Getting Fit Without the Pain

Athletes over 50 usually hire a physical therapist after a problem, often an injury if not surgery.

But more older people are starting to hire physical therapists before they get hurt to fill the role of personal trainer.

Before he began training for a marathon, 62-year-old veteran runner Joseph Goldberg consulted with a physical therapist about the shin splints that had developed whenever he'd run more than eight miles at a stretch. She diagnosed an imbalanced gait, ordered custom orthotics for him to wear in his shoes and prescribed exercises to strengthen his hips, a corrective proven to reduce leg-related ailments. "I finished the marathon without injury," says Mr. Goldberg, a Virginia attorney.

By fitness-training standards, physical therapists who specialize in sports medicine are extraordinarily highly educated in the science of preserving, restoring and improving human function. Most have master's degrees, and the profession is pushing its members to obtain doctorates as a matter of course by 2020.

But while physical therapists have become fixtures on the sidelines of professional and college sports, their health-preserving skills are little known among recreational athletes. "We're the best-kept secret in sports medicine," says James Glinn, a physical therapist who runs a set of clinics called Movement for Life, based in San Luis Obispo, Calif.

Word is getting out, as Jane Esparza can attest. The owner of a speakers bureau, Ms. Esparza encountered intensifying levels of knee pain as she entered her 50s. Her doctor told her that losing weight and getting fit would help.

But the trainers she interviewed paid less attention to her knee pain than to her excess weight. All of them, she says in an email, responded with some variation of "We'll whip you into shape."

Then she learned about a fitness clinic near her Virginia home called Body Dynamics, run by Jennifer Gamboa, who holds a doctorate in physical therapy. Following a thorough study of Ms. Esparza's needs and limitations, a Body Dynamics physical therapist worked one-on-one with her for eight weeks, leading her through exercise routines that improved fitness and built confidence without straining her knees. Then she was handed over to a Body Dynamics personal trainer, who continued the regimen that the physical therapist had crafted, with an easy-does-it emphasis.

After 18 months, "I've lost weight," Ms. Esparza says. "My blood pressure has gone down. My cholesterol has improved. I breathe better. My strength and balance are improved. And the pain I lived with daily in my knees has greatly improved. Some days I'm almost pain free."

"What physical therapists are very good at is identifying barriers to exercise-knee injuries, chronic ankle pain-and building a program around them that creates incremental improvements," Dr. Gamboa says. Half of people who start an exercise program drop out within six months, partly because of "fear, discomfort and lack of confidence," she says.

Physical therapists often charge far more than $100 an hour, well above the cost of a personal trainer. Insurance companies tend not to cover the cost of physical therapy without a physician's referral; referrals are often limited to patients recovering from injuries, accidents or surgery. After receiving a fitness program from a physical therapist, many patients will, like Ms. Esparza, hire a personal trainer to implement it. But prevention is where many physical therapists say their profession could make the most difference.

A large percentage of aging athletes eventually suffer sprains, strains, overuse injuries and joint pain, and as part of their recovery they go to a physical therapist who focuses on resolving inflammation, restoring flexibility and developing a more-efficient and balanced program.

A proactive visit to a physical therapist can reveal the muscle imbalances and inefficient movement patterns that cause injury. The therapist can provide a regime that corrects those problems while enhancing endurance, balance, strength and weight control.

The American College of Sports Medicine says that it has certified hundreds of physical therapists and that it has no official position on whether injured athletes should seek help first from a physician or physical therapist.

Even so, fitness trainers shouldn't attempt to treat, and certainly shouldn't ignore, sports injuries, says Diane Buchta, spokeswoman for IDEA, a trainer organization. "We must refer those clients to a physician," she adds.Of course, many personal trainers specialize in treating the aging population. But the credentials of personal trainers can range from doctorate-level academic degrees to little or no certification at all. To address that problem, officials at IDEA recently established FitnessConnect, an online directory of more than 100,000 trainers with verified credentials.The American College of Sports Medicine says that it has certified hundreds of physical therapists and that it has no official position on whether injured athletes should seek help first from a physician or physical therapist.

Physical therapy "is largely built on the sciences of anatomy, biomechanics, exercise science and movement analysis," Carl DeRosa, a doctor of physical therapy at Northern Arizona University. That combination, he says, provides "a comprehensive and efficient 'start-to-finish' service to recreational athletes."

In five states, a physician's referral is required for patient visits to a physical therapist. Elsewhere such restrictions have been eliminated, and physical therapists are allowed to diagnose and treat conditions involving impaired movement. Not all physical therapists are sports-medicine specialists, however. The Find-A-PT link on the Web site of the physical therapy association lists 15 specialties other than sports medicine, including wound management, wheelchair mobility and hand rehabilitation.

By Kevin Helliker, The Wall Street Journal

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Finding Time

"Those who think they have no time for bodily exercise will sooner or later have to find time for illness."

-- Edward Stanley, Earl of Derby. The Conduct of Life. Address at Liverpool College, December 20, 1873

10 Health Habits That Will Help You Live to 100

You don't need to eat yogurt and live on a mountaintop, but you do need to floss.

The biggest factor that determines how well you age is not your genes but how well you live. Not convinced? A new study published in the British Medical Journal of 20,000 British folks shows that you can cut your risk of having a stroke in half by doing the following four things: being active for 30 minutes a day, eating five daily servings of fruit and vegetables, and avoiding cigarettes and excess alcohol.

While those are some of the obvious steps you can take to age well, researchers have discovered that centenarians tend to share certain traits in how they eat, move about, and deal with stress—the sorts of things we can emulate to improve our own aging process. Of course, getting to age 100 is enormously more likely if your parents did. Still, Thomas Perls, who studies the century-plus set at Boston University School of Medicine, believes that assuming you've sidestepped genes for truly fatal diseases like Huntington's, "there's nothing stopping you from living independently well into your 90s." Heck, if your parents and grandparents were heavy smokers, they might have died prematurely without ever reaching their true potential lifespan, so go ahead and shoot for those triple digits. Follow these 10 habits, and check out Perls' lifetime risk calculator to see how long you can expect to live.

1. Don't retire. "Evidence shows that in societies where people stop working abruptly, the incidence of obesity and chronic disease skyrockets after retirement," says Luigi Ferrucci, director of the Baltimore Longitudinal Study of Aging. The Chianti region of Italy, which has a high percentage of centenarians, has a different take on leisure time. "After people retire from their jobs, they spend most of the day working on their little farm, cultivating grapes or vegetables," he says. "They're never really inactive." Farming isn't for you? Volunteer as a docent at your local art museum or join the Experience Corps, a program offered in 19 cities that places senior volunteers in urban public elementary schools for about 15 hours a week.

2. Floss every day. That may help keep your arteries healthy. A 2008 New York University study showed that daily flossing reduced the amount of gum-disease-causing bacteria in the mouth. This bacteria is thought to enter the bloodstream and trigger inflammation in the arteries, a major risk factor for heart disease. Other research has shown that those who have high amounts of bacteria in their mouth are more likely to have thickening in their arteries, another sign of heart disease. "I really do think people should floss twice a day to get the biggest life expectancy benefits," stresses Perls.

3. Move around. "Exercise is the only real fountain of youth that exists," says Jay Olshansky, a professor of medicine and aging researcher at the University of Illinois at Chicago. "It's like the oil and lube job for your car. You don't have to do it, but your car will definitely run better." Study after study has documented the benefits of exercise to improve your mood, mental acuity, balance, muscle mass, and bones. "And the benefits kick in immediately after your first workout," Olshansky adds. Don't worry if you're not a gym rat. Those who see the biggest payoffs are the ones who go from doing nothing to simply walking around the neighborhood or local mall for about 30 minutes a day. Building muscle with resistance training is also ideal, but yoga classes can give you similar strength-training effects if you're not into weight lifting.

4. Eat a fiber-rich cereal for breakfast. Getting a serving of whole-grains, especially in the morning, appears to help older folks maintain stable blood sugar levels throughout the day, according to a recent study conducted by Ferrucci and his colleagues. "Those who do this have a lower incidence of diabetes, a known accelerator of aging," he says.

5. Get at least six hours of shut-eye. Instead of skimping on sleep to add more hours to your day, get more to add years to your life. "Sleep is one of the most important functions that our body uses to regulate and heal cells," says Ferrucci. "We've calculated that the minimum amount of sleep that older people need to get those healing REM phases is about six hours." Those who reach the century mark make sleep a top priority.

6. Consume whole foods, not supplements. Strong evidence suggests that people who have high blood levels of certain nutrients—selenium, beta-carotene, vitamins C and E—age much better and have a slower rate of cognitive decline. Unfortunately, there's no evidence that taking pills with these nutrients provides those antiaging benefits. "There are more than 200 different carotenoids and 200 different flavonoids in a single tomato," points out Ferrucci, "and these chemicals can all have complex interactions that foster health beyond the single nutrients we know about like lycopene or vitamin C." Avoid nutrient-lacking white foods (breads, flour, sugar) and go for all those colorful fruits and vegetables and dark whole-grain breads and cereals with their host of hidden nutrients.

7. Be less neurotic. It may work for Woody Allen, who infuses his worries with a healthy dose of humor, but the rest of us neurotics may want to find a new way to deal with stress. "We have a new study coming out that shows that centenarians tend not to internalize things or dwell on their troubles," says Perls. "They are great at rolling with the punches." If this inborn trait is hard to overcome, find better ways to manage when you're stressed: Yoga, exercise, meditation, tai chi, or just deep breathing for a few moments are all good. Ruminating, eating chips in front of the TV, binge drinking? Bad, very bad.

8. Live like a Seventh Day Adventist. Americans who define themselves as Seventh Day Adventists have an average life expectancy of 89, about a decade longer than the average American. One of the basic tenets of the religion is that it's important to cherish the body that's on loan from God, which means no smoking, alcohol abuse, or overindulging in sweets. Followers typically stick to a vegetarian diet based on fruits, vegetables, beans, and nuts, and get plenty of exercise. They're also very focused on family and community.

9. Be a creature of habit. Centenarians tend to live by strict routines, says Olshansky, eating the same kind of diet and doing the same kinds of activities their whole lives. Going to bed and waking up at the same time each day is another good habit to keep your body in the steady equilibrium that can be easily disrupted as you get on in years. "Your physiology becomes frailer when you get older," explains Ferrucci, "and it's harder for your body to bounce back if you, say, miss a few hours of sleep one night or drink too much alcohol." This can weaken immune defenses, leaving you more susceptible to circulating flu viruses or bacterial infections.

10. Stay connected. Having regular social contacts with friends and loved ones is key to avoiding depression, which can lead to premature death, something that's particularly prevalent in elderly widows and widowers. Some psychologists even think that one of the biggest benefits elderly folks get from exercise the strong social interactions that come from walking with a buddy or taking a group exercise class. Having a daily connection with a close friend or family member gives older folks the added benefit of having someone watch their back. "They'll tell you if they think your memory is going or if you seem more withdrawn," says Perls, "and they might push you to see a doctor before you recognize that you need to see one yourself."

By Deborah Kotz, U. S. News & World Report

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Phys Ed: Can Vitamin D Improve Your Athletic Performance?

When scientists at the Australian Institute of Sport recently decided to check the Vitamin D status of some of that country’s elite female gymnasts, their findings were fairly alarming. Of the 18 gymnasts tested, 15 had levels that were “below current recommended guidelines for optimal bone health,” the study’s authors report. Six of these had Vitamin D levels that would qualify as medically deficient. Unlike other nutrients, Vitamin D can be obtained by exposure to ultraviolet radiation from sunlight, as well as through foods or supplements. Of course, female gymnasts are a unique and specialized bunch, not known for the quality or quantity of their diets, or for getting outside much.

But in another study presented at a conference earlier this year, researchers found that many of a group of distance runners also had poor Vitamin D status. Forty percent of the runners, who trained outdoors in sunny Baton Rouge, Louisiana, had insufficient Vitamin D. “It was something of a surprise,” says D. Enette Larson-Meyer, an assistant professor in the Department of Family and Consumer Sciences at the University of Wyoming and one of the authors of the study.

Vitamin D is an often overlooked element in athletic achievement, a “sleeper nutrient,” says John Anderson, a professor emeritus of nutrition at the University of North Carolina and one of the authors of a review article published online in May about Vitamin D and athletic performance. Vitamin D once was thought to be primarily involved in bone development. But a growing body of research suggests that it’s vital in multiple different bodily functions, including allowing body cells to utilize calcium (which is essential for cell metabolism), muscle fibers to develop and grow normally, and the immune system to function properly. “Almost every cell in the body has receptors” for Vitamin D, Anderson says. “It can up-regulate and down-regulate hundreds, maybe even thousands of genes,” Larson-Meyer says. “We’re only at the start of understanding how important it is.”

But many of us, it seems, no matter how active and scrupulous we are about health, don’t get enough Vitamin D. Nowadays, “many people aren’t going outside very much,” Johnson says, and most of us assiduously apply sunscreen and take other precautions when we do. The Baton Rouge runners, for instance, most likely “ran early in the morning or late in the day,” Larson-Meyer says, reducing their chances of heat stroke or sunburn, but also reducing their exposure to sunlight.

Meanwhile, dietary sources of Vitamin D are meager. Cod-liver oil provides a whopping dose. But a glass of fortified milk provides a fraction of what scientists now think we need per day. (A major study published online in the journal Pediatrics last month concluded that more than 60 percent of American children, or almost 51 million kids, have “insufficient” levels of Vitamin D and another 9 percent, or 7.6 million children, are clinically “deficient,” a serious condition. Cases of childhood rickets, a bone disease caused by lack of Vitamin D, have been rising in the U.S. in recent years.)

Although few studies have looked closely at the issue of Vitamin D and athletic performance, those that have are suggestive. A series of strange but evocative studies undertaken decades ago in Russia and Germany, for instance, hint that the Eastern Bloc nations may have depended in part on sunlamps and Vitamin D to produce their preternaturally well-muscled and world-beating athletes. In one of the studies, four Russian sprinters were doused with artificial, ultraviolet light. Another group wasn’t. Both trained identically for the 100-meter dash. The control group lowered their sprint times by 1.7 percent. The radiated runners, in comparison, improved by an impressive 7.4 percent.

More recently, when researchers tested the vertical jumping ability of a small group of adolescent athletes, Larson-Meyer says, “they found that those who had the lowest levels of Vitamin D tended not to jump as high,” intimating that too little of the nutrient may impair muscle power. Low levels might also contribute to sports injuries, in part because Vitamin D is so important for bone and muscle health. In a Creighton University study of female naval recruits, stress fractures were reduced significantly after the women started taking supplements of Vitamin D and calcium.

A number of recent studies also have shown that, among athletes who train outside year-round, maximal oxygen intake tends to be highest in late summer, Johnson says. The athletes, in other words, are fittest in August, when ultraviolet radiation from the sun is near its zenith. They often then experience an abrupt drop in maximal oxygen intake, beginning as early as September, even thought they continue to train just as hard. This decline coincides with the autumnal lengthening of the angle of sunlight. Less ultraviolet radiation reaches the earth and, apparently, sports performance suffers.

Concerned now about your Vitamin D status? You can learn your status with a simple blood test. An at-home version is available through the Web site of the Vitamin D Council. (Use of the tests is restricted in some states, including New York. See the website for details.) Be sure that any test checks the level of 25(OH)D in your blood. This level “should generally be above 50 nanograms per milliliter,” Larson-Meyer says.

If your levels are low, talk to your doctor about the best response. Sunlight is one easy, if controversial, fix. “Most dermatologists will still tell you that no amount of sun exposure is safe,” Johnson says.

But Larson-Meyer and other Vitamin D researchers aren’t so sure. “There’s no good, scientific evidence that five to thirty minutes of sunlight a few times a week is harmful,” she says.

Or try supplements. “1,000 IU a day and much more for people who are deficient” is probably close to ideal, Larson-Meyer says. This, by the way, is about double the current recommended daily allowance. Most experts anticipate that this allowance will be revised upward soon. Consult with your doctor before beginning supplements. Overdoses of Vitamin D are rare, but can occur.

Finally, stay tuned. “In the next few years, we’re going to be learning much more” about the role of vitamin D in bodily function and sports performance, Larson-Meyer says.

From The New York Times by Gretchen Reynolds

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

Busted Fitness Myths

Think you know the facts about getting fit? You may be surprised to learn how many are really fiction.

It's easy to fall into the trap: A workout buddy passes along an exercise tip, and then you pass it on to several folks you know. One day, you're at the gym, and sure enough, you hear the same tip repeated, so you figure it must be true. But experts say that in the world of fitness, myths and half-truths abound – and some of them may be keeping you from getting the workout you need.

"Some myths are just harmless half-truths, but many others can actually be harmful," says professional triathlete and personal coach Eric Harr, author of The Portable Personal Trainer. "They can cause frustration in working out and sometimes even lead to injury," he notes.

One reason myths get started, says Harr, is that we all react to exercise a little differently. So what's true for one person may not be true for another.

"In this sense you sometimes have to find your own 'exercise truths' – the things that are true for you," says Harr.

That said, experts say there are also some fitness myths that just need busting, and the sooner the better!

To help put you on the path to a healthier, safer, and more enjoyable workout, WebMD got the lowdown from several top experts on what's true and what's not when it comes to exercise tips.

Fitness Myth No. 1: Running on a treadmill puts less stress on your knees than running on asphalt or pavement.

"Running is a great workout, but it can impact the knees -- and since it's the force of your body weight on your joints that causes the stress, it's the same whether you're on a treadmill or on asphalt," says Todd Schlifstein, DO, a clinical instructor at New York University Medical Center's Rusk Institute.

The best way to reduce knee impact, says Schlifstein, is to vary your workout.

"If you mix running with other cardio activities, like an elliptical machine, or you ride a stationary bike, you will reduce impact on your knees so you'll be able to run for many more years," says Schlifstein.

Fitness Myth No. 2: Doing crunches or working on an "ab machine" will get rid of belly fat.

Don't believe everything you hear on those late-night infomercials! Harr says that while an ab-crunching device might "help strengthen the muscles around your midsection and improve your posture," being able to "see" your abdominal muscles has to do with your overall percentage of body fat. If you don't lose the belly fat, he says, you won't see the ab muscles.

But can doing ab crunches help you to lose that belly fat? Experts say no.

"You can’t pick and choose areas where you’d like to burn fat," says Phil Tyne, director of the fitness center at the Baylor Tom Landry Health & Wellness Center in Dallas. So crunches aren't going to target weight loss in that area.

"In order to burn fat, you should create a workout that includes both cardiovascular and strength-training elements. This will decrease your overall body fat content," including the area around your midsection, he says.

Fitness Myth No. 3: An aerobic workout will boost your metabolism for hours after you stop working out.

This statement is actually true -- but the calorie burn is probably not nearly as much as you think!

Harr says that while your metabolism will continue to burn at a slightly higher rate after you finish an aerobic workout, the amount is not statistically significant. In fact, it allows you to burn only about 20 extra calories for the day. While there's a little bit more of a metabolic boost after strength training, he says, it's still marginal.

"It doesn't really count towards your caloric burn," he says.

Fitness Myth No. 4: Swimming is a great weight loss activity.

While swimming is great for increasing lung capacity, toning muscles, and even helping to burn off excess tension, Harr says the surprising truth is that unless you are swimming for hours a day, it may not help you lose much weight.

"Because the buoyancy of the water is supporting your body, you're not working as hard as it would if, say, you were moving on your own steam -- like you do when you run," says Harr.

Further, he says, it's not uncommon to feel ravenous when you come out of the water.

"It may actually cause you to eat more than you normally would, so it can make it harder to stay with an eating plan," he says.

Fitness Myth No. 5: Yoga can help with all sorts of back pain.

The truth is that yoga can help with back pain, but it's not equally good for all types.

"If your back pain is muscle-related, then yes, the yoga stretches and some of the positions can help. It can also help build a stronger core, which for many people is the answer to lower back pain," says Schlifstein.

But if your back problems are related other problems (such as a ruptured disc) yoga is not likely to help, he says. What's more, it could actually irritate the injury and cause you more pain.

If you do have back pain, get your doctor's OK before starting any type of exercise program.

Fitness Myth No. 6: If you're not working up a sweat, you're not working hard enough.

"Sweating is not necessarily an indicator of exertion," says Tyne. "Sweating is your body’s way of cooling itself."

It's possible to burn a significant number of calories without breaking a sweat: Try taking a walk or doing some light weight training.

Fitness Myth No. 7: As long as you feel OK when you're working out, you're probably not overdoing it.

One of the biggest mistakes people tend to make when starting or returning to an exercise program is doing too much too soon. The reason we do that, says Schlifstein, is because we feel OK while we are working out.

"You don't really feel the overdoing it part until a day or two later," he says.

No matter how good you feel when you return to an activity after an absence, Schlifstein says you should never try to duplicate how much or how hard you worked in the past. Even if you don't feel it at the moment, you'll feel it in time, he says -- and it could take you back out of the game again.

Fitness Myth No. 8: Machines are a safer way to exercise because you're doing it right every time.

Although it may seem as if an exercise machine automatically puts your body in the right position and helps you do all the movements correctly, that's only true if the machine is properly adjusted for your weight and height, experts say.

"Unless you have a coach or a trainer or someone figure out what is the right setting for you, you can make just as many mistakes in form and function, and have just as high a risk of injury, on a machine as if you work out with free weights or do any other type of nonmachine workout," says Schlifstein.

Fitness Myth No. 9: When it comes to working out, you've got to feel some pain if you're going to gain any benefits.

Of all the fitness rumors ever to have surfaced, experts agree that the "no pain-no gain" holds the most potential for harm.

While you should expect to have some degree of soreness a day or two after working out, Schlifstein says, that's very different from feeling pain while you are working out.

"A fitness activity should not hurt while you are doing it, and if it does, then either you are doing it wrong, or you already have an injury," he says.

As for "working through the pain," experts don't advise it. They say that if it hurts, stop, rest, and see if the pain goes away. If it doesn't go away, or if it begins again or increases after you start to work out, Schlifstein says, see a doctor.

From WebMD, By Colette Bouchez

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP