Journey to the Center of the Pendulum

Most of us don’t consciously want to hurt ourselves. However, by driving our bodies beyond what they can do or, conversely, by not challenging them at all, we are hurting ourselves. I’ve swung to both extremes of the exercise pendulum. I was an extreme exerciser for several years while losing weight and in the early years of maintenance. Body parts started falling apart and still I pushed myself because: A) I was afraid I’d gain all my weight back if I didn’t kill myself working out; B) I didn’t believe osteoarthritis was a big deal and I called myself a wimp (Yeah, that was real helpful.); and C) I was afraid of what all the pain meant. After knee surgery in 2010, I worked pretty hard to get myself back in shape, although not to the too-thin body I once had that hurt all the time. Things were going along pretty well until this past summer when my hip started to burn. I thought it was “just” sciatica and a tight IT band. Stretching helped. So did deep-tissue massage. And nothing beats a foam roller for working out the kinks in your glutes and those hard-to-reach muscles in the hip when you’re not in the presence of someone with a willing fist or elbow. I felt it most when I rode my bike (my favorite exercise in the whole world). Some days my hip would complain like a 7-year-old in the back seat: “Are we there yet? How many more miiiiiiles?” I’d stop a few times to dig my right butt cheek into the corner of a bench or the edge of a guard rail. Don’t think THAT didn’t get me a few strange looks from other bikers. But still I biked and sucked down Advil like Tic-Tacs and told myself it would go away. Then in December, my hip did more than complain. Standing up became difficult and I stopped exercising almost entirely, adopting George Carlin’s philosophy on exercise: “No pain, no pain.” But exercise keeps me sane and not exercising feels as natural as breathing through my ears. It was time to get my head out of my ass and address the problem. I went to the doctor in January and according to the x-rays, I have OA in both the sacroiliac and hip joints. She prescribed meloxicam (a prescription NSAID), and as much as I hate taking drugs, it’s made all the difference in how I move. Not a half hour after I took it the first time, I was on my elliptical working out with minimal pain. Of course, having gone to the extreme of no exercise for several weeks, my lungs and legs let me know they were not happy. Thank goodness muscles remember, though, and within three weeks I was back to 30 minutes of cardio and 20 to 30 minutes of strength training.In this journey to live in the middle of the exercise pendulum, I won’t push myself so far to get in shape and stay there. It’s about building what I can and maintaining what is complete. (This is true with weight, too, am I right?) And while my routine is not as intense as the routines of other people, it’s crucial that I stop comparing my abilities to what I could do in the past and to those who don’t have the same issues. Do I wish I could run like Sondra? Lift weights like Lori? Do lunges like Carla? Swim like Shelley? Box like Mari-Anne? Zumba like Kristin? Spin like Angie? Crush a Cathe Friedrich DVD workout like AJ? Absolutely! But I can’t and I won’t try and I’ve stopped wishing I could.

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Weight loss and walking help seniors | News Center | Wake Forest <b>...</b>

Jack Rejeski led the Cooperative Lifestyle Intervention Program (CLIP).

Walking more and losing weight can improve mobility as much as 20 percent in older, obese adults with poor cardiovascular health, according to a new Wake Forest study.

The results from the five-year study of 288 participants appear online Jan. 24 in the Archives of Internal Medicine.

The combination of weight loss and physical activity is what works best. These findings run counter to the commonly held belief that it is unhealthy for older adults to lose weight.

“To improve mobility, physical activity has to be coupled with weight loss,” said Jack Rejeski, Thurman D. Kitchin Professor of Health and Exercise Science.  “This is one of the first large studies to show that weight loss improves the functional health of older people with cardiovascular disease.”

The study addresses what to do to help seniors with poor mobility, but it also proves existing community agencies can be used effectively to get seniors the help they need.

“With 60 percent of adults over age 65 walking less than one mile per week and a rapidly growing population of older adults, the need for cost-effective community-based intervention programs to improve the mobility of seniors is critical,” said Rejeski, principal investigator for the Cooperative Lifestyle Intervention Program (CLIP).  Key co-investigators included Dr. David C. Goff and Walter T. Ambrosius from Wake Forest University School of Medicine; Peter Brubaker, professor of health and exercise science at Wake Forest; Lucille Bearon and Jacquelyn McClelland from North Carolina State University; and Michael Perri from the University of Florida.

“Community-based preventative programs are extremely important,” Rejeski said.

The researchers partnered with the North Carolina Cooperative Extension and trained health-care professionals at centers in three counties (Davidson, Forsyth and Guilford) to lead the programs along with an intervention team from Wake Forest.  The participants, ranging in age from 60 to 79, were tracked over an 18-month period.  The study divided participants into three groups:  a control group who received education on successful aging, a physical activity only group, and a physical activity and weight loss group.

The physical activity group did well, but the most dramatic effect was found in the participants who combined an increase in physical activity with weight loss.

On average, they improved their mobility by 5 percent as measured by the time it took them to walk 400 meters.  Those with the most limited mobility improved by as much as 20 percent.

The 400-meter walk is a widely used measure of mobility disability in older adults because for those who cannot walk this distance the likelihood of losing their independence increases dramatically.

Rejeski uses this analogy for the loss of mobility in seniors who often don’t realize its seriousness. “It is like being in a canoe paddling down a river and being completely unaware that a waterfall is only a short distance away. Once your canoe starts down the waterfall of disability, the consequences are severe.”

The waterfall is the cascade of adverse outcomes including hospitalizations, worsening disability, institutionalization, and death that are more likely when seniors lose the basic ability to get around.  Seniors with limited mobility require significantly more high-cost medical care.

“Clearly the ability to walk without assistance is a critical factor in an older person’s capacity to function independently in the community,” he said. “The next step is to develop a model that can be replicated at similar sites across the state and the country and we look forward to working with our colleagues from North Carolina to achieve this goal.”

The National Heart, Lung and Blood Institute was the primary source of funding for the CLIP study.

Rejeski is also one of the lead behavioral scientists on the national Lifestyle Interventions and Independence for Elders (LIFE) Study, a six-year project funded by the National Institutes of Health that is designed to determine the effects of physical activity and successful aging interventions on major mobility disability. He also serves on the intervention committee for the Look AHEAD Study, a 20-site trial funded by the National Institutes of Health that is evaluating the effects of weight loss on cardiovascular events in adults with Type 2 diabetes.  He is associate director of the Translational Science Center at Wake Forest.

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