Essential Summer Exercise Tips for Older Adults: Stay Safe and Healthy in the Heat

Written By: Dr. Allison Leonard, PT, DPT and Healthy Aging Physical Therapist

With summer heat here to stay, it’s crucial to be prepared to avoid heat-related illnesses, especially for older adults. As we age, our bodies become more susceptible to dehydration and injury, making it important to take extra precautions when exercising in hot weather. Older adults may have a diminished sense of thirst, reduced sweat production, and often take medications that can affect hydration levels. Additionally, the body’s ability to regulate temperature decreases with age, increasing the risk of heat-related issues. To help you stay safe and active this summer, here are some valuable tips to keep in mind:

1. Exercise Early or Late: Schedule your workouts during the cooler parts of the day, such as early morning or late evening.

2. Stay Hydrated: Drink plenty of water before, during, and after your workout. Avoid alcohol and caffeinated drinks as they can dehydrate you.

3. Wear Lightweight Clothing: Choose loose-fitting, light-colored, and breathable clothing to help keep your body cool.

4. Use Sunscreen: Apply a broad-spectrum sunscreen with at least SPF 30 to protect your skin from harmful UV rays.

5. Take It Indoors: Consider indoor alternatives such as gyms, swimming pools, or home workouts. Indoor malls, big box stores like Target or Costco are great options for getting in your steps.

6. Lower the Intensity: Reduce the intensity of your workout to avoid overheating. Listen to your body and take breaks as needed. Use less weight/resistance, shorter periods of exercise and longer rest periods.

7. Acclimate Gradually: If you're not used to the heat, gradually increase the duration and intensity of your outdoor workouts over a week or two.

8. Know the Signs of Heat Exhaustion: Be aware of symptoms like dizziness, headache, nausea, excessive sweating, and rapid heartbeat. If you experience any of these, stop exercising, move to a cooler place, and hydrate.

9. Cool Down Effectively: Use cooling towels, take cold showers, or apply ice packs to lower your body temperature after exercising.

By following these guidelines, you can stay active and healthy even during periods of extreme heat. Stay cool AND stay active!

Enjoy Summer WITHOUT Back Pain: Effective Strategies to Reduce Back Pain in Older Adults

Written By: Dr. Tracey Berman, PT, DPT and Healthy Aging Physical Therapist

It is a beautiful summer day, and you bend over to grab your bag to go to the beach. Suddenly, ouch! You feel pain in your lower back. Back pain is never fun to deal with and can put a damper on your summer plans. But remember, you are not alone. According to the National Institute of Health, back pain is one of the most common reasons people visit their doctors. As we age, various factors can contribute to back pain. Sometimes it is muscular, and sometimes it is structural. Finding the cause of your back pain can direct your course of treatment, and most treatments will involve some type of therapeutic exercise.

Understanding the Causes of Back Pain in Older Adults

Osteoarthritis: A Common Structural Cause

As we age, one of the structural causes of back pain is osteoarthritis. This is the breakdown of cartilage, the tissue that covers the ends of bones where they form a joint. When this tissue breaks down, bones are left unprotected and rub together, causing inflammation and pain. Osteoarthritis can also narrow the small holes that direct the nerves of the spine, often resulting in tingling, numbness, and pain that can radiate down your leg, commonly known as sciatica.

Osteoporosis: Loss of Bone Mass

Another reason for back pain as we age is osteoporosis, or the loss of bone mass. Your vertebrae can weaken to the point that you lose height, develop a hunched posture, and experience back pain. In some cases, this weakening can lead to fractures in the vertebrae, which can be quite painful.

Muscular Changes and Their Impact on Back Pain

Decreased Flexibility

Flexibility, or how limber you are, diminishes as we go through life. Normal aging involves a loss of collagen, which increases stiffness in our spine and joints and reduces the elasticity of muscles and tendons. This stiffness can make us want to move less because some motions cause pain, creating a cycle of moving less and becoming stiffer.

Sarcopenia: Loss of Muscle Mass

Sarcopenia, the loss of muscle mass and strength, can begin as early as your 30s. Physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after age 30. Weaker muscles make you more prone to injuries like back sprains and strains.

How Back Pain Affects Daily Activities

Back pain can significantly impact how we move throughout the day, interfering with activities like standing in line at the grocery store, sitting to watch TV, reaching up in cupboards, climbing stairs, or picking up grandchildren. This pain can cause us to move less to avoid discomfort, but sometimes movement can actually help reduce pain by increasing blood flow and fighting inflammation.

The Role of Exercise in Reducing Back Pain

Aerobic Exercise

Walking is a fabulous low-impact aerobic exercise that can help reduce back pain. Swimming and cycling, whether on the road or a stationary bike, are also excellent options. Aerobic exercise promotes blood flow, bringing nutrients to the spine and boosting endorphins, the body’s natural painkillers.

Strength Training

Strength training builds muscle strength and doesn’t require a gym membership or heavy weights. Your physical therapist can guide you through appropriate strength training exercises using body weight, resistance bands, and light weights. Strengthening your core muscles is crucial for protecting your spine. Core muscles include your obliques, transverse abdominals, and rectus abdominals, which form a “corset-like” support for your spine.

Stretching

Stretching improves flexibility and can alleviate pressure on joints, especially for those with osteoarthritis. Incorporating yoga poses like child’s pose and cat-cow, along with static stretching routines for your hamstrings, hip flexors, and trunk muscles, can be beneficial.

Balance and Stability Exercises

Balance exercises, such as standing on one leg or walking with slow head movements, activate the small postural muscles in your back that help you stay upright. Stronger postural muscles provide more support for your back, reducing pain. Tai Chi is an excellent exercise for improving balance and incorporating deep breathing, which helps decrease muscle tension.

Starting an Exercise Program Safely

Getting Started

First, get medical clearance from your doctor before starting any exercise program if you have any unstable medical conditions or other health concerns. Start slowly and for short periods, keeping a journal to track your progress. Listen to your body and recognize signs of overexertion, such as fast breathing, dizziness, or chest pain. Warm up before exercising, and cool down afterward to allow your heart rate and blood pressure to return to pre-exercise levels.

Avoiding Common Mistakes

Proper technique and form are crucial to prevent injury. Avoid bouncing in a position, ignoring your limitations, and lifting weights that are too heavy. Consult a physical therapist or reputable instructional videos for guidance.

Diet and Sleep: Supporting Your Back Health

Maintaining a Healthy Weight

Carrying excess weight can strain your back. Aim to maintain a healthy weight through a balanced diet and regular exercise. Incorporate anti-inflammatory foods like tomatoes, olive oil, green leafy vegetables, nuts, fatty fish, and fruits such as strawberries and blueberries. The Mediterranean diet is a great example of an anti-inflammatory diet.

Proper Sleep Positions

Supporting your back during sleep is crucial. If you’re a side sleeper, place a pillow between your legs to keep your spine aligned. If you sleep on your back, place a pillow under your knees to relax your back muscles. Try to avoid sleeping on your stomach, but if you must, place a pillow under your hips to reduce strain on your back.

Back pain doesn’t have to ruin your summer plans. By understanding the causes and implementing a comprehensive management plan that includes exercise, diet, sleep, and other pain management tools, you can ease the pain and enjoy your favorite summer activities. Talk to a physical therapist to develop a personalized plan to keep your back healthy and pain-free.

Staying Hydrated: A Vital Guide for Older Adults During the Summer Heat

While it may be ‘hot girl summer’ everywhere else you look, here over at Healthy Aging, we’re entering ‘hot patient summer’ season. Last week, as temperatures climbed, I challenged my Parkinson’s class to a drinking contest - except instead of chugging beers, we tried to finish a bottle of water between exercises. While for most people, summer heat brings thoughts of bathing suits, pool parties and barbeques, for me, and most of my home health colleagues, we go to thoughts of dehydration, low blood pressures and passing out. So, as the summer heat approaches, I want to talk to you today about staying hydrated. Hydration over the summer is crucial for everyone, but especially older adults. Dehydration can lead to serious health complications, but with a few simple strategies, it’s easy to stay hydrated and healthy throughout the season. 

Why Are Older Adults More Prone to Dehydration?

Several factors make older adults more susceptible to dehydration. Older adults tend to have a reduced thirst sensation combined with lower kidney function. With aging kidneys becoming less efficient at conserving water, while we lose more water, we also have less drive to replace it. Older adults also often take medications that impact hydration like diuretics that lead to increased urination, or anticholinergic drugs that lead to reduced sweat production. Many older adults have mobility limitations, and try to avoid the ‘extra walks’ or nighttime waking to use the bathroom that they fear may come with increased hydration. Lastly, you may also notice that you sweat less when you get older. It’s not all in your head! Older adults sweat less as they age due to reduced sweat gland function and impaired thermoregulation - this means that on top of reduced hydration, they are less able to internally cool themselves down! All these factors combined make dehydration one of the most common causes for hospitalizations in older adults - especially in the summer months.

How do I know if I’m dehydrated?

While younger adults may be able to quickly identify the signs of worsening dehydration and take quick action, the signs in older adults can be a little tricker, often leading to delayed treatment. The most common signs we see when we suspect a patient may be dehydrated are dizziness, especially when coming to stand, and confusion. Orthostatic hypotension, a drop in blood pressure related to changing position when coming from laying down to sitting, or from sitting to standing, can happen at any time, but dehydration can make this worse. Confusion or irritability, or any other changes in mental status can also be a confusing symptom especially in an older adult who may already have some form of dementia, but look for worsening confusion from their norm. Other common signs of dehydration in older adults include reduced urine output, increased muscle cramping, dry skin and a rapid heart beat.

How do I prevent dehydration?

The easiest way to treat dehydration is to PREVENT IT! Try to drink 8 glasses of water a day, choose fluid-rich fruits like watermelon and oranges, veggies like cucumbers and other foods like soup and smoothies that can give you a little extra hydration throughout the day. Keep an eye on drinks that make you LOSE fluid and avoid excessive caffeine, soda and alcohol - or at least pair them with a glass of water to off-set the fluid loss. Stay cool by dressing in light, ‘flowy’ clothes and carry a bottle of water with you wherever you go to sip on throughout the day. Try to drink BEFORE you feel thirsty, even if it’s just a few sips at a time. Prevention can make a world of difference.

How do I treat dehydration?

If you are already feeling the signs of dehydration, don’t panic! Try to move to somewhere cool and rehydrate. Rest for 30-60 minutes and see if you start to feel better. If the symptoms don’t improve, or you experience any fainting, fevers, changes in heart rate or chest pain, nausea, vomiting or diarrhea, it’s time to get some help. Call your PCP for further instruction or go to your local urgent care or emergency department. While mild dehydration may be easy to treat at home, severe or ongoing dehydration can lead to serious medical complications like kidney failure, urinary tract infections and heat stroke. The faster you get the proper care, the better!

Challenge a friend to a drinking contest!

Now that you know the signs, symptoms and treatment of dehydration - let’s have some fun. Challenge the next person (or patient) you see to a drinking contest! Suggest you both take sips of water between conversation, exercises or along a walk and see who can empty their bottles first. Try flavoring water with hydration tabs or fresh fruit or make it fun by using a special glass, straw or turning it into a summer mocktail. Want a fun recipe to try? Here’s my favorite thirst-quenching mocktail: Fill half your glass with coconut water, and top it off with a flavored seltzer or fruit juice. The cool coconut flavors will take you to a warm, sandy beach in your mind - and your body will be hydrated. Win-win:)

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.