This is the fourth in our two-months-long series (40 Things for Every Woman in Her 40s) of Medical Monday articles intended to be useful to all our readers, but pointed especially toward those in their 40s—that in-between decade in which hormonal change has begun but fertility is still possible. Our first article (ideas 1 through 5) focused on self-care; our second (ideas 6 through 10) emphasized the need to pay attention to psychological issues; the third provided tips on preventing and repairing skin damage; and this week the topic is ‘exercise as medicine.’
Our expert this week is James Wyss, M.D., P.T., is an Assistant Attending Physiatrist in the Department of Physiatry at the Hospital for Special Surgery. He completed his graduate degree in physical therapy at the University of Scranton. After completion, he returned to New York and practiced physical therapy in a sports and orthopedic setting for three years before pursuing a degree in medicine. He then attended New York Medical College and graduated with honors. He completed his residency in physical medicine & rehabilitation (PM&R) at Kessler Institute of Rehabilitation and a fellowship in Interventional Spine and Sports Medicine at Hospital for Special Surgery. —Ed.
Photo by Steve Baker via Flickr (Creative Commons License)
The 40s are certainly the decade for beginning a comprehensive exercise program, if you have not created one. The American College of Sports Medicine (ACSM) strongly promotes the concept that “exercise is medicine.” Their recommendations include 150 minutes of moderate intensity aerobic exercise per week and strength training exercises for all the major muscle groups of the body two to three times a week. These forms of exercise help to maintain endurance, cardiovascular and pulmonary health along with maintenance of normal muscle mass and bone density. Their more recent guidelines include recommendations for neuromotor exercises — yoga and tai chi to improve balance, coordination and agility — to be performed two to three times a week. These are recommendations that require a significant weekly time commitment — approximately 5 hours a week — but “exercise is medicine” and this is a major investment in your health.
See More: “The Yoga of Turning 40,” by Jessica Caplan
Age 40 is the right time for women to develop injury prevention strategies to both maintain and continue to advance a personal exercise program. Find ways to warm up with 10 minutes of light activity that mimics the exercise you will be performing that day. Passive stretching before an activity (which we were all told to do in high school gym class) actually decreases muscular performance. So before jogging it would be wise to walk briskly, perform dynamic stretches/movements to wake up the knees and hips to prepare for running safely. Then perform passive stretching to improve flexibility during the cool down period, and include some time for walking to slowly decrease the heart rate to its baseline state. Cross training is another extremely important concept. Many athletes develop overuse injuries by performing the same exercises over and over again. Choosing a variety of exercises to perform each week will decrease the risk for overuse injuries. Runners can be susceptible to knee injuries, and swimmers can encounter shoulder injuries. (Mixing running and swimming can reduce the risk of both injuries.) The plan for avoiding overuse injuries includes proper warm-up, good posture and addressing muscle imbalances.
Many women reach their 40s with postural problems. This is certainly the time to change that. Good posture is an extremely important part of musculoskeletal health. Proper spine alignment is the foundation for healthy movement patterns. If your posture is poor consider seeking help from a physical therapist to correct muscle imbalances (tight chest muscles and weak shoulder blade muscles) and to relearn proper alignment of the spine (head over the shoulders, hips in line with the trunk – please add image of proper posture alignment). Once you have aligned your spine, you can begin incorporating core strengthening exercises that may help prevent injuries, like low back pain, and will improve your overall physical functioning.
See More: “Good Posture: How to Gain and Maintain It,” by Evelyn Hecht, PT, ATC
This is the decade to find a health care professional who will help you maintain good musculoskeletal health. Many medical specialists help patients maintain normal blood pressure, lower cholesterol and prevent heart disease, however, very few specialists focus on musculoskeletal health. General orthopedists, sports medicine specialists and/or physiatrists (doctor of physical medicine and rehabilitation) are potentially good choices when common sources of pain that may negatively impact your overall function occur. Low back pain, neck and shoulder pain, ankle, knee or hip pain can limit mobility and force a more sedentary, and a less-than-healthy lifestyle. With proactive medical care, recovery can be quicker and then key therapeutic exercises can be used to prevent injury recurrence. This allows the maintenance of an improved quality of life that includes participation in an ongoing personal exercise plan.
Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change. (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)
This week, Dr. Pat has asked Megan Riddle, M.D./Ph.D.— a psychiatry resident at the University of Washington and a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional M.D.-Ph.D. Program—to answer the questions of a woman who wonders about alternative medicine’s effectiveness in the treatment of depression.
Image from Flickr via (Creative Commons License)
Dear Dr. Pat:
I am 45 and still have regular periods and no symptoms of menopause. I had my first child four years ago, after fertility treatments that worked quickly, and I have loved being a mother. I had no problem adjusting to being a new mother, breast-feeding, or going back to work after a six-month maternity leave. I work full time at a job where I am appreciated; I do work that is rewarding, and the stress is manageable. I am allowed flextime and do a lot of work from home. I have a supportive husband and good help with childcare. I should be the happiest woman in the world, but I have been dealing with a low mood for some time now. It takes a lot of energy for me to get out of bed and to go to work—at a job I once loved. Now I just go through the motions to do what I have to do—and then I come back home and get done what I need to around the house. Everything has become an effort. Sometimes I can’t even concentrate enough to read—something I used to enjoy. My husband encouraged me to go to my doctor, and she gave me a clean bill of health, but diagnosed me with depression. She gave me a list of therapists in the area and offered me an antidepressant. I took the list, but said I’d pass on the medication at this point. I am not completely anti-meds, but like to avoid them whenever I can. However, I do feel as if I need to do something to help me get my spark back. I’ve heard there are natural options out there for treatment of depression. What are your thoughts on going this route? Do they work? I didn’t really want to bring it up with my doctor, since I wasn’t sure how she would react.
Dr. Riddle Responds:
I am sorry you have been struggling. Depression is a debilitating illness, and I am glad you are seeking treatment. Yes, there are a number of options for treating your depression that are outside the more conventional antidepressant-plus-therapy equation. This is a field of treatment outside the mainstream; it is referred to as “Complementary and Alternative Medicine” (CAM). It includes a variety of interventions, such as herbs, supplements, sleep modification, and light therapy. Although many of these options are available without a prescription, it is important to work with your doctor as you explore these interventions; she can help you monitor symptoms, be on the lookout for side-effects, and advise on any possible interactions with other medications you may be taking. When you share your interest in these treatments with your provider, together you can establish a treatment plan that incorporates your beliefs and principles. Medical education is slowly beginning to address the importance of incorporating an awareness of complementary treatments into mainstream practice. If your provider is not comfortable with these alternative treatments, she can refer you to someone with more expertise.
A wide range of CAM treatments for depression are available. A challenge of the field is determining how well these treatments work. Unlike the case with pharmaceuticals, where there is money to be made in drug discovery, CAM treatments often lack the large-scale studies we rely on for more conventional treatments. However, as interest has grown, so has the number of well-done (albeit smaller) studies. Below is a brief description of a number of different treatment options for which there is data supporting their use for depression. Wherever possible, I specify whether the treatment has been shown to be effective alone, or is better combined with other treatments. This list is not exhaustive; I have focused on the more popular and better-studied options.
St. John’s Wort (Hypericum): The herb St. John’s wort is one of the better-known alternative treatments for depression. It is quite popular in Europe. Study results have been somewhat mixed, but several have shown that it is better than placebo, and for many its efficacy is similar to that of traditional antidepressants. For those with mild to moderate depression, St. John’s wort is typically well tolerated and may offer relief. However, it is very important to discuss your use of this herbal treatment with your doctor prior to trying St. John’s wort, because it interacts with many other medications. It increases the rate that some medications are broken down in the liver, making them less effective. These include commonly used medications such as oral birth control, hormone replacement therapy, anticoagulants, and chemotherapy. Thus, this may be a good option for individuals with mild to moderate depression who are not taking other medications.
S-adenosyl-L-methionine (SAMe): SAMe is a small molecule that your body makes and uses while carrying out a number of important functions. It is sold as a nutritional supplement. A series of well-controlled studies showed SAMe to be as effective as, and better tolerated than, the older tricyclic antidepressants, and the majority of studies show it to be more effective than placebo. It can be used on its own for the treatment of depression.
Omega-3 fatty acids: Omega-3 fatty acids, the kind of fat found in fatty fish, walnuts, flaxseed, and soybean and canola oil, have gained increasing popularity for their various health benefits. These include reducing the risk of clots, decreasing atherosclerosis, and reducing inflammation. Evidence now suggests that we can add treating depression to that list. Initial epidemiological studies showed an association between higher levels of fish consumption and lower levels of depression. While the results of using omega-3s alone have been mixed, well-controlled trials have suggested that they are effective when added to other treatments. For example adding omega-3s to Prozac was more effective than either treatment alone. Thus, the best evidence supports using Omega-3s in conjunction with mainstream treatment.
You must walk before you can run: Throughout our lives, this age-old mantra reminds us of the importance of attaining basic knowledge and skills before attempting something more challenging. Now, with spring upon us, maybe it’s time we take this metaphor a bit more literally.
The sunshine has an undeniable effect on our desire to be outside. For many, this means a morning walk in the park, and for others it’s a regular game of tennis or the extra motivation to train for that end-of-summer triathlon. Regardless of the degree of exercise, take it slowly! Overdoing it now can lead to injury later, and being stuck inside with an injury is the last way to lead off spring and summer.
There are many ways to ease into your preferred sports this spring. First, always make sure to set aside time to stretch before heading outside. Not just your legs, but your arms, your back, and your neck—everything. Like it or not, our bodies stiffen as we age, our flexibility wanes, our muscles tighten. Stretching appropriately not only loosens our limbs but generates blood flow as well, consequently improving our circulation. And increased circulation means the added bonus of more energy for that fun outdoor activity!
With some practice, you may even start to find stretching relaxing—both a way to improve flexibility and a calming way to start your day. Even five minutes of stretching a day is enough to feel improvement. Take a look at this video for ideas on how to begin a new stretching routine each morning.
No matter what sport you choose, you need to stretch all parts of your body. For example, you use your legs just as much as your arms when playing tennis. Here’s a great video, by the Stretching Institute, that can guide you through a set of stretches most appropriate for tennis.
Drink up! It’s probably best to save that glass of wine for after your workout . . . but drinking enough fluids throughout the day is essential to maintaining a healthy and fit existence. Water is the most effective option for staying hydrated. The added sugars in juices, sports drinks, and soda are not necessarily our friends, even though they do taste good.
The more energy you plan to expend through exercise, the more water you are going to need to drink to maintain your hydration. As the temperatures rise, staying hydrated becomes ever more important, since it allows our bodies to cool ourselves through sweat. A dehydrated “athlete” (yes, that includes you women who like your morning walk!) becomes lackluster, dizzy, and weak; this significantly increases the likelihood of injury. And remember that hydration needs to occur before as well as during exercise. By the time you feel thirsty—or, worse, dizzy—it is most often too late. A simple glass of water with your breakfast and coffee is a great way to kick off the day on the right foot; it might even get you musing about the fun outdoor fitness session to come, adding motivation to that inner athlete you didn’t even realize existed.
Once you’re out on that tennis court, be sure to take breaks often, and always drink water during the breaks. And if you’re playing nine holes with your friends, make sure to pack plenty of water in the cart. Most courses have water on every few holes, so you will have plenty of opportunity to refill as needed. It’s always a good idea to pack small snacks in your bag as well. Something as simple as a banana, trail mix, or a granola bar can go a long way towards to keeping your energy up and your muscles happy. A body filled with energy is less likely to get injured and more likely to enjoy your weekly game.
Lastly, take things slowly. Just because you ended last summer playing tennis on Monday, golf on Wednesday, and jogging all weekend doesn’t mean you should start there. Ease into your ultimate, desired activity level gradually. Let your body be your guide. Even the greatest athletes in the world have to work relentlessly to build up to the regimen they deem acceptable. We all have different goals for ourselves athletically; getting there methodically will be rewarding, for you’ll be avoiding injury while you’re having fun.
Now that it’s sunny, I’m heading outside. After I finish this water.
So…how are those New Year’s resolutions going?
As we embark on the second month of the year, maybe you feel like a million bucks. After all, you’ve gotten four productive weeks under your belt, fulfilling your resolutions to eat healthier, exercise more, save money and improve yourself across the board.
If you’re anything like the rest of us, your resolve has not only begun to fade, it’s starting to sit like that last glass of eggnog on Christmas, weighing you down literally and metaphorically. Studies show that by March, over 50% of us will have abandoned our New Year’s resolutions entirely. And it may be cynical of me, but I’d venture that the number would be even higher if people were truly being honest about it.
So maybe it’s time for a February resolution. Rather than make these winter months more dreary than short days and cold nights already do, why not find a way to make this year different—not simply enduring, but embracing.
It’s about having some fun.
There’s no shortage of emotional and physical benefits to exercise. And there’s no shortage of books, magazines, and people that want to tell us all about them. The problem isn’t a lack of information, it’s finding the time, energy, and essential motivation to gear up for the dreaded word we so badly want to love and enjoy: exercise.
Here are a few suggestions to make it more fun, especially at this time of year.
Do it with friends. Exercising with friends is a lot more fun than exercising alone. Everyone’s time is precious, and all too often we end up canceling on our pals as life gets in the way. But catching up doesn’t have to be over coffee, lunch, or wine—maybe it’s a weekly tennis game or a line of bowling, even if you’ve never played the sport regularly. Friendships forged through sport often last a lifetime, since shared hobbies and passions can intertwine lives in a wholly unique way.
Stake out the time and protect it. If you commit to a weekly time slot with a friend or two, you’ll find it much more difficult to cancel. Book a racqet court at a regular time, or sign up together for an exercise class. Once you actually work it into your schedule, you’ll probably find it much easier to keep it going.
Add a touch of competition. Many of us were raised to be “nice,” and a healthy sense of competition wasn’t always part of that definition. Instead, it was something we’ve had to nurture in ourselves. Now that we’ve finally managed to acquire it, why not have some fun with it? Don’t underestimate the zing that a little competitive adrenaline can add to your sport or workout.
Consider joining a sports league. I know—chances are, you’re scoffing at the mere notion of such a thing. But not so fast. As the world has gotten used to the idea of healthier living—and strong, independent women—an abundance of women’s sports leagues have popped up across the country, in tennis, soccer, golf, running, volleyball, and even ice hockey, to name just a few. They’re out there, and probably closer than you think. They welcome beginners young and old who are willing to get out there, get some exercise, and to play to the best of their abilities, whatever that might be.
I recently joined a women’s soccer league that plays every Sunday morning. The athletic level is moderate, but the enjoyment is outstanding. Many of our players are well into their 40s, and all of us are committed to that hour out of the house, doing something for ourselves, and enjoying every second of it. Every week I’m astounded at how good it feels, even though it’s only an hour. In addition to the fun of the game itself, there’s the added benefit of an entire new group of friends, with a shared enthusiasm to boot.
Whether you’re an independent working woman, devoted wife, caring mom, or some combination of the three, we all know how hard it can be to find time for ourselves. But there are many ways to make exercise more fun. Maybe this approach can help you find the motivation to keep moving through these cold, dark days until spring finally kicks in and lures us all outside. And when it does, perhaps this way of thinking will find you embracing this special time for yourself each week, discovering that a little innocent competition can be utterly invigorating, and getting acquainted with the inner athlete you may have forgotten—or never knew.
To many of us, the Jane Fonda Workout is how we got ourselves, back in the ’80s, to “feel the burn” and learn to at least like exercise. Today, we can’t imagine going through all that. At 73, neither can Fonda, so she’s devised a new workout for women in “prime time,” complete with new videos. Last week on the Today show, Fonda got both Kathie Lee Gifford and Hoda Kotb to work out with her; watch below as she talks about her new venture, and shows off the remarkable fact that she can still fit into that signature leotard 30 years later.
Some claim hormone therapy made them fat. Others are certain that the loss of estrogen caused their weight gain. One thing’s for sure, they say: Something is making us fat, and it is worsening with age.
Is menopause to blame?
Mid-life weight gain can partly be explained by an alteration in fat cell biology that seems to promote fat deposition in the abdominal area. But other triggers are your food and alcohol consumption. And here, you are still in control.
There are five major causes for weight gain during menopause:
- Being overweight to start. Often, women enter menopause already 20 pounds overweight. It is harder to slim down after a steady weight gain accumulated over decades.
- A sedentary lifestyle. With less activity, you burn fewer calories. Regular exercise increases body mass and raises the metabolism rate.
- Unmanaged stress. In stressful times, the levels of cortisol — a hormone produced in the adrenal glands — rise, which increases appetite and triggers fat accumulation in the abdomen.
- Sleep deprivation. We don’t sleep the recommended eight hours a night, which in turn alters our metabolism. It causes a decrease in leptin levels in the blood (the hormone that signals the brain that you are not hungry) and an increase in ghrelin levels (this hormone stimulates hunger).
- Alcohol consumption. Alcohol increases appetite and is converted to sugar. It burdens the mid-life pancreas and causes a two-hour insulin spike. Sugar in alcohol is deposited as—you guessed it—belly fat.
If you want to break this cycle, work on reaching your ideal weight and commit to a few (perhaps long-overdue) behavior modifications:
- Buy a scale and use it. The number on that scale is not an emotional event but the result of your food choices and calorie expenditures.
- Shed the magical thinking about food. Yes, you do gain weight by eating while standing, while eating off someone else’s plate, and certainly when you eat whatever you want washed down with a Diet Coke. “Fat free and sugar free” still means calories.
- Fight situations that trigger impulsive eating. Let family members and the food pushers in your life know how they can help you achieve your goals.
- Eat responsibly and exercise. Stop the excuses. Chose a reasonable diet that works for you, and an exercise routine you can stick to.
- Preparation is essential. Make sure that the foods you need for your weight-loss plan are ready and waiting in your kitchen. Take meals to work that fit into your new eating plan.
- Stay in charge of what you eat even while you travel. Ask the hotel concierge to empty the mini-bar of alcohol and junk food and stock it with healthy foods.
- Arrive at cocktail parties late. Don’t consume alcohol, and eat at home before you go. Imagine how many people have put their unwashed hands on those canapés. That should be a real appetite suppressant.
- Mindfulness is essential to any weight loss process. Think before you make food choices.
Menopause is your time for reinvention! This is the rest of your life; now make it the best of your life.
On April 10 this year I set a new, personal record: 100 workouts in the first 100 days of the new year. (A feat that’s all the more unlikely if you actually knew me – I’m far more likely to be found in a library or kitchen than in a gym.)
Years ago, I endured a five-year bout with chronic fatigue syndrome from which I fully recovered. I wrote a series of articles about it, and a book, Gentle Medicine. My recovery was profiled in a women’s magazine (see right) because recovery was – and still is – a true rarity. I turned first to Western medicine and then later to essentially anything that helped. But what really got me over and through it was a series of classes in T’ai Chi and Qi Gong for participants sidelined by chronic illness, such as chronic fatigue, fibromyalgia, and cancer. They were taught by a wonderful woman in Seattle, Kim Ivy, who was experienced in teaching the less than fabulously fit or consummately healthy. (The Chinese refer to the life force energy as “Qi,” also sometimes spelled “Chi.”)
A friendly, positive black belt in every martial art known to woman, and a longtime yoga devotee, Kim had experience teaching at Seattle’s Swedish Hospital, in their pain clinic. She turned out to be a perfect fit for those of us who weren’t strong enough to do regular exercise. I remember the classes with Kim vividly, and most of all how much I enjoyed her two gifts to the class: Qi Gong, which was eminently accessible, even at my sickest; and readings from the Tao, with which Kim closed each week’s class. I can’t remember now how long I took the classes for – maybe six months – but I do remember the day I realized I was no longer sick. T’ai Chi and Qi Gong, both of which “create” and “move” energy, had been my lifesavers, compassionately introduced to me and others by a great athlete with a heart for those who couldn’t keep up.
It’s been years now since I had that experience, but every once in a while I remember how great Qi Gong was. How I could do it even sitting in a chair (!). And how peaceful and useful it seemed. I wanted to find some instruction again, but no longer living in Seattle, I had no Kim to go to. And Qi Gong is a little esoteric for finding great instruction on a DVD – or so I thought. Yet I continued to miss it. That “still, small” inner voice prompted me periodically to make at least some effort to get those benefits back into my life.
The unpaid work I do with combat veterans who have post-traumatic stress disorder is stimulating and rewarding, but also emotional and draining. By the end of last year, I wanted something that could help me stay strong inside despite the pull of other people’s difficult emotional states. What I was looking for, and didn’t realize it, was “fitness for empaths” – with a strong helping of internal fortitude.
As last December ended, knowing that the New Year was approaching, I got more serious about finding Qi Gong again. A chance mention turned me on to Lee Holden, who has a book and DVD called Seven Minutes of Magic: Recharge Your Body Each Day with Qi Gong. Holden is a former UC Berkeley soccer player who found Qi Gong after being sidelined by an injury, thinking he would never play again. Qi Gong both brought him his strength and flexibility back – he returned to playing a month later – and turned him on to a lifetime interest in the practice. Turns out that, while I hadn’t noticed, he’d had a series about it on PBS and was the new go-to expert on the subject.
Holden’s website has about a dozen DVDs to choose from, but my local library only had one on its shelf. It turned out to be a complete winner: Qi Gong: The Beginner’s Practice Continued. There are two workouts on the DVD, 24 minutes and 28 minutes long. They differ only by a longer, stronger warm-up. I started with the easier one, and once I got the hang of it progressed to the harder. Now I switch back and forth between them, depending on how much time I have to exercise. According to Holden, the flowing movements of Qi Gong teach the nervous system to clear stress from the body, leaving you “relaxed, balanced, and energized” — a powerful combination.
But back to goal-setting and creating momentum for the year: In mid-December, I ran across an article in the Washington Post by Ann Patchett, entitled “Resolved: Writing is a Job.” That introduced me to a key metric. Patchett wrote that a friend of hers had a yogi who believed that “whatever a person did with thoughtful consistency for the first 32 days of the year, set the course for that entire year.” Suddenly, I had my inspiration. Whatever I was planning to do, I had to accomplish for the first 32 days of 2010, ideally building the momentum that could carry me through the rest of year.
I’m no lifetime jock, and I prefer competition with myself to that with others. So I started keeping a spreadsheet to document my progress, calling it “Good Health Habits for 2010.” I chose good habits that really resonated for me. I knew if I just kept track of what progress I made on those goals, the process itself would nudge me toward making better choices. Some people say that a good habit takes three weeks – 21 days – to establish; so I hoped that setting a goal for the first 32 days, and being consistent with it, would make the progress “stick” even better.
I tracked wake time and bed time; how I felt on waking; whether I juiced fresh fruits in the morning; how much wine, water or coffee I drank; how my stomach felt (a typically weak link); whether I exercised, what type of exercise I did, and where (inside or outside); and whether I read the Tao daily or not – a peaceful habit much like Qi Gong. I tracked whether I was on time for appointments, and even whether I bothered to neaten or do the dishes. (All habits that contribute to internal peace and calm.) As time went on, new columns got added or dropped out, usually because I’d moved past the habit, often a bad one. I wanted to track only what mattered to me, and 2010 was going to be the year of “internal” fitness – with external, if I accomplished any, being only a byproduct, if that.
It wasn’t until about Week Two that I was able to find the Lee Holden DVD and start the Qi Gong. I alternated that with hill climbs as the main forms of exercise: 85% Qi Gong, 15% hill climbs if the weather complied. A few “moves” in the Qi Gong routine quickly became favorites: one called “Cloudy Hands,” which “clears stuck emotional energy” from the heart and “balances the emotions;” and another, at the end of the practice, that centers and grounds you. I find myself doing that at work, away from prying eyes, whenever I feel myself getting affected by other people’s stress and thrown off-balance.
Right away I started to see results. I can’t attribute it all to Qi Gong, but I surely am pleased at what the momentum started on January 1 created. Two physical ailments that have plagued me pretty much dropped right out, for different reasons. For one thing, the stuck hip I’d nursed for years, palliating with ice packs and Motrin, went away within days of starting the Qi Gong, never to return. And Qi Gong created so much energy that I could no longer drink my beloved double espresso (Cuban) with raw sugar in the morning. The digestive problems that I’d suffered for years disappeared right after I gave up coffee and its junior cousin, Coca-Cola. (Tea turns out to be fine, though not as exciting.)
I’m amazed by the benefits that just keeping track of my health habits have produced. I’ve lost ten pounds, a handful of inches, and gained true satisfaction from creating a good practice in my life. I also saw some longstanding vertigo just disappear, and I still don’t know what to credit that to – but possibly the Qi Gong as well.
The 32 days I’d set as a goal came and went. Coasting on a full rhythm of momentum, I wanted to go further. Organically, I settled on the concept of one workout a day, ideally for the year, but certainly through the first quarter of the year – which then became the first 100 days of the year. Some days I did more than one workout, Qi Gong and walking, for instance, to put extras in the bank. Other days, I wasn’t able to fit any in. But amortized over the full 100 days, 100 workouts actually happened.
The only thing that truly threw me off my game was going to an otherwise incredible gourmet eating and drinking fest known as “Camp Schramsberg” – we’re here in Napa Valley wine country after all – and Schramsberg is the (fabulous) sparkling wine served by every president since Nixon toasted Cho En Lai with it when China opened to the West. The three-day extravaganza, focusing on pairing sparkling wine with fabulous food treats from the Culinary Institute of America at Greystone, found me enjoying the marvelous experience and stuffing my spreadsheet in a drawer, as it were, until it was over.
Not only did I manage to create a good habit for the first 100 days of the year, I’ve also found in Qi Gong an exercise I can enjoy sticking with, ideally for the rest of my life. And as far as whether it gave me what I was looking for in terms of increasing my internal fortitude, I’d say: definitely. I’ve been a calmer, more centered person since January 1st, and even under strong duress have seen myself be able to keep my cool, but with compassion: Exactly what I was looking for. I’ve even turned a veteran or two onto it.
A lot of us are conflicted about New Year’s resolutions, and if, when we fail to keep them, they’ve done more harm than good. But based on this year’s positive experience of setting a goal and achieving it, I’m going to make striving for internal fitness in the first 32 days of the year a new habit, one that continues to pay benefits throughout the new year.
Snow is still falling in many parts of the country, but take a look at the calendar: spring is three weeks away. Hibernation is no longer an option. Time to start moving.
Last month, one of our guidelines for heart health was: Get physically active! That may have been impossible to imagine on Ground Hog Day, but as spring inches closer, it’s a more attractive proposition.
In fact, it’s more important than ever.
While we all know that excess weight and lack of exercise can be hazardous to our health, recent news has pumped up the volume on that warning. Recently Business Week noted that, according to a study at the Toronto Western Research Institute, U.S. women had significantly higher rates of arthritis and arthritis-attributable activity limitations (AAL) than Canadian women. Americans’ poor showing “may be a consequence of greater obesity and physical inactivity in that country,” wrote the report’s author Elizabeth Badley, “particularly in women.” University of California researchers blame the same factors (extra belly fat in particular) for a growing gender gap in strokes among our age group.
Luckily, other research makes a strong case for the benefits of moving your body, even a little.
In “Underused Therapy for the Heart: The Gym,” the New York Times reported on a study showing that the longer and more often over-65 cardiac patients attended exercise rehab sessions, the greater their survival rates after a heart attack. According to the researchers:
… 12 sessions improved survival and reduced future heart attacks, 24 sessions had still greater impact and 36 sessions — the number that Medicare covers — showed the greatest effect of all.
Patients who came to 36 sessions, usually three times a week, lowered their risk of death by nearly half and their risk of a heart attack by nearly one-third, compared with those who attended just one session. They also had a 14 percent lower risk of death and a 12 percent lower risk of a heart attack than those who attended 24 sessions, and substantially lower risk than those who came to just 12.
Even if you currently have health problems, exercise helps — at least with anxiety. So says a recent study in the Archives of Internal Medicine . “We found that exercise seems to work with just about everybody under most situations,” one of the report’s authors told the Los Angeles Times. “Exercise even helps people who are not very anxious to begin with become more calm.”
And just as this post was about to go up on our site, the New York Times’ Jane Brody came through with a comprehensive survey of about 20 studies on the subject, adding bone health, improved cognition, and better survival rates for breast and colon cancer to our list of exercise’s benefits. But first, she starts with a letter from a reader: “I’m 83 going on 84 years! I find that daily aerobics and walking are fine,” giving us all something to aspire to.
Don’t know where to start? Just stand up! According to evolutionary biologist Olivia Judson, I should be standing up as I’m typing this — it’s a terrific way to avoid the “slow creep” of midlife weight gain. “Sitting is one of the most passive things you can do,” she writes. “You burn more energy by chewing gum or fidgeting than you do sitting still in a chair. Compared to sitting, standing in one place is hard work. To stand, you have to tense your leg muscles, and engage the muscles of your back and shoulders; while standing, you often shift from leg to leg. All of this burns energy.”
And just sitting all day, Judson warns, can put us on the road to a multiplicity of health problems. The answer might be to take lots of breaks when you do sit. “A study of people who sit for many hours found that those who took frequent small breaks — standing up to stretch or walk down the corridor — had smaller waists and better profiles for sugar and fat metabolism than those who did their sitting in long, uninterrupted chunks.” Even fidgeting counts: trudging down the hall to feed that annoying cat for the 17th time, standing up to check the shelf for a long-lost phone number — it can help.
All of us have our favorite ways of being active, and we’d love to hear about yours. Meanwhile, the message is: Whatever it is, do more of it. And enjoy!
As the icy wind howls (for many of us) and we all get back into our weekly routines, it can be hard to believe the resolutions we made in the glitter and shine of New Year’s Eve: making time for the gym, packing a healthy lunch, remembering to breathe.
To help you stay motivated for healthy changes, here’s some WVFC posts you might have missed the first time around.
A few smart cooking techniques can make healthy eating delicious, and pretty easy. Check out our recent excerpt from the Mayo Clinic’s latest report for tips about braising and baking, and using herbs and spices to capture flavors without salt or fat. Earlier, Keri Gans, our nutrition expert, offered some tasty diet tips to get you through the holidays, and not exacerbate menopause’s increased diabetes risks.
Of course, exercise — even just walking more inside your house! — was also on most lists. We learned that even Oprah struggles just as much as the rest of us to make healthy diet and exercise a priority. But Dr. Pat fought back the holidays with boxing lessons from her trainer, loving its twin challenges of body and mind.
“I see myself fighting back from sloth, fighting off gluttony, fighting in Madison Square Garden.
As I am boxing, I imagine that I am wearing a special form-fitting body suit like those worn by superheroes, only my colors will be those of our own www.womensvoicesforchange.org: orange and white. I am suddenly fighting for The New Menopause!”
Feeling daunted by the thought of fighting for time on the treadmill? Contributing editor Elizabeth Willse has some tips and tricks to help you find space for your workout in a crowded gym. Interestingly, this season she reports that her favorite gym in Midtown Manhattan doesn’t have the usual throngs. Maybe this is the year everyone’s working out at home? Maybe each got a Nintendo WiiFit game for Christmas? (The latter’s not a bad option, as long as you actually do more than use it to create a million mini-Miis.)
You can work out at home, of course, if you have space. You could use that Wii, and/or follow along with a DVD. (Netflix.com and Blockbuster Videos actually have fitness videos you can rent and try out.) Or if you want a personal trainer to come to your house, you can find someone online. Accredited certification organizations like the National Academy of Sports Medicine and the American Council on Exercise maintain databases of personal trainers who can come to your house and train you there.
At the gym or at home, listen to our resident physical therapists, Eveline Erni, who offered serious tips (and a few protective exercises) to make sure your knees stay healthy.
Perhaps dancing is more your style than jogging or jabbing (it’s great for your mind and body, too). Last April, Chris Lombardi reported on a scientific study that proves dancing is good for you. And we’ve all seen how Dr. Pat has resolved to greet the new decade, by making time for music and dancing.
I resolve to add music back to my life. I lost the habit of turning on the sound system when I walked in the door and have not given much thought to the emptiness that is there now. I need to crank up the volume and start dancing again every night.
At Mount Sinai Hospital, here in New York City, I lectured last month to a group of orthopedists, physiatrists and physical therapists. Our topic of interest was the patella, and my specific lecture was how to protect the knee from undue stress. As a clinical director, I can tell you without looking at numbers or charts: Knees give people a lot of problems! They are right up there with low back pain. So how do we protect this extremely useful joint (you never realize how much you walk until the knee starts to hurt)? In a word—stability. But before I write about what the word stability really means, let’s take a moment and imagine the stresses we place on our knees. You can picture it this way.
Imagine the body as a long, straight rod extending from the floor up to five or six feet. Now have a large muscular individual (go on have some fun, I’m thinking of those romance novel covers) grab the top of the rod and bend it into a bow. The force applied at the top of the rod is transferred along the rod and results in strain from the top to the bottom. Guess where the body has significant vulnerabilities? If you are glancing suspiciously at your knees, then you get two points for the correct answer.
Let’s take our example and translate it into what this means for a human being. Whenever the upper or lower half of your body moves from being centered over or under the hips (i.e., during activities of daily living, going from sit-to-stand, climbing stairs, reaching for that tennis shot, etc.), you put serious strain on the knee joints. Over time, as the knee puts up with this wear and tear, we eventually run into problems. This usually manifests itself as pain, weakness or swelling and in serious cases requires surgical intervention. So how can we protect our knees?
Simply put, you need a strong, stable core (area from the bottom of the ribs to the bottom of the pelvis). This allows you to control your alignment. Now this is when I say, consult your local physical therapist for further details. Why? Because gaining control over the core is not the same as developing six-pack abdominals. Controlling the core is a very complicated process that involves kinesthetic awareness (fancy term for movement awareness) of both superficial and deep musculature, balanced muscle length, strength and endurance. It involves more than just performing non-stop crunches. A strong, stable core requires a sophisticated exercise program.
A physical therapist can guide you through this process, devising and implementing a program that will get you core control. And if your knees are already giving you problems, that is probably the optimal solution. But if you aren’t currently experiencing knee issues, then I might recommend some approaches to your exercise routine that will be helpful. As with any written recommendation, you should consult a medical professional before implementing the following information.
Keeping in mind my cautionary sentence above, what can you do to challenge your core musculature? You can start by bringing a bit of instability into your life. Basically, incorporate balance training as an underlying condition of exercise. How? Well, these days every gym has a Physioball, Bosu (inflated half-globe), balance boards, etc. All of this equipment was designed to challenge your core. For instance, consider using a Wobble-Board or a Bosu (right) when you perform your squats. The squats not only become much harder to perform correctly, but your core muscles get a tremendous workout.
- Try sitting on top of a Physioball and carefully lifting one foot off the floor, while maintaining your balance.
- For something completely different, lie down on a pliable workout mat with your legs on a Physioball (knees at a 90-degree angle). Once you are positioned correctly, carefully raise your hips into a bridge position while straightening out your legs; if you feel any neck or upper-back strain, stop immediately. Hold for 10 seconds; then lower and repeat.
- How about putting your feet on a Physioball while maintaining a push-up position? Don’t worry, everyone looks awkward trying to get into this position.
- Eventually work up to an actual push-up.
If you really want stability incorporated into your exercise routine, consider Pilates exercise routines, and equipment specifically designed to connect your core musculature with the rest of your body.
Once again, I strongly recommend that you perform the above exercises with a professional’s help. He/she can also help you in developing an exercise routine, increasing the difficulty, checking your form, and preventing falls.
The benefits of a strong and stable core are plentiful. Real strength at the core protects your joints (not just the knees), prevents falls, improves athletic performance, and gives you confidence that you can handle what life throws at you. When done properly, it works on the waist, stomach and hips. Toning, trimming and generally giving you a longer, sleeker form. So what are you waiting for? Think about putting a little instability into your life. It can pay big dividends.
Eveline Erni is a physical therapist with 27 years of experience, who has run a private practice in New York City since 1990. Along with four colleagues, Erni has helped more than 2,000 patients. Erni is also a member of the Hospital for Special Surgery’s Rehabilitation Network, one of New York’s premiere surgical orthopedic hospitals.
WVFC is happy to welcome Dr. Holly Andersen, a member of our Medical Advisory Board. Dr. Andersen, Assistant Professor of Medicine at the Weill Cornell Medical Center,
has additionally served as the Chief Medical Resident for
the Department of Medicine and Director of Education and Outreach for
the Ronald O. Perelman Heart Institute at The New York Presbyterian
Hospital. She has also
been an expert panelist on internet webcasts and an on air medical
consultant to ABC World News Tonight, MTV, the CBS Evening News, NBC
Evening News, The Early Show, The Fox Television Network, The Fox News
Channel, and The British Broadcasting Company. Dr. Andersen speaks
extensively on preventive cardiology, cardiovascular disease in
athletes and in women.
Dear Dr. Andersen,
I am 50 years old and am in really good health and if I may say so, in really good shape. I am 5’5″ and weigh 115 pounds. I eat very carefully, avoiding most fats, and eat multiple small meals a day, all with lots of vegetables, fish and organic poultry that is skinless. I eat low fat cottage cheese with fruit twice a day. I take a fish oil supplement for Omega 3 and calcium and Vit D. I exercise every day, aerobic exercise 30 minutes and then 30 minutes of weight training and stretching alternating with Yoga and meditation. I never smoke and I have two glasses of red wine a week to improve my heart health. My blood pressure is perfect, my pulse is low normal, and I have no illnesses. I take no medicines. I have a great life and very little stress.
But, I have a problem that seems to be genetic. My mother and her family all had very high cholesterol, but lived to be in their late 80’s without strokes or heart attacks. I don’t think that they used any of the lipid lowering cholesterol drugs that are being pushed these days. My general internist feels that it is very important that I take one of these drugs. I tried lipitor but felt lousy on it. I had muscle pain, nausea and just not well in general. I gave it a month then I gave it up. My total cholesterol is 270 and my LDL is 170. My trigylcerides are normal.
Since my family did well with this same genetic cholesterol problem and I am otherwise healthy, how do I find out if it is essential for me to use these drugs? Honestly, there is nothing else that I can change to lower my bad lipids.
I know you can only give general advice but lots of my friends are being pushed to take these drugs as well. How do we know if we have to do this?
Congratulations: you certainly seem to be taking your health and particularly your heart health seriously. It matters. We have many good treatments and technologies today, but nothing replaces or is more important than a healthy lifestyle. A healthy diet, regular exercise, and abstaining from smoking are crucial to good health.
Before counseling you, I would ask a few more questions.
- How “perfect” is your blood pressure? Blood pressures of less than 120/80 are most desirable, but basically the lower, the better.
- What’s your waist-to-hip ratio? Your body mass index (BMI) — a measurement of your weight indexed by your height — is 19.1. This is normal, but another important measurement to consider is your waistline. The fat stored in your abdomen stimulates the process of atherosclerosis (plaque formation in the arteries). The safest waistline for heart health in a woman is < 29 inches, although some reports say that waistlines under 33 inches are okay. What’s yours?
- I am a big fan of yoga and meditation — although the benefits of these are more difficult to measure, I believe they significantly positively impact your health.
I would say the same for laughter, sleep, good companionship and optimism.
It is a good sign that your mother and her family lived into their eighties without heart disease or stroke, despite their high LDL’s and total cholesterols. Perhaps you have a genetically potent HDL – the good or “scavenger” cholesterol — which helps rid your arteries from cholesterol and fatty plaque. We have investigational assays to measure the effectiveness of HDL’s, but these are not clinically available. How high is your HDL? The higher, the better. What are your triglycerides (another contributor to atherosclerosis)? Fasting levels should be less than 150.
Margaret, depending on your answers, you may be feeling more or less at risk right now. You should be happy that you have so many good things going for you, but you are still more likely to die from cardiovascular disease than all cancers combined. So what do you do? Should you add a medication that may help you further prevent this disease?
It is certainly not wrong to do so. I like my low to moderate risk patients to have LDL’s below 130, and like it better when their LDL is below 100. I discuss the risks and benefits of adding cholesterol-lowering medications with my patients quite frequently. I don’t tell my patients to take a heart medication that makes them feel bad, but today there are many medications to choose from, if one is not easily tolerated. Furthermore, I know that if a patient is reluctant to take a medication, they probably won’t – even if I prescribe it for them. You need to feel you are making the right choice for you.
You may wish to consider having a further test to better evaluate your risk. Although no test is perfect, you might talk to your doctor about one of the following:
Measuring your C-reactive protein, or CRP. This protein, easily measured in your blood, has recently been established as an independent prognosticator of your cardiovascular risk. A recent study found that people with elevated CRP’s, even with acceptable cholesterol levels, can benefit from taking a statin medication.
A carotid doppler, which is an ultrasound image of your neck arteries. It can help determine if the process of atherosclerosis has begun.
- Lastly, (although I rarely order this test) a scan of your heart called an EBCT, which does expose you to some radiation, will give you a “calcium score” that roughly estimates the plaque build up in your heart.
Good luck, Margaret. Continue your healthy ways.
I don’t get out much. It is easier to control how much you eat if you don’t go out to breakfast, lunch and dinner as part of your professional and social life. It does amuse me (or it may in two weeks when I recover from this debauched period of my life) that I stress mindfulness as a key to obtaining and keeping optimal weight and fitness, then I, the teacher, mentor, doctor, fall right off the cliff.
I usually exercise for an hour three times a week, in a focused and serious way; then two or three other times on the treadmill, or take long walks in the park with the husband and Asta the Airedale. Since January however, despite my New Years’ promise, I have just been working and not working out. I have controlled my diet but have not seen a trainer more than once a week.
I was a guest at a marvelous dinner party last night. The apartment and the art collection were breathtaking. Our hosts were charming and provided a wonderful atmosphere for relaxed conversation. The mix of people and personalities were just right for a memorable evening.
At one point, my host said to me, I swear this is true, “You eat a lot for a little person, don’t you?” I pointed out that I generally eat for energy, for fuel. But on some special nights, when the food and the wine are wonderful, then I go off the reservation.
I knew that I was in trouble— I was at least capable of knowing that sloth and mindlessness were taking their toll on my body, my energy and my spirit — so I’d arranged to work out with PJ at 7 a.m. the next morning. At six, after that late night, I dragged my unhappy self out of bed, struggled into exercise clothes and headed off to the gym.
It always amazes me how quickly the body loses its strength, balance and tone and how quickly my stamina disappears. It took about 45 minutes for the endorphins to kick in and then I felt great.
I had those tired twitchy muscles from workout exhaustion, but I felt full of energy. My head cleared, my focus became sharper. I was right back to mindful living.
We all take a holiday from controlled eating and drinking and living a very healthy life. It is human nature. But the trick is to know that all holidays end and that not every meal is meant to be special.
It is time to get in shape for spring. The season changes on March 21st.
- Move those heavy dark winter clothes away from the front of your closet.
- Rotate the clothes that are left. Find the brighter colors, lighter fabrics.
- Focus on what you can do to have a healthier and more meaningful life.
You do have choices. You can focus on the negative and increase your despair with feelings of hopelessness and misery. You can focus only on what you have lost and not what you have. You can become isolated and forget that you still have something to give to those who have less.
Or, in the midst of global upheaval, you can focus on self care.
You can give in to the vices of sloth and gluttony. Or you can take charge, day by day, and move on.
I am making the choice to come out of the winter and the frozen ground of this period of despair. I am choosing to come alive just like the daffodils will do in days, forcing myself into the optimism of spring.
Spring training is not just for athletes. It is for all of us, as we work to become mindful again.
“6, 5, 4, 3, 2, 1!”
Maybe watching the countdown, you were thinking of a countdown of your own. Making 2009 the year you drop a size, drop some weight, feel strong and healthier. Maybe you’re thinking about joining a gym.
You’re not alone. And, when you get to the gym, you’re really not alone. Everyone’s on the elliptical. You’re battling for bicycles. Working out’s a lot of work, even before you sweat. It can be tough to stay motivated when you’re feeling lost in the crowd.
Working as a personal trainer, I’ve seen the ebb and flow of resolution crowds. And there are a few simple ways to keep your space, and keep your sanity, while you’re meeting your exercise goals.
Dear Dr. Pat,
I began a diet just before Thanksgiving and lost three pounds in 2 weeks by giving up bread, sugar and wine and eating smaller amounts. I saw my GP before starting the diet and found that my cholesterol was high, my triglycerides were high and my diabetic monitoring test, hemoglobin A1C, was in the borderline range…almost diabetic. My thyroid tests were normal. There are many diabetics in my family, aunts, uncles and my mother. I know that the weight I have put on does increase my risk for this terrible disease. I have gained 45 pounds in the last decade, most of it around my waist. I am only 5’2” tall. I weigh 185 pounds. And I can’t wear any of my nice clothes.
Lifetime TV’s Laurette Hayden Tapped for WeTV’s Next Stage; Dating At 50? New Safe-Sex Guide Helps; Forbes Slide Show Zips Thru Dementia Prevention; Realistic Goals Keep Workouts on Track
Beyond “Bridezilla,”with a vet at the helm: Women’s media network WeTV, known until now for reality shows like “Bridezilla” (above), has just hired Lifetime/USA Networks exec Laurette Hayden to oversee a new line of original movies. Hayden, 54, comes with a thorough Hollywood pedigree, and she’s used to working on ‘women’s projects,’ having cut her teeth producing on Joyce Chopra’s 1996 My Very Best Friend.”
Now, Hayden will be tasked with turning WeTV into competition for her former employers:
Look out, Lifetime, WEtv is getting into the longform game. The Rainbow Media-owned women’s network plans to start making
original movies, with an eye toward releasing the first title late next
“We should be out there in the game making films for television,” said Steve Cheskin, senior vp programming at WE.
Top 10 cable network Lifetime tends to dominate this space,
however, and its spinoff Lifetime Movie Network has grown by leaps
and bounds. “Lifetime does what they do, and we do what we do,” Cheskin said.
“We’re going to do movies that fit our brand.”
Part of that branding is finding movies that can be cross-promoted
with the network’s reality fare. A well-promoted original movie
that involves a wedding, for example, could help bring new viewers
to “Platinum Weddings” or “Wedding Central.”
WVFC trusts that Hayden, as a prominent advocate for children with epilepsy and who shepherded the 2001 docudramas “Ask Me About My Children” and “Within These Walls,” will bring a diverse set of interests to the job.
Meanwhile, in honor of her mother Eva Marie Saint, we thought we’d take the only excuse WVFC will ever have to offer a clip from On the Waterfront:
Never too late to ask the questions: A new handbook offered by the New Zealand Department of Family Planning equips women over 40 some smarter ways to dive into the dating pool:
New Zealand women dipping their toes in the dating game at 40 or older have a new handbook.
But it’s not just a guide on how to tell whether the lawnmower man is Mr Right, Mr Right for Right Now, or someone to avoid altogether. Rather, it’s a handbook on sexual health, safe-sex practices and dating education, for a generation of women who, in large part, missed such an education while growing up.
The state-funded Upd@teMe booklet was produced to educate heterosexual women who found themselves back in the dating game post 40, Family Planning chief executive Jackie Edmond said. Those women might never have imagined the possibility of their long-term relationship ending, and could be faced with considerable adjustments to accepting new possibilities, she said.
“This is compounded by changes in society – more ways of meeting someone, increased risks of sexually transmissible infections. We know, too, that many people in the over-40 age group aren’t good at taking care of themselves. They’ve simply not had the safer sex messages that young people have been getting.”….
Some sample of the book’s “dating advice,” useful no matter how often you’ve told it to yourself: