A forensic pathologist tells us how to live to a good old age

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Adapted from Medscape August 31 2022 Would you like to live to a ripe old age? George D Lundberg MD

Do

Choose ancestors who did not die of natural causes in young adulthood or middle age (oophs…too late!)

Maintain a body mass index within the healthy range using a variety of tools

Maintain blood pressure within a normal range with or without medications

Maintain a low resting heart rate

Do eat whole grains including bran

Consume above ground leafy vegetables, some root vegetables, tree nuts, peanuts and berries

Ingest supplemental fibre such as psyllium husks

Ingest supplemental magnesium and possibly vitamins K2, C and D

Enjoy eating animal and vegetable fats including milk, cheese, meat, poultry, seafood, and eggs in moderation.

Eat two full meals a day

Do drink alcohol after 5pm

Sleep 6-8 hours a night

Walk up and downstairs and use handrails if necessary

Continue to be active physically, mentally, socially and sexually

Study and enjoy birds, bees, trees, plants, flowers and wildlife

Value your family life and participate actively while encouraging individuals to live their own lives

Read great books, fiction or non fiction a little every day

Actively engage in person or electronically with younger people

Stay informed about current world affairs and care about what you can change

Be passionate about culture such as performing and visual arts and sport

Recognise the value of spirituality and religion and feel free to live otherwise if you choose

Do your best to earn and retain as much money as needed to control your environment into old age

Take charge of your own health

Listen to your body

Maintain a long term relationship with a reliable and conservative primary care physician and certain specialists that fit the needs of older people.

Promote good vision in any way you can

Use hearing aids if you need them to retain brain function

See your dentist every 6 to 12 months and practice good oral hygiene. There is a strong correlation between the number of original teeth and length of life

Keep up to date with vaccinations

Maintain a safe distance and use mask if you may be around infective people

Take as few medications as necessary

Have as few diagnostic tests and surgical procedures as possible especially on the back and the knees

Use acupuncture and massage appropriately

Apply moisturising skin lotion especially after sun exposure

Use saline mist often to prevent nosebleeds

Walk at least 2 miles every day

If you can, swim every day

Practice yoga particularly the standing side bend, prone baby cobra, forward plank and windshield-wiper

Eat a protein rich diet and deliberately weight train or lift heavy objects to reduce sarcopenia

stand on one foot to improve balance

Use wearable exercise monitors if you find them useful

If you retire from work do some part time or volunteer jobs

Have something productive and fulfilling to do each day

Don’t

Inhale tobacco smoke

Consume sugar or sugar in anything in home cooked or restaurant meals, in soft drinks, fruit juices, pastries, desserts or processed foods

Use street drugs

Use natural or synthetic opioids except for short term relief of severe pain or the relief of pain from advanced cancer: then use all you need

Use sleep medication

Drink more than moderately or binge drink

Drive a vehicle after drinking or taking certain psychoactive drugs

Keep firearms in your home or workplace

Fret about things in your personal life or world affairs that you cannot change

Completely retire and have nothing useful to do

My comments: Dr Lundberg has a pretty long list of sensible suggestions. To these I would add, get some daily sunshine if you can and enjoy your pets. Have things to look forward to. Keep in touch with your friends and make contact with old ones who you value but don’t see often. Learn new things. What other suggestions do you have?

Sheri Colberg: exercise for living your best life as you age

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Adapted from BMJ 30 Oct 21: A study from the Mayo Clinic indicates that cardiorespiratory fitness tests were a better predictor of of survival in older people than blood lipids, diabetes, smoking and hypertension.

6,500 people aged 70 or over were tested on treadmills. The fittest showed the lowest mortality rates ten years on, and the burden of other risk factors made no difference at all.

Adapted from Diabetes in Control 10 August 21: Sheri Colberg says: Aging successfully takes a lot of work, If you don’t use it, you lose it. Physical fitness peaks around the age of 25 and then declines. Balance gets worse after the age of 40, bones get thinner, muscle bulk diminishes, and even with training maximal aerobic capacity declines. Your reflexes get slower and recovery from workouts takes longer.

The good news is that you can’t stop the aging process but you can slow it down to some extent. This means paying attention to regular physical training, nutrition, sleep and stress management.

Her advice is:

In addition to regular activities like walking, cycling, and swimming, add in some faster intervals to any workout such as walking faster for ten to sixty seconds at a time during your normal walk or doing a hill profile on a cardio training machine. This will improve your cardio respiratory fitness and improve insulin sensitivity for longer. It is fine to to high intensity interval training once a week, but if you don’t already do this you need to work up to it slowly. You should vary the intensity of your workouts to allow recovery and reduce the risk of injury.

Pick at least eight to ten resistance exercises that cover the major muscle groups in the upper, core and lower body and do them two or three days a week. You can use your own body weight, weights, kettlebells, resistance bands or water bottles. Improving muscle mass and strength is critical to being able to live independently through your lifespan.

Improve your balance by standing on one leg for a minute at a time. Make sure you can grab something if you feel unsteady. Once you can do this, make it harder by moving the raised leg in different directions. My comment: Wii Fit has a lot of balance exercises included. Ballet and Yoga also include balance exercises and Tai Chi is a good starting point.

High blood sugars take a particular toll on the flexibility of joints and tendons. Stretch two or three times a week. The worse your flexibility and the older you are the longer you should hold the stretch. Up to a minute with each stretch may be necessary. My comment: There are lots of You Tube videos on stretching. You may like to use rubber bands and yoga blocks or use props such as chairs.

Weight bearing exercises to reduce bone loss can be achieved by weight training, carrying shopping in both hands, and hopping up and down on one leg at a time, and by doing body weight exercises such as press ups.

It is very important that you can get off of a chair as you get older. Practice standing up from the sitting position without using your hands. You can enhance your strength by sitting against a wall with your knees at 90 degrees. My comment: I used to do this for two minutes at a time. I would suggest 30 seconds to start with.

Last, but not least, pelvic floor exercises. You pull in all the muscles around your urethra and anus and practice a combination of long holds and pulses. This improves continence.

Physical activity can improve cognitive function if you have type two diabetes

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Adapted from Diabetes in Control Aug 10 2021 by Macrina Ghali, Pharm D candidate, Florida.

Hyperglycaemia has been linked to reduced cognitive function and can impair life through impairing memory and language. Mistakes with medication are more likely. Some studies have shown that exercise can reduce the risk of dementia on the long term.

The meta-analysis sought to answer the question, does cognitive ability change from baseline, while on the exercise programme compared to the non-exercising controls? Just over 2,500 patients with diabetes were analysed, almost evenly split to control groups and exercise groups.

The exercise group did aerobic exercise, resistance exercise and non aerobic exercise. The control groups did monthly telephone calls, stretching, gentle movement and education. The interventions ranged in time from 12 months to 9.8 years and sample sizes ranged from 47 to over a thousand.

Standard tests such as the mini-mental state examination, mental state examination and global cognitive score were undertaken.

Surprisingly the study found that the greatest change in cognitive scores between both groups was in the studies done for 12 months rather than longer periods. They were not sure if this was due to patient drop out or the development of dementia. They think that more studies would need to be done to clarify the issue.

Meanwhile they think that physical activity programmes should be started soon after diagnosis of type two diabetes to prevent a worsening of cognitive functioning as time goes on.

Physical activity monitors have some role in increasing activity by 10 minutes a day

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Adapted from BMJ 29 Jan 2022

Like many other people I eventually bought a smart watch. I was a late adopter of this but after visiting my son in London, and seeing what a benefit it would be to scan in and out of the tube with a device, I got one just over a year ago. Many people had already been tracking their steps, heart rate and sleep schedules with these. So, are they of any use?

This was a systematic review which looked at 121 RCTs (so many!) covering 16,743 participants.

They found that there was a small but definite improvement in physical activity when people wore the trackers.

Physical activity increased by ten minutes a day. This was equivalent to 1,235 daily steps and works out at an additional 48.5 minutes a week.

To put this into context, I work out in different modalities for about this time every day, so it is like the equivalent of working out 8 days a week instead of 7.

Although this level of increased activity is unlikely to make much difference to your weight, what may do is a broadening of referral sources to the UK NHS online weight management programme. Community Pharmacists are now allowed to refer patients to the programme, instead of just GPs.

The course is 12 weeks long. You can join if you are in the obese category (BMI 30 or over), or if you are overweight (BMI 25 and over) and have hypertension, or type 2 diabetes. If you are of ethnic minority you can join if your BMI is 27.5 or over because you are more likely to develop type 2 diabetes.

Entrants to the scheme are currently 5 pounds heavier on average compared to pre-covid pandemic weights.

Oldies need to exercise more to improve their sleep


Adapted from BMJ 13 March 21

A randomised controlled trial in older adults with insomnia found that 12 weeks training in Tai Chi improved both subjective and objective measures of sleep quality. Although the effect size was modest it persisted for over two years.

Sleep quality also improved in groups that took part in brisk walking programmes and muscle strengthening exercises.

My comments: With consideration to my last post, about the importance of sociability in brain health, I do wonder if it is the exercise or the social factors that improve sleep.

Free You Tube sites to help you look and feel your best

The Times recently published a long list of exercise sites that you can get for free or pay for. Being a home exercise enthusiast I read this carefully and decided to try out the sites they listed as being FREE. These were my favourite ones. All had a variety of exercises eg low and high impact aerobics, walking, weights, rubber bands, stretching, relaxation and even dressing, hair and make up tips.

Top of the pops was Fabulous 50s. There are over a hundred workouts on this site. All are one to one, and set in beautiful Australia. This lady’s house is so clean, tidy, uncluttered that I was immediately pea green with envy. Of course, if I moved into her house, it wouldn’t stay that way for long. There is a fantastic range of exercises and from the ones I have tried, they were well produced and constructed, and even if you are a complete beginner, are pretty easily done. They range in time from 5 minutes to 30 minutes really giving you plenty of options no matter how hard pressed you are for time.

Mad fit, Lucy Wyndam-Read and Fitness Blender also are free and have multiple workouts in terms of types and durations. They seemed more tuned to the younger or fitter age group than Fabulous 50s and I have only done a few of them being 61 with some unfortunate back issues right now. They are not quite as beautifully produced as Fab 50s but they are free!

You will get adverts popping up during all these workouts. Now this is where you have to be careful because the marketing folks know who they are aiming at here and the top products seem to be wrinkle cream, make up and chocolate. It doesn’t matter how lucious it looks. Do not buy it. Because you will eat it.

Adriene is purely a yoga site. This is free too, and she sometimes has her dog with her. Again, there are a lot of different length and types of workout.

Now, if you have a smart phone, a tablet, a pc or a smart television, whatever your favourite form of home exercise is, and even if you only have five or ten minutes, you can workout for free at home.

CrossFit: exercise, diet and research

CrossFit is a website which you may enjoy visiting.

In one site you can find detailed exercise advice, often in the form of videos, for strength training, recipes, and research findings related to health and dietary composition.

There is information on the low carb diet, which is particularly helpful for those with diabetes, who wish to lose body fat, or who wish to reduce their cardiovascular risk.

Lectures by a wide variety of speakers are also included.

https://www.crossfit.com/essentials

Walking is a miracle cure

Adapted from BMJ  Sept 19 Promoting physical activity to patients by Christine Haseler et al.

The Academy of Medical Royal Colleges has described walking as a miracle cure. Despite this many of us are not as active as we should be and inactivity is thought to result in as many deaths as smoking. More than a quarter of UK adults do less than 30 minutes physical activity a week.

Quantified, these are the benefits of just plain walking:

30% lower all cause mortality, even 10 minutes a day is worthwhile.

20-30% lower risk of dementia.

Better relief from back pain than back exercises

30% lower risk of colon cancer

30% reduction in falls for older adults

22-83% reduction in osteoarthritis

even lower body fat than playing sports

20-35% lower risk of cardiovascular disease

20% lower risk of breast cancer

30-40% lower risk of metabolic syndrome or type two diabetes

 

 

The people who need to see their GP before undertaking exercise are few but include people with unstable angina, aortic stenosis or uncontrolled severe hypertension.

In pregnancy the sort of activities that need to stop are: impact activities, lying on the back for long periods, high altitude activities and underwater activities.

Sheri Colberg: Motivate yourself to exercise

From Diabetes in Control: Getting and Staying Motivated to Be Physically Active
Jan 4, 2020

Author: Sheri R. Colberg, PhD, FACSM

Every New Year all of the fitness clubs and gyms run specials to bring in new members, and they know—and even count on the fact that—most of those people will no longer be regularly attending classes or doing workouts by the time spring hits. How do you avoid becoming one of those exercise dropouts?
Even elite athletes have some days when they are not as motivated to exercise. You know those days—the ones when you have trouble putting on your exercise gear, let alone finishing your planned workout. For the sake of your blood glucose and your health, do not use one or two bad days as an excuse to discontinue an otherwise important and relevant exercise or training routine.
Here is a list of motivating behaviors and ideas for regular exercisers and anyone else who may not always feel motivated to work out:
Identify any barriers or obstacles keeping you from being active, such as the fear of getting low during exercise, and come up with ways to overcome them.
Get yourself an exercise buddy (or a dog that needs to be walked, you can borrow one!).
Use sticker charts or other motivational tools to track your progress.
Schedule structured exercise into your day on your calendar or to-do list.
Break your larger goals into smaller, realistic stepping stones (e.g., daily and weekly physical activity goals).
Reward yourself for meeting your goals with noncaloric treats or outings.
Plan to do physical activities that you enjoy as often as possible.
Wear a pedometer (at least occasionally) as a reminder to take more daily steps.  You can get free pedometer apps that turn your mobile into a pedometer.
Have a backup plan that includes alternative activities in case of inclement weather or other barriers to your planned exercise.
Distract yourself while you exercise by reading a book or magazine, watching TV, listening to music or a book on tape, or talking with a friend.
Simply move more all day long to maximize your unstructured activity time, and break up sitting with frequent activity breaks.
Do not start out exercising too intensely, or you may become discouraged or injured.
If you get out of your normal routine, and are having trouble getting restarted, take small steps in that direction.
As for other tricks that you can use, start with reminding yourself that regular exercise can lessen the potential effect of most of your cardiovascular risk factors, including elevated cholesterol levels, insulin resistance, obesity, and hypertension.

Even just walking regularly can lengthen your life, and if you keep your blood glucose better managed with the help of physical activity, you may be able to prevent or delay almost all the potential long-term health complications associated with diabetes.
From Colberg, Sheri R., Chapter 6, “Thinking and Acting Like an Athlete” in The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities. Champaign, IL: Human Kinetics, 2019.
Sheri R. Colberg, Ph.D., is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest edition of Diabetic Athlete’s Handbook), available through Human Kinetics (https://us.humankinetics.com/products/athlete-s-guide-to-diabetes-the), Amazon (https://amzn.to/2IkVpYx), Barnes & Noble, and elsewhere. She is also the author of Diabetes & Keeping Fit for Dummies. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 28 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).

 

Fitter, better, sooner

From BJGP May 2020 by Hilary Swales et al.

Having an operation is a major event in anyone’s life. There is a lot a patient can do to improve their physical and mental health before surgery that will improve their recovery and long term health.

Fitter, better, sooner is a toolkit was produced by the Royal College of Anaesthetists with input from GPs, surgeons and patients.

The toolkit has, an electronic leaflet, an explanatory animation and six operation specific leaflet for cataract surgery, hysteroscopy, cystoscopy, hernia, knee arthroscopy and total knee joint replacement.

These can be seen at: https://www.rcoa.ac.uk/patient-information/preparing-surgery-fitter-better-sooner

The colleges want more active participation with patients in planning for their care.

The most common complications after surgery include wound infection and chest infection. Poor cardiorespiratory fitness worsens post op complications. Even modest improvement in activity can improve chest and heart function to some extent.  Keeping alcohol intake low can improve wound healing. Stopping smoking is also important for almost all complications. Measures to reduce anaemia also reduce immediate and long term problems from surgery and also reduce the need for blood transfusion. Blood transfusion is associated with poorer outcomes particularly with cancer surgery. HbA1Cs over 8.5% or 65 mmol/mol causes more wound complications and infections.  Blood pressure needs to be controlled to reduce cardiovascular instability during the operation and cardiovascular and neurological events afterwards.

This toolkit is already being used in surgical pre-assessment clinics but access to the materials in GP practices will also help. After all, the GPs are the ones who are initially referring the patients for surgery, and improving participation early can only be helpful.

It is hoped that this initiative will result in patients having fewer complications, better outcomes from surgery but also from their improved lifestyle.