Will walk for feedback

I ask all my patients about their personal exercise routines. They often answer that while they do no exercise, they are "extremely active" all day at work. I encourage them to wear pedometers in order to gauge just how active they are. One dismayed lady tried it out, then wailed in a follow-up email "There are only three steps between my desk and the file cabinet!". Not such a whirlwind at work after all.

Researchers in New Zealand decided to see if sedentary seniors could be persuaded to move more if equipped with encouragement and a pedometer(1). One group of geezers (geezettes too!) were given step-counting gadgets along with exercise counseling and follow-up phone calls to set ever greater step-counting goals. A control group were counseled and called but were not issued any freebie pedometers.

At the end of a year, both groups had significantly increased their leisure walking, proving that mere encouragement and phone calls are useful interventions. The pedometered seniors, however, doubled their extra walk-time compared with the unmetered oldsters. Blood pressures dropped in both groups. No surprise--this step-counting strategy works in middle-aged ladies as well(2).

I've been through multiple pedometers in multiple years. I've lost more than a few--in a cab, a nail salon, into the toilet. I've tossed out several due to inaccuracy; so sensitive to motion, they registered any shift of position. I currently wear a Fitbit designed to remain true to step count even if stuffed in a pocket. It also has a flower that gains more leaves the more active you are.

If the Fitbit is too pricey for you, I encourage you to invest in a mid-range device. The Yamax SW701 Digi-Walker Pedometer has been trial-tested for accuracy.

_____
1) Kolt, GS et al. Healthy Steps Trial: Pedometer-Based Advice and Physical Activity for Low-Active Older Adults. Ann Fam Med May/June 2012 vol. 10 no. 3 206-212.

2) Hultquist CN, Albright C, Thompson DL. Comparison of walking recommendations in previously inactive women. Med Sci Sports Exerc. 2005;37(4):676–683.

Walking across Virginia

Wondering where I've been? Well, busy for one, very busy. For those of you who didn't get the mailing, we've moved our office. From our vintage little office building that was originally built by my pediatricians in 1949 to sleek revamped office digs on the old Children's Hospital medical campus. If you can get through on the phones and find the darned office (still a few glitches to work out!), I think you'll be pleased to see that Adele and I are business as usual under the auspices of Exempla Healthcare here in Denver.

In my spare time, however, I've been walking across Virginia. Well not really walking across Virginia which would doubtless be even hotter than Denver and logistically problematic. I'm talking traversing in a virtual sense. I urge my patients to find an exercise activity that engages their interest as well as their heart. Used to be Jazzercise for me, step aerobics too, but that was years and a lot of knee cartilage ago. Walking with a dog is a personal joy, but I've got no pooch on-site with whom to mosey. So instead, I'm walking solo across the United States with an eye on the West Coast by 2020.

Wanna' come along? Check out the TransAmerica Trail (aka Tools to keep you active) at http://exercise.lbl.gov/index.html. Sign me up as your partner--they'll put you on my map and me on yours at the same starting point. I'm walker number 65471 about to enter Kentucky but happy to join you back on the Virginia coast.

Best personal trainer deal in Denver

Please note the corrected dates for this program

I have struggled mightily with back pain from scoliosis and degenerative arthritis. Thanks to a program of core strengthening courtesy of two knowledgeable young women--one a Pilates instructor with a strong background in physical therapy and yoga, the other an athletic trainer with a gift for modifying her workouts for older, less flexible non-athletes--my spasms and debility are yesterday's news.

I've put a lot of time and money into this program figuring properly that any bottom line beats crippling pain and decreased mobility. I am pleased to announce now that my trainer Tanya Martelli (Dr. Sykes goes to her too!) has assembled a low cost solution for those of you displeased with your aging spines.

She will be conducting a three class workshop for five participants Oct. 8, 15, and 22 at our office from 4-5 p.m. The focus will be on posture and core power, and at the end of the sessions, each person will have a home program to continue progress made during the class. The cost is $45. If these times do not work for you, Tanya plans another three week session mid-day Tuesdays at the end of this series.

You do not need to be our patient to attend these classes. Interested? Contact Tanya at tlyaskoff@mac.com to sign-up or inquire about future classes. She just designed a home program for me that I took on a recent road trip to California--worked just perfectly to keep me upright and buff while away from home. She could do that for you too!

Pilates, back pain, and Denver's old spines

I see a lot of older women going to ground--their spines telescoping downward and often acquiring notable, painful curves in the journey south. Unfortunately, got one of those backbones myself. I've tried a lot of things to shore it up but none more useful than my lessons with Dana Dreifus, a wonderful Pilates instructor in central Denver. She has an incredible intuition for that which you need to balance and strengthen, and she's quick with adjustments to the standard postures in order to accomodate your ability and level of fitness.

But you don't have to be old and degenerating to enjoy Dana's careful attentions and enthusiasm. If you're new to Pilates or wish ongoing instruction, you could not do better than to call her at: 720-936-3667.

Pedometer-based walking intervention

I love these names--if I recommend pedometers, and I do, then I am conducting pedometer-based walking interventions. Visions of two wild-eyed pedometer experts swooping unannounced into your workplace, grabbing you one arm apiece, and carrying you out to the parking lot where they install a pedometer on your waistband and drag you screaming, half-walking/half-kicking around the parking lot until you hit 10,000 steps.

Anyway, scientists from the Dept. of Family Medicine conducted a meta-analysis of PBWI's which means that they not only searched six electronic databases for weight loss outcomes in nine different studies that compared the pedometered with the pedometerless to see who lost the most weight, but they also contacted real-life pedometer experts just in from field interventions to interpret the results. Their conclusion?

Pedometer-based walking programs result in a modest amount of weight loss. Longer programs lead to more weight loss than shorter programs.

I trust the experts were pleased.

Fat or not, the fit live longest!

I mentioned in my previous post that exercise promotes immunity, just one more reason to dance as if your life depends on it. Exercise scientists set out to study the association between cardiorespiratory fitness, extra weight, and the predisposition to keel over dead in older adults. They enrolled 2600+ adults aged 60 or older in the Aerobics Center Longitudinal Study, poked, prodded, measured, and then watched their subjects' survival stats over 22 years. Here's what they found:

In conclusion, in this prospective study of adults 60 years or older, low fitness predicted higher risk of all-cause mortality after adjustment for potential confounding factors, including adiposity. Fit individuals had greater longevity than unfit individuals, regardless of their body composition or fat distribution...It may be possible to reduce all-cause death rates among older adults, including those who are obese, by promoting regular physical activity, such as brisk walking for 30 minutes or more on most days of the week which will keep most individuals out of the low-fitness category(1).

So here's what I hear: "I'm so discouraged. I've been working out for a month now and I haven't lost any weight." A couple of points: 1) Working out at the rate of 20 minutes on a treadmill 3 days per week is insufficient to promote fitness or weight loss, though theoretically it's better than nothing at all, and 2) If you are on the road to fitness with sufficient cardiovascular workouts, you are promoting good long-term health--and survival--whether or not you lose weight. All-cause mortality is just that, death from any cause whether it be heart attack, stroke, cancer, or sepsis from an overwhelming infection with some nasty, multi-drug resistant bacteria.

What's on your New Year's resolution agenda?
_____
(1) Sui, X, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007 Dec 5;298(21):2507-16.

An Aged Athlete

From a simpler time, when old was old, and physically fit was not (old that is):

An old-time champion pedestrian, whose record 30 or 40 years ago aroused the country, has recently at the age of nearly 70 performed the feat of walking from Philadelphia to New York, a distance of 96 miles, in a little over 23 hours and finished the task in excellent physical condition. This is a good example of the fact that the physical organization of man need not necessarily go to pieces before the allotted three score and ten, when, according to some, the system is worn out and useless. Of course, this man is an exceoptional case, but he shows what the possibilities are, and probably a great man other individuals of as great age could do likewise.

----JAMA, June 23, 1906

Exercise and illness

Consider, briefly, the brave little mice of Urbana, Illinois. Despite coming down with influenza, these rodents rallied themselves off their couches and hit the exercise wheel for a gentle workout in the first days of the illness. They envied at first their colleagues who were allowed to continue vegging out in front of the TV, but were grateful in the final analysis to the scientists who urged them onward.

Those aging mice who overcame aches and fever to sweat it out a little on the wheel were significantly more likely to survive the virus than their sedentary buddies. Those go-getter mice, however, who followed the 'if a little is good, more is better philosophy' were also more likely to suffer complications or death from the flu.

Dr. Jeffrey Woods and colleagues theorized that the mice who motored fared better due to the inflammation modulating effects of exercise. Dr. Woods said "We think what leads to mortality is not the virus per se, but the host's response to the virus, and what exercise does is actually decrease the immunopathology within the lungs."

Better then to meet this flu season (and the morning paper predicts a brisk uprise in cases in the coming month) in good shape. Once you succumb (and no thanks to the lady who coughed up a storm in my exam room yesterday WITHOUT covering her mouth), a little treadmill workout may be a good thing.

Mobic and Caramel Pudding

The perfect reward for a morning spent clearing heavy, wet snow from the sidewalks of our corner lot. Pain relievers for the body and soul...

If Barbara Hillary...

can make it to the North Pole on skis...at age 75...after winning a battle with lung cancer at 67...you can make it to the gym today!

An Aged Athlete

From a simpler time, when old was old, and physically fit was not (old that is):

An old-time champion pedestrian, whose record 30 or 40 years ago aroused the country, has recently at the age of nearly 70 performed the feat of walking from Philadelphia to New York, a distance of 96 miles, in a little over 23 hours and finished the task in excellent physical condition. This is a good example of the fact that the physical organization of man need not necessarily go to pieces before the allotted three score and ten, when, according to some, the system is worn out and useless. Of course, this man is an exceoptional case, but he shows what the possibilities are, and probably a great man other individuals of as great age could do likewise.

----JAMA, June 23, 1906