5 Things to Know about Exercise and Depression in Older Adults

May is Mental Health Awareness Month! In this blog post, we delve into the critical relationship between exercise and depression in older adults. Discover five essential insights to empower seniors in managing their mental health through physical activity.

1. Depression is common in older adults and can have a profound impact on daily function.

It is estimated that around 7% of adults over age 65 experience some form of depression, though this number is likely much higher in reality. Depression in older adults can stem from neurological changes and drops in neurotransmitter levels, but can also be related to the many changes older adults face as they age. Older adults face the loss of friends and family, and also experience changes like retirement that can significantly impact their perception of their place and role in society. Chronic illness and disability can lead to stress and lead to a loss of independence and a greater reliance on others for support. Depression can impact sleep and motivation and be also related to an increase in anxiety. Older adults facing depression frequently withdraw from activities they once found meaningful and engaging and this can further exacerbate the issue. Depression is linked to an increased risk of falls - as are the medications people take to manage this condition! All in all, depression is more than a sense of ‘sadness’ in older adults - it can have a wide-spread impact on health, wellness and overall quality of life especially in the aging population. 

2. Depression in older adults doesn’t always look like depression.

Depression in older adults may present with a range of signs beyond sadness, including persistent physical symptoms like aches and pains, changes in appetite or weight, sleep disturbances, fatigue, irritability, and agitation. Additionally, they may experience a loss of interest in previously enjoyable activities, difficulty concentrating or making decisions, feelings of worthlessness or guilt, and thoughts of death or suicide. Recognizing these varied symptoms is crucial, as depression in older adults can often go undiagnosed or be mistaken for other age-related changes, highlighting the importance of early identification and intervention to ensure optimal mental health and well-being.

3. Exercise can have a significant impact on depression.

Exercise and depression has been well-researched. Regular participation in aerobic exercise has been shown to reduce depressive symptoms by 30-47% in randomized control studies as compared to control groups. Exercise improves brain health, and reduces depressive symptoms in a variety of ways. Exercise stimulates blood flow to the brain, which improves energy and motivation, and encourages neurogenesis and synaptogenesis (fancy words for more neurons and more neural connections = faster brain speed and better brain health!). It also promotes release of endorphins, neurotransmitters that act as natural mood elevators, and helps to regulate stress, reduce inflammation and improve sleep quality - all factors that contribute to improved well-being and reduce depressive symptoms. In fact, it has been demonstrated (in randomized control studies like the SMILE trial), that exercise is AS EFFECTIVE as antidepressant medications at treating major depressive symptoms - with NONE of the side effects.

4. Exercise can reduce pain (and pain is linked to depression!)

Upwards to 50% of older adults report they struggle with chronic pain. Exercise is the GOLD STANDARD for treatment for chronic pain. Aerobic exercise in particular manages chronic pain well by improving circulation, releasing endorphins, improving management of arthritis and improving muscle health, and by promoting the normalization of neural circuits that have become maladaptive due to long term exposure to the pain cycle (story for another blog post..). Pain also keeps older adults from participating in social experiences and in the community, further increasing isolation and encouraging depression. Less pain = less depression!

5. The best exercise for depression is…

While the research points towards aerobic exercise as the most effective exercise to manage depression, I personally think the exercise that you ENJOY is the one to choose if you are hoping to use exercise to improve your mental health. If you enjoy what you are doing, you are more likely to be CONSISTENT with your exercise, and it is the consistency that will make the most impact. Take a walk each morning, try a zumba class at your local senior center or work with a therapist or trainor to develop a strength training routine. Whatever exercise you choose (and bonus points for doing it all!), you can feel secure that any steps you take to improve your activity level WILL have a positive influence on your mental health. 

If you are an older adult struggling with depression, or worried about a loved one who may be experience depression, I also want you to know there are some really helpful resources out there. For more information about depression in older adults, check out the links below:

Depression is Not a Normal Part of Getting Older:

https://www.cdc.gov/aging/depression/index.html

Older Adults and Depression PDF from the E4 Center:

https://e4center.org/wp-content/uploads/2021/04/Older-Adults-and-Depression.pdf

Caregiver Guide: Depression from HealthInAging:

https://www.healthinaging.org/tools-and-tips/caregiver-guide-depression

Older Adults and Depression Guide from the NIH:

https://e4center.org/wp-content/uploads/2021/09/Older-Adults-and-Depression.pdf

On Recovery and Resilience: Three Things I’ve Learned in the Hardest Season of my Life

On August 29th, 2023, my mom developed Covid, had a seizure, and became unresponsive for twenty five minutes. For ten of those, I held her, alone, waiting for the EMTs, and thought she was brain-dead or dying. At one point, she turned blue and I gave her mouth to mouth. I still don’t have the right words to describe quite what it was like, but I can tell you those ten minutes were long enough to go from confusion, to panic, to action, to acceptance.  Once the seizure stopped, I just held her and tried to breathe and kept asking her to do the same, telling her over and over ‘you’re okay, mom, I’ve got you, you’re okay, keep breathing.’ I should mention that my mom has had Parkinson’s disease for 20 years, so while considering the inevitability of her mortality is nothing new or shocking to me, I definitely didn’t think it was going to be like this. 

While I have wanted to write about this experience for some time now, I didn’t quite know how. While two months seems so short in retrospect, it feels like it has been much longer since this event. These past two months have been one of the hardest seasons, literally and metaphorically, in my life. However, time and perspective has helped me frame my thoughts in a way that I hope will help some of you get through your hard seasons, too.

Most importantly, I’ve learned that my body (and your body, too) has limits. 

Most people I know fall into one of two camps when ‘the going gets tough’ - either they give up and don’t do anything because it either seems too hard or too futile, or they push right through, past any sort of reasonable or healthy limits because they don’t know any other way. I, for one, always fall into the latter. And so that’s what I did.

I am grateful to be able to say that my mom did regain consciousness, right as we rolled into the hospital in fact. She looked up at me from the gurney as she was rolled into the ER and, almost sounding amused, said ‘hey, what are you doing here?’ (Cue my own shock, disbelief, relief and a big WHAT IS HAPPENING!?!) The seizure was followed by a week in the hospital, a battery of tests, and a course of remdesivir and steroid to treat her Covid. She was later discharged to short term rehab and eventually returned home, back to her independent living apartment where she now needed 24/7 care. I went from being a ‘distant supervision’ caregiver (calling to check in, weekly visits with the kids, paying her bills, taking her to her medical appointments) to a full-time, very overwhelmed, daughter-caregiver to a mother who not only was recovering from the physical effects of covid, a seizure, and a hospital stay, but also the cognitive impacts; my mom suffered short term memory loss after this event which lasted about 3 weeks, requiring many reminders why she was in the hospital, support throughout the day, and the brunt of her medical care coordination now fell onto my shoulders. I would wake up each day, do some work for ‘actual work’ and then drive down to Gloucester to spend the day at the hospital with her. I’d drive home sometime in the evening, make dinner for the kids (or eat leftovers if my husband beat me to it), sleep and start over again the next day. This continued this way over and over again for the next three weeks, as I also incorporated a return to work, the kids’ return to school, and everyone’s return to normal life. And as you can imagine, I wore myself out. 

I took this picture in the ER to send to our family to let them know she was alive!

This was at the end of week one in the hospital. Looking so much better!

Fast forward one month to the weekend of September 23rd, 2023. My practice was hosting a Fall Preparedness Workshop this particular weekend, which I had been preparing to launch for many months. I left the event, relieved it went well (and really relieved it was over), and started to feel unwell. I tested for covid - it was negative. I never left the couch on Sunday and woke up Monday with fevers, chills and a cough, and felt pretty darn miserable. I stayed home from work, stayed in pajamas, and spent the day in bed. Woke up Tuesday, still testing negative and decided to go to the doctor for a PCR and Flu test. All negative. Was sent home and told to ride out whatever virus I apparently had. Wednesday passed, and Thursday came, and I was still having high fevers and chills and feeling even worse. I went back to the doctor because at this point, I was concerned that something was really wrong. When my very conscientious nurse practitioner suggested a chest x-ray, I balked - ‘this can’t be pneumonia, I’m young, I’m healthy, I don’t even have Covid!’ Sure enough, half an hour later, she called back, told me I had pneumonia and put me on a smorgasbord of antibiotics. Turns out you can get pneumonia out of the blue, when you’re young and healthy…and wear out your body to the max.

So, I did what any normal Type A overachiever would do; I took the antibiotics and went back to doing all the kid/family/house stuff while I finished out the week home from work. I spent the extra day cleaning out my office (I even hauled a truly embarrassing number of bags of crap to the garage). I started to feel better by Sunday and went back to work on Monday. I taught all my fitness classes that week, too, letting my students know ‘I’m okay, but I may be coughing for a while’ and I pushed through. 

Don’t worry, the fun didn’t stop there. On the Thursday I found out I had pneumonia, we also went to our daugther’s back to school night (or as a friend appropriately called it ‘back to flu night’). While we left half way through, it turns out, it was long enough for my husband to pick up Covid somewhere between our homeroom, ELA and social studies visits. I was, of course, wearing my ‘I have pneumonia’ mask, so somehow dodged that bullet (for now..). Jason got sick on Sunday, tested positive on Monday and we quickly decided to banish him to the basement for the week to try to keep me from getting it, too. 

Well, as you can probably guess, our efforts were futile and I wound up with Covid, too. We managed to push it off a little, through our quarantine attempts, but my daughter had it by Thursday, and I was positive the following Monday. Fortunately, this round of Covid was nothing compared to the pneumonia, but it did exacerbate the symptoms I was still having from pneumonia. It also made me take a good hard look at how I treat my body. 

Having to take a forced Covid-cation with another 5 days out of work, gave me some time to think. I don’t get Covid easily. I’ve had it once in 3 years, and I’ve been exposed more times than I can count. I didn’t even get it when I gave my Covid-positive mother mouth to mouth! But here I was, Covid-positive myself, stuck at home again. Why was this happening to me? Why couldn’t I just ‘bounce back’ like I always do and get well again?

It was because my body has limits. And I was not respecting them. 

I had been through an emotional trauma. I had followed that emotional trauma by three weeks of running on adrenaline to take care of my mom and then immediately began layering in the chronic stress of work, kids and home-life and all the day-to-day, non-stop, going-and-going involved with all three. In the body, when an emergent threat is identified, we experience a rush of adrenaline and cortisol to drive the ‘fight or flight’ sympathetic response. This is good, and necessary! It allows us to do things like run from bears and fight off attackers! But, in theory, this should then ‘turn off’ when the threat is extinguished. However, when we have chronic stress in our lives, or run on ‘high alert’ in response to low-level threats and stressors, the cortisol never turns off and this causes systemic inflammation and leads to other issues like impaired sleep, impaired blood sugar regulation, higher blood pressure, increased weight gain, impaired cognitive performance..the list goes on and on. It also, very significantly, impairs your immune system and its ability to fight off disease.

I have a high-stress job; I manage a busy therapy practice and treat nearly full-time myself. I have two busy kids; I make their lunches, drive them to school, take them to their sports and extracurricular activities and try to be there for them emotionally. I am a caregiver for my mom; her needs vary, but when she is ill or injured, those needs go up and I’m on constant on-call. But I’m also used to this lifestyle, and my body is used to this lifestyle. I am active, exercise regularly and eat well. I sleep great and have amazing support systems - my husband, my friends and our family help whenever I need it. So, on an average day, week or month, I have it covered and my body can handle it. 

But, this event and the weeks that followed tipped the scales to a place where my body couldn’t handle it, and I couldn’t cope with the stress anymore. While I thought I could handle it, my body was telling me loud and clear what I needed to hear by failing on me. I need to learn the hard lesson that even my body has limits - and I needed to start to respect them.

I’ve also learned that recovery is NOT linear.

So, I started trying to listen. I took the next week off. I even canceled my virtual fitness classes. Could I have ‘handled’ teaching them? Sure, physically I could do it. But would it be good for me? No, not at all. So I sent out the emails. I canceled all my patients. I made my peace that this would be a ‘do nothing’ week. I was feeling better, but knew I had to dial it WAY back to give my body time and space to heal. I took breaks. I cooked bone broth and chicken soup. I made sure I stayed hydrated.  I asked for help.  I went to bed early. I did all the things I should have been doing a month ago…and in reality, these are things I should have been doing all along. 

I also learned that Recovery is NOT linear. Between my mom, and pneumonia, and then covid, I had not been able to exercise for four weeks. I did get one session with my trainer in after-pneumonia and pre-covid, but then was out again for another week. When it came time to return to the gym, I told her I was going to do what I can, but was going to have to take it slow. That first session back, I made it 37 minutes before I started to feel dizzy and out of breath (There is a time clock, so I started making a habit of identifying when I got to my ‘maxed out’ point so I could track my progress). The next session I made it to 43 minutes, then 49, then 51, and finally this past Friday, I made it the full hour and I felt good. I felt like I was back! Then I went back to Hot Yoga on Sunday, and by the 45 minute mark, I was absolute toast. I’ve never had to bail out of a sequence or stop and take a child's pose, but in the middle of my 75 minute class, there I was, laying on my back, just trying to breathe while everyone around me downward dogged and warrior’d their way through class. It was humbling to say the least. 

But as I now know, recovery is not linear.

Maybe it was the heated room, or the fact that I had a cosmo on Saturday night before bed. Who knows. But the important part is that I am learning to listen to my body. Instead of pushing through, I took a (very) extended savasana and used the time to rest. It felt good. I didn’t feel ashamed or weak, I felt proud I was learning to listen to my body (I also really, really didn’t want to be that yogi who passed out cold in the middle of my tree pose - maybe they could call it falling tree and name it after me?). 

Like yoga, our body’s only goal in life is to maintain homeostasis, which means it is in a constant state of trying to maintain balance. If you’re hot, you sweat to cool off. If you’re cold, you shiver to warm up. If you’re dehydrated, your brain triggers thirst. Low on sugar, it triggers cravings. If you’re injured, you bleed so your immune system can shuttle white blood cells to the surface to clot and heal your wound. We all go about our days, generally oblivious to all the hard work going on under the surface, that literally keeps you alive from moment to moment. The body is a truly incredible, self-sustaining, machine. There will never be a computer or artificial intelligence quite as impressive.

While you are in a state of healing, whether from trauma, illness or injury, your body has different needs. It needs more sleep to allow your immune system to function properly, better nutrition to allow for tissue remodeling and plenty of hydration to support all the metabolic and energy systems. What may be considered an ‘easy’ activity for your body during a normal state of health, may be more taxing, more draining and use more resources when your body is in a state of healing. This means if you have a day that uses more energy, for whatever reason (less sleep, less nutrition, dehydration or simply, more stress and activity), then you are likely going to feel worse that night or the next day because you have ‘less in the tank’ to begin with than you are used to. So, while I heal from my own trauma and illness, I’m trying to be mindful that some days I can do it all, and, some days I just can’t.

To support myself as I recover, I’ve been working on making positive changes. Some changes are designed to support my mind, and some for my body, but in reality, the mind and body are so intertwined that they really support both. 

1. I am slowing things down. I’m not putting pressure on myself to return every email immediately. I’m being conscientious of wrapping up for the day on time, and putting aside work until tomorrow. I’m taking time to do more downtime activities like read or simply lay down with my feet up and rest.

2. I am eating regular meals and focusing on hydration. No more missing meals to make it somewhere on time or ‘get one last thing done.’ I’m taking the time to actually pack a lunch and focusing on protein to support my body as it recovers physically and I’m trying to drink a gallon of water a day to really give it what it needs and then some. 

3. I am saying ‘no’ more often and better prioritizing the things that I do have to take on. I’ve left boards and committees that can live without me, turned down extra work projects and tried not to overcommit myself, spreading meetings and events out more, instead of trying to get things scheduled ASAP as I usually do.

4. I’m streamlining anything I can. I started thinking about the weekly things I do that feel overly time consuming or draining, and I’m trying to find ways to make them more efficient. I restarted our organic produce delivery service, and added in a monthly butcher box delivery. I’ve let myself rely more on weekly meal services, too, to cut down on how much cooking I have to do on my busy days. During the *many* days I was stuck at home, I streamlined some of my work processes too, and created a structured task-flow for my routine to keep everything more manageable and organized. 

5. I’m taking more time for self-care. I know it’s overused and a little cliche, but you can’t pour from an empty cup - and mine has been bone-dry for a really long time. For me, this is making time for exercise, yoga and booking the occasional massage. It’s taking the extra long shower instead of rushing out to make dinner. It is taking the time to read and finding time to see friends. Sometimes it’s just sitting for a few extra minutes in my car to get caught on text messages and read the news before I walk in to deal with the demands of my household. 

6. Lastly, I’m taking time to breathe. Literally. My goal is simple - take ten minutes a day to just stop and breathe. I didn’t put any more rules on it than that - I can listen to a meditation, do some restorative yoga or just lay there and tune out the world. Breathing is like a reset button for your body; a gentle nasal inhale followed by a slow, controlled exhale stimulates your Vagus nerve and literally tells your body to chill out. It allows it to enter a state of ‘rest and digest’ instead of the constant ‘fight or flight’ we all get stuck in throughout the day. It’s cheap and easy and you can do it literally anywhere and it's a simple, effective way you can reduce your stress and improve your overall health. 

Lastly, I’ve seen first-hand, the impact of RESILIENCE.

Resilience is the body’s ability to withstand stress - physical and emotional. If you have high resilience, you are more capable of coping with stressors and can heal and recover more quickly. If you lack resilience, this process can take longer and you are at an increased likelihood of complications and functional decline. We develop resilience primarily through exercise, but also through healthy habits like sleep, good nutrition and adequate hydration. 

My mother bounced back from Covid AND a significant neurologic event in three weeks. THREE WEEKS! She has had Parkinson’s for TWENTY YEARS. I had to literally keep reminding her why she was in the hospital because she kept forgetting she had Covid. There are many studies that clearly correlate the impact of even 48 hours in a hospital bed on a reduction in strength and functional capacity. Prolonged stays can lead to sarcopenia and permanent functional setbacks for older adults and people with progressive diseases like she has. She spent the first few days resting in bed, but as soon as she was ready, I got her up, sitting in a chair, walking laps in her room and doing some basic exercise. By the time she got to rehab, she was antsy to get moving, she got busy reorganizing her room and planning her exit strategy. She was sent home with Home Health therapies, and they discharged her almost immediately because she was so high level and no longer homebound. How did this happen? Why did she not rapidly decline and waste away like so many people in her situation would? Because she is RESILIENT. Over the past 20 years, she has made it her mission to fight Parkinson’s Disease with whatever resources she has. She made exercise a regular part of her life, still working out twice a week with a therapist, often ‘racing’ up and down 6 flights of stairs as part of her routine. Yes, she has a progressive neurological disease and yes, she has declined over the past twenty years, but she has managed to slow this process down, maintain her independence and develop an impressive level of resilience that has enabled her to heal and recover more efficiently from events like this. 

I also feel like my own resilience supported my recovery from Covid and pneumonia. While pneumonia had me down and out for a week, as soon as I got the proper treatment, I started to bounce back. I was able to return to work the next week, get back to my other household responsibilities and resume my gym workouts, albeit a little slower and a little more out of breath than normal. When I got Covid on top of it, I was really worried I could wind up in the hospital. I had heard of Covid Pneumonia, but not Pneumonia then Covid! But it felt like a small bump in the road instead of a crater. I took that week to rest, but then got right back to my routine after my quarantine ended. Within about two weeks of getting back to my strengthening routine, I could make it through the full 60 minutes feeling pretty darn good. I could feel my energy returning daily and by about 3-4 weeks from my initial pneumonia diagnosis, despite having Covid in the mix, I felt pretty close to my normal self. I know this could have been a lot worse. We lost two local parents in our community from septic pneumonia in the past few years, so it’s fresh in my head how serious this can get and how quickly. I truly credit the fact that I lead a healthy lifestyle, exercise regularly and take regular action to make decisions that support my resilience.

I speak to my patients about resilience on a regular basis. As we age, resilience can make the difference between a UTI that can be treated at home with a round of antibiotics and a UTI that turns septic, or leads to a hospital stay, which leads to weakness and loss of balance, which leads to functional decline, which leads to a loss of independence. I often refer to the Slippery Slope of Aging; while injuries and illness are small bumps in the road when you are healthy and active, they become more serious and have a larger impact when you are inactive and frail. The goal should be to stay as high as you can on the Slope, so you can be more resilient in the face of such injuries, illnesses and chronic diseases. 

Do you want to live a life of Fun or Failure? Resilience is what keeps keeps you higher on the Slipper Slope of Aging!

While there is no magic pill (or even a cocktail of pills!) that can build resilience, it is simpler than you might imagine. The key is Activity and Exercise. It’s that simple. Activity is a global look at how much you move; do you sit for the majority of the day or move around frequently, get outside and stay active in your community? Exercise is structured and goal-driven; every adult should aim to participate in 150-300 minutes of moderately-intense physical exercise each week, including 2-3 sessions of strength training and regular balance and flexibility work. Consider this your most important prescription you’ll receive for your health - regular exercise has shown to reduce your chance of premature death by 30%! It is often more effective at treating depression than medications, and inactivity is an independent risk factor of almost all the chronic diseases that impact our older adults and create such strain on our medical systems. It’s the real deal, folks! If you aren’t yet finding ways to exercise regularly, it’s not too late. Studies have shown that even adding in 1 Minute bouts of ‘exercise snacks’ like squats or taking the stairs can have positive impacts on your health, and as little as 10 minutes of walking a day can make a difference.

This is what resilience looks like.

While I wouldn’t wish my ‘hard season’ on anyone, I am grateful for the lessons I’ve learned from it. Illness, injury, stress and trauma are, and always will be, a part of the human experience. While we can’t prevent all of these unexpected twists and turns, we can improve our ability to cope with them, by building our resilience. I hope at the least you were entertained by my recent tales of woe, and at best, that you take something from my experience that you can apply to your life to improve your own resilience and ability to weather hard seasons, too.

May Staff Meeting Updates

Did you know that HAPT meets monthly to review patient cases and provide feedback and ideas, as well as for in-services and education? (Ten heads ARE better than one!) As much as I love learning, I love teaching even more, so thought I'd share a few lessons learned with you.

This month we were lucky enough to have two great presentations. First, Dahlia Cohen, Registered Dietician, spoke to us about Nutrition in Parkinson's Disease. We learned that weight management, in particular keeping weight ON, is a big issue for people with Parkinson's Disease. Not only are there changes in taste, swallowing and digestion that can be problematic, but due to the extra movement and muscle resistance that occurs in movement disorders, individuals with PD are often burning way more calories than normal during the day. This creates an energy deficit and this leads to weight loss. How can we help our patients with this problem? Here are a few ideas Dahlia gave us:

• Encourage 3 meals a day + 3 Nutrient Dense snacks (like greek yogurt, or nuts).
  

•  Make sure to get adequate amounts of protein throughout the day. Your body can only digest about 30 grams at one sitting, so one big steak at dinner won't cut it. Try adding in smaller amounts, more frequently, making sure to time around your meds (levodopa competes with protein for receptor access, so it can make your meds less effective if taken with protein!). Protein is best eaten 30 minutes before taking levadopa or 60-90 minutes after taking meds.

•  Don't forget your fiber! We need 25-30 grams of fiber/day for optimal digestion and bowel management, and constipation is even more common in PD because gastrointestinal motility is slowed. Adding in green vegetables, whole grains and beans to your daily diet is helpful, and supplementing if needed with something like Metamucil can be helpful when needed.

After we finished learning about what to take in, we talked about 'how it comes out' with our staff PT, Katie Moulison. Katie just finished a great course in Pelvic Health and shared some helpful considerations for working with individuals who may be experiencing incontinence as they age. Here are some helpful take home messages:

•  Incontinence is common, but not a normal part of aging and there is a lot we can do about it. Wondering if how often you wake at night to 'go' is normal? Normal nocturia (peeing at night) is waking 0-1 times to get up. If it's more often than that, it can disrupt sleep cycles, leave you more tired during the day and lead to increased risk of falls.

•  Dehydration, constipation and bladder irritants are all common causes of increased frequency, urgency, nocturia and leakage (PS. the acronym FUNL can help you remember what to ask your patients about!). 

•  If you're wondering about your own bladder habits, or trying to help a patient problem-solve their incontinence troubles, start by keeping a Bladder Diary and share it with a pelvic health specialist to get their take. There may be some simple strategies we can try to make it better!

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

How NOT to Fall on the Ice this Winter

It’s Black Ice Season here in Boston and time for me to share my best tips for how NOT to fall on the ice.

But before I do, I have to share my #1, Hands-down, favorite video on the internet. This came across my feed years ago, and I still watch it every so often just because it cracks me up every time. I don’t know if it’s the dad’s laugh, or the fact that I so relate to spending hours waiting in pick up lines outside of schools, but it is absolute gold. Don’t worry, no teens were harmed in the making of this film.

Now, onto the good stuff. What is the best way to avoid taking a digger on the ice this season? Here are my Top 5 Tips to Keep You on Your Feet (and off your rear!) this Winter:

1) Invest in a pair of Ice Cleats:

These come in various brands, shapes and sizes, but a good pair of ice cleats can be your best friend. They are generally mesh and can wrap around whatever shoes or boots you are wearing to give you better traction on the ice. I typically recommend Yak Tracks (See on Amazon here), but LL-Bean also sells their own version (LL Bean Stabilizers), as does REI and other Outdoor stores.

2) Ice-Proof your Cane:

Whether you use a cane on a regular basis or not, it can be a helpful tool in the winter, especially if you add on an Ice-Tip (See Vive Ice Tip on Amazon here). Another great alternative is a hiking pole, and these generally come with a set of tips for various conditions as well (this one is the kind I typically use). Having something to ‘grab’ the ground with, in case of a slip, can be the difference between a ‘phew’ and a hard landing.

3) Walk like a Penguin:

When you’re out there trying to get from Point A to Point B, walk like a penguin! Take wide, short steps and avoid pushing off at the end. Basically, waddle like a penguin! It may seem silly, but it works:

4) Bulletproof Your Balance:

We all know that Prevention is the best Medicine and when it comes to walking around this winter, this is especially true. We all have these automatic fall-prevention reflexes, called Reactive Balance Strategies, that are designed to help us regain our footing after a loss of balance. Whether that is a little ankle rock, bending over at the trunk to lower your center of mass, or getting a foot out there to step and prevent a fall, these need to be practiced to remain effective! If you’ve been having falls, or even find yourself having a lot or near misses, it may be a good time to see a Physical Therapist to work on your balance. Even if you feel like your balance is pretty good, as you age, it’s a good habit to do some regular balance exercises to keep it up to snuff. Check out our Otago Exercise Page for a routine you’d an try at home, or join us at one of our Strong and STEADI sessions if there is one available near you. Looking for 1:1 Balance Training? Contact us today to see if we can help.

4) Stick the Landing:

Slips, trips and falls happen, so if you’re going down, you’re better off knowing how to land. We’ve put a page together with helpful tips on how to land safely to reduce risk of fractures and other injuries and practice this skill often with our patients. If it can mean the difference between a bump or bruise and a hip fracture or head injury, believe me, it’s well worth it. Check out our How to Fall Safely page here.

We hope these tips keep you on your feet and off the ice this winter! Physical Therapists like us are Fall Prevention Experts and we love to help. Read more below to learn about our practice, meet our therapists and find out how to get in touch so we can help you stay safe this winter.

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.

How do we RETRAIN the BRAIN?

Ever wonder how to RETRAIN the BRAIN? Read on learn all about the wonderful world of NEUROPLASTICITY….

I asked a patient of mine to do a particular exercise "100 Times a Day" last week. I told him I didn't care if he did it 100 times in a row or if he breaks it up throughout the day, but I told him it was the only thing I wanted him to focus for the week. I walked in today, and not only did he tell me he's done it every day, but that one night he went to bed at 11:30PM, realized he forgot and got OUT OF BED to do his last 25. (Yes, this WAS the highlight of my day!)

Now, this is not something I do all the time, and certainly not an effective way to strengthen a muscle or stretch something tight. But what I wanted to do, is 'retrain' his brain to recognize a movement pattern and perform it better to improve his walking pattern. Did you know it takes an average of 2000 trials for an animal to learn a reward-motivated pattern (like tapping a lever for a treat), and even more for athletes or musicians to master a new motor skill involved with their sport or craft?

Rehab is no different. If we are asking our patients to make changes that we hope become habit, we need to follow the principals of neuroplasticity (neuro-what??! Yes, neuroplasticity is one of my favorite words - no surprise there, right!). Neuroplasticity is the ability for the brain to change - and this change can be positive, like learning a new skill, or negative, like losing a motor pattern like walking, dressing or eating, after experiencing a stroke, brain injury or other neurologic injury.

So what encourages 'positive neuroplasticity' - and how DO we 'retrain the brain?' It's simpler than you may think:

1. Repetition: Back 'in the day,' (aka when I went to grad school), it was thought that we had to complete repetitions in perfect form to retrain the brain properly. This meant lots of hands-on guidance from therapists, and even passive exercise like forced cycling. Fortunately, what the research has shown lately, is that the movement doesn't have to be perfect, but it does have to be repetitive...and INTENSE.

2. Intensity: Like the old adage says, nothing good ever comes easy, and harnessing the power of neuroplasticity is no different. Retraining the brain is just like strengthening a muscle. If I wanted stronger biceps, lifting a one-pound weight over and over is not going to cut it. I'd have to lift something heavier than I can currently handle, to stimulate the muscles to grow STRONGER to be able to manage this new load. The brain is the same. We need to give it a task that requires focus, concentration and demands attention. It needs to be INTENSE to give the brain a good reason to pay attention!

3. Saliency: PS. It's also got to MATTER. The brain pays more attention to something that it cares about. Picture someone on an assembly line doing the same menial task day in and day out. This is not salient to that person, but making money to feed his or her family may be, so they show up and do it again each day. We've got to choose tasks, and activities that are interesting, motivating and personally relevant to our patients, to encourage neuroplasticity. Whether this means linking an exercise or activity directly to one of their personal goals, or engaging them in activity that they get joy, pride or some other form of satisfaction from participating in, it’s got to MATTER to make a DIFFERENCE.

4. Repetition: See what I did there? (ahh, PT jokes...), but seriously, repetition MATTERS, maybe more than anything on this list. I'm learning as I become a more experienced (/OLDER) clinician to give less, while giving more. Ever been gone to PT and been given 10 pages of exercises only to 'lose them' on the way home, or tuck them away somewhere never to be seen again? (yes, I have too...no judgement here). What if we give them ONE thing to focus on - that hits all these criteria - something intense, meaningful and challenging - and ask them to do it over and over again? THAT'S where the magic is going to happen.

So back to my motivated, compliant, amazing patient above. Guess what? I came back to today, and he was walking BETTER. Five days of specific focus on one activity. It works, guys, I promise...

Who are we and where do we go?

Healthy Aging Physical Therapy provides Physical and Occupational Therapy in the comfort of your own home (“Outpatient at Home”). We accept Medicare B, Blue Cross Blue Shield and most Medicare Advantage Plans and provide care in the following communities: Concord, Arlington, Belmont, Lexington, Winchester, Woburn, Stoneham, Melrose, Medford, Malden, Wakefield, Lynnfield, North Reading, Reading, Middleton & Peabody, Massachusetts.

We specialize in caring for the older adult, people with Parkinson’s Disease and other complex medical and neuromuscular conditions.