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oatmeal

Fueling Tips for Early Morning Exercisers

Many athletes train in the early morning. Rowers commonly meet at 5:30 a.m. Hockey players might get rink-time at 5:00 a.m.. Athletes who need to be at work at 7:00 often train at 4:30 a.m. Many of these athletes report eating nothing before their training session. My stomach isn’t awake. … It’s too early to even think about food. … I get reflux if I eat. Others report they have better workouts when they eat something simple. The question arises: What’s the best way to fuel for early morning workouts?

Before answering that question, let’s first address the physiological goals for fueling before morning workouts.

1) To change the stress-hormone profile. Cortisol (a stress hormone) is high in the early morning. This puts your body in muscle-breakdown mode. Eating carbs + protein can switch to muscle-building mode.

2) To provide energy and prevent low blood glucose with the consequences of feeling light-headed, dizzy, and needlessly fatigued.

3) To be adequately hydrated. Dehydration slows you down.

If you are making the effort to get up early to train, you might as well get the most out of your workout! In a fueling study, athletes had dinner the night before and then a 60-minute exercise test the next morning. They performed 6% better in the 10-minute sprint to the finish when they had some fuel (carb) compared to having had nothing;  6% better when they had adequate water (compared to minimal water), and 12% better when they had both fuel + water (a sport drink). (1) Twelve percent better means running an 8-minute mile in about 7 minutes. Powerful, eh?

Your body can digest pre-exercise food and use it to energize your exercise as long as you are exercising at a pace that you can maintain for more than 30 minutes. (If you do stop-and-start exercise, you can still digest the food, but at a slower rate.) In another fueling study, athletes ate dinner and than nothing for the next 12 hours. Those who ate 180 calories (sugar) just five minutes before an hour-long exercise test performed 10% better in the last 15 minute sprint compared to when they ate nothing (2). Grab that granola bar or swig of juice!

If you are tempted to skip pre-exercise food so you can lose weight by burning more fat, think again. Yes, pre-exercise food will contribute to burning less fat at the moment, but that is irrelevant. The issue is not whether you have burned fat during exercise but if you have created a calorie deficit by the end of the day. Eating excess calories after a fat-burning workout gets you nowhere.

All of this means consuming some food and fluid on your way to the gym, spin class, or boot camp will enhance your workout—assuming you have trained your gut to tolerate the food and fluids. If you are worried about intestinal distress, start small (a few crackers) and work up to a handful of crackers, and then add, let’s say, a latte. For workouts longer than 60 minutes, the recommended intake is about 200 to 400 calories within the hour before you train. That recommendation obviously varies according to body size, exercise intensity and duration, and personal tolerance to food.

If you have been exercising on empty, you will likely discover you can exercise harder, feel better, and get more enjoyment from your workouts. Research subjects who ate 400 pre-exercise calories were able to exercise for 136 minutes until they were exhausted, as compared to only 109 minutes with no breakfast (3). Big difference! After learning this, one of my clients reported he was done with skipping pre-exercise fuel in the name of intermittent fasting. “Not eating is slowing me down and taking the fun out of my workout.”

Early morning options

Here are some options for fueling your early morning workouts so you are adequately hydrated and fueled.

Eat a quick and easy snack with about 200 to 400 calories (depending on your body size and workout intensity). Some popular options include: English muffin, toast, bagel or banana (with peanut butter); oatmeal, a smoothie, Fig Newtons, or granola bar. Coffee is OK; it’s a functional fluid that boosts performance and yes, helps with hydration.

Wake up 4 hours before important training sessions/events, eat a simple breakfast (bread + peanut butter), then go back to bed. This is a common practice among elite athletes. As one marathoner explained, “I don’t want to have food in my stomach when I’m racing. If a race starts at 8:00 a.m., I’ll get up at 4:00, eat a bagel with peanut butter and a banana, and then go back to bed. At 6:00, I’ll get up, have some coffee (to help me take a dump and wake me up), and then get to the race start. Because I never really sleep well the night before an event, getting up at 4:00 isn’t terribly disruptive.” In comparison, a rower reported she used to wake up two hours before practice to eat. She became too sleep-deprived and decided she needed sleep more than food. She started eating a bigger bedtime snack.

Eat your breakfast the night before via a bedtime snack, such as a bowl of cereal, or yogurt with granola. If you have dinner at 6:00, you’ll be ready for a bedtime snack by 9:00. Choose quality calories; this is your breakfast that you are eating the night before. Limit the cookies and ice cream!

Fuel during your workout.If your stomach isn’t awake when you first get up, it may be receptive to fuel when you are 30 minutes into your bike ride, run, or row. Be sure you have some fuel with you: sport drink, dried pineapple, gels, chomps, gummy bears—whatever is easy to carry and simple to digest. You want to target about 30 to 60 grams carb (120 to 240 calories) if the workout lasts 1 to 2.5 hours, and 60 to 90 g carb (240 to 360 cal) if the workout is longer than that..

What about “training low”?

If you are highly competitive and has mastered the sports nutrition basics (eat a diet with 90% quality foods; fuel evenly during the day; have no disordered eating behaviors), you might try training low (with depleted muscle glycogen and/or low blood glucose) once a week or so. To do this, eat primarily protein for dinner after a late-afternoon workout. The next morning, train without having eaten carbs. Exercising depleted like this is not fun, but it stimulates cellular changes that can be performance enhancing if you need to get to the next level (4). Novice and recreational athletes, however, first need to work on the basic ways to improve performance—by surrounding their workouts with food, and fueling wisely the rest of the day.


Nancy Clark, MS, RD counsels both casual and competitive athletes at her office in Newton, MA (617-795-1875). Her best selling Sports Nutrition Guidebook and food guides for marathoners, cyclists and soccer players offer additional inform-ation. They are available at NancyClarkRD.com. For her online workshop, visit NutritionSportsExerciseCEUs.com.

References

  1. Below, P. et al. Fluid and carbohydrate ingestion independently improve performance during 1 hour of intense exercise.Med Sci Sports Exerc27:200-210, 1995.
  2. Neufer P. et al. Improvements in exercise performance: effects of carbohydrate feedings and diet. J Appl Physiol62(3):983, 1987
  3. Schabort, E. et al. The effect of a preexercise meal on time to fatigue during prolonged cycling exercise.Med Sci Sports Exerc31(3):464-471, 1999.
  4. Hawley J and Burke L. Carbohydrate availability and training adaptation: effects on cell metabolism. Exerc Sport Sci Rev. 38(4):152-60, 2010.
doctor-health

Adaptive Health Paradigm: A Principle-Centered Perspective for Medical Fitness

I hope to give you some insights to both how the human body works as well as why medically-based fitness is not only valid, but absolutely necessary to reverse, assist, or prevent various chronic and acute disease conditions.  Wow, that is a “mouthful” to say the least. I feel so strongly about this perspective that I hope to create the Adaptive Health Model as a major “brand” of fitness. My company (Principle-Centered Health) for the past couple of decades has always had a systems-based approach to health and fitness. This approach ties a lot of different facts into a common theme, usually called a theory in science. Even my dissertation looked at how people adapted to the physical, mental and social issues in their lives using exercise, self-efficacy, and social support, respectively, and levels of strain and burnout. How humans adapt to the stresses put on them is very specific and can go in good or bad directions.

What is the Adaptive Health Paradigm?

Like most theories, paradigms or what people consider “original thought”, this “adaptive” paradigm builds on the “regenerative medicine” framework, and some disease models; thus, is not original at all. What may be new, or unique about the adaptive perspective is taking the old phrase from physicist Isaac Newton and his third law of motion, “for every action there is an equal and opposite reaction.” The body will respond to stresses by reacting in a “defensive” manner. If we break something down, the body builds it up (opposite reaction). If we are too low or too high in some function, the body will try to correct this. This negative feedback loop controls most systems in our bodies. I have often described our bodies as fragile but resilient. It is our fragility that signals the resilience to kick into gear!

Luckily for us, fitness is based on this exact principle. If we do endurance training, we are going into a lower oxygen state and there are many mechanisms or functions that kick in (sympathetic nervous system) when we push or stress our bodies. The body is responding to what is known as an “acute insult” by increasing the ability to transport and use oxygen, so that this “insult” doesn’t hurt us next time. The same “specificity of training principle” occurs with resistance training. We breakdown muscle and the body builds it back stronger to tolerate that “insult” the next time. When multiple acute exercise stresses are added up, the body changes and we call this “training”.

If stresses are really high, either too intense, too long, or too often, the body gets injured due to this overload, or it needs a lot more time to heal back up. This is why overload needs to be done gradually and progressively. Even our brains use this idea as a guiding principle. We push our mental capacities to learn more, but if we stress it too much, it will repress memories or shut down (burnout).

This same principle applies when we give our body bad things, or a lack of good things, it adapts with a dysfunctional state or disease state. Chronic inflammatory diseases, diabetes, metabolic syndrome, coronary artery disease, emphysema and heart disease are just a few of the examples of how the “garbage in and garbage out”, or “use it or lose it” works. If we sit and work at the computer too much we develop dysfunctional postures and upper cross syndrome may develop. If we do not constantly stress some system, it reverses the training changes, and goes into the “default” state, which is untrained and unable to respond to daily stresses. We simply need to obey our bodily blueprints, we need to constantly use our bodies to maintain function, and overload it to improve function. We need to have the right nutrients in place to allow this to happen, and then basically – get out of the way!

Intelligence in the Body – Applications the Adaptive Health Paradigm

The perspective being proposed in this article shares much with the more holistic medical practices. The human body is really good at healing itself when is it given the right factors to do so, and when we “get out of the way” for it to do so. I know many people who strongly believe in using alkaline water to “cure their ills”. They believe that the body does not know how to regulate itself with its own pH.  Most of these same people don’t know what pH even stands for! They don’t know that it is actually the inverse log of the hydrogen ion concentration relative to the hydroxide ions, and that the respiratory system and renal system will go into action as soon as blood pH goes 0.05 pH units high or low!

In other words, these people believe their own bodies are naïve or incapable of curing itself, and like a young child or baby, their body needs constant care and guidance. Most people are so stressed about “taking care” of their bodies that they are doing more harm than good via the stress hormones, especially cortisol being constantly secreted and their adrenal gland is getting fatigued. In reality, the body is really good at healing itself, when we keep it strong and in good operating condition (via exercise and movement) and when we give it the right components to do the healing (via nutrition), and we get out of the way of the immune system (by managing our daily stress levels).

The mind works very much like a muscle. It must be trained and kept strong and when injured it will react in dysfunctional ways, and fight to protect itself. I recently heard an expert in human behavior change speak on how to keep a resolution. He said, we can’t keep a resolution without changing the underlying behaviors which caused the bad habit or lack of a good habit in the first place. By changing the way we think, we change the way we act, and changing our actions will change the way we think!

“What goes Around, Comes Around”

The quote often stated by Thomas Edison in 1903, which was to give rise to the HMO concept, “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.” Medical doctors (M.D.s) upon completing medical school and prior to practicing take the Hippocratic Oath, which is to do no harm. Even back in Ancient Rome, Hippocrates understood the importance of individualized medicine and the power to “get out of the way” (#5) and give the body what it needs to take care of itself. He had five rules that are still relevant in today’s medical practices.

  1. Walking Is Man’s Best Medicine.
  2. Know What Person the Disease Has Rather Than What Disease the Person Has.
  3. Let Food Be Thy Medicine.
  4. Everything in Moderation.
  5. To Do Nothing Is Also a Good Remedy.

Integrative and Functional Medicine – Highly Inclusive and Holistic Perspectives

A philosophy of practice using these practices is integrative medicine. A brand of medicine created or at least popularized by Andrew Weil. The University of Arizona has this “brand” of medical school. Again, the academic requirements are similar to the M.D. and D.O. but expands its scope to other areas. From the website, Integrative Medicine (IM) is defined as a “healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. many different ways in the patient.
A new type of medicine is emerging from this Functional perspective which is called personalized medicine. Again, the two are basically two sides of the same coin.

Figure 1: A diagram above showing the greater scope of each medical perspective- Integrative and Functional medicines are close in their holistic perspectives, with differing points of emphasis


What is going on within the individual to cause the disease or prolong its existence?

Sometimes disease hits simply because we were genetically predisposed to get it. However, very often if our system is strong and in good operating condition, we resist it from every occurring or overcome it quite quickly. Cancer is a prime example of this. We all have cancers in our bodies all the time. It is the strong immune system that fights it off. This is amongst the reasons that many, many chronic diseases hit us when we are old. The various system have lost their capacity to fight the dysfunction off, or recover from its destruction. Soon cell death (necrosis or apoptosis) or neoplastic (cancer) growth kicks in.

Harnessing the Power of Exercise and Diet to Fight Chronic Disease

Many, many chronic conditions that the MedFit Education Foundation/MedFit Network addresses are helped by exercise and diet because the ability of body to adapt and regenerate itself is enhanced. Most systems in our body fall under the “use it or lose it” scenario. High sugar, alcohol, smoking, and lack of movement are culprits in our health. Our body is not designed for an overload of these factors and across time, many different symptoms will develop because our body can no longer compensate or regenerate.

It is important for the medical fitness professional to understand the power of exercise and nutrition, and the proper application of these tools given the client’s or patient’s current condition. The field of physical therapy developed because many musculoskeletal conditions are helped by movement therapy or exercise. Many chiropractors believe that proper spinal alignment delivers proper neural signals throughout the body, which allows the body to optimize its regenerative capacity.  Thus, an expert in medical uses of exercise to combat disease is critical to a healthcare team.

Join Dr. Mark Kelly at the Medical Fitness Tour in Irvine, CA! Dr. Kelly will be a presenter for the Aging Stronger pre-conference workshop on Friday, February 8, and the session Using Exercise and Diet to Fight Alzheimer’s during the main conference on Sunday, February 10. Click for Event Details


Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.

References

Center for Integrative Medicine, Univ. of Arizona (n.d.). What is IM/IH? Retrieved from: https://integrativemedicine.arizona.edu/about/definition.html

Science Daily (n.d.). Personalized medicine. Retrieved from: https://www.sciencedaily.com/terms/personalized_medicine.htm

Good Reads (n.d.). Retreived from: https://www.goodreads.com/quotes/13639-the-doctor-of-the-future-will-give-no-medication-but

Kalish, N. (2018). Hippocrates’ Diet and Health Rules Everyone Should Follow. Reader’s Digest. Retrieved from: https://www.rd.com/health/wellness/hippocrates-diet/

CT scan of the patient's brain and the hand of a doctor.

82-year-old Stroke Survivor & Wife Travel From New Jersey to Oregon To Train with Tracy L. Markley

I received an email from a wonderful woman who lives on the New Jersey Coast. She had read my books and wanted to know if she could fly herself and her 82-year-old stroke survivor husband to Florence Oregon, to train with me. She shard some stories of trainers refusing to work with him and those who did not have the knowledge needed. She also shared a couple stories about physical therapist not wanting to bother with using specific equipment that was needed for him. This is so disappointing. He is now almost 4 years post stroke and she has still searched out some guidance toward a better recovery for him. It saddens me with all that she has gone through, but I am grateful that I could help, the best I know how, in the past four weeks. I made some great life time friends.

I am honored that she reached out to me.  I am still in “ahh”, by the whole experience. Often stroke survivors and their caregivers do not find the help needed to further their recovery after physical therapy ends. Unfortunately, some survivors do not even get good physical therapy in the crucial, early stages in recovery, when it is essentially needed. She shared with me some not so good experiences she and her husband had faced, like many others I have spoken with.

They arrived the last week of September, and we met to train almost every day for 4 weeks. It was a productive training month for him. He made some important gains, but has much more hard work to do. I am helping them find a professional near them with the neuro and biomechanics knowledge, needed to bring him further in recovery.

She shared with me that what sold her to come see me was a hand written note I sent to her inside of the book order she had. She ordered “The Stroke of An Artist, The Journey of A Fitness Trainer and a Stroke Survivor.”  I knew she would get more out of help with that book if I sent her my second book “Tipping Toward Balance, A Fitness Trainer’s Guide to Stability and Balance.” I included it with the other book as a gift.  I had no idea that that would lead to her and her husband taking a journey from the Jersey coast to the Oregon coast to train with me in person.  It is very special.

I have surveyed 100s of stroke survivors in the challenges they have faced finding good guidance in further recovery. Even though there are good stories, there were a much higher amount of disappointing experiences many survivors and their care givers have faced. Some keep pushing forward and some gave up.

Gain Education to Work with Stroke Survivors

If you’re a fitness professional interested in learning how you can work with stroke survivor, join Tracy for an introductory 60 minute webinar on the topic. Click here to register

For more in-depth coverage on the topic, Tracy has also authored a 4 hour online course with PTontheNet, Stroke Recovery and ExerciseClick here for course details.

Article reprinted with permission from Tracy Markley. 


Fitness Specialist and Educator Tracy Markley is the Founder of Tracy’s Personal Training, Pilates & Yoga in Florence, OR. Tracy has over 2 decades experience in the fitness industry; she holds numerous specialty certifications, including many for those with medical conditions & chronic disease. She’s also studied the Brain and the neurological system, and has had great success working with seniors and special populations in stroke recovery, neurological challenges and fall prevention. Tracy also serves on the MedFit Education Foundation Advisory Board

She’s authored 3 books: “The Stroke of An Artist, The Journey of A Fitness Trainer and A Stroke Survivor” and “Tipping Toward Balance, A Fitness Trainer’s Guide to Stability and Walking” and “Stroke Recovery, What Now? When Physical Therapy Ends, But Your Recovery Continues”. Her books bring hope, knowledge and exercises to those in need, as well as sharing her knowledge and experience with other fitness professionals.

Arthritis

Stress and Arthritis

Many people believe that arthritis can only come from physical activity in your body, and it certainly does, but what others tend to forget, or simply don’t know, is that an individual’s mental health is a huge factor in arthritis as well. A study in 2009 by researchers at the Centers for Disease Control and Prevention claimed that people who experienced traumatic events during their childhood, which included physical or emotional abuse, had a much higher risk for developing rheumatoid arthritis compared to individuals who did not experience trauma.

Can Stress and Anxiety Actually Worsen Symptoms of Arthritis?

Some researchers claim that there is a direct relationship between a person’s stress response and inflammation in their body. Author Andrea W.M. Evers, PhD, took blood samples from 80 rheumatoid arthritis patients once every month for six months to measure the correlation between the stress hormone and inflammatory cytokines, and found that it played a main role in the amount of arthritis severity. Releasing cytokines in your body are the cause of inflammation, and exhibiting various levels of stress can also cause these specific molecules to be released, which eventually will promote inflammation and pain. Evers concluded that “patients who have a tendency for more worrying reported slightly more disease activity, more swollen joints, and more pain.”

Identifying the Root of Your Stress

As an individual becomes diagnosed with arthritis, their emotions can become extremely overwhelming. They may grow frustrated, uncomfortable, or in some cases, become very depressed. It becomes harder to perform normal daily tasks like putting on socks, cooking food, climbing stairs, and even just walking for some people. Their daily routine has become altered, and while some people can handle the change in lifestyle, others find it harder to cope and their stress can actually make the physical pain worse. Being able to identify where the arthritis is coming from in the body and developing a plan to improve it is the first step to reducing the stress associated with this disorder.

Tips for Handling Stress with Arthritis

Learning how to cope and finding ways to relieve tension can improve an individual’s quality of life physically and emotionally. One tip to handling stress would be to stay as active as you can throughout the day. Many people who have arthritis are often fearful of performing exercises simply because they worry it might make the pain worse or damage the joints, however, physical activity can actually improve the symptoms of rheumatoid and osteoarthritis. Daily activities like swimming and walking can reduce stiffness and stress on the joints while releasing endorphin hormones, (the hormones that make you feel good), ultimately improving the pain associated with arthritis and putting you in a better mood altogether.

Another tip would be to eat right so your body can fight inflammation. This tip seems like common sense, however many people don’t know which foods to eat and which ones to avoid. Some foods to start including in your every day diet are salmon, berries, and leafy green vegetables. Foods to avoid are red meats and vegetable oils, mainly because they contain omega-6 fatty acids which actually cause inflammation instead of reducing it.

Becoming more aware of your arthritis and coping with it appropriately will relieve pain in the body, resulting in an all-around happier and healthier you.


Lauren Adkins is a senior at Rowan University studying Health Promotion and Wellness Management. She is currently an intern at The Stress Management Institute and has a passion for helping people live a healthier lifestyle and improving their well-being. Lauren has also volunteered for a program at Rowan called “Get-FIT,” where she worked with individuals with developmental disabilities and promoted a happy, healthy, and fit lifestyle for them. Other than working towards a degree, Lauren enjoys spending time with family and friends, painting, and listening to music in her free time.

References

https://www.arthritis.org/living-with-arthritis/comorbidities/depression-and-arthritis/stress-rheumatoid-arthritis.php

https://www.everydayhealth.com/rheumatoid-arthritis/living-with/rheumatoid-arthritis-stress/

heart-stethoscope

Aligning with Medicine

I’ve been to the mountain. Yes, I’ve been in the world of medicine. I’ve run my programs in hospitals, collaborated with physicians to address chronic disease, and spoken at medical conferences on topics ranging from “emotion and the patient” to “the healing powers of synergy.”

Between you and me, I’ve been to nicer mountains. While I have nothing but praise for doctors, when we lift up the medical curtain, the overall system, the collective mindset, and the impotence of the treatment of chronic disease provide an open door. For who? For fitness professionals, and I say that with qualification.

The challenge in great part is a naivete. Our “industry” is not well versed in the living dynamics between medical institutions, health insurance, and pharmaceuticals, so these lobbying giants are viewed by personal trainers as purely corrupt, as the evils that plague our population. Yet, when the mirror of honesty is confronted, the limitations of conventional exercise and eating are not by any means the panacea trainers profess them to be in the midst of a population struggling with health compromise.

YES, THERE’S AN OPPORTUNITY BUT . . .

. . . it requires a re-education, an enhanced skill set.

Physical therapists are not thrilled with the idea of personal trainers working to address muscular imbalances and injury recovery. Nutritionists approach trainers who coach their clients nutritionally with caution. The trainer is not deemed a player on the Allied Health Care Team.

We therefore hear assertions from “trainer island” with limited foundation.

“Insurance should pay for our client sessions, after all, it pays for medical treatments that don’t work.” Wow, is that a slippery slope, one I wouldn’t approach if it showed up in my backyard and I was equipped with anti-slip cleats.

“Doctors should refer clients to us.” That is best responded to with a simple, “why?”

“Doctors don’t care about their patients.” There’s a globalized bias that fails to account for a system that makes “exploration of the client condition” one of the greatest challenges in the field, regardless of the physician’s heart.

* * * * * * The opportunity lies in humility, in a willingness to step up and learn, and in providing a true complement to the system that is flawed. It isn’t an “us or them,” but it also shouldn’t be a one way street of elusive referrals. It’s a recognition that we have the per-session time to invest. We can gain the trust of clients. We can see clients regularly and facilitate programs that require joint responsibility.

The most important piece of creating an industry wide recognition of the trainer’s power is perhaps the dismissal of ego, the acknowledgement that trainers deemed competent in prescribing safe and effective exercise, have not learned to address metabolic imbalance, hormonal disruption, and inflammatory issues that underlie the most common conditions.

It’s in the spirit of betterment that I’ve committed to learn and teach, to isolate practices fully within the trainer scope of practice that address the sources and causes of the plagues that impact 65% of our adult population. It’s time, not to urge doctors to respect trainers, but for trainers to create a legitimate platform of respect, one where chronic dis-ease is treated as a self-induced condition with patient / client empowerment as the greatest vehicle for true opportunity, as the vehicle for collaborative respect, a vehicle for the trainer to serve as a bona fide health catalyst.


Phil Kaplan has been a fitness leader and Personal Trainer for over 30 years having traveled the world sharing strategies for human betterment.  He has pioneered exercise and eating interventions documented as having consistent and massive impact in battling chronic disease.  His dual passion combines helping those who desire betterment and helping health professionals discover their potential.  Email him at phil@philkaplan.com

 

senior-exercise-trainer

Exercise and Dementia: Thinking Differently about Thinking

Many people are aware of the devastating effects dementia and Alzheimer’s disease (AD) has on families. I know this devastation personally, as my mother suffers from advanced stages of AD. It is very sad to have only the body present of someone you have known and loved your whole life! This article will discuss some of the newer developments in understanding and possibly reducing the disease, as well as the positive role exercise may have in slowing the onset and development of symptoms, and disabilities for any form of dementia.

The impact on family units and caretakers is even greater and can’t be measured by financial impact. Dementia is a group of symptoms that affect mental tasks like memory and reasoning. Dementia can be caused by a variety of conditions, the most common of which is Alzheimer’s disease. Alzheimer’s disease accounts for 60 to 80 percent of dementia cases (http://www.alz.org). Much of the recent attention to professional football players and the repeated brain trauma is due to the increased incidence of dementia, not Alzheimer’s. Dementia is characterized by loss of memory, intellectual capabilities and executive functions.

Alzheimer Concept.According to the Alzheimer’s Association, in 2015, 5.3 million Americans are believed to have this incurable disease. The cost of Alzheimer’s to the U.S. is $226 billion, and this figure is estimated to more than quadruple to $1.1 trillion by 2050 unless some major discoveries are made. It is the 6th leading cause of death behind heart disease, strokes, and cancer but it is the only one that cannot be prevented. One in three seniors will die with some form of dementia. Alzheimer’s is far more prevalent in women, with about 3.2 of the 5.1 million people, or 2/3rds, being women. The Baby boomer generation should cause the number of those affected to swell to 7 million, which may double by 2050. (http://www.alz.org/facts/overview.asp).

Factors Associated with Alzheimer’s Disease

While no one really knows exactly what causes Alzheimer’s disease (AD), there are several factors that are highly associated with it, and even some treatments that seem to slow its progression and onset. The two most prominent factors associated with AD are age and family history.

After age 65, the risk of Alzheimer’s doubles every five years. After age 85, the risk reaches nearly 50 percent. A type of AD is known as early onset or younger onset. This term actually is used for two types, a risk and deterministic form. Both may start in someone’s 30s or 40s and if someone has the gene it is 100%. This “determined” form is rare, accounting for only 5% of the total cases. Research has shown that those who have a parent, brother, sister or child with Alzheimer’s are more likely to develop the disease. The risk increases if more than one family member has the illness.

Biomarkers of Alzheimer’s Disease

  1. APOE genes
  2. Neuro-tangles associated with the Tau protein
  3. Beta amyloid plaques- a protein clump found in the brain- disrupting communication
  4. Inflammation
  5. Decreased brain size

(http://www.alz.org/research/science/alzheimers_research.asp)

When diseases tend to run in families, either heredity (genetics) or environmental factors, or both, may play a role. There are two categories of genes influencing a person developing a disease: risk genes and deterministic genes, both of which are present in Alzheimer’s disease.

Risk genes increase the likelihood of developing a disease, but do not guarantee it will happen. Researchers have found several genes that increase the risk of Alzheimer’s.  Apolipoprotein (APOE)-e4 is the first risk gene identified, and has the strongest impact on disease risk. APOE-e4 is one of three common forms of the APOE gene; the others are APOE-e2 and APOE-e3.

Those who inherit one copy of APOE-e4 have an increased risk of developing Alzheimer’s and those with two copies have an even higher risk, but still not a certainty. In addition to raising risk, APOE-e4 may tend to make symptoms appear at a younger age than usual (early onset). Scientists estimate that APOE-e4 is implicated in about 20 to 25% of Alzheimer’s cases.

Brain Size and Function

We often associate brain size with cognitive capacities and for the most part this relationship holds true. While it is very difficult to measure any increase in mass due to neuroplasticity, we can measure increase activity in the brain due to exercise, or decreased activity from AD and other dementias.

How can Exercise and Diet Help

senior-exercise-trainerIt is important to understand some of the limitations of exercise and diet in helping either dementia or AD. First of all, one must separate non-Alzheimer’s dementia from Alzheimer’s, and then must understand what stage of AD the individual is in. Finally, one must realize if the symptoms have already manifested (onset), and then monitoring the progression.

Exercise has a more pronounced effect on helping decrease progression and even reversing some symptoms with non-Alzheimer’s dementia.  In addition, the earlier someone is able to perform preventative actions, the greater the effect those therapeutic actions will have. Exercises that really activate the brain such as dance, yoga, and new sports or techniques are the best for prevention.

By exercising regularly throughout your life you will lower your incidence of getting Alzheimer’s by 50% and by doing mental exercises with the physical exercises may lower your chances by 70%! This reduction would not apply to those with deterministic genes but it would for others.  Some researchers believe exercise can both delay onset and reduce symptom severity no matter what the cause.

Aerobic exercise in particular causes a release of brain derived neurotropic factor, which has been labeled as “Miracle Gro for the Brain” by the author of SPARK, John Ratey, M.D. In addition, aerobic exercise causes some angiogenesis or the development of additional circulation to the brain. When the brain cells receive more blood, they get more oxygen, and thus function better.

Other side benefits of exercise are the muscle strengthening and enhanced balance and activation of postural muscles. Many Alzheimer’s patients will be at risk for falls and disturbed gait patterns. A consistent exercise program can delay and slow these issues even in somewhat advanced stages.

The dosage is the same as that for the general public or 150 minutes of moderate activity a week. It is important not to push an Alzheimer’s patient into exercise. Many AD victims can become agitated quite quickly and the stress is unwarranted. Simply walking is the best exercise. Make sure the walking path is smooth and not filled with obstructions or difficult terrain.

In an article from Science News, “Walking slows progression of Alzheimer’s”, Cyrus Raji, Ph.D., from the Department of Radiology at the University of Pittsburgh in Pennsylvania, mentions, “We found that walking five miles per week protects the brain structure over 10 years in people with Alzheimer’s and MCI, especially in areas of the brain’s key memory and learning centers. We also found that these people had a slower decline in memory loss over five years. 

The type and magnitude of exercise needs to be carefully monitored with advancing Alzheimer’s or dementia but in those with mild cognitive impairment, a “healthy dose” of both resistance and aerobic exercise is advocated.

Register for Dr. Kelly’s upcoming webinar:


Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.

Trainer helping senior woman exercising with a bosu balance

Creating Fit and Functional Older Adults

Beginning in the seventh grade, I became fascinated with age—specifically how our bodies’ functional capacities decrease with the passage of time. When I once shared this perception with my 98-year-old grandmother, she said, “Just wait until you’re 80.” I’m still far from 80, so I can only imagine how difficult it will be then to stand up from a chair or run around the neighborhood.

The biggest factor in the decline in physical capacity with age is level of physical activity. When your clients remain active throughout adulthood, they can retard the aging process and continue to live a life worth living. I know 70-year-olds who are fitter than 30-year-olds.

Physiology of the Older Adult

After age 30, most physiological functions decline at a rate of approximately 0.75 to 1 percent per year. Perhaps the biggest functionally-related physiological change with age is a decrease in muscle mass, called sarcopenia, which is due to a loss of motor units (a motor neuron and all the muscle fibres it connects to) and atrophy of fast-twitch muscle fibres. With the loss of motor units comes denervation of muscle fibres (a lost connection between the motor neuron and the fibres within the motor unit). This denervation causes the muscle fibres to deteriorate, resulting in a decrease in muscle mass, which significantly decreases the older adult’s muscle strength and power, making certain activities of daily living difficult.

Men and women generally attain their highest strength levels between ages 20 and 40, after which the strength of most muscle groups declines, slowly at first and then more rapidly after age 50. Muscle strength decreases approximately eight percent per decade after age 45, with greater strength losses occurring in women compared to men. In both men and women, lower body strength declines more rapidly than upper body strength.

With the loss of muscle mass also comes a loss in mitochondria, which decreases muscular and aerobic endurance. Mitochondria are unique in that they have their own specific DNA, so when older adults lose mitochondria, they also lose mitochondrial DNA. If your clients want healthy functioning muscles as they age, they need lots of healthy mitochondria.

Cardiovascular fitness also declines with age, in part due to a decrease in maximum heart rate and stroke volume (the volume of blood the heart pumps per beat). With a lower maximum heart rate and stroke volume comes a lower maximum cardiac output (the volume of blood the heart pumps per minute), a decreased ability to deliver oxygen to the muscles, and thus a lower VO2max (the maximum volume of oxygen the muscles can consume). VO2max decreases by 8 to 10 percent every 10 years after the age of 30 in healthy, sedentary adults. When maximum cardiovascular functioning declines, so does the workload that can be tolerated at a given percentage of the (lower) maximum. Decreases in VO2max with aging can be variable, particularly if your clients remain active. But if not attended to, a youthful run becomes an aged walk.

Training the Older Adult

Although many physiological factors decline with age, up to 50 percent of this decline is due to deconditioning rather than aging. With proper training, your clients can lessen the physiological effects of aging and remain fit and functional.

Arguably, cardiovascular exercise will always be more important than strength training throughout your client’s life because heart disease is the most common cause of death for both men and women. No one has ever died of a weak biceps muscle. But people die of weak hearts every day. One cannot live very well or very long without a strong heart. Since the risk of heart disease increases as people age, older adults need cardiovascular exercise just as much or even more than do younger adults. Like younger adults, older adults should do at least 30 minutes of cardiovascular exercise on most, if not all, days of the week. The more physically fit one remains, the slower the rate of cardiovascular decline. Maintaining exercise intensity, rather than a higher volume of training, is the key to minimizing the loss of aerobic fitness as your clients age.

Strength training also becomes more important as people age. Given that aging is accompanied by a decrease in muscular endurance, strength, and power, resistance training should take on greater weight (pun intended) when training an older client. I’d even go as far to say that every person over the age of fifty should strength train because that’s about the age at which people start to lose a significant amount of muscle mass. And that loss in muscle mass with age affects your client’s ability to function. If you’ve ever seen a senior citizen try to stand up from sitting in a chair or witnessed how catastrophic a fall can be to a senior, you know how much benefit strength training can have. The positive effects of strength training on bone density, muscular strength and endurance, balance and coordination (which reduces the risk of falling and fractures), functional mobility, physical aesthetics, and self-esteem cannot be denied.

Train older clients with heavier weights and fewer reps per set to target improvements in muscular strength, or with lighter weights lifted quickly to target the fast-twitch muscle fibres and improvements in muscular power. Greater strength gains occur at intensities of 80 to 90 percent of the one-rep max (the maximum weight that can be lifted just once). Although we tend to think of power training as something done to improve athletic performance, it has big implications for older adults, whose muscles lack strength and power. Research has shown power training to be very effective for strength and power development in seniors. Since it takes longer to recover from workouts as people age, give your clients more time between intense resistance and cardio workouts.

If you train older adults with higher intensity, less volume, and more recovery between workouts, not only will they be fitter and stronger, they may even be able to keep up with my 98-year-old grandmother.

From CanFitPro magazine. Sept./Oct. 2017.  Reprinted with permission from Jason R. Karp, PhD


Jason Karp, PhD, is the 2011 IDEA Personal Trainer of the Year, 2014 recipient of the President’s Council on Fitness, Sports & Nutrition Community Leadership award, and creator of the REVO₂LUTION RUNNING™ certification. He has more than 400 published articles in international running, coaching, and fitness magazines, is the author of eight books, including Run Your Fat Off and The Inner Runner, and speaks at fitness conferences and coaching clinics around the world. Get training programs and autographed copies of his books at run-fit.com.