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Sarcopenia & Diabetes: Untangling the Connections

Today's Geriatric Medicine/9 March 2021/ All MFN blog/

Muscle loss is a significant quality-of-life issue for patients with diabetes.

Diabetes is extremely common in the older adult population, affecting more than one-quarter of Americans aged 65 and older.(1) It’s increasingly recognized that individuals with type 2 diabetes—who comprise the vast majority of all diabetes cases—are vulnerable to sarcopenia—excessive age-related muscle loss. Although muscle loss can begin in persons with diabetes even at younger ages, it’s of particular concern among older adults.

“People with diabetes are living longer now, which is incredibly exciting,” says Rita Kalyani, MD, MHS, an associate professor of medicine in the division of endocrinology, diabetes, and metabolism at Johns Hopkins School of Medicine. But “it’s important to recognize [the potential for accelerated muscle loss] because it can significantly impact quality of life for people with diabetes and also mortality.”

What Is Sarcopenia?

Muscle loss is natural with advancing age. It is routine for individuals to lose 3% to 8% of their muscle mass per decade beginning at age 30, and the rate of decline is even higher after the about age 60.2 Muscle strength declines even more rapidly—at a rate of 3% to 4% per year in men and 2.5% to 3% per year in women by the age of 75.3

While some muscle loss is typical, sarcopenia refers to a condition of accelerated muscle loss. Earlier definitions of sarcopenia focused exclusively on loss of muscle mass as the key determinant of the condition, but more recent definitions have recognized that muscle strength and function are equally important for predicting adverse outcomes.(4-6) Thus, newer definitions for sarcopenia have included low walking speed and grip strength alongside low muscle mass.(5) Sarcopenia is associated with an increased risk of falls, functional decline, frailty, and mortality.(7)

How Strong Is the Connection Between Diabetes and Sarcopenia?

The link between diabetes and sarcopenia is well established. In a study of 810 Korean adults, 15.7% of participants with diabetes were found to have sarcopenia, compared with just 6.9% of participants without diabetes.(8) A later study led by the same author, also in Korea, produced similar findings: in a sample of 414 adults aged 65 or older, participants with type 2 diabetes had significantly lower muscle mass (defined as appendicular mass/height) than did those without diabetes.(9) A link between low muscle mass and diabetes has been found in several other populations as well.(5,10)

Multiple studies have also linked diabetes to reduced muscle strength. In a cross-sectional investigation of 1,391 adults aged 60 to 70 years from the Hertfordshire (UK) cohort study, men newly diagnosed with diabetes had significantly lower grip strength than did those without diabetes.11 The effect sizes were smaller in women, but the trend was the same for both genders. Similarly, among 1,840 participants aged 70 to 79 years in the Health, Aging, and Body Composition study, subjects with type 2 diabetes showed a greater loss of both muscle mass and a greater loss of leg strength and leg muscle quality (though not arm strength/quality) over three years, compared with those without diabetes.(12) These declines were attenuated after adjustment for demographics, body composition, physical activity, and other factors, but the association remained significant.

The association between sarcopenia and diabetes has led some researchers to argue that sarcopenia is probably one of the underlying mechanisms that explains the reduced functional ability and mobility that is often seen in older patients with type 2 diabetes.(13)

Mechanisms: How Diabetes Contributes to Sarcopenia

While diabetes accelerates the process of muscle loss, the mechanisms aren’t yet thoroughly understood. “There are probably multiple underlying pathways linking the observational findings that we see between type 2 diabetes and accelerated loss of muscle,” Kalyani says.

The presence of insulin resistance, which is the key feature of type 2 diabetes, appears to be a major pathway. “Insulin resistance is associated with decreased protein synthesis in the muscle,” Kalyani says. One of the key roles of insulin is to drive nutrients (ie, glucose) from the blood into skeletal muscle tissue and stimulate protein synthesis. In type 2 diabetes, however, insulin signaling is impaired; insulin is not able to effectively drive glucose into the muscle tissue, and the muscle cannot synthesize new protein rapidly enough to keep pace with natural muscle degradation.(13)

Insulin resistance is linked not only to decreased protein synthesis but also to mitochondrial dysfunction. Individuals with diabetes frequently have decreased mitochondrial function, which again appears to contribute to the impairment of muscle function (possibly in part because these mitochondrial alterations may increase insulin resistance).(5)

Diabetes can also promote sarcopenia via peripheral neuropathy. Approximately 30% to 50% of diabetes mellitus patients experience peripheral neuropathy, and the condition has been shown to be an independent risk factor for sarcopenia in individuals with diabetes.(14) “Nerves are needed to help the muscles contract properly,” says John Morley, MD, a professor of medicine in the division of geriatric medicine at the Saint Louis University School of Medicine. “My leg muscles are almost certainly contracting as I sit here. If I’ve got some degree of neuropathy, I won’t get the same amount of contraction.”

Still other factors also may play a role in causing muscle loss in the context of diabetes. People with diabetes frequently have higher than normal levels of inflammatory cytokines, including tumor necrosis factor and interleukin.(6) Such cytokines have been shown to have negative impacts on both muscle mass and strength in older adults.(15) In addition, “people with diabetes are also more likely to have hypothyroidism, and people with hypothyroidism get a myopathy of the legs as well,” Morley says. “So you should always be thinking, if you see a diabetic who’s lost a lot of muscle, ‘Could this be due to something else, like low thyroid’?”

Thus, a wide variety of factors likely contribute to the connection between diabetes and sarcopenia. Some data suggest that these varying mechanisms come into play even in individuals who are comparatively young or who are comparatively early in the disease process. Kalyani and her colleagues examined a group of 984 participants from the Baltimore Longitudinal Study of Aging and found that loss of muscle function as a result of hyperglycemia was seen in some patients who were only in their 40s. Interestingly, peripheral neuropathy appeared to be a contributing factor. Also of note in this investigation is the fact that hyperglycemia affected muscle strength and quality even for patients with blood glucose levels in the prediabetes range.(16)

A Bidirectional Association: How Muscle Loss Can Lead to Diabetes

Until recently, scholarly attention on the connection between diabetes and sarcopenia has focused on diabetes as a cause of sarcopenia. “Clinically the direction that we think about most is accelerated muscle loss being a complication of diabetes—that people who have diabetes develop accelerated muscle loss over time,” Kalyani says. “But it’s possible that the reverse direction is also true.”

Kalyani herself explored this hypothesis in a recent study of 1,855 US adults (baseline mean age of 58.9 years). She and her colleagues found that men—though not women—who had a higher percentage of total or leg lean body mass had a lower risk of developing diabetes over the seven-year average follow-up period, even after adjusting for race.(17) The findings are in line with a previous study of young and middle-aged Korean adults (median age of 39 years at baseline) showing that individuals in the lowest quartile of relative muscle mass had a two-fold higher risk of developing diabetes than did those in the highest quartile over an average of nearly three years of follow up.(18)

According to Kalyani, the findings make sense. “Skeletal muscle is the main site of glucose uptake in the body after we eat,” accounting for about 80% of glucose clearance in a healthy individual. “So if we don’t have enough skeletal muscle, then the glucose is not taken up by the body, and it stays in the blood. As a result, your glucose levels are higher, and over time that could lead to the development of diabetes,” Kalyani says.

A recent review on the bidirectional relationship between diabetes and sarcopenia supports Kalyani’s hypothesis, arguing that loss of skeletal muscle mass and function is both a cause and a consequence of diabetes. As for how muscle loss can cause diabetes, the review supports Kalyani’s assertion that muscle loss results in a diminished target for insulin, altering glucose regulation. But the review also notes another mechanism by which muscle loss can lead to diabetes—namely, it can contribute to a decreased metabolic rate and a decrease in physical activity, which can cause inter- and intramuscular adipose tissue accumulation, in turn leading to insulin resistance.(19)

One of the difficulties associated with type 2 diabetes is that the disease doesn’t necessarily produce obvious symptoms in the early stages, meaning that some patients may not be diagnosed until after they have already developed cardiovascular problems.

However, the recognition that loss of muscle strength predicts risk of diabetes has led to new possibilities for diagnosing type 2 diabetes in its earlier stages. A recent study led by researchers at Oakland University in Rochester, Michigan, used data from more than 5,000 participants in the National Health and Nutrition Examination Surveys to identify specific cut points of handgrip strength that take into account age, sex, and body weight and that indicate the presence of type 2 diabetes in adults that appear otherwise healthy.(20) According to the authors, these cut points can be a useful screening tool for identifying diabetes at earlier stages and getting patients into treatment sooner.

The Role of Blood-Glucose Management in Preventing Muscle Loss

The growing body of research on the connection between diabetes and sarcopenia has raised an important question: Does lowering blood glucose help preserve muscle mass?

According to Morley, there’s little research on that question, but diabetes medications that control blood glucose levels likely do have a role to play in treating (and preventing) muscle loss among older adults with diabetes. “If you’re using something like metformin or the gliptins, those improve insulin resistance. Improving insulin resistance will allow you to get more nutrients into your muscle tissue.”

The question of whether lowering blood glucose helps prevent sarcopenia is relevant because most clinical practice guidelines for older adults with diabetes recommend less aggressive glucose control as people get older. “The older adult population is heterogenous—there are some people who have long life expectancy, some have greater life expectancy, some are at greater risk for polypharmacy or hypoglycemia,” Kalyani says. “So in general glucose targets for older adults are not as strict as they are for younger adults.”

Unfortunately, Kalyani says, it’s possible that these relaxed targets may exacerbate muscle loss in vulnerable older adults. Key clinical trials on which clinical management guidelines for blood glucose have been based haven’t usually included older adults, so there’s no way to know at present. According to Kalyani, future research is needed to better understand the effects of glucose-lowering on muscle mass in older adults.

The Importance of Exercise

While diabetes medications may have a role to play in lowering blood glucose and in staving off muscle loss, Morley is adamant that no medication is as beneficial for treating sarcopenia as physical exercise. “The major treatment is resistance exercise,” Morley says. “You can argue that aerobic exercise is also useful, but if you’re going to do anything as a diabetic, you want to do resistance exercise to build your muscle bulk.” For older adults with sarcopenia, the key exercises he recommends are walking around the block four to five times, doing some weight lifting, and sitting in a chair and getting up ten times in a row as fast as possible.

Kalyani agrees on the importance of activity. “Physical exercise is always recommended,” in part to promote fat loss and maintain muscle mass, both of which can improve glucose levels. Those recommendations apply equally to both younger and older adults, she says. “As long as they can tolerate the exercise they are doing, we definitely recommend that, particularly muscle strengthening exercise and resistance activity.”

Recommendations for Clinicians

• Take seriously the fact that patients with type 2 diabetes are vulnerable to muscle loss. “Accelerated muscle loss is an underappreciated condition that occurs in people with type 2 diabetes. I don’t think it’s well recognized,” Kalyani says. One reason for the under-recognition, she says, is that most providers who treat diabetes aren’t geriatricians and thus aren’t as likely to be familiar with age-related muscle loss and how it can affect mobility. “It needs to be better recognized in clinical practice that this occurs at greater frequency in people with diabetes,” she says.

• Screen all individuals with diabetes for sarcopenia. Everyone aged 50 or older should also be screened, even if they don’t have diabetes, Morley says. “You can argue, ‘Well, I don’t really need to do that, I just need to get them out exercising, and they’ll do well,’ but people don’t do well if you don’t give them a diagnosis.”

As for a specific screening tool, Morley recommends SARC-F. This screen contains five questions that focus on a patients’ ability to lift and carry 10 pounds, their ease in walking across a room, their ease in rising from a chair, their ability to climb a flight of stairs, and the number of falls they have had in the last year. The questionnaire and scoring instructions are available at cgakit.com/sarc-f-questionnaire.

• Spend time making sure patients understand the importance of exercise. “Every clinician knows that diabetics should exercise and exercise is good for them,” Morley says. “Realistically, every diabetic should be in an exercise program. It should be covered by medical insurance, because that’s by far the best treatment for diabetes, period.” The problem, according to Morley, is that physicians often recommend exercise without driving home how thoroughly important it is. “[We need to] stress that this is more important than the drug.”

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This article was featured in the November/December 2020 issue of Today’s Geriatric Medicine.

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

Get a Free Subscription to Today’s Geriatric Medicine

This article was featured in the November/December 2020 issue of Today’s Geriatric Medicine (Vol. 13 No. 6 P. 14). Written by Jamie Santa Cruz, a health and medical writer in the greater Denver area. Reprinted with permission from Today’s Geriatric Medicine.

References

1. Centers for Disease Control and Prevention. National diabetes statistics report, 2020. https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf. Published 2020.

2. Volpi E, Nazemi R, Fujita S. Muscle tissue changes with aging. Curr Opin Clin Nutr Metab Care. 2004;7(4):405-410.

3. Wilkinson DJ, Piasecki M, Atherton PJ. The age-related loss of skeletal muscle mass and function: measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans. Ageing Res Rev. 2018;47:123-132.

4. Sobestiansky S, Michaelsson K, Cederholm T. Sarcopenia prevalence and associations with mortality and hospitalisation by various sarcopenia definitions in 85–89 year old community-dwelling men: a report from the ULSAM study. BMC Geriatr. 2019;19(1):318.

5. Morley JE, Malmstrom TK, Rodriguez-Mañas L, Sinclair AJ. Frailty, sarcopenia and diabetes. J Am Med Dir Assoc. 2014;15(12):853-859.

6. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis [published correction appears in Age Ageing. 2019;48(4):601]. Age Ageing. 2019;48(1):16-31.

7. Cruz-Jentoft AJ, Sayer AA. Sarcopenia [published correction appears in Lancet. 2019;393(10191):2590]. Lancet. 2019;393(10191):2636-2646.

8. Kim TN, Park MS, Yang SJ, et al. Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: the Korean Sarcopenic Obesity Study (KSOS) [published correction appears in Diabetes Care. 2010;33(10):2294]. Diabetes Care. 2010;33(7):1497-1499.

9. Kim KS, Park KS, Kim MJ, Kim SK, Cho YW, Park SW. Type 2 diabetes is associated with low muscle mass in older adults. Geriatr Gerontol Int. 2014;14(Suppl 1):115-121.

10. Leenders M, Verdijk LB, van der Hoeven L, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013;14(8):585-592.

11. Sayer AA, Dennison EM, Syddall HE, Gilbody HJ, Phillips DI, Cooper C. Type 2 diabetes, muscle strength, and impaired physical function: the tip of the iceberg? Diabetes Care. 2005;28(10):2541-2542.

12. Park SW, Goodpaster BH, Strotmeyer ES, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care. 2007;30(6):1507-1512.

13. Umegaki H. Sarcopenia and diabetes: hyperglycemia is a risk factor for age-associated muscle mass and functional reduction. J Diabetes Investig. 2015;6(6):623-624.

14. Yang Q, Zhang Y, Zeng Q, et al. Correlation between diabetic peripheral neuropathy and sarcopenia in patients with type 2 diabetes mellitus and diabetic foot disease: a cross-sectional study. Diabetes Metab Syndr Obes. 2020;13:377-386.

15. Jang HC. Sarcopenia, frailty, and diabetes in older adults. Diabetes Metab J. 2016;40(3):182-189.

16. Kalyani RR, Metter EJ, Egan J, Golden SH, Ferrucci L. Hyperglycemia predicts persistently lower muscle strength with aging. Diabetes Care. 2015;38(1):82-90.

17. Kalyani RR, Metter EJ, Xue QL, et al. The relationship of lean body mass with aging to the development of diabetes. J Endocr Soc. 2020;4(7):bvaa043.

18. Hong S, Chang Y, Jung HS, Yun KE, Shin H, Ryu S. Relative muscle mass and the risk of incident type 2 diabetes: a cohort study. PLoS One. 2017;12(11):e0188650.

19. Mesinovic J, Zengin A, De Courten B, Ebeling PR, Scott D. Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship. Diabetes Metab Syndr Obes. 2019;12:1057-1072.

20. Brown EC, Buchan DS, Madi SA, Gordon BN, Drignei D. Grip strength cut points for diabetes risk among apparently healthy U.S. adults. Am J Prev Med. 2020;58(6):757-765.

Pandemic Proofing our Muscles

Shira Litwack/4 March 2021/ All MFN blog/

My first published article as a medical fitness pro (30+ years ago) was “Muscles…our True BFF (Best Friend Forever) in Life.” Fast forward over 30 years later in a global health pandemic, this is even more critical. Alas, our muscles have not prospered as Netflix and liquor sales.

We all know that muscles exemplify “use it our lose it.“ Fascinating study August 2020:
“Exercise Induces Different Molecular Responses in Trained and Untrained Human Muscle”

Conclusion: “…several key regulatory genes and proteins involved in muscular adaptations to resistance exercise are influenced by previous training history. Although the relevance and mechanistic explanation for these findings need further investigation, they support the view of a molecular muscle memory in response to training.”

⇒ Our “muscle memory” speeds the process by which we regain our former muscular strength and size. This merits the word “awesome”.

What an evolutionary advantage to regain muscle mass, for both physical and mental health. Survival of the fittest in action.

Before the pandemic, studies showed 60% of US adults do not strength train. We are our own worst enemies.

During the COVID pandemic: Working from home, not getting up and going out to work — various factors have made us more sedentary. A study from eMarketer said TV viewing dramatically increased this year, ending a 9-year steady decrease in television viewership. Studies show there’s been a 32% reduction in physical activity this year, and not surprisingly, another poll says 53% of people struggle with mental health issues due to the pandemic.

Sitting truly is the new smoking.

I think gyms were closed more in 2020 than they were open. Many of us love the gym — a real adrenaline rush. Many people are dependant on the gym for exercise, whether it’s to see their trainer, attend a class, discipline, motivation. The fallout: this pandemic has been more of a sit down than a lock down!

If there is ONE thing, COVID has taught us: Adaptation, the ability to change to our environment, is truly paramount to survival.

Exercising and working our muscles is a vital part of preventative health, even more so now. Muscle wasting is a product of aging, too much tush time and many diseases, including COVID.

Pop exercise advice always mentions get 10k steps per day”. And yes, “strength train 2-3 times per week”. Sadly, the perception of strength training is that it must be with heavy barbells and machinery at the gym. No gym, no strength.

May I suggest we encourage muscle mindfulness? Working our muscles is not just for “exercise time”. We can encourage muscle work in many forms, multiple times per day. Just like we eat, use the washroom, have screen time… let’s help people anchor some muscle time to daily activities.

Example: cooking in the kitchen – hang on to the counter and give me 10 squats.

Muscles are a key factor in our metabolic equation. Increasing our muscle mass boosts our resting metabolic rate, burning more calories at rest, not just during exercise. Muscles help balance hormones such as leptin, insulin, estrogens, androgens and growth hormones. These are all imperative for appetite control, cravings, metabolism and body fat distribution and management. At the ripe old age of 30, we start to lose muscle mass (sarcopenia) unless we are mindful to nurture it. And yes, people over 90 can still build muscle mass.

Amongst the many functions of our muscles is utilizing the glucose in our blood, therefore reducing blood glucose levels, irrelevant of the presence of insulin.

Diabetes is an inflammatory disease. Type 2 diabetes causes the body to become less sensitive to insulin, and the insulin resistance leads to inflammation. A vicious cycle.

1 in 3 people in the US are pre-diabetic
Most people are unaware of their diabetes
13% of the population has diabetes
42% of the population are obese

Diabetes is a gateway disease. It is a red flag for the potential to develop other diseases such as heart disease, cancers, kidney disease, eye issues. As I mentioned before, insulin resistance leads to greater levels of chronic inflammation, which greatly increases the risk of all of our plaguing chronic diseases.

Lowering chronic inflammation has been the focus of my medical fitness journey, research, coaching and published work. Getting people to move “chronic inflammation” into their daily vernacular, permanently affix it to the top of their health wish list has been my professional raison d’être.

My last article here on MFN was all about chronic inflammation, how it is at the root of all of our chronic illnesses, mental & physical: diabetes, many cancers, mental health challenges, heart disease, arthritis, prostate issues, Alzheimer’s, neurodegenerative disorders… and yes, COVID-19. One line here: Please don’t get caught up in pop anti-inflammatory diets causing people to eliminate vital food groups.

The inflammatory response of COVID-19: The severe reactions to the virus happen more in seniors, and those with diabetes or obesity, or other preexisting inflammatory issues. No coincidence. COVID provokes an exaggerated immune response, excessive inflammation and inflammatory products called cytokines – the infamous cytokine storm. Exercise is a crucial factor in controlling inflammation – moderate cardio (NOT long high-intensity cardio, which actually can increase chronic inflammation) and preserving muscle.

So just how important is it for us to encourage our clients to build muscle? Obviously, it is HUGE, and unfortunately, most people do not focus on muscle work. It is our job as MedFit pros, friends and family, to demonstrate how to creatively and seamlessly incorporate muscle mania into their daily lives — yoga, Pilates, resistance bands, dancing…

The COVID pandemic is going to have far-reaching complications for many years to come. Adaptation is key. Integrating muscle work throughout the day along with other activity bodes well for lowering our levels of inflammation — helping to pandemic proof our bodies. Don’t just depend on a vaccine, we could have a new normal for a while. Preventative health is more important now than ever. Our muscles are truly our BFF.

Shira Litwack has been in chronic care management and prevention for 30 years, specializing in lifestyle habits including holistic nutrition, medical fitness and oxidative stress reduction. She is frequently called upon by the media, has her own podcast bringing current research to the public. She has created and provided oxidative stress assessments, to help clients identify potential health risks. From these, she provides guidance to lower inflammation. Shira is now a product specialist with a major COVID-19 test kit supplier, working with epidemiologists educating people on COVID testing, and setting up and designing protocol for COVID testing clinics

We Need More Sleep

Maurice D. Williams, MS/2 March 2021/ All MFN blog/

We need more sleep because we were not designed to be awake each day for 24 hours. I know in today’s society, a lot of us try and are successful at staying awake for 24 hours.

However, I am sure it came with consequences right?

How much coffee or red bull did you have to drink to do it? How did you feel when you finally did get some sleep? I bet that the next morning when you woke up felt horrible, didn’t you?

In today’s blog, I want to highlight three reasons why we all need more sleep. I hope these three things are simple enough for us to put into practice NOW!

#1. Growth Hormone

There is a hormone that our bodies produce called growth hormone. Without it, we make it harder for us to get bigger muscles. Growth hormone also helps with getting rid of body fat and it helps our bones retain calcium. Wow, sounds like pretty important stuff right? Well, if we are not getting enough sleep in general, and enough quality sleep, then, our growth hormone can’t work like it should.

#2. Leptin

During good sleep, our bodies use something called leptin to control our hunger feelings. Well, this hormone can only do its job properly with a good night’s rest. Leptin helps to curb our appetites and gives us a satisfied feeling. However, if we are not getting 7-9 hours of sleep each night (ideal sleep time), then another hormone, ghrelin, will work for us. This is the hormone that gets released to let us know that we are hungry.

We want ghrelin to work for us when we are actually hungry, not because we did not get a good night’s rest. If you’ve awoken starving, it could have been from a lack of quality sleep!

#3. Exercise Suffers

Yep, all that hard work you’ve been putting into exercise becomes null and void without proper sleep. One of the great benefits of lifting weights is the increase in muscle size and as a result, better metabolism that leads to weight loss. Well, lack of sleep is an enemy to protein synthesis (how our bodies make muscle). If your muscles are not getting stronger and/or bigger, then, your metabolism is not working for you.

Also, inadequate sleep leads to your body having a harder time recovering from your workouts. If you cannot recover from your workouts, then you could potentially 1.) injure yourself and 2.) have less slow-wave sleep.

Conclusion

We need more sleep. There is no way around this, folks! Sleep really does our bodies well. I recommend we at least do the following to get more sleep:

Go to bed one hour earlier than you normally do.
Shut down all electronics one hour prior to going to bed.
Meditation
Drink something soothing like chamomile tea

Maurice D. Williams is the owner of Move Well Fitness in Bethesda, MD, and Assistant Professor of Health & Human Performance at Freed-Hardeman University. He is a NASM Master Instructor and Master Trainer, and is also certified with NASM as a Corrective Exercise Specialist, Performance Enhancement Specialist, Senior Fitness Specialist & Weight Loss Specialist, and as a Certified Strength and Conditioning Specialist by NSCA.

Mental Habits and Chronic Pain

Justin Price/1 March 2021/ All MFN blog/

People faced with the day in day out experience of ongoing muscle and joint pain often develop mental habits to help them cope that can actually make their condition worse.1 Emotions such as anger, depression and/or making comparisons to how things used to be before the physical problem began, distracts the brain temporarily to help override current sensations of pain. While these mental habits can provide fleeting relief, they also serve to prolong chronic pain conditions by changing brain chemistry and altering the mind and body’s response to pain.

Living Through The COVID-19 Pandemic: 5 Keys To Finding Your Path Forward

Nicholas Prukop/26 February 2021/ All MFN blog/

The recommendations are simple: Wash your hands, maintain proper social distancing, wear a mask, and don’t attend large gatherings. Why has this been so hard for so many people to do? What is in our future since we are faced with so many unanswered questions? How can we gather the strength to survive the crisis of our lifetime?

These and so many other questions have been on my mind over the past year. I believe in the power of choice and living in the present. These two points of reference guide my activity each day and I will share the 5 keys with you that could make a significant difference in your life and yield a rich and rewarding path forward when we finally “get to the other side” of this terrible worldwide tragedy.

THE 5 KEYS

#1 – Mental Clarity

This key gives us the power to review and “listen” to our thoughts – the place where our reality begins to take shape. I am grateful for my life because I nearly died in 2019 after being hit by a truck (8 fractured ribs) when I was riding my bike. My conditioning and my training as a fitness professional helped me survive the initial incident and also the 2nd emergency (2 months later) that led to the blood clots that nearly killed me.

2020 represented a “foundational” training year for me and included challenging hill cycling (I didn’t quit) and complementary weight training. As I entered 2020, strengthening my heart, legs and overall strength became my focus. I am close to being back to where I was before the truck hit me and now I enter 2021 with a new plan: To build an “athlete’s” mind set!

KEY: Set your intention and direction establishing your priorities. For me, it became strengthening my heart and legs so I could resume my beloved running program of more than 50 years. This year I will build on what I started last year and find my way from there.

#2 – Faith

Setting your intention helps you in charting your course and finding your path forward (the subject of my 3rd book not yet published). It is in establishing purpose that we “find ourselves”. I am working on becoming the “example of the change I wish to see in the world” since my path is becoming a passionate advocate for the principles of healthy aging as discussed in my first book Healthy Aging & You”: Your Journey to Becoming Happy, Healthy & Fit.

KEY: Focus on your intention and “tune out” the noise of the day. Get close to your passion by focusing your attention on what you WANT in your life and “let the rest go”! Faith in yourself is most important (my conclusion in my yet unpublished 3rd manuscript). It is critical to spend time each day contemplating this thought!

#3 – Commitment

This principle applies to all of life. Those of us who commit to “a greater good” have the best chance for growth, expansion, and eventually success. I am committed to sharing my message with the world so I am joining with my daughter who has an excellent background in PR and media relations to help me connect with journalists and media outlets in print, TV, and radio. We are committed to “making a difference” in the world so my training, writing, and passion will eventually “get me there”. (I am now 74 so I have no time to waste!)

KEY: Become passionate about your life and finding your “true” message. Define it clearly and develop your plan for achieving your own dream. Dreams are what fueled Walt Disney’s success so if it was good enough for Walt, it is definitely good enough for me. How about YOU?

#4 – Training

Training represents my foundation and it encompasses “all of me” – mind, body and spirit. I say spirit in reference to our belief systems and what they represent to us. For me, my belief is in my “greatness” – meaning I have value and will be able to share that value with others. I encourage you to define your training program and work on it each day. Mine includes cardiovascular conditioning, weight training, meditation and prayer work, and daily affirmations I repeat throughout the day reinforcing my commitment to my purpose.

KEY: Discipline and purpose work hand in hand. Living in the present and making your choices in the only moment that matters (the present) is a very important concept. Practice it daily and you will find yourself not getting distracted with the unimportant details in life that can literally “derail” our success.

#5 – Programming

This final key is important because our minds control our lives and destiny. The subconscious mind is where the “tapes” are stored that influence every aspect of our lives – including our attitudes and behavior. Be careful in programming your mind since what you say, feel, express, and do will alter your course if you are not careful. This is where affirmations and visualization – and your imagination – come in.

Be aware of how you express yourself and gather to you all the goodwill you can because we need each other. One of my favorite teachers shared a belief I now hold as well: “Everything we desire in life comes through relationship.” A corollary belief I hold is “the mind of man is unlimited in its potential and responds to the demands placed upon it.” Place the BEST demands on yourself every day and see what happens!

KEY: Programming your mind is an activity that is priceless. Do it with love and passion and your old negative patterns will no longer restrain you from achieving what you envision for yourself. People will want to be with you because of “who you are”!

Nicholas Prukop is an ACE Certified Personal Trainer & a Health Coach and fitness professional with over 25 years of experience. His passion for health and fitness comes from his boyhood in Hawaii, where he grew up a swimmer on Maui. He found his calling in writing his first book “Healthy Aging & You: Your Journey to Becoming Happy, Healthy & Fit” and since then he has dedicated himself to empowering, inspiring and enabling people of all ages to reach for the best that is within them and become who they are meant to be – happy, healthy and fit – and be a part of a world where each person can contribute their own unique gifts to life.

Deliberate Wellness at Home

Debbie Bellenger/23 February 2021/ All MFN blog/

In the daily grind of life, it can be challenging – between doctors appointments, grocery shopping, meal prepping, upkeeping your home – to prioritize what benefits your wellness and wellbeing. Things like enjoying healthy meals, making the time to go out for a walk, maybe even taking an art class – these activities take deliberate effort, planning and determination to find, coordinate and attend.

Teaming Up with Good Nutrition

Nancy Clark, RD/17 February 2021/ All MFN blog/

If you are a solo athlete, such as a singles rower, figure skater, or runner, the benefits that come from fueling your body wisely benefit you personally. Team athletes, how-ever, commonly participate in group meals that may focus less on nutrition and more on fun foods. (Nachos and beer, anyone?) Coaches may find it hard to enroll all their athletes in responsible fueling. Yet the team that fuels wisely will have an edge over the team that eats a sub-optimal sports diet, particularly when traveling to competitive events.

Young beautiful brunette sportswoman wearing sportswoman training over white background confuse and wonder about question. Uncertain with doubt, thinking with hand on head. Pensive concept.

Training Considerations for Individuals Recovering from Alcohol Use Disorder: Part 1

Nicole Golden/12 February 2021/ All MFN blog/

Alcohol Use Disorder (AUD) may not be the first condition that comes to mind when discussing chronic conditions where exercise can provide substantial benefit. Yet, there is considerable evidence to support the idea that exercise therapy can prove quite beneficial in recovery from AUD Approximately 17.6 million Americans are diagnosed with alcohol addition or dependence each year. Likewise, AUD, like eating disorders, is a chronic condition that must always be managed as relapse occurs in 60-90% of patients (Brown et al.,2009).

Cardio Exercise Routines May Improve Memory

Mirabai Holland, MFA, EP-C, CHC/10 February 2021/ All MFN blog/

I became interested in cardio exercise routines and memory several years ago when my older students began to tell me that their memories seemed to improve after they took my class. I was teaching mostly cardio exercise routines in those days. I started with simple steps and built up to a pretty complex routine. There has to be a connection I thought, between the physical movement, making your brain learn this routine, and improved memory.