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Movement and Cognition

How our ability to maintain balance, walk, and move is directly reflective of our higher human functions (A brief overview and case study)

Balance and cognition are inextricably linked. Quantification of improvement in key performance indicators of cognition is directly related to precisely measured improvements in balance and postural stability. A thorough understanding of this relationship is paramount to the understanding of conditions related to cognitive impairment, leaning and behavioral struggles, brain injury, and so much more.

At the time of presentation to APEX Brain Centers, Roger was a 70-year-old male struggling with severe balance problems, clumsiness, fatigue, and a general disinterest in life. He used to enjoy life as a family man, successful entrepreneur and golfer. Just over 10 years prior he had undergone radiation therapy for cancer that damaged his 8th cranial nerve (the balance and hearing nerve). He had also undergone prism therapies and surgery for eye position abnormalities, which have caused further insult to his ability to maintain good balance and to learn effectively. Although not listed as a primary complaint, he also suffered from significant cognitive decline in several areas as evidenced by very low to low average scores on standardized cognitive testing.

Roger sought care at APEX Brain Centers in Asheville, NC in May of 2015 and underwent an intensive course of brain/body rehabilitation. He was admitted into an individualized program directed by extensive diagnostic testing and led by clinicians highly experienced in functional neurology. What follows is a sampling of some of the leading-edge clinical interventions and significant functional gains Roger experienced during his program.

Intervention for balance and cognitive decline

Roger underwent comprehensive brain/body rehabilitation at a frequency of 3 times per day over the course of 15 days (with 2 days off between each for much needed rest and recovery). His brain function was carefully monitored throughout the training process with measurement of EEG, vital signs, eye movements, balance, mental and physical timing, and more to ensure he was receiving the proper amount therapy to be effective, but not too much so as to be counter-productive. Modalities implemented included, but were not limited to: neurofeedback, Interactive Metronome, vestibular rehabilitation, metabolic and nutritional therapies, eye movement and neurological rehabilitation, whole body vibration, electrical stimulation, breathing exercises, and home care recommendations.

Outcomes after Brain Training

Subsequent to his rehabilitative program, Roger reported subjective improvements in the vast majority of his pre-intensive complaints. More profound than that, his wife was quoted as saying, “it’s like I have my old husband back.” She noted that he used to be the life of the party and had been slowly deteriorating over time to the point of sitting in his chair all day and sleeping more and more often. He was finally plugging back into life, putting an end to his isolation and apathy. As is demonstrated by his balance testing, he is also experiencing a renewed ability to maintain balance, allowing him to be safer and more efficient in navigating his physical environment and getting back on the golf course.

Actual, measurable objective improvements recorded with post-intensive diagnostic testing include:

  • Cognitive Testing: Increase in his Neurocognition Index of 48%. This is a standardized overall score of cognitive performance. Increases in various aspects of memory, attention, processing speed and more as great as 21%.
  • Interactive Metronome: 56% improvement in task average with motor timing, and normalization of hyper-anticipatory timing tendency with motor tasks (i.e. responding prematurely to a pre-set reference tone).
  • Computerized Assessment of Postural Stability (CAPS): 20.5% improvement in balance on an unstable surface with eyes closed – bringing him from severe to mild reduction in balance compared to his peers. Elimination of a posterior center of pressure (CoP); significantly reducing his risk of falling backwards.
  • Video Oculography (VOG): Significant improvements in numerous aspects of oculomotor (eye movement) functionality including: gaze holding, slow and fast eye movements, optokinetic responses, and spontaneous/involuntary eye movements.

Better Movement Equals Better Cognition

With an alarming increase in the number of baby boomers and seniors experiencing balance issues and cognitive decline (that are in fact related and measurable), it is important to recognize the symptoms of these potentially debilitating disorders and, more importantly, that something can be done about them. Early intervention is key, as the longer one waits and the more function is lost, the more difficult it is to recover and have full engagement with life. These same concepts apply to all areas of cognitive and mental health.

Learn more on this topic… join Dr. Trayford for his MedFit webinar, Movement and Cognition.


Dr. Michael S. Trayford is a Board Certified in Chiropractic Neurology and Neurofeedback; and is the Founder and Director of Clinical Operations at APEX Brain Centers in Asheville, NC. His primary areas of focus in clinical practice, associated research, and teaching are learning and behavioral disorders of adulthood (with a focus on addictive and compulsive behaviors), brain injury, and cognitive impairment.

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Managing Your Exercise In a Pandemic: 10 Easy Exercises to Build a Strong Core Without Leaving the House

Just in time for the novel coronavirus (COVID-19) social distancing and closures of gyms and fitness centers in many areas, here’s a revisit of many important core exercises you can do at home to keep yourself strong and healthy. Download the free illustrated PDF (Chapter 21 of Diabetes & Keeping Fit For Dummies) for illustrations of the exercise listed below. (You can also find a variety of other at-home exercises on Diabetes Motion Academy Resources for free download.)

Many people are stuck at home for one reason or another think they can’t work on staying fit, but the truth is that you can get a stronger core and stay fitter without leaving home. You’d be amazed at how easy it is to get your fit on.

Remember: Your body core — the muscles around your trunk and pelvis — is particularly important to keep strong so that you can go about your normal daily activities and prevent falls and injuries, particularly as you age. Having a strong body core makes you better able to handle your daily life, even if that’s just doing grocery shopping or playing a round of golf.

Core exercises are an important part of a well-rounded fitness program, and they’re easy to do at home on your own. To get started on your body core workout, you don’t need to purchase anything. (Some of the advanced variations do call for equipment like a gym ball or dumbbells.)

Tip: Include all 10 of these easy core exercises in your workouts, doing at least one set of 15 repetitions of each one to start (where appropriate). Work up to doing two to three sets of each per workout, or even more repetitions if you can. For best results, do these exercises at least two or three nonconsecutive days per week; muscles need a day or two off to fully recover and get stronger. Just don’t do them right before you do another physical activity (because a fatigued core increases your risk of injury).

#1: Abdominal Squeezes

This exercise (Figure 21-1) is great for working your abdominals and getting your body core as strong as possible. If you’re female and have had gone through a pregnancy at some point, getting these muscles in shape doing these squeezes is a must.

  1. Put one of your hands against your upper stomach and the other facing the other direction below your belly button.
  2. Inhale to expand your stomach.
  3. Exhale and try to pull your abdominal muscles halfway toward your spine.

This is your starting position.

  1. Contract your abdominal muscles more deeply in toward your spine while counting to two.
  2. Return to the starting position from Step 3 for another count of two.

Work up to doing 100 repetitions per workout session.

#2: Planks or Modified Planks

Nobody likes doing planks, but they get the job done when it comes to boosting the strength of your core. Both planks and modified planks (Figure 21-2) work multiple areas, including your abdominals, lower back, and shoulders.

  1. Start on the floor on your stomach and bend your elbows 90 degrees, resting your weight on your forearms.
  2. Place your elbows directly beneath your shoulders and form a straight line from your head to your feet.
  3. Hold this position as long as you can.

Repeat this exercise as many times as possible during each workout.

#3: Side Planks

A modification of regular planks, this side plank exercise (Figure 21-3) works some of the same and some slightly different muscles that include your abdominals, oblique abdominal muscles, sides of hips, gluteals, and shoulders. Try doing some of both types for the best results.

  1. Start out on the floor on your side with your feet together and one forearm directly below your shoulder.
  2. Contract your core muscles and raise your hips until your body is in a straight line from head to feet.
  3. Hold this position without letting your hips drop for as long as you can.
  4. Repeat Steps 1 through 3 on the other side.

Switch back and forth between sides as many times as you can.

Tip: Try these plank variations to mix things up a bit:

* Raised side plank: Lifting both your top arm and your leg upward brings other muscles into play and makes your core work harder to maintain balance, but don’t let your hips sag.

* Gym ball side plank: Resting your supporting arm on a gym ball, use your core muscles to control the wobble to further strengthen your side muscles.

* Side plank with lateral raise: While holding the side plank position, slowly raise and lower a light dumbbell or other weight with your top arm to improve your coordination and strength.

* Side plank pulse: From the side plank position, add a vertical hip drive by lowering your hips until they’re just off the floor and then driving them up as far as you can with each repetition of this move.

#4: Bridging

If you work on your abdominal strength, you also need to build the strength in your lower back to keep things balanced. Bridging (Figure 21-4) is a good exercise to do that as it works your buttocks (including gluteals), low back, and hip extensors. Remember to breathe in and out throughout this exercise.

  1. Slowly raise your buttocks from the floor, keeping your stomach tight.
  2. Gently lower your back to the ground.
  3. Repeat Steps 1 and 2.

Tip: Try the bridging with straight leg raise variation: With your legs bent, lift your buttocks up off the floor. Slowly extend your left knee, keeping your stomach tight. Repeat with the other leg. Do as many repetitions as possible.

#5: Pelvic Tilt

An easy exercise to do, the pelvic tilt (Figure 21-5) works your lower back and
lower part of your abdominals.

  1. Lie on your back on the floor with your knees bent and feet flat on the floor.
  2. Place your hands either by your sides or supporting your head.
  3. Tighten your bottom, forcing your lower back flat against the floor, and then relax.
  4. Repeat Steps 2 and 3 as many times as you can.

#6: Superhero Pose

Whether you want to leap a tall building with a single bound or not, try doing this superhero pose exercise (Figure 21-6) to get a stronger core. It works many areas, including your  lower back, upper back, back of shoulders, and gluteals.

  1. Lie on your stomach with your arms straight over your head.
  2. Rest your chin on the floor between your arms.
  3. Keeping your arms and legs straight, simultaneously lift your feet and your hands as high off the floor as you can.

Aim for at least three inches.

  1. Hold that position (sort of a superhero flying position) for 10 seconds if possible, and then relax your arms and legs back onto the floor.

Tip: If this exercise is too difficult, try lifting just your legs or arms off the floor separately — or even just one limb at a time.

#7: Knee Push-Ups

Push-ups are hard to do if you haven’t built up the strength in your shoulders yet, so this knee version (Figure (21-7) is an easier way to start for most people. This exercise works your chest, front of shoulders, and back of upper arms.

  1. Get on your hands and knees on the floor or a mat.
  2. Place your hands shoulder-width apart on the floor.
  3. Tighten your abdominal muscles to straighten your lower back and lower yourself down toward the floor as far as you can without touching.
  4. Push yourself back up until your arms are extended, but don’t lock your elbows.

Tip: If knee push-ups are too hard for you, try doing wall push-ups to start instead. Stand facing a wall at an arm’s length and place your palms against it at shoulder height and with your feet about a foot apart. Do your push-ups off the wall.

#8: Suitcase Lift

This exercise (Figure 21-8) is the proper way to lift items from the floor. Before you begin, place dumbbells or household items slightly forward and between your feet on the floor. You work the same muscles used in doing squats (lower back and lower body) with this activity.

  1. Stand in an upright position with your back and arms straight, with your hands in front of your abdomen.
  2. Bending only your knees, reach down to pick up the dumbbells.
  3. Grab the dumbbells or items in both hands and then push up with your legs and stand upright, keeping your back straight.

#9: Squats with Knee Squeezes

These squats (Figure 21-9) are not your normal squats. They’re more like a combination of squatting and wall sitting with a twist. You work the front and back of thighs, inner thighs (adductors), hip flexors and extensors all with this one exercise.

  1. Stand with your back against the wall, with your feet aligned with your knees and straight out in front of you.
  2. Place a ball or pillow between your knees and hold it there with your legs.
  3. Inhale to expand your stomach and then exhale and contract your abdominal muscles.
  4. Bend your knees and lower yourself into a squat.

Warning: To avoid injuring your knees, don’t bend them more than 90 degrees.

  1. Squeeze the ball with your thighs, drawing your stomach muscles more deeply toward your spine.
  2. Do as many squeezes as you can up to 20 and then return to the starting position.

#10: Lunges

Lunges (Figure 21-10) are a common activity to work on the front and back of thighs, hip flexors and extensors, abdominals, and lower back all with one exercise. Do them with proper form to avoid aggravating your knees, though.

  1. Keep your upper body straight, with your shoulders back and relaxed and chin up.
  2. Pick a point to stare at in front of you so you don’t keep looking down, and engage your core.
  3. Step forward with one leg, lowering your hips until both knees are bent at about a 90-degree angle.

Make sure your front knee is directly above your ankle, not pushed out too far, and don’t let your back knee touch the floor.

  1. Focus on keeping your weight on your heels as you push back up to the starting position.

Tip: To prevent injuries, if you feel any pain in your knees or hips when you do a lunge, do the following instead:

* Take smaller steps out with your front leg.

* Slowly increase your lunge distance as your pain gets better.

* Try doing a reverse lunge (stepping backward rather than forward) to help reduce knee strain.


Reprinted from Colberg, Sheri R., Chapter 21, “Ten Easy Exercises to Build a Strong Core Without Leaving the House” in Diabetes & Keeping Fit for Dummies. Wiley, 2018.

Sheri R. Colberg, PhD, FACSM, is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook). She is also the author of Diabetes & Keeping Fit for Dummies, co-published by Wiley and the ADA. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 30 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com, DiabetesMotion.com, or DMAcademy.com).

woman-video-chatting

Social Distancing – Not Social Isolation: Coaching for Connectedness

We all still need each other. Even in the age of COVID-19, our health continues to depend upon healthy supportive relationships. Our coach training company, Real Balance 1 has always stressed what we call Coaching for Connectedness.  We‘ve seen lifestyle improvement occur and last more often when people receive support for the changes they are making to live healthier lives.  When a coaching client sets up an action step we ask “Who/what else can help support you in this?”. Research on what makes health behavior last points primarily to two factors: a shift in self-concept and community support. (2)   It’s also a well-established fact that people who are more socially isolated have significantly higher rates of all major chronic illnesses. (3)

Our challenge in the midst of a pandemic situation is how we distance from each other while remaining connected to each other. Yes, follow the CDC guidelines for social distancing. We can still greet each other with elbow bumps, and then go for a walk, a bike ride, a cruise in kayaks, etc., and continue to avoid the proximity that puts us at any risk. We can connect via phone and receive the nourishment of live, interactive conversation that texting and e-mail don’t quite match. We can climb on board a web-based platform such as Zoom and Skype where we are face-to-face for our conversation. We also have all sorts of apps such as Facetime, WeChat, and many more that allow us to have face-to-face interaction for live conversations.

As coaches we can continue to work remotely with our clients, as the majority of coaching is already done. As we do, explore the feelings that the changes brought about by social distancing are bringing out in your clients. Empathize. Explore. When people talk about their fears, the intensity of those fears almost always lessens. As people become less afraid, their thinking improves. They aren’t so quick to jump into dismissive all-or-none thinking. They are then able to engage in strategic thinking with their coach to find unique solutions to staying healthy.

  • The fitness center is shut down. How can you shift to working out at home? Use stretch bands. Modify a spare room into a place to do Yoga, floor exercises, etc. Spring brings better weather allowing more cardio outdoors.
  • Do more outdoor exercise/activity with other people – just keep your proper distance.
  • Encourage clients to find new ways to electronically visit their friends, grandchildren, and others. Play online games together.
  • Check in with your clients to make sure they have CDC information/WHO information about how to stay safe during the COVID-19 pandemic. (5,6)

Take heart at how people are showing concern for each other during this time. Younger people who are at somewhat less risk are engaging in social distancing, handwashing, etc. not only for themselves, but for the older and more vulnerable people who could be affected by the contact they are having. People in neighborhood chatlines are volunteering to go pick up groceries and prescriptions for older or more sickly neighbors. Hopefully what will come out of all of this is a greater sense of how we are all in this together. Distancing does not mean isolating. The truism of wellness pioneer Jack Travis is still valid: Connection is the Currency of Wellness.

Be well and stay well!


Michael Arloski, Ph.D., PCC, NBW-HWC – A psychologist with over twenty-five years of clinical work, and more than 23 years as a professional wellness coach, Dr. Arloski is one of the key developers of the field of health & wellness coaching. He is the author of Wellness Coaching For Lasting Lifestyle Change, 2nd Ed., and Masterful Health & Wellness Coaching: Deepening Your Craft.  His company, Real Balance Global Wellness Services, Inc., has trained over 9,000 health & wellness coaches worldwide www.realbalance.com.

References

  1. https://realbalance.com
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753403/  
  3. https://www.apa.org/monitor/2019/05/ce-corner-isolation
  4. https://www.cdc.gov/coronavirus/2019-ncov/index.html
  5. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

This article was published on Dr. Arloski’s blog. Reprinted with permission.

stretch_2

Did You Hear? Stretching is Back in Fashion, Part 2

For any person, a regular stretching routine can bring some surprising benefits. While you might think that stretching right before activity is beneficial, it needs to be done on a regular basis for a minimum of 10 minutes in order to bring some major changes to muscles and tendons. Research shows that people with the least flexibility have increased chances of injury…

Use Exercise Bands to Boost Your Cardio Endurance and Reduce Inflammation

Researchers studied 1,544 people age 50-plus. Some of those in their 80s had the lowest inflammation levels in their bodies because they took care of their health. This included cardio exercises along with resistance – weight training with weights and bands, stretching for flexible joints and mobility. Even in extreme old age, centennials showed positive outcomes when they exercised. Low levels of inflammation were also an important predictor of people’s cognitive function, especially those in the oldest age group.

Lori Michiel in her studio

I’d have to say that of all the exercises I do, I love anything aerobic (getting my heart rate up) the most.  Walking, jogging, biking and dancing are the most common forms to get your motor running and is a great way to shake off the cobwebs. Any quick, sustained movement can increase your heart rate.

Before you start moving around, think about what motivates you to push a little harder. Are you interested in exercise to reduce stress and shake off the blues, lose weight, build a healthier brain (cognition), or make new friends?

Researchers say those who believed exercise was good for stress reduction valued it more with increased age. Motivation to move when reaching 60-plus can yield different benefits. For instance, people who exercise experience less inflammation in their bodies. Inflammation can lead to illness (stemming from a lower immune system) and difficulty losing weight. Losing weight can be especially troublesome if you have joint issues (hip, knees or back). With each pound you lose, the equivalent of four pounds of pressure can be released.

The combination of cardio mixed with bands is one solution for cardio exercise to keep inflammation at bay. It is fun. Be creative and you will never get bored. In this month’s Exercise Snack Video, I will show you a few quick examples. Pay close attention to my cues on form and technique and in the long run (pardon the pun), you’ll have fun!!

Side note: The familiar tune of the Bee Gees song “Stayin’ Alive” has been used for medical training for some time. It has the right beat — not to mention the perfect title — for providing CPR’s chest compressions at the right pace to revive a patient. Try playing it sometime when you exercise.

Reprinted with permission from Lori Michiel. Originally published on Lori’s Fitness Blog For Active Adults and Seniors.


Lori Michiel, NASM, has been assisting seniors in their homes since 2006 with customized exercise programs including those designed to address Parkinson’s, metabolic disorders, arthritis and diabetes. These adaptive programs are specifically designed to improve balance, circulation, flexibility, mobility and promote independence. Lori Michiel Fitness has over 40 certified trainers who are matched with clients in Los Angeles, Ventura and Orange Counties. Connect with Lori at www.LoriMichielFitness.com.

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Exercise Solutions for Fibromyalgia

Approximately 4 million people in the United States live with fibromyalgia, an illness which manifests as severe muscle pain and chronic fatigue. Living with fibromyalgia — the cause of which is unknown, but seems to be connected to the nervous system — means coping on a daily basis with debilitating discomfort and a lack of energy, making exercise difficult. Indeed, a lot of different exercises can actually make the symptoms of fibromyalgia more acute, but there is a common misconception that exercise should be avoided completely by those with the condition.

Giving up exercise is not the answer. Some forms of physical exercise may exacerbate pain, but this is due to the unsuitability of the exercise itself, rather than just doing exercise. In fact, performing exercises that don’t trigger symptoms can actually help, not the least of which is relieving mental and psychological fatigue which is connected to living with the illness.

Start slowly

Throwing yourself into a workout with no gradual build-up is not recommended for anybody, but least of all if you live with fibromyalgia. Intense workouts need to be increased over time, whether you’re 18 or 80, in good shape or not. Unprepared muscles will not respond well and it could take days to undo the damage caused. As little as 5 minutes spent walking can be the best approach.

“After a while, start to increase the amount of time you spend exercising bit by bit, but do not increase the rigorousness of the exercise, which will have a detrimental effect,” warns Pamela Chase, a Fibromyalgia expert at SimpleGrad and Revieweal.

Keep it low intensity

And with the case of fibromyalgia, high-intensity workouts should never be the aim. Pain will only be exacerbated if you take on exercise that’s intense on the muscles, so again, walking is a great option, as is a gentle swim using breaststroke or backstroke. Other great options for fibromyalgia are yoga and tai chi, which include slow movements and little impact.

Take plenty of breaks

In addition to keeping exercise low intensity, take plenty of breaks. Not only will this allow you to recover energy levels, but you’ll actually be able to participate for longer, if you break your routine into smaller, bitesize chunks.

Listen to your body

Exercise can mean overcoming mental obstacles, no matter who you are, but when you suffer from fibromyalgia, it’s imperative you listen to your body. Don’t try to undertake exercise when the message coming from inside is ‘no’. There will simply be times when your energy levels are too low to participate in any form of exercise, so despite the mental frustration this will cause, listen to what your body is communicating.

Measure impact and recovery

Listen to what your body is telling you, and that means keeping tabs on it for two or three days after. As you start to build in exercise routines, do so gradually so the impact of each one can be measured independently. It will help you understand what is working for you, and what isn’t, and then you can develop routines that work for you.

“Although exercise tips are generic, and medical guidance is quite standard for fibromyalgia sufferers, the reality is that no two individuals will respond in exactly the same way to what could appear to be an identical workout, so continue to listen to your body, and continue with routines that work for you as an individual,” says Bruce Sorenson, a journalist at UKTopWriters and AustralianReviewer.

Additional tips

The nature of fibromyalgia means that there are related issues to look out for and manage with your workouts. One such issue is orthostatic intolerance — which means the blood rushes to the legs when sufferers stand up, and stays there. The solution to this is vastly increasing water and salt intake prior to and during exercise, and exercising in warm water. Using a recumbent bicycle can also greatly assist as a warm-up, or even as the exercise itself.

You should consult your physician or other health care professional before starting any exercise routine or program to determine if it’s suitable for your needs.


Aimee Laurence is a personal trainer and blogger at Paper Writing Service and Essay Service. She writes about Fibromyalgia and health. Also, Aimee tutors at Assignment Help Australia portal.

 

References

Pamela Chase, a Fibromyalgia expert, Simplegrad and Revieweal.

Bruce Sorenson, a journalist, UKTopWriters and AustralianReviewer.