Your Strength Is Your Independence As You Age

Think about how hard activities can  become as you lose muscle. Activities such as getting up and out of a chair without using your arm strength, getting off the floor, walking up and down stairs while carrying objects, carrying in groceries from the store, maintenance of your home, lifting or holding a grandchild. These are concerns patients I have worked with bring to me. Things they would like to do but don’t have the strength to handle. 

My answer is building muscle, which we can do at any age. I have had people with heart disease in their 90’s working with weight machines. I start most with dumbbells or soup cans and build them up to exercises using their own body for resistance, then if able get them to the weight machines. The results are not always noticeable in the physique, but rather in the abilities to do perform activities of daily living. As we age we develop many orthopedic – bone and joint issues which limit ability to do traditional strengthening exercises – such as weight machines. Don’t let that stop you from performing strengthening exercises. There are many ways to work around the barriers. Find an ACSM certified exercise specialist in your community to assist you, or a physical therapist. Work these exercises into a daily routine, not just a quick fix for a particular issue. Stick with these exercises, if you have to stop, so be it but build them back into your routine as soon as possible. Your body will thank you!

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Maintaining Muscle

Your strength is your independence.

So often people will do some form of aerobic exercise, walking, biking, jogging etc., but will neglect muscle strengthening. Getting a couple of sets of dumbbells at home, some theraband, or doing exercises such as wall slides, push ups against a wall, step ups, yoga are all great ways to work on improving strength. When people become frail it is often due to severe muscle atrophy or wasting. You can build and improve strength at any age. The key is to begin light and continue to push yourself to do a little more. Start with soup cans if needed, to make your own leg weights three rolls of pennies equals one pound, put them in a sock and tie it around the ankle, do leg extensions, leg lifts to build leg strength.

 A key for heart patients with muscle building exercises is to EXHALE ON EXERTION.

Many will find they hold their breath or inhale when lifting a weight. It is the opposite, when lifting the weight blow out, this helps to keep the blood pressure from elevating dangerously high, and placing increased forces on the artery walls. You will find if you focus on the breathing technique you are able to lift more weights. It is crucial to maintain muscle mass to maintain independence, to be able to do activities of daily living such as carrying in groceries, taking out trash, moving furniture, lifting boxes, getting up off the floor etc.

Fitness as we age

It is important to work on physical fitness life long.

Physical fitness benefits include reduction of heart disease, reduction in Alzheimer’s and most importantly independence.  A recent study showed Finnish men who lost more than 15% of their cardiorespiratory fitness over a 10-year period faced a near doubling of their risk of acute MI over the subsequent decade and more than twice the risk of dying of any cause, a new study shows. But as we age fitness programs change. It isn’t realistic to ask the very elderly to jog, participate in spinning classes, hit the elliptical or rowing machine like those who are younger. The issues with mobility and frailty prevent such activities for most. So what does one do for fitness as they age?

Walking, stationary biking, water aerobics, swimming laps with a kick board, recumbent bike or  recumbent steppers are some of my favorite means of obtaining aerobic exercise. Also programs such as Sit and Be Fit. http://www.sitandbefit.org/   Any is exercise is better than no exercise. If exercise is done in a group or a class you also get the additional benefits of socialization. As we age socialization is vital. The more socially isolated a person becomes the worse the predictors for health. I found over the years many adhered to light continuous aerobic exercise because of the socialization of the classes more than the physical benefits of the exercise. New interns would come aboard and roll their eyes when they noted the workloads of many of the elderly, then I would point out the ages of many of my clients being in upper 80’s to mid 90’s and regularly attending classes 2-3 times per week, aerobically exercising, resistance training, stretching and socializing.

Resistance training is very important as we age as well as I am frequently promoting the following:

Your Strength is your Independence

This is what allows you to live in your own home, to care for yourself, to get up off the floor if you fall, to carry in the groceries.  It is your ability to cope with emergencies, to interact with the grandkids by walking up the bleachers, or across the soccer field, to lift up the two-year old, to get to their musicals across a long parking lot, to walk the hills at the nature center etc.

 

Here are a few simple strengthening exercise that most can perform. Wall squat

Wall Squats

With feet 8-12 inches apart and approximately 6 inches from the wall, slide down the wall a few inches. Hold this position as long as able. Push back up to standing. Repeat as many times as possible. Don’t go down to far, and if you fear not being able to stand all the way back up, keep a chair next to you for assistance. Breath out as you push back  up.

calf raises

Toe Raises

This exercise is surprisingly hard for many of the elderly to perform. Go up on tip toes and back down as many times as possible. To make harder try on a stair step or try doing on only one leg.

Wall push ups

Just like the old-fashioned push up but do against a wall. Breath out as you are pushing yourself back from the wall. Exhale on Exertion! I say this because many hold their breath which is hard on the heart and blood pressure.

Lateral leg exercises

These are really important for maintaining a good gait when we walk as we get older. Lying on side – do in bed – as easier than getting up from the floor. Lift leg out and back down. Do as many as possible.

Be a mentor, assist to make it happen

As most blog readers tend to be younger, pass this advice on to your elders, work out with them, purchase and arrange for transportation to fitness classes, make a big deal out of wanting them to stay fit and healthy to participate in life with you. We all need encouragement at times. Don’t assume being old means sitting in the recliner all day. Keep those in your live vital through physical activity. And have a great day!

Building the chest and back muscles after open heart surgery

Once you have your weight restrictions from bypass surgery lifted (and your physician’s permission)  it is time to build back the muscles you lost from surgery.

The muscles are weak from the limited lifting for the last 3 or more months. It is important to go slow and to balance the muscles. In previous posts I write about the importance of posture and stretching after open heart surgery to prevent or manage pain.  https://rehabilitateyourheart.wordpress.com/2012/05/21/stretching-your-upper-body-following-open-heart-surgery-12/

The muscles of the chest and back balance one another.

Muscles work like a pulley system, if one group is shortened the other is lengthened. By strengthening the chest muscles the opposing muscles of the back are lengthened. Therefore the back should be worked just as much as the chest to maintain a balance. A common issue is many only train their chest, neglecting the back and this sets the stage for shoulder, neck and back problems down the road. By strengthening both you create a balance to the muscles.

There are many ways one can work the muscles including free weights, dumbbells, resistive bands, or the bodies own resistance – such as push ups. . It is important to start out light. You may have had a 10-20 lb lifting restriction for some time. It is not graduated up but simply lifted.  Therefore don’t start with really heavy weights. Work your way up. Start with a few exercises, see how your body feels the next day. You shouldn’t experience days of pain from the first few workouts, you should be able to tell you worked the muscles but not be suffering.  Don’t overdo it!

Remember it is approximately one full year of healing following surgery.

The bone is knit together but to rebuild the strength, decrease the inflammation and allowing the nerves to heal it takes a full year.  Some precautions to note – if you feel any shifting, cracking or popping of the sternum stop. Try again in a month or two, or modify the movement to avoid the shifting. If you cannot move it without the shifting contact your surgeon.

Breathing with weight training is vital. 

Exhale on exertion. This means when you are pushing the weight away from your body breath out. When you are returning the weight to your body breath in. It is extremely important to your heart’s health not to hold your breath.  Holding your breath increases the blood pressure, strains the heart, and for some people can make them light-headed or pass out. Not good when you have weights in your hands to pass out!  This breathing technique should be used with all of your strenuous physical activities or lifting, pushing, or carrying.

The following images of exercises address the key muscle groups lost from open heart surgery. Start with a light weight – it may be 10 lbs in each hand or it might be 5 lbs, everyone is different but you will appreciate starting with light weights as we expect a little soreness initially. See what works for you. The initial goal is to do many repetitions, gradually build up the amount of weight over time. Try doing each exercise 10 times, if it is easy then next time add a little more weight. If it is difficult, try less weight next time. It is recommended you start with 10-15 repetitions of each exercise, and do it in 1-2 sets the first week or two. You can gradually add in more sets of the 10-15 repetitions. Don’t work the muscles every day, try for 2-3 times per week. The muscles need recovery time.

Chest muscles – note the elbows of the lady in the second picture, this is an example of good technique. Don’t let the elbows come lower than the shoulders as it puts a lot of stress on the the sternum and shoulders, and you don’t want to be hurting the next day. Breathe out as you lift the weight up. Don’t hold your breathe!

Shoulder muscles – note only lift the weights to 90* lifting higher than this tends to irritate the shoulders. Be aware to use your muscles not the swinging of your body for momentum. Lift the weight to a slow count of 1 -2, then lower it even slower a slow count of 1-2-3-4. Remember breath out as you lift the weight up.

These are standing fly’s, the knees are bent to support the lower back’s natural curves and prevent injury.                                                                                                                          

Back exercises – standing row. This works the muscles between the shoulder blades.  When doing exercises bent over remember to come back up gradually, as many heart patients experience dizziness when bent over. Again remember to BREATHE!  If you don’t have weights there are resistive bands that can be used. They can be found at your physical therapy centers, medical supply stores or fitness stores. They come in a variety of strengths, remember start light. Make sure you control the band or weight and that it doesn’t control you.                                                                                                                                                                                                                                                                                                               

Weight machines are good. Here is an example of working both the chest and the back. I love lat pull downs and seated rows. Typically I will have patients work these for 1-2 weeks before I introduce the chest press, as the back is far more neglected than the chest muscles in our day to day use.  Below are ways of doing the upper back using resistive bands.                                                                                                                                                                                                                                                                                   

I know some of you  are impatient about getting back to push ups. I generally start patients with push ups against a wall initially, gradually moving feet further back. When through the initial muscle soreness, have good breathing techniques then have them begin floor push ups.