Knowledge Is Power

I recently read an interesting article in the New York Times Health section discussing informed consent in medical treatment. Sounds exciting, right?

Informed consent – a term your doctor probably uses quickly, if at all – sounds in-depth and jargon-y and like it will take a long, painful time to get through, and I’m sick and just fix me already, would you? Wading through the medical-and-legalese can be eye-glazing and overwhelming. You probably don’t need to read this story to know what I’m talking about.

Despite this, as patients we often hastily agree to whatever our doctor recommends rather than risk appearing to not understand what our doctor is telling us, or not wanting to waste their time with our questions. This is human nature, so don’t feel bad if this sounds like you! This is also unfortunate, because whether you’re in for heart surgery or a sinus infection, you should know what your doctor plans to do with your body, what you should expect to happen because of this, and what else could happen by following the treatment plan or by rejecting it.

Sometimes this knowledge doesn’t change a treatment plan: When I was diagnosed with Hodgkin’s lymphoma, we spend an hour with my oncologist going through his proposed treatment plan, how he expected my body to respond, and what I might experience with side effects. He was very thorough and I’m sure I didn’t hear more than about 20% of what he said. Regardless, when he asked at the end if I wanted to go ahead with treatment, I said “You Bet” and we got started. But after everything sunk it, you can bet that over the next month I pestered every nurse and doctor involved in my treatment about the fine points of this drug, that pill, what does what, and why is this other thing happening. If I didn’t understand the answer, I would ask them to dumb it down. And I’m glad I did…

Sometimes this knowledge does change the plan: About two months into my chemotherapy treatment, I had turned into a rage machine. I was angry all the time, at everything, and truly awful to be around. When I realized I was livid as soon as I opened my eyes in the morning, I knew there was something going on beyond the whole “mad that I had cancer” phase. I knew that the steroid doses given to prevent nausea after a chemo treatment can make a person more prone to anger and depression, so I called my doctor. We dropped the steroid dose, and I was back to a much more normal, tolerable state. If I hadn’t been aware of that potential side effect, I may have been murdered by my family before I could finish cancer treatment.

It pays to know your treatment’s side effects, and to know your body!

This is true whether you’re in a serious situation, as I was, or if you have a mild sinus infection that your doctor wants to treat with antibiotics. I want to emphasize that in no way am I saying that you should outright reject the suggestions of your medical team. What I am saying: knowing and understanding what the plan may entail is useful knowledge, particularly when you’re paying attention to how your body actually reacts to the plan once it’s put in place. No one will know that better than you, and no one will care as much as you do.

This is why it’s so important to me that the information you see on the HealthFit Coaching website is evidence-based (i.e. has scientific research to back it up) and accurate, giving you tools to understand your body and your health, and to make decisions that YOU are confident are in your best interest.

Knowledge is power, and you have to be your own best advocate, because no one else will.


Exercise For Older Adults, Part 2

In the first part of this series, we discussed the difference between physical activity and exercise. Let’s get more in-depth. There are four types of exercise and activity that will provide the greatest benefit:

Resistance training

These are the exercises that are often the highest intensity. Good thing you don’t need to do a whole lot of it! Resistance training uses your own body weight or an additional weight to stimulate your muscles to grow in size and strength.

If there was one type of exercise I’d ask someone to do, strength training would be it (though I would hope never to have to pick just one!). This is because strength training helps limit the loss of muscle mass and strength that starts occurring around age 30 and that occurs much more rapidly after about the age of 50. Maintaining muscle mass and strength means that you’ll also maintain your ability to complete day to day tasks with fewer potential problems, and will be better able to handle health hurdle and injuries that might come your way.

Exercises like squats, seated rows, and chest press or pushups are all excellent examples of strength training exercises, because they use large muscles and multiple joints, so you get the most bang-for-buck. Other strength training exercises like calf raises or bicep curls are also valuable, though involve slightly less muscle.

Aerobic or cardiovascular exercise

Cardiovascular (or aerobic) exercise helps build both muscular endurance, so you can spend more time doing things you enjoy (gardening, walking) before getting tired, and improves the strength and endurance of your cardiovascular and respiratory systems.

Cardiovascular exercise – what we’re doing when we walk, run, swim, dance, do the yardwork – helps our bodies in two ways. It builds muscular endurance in our large muscle groups that are used to create movement, and it builds strength and endurance in our cardiovascular and respiratory systems, meaning that it strengthens our heart (remember it’s a muscle!) and the muscles we use to breathe, as well as creating a stronger delivery system for oxygen and nutrients to our working muscles.

Plus, there is a significant and growing body of research showing that the repeated, rhythmic movements inherent to cardiovascular exercise are calming and relaxing. Not only does this relieve stress, but it can help alleviate anxiety and the symptoms of depression. Yay for improving physical and mental health at the same time.

Balance exercise

Good balance depends in part on muscular strength and the reflexes and reaction time of the nervous system. Since balance is a key component in preventing falls, it’s increasing important to work to maintain good balance as we age.

Though other types of exercise are helpful in maintaining good balance, specific exercises are as simple as putting yourself in a position where your balance is slightly or moderately challenged (but that is still safe), and letting your body figure out how to adjust for the slight instability. This can be as low-tech as standing on one foot with a hand on a wall for some stability help (to make it more challenging, try closing your eyes).   Another great option is tai chi, a form exercise that slow, continuous movement and emphasizes body alignment shifting your body weight in a controlled manner. Often spoken of as “meditation in movement”, tai chi is also a great break for your brain.

Flexibility exercise

Though not “exercise” in the traditional sense, flexibility exercises are nonetheless an important part of maintaining movement ability and quality of life. Losing flexibility means losing the ability to move to the same degree that you did when you were young.

Most people think of flexibility and static stretching (the traditional stretch-and-hold) as the same thing, and to some degree this is true. Static flexibility tells us the about the range of motion available at a given joint. However, in day to day life, we should take dynamic flexibility into greater consideration.

Dynamic flexibility considers both the range of motion available at the joint, and takes into account any resistance to the stretch that might be caused by muscle tension or any other resistance to the movement. In many ways, this is real-life flexibility. Consider trying to reach a jar down from a tall shelf. As you stretch to reach it, your body is contracting muscles to help stabilize you and to complete the movement. Your flexibility in this action will be much different than your flexibility if you were sitting somewhere relaxed and supported.

Despite these differences, any flexibility exercise is worth doing. All age groups appear to respond to flexibility training, and this is key to maintaining your ability to move well, helping to maintain quality of life and independent living. There are many types of stretching, and most seem to provide roughly the same level of benefit, though to maximize your results from flexibility exercises, you should be looking for the line between a comfortable stretch and slight discomfort. Finding stretches that take you to (but not over) this slight discomfort line while still keeping you in a safe and supported position will be your best bet.

So whats the bottom line?

As always, the most effective exercise is the exercise you’re willing to do! The benefits provided by each typoe of exercise have a lot of overlap, though you’ll certainly get a more even spread of these benefits by including some of each of the above. Remember to stay safe, listen to your body, and work to find exercises that are challenging but achievable, and you’ll go farther than you might expect!

 

References
Carter, N. D., P. Kannus, *K. M. Khan. “Exercise in the prevention of falls in older people: A systematic literature review examining the rationale and the evidence”. Sports Medicine. 31(6):427-438 (2001).
Claxton, D. B., M. S. Wiggins, F. M. Moode &R. Crist. “A Question of Balance”. Journal of Physical Education, Recreation and Dance. 77(3):32-37 (2006).
Keller, K.& M. Engelhardt.  “Strength and muscle mass loss with aging process. Age and strength loss”. Muscles Ligaments Tendons Journal. 3(4):346–350 (2013). 
Plowman, S. A. & D. L. Smith. Exercise Physiology For Health, Fitness, And Performance. 4th ed. Baltimore: Lippincott Williams & Wilkins, 2014.

 

 


What’s Your Why?

Let me pose a question to you:
Why are you working so hard to improve your health and fitness?

I ended up where I am in this business because I love the buzz I get when a client comes back to me and exclaims any of the following: I don’t have to take my blood pressure medication anymore/My knees don’t hurt/I can’t believe how good I feel!

It’s awesome to be a part of that. But it’s taken me the better part of a decade to figure out that helping people feel better is why I stay up at night poring over research papers or writing three different programs to make sure one will work. I’m doing those things because I want each client to get the best program, with the most up to date information and most efficient approach possible. I want you to get better, fast, and to help you find a way to do it that works for you.

Finding what works for you is the key component of creating a successful program. That includes setting SMART goals, and creating measurable steps along the path to the ultimate goal so that you can definitively tell that you are making progress. I have operated this way for years, and have had a lot of success with this approach. But inevitably, at some point, progress stalls and clients plateau, and I’m juggling to kick-start their motivation again. Clearly, there is a piece missing.

That piece is Why.

Goals are great, and absolutely necessary to keep you going through the hard work required to change your life and well-being. But even the best goals aren’t always enough to take you all the way. Here is a classic example: I had a client, Bryan, who came to me for help with training to run a marathon. His two best friends had started running a few years before, and had started running races not long after. His running friends had decided to do the Las Vegas marathon, and had invited him along to hang out. Bryan decided he’d like to run the marathon with his friends, but needed to get training right away. A marathon is a classic SMART goal: You have a set date by which you have to be capable of a certain measurable thing, and you can prepare for this by taking the right steps at the right times.

Bryan’s preferred training time was early morning, before work. He was going really well for quite some time, making great progress with increased running distances and appropriately incorporating strength training and recovery activities. About two-thirds of the way through his training program, it started getting harder and harder to continue those early morning training runs. After spending some time discussing how he felt the training plan was going overall, we turned back to the ultimate goal: Finishing the marathon with his friends. Bryan was confident that he could run the whole way, but he wasn’t sure he could keep the pace with his friends, and the thought of getting left behind was a huge turn-off.

This was a lightbulb moment: Running the marathon wasn’t about running a marathon. It was about having an equal part in an amazing experience with two of his closest friends. A couple small tweaks to the training program to help his speed, and he was pumped to be running again. He was getting up even earlier to make sure he warmed up well before his training runs. His times dropped a little and his confidence and excitement skyrocketed. When it came to running the marathon, though he had to work for it, he kept pace with his friends and more importantly, had a great time.

Bryan figured out why he wanted to run.

Bryan’s why wasn’t the hardest to figure out, and each of us has our own reasons behind the “whats and hows” of our goals. Figuring out these “whys” out can be a time-and-thought-consuming process, and in my experience, there can be several false starts as you make your way through the many reasons that make up your motivation. You don’t ever have to share them, but knowing them yourself is powerful: There is no stronger inspiration than your deepest desires.

So, what’s your why?