Tag Archives: health

Dance for Your Health!

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My friend posted an article with this title: “Neuroscientists Finally Revealed the Number One Exercise for Slowing Down the Aging Process.”  Well who wouldn’t click on that?  I admit, I did not think long enough to guess the exercise, but I somehow knew it would not be running or weight lifting.  Turns out, according to the article and the study it cites, it’s dancing.

“Of course it’s dancing!” I said to myself and commented on my friend’s page.  That makes so much sense.  It’s fast (or at least it can be), so you get your cardio.  It requires flexibility, erect posture, and excellent core stability and strength—all physical attributes of healthy aging.  Dance steps, taken in temporal and spatial order, require visual, auditory, and motor coordination, connecting all different parts of the brain at once, in concert and synchronization.  Moreover, I’m convinced that the simple rhythm of music resonates with something deeper in us, something transcendent, which must have anti-aging neuro-hormonal benefits!

In addition, dancing is usually done with others.  This social aspect of the activity cannot be underestimated, especially as we age.  I am convinced and have said many times on this blog and in life, it’s our relationships that kill us or save us.  And when we’re having fun dancing to songs and rhythms that move collective body and soul all at once, that has to be a good thing.

So basically, dancing activates key areas of the brain and body in an orchestrated fashion, igniting motion, joy, connection, exhilaration, sensory integration, creativity, passion, cardiovascular elasticity, and fun.  How could this not make us all younger?

The article, however, describes changes in the brain that occurred in 2 groups of elderly study participants, one randomized to dance classes with varying choreography, the other to training for strength, endurance, and flexibility. The primary measure of ‘anti-aging’ was measurement of the hippocampus area of the brain and its sub-regions.  Both groups had increases in volume in this area, but the dance group had increases in more sub-regions than the exercise group.  This is a far less exciting interpretation of ‘slowing down the aging process’ than my own instant and intuitive “a-HA” conclusions above.

It’s okay though, because I can choose to follow my own understanding while the scientists continue their quest for the neuroanatomic proof of what we all know through living.  Mine is the deduction that will resonate with people and help get my kids, friends, family, and patients moving (dancing!) toward more optimal and youthful health.

I learned from my trainer about the five factors that keep kids in sports; we agree they are the same five factors that keep adults in any exercise routine:

  1. It’s FUN. Who wants to do something three to five times a week that’s a total slog?  So we gotta find something we enjoy, that we look forward to doing.  Just this brings the exercise threshold to a low enough activation energy that anyone can do it.
  2. Our friends are doing it. I have not studied the social aspects of exercise and motivation, but I know this is a common experience.  We have more fun and work out harder, and time goes by faster when we’re with our friends.  Not to mention, the exercise becomes a bonding activity.  Here is one of many summaries of the benefits of workout buddies.
  3. We feel like we fit in. I used to think this was the same as #2.  But this is more about self-consciousness.  It’s distracting and kills motivation.  Maybe all you need is to buy the cute yoga clothes and hang out at the back of the class to feel like you fit in enough, while you fake it ‘til you make it.  Or maybe you need to go with your friend who’s been a hundred times, who can introduce you to her buddies, who will welcome you, and you will immediately feel like one of the tribe.  That acceptance fosters relaxation that allows you to engage with your full presence and then some.
  4. We feel competent. This one is key, I think.  If we walk into the gym with no idea how to use the equipment, or walk on the court feeling embarrassment about our poor skills, we are far less likely to return than if we can say to ourselves (quietly), “I’ got this, bring it.”  Competence prevents injury and breeds confidence, which fuels motivation, and then–
  5. We feel we can improve. We relish the challenge.  One more push up, pull up, half mile, weight bar; better form, faster pace, farther distance—when we feel inspired to reach, stretch, and expand our limits, we cannot wait to get back at it.  Can you not hear Gloria Estefan singing in your head right this moment??

So get your groove on, my friends.  Even if it doesn’t make you younger, it’ll make whatever time you have in this life a lot more fun and memorable!

 

Stability is Strength

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The holidays are coming.  People will be bustling up and down Michigan Avenue with large shopping bags and puffy coats, fuzzy hats and determined gait.  If someone knocked into you on the sidewalk, would you be stable enough to hold your space and not get pushed over?

I asked this to a friend today, a woman about my height and twenty pounds lighter, ‘bird-boned’ by her own description.  I swear, she looks like a feather to me.  We were talking about our habits, what seems to be changing as we approach menopause, and how we envision our best selves in old age.  I thought about the elder women in my family, who are all healthy in general, but not necessarily fit.  What if someone knocked into them this holiday season, would I be dealing with a hip fracture over Christmas?  The mortality rate for people over 65 in the year after a hip fracture is somewhere on the order of 25%.  My friend and I definitely do not envision this for ourselves.

So what needs to happen in order for me to stand my ground in the face of some external force?  I need a stable foundation, my feet in firm contact with the ground.  I need a low, massive center of gravity.  I need fast reflexes to contract and relax opposing muscles groups to bear the sudden and unexpected load.  I cannot be rigid and brittle; rather I must exert flexibility, to absorb enough force to move with it and away from it on my own terms.  I need to stand tall and face the force head on, with openness and grace, firmness and self-assurance, ready to assess instantly whether it was inadvertent or intentional, benign or malicious.  And then I need clear-minded judgment to determine how to respond to either condition.

This may come naturally and easily in our 20s.  Today, bum knee notwithstanding, I feel confident that I could meet such a force with appropriate strength and stability.  My friend and I agreed today on a shared vision: STRONG OLD LADIES.  We understand that this will not just happen because we will it; we need to fuel and train, rest and recover, and cultivate our mind-body connections, as well as our connections with others.  Small habits, sustained over time, positive or negative, will yield predictable results.  So the time is now to pay attention and establish some excellent patterns.

It occurs to me that this idea of stability and strength relates our physical to our mental and emotional well-being.  While Amy Cuddy’s research has recently been called into question, I still adhere to the idea that power posing and physical posture can enhance or diminish confidence and self-efficacy. Wide stance, low center of gravity, elongated spine, and open arms:  Stand strong, feel strong, think strong, speak and act strong.  I have practiced power posing before presentations since 2015 and I believe I am better for it.  And if it’s a placebo, I’ll take it—the benefits so far have outweighed the risks and costs.

Lastly, I think we can also apply this stability and strength awareness to our inner lives.  Here I refer to our integrity.  Our world changes ever faster, technology offering capabilities we had not dreamed even a decade ago.  It seems every interaction these days is shorter, more ‘efficient,’ less personal.  That is the default goal—low cost, high speed above all else.  Change is often good.  But we must also exercise judgment, and practice taking the long view, casting light from our core values onto a cautiously optimistic future, attending to and addressing the shadows.  We should gut-check, with ourselves and one another.  What are we really getting here?  How will we use it mindfully? How can it serve us, rather than us serving it?  When we are stable and strong in our shared humanity and collective goodwill, we arrive at the best answers to these questions.  Then we can all be stable and flexible, and stronger as we age together.

 

Just Do It My Butt

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Happy late Monday, all!

Continuing my critical analysis of our American medical system…  This is not what I set out to do on November 1, I swear, and I have other more interesting prompts to expound on after today, I promise.  For now, thank you for indulging me in this rant of sorts:

My friend posted this article today, explaining how most methods of trying to get people to take their medications do not work.  It cited this meta-analysis, which concluded that “Current methods of improving medication adherence for chronic health problems are mostly complex and not very effective, so that the full benefits of treatment cannot be realized.”  It also reviewed findings from another study, concluding that, “A compound intervention integrating wireless pill bottles, lottery-based incentives, and social support did not significantly improve medication adherence or vascular readmission outcomes for AMI [acute myocardial infarction—heart attack] survivors.”  The piece basically asserts that behavioral economics, or the art and science of ‘nudging,’ will not by itself heal what ails our behaviors, despite what Thaler and Sunstein suggest.

The discussion on my friend’s page then centered around ideas like motivational interviewing, coaching, and the like—methods that have been shown to improve likelihood of overcoming addiction, obesity, and other behavioral maladies.  It occurred to me that this is the best part of my work: asking the important questions to help patients identify meaning and intrinsic motivation for behavior change, and collaborating in such a way that they own the plan because they have an authentic hand in crafting it.   And even then it can take years for new, healthier habits to entrain, because we are complex beings each with myriad influences affecting our actions at any given time.  When I can sit and listen to what makes meaning for my patients (if they know—if they don’t then it can get really interesting or really not, it’s hit or miss), and talking about what the future might look and feel like with a few relevant changes, I bask in my professional heaven.

But who can actually do this in the modern American healthcare system??  It takes time, and as we all know, time is money.  It also takes training and resources.  We are not born knowing how to perform motivational interviewing and cognitive behavioral therapy, and even today, these skills are not necessarily mainstream medical school curriculum (well if we’re being honest, communication skills in general are still given short shrift, which boggles me).  Physicians can and do learn these skills. But they don’t necessarily have to.  Medical systems which include dieticians, exercise physiologists, and health psychologists can deploy these team members to support patients in their health journeys.  But does your doctor’s office have this kind of set up?  Does your insurance pay for these services?

Most likely the answer is no.  It’s shocking and dismaying, because this approach is proven to be successful in important ways.  I refer here to the Diabetes Prevention Program.  This study was published 15 years ago, on February 7, 2002, in the New England Journal of Medicine.  From the link, here is the study design summary:

“…Participants from 27 clinical centers around the United States were randomly divided into different treatment groups. The first group, called the lifestyle intervention group, received intensive training in diet, physical activity, and behavior modification. By eating less fat and fewer calories and exercising for a total of 150 minutes a week, they aimed to lose 7 percent of their body weight and maintain that loss.

“The second group took 850 mg of metformin twice a day. The third group received placebo pills instead of metformin. The metformin and placebo groups also received information about diet and exercise but no intensive motivational counseling.

“All 3,234 study participants were overweight and had prediabetes, which are well-known risk factors for the development of type 2 diabetes. In addition, 45 percent of the participants were from minority groups-African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander-at increased risk of developing diabetes.”

What do you think happened?

“Participants in the lifestyle intervention group-those receiving intensive individual counseling and motivational support on effective diet, exercise, and behavior modification-reduced their risk of developing diabetes by 58 percent. This finding was true across all participating ethnic groups and for both men and women. Lifestyle changes worked particularly well for participants aged 60 and older, reducing their risk by 71 percent. About 5 percent of the lifestyle intervention group developed diabetes each year during the study period, compared with 11 percent of those in the placebo group.

“Participants taking metformin reduced their risk of developing diabetes by 31 percent. Metformin was effective for both men and women, but it was least effective in people aged 45 and older. Metformin was most effective in people 25 to 44 years old and in those with a body mass index of 35 or higher, meaning they were at least 60 pounds overweight. About 7.8 percent of the metformin group developed diabetes each year during the study, compared with 11 percent of the group receiving the placebo.”

Lifestyle modification surpassed medication alone in preventing progression to overt diabetes in these high risk patients—almost double the benefit.  Well duh, you say, we all knew that.  We just need to eat less and move more.  But did these people ‘Just Do It?’  As if we can wake up one day and open a shiny new box of motivation that suddenly removes all of our circumstantial, emotional, and habitual barriers to optimal health?  No.  These patients were intensely supported by a dedicated, multidisciplinary team, day in and day out, for the long haul.  Every week patients reject my team’s offers to explore strategy for habit change, saying, “I know what I need to do, I just have to do it.”  Seriously, if it were that easy we’d all be doing it already (she screams as she pulls her hair out in knotted handfuls).

So, if this unequivocal study came out a decade and a half ago, why have we not implemented its procedure in primary care practices across the country?  I’ll wait while you think it over…

It’s money, of course, right?

It’s not that people in charge of healthcare spending don’t care about patients.  It’s that the financial returns of such an investment occur too far in the future to make for a good P&L calculation today.  Most insurance companies do not cover patients for the long run, so why should I expend all these resources to get you healthy today, so you can be healthy later and cost Medicare less many years from now?  The more I think about it, the more it makes sense to me to have a single payer system that can truly invest in our health, as a population of individuals, from birth to death.  And since habits and behaviors are established at very early stages of development, doesn’t it also make sense to have the medical/healthcare system integrated with the education system?  If we are a nation dedicated to the health and well-being of children so they can become healthy and well adults, why would we allow junk food in our schools and cut physical education?  What private, for-profit entity in its right capitalist mind would want to take that on?

Well, I trust you get my point.  It’s late and I have committed to writing every day this month, so I must stop here tonight.  Thank you again for your indulgence as I strode into the weeds on this one.

Hope to see you back tomorrow!