Tag Archive for: exercise

, , ,

How to Age Well, Part 2

This is the second part of a series on aging well. – Janet

It all makes sense, but sometimes we need to hear this stuff anyway.  Eat right, get vaccinated, and get some sun, because Vitamin D protects your body and helps prevent cancer.  This is from How to Age Well, Part 1.   Part 2 is about how we all need to get off the couch, mentally as well as physically.

Jeremy Walston, M.D., a gerontologist at Johns Hopkins, co-directs the Biology of Frailty Program and is co-principal investigator of the Older American Independence Center.  He has spent his career studying how we age.  In addition to many studies on specific aspects of aging, he has looked at what healthy older people have in common — at what they eat and don’t eat, and how they live – and has come up with some practical tips.  I recently interviewed Walston for Breakthrough, the magazine for the Johns Hopkins Center for Innovative Medicine.

Here’s more of what he had to say:

Keep Moving

exercise“Stay active as long as possible,” says Walston.  “Don’t sit for long periods of time, especially in the late afternoon or evening.  Studies show that those are low-activity times for many people, so it’s good to try to boost your activity during those times.”  Go for a walk after dinner.  Walking is good; in fact, you should walk a lot, or do some aerobic activity – there’s plenty to choose from. 

Just a few examples include taking a Zumba or Jazzercise class, riding a bike, swimming or doing water aerobics, hiking, jogging, or dancing.  In addition to getting cardiovascular exercise, “it’s also important to do exercises that help you stay flexible, that help your balance and gait, and that help strengthen your muscles.  Don’t forget your shoulders,” which are important for maintaining core body strength and higher levels of function.  And if you have an “orthopedic issue,” like knee or hip trouble, address it.  “It is essential to maintain your mobility as long as possible.”  This may mean that you need a knee or hip replacement – but it also could be something as simple as starting to use a cane.

However, while you’re staying active: 

Don’t Fall

balanceThe body literally takes a hit when you fall.  Many older people, who otherwise have been doing pretty well, take a turn for the worse after a fall.  Just being laid up for a few days, or even longer, can be difficult for the elderly because they tend to lose strength quickly. 

The best way not to fall is to be aware of the risk, and do your best to prevent it, says Walston.  “Things that can make you fall include not watching your medication; vision problems; weakness in the lower extremities; and balance and gait problems.” 

One huge risk factor is easy to fix:  “low lighting and a cluttered living area.”  Make sure your rooms are well lit – that you not only have enough lamps or ceiling lights, but that the bulbs are high-powered enough so you can see where you’re going.  And go after the clutter.  It doesn’t take much – maybe a stack of books or magazines that slips over, or a puzzle left by a grandchild on the floor – to make a walkway treacherous. 

Sometimes, you’re so used to looking at clutter that you don’t see it.  This is why Walston recommends bringing in an independent party – a friend or relative who is not used to your home, who can see potential trouble spots you haven’t noticed.

You can lower the odds of falling, as well, by working on your balance.  Tai Chi is a great way to do this, and many community centers offer classes (another bonus: taking a class helps you stay connected – see below).  Weights and exercises can also help your legs get stronger. 

Keep your mind active, too

puzzle“Cognitive risk factors include diabetes, elevated lipids, and high blood pressure,” says Walston.  Medications can keep all of these problems in check.  Even if you are currently being treated for these, it’s good to go the doctor for “tune-ups” every so often, to make sure you’re still on the right dosage.   

But other things can affect how well you’re thinking and functioning, too, and they may not be what you’d expect:

Poor hearing:  If you don’t feel connected, you may tend to withdraw from the conversation, smiling politely, not engaging, because you don’t know what people are saying.  This is bad.  “Get a hearing aid if you need one.”  It won’t just help your hearing; it will help your brain.

Personal note: I find this especially poignant.  There’s a feedback loop between our brain and the world.  We need stimulation to keep our brain going.  If we withdraw and isolate ourselves, we don’t get that feedback, and this hurts us mentally.  If all you need to do to help stop this from happening is get a dang hearing aid, swallow your pride and go get one!  Do it for your brain.

Physical inactivity:  Being active affects every part of your body.  It helps your heart work better, helps your lungs get more air, strengthens your muscles, and helps your brain work better.  Many studies have shown that older adults who are active are less likely to get dementia and Alzheimer’s. 

Depression:  If you are depressed, you are going to be withdrawn, you may not eat or sleep very well, and you may not get enough exercise.  All of these can affect your cognitive skills. 

Addressing all of these risk factors is good “cognitive protection,” says Walston.  And one of the most important ways to protect your brain is to stay active is to “interact with others more frequently.”  Stay connected.  Talking to people — volunteering, interacting with others in church, clubs, or other groups, being around family or friends – is good medicine. 

This is the second part of a series on aging well. To read part one click here. 

©Janet Farrar Worthington

/0 Comments/by
,

Heart Attack Triggers: The Four Deadly Horsemen

CigarettesA broken heart.  Shoveling snow.   Being a weekend warrior.   Eating like a pig, no offense to pigs.  What do these things have in common?  They all have the potential to cause a heart attack.  They could kill you. 

“But wait!” you may say.  “I exercise.  I have a good diet.  Gosh darn it, I’m heart-healthy!”  And that, with the use of prescription medicines, if you need them, is the best way to take care of your heart, says cardiologist Curtis Rimmerman, M.D., of the Cleveland Clinic, who also contributes to a blog called Health Essentials for that institution.   

But even so, he adds, there are some things that can trigger a heart attack.  All of them relate to sudden stress on the heart.  He categorizes them as the four “Es” – Exertion, Exposure to cold, Emotion, and (over) Eating.  (Shoveling snow could fit into three of these four categories, by the way; four if you also actively hate it as you lift each heavy shovelful.)

Sudden or overexertion.  The thing about exercise is, you need to ease your way into it.  Aerobic exercise means your heart works harder, causing you to take in more oxygen.  It is important, Rimmerman says, not just to hurl yourself into an activity that will leave you gasping for breath and have your heart working overtime.  Slowly build up your strength and endurance.  Some bad examples:  Playing a vigorous game of basketball or football if you’re not used to it.  Deciding, since you used to bench-press 150 pounds in your twenties, that this is a good weight for you to start with now that you’ve got that new gym membership, and forcing yourself to do it.  Spending your weekend doing heavy lifting of furniture or books or anything, if you haven’t done hard physical labor in years.  Sudden heart stress has even been known to happen after too much exertion in the bedroom.   And again there’s the classic example:  Shoveling snow. 

Ride the HorseCold Weather.  When it’s cold, your arteries constrict.  This raises your blood pressure.  Add intense physical activity, and your heart could feel the strain doubly.   Every year, Rimmerman says, more than 11,000 people go the hospital with problems related to snow-shoveling.  Most are orthopedic issues – oh, my aching back! – but 7 percent are cardiac, and many of those cardiac events are heart attacks.

Extreme emotions.  Maybe it’s a sudden, fierce surge of happiness; maybe it’s acute grief.  Both extremes, happiness, and sadness, can affect the heart’s electrical impulses, and both can set off a heart attack.  Rimmerman explains that this is because of the body’s “involuntary and sudden increase in heart rate and blood pressure brought on by a surprising event.”  Have you ever heard of someone dying, and then very soon afterward, someone close to that person has a heart attack or dies, as well?  The risk of having a heart attack is greatest within the first 24 hours after a loved one dies, but it remains higher than normal for a month, Rimmerman says. 

A subset of this is would be a category called “having a short fuse:” A 2002 Johns Hopkins study of more than 1,000 physicians, published in the Archives of Internal Medicine, found that young men whose knee-jerk response to stress is anger have three times the normal risk of developing premature heart disease.  In the study, such men – whether they vented their anger or bottled it up – were five times more likely than calmer men to have an early heart attack, even if they didn’t have a family history of heart disease.  Their short fuse was the risk factor.   “In this study, hot tempers predicted disease long before other traditional risk factors, like diabetes and hypertension, became apparent,” reported Patricia Chang, M.D., lead author of the study.  “The most important thing angry young men can do is get professional help to manage their tempers, especially since previous studies have shown that those who already have heart disease get better with anger management.”

dirty handsEating a huge meal.   A Harvard-led study at the 2000 American Heart Association’s Scientific Sessions found that eating an unusually heavy meal can increase the risk of a heart attack by about four times within two hours after eating. That was the first time that this, by itself, had been proven as a risk factor.  “We hope that the results of our study will help convince people to be more cautious about eating exceptionally heavy meals, especially for people who have coronary artery disease or have suffered a previous heart attack,” said the study’s lead author, Francisco Lopez-Jiminez, M.D.  The investigators asked nearly 2,000 men and women about what they had eaten just before their heart attacks.  Of these, 158 said they had eaten a heavy meal within 26 hours before the heart attack, and 25 had eaten a big meal within two hours before the heart attack.

When you stuff yourself and your body begins the task of digesting what you just put into it, it releases many chemicals, such as norepinephrine, into the bloodstream.  This can cause your heart rate and blood pressure to rise.  Your heart works harder.  Higher blood pressure can act as a power-wash of your arteries, causing chunks, or plaques, of cholesterol to break loose and to form a clot.  This, in turn, can block a blood vessel, cutting off blood flow to the heart – triggering a heart attack or stroke. 

In addition to too much food, too much alcohol, drugs, or even caffeine also can trigger a heart attack in people who already have some heart disease.  Here’s a sad example:  In 2013, “Sopranos” star James Gandolfini died at age 51 after eating a decadent meal, including a lot of foie gras and two big orders of fried prawns with  mayonnaise chili sauce.  He washed it down with four shots of rum, two Pina Coladas, and two beers.   A few hours later, he had a massive heart attack.   

The lesson here?  You can’t help some things, like excessive grief.  But what you can do is try to start off with as clean a slate as possible.   Eat some stuff that’s not fried, not covered in cheese, not fatty, and not bad for you.  Eat some fruits and vegetables.  Try to exercise regularly; you don’t have to climb mountains or run marathons – start by walking.  Walking is good.  Don’t drink a lot of alcohol all at once.  Remember, moderation in all things.  And if you have a problem with anger or stress, get some help dealing with it.  Your heart will thank you.

©Janet Farrar Worthington

/0 Comments/by
,

Exercise and Alzheimer’s – Part 2

Darth Vader BoxingI’m going to talk about the brain via an organ I know a little bit better: the prostate.

Bear with me.

Scientists have long known that, at autopsy, many men are found to have prostate cancer that never spread, never caused a problem, and never needed to be treated. They died with it, not of it. Why that is, is the subject of future posts, but trust me on this. Sometimes, diseases only show up at autopsy. People live a good long life and never show any signs of trouble, and yet, when they die, there it is under the microscope. For whatever reason, the disease never got out of hand. People died with it, not of it.

I did not know, until I interviewed Richard O’Brien, M.D., Ph.D., for an article for Breakthrough,  http://www.hopkinsmedicine.org/innovative/research/newsletter.html a publication of the Johns Hopkins Center for Innovative Medicine, that the same thing happens with Alzheimer’s. O’Brien, who was Chairman of Neurology at Johns Hopkins Bayview Medical Center, now Chairman of the Department of Neurology at Duke University School of Medicine, told me that some people, at autopsy, have Alzheimer’s pathology. They have the telltale brain plaques and protein tangles seen in Alzheimer’s disease – but they never develop any cognitive impairment. Other people have the exact same pathology, and they die of heartbreaking dementia. Why is this?

O’Brien sees opposing forces at work in the brains of people as they age. Think of the good Anakin Skywalker, still a part of the bad Darth Vader: a light-saber fight, now tilting toward the good side, now toward the dark side. Eventually, the good tips the balance, and Darth Vader dies on the good side, after having done a very helpful deed.

Well, in Alzheimer’s, the tipping point – the game-changer, the key factor that weights the scales toward dementia – seems to be ischemic disease. Stroke, or mini-stroke. “With a given amount of Alzheimer’s disease pathology in the brain,” O’Brien told me, “there are two forces at work. One is driving you to become demented, and the other is protecting you from being demented. The biggest force that we’ve found thus far is cerebrovascular disease.”

Note: This does not mean that every man who has had a stroke or who has cerebrovascular disease is going to get Alzheimer’s. That’s not what he’s saying at all. What it does suggest is that if a man has significant atherosclerosis, or if he has had a stroke, even if it’s asymptomatic – AND he has the plaques and tangles, that is a very powerful predictor that he will develop dementia.

The body has a limited capacity for what scientists call “insults.” Stroke is an insult. Plaques are an insult. Think of a boxer who can take a lot of punches, but he can only withstand so much. The brain has a tipping point, too. O’Brien believes that “either one of these alone isn’t enough, but the two existing together in the same brain are enough to tip you over.”

But there is very good news here:
Doctors are getting better at spotting and treating the risk factors that lead to stroke. In fact, two studies published last year found that the incidence of dementia has declined over the last 30 years. “The primary reason for that is the treatment of coexisting cardiovascular risk factors,” O’Brien said. He cautions that none of these treatments prevents the Alzheimer’s pathology from building up – but they “prevent it from becoming manifest. So you die with your plaques and tangles, but you’re still cognitively intact.”

So, what can you do to protect your brain? A huge one is exercise. The choices that we make today can help influence our risk of dementia later. In a report published in the Annals of Internal Medicine, scientists followed up on about 20,000 people who took part in treadmill testing in the 1960s as part of a cardiovascular study. Today, these people are in their eighties, nineties, or are deceased. “By searching the Medicare records for dementia diagnoses,” said O’Brien, the scientists “found that the people who had been in the fittest 30 percent of that group had a dementia rate that was half that of the other people in the cohort,” which confirms that “one of the side effects of regular exercise is a significant reduction in your risk of dementia.”

Another huge factor is cognitive reserve, and this is from education. It turns out that people who go to college tend to have more cognitive reserve than people who don’t. Note: I would imagine, although it hasn’t yet been proven, that if you haven’t been to college but you read and learn a lot, you are building up a cognitive reserve, as well. Learning a language or playing a musical instrument, doing research for your work, or singing in a choir – basically, anything that challenges your brain, as opposed to sitting on the couch and staring passively at the TV – all of these things have been shown to have beneficial effects on your ability to think, on the brain’s ability to make neural connections inside itself.

“All things being equal, people who go to college are much less likely to get demented,” O’Brien says, “people who are very fit are much less likely to get demented.” And there’s a third thing – “People with certain types of personality traits are less likely to get demented. Our latest data suggest that obesity is playing a similar role, too.” We already know (see my previous post on Low T) that fat, especially belly fat, changes your levels of hormones. What else does it do? Scientists are still figuring that out, but chances are good that obesity is not of great benefit to the brain.

Personality traits?
People who are positive and upbeat seem to have some protection from dementia. Again, why this is, is uncertain. It may be that people who are positive are more likely to educate themselves and exercise. They may also be more likely to do crossword puzzles or sign onto Luminosity, although O’Brien said he doesn’t think doing a puzzle here or there is enough by itself. One study published in the New England Journal of Medicine showed that people who did crossword puzzles had a lower rate of dementia than did people who spent a lot of time watching TV. But, O’Brien noted, this might be because the brains of people who choose to do crossword puzzles are very different from those of people who like to watch TV. “If you forced the people who are watching TV all the time to do crossword puzzles, would they have a lower incidence of dementia? I doubt it.”

Cognitive reserve is a very robust thing, according to O’Brien. “If you look at the neurons of people with high levels of cognitive reserve, they’re pretty resistant to the toxic effects of Alzheimer’s disease pathology. They actually have bigger neurons in the key areas of the brain. Their neurons are more healthy, even though there’s a lot of Alzheimer’s disease pathology.”

And finally, there is diet. O’Brien suspects that the Mediterranean diet might also have a significant effect on dementia, because it also has significant effects on cardiovascular health. “The data’s pretty clear that if you can prevent cerebrovascular disease, your chances of becoming demented are much lower.”

 

In addition to the book, I have written about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org.  The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  I firmly believe that knowledge is power.  Saving your life may start with you going to the doctor and knowing the right questions to ask.  I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

/0 Comments/by

Can Exercise Reduce Your Alzheimer’s Risk? – Part 1

300_200_walk_gravel

Part one of a two-part discussion of exercise and Alzheimer’s.

I’m not one for guilt trips. Mainly, because guilt backfires. If you were my dad, or brother, uncle, grandfather, or son and I were to try to guilt you into doing something that you already know needs to happen, like exercise, you might make a few grudging trips to the gym, but you might also resent it, and me, and wish I would shut the heck up. I would, and do, feel the same way when somebody does that to me.

So, this isn’t about guilt.

Instead, it’s some really positive findings that have to do with Alzheimer’s disease. A couple of years ago, a study led by scientists from the University of Maryland School of Public Health, published in the Journal of Alzheimer‘s Disease, found that just 12 weeks of moderate exercise – basically, this means walking fast enough on a treadmill to get your heart rate up, but not so much that you couldn’t carry on a conversation with someone else while you did it – made a difference in how people’s brains functioned. It made their brains work better; their neurons, or nerve cells in the brain, were more efficient. People could remember things more easily, and their brains didn’t have to work as hard to do it.

Just 12 weeks of moderate exercise causes your brain to work better.

The lead scientist, J. Carson Smith, of the University of Maryland’s Neuroimaging Center, and said at the time, “No study has shown that a drug can do what we showed is possible with exercise.” The people in the study weren’t spring chickens, either. They ranged in age from 60 to 88. They weren’t athletes – far from it; they were considered “physically inactive older adults.” Some of them had already shown some mild cognitive impairment, which suggests that they had a higher risk of getting Alzheimer’s. The people in both groups – those with the mild impairment and those with healthy brain function – improved their cardiovascular fitness by about 10 percent in the three months of the program.

They also improved their memory. MRI brain scans taken before and after the study showed “a significant decrease in the intensity of brain activation in 11 brain regions” while the oldsters did tasks including identifying famous people from back in their day – heart throbs like Frank Sinatra, for instance. Even more exciting, the places in the brain that got better are the same ones that are affected when some one has Alzheimer’s disease – the precuneus region, the temporal lobe, and the parahippocampal gyrus. Their word recall – remembering as many as possible out of a list of 15 words – got better, too, and Smith called this improvement “a very big step in the right direction.” In their paper, the scientists concluded that larger studies are needed to see if exercise can actually delay or slow the progression of Alzheimer‘s disease.

What does this mean for you? It means that, whatever age you are, you can make your brain work better even with a fairly pitiful amount of effort. You don’t have to be in marathon-running shape. You don‘ t have to go grunt and sweat and dead-lift huge weights and then drop them in an attention-getting way. Just walk for two and a half hours a week – 30 minutes a day, five days a week. If you don’t have 30 minutes, do it twice for 15 minutes. I don’t know if the results will be exactly the same, but I truly believe that this evidence shows that any effort is going to pay off. No guilt required.

 

A word about prostate cancer:  In addition to the book, I have written about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org.  The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  I firmly believe that knowledge is power.  Saving your life may start with you going to the doctor and knowing the right questions to ask.  I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington

/0 Comments/by