by Nancy Alexander, PT
As we get older, we become managers. Managers of our own body. I want to show you how movement can help you manage your health and help you feel better. I want to show you how movement can help you participate in activities you enjoy.
I want to share with you a chapter from my new book titled, “Get UP! Defy Aging with Movement.” Movement is powerful and this chapter looks at some of the more common chronic conditions you might face as you age and describes how movement can help. Let me know what you think.
Chapter 7 – The Miracle Drug for Chronic Conditions
Last October my husband and I moved into an over-55 community in central Florida. We love it here. There are over 800 residences ranging from villas to single family homes. All are one story and we have access to a fitness center, three pools, tennis and pickleball courts, and more. It is a vibrant community with many active adults just like us. It is also a community filled with folks doing their best to manage chronic conditions. You can’t reach 55 without going through some stuff, right?
Last week my husband and I left to do some grocery shopping when we saw our neighbor, Larry, out for a walk. We stopped and rolled down the window to say hello. Larry and Ellen live just down the street and we became fast friends just a few months ago.
“How’s it going Larry? Good to see you,” I said.
“Oh, it’s going,” he said.
Larry has had his share of physical challenges and is now dealing with a flare-up. He is experiencing low back and hip pain and has seen physicians to help control it. He is currently enrolled in physical therapy and is diligent with his home exercise program.
“I just had another shot in my hip,” he said. “I think it’s helping.” He recently had injections to his low back, too, and had a nerve ablation done. A nerve ablation is when nerve endings are cauterized to stop the signal of pain to an area. Larry is doing all he can to feel better and return to activities he enjoys. He belongs to the community golf league but hasn’t played recently due to his pain. Also, he and his wife just postponed a trip to see their daughters up North, in part, due to Larry’s current physical condition. I know this had to be hard on him. But Larry is still Larry and he is still smiling. He has a wonderful sense of humor.
“They tricked us,” he said. “They really did. Who said these years are golden?”
I wish I had a dollar for all the times I’ve heard that from my patients. “These golden years aren’t so golden,” they would say. Still, so many soldier on and do whatever it takes to feel better and stay active. Applause, applause.
When I first met Larry, his walk was memorable as his upper body would lurch side to side excessively with each step. He was pretty steady, but the compensations he showed were remarkable. Turns out, this was normal for him. When his recent flare-up occurred, he began to walk with a straight, single-point cane. He was not steady then and he certainly needed something more to support him. Well today, Larry was walking with a four-wheeled walker with a seat. That is a lot of support and I was part shocked and part relieved to see him using it. With the walker, he could walk longer and more easily negotiate sidewalks and uneven ground. He could walk for exercise. And he improved his safety by reducing his risk for falls.
“I feel better when I move,” said Larry. “So I move.”
More applause, applause.
How many of you can relate to Larry and his situation right now? We all have our challenges, don’t we? We have physical ailments that need attention and typically they bring along emotional challenges, too. Larry’s movement paid off. As I edit this chapter, Larry has since returned to playing golf, and he and Ellen rescheduled their trip to see their daughters and leave next week.
Put your faith in movement. We are not built to sit. We are built to move. What’s more, what can help us live an active and healthy life when we are young can help us overcome limitations when we are older.
As this chapter continues, I will address five of the more common chronic conditions affecting older adults that do not have a cure. There is no magic pill either. In some severe cases, surgical intervention can help. An example of this might be a total knee replacement for a joint deteriorated by osteoarthritis. In my years of practice, though, I have learned that this rarely comes on suddenly. Surgery is often not the answer especially in the early stages of degenerative changes. This is when you manage it.
The five conditions I address here affect millions of people in this country alone. Space limits my ability to address allchronic conditions, but know the ones below are extremely common and their impact on you can be significant. They require awareness of your health and knowledge of the tools to help keep these conditions from worsening or causing other problems down the road. One common tool helps manage them all, and that is movement. They all require some form of movement to maintain or even improve their impact on you. I list them all first and then I will describe the condition, share its impact on your health, and finally show you how movement can improve each one.
What is it?
Did you know there are over 100 types of arthritis conditions out there? The one we’re discussing here is the most common and called osteoarthritis (OA). In general, it is an inflammation (any time you see a work ending with itis, it means inflammation) or swelling of one or more joints and most commonly occurs in the hands, hips, and knees. It is caused by damage or breakdown of joint cartilage between bones and is, therefore, considered degenerative.
According to the Centers for Disease Control and Prevention, osteoarthritis is defined as a wearing down of cartilage within a joint and the underlying bone begins to change. (CDC, Arthritis.) I liken it to a road. Pretend the road you’re driving on is the bone surface at a joint. A new road is smooth and flat and the ride is not bumpy. When you have OA, the road is full of cracks and maybe even some pot holes. The ride (or movement of the joint) is no longer smooth but is bumpy and often painful. Inflammation occurs as a result and over time, the road continues to worsen. This is consistent with OA as symptoms usually develop slowly and get worse over time.
OA causes pain, stiffness, decreased flexibility, and swelling in affected joints. Over time, mobility suffers and the joint cannot move as fully as it once did. Soft tissue around the joint such as muscles and tendons then shorten because they are not used to their full advantage any more. Deformity of the joint often occurs in later stages and can be visible to the naked eye. Have you ever seen someone who is bowlegged? That is one example of a deformity at the knees. Imaging such as x-rays are useful in confirming this diagnosis.
Most joints are synovial joints, and this includes joints of the hand, hips, and knees. You may recall we discussed this in Chapter 5. Joints with OA benefit from movement because as the joints move, synovial fluid coats all the bony surfaces. This fluid lubricates the joint and results in less friction, so the ride is smoother if we again use the analogy to a road surface. Synovial fluid provides oxygen and nutrients to the boney surfaces, which helps reduce pain and swelling.
Other purposeful movement including strengthening and stretching can help improve the function of that joint and help normalize the forces within that joint. This allows it to better perform and, therefore, reduces pain and swelling.
There is something to keep in mind here. When you hurt, often the last thing you want to do is move. I get that. But, especially in the early stages of OA, movement is exactly what you need. That’s where your physician and movement specialist can help. As I said in Chapter 6, they can assess where you are now and develop a plan to gradually improve your flexibility, strength, and function to reach your goals for the future.
Here’s another bonus. Movement can help you lose weight as you begin to burn more calories than you did when you were sitting in pain. Weight loss is a tremendous strategy to help offload those joints where you bear weight like your knees, hips, and even your spine. You will feel better with less down force (or compression) through those joints.
What is it?
Certain spine conditions can be considered degenerative, and one of the most common is spinal stenosis. Spinal stenosis is a narrowing of the openings at the side of your spine where the nerves exit from the spinal cord and feed the rest of your body.
Spinal stenosis often occurs at your low back (lumbar spine) and can cause pain down your legs and even numbness and weakness. You can also experience stenosis at the cervical spine (neck). However, this affects your arms and not your legs. The nerves from the spinal cord at the neck feed your arms, and with stenosis, you would experience the same symptoms noted above, just at your arms.
There is a directional preference for movement with stenosis to help relieve symptoms. And it is typically to flex your spine, that is, to bend forward. At your neck, you would bring your chin down to your chest. For your low back, just sitting can be enough to relieve your symptoms. Occasionally, you can benefit from sitting at the edge of a chair and bending forward trying to touch your toes. Forward bending enlarges the openings where the nerves go and, therefore, relieves the pressure on those nerves. Standing and arching backward make the openings smaller. This would typically make your symptoms worse.
I cannot stress enough that if you experience these symptoms, please see your physician first before trying these maneuvers. They are to be prescribed to you by a trained professional and you may have certain conditions where bending forward is a risk to you (called a contraindication). Decreased bone density (such as osteopenia and osteoporosis) poses a significant risk, for example. Team up with your health professionals to devise a plan that is safe for you. That is what they are there for.
What is it?
Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both, according to the National Osteoporosis Foundation (NOF). (NOF, What is Osteoporosis and What Causes It?) As a result, decreased bone strength and mass significantly increase your risk for fractures. About 54 million Americans have osteoporosis and low bone mass, called osteopenia, and though scores are not as severe as those with osteoporosis, people with osteopenia are still at increased risk of fracture. A bone density test, called a DEXA scan, can assess bone density at specific body sites and is considered the gold standard for diagnosis. Barring any family history or other comorbidities that may warrant more frequent testing, the NOF recommends women over the age of 65 and men over the age of 70 be tested. Typically, follow-up testing occurs every 2 to 3 years and will be determined by your physician.
Unfortunately, osteoporosis is often called a silent disease, because we can’t feel our bones weakening. Some are first diagnosed with this disease because of an injury where they sustained a fracture. Others with low bone density often experience pain, especially at the spine, which most write off as occurring due to something else. This is why testing and knowing your numbers are so important.
With advanced stages, a stooped posture is noted and a scoliosis can appear as vertebrae compress. Vertebrae and the ends of our long bones, such as the femur in the leg and the radius in the arm, are more prone to low bone density because of their composition.
Exercise is usually the first line of defense for those with low bone density. Thankfully, you can improve your bone density at any age. The most effective regimen includes weight-bearing exercise, such as walking. Impact helps build strong bones, so standing exercises, such as marching, can also be beneficial. Core strengthening to protect your spine as well as balance training to reduce risk of falls should also be incorporated into any exercise program. Resistance training also helps, since the bones where muscles and tendons insert get stronger with each lift of a weight.
When you put all of these exercise components together, it becomes a powerful tool to help build strong bones. There are programs designed to do this but there is one I know very well and that is called Buff Bones®. I have been a licensed Buff Bones® instructor for almost five years now and have seen the benefits first hand through my class participants. As a physical therapist, I can get behind the principles of this program as they are sound and well thought out.
Exercise is often the most desired treatment strategy for bone loss, especially if discovered early. There are medications that can help, but their side effects are not desired by most people. If you have advanced osteoporosis, however, you are likely on some kind of medication dose. Regardless of whether you take medication for this or not, targeted and prescriptive exercise can help.
What is it?
Diabetes is considered a metabolic disorder that prevents your body from using food properly. Beta cells in the pancreas produce insulin, the hormone that helps blood sugar enter cells to be used as fuel. When you have Type 1 diabetes, beta cells are destroyed by the immune system, so the body doesn’t make any insulin. With Type 2 diabetes, beta cells either don’t produce enough insulin or the body’s cells don’t respond to it. Type 2 diabetes most often occurs in adults due to their lifestyle choices.
When blood sugar is unable to penetrate cells to be used for energy, it accumulates in the bloodstream. Over time, the excess blood sugar leads to body-wide damage, including heart and kidney disease, nerve damage, and vision loss. Oral medicines and injectable insulin can help. More importantly, be sure to eat right and move your body.
Diabetes is a very serious condition and should be aggressively managed by you in partnership with your physician. Examples of damage from this disease include neuropathy (loss of sensation usually to feet and hands), blindness, damage to blood vessels, and amputations. It is critical to control this disease to avoid serious complications including seizures and even diabetic comas. In the battle against diabetes, a sedentary lifestyle can be your worst enemy. This is why you often see someone with diabetes who is also obese.
Prolonged sitting at work, in meetings, or at home watching TV can set back efforts to prevent or manage the disease. The American Diabetes Association (ADA) recommends people with diabetes get up and move for at least 3 minutes every half hour. According to their evidenced-based guidelines, physical movement improves blood sugar management and helps avoid the very high and very low levels of blood sugar. (ADA, Get and Stay Fit.) Exercise helps to lower blood glucose, because it increases insulin sensitivity, your body’s ability to use insulin to break down glucose. Insulin sensitivity is heightened during and after physical activity. The more you exercise, the more you help this process.
If you suffer complications from diabetes that make it difficult to exercise, talk to your health provider, such as a physical therapist or physician, about the safest activity for your situation. Keep Moving. This is vital for everyone and even more so for those with diabetes.
Two types of physical activity are most important for managing diabetes and they are aerobic exercise and strength training, according to the ADA. They add that if you’re not used to being active, you can start with 10 minutes of walking each day and build as your fitness improves.
You’re probably wondering why I chose to address this one here. If you know me or read my first book, An Unlikely Gift: Finding Inspiration Caring for My Father with Dementia, you know why. I cared for my dear father for the last 18 years of his life through his battle with dementia. This topic matters to me. What’s more, the Centers for Disease Control and Prevention lists Alzheimer’s Disease (the most common type of dementia) as the sixth leading cause of death in the United States. (CDC, National Center for Health Statistics.) Movement and exercise have an impact on this chronic disease, too.
What is it?
Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. As noted above, Alzheimer’s disease is the most common type of dementia. While the likelihood of having dementia increases with age, it is not a normal part of aging. Light cognitive impairments, such as poorer short-term memory, can happen as a normal part of aging. This is known as age-related cognitive decline rather than dementia, because it does not cause significant problems.
Some risk factors for dementia, such as age and genetics, cannot be changed. But researchers continue to explore the impact of other risk factors on brain health and prevention of dementia. Some of the most active areas of research in risk reduction and prevention include cardiovascular factors, physical fitness, and diet.
Scientists have just recently endorsed three strategies for preventing dementia and cognitive decline associated with normal aging: being physically active, engaging in cognitive training, and controlling high blood pressure.
While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:
- Communication and language
- Ability to focus and pay attention
- Reasoning and judgment
- Visual perception
(Cure Alzheimer’s Fund, Dementia)
More and more research shows that regular physical exercise may help lower the risk of some types of dementia. It is thought that exercise may directly benefit brain cells by increasing blood and oxygen flow to the brain. Exercise changes the structure and function of the brain as follows:
- Increases brain volume
- Possibly reduces the number and size of age-related holes in the brain’s white and gray matter
- Promotes neurogenesis, which is the creation of new brain cells in an already mature brain
Much of the research seems to indicate that aerobic exercise specifically is most effective. Why is this so? According to Gretchen Reynolds of The New York Times, researchers have found that distance running stimulates the release of a particular substance in the brain known as brain-derived neurotrophic factor (BDNF) that is known to regulate neurogenesis. The more miles an animal runs, the more BDNF it produces. (Reynolds, Gretchen, Exercise Best for the Brain.)
Some evidence suggests it’s never too late to start exercising for brain health. According to Alzheimer’s & Dementia, a study at the University of Eastern Finland found that physical activities in midlife seem to protect from dementia in old age. Researchers found that participants who engaged in physical activities at least two times per week had a lower risk of dementia than those who were less active. (Alzheimer’s & Dementia, Physical Activity.)
More research is under way, but based on what we know so far, we can surmise that what is good for the heart (aerobic exercise) is also good for the brain. Start early. Start now.
To summarize, movement is medicine, and it couldn’t be more true for those with chronic conditions that occur as we age. Movement can help them all. For even more good news, you don’t need to walk this road alone. (See what I did there?). In fact, always consult with your physician about your condition and when starting any new exercise program. Request a referral to a physical or occupational therapist to help gently and safely guide you to a more active lifestyle. These are lifestyle choices and your choices now will define your future.
Here’s another key to all this movement talk. Many of my patients do not like taking prescription medications. They don’t want to rely on them or worse get addicted to them. They don’t like the side effects, especially constipation, which is not only painful but dangerous. Movement and prescriptive exercise that you get from a therapist can effectively reduce the medication you take. Keep moving and you may not need that pill you take, after all.
This is powerful, my friends. And you have the ability–yes, you, and only you–to make this happen. Now that should get your attention. Health is wealth. Are you ready to get rich?
Copyright ©2020 Nancy Alexander
All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information retrieval system without the prior written permission of the author.
“Get UP! Defy Aging with Movement” to be published in early 2021.
Many adults over 50 think it’s normal for their activity to decline. Truth is, movement as we age is not only possible, it is more important than ever. Nancy Alexander, PT, explains why with evidence-based facts and stories from her 25 years as a physical therapist and certified fitness professional. She’ll inspire you while showing you the how. Here, you’ll create your own action plan and partner with your own health professionals to move effectively and safely. She’ll even help identify appropriate exercises for you based on your activity level. You can improve your strength, mobility and balance at any age. Get up, keep moving, and make your next years your best years.