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Flip the Script: How Fitness Professionals Can Overcome Challenging Clients

If you are a fitness or medical fitness professional, there is a good chance you have heard one or more of the following statements at least once in your career. In fact, there is also a good chance you have heard these statements on a daily basis. 

1. I am a little tired and my muscles are a little sore from our last session, so I am going to cancel today and rest. 

2. I don’t want to do “that exercise” because I have never done it before.

3. My doctor told me that I should not be squatting, bending, reaching, twisting, etc… 

Many of you reading this article can relate to at least one of the above and may have even let out a slight sigh of frustration when it comes to overcoming challenging clients. Overwhelming amounts of research show that exercise can help to improve your health and fitness without hurting your joints.(1) With your current treatment program, exercise can: 

  • Strengthen the muscles around your joints 
  • Help you maintain bone strength 
  • Give you more energy to get through the day 
  • Make it easier to get a good night’s sleep 
  • Help you control your weight 
  • Enhance your quality of life 
  • Improve your balance 

However, many of our clients still believe that exercise will aggravate their joint pain and stiffness, but that is not the case. Lack of exercise actually can make your joints even more painful and stiff.(2) If the muscles and surrounding tissue are strong, it helps to maintain support for your bones. Choosing not to exercise weakens those supporting muscles, creating more stress on your joints. 

While fitness and medical fitness professionals understand the importance of exercise, the way we translate this to our clients is key. Oftentimes, clients receive misinformation along with mixed messages from doctors, family members, friends, and of course, social media. However, after decades of both academic and professional research working with special demographics, I have discovered a powerful technique to increase clients’ willingness to improve their health through exercise. The answer lies not only in showing the client how each exercise emulates real-life situations, but also how it affects their independence.

For example, telling a client, “Today we will be working on how to safely and effectively execute a squat,” is a lot different than saying, “Today we will be practicing our sit to stand movements so that you have the lower body strength and flexibility to rise from your favorite chair without assistance.” 

Most importantly, it is important to reiterate to your client that their lack of strength, mobility, and balance leads to a more sedentary lifestyle that will decrease their ability to function independently as time progresses. Additionally, muscle atrophy, joint immobility and poor flexibility are key indicators that functional movements, or movements that are required to perform everyday tasks, will soon be a thing of the past.

If a client is unwilling to perform various exercises, here are some conversation starters:

  1. Did you know that this is not just an exercise, but one of the foundational movements to support strength, balance and flexibility in your everyday life?
  2. Do you know the definition of functional fitness?
  3. Do you know that this isn’t just an exercise, but will help you walk up and down the stairs, get up from a seat, carry your groceries, and pick up a grandchild?
  4. Are you ready to give up your independence? 

Christine M. Conti, BA, M.Ed, is an international fitness educator and presenter. She currently serves as the Director of Membership for MedFit Network, sits on the MedFit Education Advisory Board and is a course author for MedFit Classroom. She is also CEO and founder of ContiFit.com and Let’s FACE It Together™ Facial Fitness & Rehabilitation and co-host of Two Fit Crazies & A Microphone Podcast

Check out Christine’s online course with MedFit Classroom, Arthritis Fitness Specialist:

References

  1. CDC: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. (2021, April 5). Benefits of Physical Activity. Center for Disease Control and Prevention. Retrieved September 10, 2021, from https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
  2. Mayo Clinic. (2021). Exercising With Arthritis: Improve Your Joint Pain and Stiffness. Mayo Clinic. Retrieved September 9, 2021, from https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971
seniors-biking-in-gym-group

Exercise’s Impact on Cognition

It’s not news that the brain changes with age. Significant changes in regions of the brain occur in healthy adults as they age, based on MRI studies.(1) The caudate, cerebellum, hippocampus, and association cortices shrunk substantially. This shrinkage in the hippocampus and the cerebellum accelerates with age. The hippocampus, the site for new memory formation, is involved with learning and emotion with a rich supply of estrogen and progesterone receptors. The cerebellum coordinates voluntary movements including all conscious muscular activity, balance, coordination, and speech.

Incidence of Dementia

The United States is experiencing both a declining birth rate and an increased average life span. This combination will increase the percentage of people over the age of 65 to 19.6%, resulting in a total of 71 million people by the year 2030.(2) The number of people over the age of 80 is also expected to increase to 19.5 million by 2030.(2) These changes will greatly increase the number of people with dementia since 6% to 10% of North American individuals aged 65 or older have dementia; this increases to 30% in those aged 85 or over.(3)

Dementia, or senility, is a difficult-to-define cluster of symptoms that include memory loss, loss of vocabulary, and loss of motor function in the absence of a change in the level of consciousness. Dementia can be measured qualitatively by verbal memory tests such as the Blessed Orientation-Memory-Concentration test, comprising six questions as listed in the following table:

The scores from each of the table’s six items are multiplied to produce a weighted score. Score 1 for each incorrect response; weighted error scores greater than 10 are consistent with dementia.(4)

Exercise Affects the Brain

The incidence of Alzheimer’s dementia can be used as a measurement of brain health.(5) As part of his study “Exercise Is Associated With Reduced Risk for Incident Dementia Among Persons 65 Years of Age and Older,” Eric B. Larson, MD, MPH, et al asked 1,740 mentally healthy men and women over the age of 65 how many days per week over the past year they had exercised for at least 15 minutes. The incidence of Alzheimer’s disease (AD) was significantly higher for individuals who exercised fewer than three times per week (19.7 per 1,000 person-years) compared with those who exercised more than three times per week (13 per 1,000 person-years). These results were not influenced by the E4 alleles on the apolipoprotein gene, which indicates a genetic predisposition for AD.

Laura Podewils et al studied the relationship between physical activity and dementia in 3,375 men and women over the course of 5.4 years.(6) Physical activity in these individuals over the age of 65 was assessed via the Minnesota Leisure Time Questionnaire. The subjects were questioned regarding the frequency and duration of their physical activity over the previous two weeks. Like Larson et al, this study found that increased exercise decreased the incidence of Alzheimer’s dementia.

The Mini-Mental State Exam can be used as a measure of cognitive ability or impairment. The 30-point questionnaire commonly used by health care providers screens for dementia, evaluates cognitive impairment, and follows cognitive change over time, making it an effective way to document an individual’s response to treatment.(7) Kristine Yaffe, MD, et al used the Mini-Mental State Exam to show that cognitive performance increases as the number of blocks walked per week increases.(8) The study involved 5,925 women over the age of 65 over a six- to eight-year period.

The most objective measure of cardiovascular fitness is the measurement of the maximum rate of oxygen consumption as measured during incremental exercise—milliliters of oxygen per kilogram of body mass per minute. A subjective measure of exercise amount or duration is not as accurate as the above direct measure, which is called maximum oxygen consumption or VO2 max. Deborah Barnes, PhD, et al conducted a six-year study of 349 individuals over the age of 55 measuring both VO2 max and subjective measures of fitness. Barnes found only the lower levels of VO2 max correlated with cognitive decline.(9) The four studies mentioned show a positive cognitive benefit from exercise. A meta-analysis performed by Colcombe and Kramer from 1966 to 2001 examined 18 studies of fitness training and cognitive function in nondemented older adults. They concluded that fitness training had a positive influence on cognition.(10)

Prospective controlled human studies provide more robust data than both animal and uncontrolled studies. Stanley J. Colcombe et al were the first to show in a prospective controlled setting that increases in cardiovascular fitness in humans results in increased functioning of the prefrontal and parietal cortices. These data suggest that increased cardiovascular fitness can affect improvements in the plasticity of the aging human brain and may serve to reduce both biological and cognitive senescence in humans.(11) In addition, women tended to exhibit the greater benefit.(12) In a literature review, Kramer et al complemented these data through the use of MRI, which is very accurate in the brain. Through this technique, Kramer and colleagues concluded that older adults who participated in the aerobic training group demonstrated a significant increase in gray matter volume in regions of the frontal and superior temporal lobe when compared with controls. The results suggest that even relatively short exercise interventions can begin to restore some of the losses in brain volume associated with normal aging.(12)

Animal studies offer some insight into how aerobic exercise benefits brain function. Aerobic exercise increases brain function in both young and old animals. Aerobic exercise increases the levels of brain-derived neurogenic factor (BDNF) and insulinlike growth factor 1 (IGF-1). BDNF has been shown to regulate neurotransmitters, including dopaminergic and cholinergic systems and may be playing an important role in the exercise-induced effects on the brain.(13) BDNF may be involved in the postexercise changes seen on a brain MRI. In addition, IGF-1 may be mediating the effects of exercise on BDNF, neurogenesis, and cognitive performance. Animal studies provide information on the effects of exercise that is difficult to obtain in human intervention studies. The sum of these animal studies overlaps with results from human studies and suggests that exercise is an effective enhancer of neurocognitive functioning in both young and old animals.(12)

AD, the most common form of dementia, shares many age-related pathophysiological features of type 2 diabetes, including insulin resistance, disrupted glucose metabolism in nonneural tissues, peripheral oxidative and inflammatory stress, amyloid aggregation, neural atrophy, and cognitive decline. Brain insulin resistance appears to be an early and common feature of AD, a phenomenon accompanied by IGF-1 resistance, promoting cognitive decline independent of classic AD pathology.(14) Such a large set of shared features suggests shared etiologies.

Recommendation

High-intensity interval training (HIIT) is a type of endurance training involving short periods of maximal effort followed by periods of maintenance or recovery effort. What can differ is the timing and type of endurance exercise. A typical cycling HIIT pattern may be four to six maximal 30-second cycling sprints separated by 4.5-minute recovery periods of comfortable cycling. When HIIT is compared with longer steady endurance training, the HIIT patterns show increased mitochondrial density in muscle cells and greater muscle performance improvements.(15,16)

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This article was featured in Today’s Geriatric Medicine.

Today’s Geriatric Medicine is a bimonthly trade publication offering news and insights for professionals in elder care.

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This article was featured in the Jan/Feb 2016 issue of Today’s Geriatric Medicine (Vol. 9 No. 1 P. 26). Written by Robert Drapkin, MD

Robert Drapkin, MD, a medical oncologist and competitive bodybuilder in Clearwater, Florida, specializes in helping elderly adults achieve a healthful lifestyle to combat illnesses or disease and to extend lifespan.

 

References

1. Raz N, Lindenberger U, Rodrigue KM, et al. Regional brain changes in aging healthy adults: general trends, individual differences and modifiers. Cereb Cortex. 2005;15(11):1676-1689.

2. Chapman DP, Williams SM, Strine TW, Anda RF, Moore MJ. Dementia and its implications for public health. Prev Chronic Dis. 2006;3(2):A34.

3. Hendrie HC. Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry. 1998;6(2 Suppl 1):S3-S18.

4. The Blessed Orientation-Memory-Concentration Test. University of Missouri Geriatric Examination Tool Kit website. http://geriatrictoolkit.missouri.edu/cog/bomc.pdf.

5. Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006;144(2):73-81.

6. Podewils LJ, Guallar E, Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol. 2005;161(7):639-651.

7. Pangman VC, Sloan J, Guse L. An examination of psychometric properties of the mini-mental state examination and the standardized mini-mental state examination: implications for clinical practice. Appl Nurs Res. 2000;13(4):209-213.

8. Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Arch Intern Med. 2001;161(14):1703-1708.

9. Barnes DE, Yaffe K, Satariano WA, Tager IB. A longitudinal study of cardiorespiratory fitness and cognitive function in healthy older adults. J Am Geriatr Soc. 2003;51(4):459-465.

10. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125-130.

11. Colcombe SJ, Kramer AF, Erickson KI, et al. Cardiovascular fitness, cortical plasticity, and aging. Proc Natl Acad Sci U S A. 2004;101(9):3316-3321.

12. Kramer AF, Erickson KI, Colcombe SJ. Exercise, cognition, and the aging brain. J Appl Physiol (1985). 2006;101(4):1237-1242.

13. Knüsel B, Winslow JW, Rosenthal A, et al. Promotion of central cholinergic and dopaminergic neuron differentiation by brain-derived neurotrophic factor but not neurotrophin 3. Proc Natl Acad Sci U S A. 1991;88(3):961-965.

14. Talbot K, Wang HY, Kazi H, et al. Demonstrated brain insulin resistance in Alzheimer’s disease patients is associated with IGF-1 resistance, IRS-1 dysregulation, and cognitive decline. J Clin Invest. 2012;122(4):1316-1338.

15. Gibala M. Molecular responses to high-intensity interval exercise. Appl Physiol Nutr Metab. 2009;34(3):428-432.

16. Billat VL. Interval training for performance: a scientific and empirical practice. Special recommendations for middle- and long-distance running. Part I: anaerobic interval training. Sports Med. 2001;31(1):13-31.

brain-digital-image

The Neuroscience of Mind-Body

In an era where neurological disorders and mental illness run rampant, effective and scalable non-pharmacological interventions are desperately needed. Luckily, science continues to demonstrate the efficacy of exercise-based interventions in improving cognitive, neurobiological, and mental health outcomes in a variety of populations. Multiple modalities of exercise, such as aerobic training and resistance training, continue to demonstrate improvements in several measures associated with brain health. While aerobic exercise has received a majority of the spotlight over the past couple of decades, other forms of exercise have also moved to the forefront of the exercise-neuroscience literature.

STRESS pencil

Helping Older Adults Flex their Stress Resilience Muscles 

We can all agree that stress levels have skyrocketed to an all-time high following the “year of fear.” Older adults with chronic conditions have been the hardest hit since they are most vulnerable to Sars-CoV-2 and severe outcomes. Millions have been struggling with the fear of infection and mortality; inactivity and muscle weakness as well as social distancing and isolation. Helping older adults build stress resilience strategies into daily life is critical to bolster and protect physical, mental and social wellbeing.

Living under chronic stress leads to bad decisions. That’s because the part of the brain called the amygdala is activated when under threat. It is our survival brain with the “fight or flight” response being its signature. This means that blood is flowing to the “reactive” brain and away from the “thinking and planning” part of our brain, the pre-frontal cortex.   

This can contribute to poor eating, activity and lifestyle choices. Convenience and processed foods can easily take center stage along with sedentary behaviors and heavier use of drugs and alcohol. This can lead to malnutrition, decreased blood flow and the increased risk and severity of chronic conditions as well as impairing immune function. It is a recipe for dis-ease and higher health risks, particularly in pandemic times.

Chronic stress puts the body into a catabolic state of “breaking down” while also turning down the volume on the body’s anabolic pathways of “building up” (1). The body was designed to live in the parasympathetic state, also known as “rest, digest, heal and repair” mode.  Constantly living in the stress response leads to high levels of cortisol, oxidative stress and pro-inflammatory cytokines (immune messengers). This chemical marinade literally shrinks muscle and brain cells (2).  

Chronic Stress Stinks & Shrinks

What happens when muscle and brain cells atrophy? Sarcopenia and cognitive decline arrive on the scene. This in turn leads to the downward spiral of physical and mental pathology that can include disability, dependency, dementia, an increased risk of falls, fractures and hospitalizations.   

Resilience is a Process

The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress,” or “bouncing back” from difficult experiences (3). It is an adaptive process that can be developed. Being “hardy” or resilient is linked with positive outcomes, including improved functional mobility, health and longevity.  

Medical fitness specialists can help older adults build stress resilience by empowering them with education and encouragement. This can be a powerful intervention as it combines education with behavior modification. It includes asking questions while providing clear messaging that reduce fears and clarify health benefits followed by simple actionable steps. The pro-active older adult can choose to practice the strategies that resonate with them.  Being accountable to and encouraged by a trainer knowledgeable about geriatrics can support the process of building resilience to weather “stress storms.” 

Building Stress Resilience

Like health, resilience is multi-dimensional and includes physical, mental and social components. As fitness professionals, we understand that exercise activity is the most powerful intervention to relieve stress because movement positively impacts the health of every cell in the body and brain. After all, who doesn’t feel better after an appropriate workout or walk in the sunshine?!

5 Simple Strategies

Being mindful of breathing, eating and moving are great ways to build stress resilience.  Living in the present moment helps develop awareness, connection and calm. Avoid overwhelm by choosing to practice one small step at a time.

1. Breathe Deeply. Breath connects body and mind. Stress breathing is shallow breathing. By focusing on the depth and pace of breath, the parasympathetic nervous system is engaged. Encourage older adults to become aware of tension and overwhelm; to take “Breathing Breaks” while focusing on breathing in and out through the nose. It can be as simple as starting with 3 deep breaths and working up to 30.  

2. Eat Slowly. In order to digest food and absorb nutrients properly, eat seated in a relaxed, calm environment.  Encourage older adults to slow down and focus on chewing food 20-30 times. This supports the mechanical breakdown of food for better digestion. While eating, focus on the food’s aroma, flavor, texture, mouth feel and swallowing. 

3. Tea Time. Take a few minutes to savor a warm cup of herbal tea like lemon balm, lavender or chamomile.  Enjoy the aroma and feeling of warmth in hand and the body. This practice is a wonderful way to wind down at the end of the day or as needed.

4. Gratitude Attitude. Before rising and/or going to bed, think about, say out loud or write down 3 things you are grateful for. Practicing gratitude is linked with boosting happiness, optimism and a sense of greater well-being (3).

5. Move more. Inactivity and sedentary time slows down blood flow, metabolism and immune function. Encourage older adults to break up sedentary time with 5 minutes of movement every hour. Light intensity activity like house cleaning has been shown to reduce the risk of mobility disability by 40%! Simply moving more throughout the day is powerful medicine, especially when paired with a tailored exercise program. 

Today, building stress resilience is absolutely critical for older adult’s functional and cognitive health.  They will be so grateful for your guidance!


Cate Reade, MS, RD is a Registered Dietitian, Exercise Physiologist and Functional Medicine Practitioner candidate on a mission to improve functional mobility and health span utilizing the power of lifestyle medicine. She has been teaching, writing and prescribing healthy eating and exercise programs for over 25 years. Today, as CEO of Resistance Dynamics and inventor of the MoveMor™ Mobility Trainer, she develops exercise products and programs that target joint flexibility, strength and balance deficits to help older adults fall less and live more.


References 

  1. Kirwan R et al (2020). Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. Geroscience. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528158/
  2. Mohammed A & Kunugi H (2021). Screening for Sarcopenia (Physical Frailty) in the COVID-19 Era. Int J Endocrinol. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152925/
  3. MacLeod, S et al (2016). The impact of resilience among older adults. https://www.sciencedirect.com/science/article/pii/S0197457216000689
Senior-and-Trainer

How Feedback Can Improve Sit to Stand Performance

Sit -to -stand transfers are important movements that physical therapists, occupational therapists, trainers, and coaches use every day with their clients. With professional guidance clients can successfully learn the symmetry of weight distribution and other mechanics required to correctly perform sit-to-stand. Without such guidance clients may not learn the safe and correct way to get up from a seated position or to use the movement as exercise. The result can be pain, falls and other injuries.

Feedback

Feedback regarding proper motor patterns is an important tool that can lead to greater movement efficiency, increased activity, and lower risk of injury. After analyzing the different phases of sit to stand (preparatory/ starting alignment, transitional movements, and the final standing posture), clinicians can use feedback to address both the spatial and temporal parameters of movement that is needed to improve overall performance.

Why We Need Feedback

A natural part of performing a skill is to use intrinsic feedback, the sensory perceptual information caused by-the movement. Vision, proprioception, touch, pressure, and audition help formulate a person’s internal representation of a movement goal.

When performing sit- to- stand, proprioceptors indicate the muscle length and tension of the position of the ankles and feet, as well as the amount of pressure through the limbs; visual information orients the individual to the environment; and vestibular inputs, contribute to sense of verticality. If your clients are not receiving the proper intrinsic feedback, they may not be aware of their movements. For example, an individual with impaired ankle proprioception may need extrinsic or augmented feedback to increase the weight and symmetry through their legs.

Augmented feedback enriches/enhances intrinsic feedback. It provides information to clients who are unaware of their body position. Augmented feedback can help engage the patient during all phases of sit -to- stand and with different modalities: visual, auditory or tactile.

What type of Feedback to Use? Auditory, Tactile, or Visual?

When training sit<>stand, what type of feedback and verbal cues would you provide to achieve forward weight shift, symmetry of weight distribution versus increasing speed of transfer?

Think about your clients who have trouble getting up from sitting and are not sure why they cannot rise on their first attempt. Often patients think the problem is lack of strength.

Sometimes using the cue “nose over toes” works for these patients. Other times, it is the size and timing of their forward weight shift that needs to be cued?

Auditory feedback provides an engaging solution in this situation. For example, the Step and Connect’s Balance Matters System features auditory feedback about the timing and amount of weight the client shifts forward. The system’s innovative foot pads make a clicking sound when the move is done correctly. The click is nonjudgmental and motivating. The client learns a new way to move without verbal instruction.  With practice the correct move becomes automatic.

During sit to stand transfers auditory feedback can improve: 

  • Starting alignment
  • Forward weight shift
  • Timing of weight shift
  • Symmetry of weight distribution
  • Postural control (decrease sway at the ankles)

Example using the Balance Matters system:

Sit to stand: Activate back clicker, activate front clicker while you stand, keep all clickers quiet during standing.

Stand to sit: Keep all clickers quiet until bottom is on the seat.

Progressions and Intervention Ideas

Part Practice (only one phase of the transfer).

  • Preparatory phase: Work on good starting posture, activating back clicker to promote anterior pelvic tilt and increased weight bearing through the legs.
  • Transitional phase: Reach forward with arms and activate front clicker to promote anterior weight shift.
  • Transitional phase for stand to sit: partial squats to sit down keeping clickers quiet to improve the timing of weight shift and decrease a “plop”.

Symmetry of movement and weight-bearing

  • Does one side activate sooner than another or do you not activate one clicker on one side since you are weight bearing more on the opposite side.
  • Verbal cue: Hear the clicker go off at the same time standing up and sitting down.

Activate the vestibular system standing on foam footpads

  • Add head turns with sit to stand on foam

Changing the Stance Position

  • Staggered stance and step to work on step initiation.

Eyes closed to improve balance in dimly lit environments.

  • This is important when standing up from bed to walk in order to go to the bathroom at night. An article “Effect of Sitting Pause Times on Balance After Supine to Standing Transfer in Dim Light” mentions that the risk of falling for older adults increases in dimly lit environments.
  • The results of the study suggest that longer sitting pause times may improve adaptability to dimly lit environments, contributing to improved postural stability and reduced risk of fall in older adult women when getting out of bed at night.
  • This is an important topic on how the speed or timing to adapt in different environments (dim lit or uneven surfaces) can change our overall balance and postural control and should be integrated into balance exercises and goals.

Using multi-sensory feedback with the Balance Matters system will:

  • Improve an individual’s awareness of their starting posture and transitional postures.
  • The auditory feedback in the footpads helps promote improved timing, sequence of the task, weight distribution for symmetry and weight shift.

Remember, there are influential factors when designing programs using feedback. Fading the feedback for retention is highly recommended. In the Balance Matters courses, we review more in-depth these influential factors and clinical applications.


Originally printed on stepandconnect.com. Reprinted with permission.

Balance Matters is a unique balance training sensory tool developed by recognized Physical Therapist Erica Demarch, intended initially for Parkinson’s patients and others suffering from balance issues. Now has become a popular sensory balance training tool for people looking to “train their brain” for improved balance. The Balance Matters system is the foundation of Erica’s company, Step and Connect, stepandconnect.com

sleep2

Sweet Dreams: 5 Tips for Sound Sleep and a Healthy Brain 

It doesn’t matter what age you are, getting a good night’s rest is essential for your physical and mental health. Taking the time to recharge every night is especially vital because sleep and brain health are closely related. However, as we age, sleep doesn’t always come as easily as it used to. 

In a 2003 poll, the National Sleep Foundation found that over 48% of older adults experience symptoms of insomnia more than twice a week, and the National Institute on Aging reported that insomnia is one of the most common problems experienced by adults aged 60 and over.

Insomnia and sleep disruptions have been known to worsen health conditions like Alzheimer’s disease and increase your risk factors for developing other health problems, including heart disease, Type-2 diabetes, and hypertension. Let’s dig into the science behind sleep and what are our five best tips for a good night’s rest!

Why sleep is so important to our bodies

Sleep gives your body some much-needed rest, but it’s also vital for maintaining your cognitive health. When you lie down to sleep at night, your body takes this time to cleanse your brain of toxins and waste. The space between your brain cells actually enlarges during sleep, allowing your body to wash out harmful substances like beta-amyloid proteins, which researchers have linked to the formation of Alzheimer’s disease. It follows, then, getting enough sleep can help ward off Alzheimer’s disease.

A poor night’s sleep has also been tied to forgetfulness and lapses in memory. Because sleep is the vital period when our brains take time to consolidate our memories, not getting adequate sleep makes you more likely to forget things during the day. A good night’s rest is one of the most powerful weapons in your arsenal in the fight against mental aging. 

Why getting enough rest is more difficult as we age

Production of the “sleep hormone” melatonin naturally decreases with age, making it harder for older adults to fall asleep and stay asleep. The aging process also causes changes to the body’s natural circadian rhythm, which can make you get tired earlier than usual. Because of this, older adults are also more likely to experience restless sleep and waking up throughout the night. 

Environmental factors can also be to blame, such as stress or a lack of structure in your life. Recent retirees sometimes have a hard time adjusting to changes in their schedule, which can lead to fitful sleep. 

How to get a good night’s sleep: build healthier sleep habits

Now that you know why a good night’s sleep is so vital, you’re probably wondering how you can improve the quality of your own rest. If you struggle with tossing and turning or restless nights, don’t worry. The good news is that healthy sleep habits are universal and can be practiced by anyone of any age. 

It’s never too late to establish a healthy nighttime routine! Here are our 5 best tips to help you combat insomnia, in no particular order.

Work up a sweat

Exercise helps to keep you in good shape, but did you know that exercising can also improve your sleep? The Sleep Foundation has demonstrated a clear link between exercise and improved sleep quality in adults. Try using a fitness tracker, which can be useful to show your progress and motivate you. To rest easier at night, try going for a brisk walk or bike ride outside. Exposing yourself to sunshine and fresh air can improve circadian rhythm, so you can stay active with your favorite outdoor hobbies like gardening and fishing. Just be careful not to exercise too late in the day–getting worked up too close to bedtime may actually keep you awake!

Don’t nap during the day

Napping is common among older adults and retirees, with research showing that around 25% of older adults take naps daily. But did you know that your daily power nap may actually be doing more harm than good?

It’s true. While a brief nap can be beneficial for a boost of energy, excessive napping can disrupt your circadian rhythm and make it harder to fall asleep at night. If you absolutely must have a nap, try to take it earlier in the day and make sure to sleep for no more than 30 minutes.

Establish a bedtime routine

Human beings are creatures of habit, so practicing good habits before bed can help improve your rest. If you don’t already have one in place, try establishing a nightly routine before drifting off to sleep. 

You can engage in soothing activities like taking a bath, reading a book or meditating to relax before bed. Sleep comes easier in a cold room, so make sure that your bedroom is cool before you lie down. Always try to fall asleep at roughly the same time every night to establish routine, and make sure that you fall asleep while lying in bed–not in a recliner or on the couch. 

Turn off the TV

Although many of us like to fall asleep with the glow of the TV to keep us company, staring at screens before bed can actually disrupt your sleep. The blue lights found in common electronic devices like smartphones, tablets, TVs and computers can disrupt your natural circadian rhythm. That’s why experts recommend cutting out all screens and electronic devices before going to bed. 

A few hours before your usual bedtime, turn off all your TVs and power down your tablets, phones and laptops. You can replace time in front of the TV with screen-free activities like doing a jigsaw puzzle, playing cards or drawing in an adult coloring book. Instead of sleeping with your phone on your bedside table, try plugging it up to charge in another room. You’ll be less likely to check for texts or emails in the middle of the night and can rest more peacefully. 

Cut back on caffeine and other foods

Eating or drinking certain things too close to bed can cause sleep problems. Foods high in caffeine like coffee and chocolate have been shown to disrupt sleep patterns and interfere with melatonin production. Drinking alcohol late at night also could lead to restless sleep because it can cause decreased REM sleep. Never use alcohol as a sleep aid. 

If you can’t do without your morning coffee, that’s perfectly all right. Just make sure that it stays a morning cup. Avoid consuming coffee in the afternoon and eating large meals too close to bedtime. Don’t drink too much water before bed, either, if waking to go to the bathroom is a problem for you. If you must eat before bed, try having something to boost your melatonin, like a handful of almonds or a cup of tart cherry juice. 

The bottom line

Along with diet and exercise, getting a good night’s sleep is one of the most important things you can do to maintain a healthy mind and body. 

If you’ve tried all these tips and nothing works, check with your doctor to see if one of your medications or an underlying health problem may be to blame. Insomnia can sometimes be a symptom of a more serious issue. 

Sleep is just one of many tools on your belt you can use to live your best life possible, so try to rest well every night!


Originally printed on aviv-clinics.com. Reprinted with permission.

Aaron Tribby, M.Ed is Head of Physiology for Aviv Clinics where he is responsible for managing a team of physiologists, physical therapists, dietitians, and stress technicians at Aviv Clinics – the first hyperbaric medical treatment center of its kind in North America dedicated to improving brain performance. He also oversees the cardiopulmonary exercise tests and CPET in the clinic, responsible for analyzing each test. Leading to Aviv Clinics, his clinical experience is focused on health and wellness, strength and conditioning and nutrition within both the non-profits and private sectors including Mercy Hospital and MusclePharm, respectively.

 

References

water bottle

Dehydration Generation – Who is Most Susceptible?

The sensation of thirst declines with age. Even young children who play outdoors in the heat are often reluctant to stop playing and drink water.

In seniors, illness and medications may further reduce thirst or increase urine production. Older adults are at increased risk of experiencing heat stroke or urinary tract infections.

I understand why people may not want to drink water. Besides possibly making extra trips to the bathroom, it is boring, tasteless and fills you up. There are many options to flavoring water from squeezing lemon or limes into a glass or water jar, to adding other assorted fruits such as apples, pears, oranges, etc. It just takes a few minutes to prepare.

Preventing dehydration is important. Whether you are outdoors or inside a cooled room, it can still happen. You lose fluids through perspiration and breathing, even if you are not exercising, your core temperature may rise and result in heatstroke. Early signs of dehydration include dark yellow urine and dry skin. In severe cases, symptoms can progress to dizziness, fainting, and even seizures. Treatment in extreme cases can also affect the heart and kidney function. Limit your prolonged activities if you feel any symptoms mentioned above. Your stamina will prevail.

To reduce your risk, sip water throughout the day rather than wait until you feel thirsty. It’s also smart to drink a full glass of water each time you take medications (if recommended). You can hydrate with foods, too, such as soup, smoothies, and produce with high water content, like celery and watermelon.

In the meantime, keep moving and exercising your body, especially if you have stiff joints from arthritis, sit too long or feel stiff or de-conditioned.


Reprinted with permission from Lori Michiel. 

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.

omega3-sources

Want to live longer? Watch your omega-3 levels

A recent study spanning 11 years and more than 2,000 participants yielded a startling finding: When comparing omega-3 index to conventional cardiovascular risk factors in older adults, it showed that having a low blood omega-3 index was as strong a predictor of mortality as smoking.1

The average age of the participants at the beginning of the study was 65, when their blood fatty acids were measured, and they were followed for 11 years. There were 2240 participants and 384 deaths over that time.

Comparing omega-3s and smoking

Omega-3 index is a measurement of DHA and EPA as a percentage of the total fatty acids in red blood cell membranes.  The average omega-3 index in the study was 5.8%, the lowest fifth had omega-3 index less than 4.2%, and the highest fifth had levels greater than 6.8%.

Using mathematical modeling, the researchers estimated that participants who were in the highest fifth of omega-3 index at age 65 gained 4.74 years of life compared to those in the lowest fifth. This was similar to the difference between smokers and non-smokers at age 65; smokers lost 4.73 years of life, according to the model.

Over the 11-year follow-up, of participants in both of the low-risk categories – non-smokers who had a high omega-3 index – 85% survived. This is compared to only 47% of those in the high-risk categories – smokers with a low omega-3 index.1 The loss of life years was similar in low-omega-3 + non-smoking and high-omega-3 + smoking.

More evidence connecting omega-3 levels with longevity 

This research comes a few months after a meta-analysis of 17 prospective cohort studies that linked higher circulating omega-3 fatty acid levels to longevity. In a pooled analysis of the studies, participants in the highest fifth of combined blood DHA and EPA were 15-18% less likely to die from any cause over the follow-up period (median follow-up time was 16 years in these studies). Higher blood omega-3s were also associated with reduced risk for death from cardiovascular disease and cancer.2

The importance of DHA and EPA

DHA and EPA are important structural and functional components of brain and retinal cell membranes. They also have triglyceride-lowering, anti-inflammatory, anti-platelet, and anti-hypertensive properties, plus beneficial effects on cell membranes that may also contribute to better health and a longer life.2

Previous studies have linked low omega-3 index (below approximately 5%) with increased risk of cognitive decline in older adults.3,4  All the above studies corroborate the prior studies linking low omega index to brain shrinkage and cognitive impairment, and they reinforce how critical it is to properly address this issue.

The bottom line

DHA and EPA supplementation is important for anyone who doesn’t eat fatty fish frequently. Omega-3 index is low in vegans – approximately 4% when measured in studies, and the research suggests that adding ALA from flax seeds and walnuts does not significantly raise omega-3 index in most people. Most of the ALA in our diet is burned for energy, not converted to EPA and DHA. Consuming pre-formed DHA and EPA is the most reliable way to increase omega-3 levels in the blood.5-8 I recommend checking the omega-3 index with a blood test and assuring DHA and EPA adequacy using an algae-based supplement (refrigerated if possible) to avoid the pollutants, microplastics, and animal protein in fatty fish, and as a more sustainable option than fish oil.

Originally printed on drfuhrman.com. Reprinted with permission.


Joel Fuhrman, MD is a board-certified family physician specializing in nutritional medicine. He is President of the Nutritional Research Foundation and the author of 7 New York Times bestselling books, including his most recent book, “Eat to Live”. Visit his website, DrFuhrman.com.

👉👉Get $10 off $150 or more on Dr. Fuhrman’s website. Use coupon LS10OFF150.


REFERENCES

  1. McBurney MI, Tintle NL, Vasan RS, et al. Using an erythrocyte fatty acid fingerprint to predict risk of all-cause mortality: the Framingham Offspring Cohort. Am J Clin Nutr 2021.
  2. Harris WS, Tintle NL, Imamura F, et al. Blood n-3 fatty acid levels and total and cause-specific mortality from 17 prospective studies. Nature Communications 2021, 12:2329.
  3. Coley N, Raman R, Donohue MC, et al. Defining the Optimal Target Population for Trials of Polyunsaturated Fatty Acid Supplementation Using the Erythrocyte Omega-3 Index: A Step Towards Personalized Prevention of Cognitive Decline? J Nutr Health Aging 2018, 22:982-998.
  4. Lukaschek K, von Schacky C, Kruse J, Ladwig KH. Cognitive Impairment Is Associated with a Low Omega-3 Index in the Elderly: Results from the KORA-Age Study. Dement Geriatr Cogn Disord 2016, 42:236-245.
  5. Craddock JC, Probst YC, Neale EP, Peoples GE. A Cross-Sectional Comparison of the Whole Blood Fatty Acid Profile and Omega-3 Index of Male Vegan and Omnivorous Endurance Athletes. J Am Coll Nutr 2021:1-9.
  6. Sarter B, Kelsey KS, Schwartz TA, Harris WS. Blood docosahexaenoic acid and eicosapentaenoic acid in vegans: Associations with age and gender and effects of an algal-derived omega-3 fatty acid supplement. Clin Nutr 2014.
  7. Office of Dietary Supplements, National Institutes of Health. Omega-3 Fatty Acids. Fact Sheet for Health Professionals [https://ods.od.nih.gov/factsheets/Omega3FattyAcids-HealthProfessional/]
  8. Arterburn LM, Hall EB, Oken H. Distribution, interconversion, and dose response of n-3 fatty acids in humans. Am J Clin Nutr 2006, 83:1467S-1476S.