficient. Choosing a PT who is an expert in gait training and mobility can help you improve your walking speed - and your shot of staying active, independent and ON YOUR FEET as you age. #HealthyAgingPhysicalTherapy #Stronger #Fitter #FASTER # #Balance #Neuro #Geriatrics #PhysicalTherapist #PT

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

Should I use a Cane or a Walker?

The answer is...it depends! (Shocking, right?)

As a Geriatric Physical Therapist, I spend oodles of time talking about assistive devices. Whether it’s working to wean off of one, or trying to convince my patient to use one, my day-to-day includes much talk of canes, walkers, wheelchairs and the like. But like most things in PT-world, the who-gets-what assistive device conversation is never black and white. That said, here are a few things I think about when deciding which assistive device to recommend.

Should I walk with a Cane?

These are your run of the mill straight stick supports like the guy is using above. They can have flat tops or curved; sometimes people buy fancy tripods to help them stand up or ice picks to add to the bottom to use in the winter. They come in all shapes and sizes, but have one thing in common - they will not stop you from falling if your legs give out. So, my first factor in determining whether to recommend a cane is strength. Basically, if you’re going to use a cane, you need to have enough strength to walk at least the distance you’ll be using it to walk (household or community) a couple of times in a row securely. The second factor I consider is balance. While a cane is great for folks who have minor balance impairments, you really need to have adequate reactive responses (the ability to catch your balance if you do start to fall) to make walking with a cane safe. The last thing I generally think about is coordination. Some people, (no judgement here..) are just not ‘cane-people’. Instead of helping, it becomes a hindrance. If the idea of using a cane seems overwhelming, requires a lot of focus or becomes another item to trip over, it probably isn’t the device for you. In fact, these are the folks I actually tend to focus towards without a device.

Does using a cane help with pain?

I tend to use canes for my folks that have pain. A cane is a GREAT way to reduce load on a painful joint - whether temporarily or ongoing as part of a pain management plan. Another pro for canes - it helps people walk with a more natural gait pattern (good for brain = good for gait). But there’s a catch - if you use a cane on the wrong side (the side CLOSEST to the painful side), you actually increase the load and as a result, the pain. So, if you’ve got a painful right  knee, the cane needs to go on the left so when you step onto that side, the cane is there to support it. I won’t go into much detail about the other cane options (large-based or small-based quad canes), because quite frankly, I don’t like them. It is hard for people to remember which way to use them (flat side goes toward you FYI), they get under-foot quite easily, and generally slow people down. Yes, they have their purpose for a small group of folks (like people with hemiplegia after a stroke) but for our general purposes today, I’ll leave them in them out of the discussion.

Should I walk with a Walker?

Walkers, like people, come in all shapes and sizes, and vary in quality. The old silver one with the wheels in the front and legs in the back is called a Rolling Walker. Four legs without wheels is a Standard Walker. (To save some time and energy, the only time a standard walker is going to the the ‘right answer’ is if you aren’t allowed to put full weight on your leg, or if you are missing a leg. Case Closed.) Despite the fact that we’ve developed crazy things like the INTERNET in the last hundred years, the design of these two basics actually haven’t changed much, if at all. These are the kinds of walkers you’ll come home from the hospital with if you’ve had a joint replacement or experience a fall and fracture. While the rolling walker has it’s time and place, and is certainly the safest option *in-home* for many people, it is not my favorite device. Using a rolling walker a) limits your speed (bad for brain = bad for gait), b) limits your trunk rotation and arm swing (again bad for brain = bad for gait) and c) frequently leads, in my opinion, to increased isolation because people often either don’t want to be seen by their neighbors and friends with a walker, or just find the darn thing cumbersome. I put *asterisks* around *in-home,* because my biggest walker pet-peeve is they are HORRIBLE for walking on most suburban streets and sidewalks. While they may work well l if you live in a brand new town with perfectly manicured roadways, where I live, between tree-roots and frost heaves, most areas I gait-train with patients are basically a head-over-heels situation waiting to happen. Watching a patient try to navigate uneven terrain with a rolling walker is not my favorite experience. Walkers don’t work on grass, they don’t work on sand, and in reality, they don’t work too well on sidewalks.

What is the best Walker to buy?

Enter the Rollator. Rollators get a bad rap because they move fast and because the brakes get loose, but I actually prefer to wean a patient onto a rollator when I can. Rollators, with their four wheels + hand brakes and a built-in chair, give a person an option for life outside of their home (in my humble opinion). Using a rollator, for most people, is more intuitive than a walker; it actually turns in a circle and makes turning corners way easier, it is smoother over uneven sidewalks, can actually go over grass - and my favorite, allows you the freedom to walk further because you have an option to sit and take a break when you need to! Rollators make  great choice for someone who may be limited by balance, endurance, cardiopulmonary impairments or back pain, but who still would like to be able get out and about in their communities. Quick note about rollator quality: while the general ‘got it for free from a neighbor’ rollator may not be the best, when a patient can afford it, I usually recommend a sturdier model called the Nitro. It is heavier, but stronger, more secure and is like the SUV of rollators.  (Nitro Walker)

Still wondering if a Cane or a Walker or Nothing at All is the right thing for you? Ask a PT:)

We are movement experts; our job is to help you find the safest way to navigate your environment while at the same time, giving you the maximum independence. For some, this may mean weaning off an assistive device; for others, it may means encouraging you to use one. The Cane Vs. Walker Showdown is rarely black and white. What may work in your home may not be what is best for use in the community. You may be able to use a Cane or Nothing at All during the day, but a Walker may be best at night. See, like I said…It Depends:)

About the author:

Dr. Katie Wadland, PT, DPT is the Owner and Primary Physical Therapist at Healthy Aging Physical Therapy. Healthy Aging Physical Therapy offers in-home Physical Therapy for older adults living in Melrose, Medford, Arlington, Stoneham, Winchester, Reading, Woburn, Wakefield and Lynnfield, Massachusetts. She is licensed to practice Physical Therapy in the State of Massachusetts (License #18193). She has over fourteen years of experience working with older adults with musculoskeletal and neurological impairments and advanced training in the care of people with Parkinson’s Disease, Spinal Cord Injury and Stroke.