Staying Healthy and Fit as We Age

February 26, 2018 / Thomas Cohn, MD

Staying fit and being healthy as we get older usually requires work. There’s always the tale of someone who smoked a pack of cigarettes a day, drank a six pack every night, ate whatever they wanted, sat on the couch and lived to ninety years. A few people having amazing genetics and nothing affects them, but this is not the norm. Most people need to take an active approach to life including fitness, diet, rest, and stress. Health is about paying attention to our lives and reducing harm as well as maintaining our bodies and minds.

Your Body is Like A Car

My favorite analogy is that our bodies start out like new cars and generally are like that until we reach adulthood. A new car needs fuel and very little maintenance to keep it running well. If you do not wreck it, the car will run smoothly for our younger years. As the car ages, more and more routine maintenance is needed and as it gets older, major overhauls are sometimes necessary. When we are young, we feed the body and let it run and generally it will be healthy. As a young adult, we need to start doing some general health care such as monitoring our cholesterol and blood pressure, and start purposefully watching things like what we eat, our exercise, and make sure we sleep and reduce our stress. After we turn fifty, technically the body is in old age range, and maintaining our health is needed to keep us running smoothly.

In the 1800’s, the average life expectancy was between forty and fifty years of age. Death was due to injury, trauma, infections, heart problems, cancer and multiple other issues of the time. Since then we have learned how to stay alive such that the modern life expectancy has risen to about 80 years. The caveat however is the body has not evolved much in the last 150 years, so it takes much more work to keep an old body healthy.

How to Stay Fit

Staying fit and healthy does take some work and affects a variety of aspects of your life. If it were easy and simple, everyone would know the secrets and live long without problems. The reality is that it does take effort to be healthy, and everyone is throwing in advice on ways to live. The books, diets, pills, retreats, and machines available for a price to make you live longer and happier are countless. Understanding our history can possibly help us understand our needs into the future.

Exercise is one of the most basic concepts. In the past, we did not sit at desks all day. Rather, we were very active and often constantly moving. Since our sources of survival and income have changed, our amount of activity and movement has plummeted. As we age, exercise to maintain our bodies are essential. Daily stretching for 10 minutes or more is necessary to keep the flexibility of muscle and joints and the health of these tissues. Stretching markedly reduces stiffness and associated pain from muscles, ligaments and joints.

Strengthening is the next pillar needed to maintain the health of muscles as well as bones and other structures in the body. Light strengthening three times a week for 20-30 minutes is needed to maintain muscle and bone health as well as to reduce injury from unexpected events like falls. Lastly, the body needs aerobic conditioning to maintain health including for the heart, blood pressure, muscle endurance, weight control, and to reduce pain from increased endorphin levels and stress reduction. The overall recommendation from the American Heart Association is 30 minutes of exercise 5 times a week, from a simple walk to an intense workout.

Diet and Sleep

Our diet is the fuel that runs our bodies. If we put the wrong fuel in our cars, they won’t run, and it is the same with our bodies. It is becoming clearer that our nutrition plays a huge role in our health. As a doctor, unfortunately we learn very little in out training about diet and nutrition. Curiosity about the subject has slowly been very enlightening. Eating better does take more planning and understanding, especially about processed food, sugars, fats, carbohydrates, and other essential nutrients. Spending some time to read and understand healthy diets helps improve the ability to control the fuel entering your body. Even an old doctor can educate himself; using my drive time to work and back, I am spending time listening to courses on nutrition.

Sleep is one subject we know we need but understand very little about. The purpose of sleep, how much we need, and whether the measures we have are helpful and accurate is debatable. Children need more sleep than adults, and adults often need more than we get nightly. Somewhere over seven hours is recommended every night for adults. Sleep is used by the brain to restore functions, to clean up waste products and to rest the whole body. What constitutes as “quality sleep” is not very clear and those sleep trackers that monitor body motion at night are not accurate, according to most experts. Feeling well rested the next day is probably a reasonable sign of adequate rest.

Lastly, having good mental health is necessary to stay fit. Society tends to ignore our mental health needs. Good mental health is needed to stay physically healthy. The body is dependent on the brain for good function. Emotional health is the part that emanates from the brain that allows us to function well physically. When we are stressed, anxious, depressed, or suffering psychologically, we often cannot put in the energy to maintain physical well being. Once we improves our psychological state, we often can focus our energies to pay attention to the rest of our life. Whether it is meditation or medication that is necessary for good emotional health, without paying attention to our psychological selves, maintaining good physical health is difficult.

Staying healthy and fit as we age requires work on our physical and mental well being. There are multiple pillars that keep up our health and as we age we need to pay more attention to these important aspects of our lives. From sleep, rest, exercise, diet and mental health, they all provide strength and structure to keep going as we age.

Why Do We Exercise?

November 28, 2016December 28, 2016 / Thomas Cohn, MD

The most common prescription discussed in my practice is for physical therapy and exercise. It is not that I am an exercise nut, but a lot of pain comes from the lack of movement, strength and general conditioning. Restoring motion is necessary to function more properly, and the closer one gets to a level that mimics an uninjured body, the more normal the body will feel. The baseline state of the body is an incredibly balanced machine. If the normal balance and motion is impaired, then the rest of the body strains to compensate. The easiest state for the body is when everything moves in the way it was meant in its original design.

Restoring and maintaining function as close to normal levels is the goal of most of medicine. Today, many people look for the shortcut to get to a normal level. A quick fix just sounds good, whether it is a pill or a surgery. Unfortunately, the simple solution is often not an answer but just a cover-up. Usually, it takes a lot of work to correct a problem, and often only a partial solution is found. Not all damage to the body can be corrected. Changes in the body related to aging, for example, may be permanent.

Exercise May Be Best

The best solutions for the body are often the simplest. The more we change, the more we have to compensate. If it is not broken, do not fix it. An over riding principle is to keep it simple. All this points to working with our bodies and teaching them once again to function normally.

The reason why I harp on activity is because it is the one thing that has been proven scientifically, in study after study that will work. It is one of the cheapest investments overall and when you actually do the right stuff to help the body heal and restore function, it works. When you skip parts, it’s frustrating and only gives partial results. Exercise may not be the only part of the solution, but it is one of the most important aspects.

Exercise for the body requires at least three components of activities to be successful. The first aspect is stretching and maintaining range of motion of the body. If the body does not move in its full capacity, muscles that do not normally do an action must step in and help compensate. These muscles that are helpers to restore balance in the body often need training and everything tends to tighten. Learning to actively stretch muscles and ligaments in an area keeps things moving correctly, and if they are not to tight, they do not hurt. Movement done correctly may hurt, but should not be causing damage to the structure, and as normal motion returns, pain lessens. Ongoing exercise programs with stretching may include activities like yoga or the martial arts.

Strength Training Also Key

Once motion is obtained, one must also have strength in the muscles. Most people think of body builders when they discuss strength. More realistic is having the muscles in the injured area perform with their normal power and what is expected in the un-injured state. There are many muscles in the body, and often we need to learn special activities to build up strength in them. Core body strengthening of the muscles in the abdomen, trunk, hips, pelvis and spine are necessary for low back injuries. This requires a number of very different exercises to engage the appropriate muscles to be effective. This type of exercise needs to be taught to people usually by a physical therapist to learn correct techniques. Once learned, they often do not require any amount of special equipment, but they do require diligence. Pilates is an excellent type of exercise to work on core strengthening. Most physicians are also recommending a general strengthening program for the whole body and large muscle groups as this has been shown to reduce the effects of aging, from joint deterioration to improved cardiac and pulmonary health.

The last component of exercise is general aerobic conditioning. This helps maintain cardiovascular health, but also allows the body to improve its overall endurance. Having the ability to perform an activity for a prolonged period of time is the goal of general aerobic conditioning. It gives the body the ability to stand or walk for a long distance, or just allows the body to make it through the day doing the necessary activities. Aerobic conditioning starts with things as simple as walking and then moves to fast walking, and then to more strenuous pursuits like swimming, biking, or running. More intense activity improves the cardiovascular system, improves the body’s immunity, and increases endorphins – the body’s own painkillers. Performing aerobic exercise at least three times a week for 30 minutes is the general medical recommendation.

Exercise that includes all three components; stretching, strengthening and aerobic conditioning does actually work. Chronic pain is usually more of a learned signal in the body that is indicating one is performing motions in the past that caused harm. Exercise when done correctly, returns the body to a more normal pattern of behavior, and reduces stresses on previously damaged components. Pain may not disappear, but it will usually be much diminished as function and overall ability improves. One needs to concentrate on all the things that one can do and not dwell on the one’s past glories. We can always move forward, but we cannot erase our past.

Being Accountable For Your Health

September 21, 2015 / Thomas Cohn, MD

Taking control of your health requires daily management, and it’s not always easy to do on your own. Sometimes help comes in the form of a gym buddy, but recently we’ve seen a rise in the number of people who wear a fitness tracker to help them track their activity, which is a great start towards a healthy lifestyle. That’s because people who wear some sort of fitness tracker tend to exercise more regularly and they are more accurate in reporting the time and amount of exercise. In the end, it all comes down to holding ourselves responsible for our health, but if these devices can help you stick to a schedule, it seems well worth the investment.

The boom in activity trackers hopefully will lead to higher rates of compliance with fitness. For my patients with pain, those who have included the use of a fitness tracker to monitor activity have been more consistent in exercise. They have also tended to be more motivated in performing an exercise routine, use less medication and have better control of symptoms.

One of the most important actions necessary to control pain is exercise. One needs to perform muscle strengthening and aerobic conditioning on a regular basis to control symptoms. Working with a physical therapist to learn how to perform the correct exercise is a good start, and after learning how to exercise appropriately, consistently being active is critical. The use of an activity tracker can significantly help a person stay the course of appropriate exercise.

The cost of a good fitness tracker runs about $100. As medicine goes, this is a relatively cheap investment into your own health. If pain is a factor in your health, get a fitness tracker, use it and get active.