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Weekly Plate of Exercises
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Ok my friends, it is that time of the year again. Time to renew my PT license here in Florida and to do that, I needed to accumulate a minimum of 24 hours of continuing education, which I am glad to say, I have completed. For the last couple of weeks I was immersed in everything from the latest management of injuries, joint replacements, kinesio taping, health coaching, I even dabbled via online in some basic yoga and pilates. Some of these may apply to my hospital work, some may apply to my personal quest to live a healthy life, some, well, some may just be useful in the future. But they are done. I think I’ve completed 30 hours.
Also, I have this feeling I’d finally be able to run a half marathon again. Yes, I have been training for it again, at age 53. I have no desire to compete with anyone, neither to compete with my previous personal records, which (ha ha ) are nothing to brag about. But something is different this time. Whereas in the past I had to squeeze in my running into my very heavy work schedule, today, I have lots of time due to less work hours. Whereas before I had to wait until sun up to park in a public park ( I didn’t trust my neighborhood’s roads), today I can run toward the beach no matter what time of day it is, yes, even in the dark. Whereas before I thought I was the healthiest bull around, today, I am dealing with diabetes.
I am at least 5 years older than the last time I ran a half marathon, and I ran more than 10 of them. This time I am more realistic about it. Running is simply a component of my total healthy lifestyle instead of being its driving force. Lately in my training, I am getting more conscious of proper form, sufficient resting, cross training, nutrition, hydration, supplementation, injury prevention more than competition. Did I say competition? Hah! I don’t think that will ever cross my mind again although, seriously, human nature can not refrain from trying to better the next person or the last personal time it took to run the same distance.
I am also in a different health level now since I am certifiably diagnosed as diabetic type 2. On top of running what pace, what distance, what time of day, I also need to know my sugar before during and after, how to maintain a safe sugar level while running, what type of gadget to use to prevent hypo or hyperglycemia etcetera. So far I was able to do a long easy paced 11 miles last weekend and no side effects whatsoever was noted on my sugar levels though I am feeling a little knee discomfort now and then.
Which I felt and had recovered from in the past. Running more than 10 miles is no picnic for ordinary people like me. And as a PT there are a few things I should watch for when training:
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Overtraining is my number 1 problem. The solution for this is hiring a good running coach but I can’t afford one. Sure there are hundreds of online running coaches that may be excellent but I prefer to self-coach which can be good and bad. Good because I can have an impromptu internal voice telling me what to do, bad because that voice can be wrong. Yeah, there can be many causes of overtraining: you feel good so you go all the way; you read an article about improving pace and time and suddenly you want to be on the road applying all of what you read; you see a person beside you who looks similar in your built and age and you want to beat the hell out of his pace; you bought a new pair of shoes and you want to test how much better they are by running on them like you’d never ran before. Oh yeah, overtraining is real and dangerous and one of the reasons why most people quit after trying to run for a couple of miles. The solution for this is simple - listen to your body and don’t hesitate to stop immediately the moment you feel any sign of pain (especially localized pain). And if this pain lingers the next time you train, then it’s time to abandon running for a couple of days and switch to another form of cardiovascular training (swimming, cycling) which will still work on cardio build-up without damaging your legs.
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Cross-train, cross-train, cross-train. Listen, majority of people over 50 won’t probably be aspiring for the Olympics anymore (unless you are shooting a target or bowling or something else) but for running, forget about beating Mr Bolt when over 50. Focus instead on beating heart disease and diabetes and kidney failure and cancer and depression and smoking and stress and poor bones and balance and oh so many enemies other than running records. In order for the body to manage itself well, it is important to address its totality instead of a specific part. This may be the problem of specificity of exercise. Sometimes we get so focused on one particular exercise we forget the others. Running is good but it involves movement of the body mainly in sagittal plane. Forward alternating legs and arms, some rotation of trunk, static head and neck. Running misses the muscles that involve side(lateral), rotational, oblique and backward movements. All those movements require muscles and they are not being strengthened (except for minor recruitment) by running. Cross training is like corrective nutrition: the more variety there is, the better. Solution: Lets come up with the weekly plate/tray of exercises then. They should not really blend but each should be given specific emphasis on a given day of the week. Cardio 3 out of 7 days preferably a day is in between. Strengthening 2 out of 7 days preferably a day is in between. Play can be 1 to 2 out of 7 days, any day.
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The tray which is a rough draft of my thoughts is something all exercise coaches have been emphasizing all along. There should be balance and harmony and totality with healthy lifestyle. First, exercise must NOT, NEVER be the priority of life. There is life, God/spirituality, family, livelihood/financial, social commitments, mental harmony and improvements, all of these should take precedence in healthy lifestyle. Exercise should be labeled as play/fun/recreation. It is important but should not be the driving force of one’s existence, UNLESS, it is your source of livelihood. Like in my case, I think about it everyday because I employ it in my work with patients. I love studying exercise and applying them on me because these are my tools to improve the lives of my patients. It sharpens my knowledge and experience thus helping me empathize better with them. This is my livelihood.
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And life by itself is full of challenges, progress and setbacks, triumphs and failures and these should always be put in proper perspective everyday. It doesn’t mean that because you failed miserably in one area of life the whole body should collapse. What matters is how to recover from the setback, how to put brakes and accelerate when needed, how to internally assess and re-assess your own well being, what tools you need to use. For example (this is my case), if running gives me pain, I switch to cross training to give my legs time for full recovery. Just like good nutrition, I have plenty of variety in my plate. If I can’t run, I bike; if I can’t bike and run, I swim; or I do weights; or I play basketball, or … you get the picture. The point is - movement and active life should be fun. And if trouble happens, as in injury and medical condition, you need not sit in a corner and contemplate the end of existence. There will always be a professional that can help you deal with that.
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Setbacks are inevitable. I am myself not immune from them. Since I started preparing for the half marathon, I felt soleus pain and recently a left patellar pain and sure I get really frustrated with these. As a Therapist, I self-analyze constantly and pretty much know what I am doing wrong - but - when fun is immense, I also forget. But these do not deter me from my quest. I slow down, I scale back, I lessen the impact by changing running variables like distance, speed, techniques, elevation. If discomfort is persistent I don’t hesitate to quit and switch to other forms of cardiovascular exercises such as biking or swimming. I also include strengthening. If all these don’t work, I rest. To deal with setbacks, one can either stop or work around it or switch to another activity or hire a specialist who can stabilize the problem without you losing the momentum or gains. There are many options.
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I am prepared to do it alone. This may sound anti-social but I am one of those who enjoy doing things on my own. At my age, it is somewhat unrealistic to expect all my friends to join me whenever I feel like doing exercises. At my age, people are completely immersed in their own lives, hardly fitting exercise into their schedules, much less exercising with someone. At this age, my friends have college kids to support, mortgages to pay, marital issues to deal with, easy fatigue from work, medical issues etc. The last thing they want to do is probably hook up with their old friends at a certain time of day to play. Regularly. Schedules at this age are erratic and unpredictable. It is the tail end of my prime and I am too vulnerable to injuries if I keep pace with the elite young and too vulnerable to performing sub-optimally if I join the much older group. When exercising alone, I create my own pace, I do my own routine, I plan everything according to my needs. And I am fine with it.
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My PT colleagues often ask, “How do we keep patients complying one hundred percent with our recommended exercises?” That is probably the most asked question not only in PT field but also in general scheme of things. How do we encourage children to move and exercise more? How do we keep the adult population active? How do we eradicate this epidemic of obesity? How do we reduce health cost by changing lifestyle? The real issue here goes back to the previous blogs I have posted. People have become passive in their lifestyles because of a culture that assures them that all things can be solved by someone else. All they need is a good medical insurance and voila, they can have all the medical experts in the world, all medicines from pharmacies, all therapists and personal trainers and gyms and nutritionists and nurses and exercise gurus that sell DVD of the latest craze etcetera that can solve all the problems. Not. A PT may give you a home exercise program of three sets of this 2 times a day. After a week, that home exercise handout is just lying on a corner table gathering dust. We buy an expensive treadmill that becomes the proverbial ‘expensive towel rack, a space waster in our living rooms’. We all buy videos of some attractive exercise guru and after a week or two, we are starting to get attracted to another guru. Of course, attempting something is better than nothing but at the end of the day, the main driving force of life is the individual herself. Imposing an exercise program and luring her into the latest craze and fad via media and apps may work but the real motivator of all is the knowledge behind all the huffing and puffing. Education and self knowledge are the key. Which is better, to tell a person do this and that and soon you will become this and that instead of, ‘Let me tell you why we are doing this and that and you decide if it will work for you or not’. When a person asks me what is the best exercise to lose weight and be healthy I ask her back, ‘What is your idea about it?’ And we start from her own understanding and we build on that, again and again and again.
Lifestyle Change
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For the last couple of years I have been planning on resuming my half marathons but school and work virtually wiped all my free time.Then I was diagnosed with diabetes (something I expected due to family history). Then a family member got sick so I had to be a caregiver in my own home. The half-marathon training was placed at a standstill.
But my work as a Physical Therapist continues, albeit as per diem (after 20 years of full time). I work in an acute trauma hospital. I used to be the official ‘floater’, one who gets assigned anywhere there is a need for PT. Recently my daily work is focused on acute-rehab. Each of my patients is required up to 3 hours of rehab per day (with rest during sessions of course) and the main goal for them is home discharge with community/family support.
Every now and then I go out to acute. I have been an acute PT all my life. Two weeks ago I offered a few hours of PT work in a local nursing home close to my place to get acquainted with their software (casamba). Being a dual degree holder of PT and IT, I am very very interested with the latest apps and softwares being utilized in hospitals and PT-related facilities.
Because I am a lot older now in this business, I feel more inclined to frequently reflect on my job, my patients and myself. My empathy gets the better of me because most of my patients belong to my age now. And I am not far behind from the age-group of my nursing home patients either. There is no day when I am reminded how the patient I am treating now could be me. And lemme tell you, the outlook can be scary with the current healthcare system. Just let me give you this advice : Stay as healthy for as long as you can. It is no fun being old and debilitated and poor and alone during non-productive years.
I am a PT inclined to self-reflection. I check my patients’ labs and make a ‘mental’ data collection and correlation between them and their conditions. For example, if I have 5 patients with acute stroke on one particular day, I take a mental picture of what is common among them. High blood pressure? High sugar? Stress? Heart problems? Weight? Race? Gender? I am focused on stroke because it is one of my most dreaded medical conditions. I also have a family history of it and I know how much it can destroy quality of life in its aftermath.
So far, two significant conditions are prominent in my very unscientific sampling of stroke patients. High blood pressure and high blood sugar. The other thing that I find interesting too is this - a few of these patients stroked out on account of ‘missing’ their meds due to having no money to buy them. I wish all of them rely on the cheaper metformin and lisinopril and generic statin (which you can get free or at only a few dollars in any drugstore) but a lot of them have too many co-morbidities (other medical problems) that need meds as well. I have read ER admission lines that begins with, “The patient developed right-sided weakness, numbness and slurring of speech after missing to take his BP meds for three days”. Delving deeper, and in private conversations, the patient confesses with extreme embarrassment that, “I could not afford all my pills.”
Then I sit down and reflect on this. If this patient cannot afford a few dollars worth of medicine, how in the world can he afford healthy food, fitness gyms, nutritionist? We can create all these wonderful gadgets and apps but this particular patient in my list will have the remotest chance to avail them. And so, I sit down with this patient and talk.
Talking about healthy lifestyle with patients sometimes feels like talking to the choir. Sometimes I get dumbfounded reactions. Sometimes I see bored faces. Occasionally I see a face lighting up with new understanding.
But it is a good start.
I often wonder how Hippocrates and Florence Nightingale would react to the current healthcare system in the US. Yes, it can be highly advanced thanks to the billions spent for its research and development but what happens to its heart and soul?
It seems to me that being healthy today costs money. I conclude that because that is what I see everyday. Pay premiums to see a Doctor regularly, buy meds, healthy food will cost money, being fit may cost extra more in joining a gym and that precludes the training and diet programs guaranteed to work if you’d let the ‘experts’ manage your lifestyle for a fee (of course). Health Coach, Fitness Coach, Personal Trainer, Nutritionist, heck, even a personal Physical Therapist can be available to trim your body good for a fee.
And I certainly do not think all this is bad - if you have the resources please use all the experts to keep healthy. But the real question is : what happens to those who can’t afford any of these?
This is where the problem of present day health care system lies : the propagation of the belief that ‘someone can manage my health as long as I hire the right expert’. In other words, a lot of people believe that no matter how unhealthy they live, it is ok since there is a Doctor or a Specialist or a pill for that. Much like saying, ‘don’t worry about your problem, there is an app for that’.
Surprisingly, not all medical problems can be solved medically or surgically. In fact, most of the health related problems of the USA are lifestyle related and can be resolved through lifestyle changes. It goes without saying that a lot of our medical conditions are better treated behaviorally than medically.
Just look: type 2 diabetes, heart disease, certain cancers, kidney disease, depression, stroke, obesity - these top killers are reducible by lifestyle changes. And you don’t need thousands of dollars to manage those changes. Stop smoking, eat proper food, be active, avoid stress, increase rest, do you really need an expert to handle these?
All you need is discipline, resolve, courage and willingness to adapt and change. Yes. All of these involve behavior modification. And change of life perspective.
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