AGING and AGING WELL

Are you, optimistic about your aging, or pessimistic?

This is one of the questions in Dr Thomas Perls life expectancy calculator.

I wavered between clicking: "I feel I am aging well" or more modestly clicking "; "I am dreading my older years"; or maybe "Something in between the above two options". In the end I went for "Aging well". Who really knows if that is true, only time will tell.

Perhaps it was thinking about aging that I noticed this story about Jean Hirst, 72, who had her purse snatched by a 16 year old girl who ran off with the purse. Jean gave chase, caught up and got her bag back - amazing.

Then there was the story of Janet Lane, 68, who also had her purse snatched - this time by a 15 year old boy. Janet took a 100 yards to chase him down to get her bag back. The teenage boy was breathless unable to run any further.

Both of these stories are from England. Are women in their 60's and 70's retaining youthful fitness ?

In the last few days the British Medical Journal has published research on simple behavior changes which radically reduce the risk of stroke. The recipe is simple:

• Plenty of fruit and vegetables (at least 5 servings a day)
• Some physical activity - it does not need to be much
• Not too much alcohol - less than 14 drinks a week
• No smoking.

US News added in their thoughts on aging well. The ideas I liked:

• Don't retire. I was retired (from software development) for about 6 months and then started up again as a Personal Trainer. A decision that has turned out very well.
• Stay connected to people - loneliness is a killer
• Floss twice a day - of course this will improve the health of gum's and teeth but more importantly, flossing will improve your overall health.
  

Intriguingly, next month Psychological Science is publishing a study showing that attitudes to aging when young affect how one ages. "At the start of the study, 440 participants, aged 18 to 49, had their age stereotypes toward the elderly measured. Thirty years later, 25 percent of those with more negative age stereotypes had suffered a heart problem or stroke, while only 13 percent of those with more positive age stereotypes experienced a heart problem or stroke.

"We found that the age stereotypes, which tend to be acquired in childhood and young adulthood, and carried over into old age, seem to have far-reaching effects," said Becca R. Levy, associate professor of epidemiology and psychology and the study's lead author. The study appears in the March issue of the journal Psychological Science. "

I tried Thomas Perls' Life Expectancy Calculator and it gave me an estimate of 93 years.
I'm going to have to cogitate on whether this is good or bad.

What's my score?

• ACTIVE - yes, very (still running)
  
• Fruit and Veg - Yes, lots of
• SMOKING - No. never
• ALCOHOL - some but never above 14 drinks a week
• RETIRED - NO, never (probably)
• FLOSS - Yes, twice a day.
  

Checking Medication Information

How accurate is Wikipedia when it comes to information about prescription medication? Is it more reliable than the websites of the drug companies?

The Annals of Pharmacotherapy thinks that Wikipedia is just not good enough - not a full set of information for safe use by consumers. They compared Wikipedia against the traditional source of prescription drug information Mescape Drug Reference.

I did my own check using Omeprazole as my drug of interest:

• Medscape was good
• Wikipedia is pretty good - more international in its reporting
• rxwiki was very good
• Mayo Clinic was of course good
• Medco was informative and believable
• The Drug Information Portal run by the US National Library of Medicine seems the most comprehensive because it pulls in all the 'official' sources on drug information.

10 things I did not know about RxWiki
- this looks like a site to use in the future.







My personal 1 2 3:

1. RxWiki
2. Medco was good and easy to follow
3. Drug Information Portal has enough information to sear the retina.

Runners Stretches

Don't stretch before running.
Do not stretch when tired.
Don't even think about stretching when you are cold.

If you follow all the advice on stretching, you'll never stretch. I definitely recommend stretching every day, maybe even twice a day. Personally I rarely stretch before running, only when I feel really stiff and warming up is not helping to get loose. I never stretch after running simply because I usually feel done for - really tired.

Why do I stretch?

• It feels good. I enjoy stretching and as long as stretching does no harm I'm going to keep on stretching.
• Stretching keeps me running freely. I see other runners of my age and their stride length seems to get shorter each year and I'm hoping that stretching will avoid the "Old runners shuffle" for as many years as possible.
• Stretching helps avoid injuries. Some research says that stretching before running does not help avoid injuries but I question the research because they did less than 5 minutes of stretching each time.

If you search you'll find lots of stretching videos.
Here is a simple straight forward stretching video I like.

I'm qualified as a Personal Trainer with both ACE and ACSM so I'll share each organizations thoughts on stretching:

• Top 10 reasons to stretch from ACE
  
• Basic stretching from ACSM - the picture are small and need a close stare to understand but it has nothing dangerous.

I've previously posted about PNF Stretching which I offer to clients. Most clients love this form of stretching.

What I've learned so far this year

Time to file the accumulation of news letters and ask that question: Did I learn anything ? It's a question I've asked of myself previously.

1. Vitamin D, I keep blog'n about it, but it was excellent news that Monterey Mushrooms now expose mushrooms (white, brown and portabella) to Ultra-violet light to increase Vitamin D content. So you can get 100% of the present, and very low, daily government recommendation for Vitamin D from one 3 ounce serving of these super Monterey Mushrooms.
All this from Tufts University Health & Nutrition Newsletter.
The only small question is that the little monsters make the D2 form of Vitamin D - D3 is much better - but D2 is OK.

2. The Berkeley Wellness Letter has given up on supplementing with Vitamin E - "Bottom line, get your Vitamin E from food, not supplements because supplements have not proved beneficial and may be risky. Get Vitamin E from: nuts; seeds; vegetable oils; whole grains; leafy green vegetables; tomato sauce; red peppers - more details.

3. The National Cancer Institute stopped the SELECT Trial Selenium and Vitamin E Cancer Prevention Trial because those taking Vitamin E had slightly higher rates of Prostate cancer while selenium takers had a somewhat higher risk of diabetes. Nutrition Action Newsletter reported on this but did not recommend against continued use of vitamin E supplementation. Their exact words "If you take a multi-vitamin, stick with one that contains roughly the daily recommended targets for vitamin E (30 IU) and selenium (55 mcg)."

4. The same issue of Nutrition Action Newsletter had a new take, new to me at least, of the belly brain connection. They reported on Kaiser Permanente research had looked at a new way to measure the size of a big belly - measure the front to back distance - look at picture. They wryly call this new dimension the Sagittal Abdominal Diameter (which gets us to SAD).

Anyone with a SAD dimension above 10 inches has a doubled to tripled chance of dementia in later years.

5. Johns Hopkins Medical Letter had a piece about issues with long term use of Proton Pump Inhibitors to treat chronic ulcers or to alleviate GERD (gastro-esophageal reflux disease). I've blog'd about my personal concerns about taking Prilosec every morning because it interferes with calcium absorption which in turn leads to reduced bone density and long term to osteoporosis. The Johns Hopkins words "I'm concerned about the long-term use of Proton Pump Inhibitors, particularly for patients who have or at increased risk for osteoporosis and people with conditions such as liver disease that interfere with their ability to utilize Vitamin D and calcium."

6. Have you wondered how the Lo-salt products manage to have less salt, and hence less sodium, that normal salt ? The answer is by increasing the amount of potassium which then reduces the sodium content. If you have diabetes reducing your salt intake is a good idea.

Then the other shoe drops and sometime later a routine blood tests shows up high blood potassium - this is not good either. The Mayo Clinic Health Letter says "Even without symptoms, moderate to severely elevated potassium can be life-threatening."

So if exercise helps with overcoming cance what exercise exactly should you try ?

My previous blog pointed at piles of research showing that exercise helps both while receiving cancer treatments like surgery, chemo and/or radiation, and after cancer treatment, so what exactly should one try or not try ?

The previous post referenced Anna Schwartz's book Cancer Fitness. It so happens that she also wrote the cancer chapter in one of my favorite text books: ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities. The whole story in the title.

It is possible to get too addicted to exercise! As Anna points out, if one has uncontrolled vomiting or diarrhea then postpone exercise. I'd agree with that.

This afternoon my wife, a breast cancer survivor, and I did our aerobic workouts on treadmills next to each other. She did interval training with the upper limit on heart rate set to 133 beats per minute and the lower limit set to 115 beats per minute. These clever treadmills allow you to set exactly how hard you want your heart to work and then when you get up that upper limit the treadmill automatically slows down so that you heart rate can come down to the lower limit - in my wife's case this afternoon - 115. When you get back to this lower limit the treadmill immediately speeds up and inclines up to take the heart rate back up.

The basic exercise plan, which needs to be varied for each person and varied by day depending upon how you are feeling, includes:

• aerobic exercise (which helps heart and lungs plus helps keep down weight gain)
• strength training to hold onto as much muscle as possible
• stretching and flexibility to try and deal with reduced range of motion in some joints which can be very uncomfortable
• Balance to keep you away from falling and hurting yourself.

Aerobic exercise such as walking, water aerobics, cycling (probably best on a stationery cycle) or rowing (again probably best on land rather than actually on the water) 3 days a week (alternate days makes sense). 10 minutes is good as a start and building upon by adding maybe 2 minutes to the length each week up to around 30 to 40 minutes. It does not all need to be in one go on aerobic exercise day. In fact there is a lot in favor of splitting the exercise up into 2 or 3 chunks.

Strength exercise on 2 or 3 days a week. This could be just using your own body weight with, for instance, push ups against a wall or with elastic bands or with weights or if you go to a gym, with gym machines. You can do really excellent strength training at home.


Stretching to try to get rid of stiffness and to improve the range of motion around tight joints is a most days of the week activity.

Then there is balance. Balance exercises are important. It's amazing just how fast balance improves with regular practice but a lot of care is needed that you try balance exercises where it's safe, you can grab hold and the floor is soft and definitely no sharp edges close by.

Watch this short video of my wife balancing or, if you want to smile, look at me trying to balance.

When should you not exercise? OK, so we are past vomiting and diarrhea, what else to be careful about ? Blood counts give a lot of exercise related information.

• If hemoglobin level is less than 8.0 g/dl-1 then avoid high intensity exercises because your body's oxygen transport capability is going to be way down.
• Neutrophil count (absolute) is less than 0.5 x 10 to the 9/l then avoid activities that might increase the risk of bacterial infection e.g. swimming.
• Blood Platelet count less than 50 x 10 to the 9 /l then avoid activities which increase the risk of bleeding. This would include high impact activities like plyometrics, sprinting and football.
• Bone pain indicates that you should avoid activities which might cause fracture at the place of bone pain. For instance, bone pain in the wrist might indicate avoiding push ups.
• Severe lymphedema then avoid upper body exercises with the affected arm.

The early research on cancer and exercise all had the objective of "do no harm" and you can't argue with that. Thus far more than 40 controlled clinical trials have been performed looking at exercise in both cancer patients and cancer survivors. In general exercise helps but common sense is essential as is shown in this controlled study of physical activity in cancer survivors.

Look at this recommendation from the ACSM entitled "Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association."

Then there is the question of improving one's fitness prior to surgery. Read this!

If there is one last thing to say, it's that even a little exercise will make you feel better about yourself. Dorelle Laffal, diagnosed with breast cancer at 37, shows that a little exercise can take you a very long way.

Cancer Survivors - does exercise help ?

Reading Melinda Irwin's paper "Physical Activity Intervention for Cancer Survivors" is like staring at the dangerous end of a gun barrel. What comes out is not going to be pleasant - maybe downright nasty. Best listen to the message.



The message is simple "Obesity and a sedentary lifestyle are highly prevalent in cancer survivors, and a growing number of publications have shown statistically and clinically significant associations between low levels of physical activity, obesity and cancer recurrence and death. Adoption and maintenance of physical activity is a difficult challenge for healthy adults, and is likely to be even more difficult after a cancer diagnosis."


The Journal of the American Medical association (JAMA) carried the article Physical Activity and Survival after Breast Cancer Diagnosis. My wife has survived breast cancer and it is the kind of article that grabs my eye!

Their summary: "Physical activity also has been linked to a lower risk of breast cancer. An expert panel of the International Agency for Research on Cancer of the World Health Organization estimated a 20% to 40% decrease in the risk of developing breast cancer among the most physically active women, regardless of menopausal status, type, or intensity of activity. Physical activity has been linked to lower levels of circulating ovarian hormones, which may explain the relationship between physical activity and breast cancer. Lower estrogen levels among physically active women with breast cancer could potentially improve survival, although few data exist to support this hypothesis.<sup>"


The CA - a Cancer Journal for Clinicians - published Nutrition and Physical Activity During and After Cancer Treatment, 32 pages of what you have to do.

Their view is "Physical activity may have benefits throughout the spectrum of the cancer experience, but cancer survivors are often more likely to become sedentary for several reasons. Survivors tend to decrease their physical activity levels after their diagnosis of cancer, and most continue lower levels of activity through treatment and beyond, rarely returning to their pre-diagnosis levels of activity."</sup>


Anna Schwartz is in do doubt about exercise and cancer: "Exercise should be a regular part of a comprehensive care plan for all cancer patients, regardless of age and physical ability. Anyone can exercise, if the exercise is tailored to the ability of each person and progresses slowly, in a step-by-step fashion. Cancer patients can, and should be encouraged to exercise the day they are diagnosed. The advice to get more rest is a myth, and not the best advice for cancer patients."

How to start working out with weights, balls and machines

Does your gym look like this ?

Strange machines everywhere. People doing impossible things.

Just how do you get started into an active, healthy, lifestyle ?

Would you prefer other gym members to look more like this on the right: 

or are you OK with:

The American Council on Exercise (ACE) has just opened a web site aimed right at you. It has words, pictures and videos going through exercises in an easy to understand manner. 

I'm qualified as a Personal Trainer through ACE   [and also the American Council of Sports Medicine (ACSM)]. This is me on the ACE web site.

ACE has a regular magazine aimed at Personal trainers ACE Certified News and the Dec2008-Jan2009 edition features their just launched online exercise library. 

I have started to comment on the ACE videos, which to a very great extent, I think are excellent. This page has one such comment - my pseudonym is skyblue60.