Movement! Exercise! Weights! Health!

Over the last few weeks, I have noticed a few articles in various media about the general health benefits of weight training. All regular readers know I am a strong supporter (OK, advocate) of weight training for ALL adult age groups including my own and older.

The first I noticed was “How Your Muscles Affect Your Mental Health

Muscles at work secrete tiny chemical messengers called myokines that exert powerful effects on organ function, including brain function.

Early 2018 I wrote about the importance of mental health especially when managing chronic conditions. Now it seems with resistance (weight) training, we can kill two birds with one stone! Help ourselves physically and mentally at the same time. This is very encouraging.

I’m on the Pacing UP journey at the moment. My personal best on the leg press in 160 kgs (back in 2018). I did 90 kgs today, will do 100 kgs on Saturday. No, I may not get back to the 160 kgs, but it can’t hurt to try! Plus it makes me feel better!

I’m careful though. I’m asking the gym staff to put the 20 or 25 kg weights on the leg press for me as my wrists don’t like lifting those weights onto the leg press – at the moment. Don’t be afraid to ask for help.

Then The Guardian published “Exercise with weights linked to lower risk of early death, study says“.

Adults who reported meeting the aerobic activity guidelines and weightlifting at least one or two times every week were found to have a 41% to 47% lower risk of premature death.

While many chronically ill patients are younger than I, I am in the older demographic. While I LOVE lifting weights, I do find it challenging to encourage others my age to do so. Hopefully research such as the above will help! For the record, I do weight sessions three times a week, roughly 30 minutes each time. The weights don’t have to be huge! The above photo has small weights, ankle weights, a hand weight for walking with and a resistance Thera band.

JAMA recently published “Association of Dual Decline in Cognition and Gait Speed With Risk of Dementia in Older Adults

In this cohort study of 16 855 relatively healthy older people in Australia and the US, a dual decline in gait and cognitive function compared with nondecliners was significantly associated with increased risk of dementia. This risk was highest in those with both gait and memory decline.

No, the above article doesn’t look at weight training, but it is about movement and exercise and staying physically “on point” if we can. Something I am aiming for personally is to get back to my old walking pace of 6 kms per hour. Now, my GP kinda rolls her eyes at me given my total knee replacement, bi-lateral foot surgery, psoriatic arthritis and age. She could have left the age bit off, but she didn’t.

I’m just not quite there yet. I can do that pace, but not for long enough. Yet. Having goals is something to strive for though – while I accept I may not get back there, that doesn’t mean I should give up!

Exercise generally and the relationship to the onset of dementia is of course a big part of the study I am currently participating in. The study is still recruiting, so if you meet the criteria and are interested, contact them!

Retirement is working for me! Well, not being retired per se, but having the time to do more Movement As Medicine stuff WITHOUT draining my internal battery is working for me. I’ve upped my daily step goal to 7,500 every day. It was 5,500 on my weights and swimming days while I was working, 7,500 the other days. I’ve paced up.

I don’t always win!

I get told many of my audience see me as an inspiration. This is a lovely compliment and I really appreciate it. The recognition actually helps keep me motivated to keep doing movement as medicine to manage my own medical condition/(s).

Having said that, not everything goes according to plan. I think it is appropriate I share the dippy things I do as well as the things that go well!

Today was a dippy day. I had a plan for the day. Around 10 am have two sets of bloods done. For the curious among you, one set was for thyroid function as I recently started Thyroxine. Some years ago I swallowed radioactive iodine and as a consequence, sooner or later I was going to go hypoactive. I was lucky, I got a few years before that happened! The time has come. The second test was to meet the PBS regulatory requirements for the authority necessary to continue a biologic treatment for my psoriatic arthritis.

At 10:30 I had a GP appointment scheduled. Then my plan was off to the gym for weights. Saturday was weights, Sunday was swimming, yesterday (Monday) was an active rest day (walked 4 kms and hit goal of 7,500 steps). So back to weights today. Then I realised that was not a great plan as I was having blood tests – and that means no lifting heavy things afterwards. Hmmmm. OK, compromise, I’ll do just lower body stuff, I thought to myself. Yes, if you are wondering, I wear a mask when doing weights.

Warmed up on the treadmill. Did leg press, leg extensions, back extensions, hamstring curls, single leg push back. Couldn’t do the seated row, of course, or get on the rowing machine. Did not feel as if I’d done enough and wasn’t keen on getting back on the treadmill. Stationary bike? Nuh, not today. The elliptical machines were standing there looking rather unloved so I decided, not having been on an elliptical machine for WELL OVER 10 YEARS (and I was never a fan of them in the first place), I decided I’d just do five minutes to “top up” my workout.

At the 1 minute 30 second mark (this is me we are talking about, I time EVERYTHING for pacing purposes) my quads were telling me they were not at all impressed with this sudden change to their routine. At this point I thought, “OK, three minutes will do this time”.

At two minutes I hit the stop button. Of course, what has happened NOW is I have decided I must pace up on the elliptical machine, haven’t I? I have no desire to become an Olympic candidate by any means, I’ll be happy with five minutes!

After my recent experience with the screwing of 48 screws with a manual screwdriver, where I subsequently needed to resort to Prednisolone (brief, one day only needed – phew) and a wrist brace, I wasn’t about to overdo the elliptical machine (after a more than 10 year sabbatical). I’d learnt my lesson. Now, why I never applied the pacing logic to screwing things, I have no idea. I know better: excitement at building stuff overrode my thought processes! It happens! But really, *rolls eyes at self* I know full well my wrists are involved in my psoriatic arthritis. I have a special mouse, for that very reason!

I also fitted in my second ‘flu vaccine for the year – one of the joys of being immunosuppressed. Just thought I should finish on a positive note!

Never forget to pace.

Movement! Exercise! Mobility!

As we know I retired in order to concentrate on managing my psoriatic arthritis condition. The obvious question is “So how is it going?”

Very well, thank you for asking!

I thought a short update was in order. After all, while I do delve into other chronic illness related topics from time to time, this website IS primarily about #MovementIsMedicine. About pacing activity to maintain or, even better, improve our mobility and reduce pain and the incidence of flares. Avoid the boom/bust cycle so many chronic illness people are familiar with.

As I type it is 9:20 am. I have already walked a kilometre this morning. Yay me! Yesterday I hit the gym for weights – well, at my age and in my condition, resistance training would be a more accurate description. I am not going into the gym and lifting to failure, after all, so I feel a little guilty describing what I do as weight lifting. I am lifting weights though, just smaller ones than in my 40s!

To paint the picture, I had not been to the gym while the Covid-19 Reff was above 0.80. Saturday was my first day back for a while. Yesterday, Tuesday, was my second day. Saturday I took it gently, probably a step back from where I had been before the latest Covid-19 wave. I did the same with swimming on Sunday – a step back.

Tuesday I was pleasantly surprised to discover I had quite an easy improvement in my leg extensions. I increased my bicep curls by a kilogram with no trouble. Very good.

The best part was at the end, when I reached that point I recognised as “That’s enough for today” and stopped the timer. I’d done 27 minutes! Now, to healthy readers who wouldn’t dream of doing less that an hour, let me tell you for me that was a 5 minute improvement over Saturday. Also, please note I superset my workouts. That means I don’t do three sets of a specific exercise with a break in between sets. Supersetting is like this: a set of leg extensions, followed immediately by a set of chest press, then back to the leg extensions, rinse and repeat until the three sets of each are completed. I tend to combine things like lat pulldown and back extensions, tripcep pulldowns and the wood chop.

Benefits of supersetting are more weights done in less time, obviously. Moves the blood around the body by alternating upper body and lower body exercises. I also use the weight machines more than I used to in my pre-psoriatic arthritis days: I find I can keep my technique correct more easily than with free weights. I’m lifting to keep my body working, I don’t need to accidentally injure myself through poor technique.

I’ve set myself some retirement fitness goals:

  1. Weights sessions x 3 a week
  2. Swims/hydrotherapy x 2 a week
  3. Steps per day 7,500
  4. Increase speed to 6 kms per hour

The last one, increase speed, is related to preventing (or delaying) the onset of dementia. There have been studies that suggest slowing walking pace may be an indicator. I have slowed in recent years. I’ve also been participating in a Monash trial, Better Brains. More on this topic another day – just explaining why that goal is there! My GP rolls her eyes at me, given my ortho surgeries (and recovery times involved) and my arthritis – she thinks my pace currently is acceptable. I am not deterred!

I will still drop my step count on the days I do weights – it’s all about the pacing, folks, all about the pacing! No point in doing weights AND 7,500 steps today if I can’t do anything tomorrow.

As for more specific goals, as in swim how far, leg press of how many kilograms, etc: at this point I’m not fussed. as long as I see progress I’ll be happy. Essentially I’ll stick to the pacing principles of 10%, but I’m not going to rush it.

I am definitely seeing retiring was the right decision for my body and my health.

(Edited to correct the cited day! I had Wednesday instead of Tuesday).

chronic conditions care courage consistency coaching

Use It (Consistently), or Lose It

Modern medicines do many things. Some cure conditions. Many do not (yet) cure, but help in other ways: medications may slow disease progression or manage condition expression (e.g. control/reduce inflammation).

Medication alone is not a silver bullet – it often isn’t enough on its own to retain or regain functional movement and quality of life.

I’m going to share my own practical experience as an illustration. Shoulders are only the example here – the concept is the important bit. Interestingly I had a conversation with my eighty-something year old neighbour this morning who concurs! He told me he has FINALLY learnt to do his rehabilitation exercises religiously, every day. But Jack (not his real name) no longer works: this is where my consistency can suffer!

As per my earlier article, I Sat in My Car and I Cried, 2021 was a bad year for me. I went through a period where everything hurt. Consequently, as I was battling so many bits of my body, my shoulder care slipped. That’s on me, my fault.

My shoulders had first played up in 2016 and with the help of a great physiotherapist and lots of CONSISTENT exercises I’d rehabilitated them. With my usual swimming and weight training, the shoulders had stayed good without the need for specific exercises daily. However, during 2021 because the rest of my body went into meltdown, I was limited in my swimming and weight training. The shoulders progressively worsened to the point I had an ultrasound-guided steroid shot in each shoulder in late October 2021. There was at the time fluid in both shoulders. Not good. I should mention at this point the shoulders may not be exclusively psoriatic arthritis, there is likely some osteoarthritis going on in there too, plus the constant irritation of mouse and keyboard work. Yes, I have a fantastic vertical mouse, but that is more for the wrist than the shoulder. The right shoulder (mouse shoulder) is worse than the left.

It wasn’t until after my new medication started working in January 2022 that I was capable of being consistent with my exercises again. But how consistent was I being? As it turns out, not very.

The last couple of weeks are good examples. Saturday I head to the gym and yes, my shoulders hurt for the first couple of reps, but I do the usual upper body routine: lat pull-downs, chest press, seated row, bicep curls etc. By the time I leave the gym I have no shoulder pain. Movement Is Medicine (point 3 in that article). Sunday I head off to the hydrotherapy pool and do more gentle exercises, some involving the shoulders. As of last week I’ve added a few swimming laps (slowly increasing as shoulders toughen up). Monday, back to the gym, but less upper body work as I did the workout on Saturday. By Monday afternoon, my shoulders are singing!

Then comes Tuesday. My first work day of the week. I’m busy. I make sure I get my step count in. No gym today. My shoulders, feeling fine, do not remind me to do my rehab exercises and I slip. Bad me.

Wednesday I might feel a twinge or two when I get up and think to myself, “Robyn, make sure you do your exercises today, you know what happened last week!” Do I? Maybe, maybe not. Depends how exhausted I am at the end of the work day. Note to self: do them before breakfast, you idiot.

By Friday I’m back where I started, with sore shoulders. Again, I kick myself (figuratively speaking).

According to my myotherapist, I am pronating my shoulders. Not surprising as a desk jockey, we have to be so careful and it gets harder as we get older. To counteract the pronation, I bought myself a PostureMedic which I wear under my clothes, not over as shown on the marketing materials! Ran it past my myotherapist for his approval. I don’t wear it all the time, as while it encourages the wearer to hold their shoulders correctly, wearing it isn’t strengthening the muscles required to hold the shoulders in position naturally. I use it as a prevention tool as I first start work to help me develop/maintain correct sitting posture at the desk when I am deeply engrossed in work and can forget about my body.

If you have ever had your shoulders taped by a physiotherapist, it is a bit like that, but something you can put on and take off yourself without the issue of wet tape on your back after a shower!

My goal this week is to be CONSISTENT! To follow my own advice to other people! To do my exercises every day and not lose the gains I make over Saturday, Sunday, Monday.

Modern medications are fantastic, but they don’t do everything. Often, there is no way of medications repairing past damage, for example. If there were, I wouldn’t have needed a total knee replacement! I need to take the time and put in the effort to get my shoulder muscles working properly again. Yes, age is also a factor. In three months I will be three years away from three score and ten – what used to be considered the nominal span of a human life.

I hope by sharing my failures at being CONSISTENT I may have encouraged you to be more consistent than I have managed recently.

Movement IS Medicine.

(Mostly) No Pain is FANTASTIC!

A few of my recent articles have been quite serious, so it is time to celebrate progress! After starting my new medication on January 14, 2022 I am happy to report I’m functional again! Friday I started Week 7 of my new medication and I very pleased with progress. Let’s hope it keeps working!

Readers may recall my list of painful bits from I Sat in My Care and I Cried. It was a pretty long list.

What was painful?

  • Shoulders
  • Ankles
  • All Toes
  • Left hip
  • Elbows
  • Wrists
  • Most fingers
  • Hands
  • Knees (yes, even the operated knee felt swollen, but not painful, the right was painful)
  • Neck
  • TMJ (jaw joint)
  • Left Achilles Tendon
  • I also had some plantar fasciitis

Today I can happily report all of that list has resolved except the shoulders and the plantar fasciitis. While I was on Prednisolone and the new medication together, the shoulders and the plantar fasciitis were barely noticeable, but as I tapered off the Prednisolone both reappeared. The plantar fasciitis is minor, only noticeable when I first get out of bed in the morning and hopefully will continue to improve the longer I am on the new medication.

The shoulders I am not so sure about. At my age and with prior injuries, I suspect the root cause of the shoulders may not be psoriatic arthritis (although it is undoubtedly not helping). The right shoulder is the worst of the two and that is the shoulder that has in the past suffered a torn rotator cuff. I’m doing lots of remedial exercises which will hopefully improve the situation (I’ll admit to letting those lapse while I was battling everything else). It is time to focus.

Other than that it is great to be able to do all these things again, pain free:

  • Fasten my bra (shoulders are at least allowing that)
  • Hold my full coffee cup in one hand (wrists)
  • Get out of bed without mobility aids (crutches or walking stick)
  • Sit down and stand up without immense difficulty (quads & glutes weren’t firing)
  • Be able to clench my fists (no, I’m not planning on using my fists!)
  • Turn taps on and off without pain (fingers & wrists)
  • WALK!!!!! (mainly ankles, although right knee & left hip had spasmodically interrupted)

That is not an exhaustive list, of course, but hopefully sufficiently illustrative! Functionally, I am almost back to (my version of) normal. I’ve been to the gym and done some hydrotherapy.

The only downside seems to be lethargy. I am quite tired. This may be temporary and may be due to my body adjusting to the new medication, the (tapered) cessation of Prednisolone and quite simply normal life things such as work-related stress. In order to give my body the best chance I have negotiated with my employer to drop my working hours to 24 hours per week. Initially this is for a temporary period of six months and then we will reassess.

The tiredness could possibly be my thyroid firing back up, although based on my last ultrasound we doubt that. Even so, that fact I do have an unhealthy thyroid cannot be overlooked. I’m due for monitoring checks again in April. I was, I gather, a little unusual as a radioactive iodine recipient. Many patients’ thyroid function becomes hypoactive after the treatment but mine never (not yet anyway) did. Both hypoactive (underactive) and hyperactive (overactive) thyroid conditions can result in tiredness/lethargy. Mine, theoretically, could go either way!

I am very concerned about the lack of strength training I have done over recent months as retaining muscle strength really is very important with this and many other arthritic conditions. However, I can’t rush back, I need to pace up again. That is part of the reason for reducing my working hours.

The shoulders, particularly the right one, may be being exacerbated by typing and mouse use. This is something that will also be reduced by reducing my working hours. Of course my bank account is NOT going to like less income, but that is simply a fact of life for those of us with chronic conditions: we have to make our bodies a higher priority than our finances, otherwise we end up with no finances at all as we lose the ability to work.

Overall, pretty darn happy! Of course, there are no guarantees. I’ll just enjoy the improvements while I have them! This gives me space to concentrate on rehabilitating the grumpy shoulders. I’m seeing my myotherapist regularly at the moment to assist.

Concurrent objective is to rid myself of the weight gain from the Prednisolone – there’s always something!

If you are interested in the fascia of the body, this is a great video! This is related to my seeking myotherapy treatment at the moment. More on this another day.

We Need Personalised Numbers!

2,000 calories. 10,000 steps. These numbers float around and almost become related: subconsciously there can be a belief that if we do 10,000 steps a day we’ll be fine eating 2,000 calories a day! Will we?

2,000 calories a day is as much a myth as is the 10,000 steps a day. While there is always the caveat that the 2,000 is an average recommendation for the average person, etc etc, it is the 2,000 number that sticks in people’s minds.

Based on these rather wide, and self-reported, ranges, some pretty loose rounding happened, and the number 2,000 was settled on for a standard. In other words, not only was the calorie standard not derived based on prevalent scientific equations that estimate energy needs based on age, height, weight and physical activity levels, but the levels were not even validated to ensure that the self-reported ranges were actually accurate.

US News
From Samsung Health app

The 10,000 steps originally came from a marketing campaign.

The magic number “10,000” dates back to a marketing campaign conducted shortly before the start of the 1964 Tokyo Olympic Games. A company began selling a pedometer called the Manpo-kei: “man” meaning 10,000, “po” meaning steps and “kei” meaning meter. It was hugely successful and the number seems to have stuck.

BBC .
Garmin Connect app

Readers who know me on social media know I am very big on getting my movement every day. This website originated from my personal dedication to Movement IS Medicine. So am I against pedometers? Not at all, I highly recommend pedometers. Just forget about the 10,000 steps a day.

Let’s look at each of these aspects of our lives separately. First, the calorie conundrum.

2,000 Calories?

My favourite illustration is the car fuel tank versus the human body. My car’s fuel tank capacity is 60 litres. No matter how hard I try, I can’t put more than 60 litres of petrol in that tank. My body? Ohhhh, I can consume as much fuel as I like. I would just keep expanding to store it all!

I have several factors at play:

  • I’m over 65 – age reduces our basal metabolic rate
  • I’m short
  • I have a chronic condition which limits my fuel burn
  • I’m on medications – medications can affect metabolism.

It would take me an hour of weight lifting in the gym on top of my three walks a day and 7,500 total steps to burn slightly over 2,000 calories a day. My usual burn would be 1,800 on a good activity day. On that basis, if I consumed 2,000 calories a day I’d be storing 200 calories a day. A rule of thumb is one kilogram of fat on the body is 7,000 calories, so I’ll let you do the maths on that. Yes, I lift weights and I walk, but not at the intensity required to be building too much lean muscle with that extra 200 calories a day!

In the image above from my Samsung Health app 1,352 calories a day is recommended for me given my age, weight, height and gender. It doesn’t know about my medical conditions or my medications – if it did, it might recommend less! That is 648 calories less that the 2,000 number that gets thrown around with abandon.

My nutritionist recommended 1,400 a day for me, just for comparison.

Everyone is different and we need to tailor our intake for our particular circumstances and output (burn). We also need to be very careful about what we eat as we have less calories to “fit in” the needed nutrients. For example, I aim for 1.5 grams of protein per kilo of body weight per day. The extra protein chews into my calorie allowance.

Those of us with chronic conditions that have a boom/bust aspect do not have the luxury of “burning it off tomorrow” either. We can’t “do extra” or we end up with a flat battery. It is all interwoven.

10,000 Steps?

I aim for 7,500 personally, at this time. A pedometer is a good way of measuring how much we are moving. It is not the number itself that is critical, it is the consistency. Not moving leads to de-conditioning which is not what we want as it has negative impacts on our bodies.

de-conditioning

A pedometer is also useful when it comes to calculating our pacing up. It is an indication of what we have done and therefore helps us calculate what our 10% increase target is. It doesn’t matter if the number is 2,000, 3,000 or 8,000. It is the relatively and consistency that matters.

I talk about steps as part of my movement regime because it is what I and many other people use. There are, of course, also many chronic condition patients who use other movement modalities. The underlying premise remains the same.

Tracking and Recording

I track and record because let’s face it, even healthy people forget they had a muffin at morning tea. Add cognitive impairment on top of that and it is easy to forget what we ate during the day. I’d be hopeless if I didn’t keep track. With only 1,400 calories to play with, I need to make sure I don’t accidentally eat 2,000!

The same with activity/movement. It is easy to think we moved more than we have and over time we find we’ve paced down unintentionally instead of UP. Our pain levels may increase as a result of less movement and more weight. Not what we want at all.

Personalised numbers are needed. Know our BMR, know our limits, work out our personal parameters and targets based on our individual circumstances and bodies: age, gender, height, weight, medications, conditions.

Are You Moving Less While Working From Home?

Working from home is with many of us, perhaps for longer that we may have initially envisaged. It is very important for all of us, but most especially those with arthritic and other chronic conditions where movement is beneficial, to ensure we don’t fall into the trap of becoming more sedentary! Most of us working from home are sedentary enough already, bound to our desks and laptops as we tend to be.

The good aspect is we now have the opportunity to put the commuting time to better use – we just have to make sure that IS what we do!

I am now balancing being back in an accounting role with my medical need to keep movement levels up plus the continuation of post-surgery knee rehabilitation exercises. What have I learnt already? I let my rehab exercises slip a couple of days, I ate at my desk twice and one morning I sat for WAY too long without getting up! Not good. For some inexplicable reason I found myself drinking more coffee and less water, so I’m being more aware of that now.

My daily physical activity commitments currently are:

  • 40 to 45 minutes of formal walking
  • achieve a total of 7,500 steps a day (limited due to post-surgery)
  • 40 minutes of rehab exercises

Swimming and weight training aren’t in the list as the gyms and pools are still closed in Melbourne due to Covid-19.

There is the need to avoid that dreaded boom/bust cycle and pace all of the above accordingly with working hours. These are not necessarily considerations for people without underlying health conditions: even so, worth bearing in mind!

Although the rehab routine is not tiring, the walking can be; especially if one has worked all day. Fatigue IS a symptom many of us live with. Mine is now minimal (thank you risankizumab), but I remember the days when I suffered quite badly from the fatigue. So rest time is important, it has to be part of the routine we establish.

I’m still at the stage of developing a daily routine. Finding what works for me. For a WFH day, I eat breakfast, walk for 25 minutes, then get ready for work (do my hair, pop on the lippy etc – all those video meetings!). Watch out for those back-to-back meeting days! The sitting time can easily extend to three hours. If you don’t have a sit/stand desk (mine is arriving soon!) this can be a trap. Watch your calendar: suggest different times for meetings if you have too many one after the other. Remember to take regular breaks from your desk.

Make sure to take a lunch break. This is important: move your body, stretch, sit in a different chair, break the mental exertion too. Do not eat at your desk.

I’m still working out the best time to do my rehab routine. If I do it in the morning, I need to get up earlier. If I do it after work, I’m becoming fatigued and I still have another 15 to 20 minutes walking to do. I’m thinking lunchtime might actually work best and will try that this coming week. The second walk is important because the one thing we lose while WFH is incidental exercise. No campus to walk around, no walking to and from the car park or tram stop. Those activities all add to our step count for the day. But we do have that extra time from the commute we no longer do, as mentioned earlier. It is finding the right balance.

Catching up on activity on the weekend is usually not an option for those with chronic conditions. Catching up just initiates a boom/bust event and none of us need that. So consistency is our friend. It is finding the right routine for each individual that is critical. What works, what doesn’t work?

Consistency is our friend

Weather can also throw all our plans completely out the window. I walk in the rain and in the cold – I can’t manage the heat. The heat intolerance that came with the hyperactive thyroid does seem to be finally abating: I found it much less troublesome last summer. I hope that persists! For others, the cold could be an issue. Weather is not related to WFH specifically, but working does mean we have less flexibility to juggle our physical activities around the weather.

Walking in the Rain

On days I physically go into the office (few and far between) I know I will get more incidental steps walking around the campus, to and from the car park, etc, therefore I don’t worry about a second formal walk on those days as long as I hit the 7,500 step count.

It is important to keep moving, get outdoors (mask up!) and not become glued to our desk and laptop. And on that note, I am now going to move, because it is Saturday and writing this is enough sitting for today!

An Announcement

I have made the decision to no longer offer personal training services. I will still write and share chronic condition experience, research and information. I am available to participate in applicable research projects and very open to speaking engagements.

I’ve made this decision slowly over the last 12 months. The primary factor that drove my decision was my responsibility to clients. Personal trainers are required to maintain current first aid and CPR certifications. The last time I did my CPR certification I struggled maintaining the position required due to my knees and my back. Now I’ve had a total knee replacement kneeling is challenging (not impossible, just challenging).

I don’t want to paint a bad picture – my operated knee is fantastic and my back rarely bothers me except for certain positions, giving CPR being one of them. I am well aware that were I struggling to maintain a CPR rhythm due to my physical limitations, that could be disastrous.

In addition, recently I have found my physical strength is not what it used to be. Partly this is due to the limited strength training I have been doing myself, partly it is due to the simple fact I’m not getting any younger. I find loading a 20 kilogram weight onto the leg press a challenge and as a working personal trainer I should be able to do that for clients.

While I am a firm advocate of Movement is Medicine and exercise has done absolute wonders for me and my condition, I don’t feel I am strong enough myself to provide the level of service to which I aspire!

It is spring, the blossoms are out, time for new opportunities!

Keep MOVING! I will be!

Glute Bridges on the Dining Table

Finding new ways to do things in our #StayAtHome world is a must!

Situation

  • Bung knee (click for details)
  • Due to above, can’t get up off the floor!
  • Gyms are all closed
  • Live in an apartment (no space for gym benches)
  • Need to keep glutes activated (part of good knee support)

When I was able to go to the gym, I would ask one of the trainers to haul me up off the floor after my floor exercises. Now that is not possible.

Solution

While I probably could use a strategically placed chair to help myself get up off the floor, I have found a much easier solution. Use my dining table as a gym bench. The bed isn’t firm enough. Also works for sit-ups.

I can get on the dining table quite easily using a chair as a step up. Much easier to get down off the table than up off the floor!

Glute Bridges

As the name suggests, this exercise is to activate, tone, strengthen your glutes. Glutes are the muscles in your posterior. Maximus, medius, minimus. The minimus is under the medius.

Image Credit: Visible Body

Once you are safely perched on your dining table, place your legs as shown and lift your butt by squeezing your glutes. Keep your spine neutral. Hold for a count of 5, lower. Repeat.

Due to both my knee and the fact I was trying to take a photo at the same time as execution, my butt isn’t as far off the table as it could be!

Progressions (making it harder):

  • Move one leg further away from the body
  • Lift one leg off the surface altogether (this is not me at this time!)

Move one leg further away from the body

Getting On and Off the Table

  • Place a dining chair roughly where you would before sitting
  • Lean butt against/on edge of table, hold onto the back of the chair
  • Lift one foot onto chair, followed by other foot
  • Wiggle back on table.
  • To get off, reverse the above.

I’d film it if I could, but that’s a bit difficult to do by myself.

Of course, if you can do these on the floor, GO YOU!

My Personal Weight Management Under #StayAtHome

Yesterday I tweeted:

I did not expect the reaction! I promised to write in more detail what I am doing to achieve this, so here it is. I want to stress this is what works for me, given my current circumstances. It is really intended for people of similar age and in similarly physically challenging circumstances. While the #StayAtHome situation is common to most of us, of course the knee issue is an added complication. Unlike my recent short videos, this will be a long read, so buckle in folks!

Situation Summary

I have been in self-isolation since March 1. The gyms closed, the pools closed. I am a weight training person: suddenly I couldn’t even do upper body or hydrotherapy. The knee is preventing any lower body weights work or walking. I am also nearly 65. We all know as we get older it becomes harder to manage our weight than when we were 25.

I was terrified of gaining weight and making my knee pain worse. Due to several changes of medications and predisolone off and on over the period in question, I had gained a few kilos during late 2018/early 2019. I have been very successful in reversing that trend, especially once my clinical drug trial got underway, with the suggestion and support of my endocrinologist to adopt the philosophies of Dr Michael Mosley. I’d never known it was considered safe to eat 800 calories a day. I do now! Before you stop reading in horror, I’m not eating 800 calories a day now! But it is a damn good kick start to get you going and I do still apply the macro principles espoused by Dr Mosley.

Comfort Eating

Several responses to the above tweet raised the issue of comfort eating. This is an issue that is exacerbated by isolation, anxiety (e.g. about the current health crisis of Covid19) and boredom among other drivers. A chronic illness patient I know once said to me she stopped comfort eating when she realised she was “eating her pain” – and she didn’t just mean physical pain, she meant emotional pain as well. Once she had that epiphany she was able to stop. She looked for and found other ways to deal with her pain.

I find boredom can be an issue for me, especially when I can’t go to the gym or swim and I am locked away. For me, the recording (discussed below) helps immensely. I can see what I’m eating instantly.

I have no great solution for comfort eating, I am sorry, as it is a bit out of my field of expertise. I would suggest perhaps consulting a psychologist if it is impacting your weight management efforts. Mental health is a critical factor and if you have a chronic illness, in Australia you are entitled to a Mental Health Care Plan. Use it.

Understand Your BMR

Before we even look at food, my recommendation to anyone on a weight management journey is to understand your Basal Metabolic Rate (BMR). This is the number of calories your body burns being alive. Nothing else, just being alive. Our BMR drops as we age. This calculator at MyDr.com.au is the one I use: http://tools.mydr.com.au/tools/basal-energy-calculator

Pop in your details at various ages and you will see the BMR drop. Of course this is a average. If, like me, you are an avid weights person you will have more lean muscle mass and your BMR will be higher. Conversely, you may be on medications that actually reduce your BMR as a side effect. Even so, as a place to start, it is a good indication.

If you do no exercise and you eat more than your BMR, you will gain weight. There is more to it than that if we want to delve into the science, but for our purposes, it is that simple, really. Note well: exercise in this context includes NEAT!

Be very aware though, your current weight may drive your BMR reading up. If your BMR says 2,000 calories a day, you don’t want to be eating that if weight loss is your goal. Try putting your target weight into the calculator – work from that.

Net Calories

If I am exercising in my normal manner, I live by net calories. My calorie target for the day plus what I “earn” exercising less what I eat. When I cannot exercise “properly” as is the current case, I aim for less than my BMR. At the moment I aim for 1,200 calories a day or less, with the odd 800 calorie day thrown in for good measure.

When I fill up my car the fuel tank capacity limits how much I can put in. Unless the car burns the fuel, no more will fit. Humans are not limited in the same way – if we don’t burn it, we just expand to make room (store the fuel).

Record, Record, Record

I cannot stress strongly enough to record your food intake. If you are anything like me, you forget that snack you had at 10 am. Or you don’t realise that SMALL muffin you grabbed en route home from the pharmacy was actually 530 calories! I use My Fitness Pal, there is Cronometer and various other apps out there. Find one that you like.

Recording means measuring. Get food scales. Measure.

Dietary Protein

My next tip is to look at your dietary protein. Are you eating enough protein? From talking to people I suggest many, especially older people living alone, are not eating enough protein. Without enough protein we can feel hungry and snack (usually on carb heavy stuff) unnecessarily.

My interest in dietary protein came about from my own experience. I noticed my protein levels had dropped when I reviewed my My Fitness Pal recording at one stage back in 2017. I was also in more pain from my psoriatic arthritis, although I wasn’t thinking of a causal link. I upped my protein for general health reasons and suddenly my pain levels dropped. Hmmmm, I thought. At the physiotherapist, I picked his brains, “Are you aware of any research around dietary protein and pain levels?”. No, he wasn’t aware of any so I came home and researched. This is one of the articles I found, which I rather like as it is succinct in stating the findings.

Effects of inflammation and/or inactivity on the need for dietary protein

Remember too that a 100 gram steak is NOT 100 grams of protein. It is about (depending on cut, quality, etc) 23 grams of protein. Know your protein sources.

Serving Sizes

All food packets have a recommended serving size. These are guidelines, not mandatory rules. Most bread packets have a serving size of two slices. I do not need two slices of bread under my omelette (see main photo above), I won’t burn that extra fuel.

My favourite high fibre muesli has a serving size of 45 grams. I have 35 grams with 160 grams of high protein yoghurt. I don’t miss the 10 grams, but over a week it adds up to less calories.

Adjust serving sizes to suit your circumstances. When I’m able to lift weights again, I’ll go back to 45 grams of muesli!

Ease of Preparation

Some people love cooking, others do not. Other people have physical challenges around standing chopping up vegetables, for example. Some of us have days where our medical conditions flare. Living alone can result in wastage as fresh vegetables go off before we use them. How I deal with this is frozen vegetables. No, I don’t find them particularly wonderfully cordon bleu – but they serve a purpose. Prepped, pre-measured, 2.5 minutes in the microwave. Here is one instance where I double the serve – as each bag contains two standard serves.

Another variety with chicken.

I’ve found this frozen spinach great for omelettes!

Two blocks of this (about 50 grams) with two eggs. I microwave it per the first half of the instructions, drain and pop in my non-stick pan for a minute or so, pour beaten eggs over. Cook. Greens and protein in one simple meal.

I stick to fresh salad vegetables such as lettuce, cucumber, mushrooms and tomato. They are easier to buy in “as needed” quantities. Of course, as I am in isolation and receiving grocery deliveries, that is more difficult. Another benefit to frozen vegetables at the moment as I’m not dependent on deliveries to have vegetables.

Meal Replacement

Eating the increased amount of protein as discussed above and keeping calories down can be a challenge. I was also told by a friend (I have NOT substantiated this) that in some cultures older people eat very little late in the day, but it makes sense, especially when there are reduced levels of activity.

I have been replacing most evening meals with a protein shake. This brand was recommended to me by a work colleague who is a amateur marathon runner. I chose this product.

I’ve tried various meal replacement shakes and work out protein shakes over the years, but I really do like this one as it is virtually all protein and suits my particular needs well at this time. Once I’m back in the gym, I’ll change to one of their “work out” formulated products and probably not use it as a meal replacement but as a work out supplement.

The cost is $2.13 a serve, which is cheaper than a steak! I buy the large container because it is cheaper per kilo and is delivery free.

Carbohydrates

You will notice not one photo of potatoes or rice. I am a very low carb, healthy fats, high protein eater. I do eat fresh fruit: bananas, peaches, apricots, apples, grapefruit, plums, mandarins. While sugar is the bane of my existence, as it is in everything, fruit has other health benefits. I do limit my intake to two pieces of fruit maximum a day.

Did you know there is 11 grams of sugar in a cup of milk? Anything low fat is often high/added sugar. I tend to triple check the sugar content of anything that is labelled “low fat”. The version that isn’t low fat may actually be better for you.

I found a great low carb, high protein bread that is really nice, highly recommend!

Watch out for “hidden” carbohydrates. This label is a classic example.

Knowing the calorie value of each macro (fats X 9, carbs and protein X 4) my mental arithmetic could not see where the 337 calories was coming from. See the red arrow? Yes, glycerol. 4.32 calories per gram. A whopping 14.3 grams! In the USA it is required it be included in the total carbohydrates. Not in Australia, it seems. Read labels, be aware of possible hidden stuff you don’t want.

Emergencies

Have healthy food you can prepare with no effort if necessary. This prevents grabbing something carb/sugar heavy. I keep four of these in the freezer for flare days. I like these ones, but everyone’s tastes are different. Find ones you like that you can have on hand for emergencies. These two are usually on special for $4.00 each, other varieties may be dearer.

I also have tinned salmon which requires no preparation or cooking. Never run out of eggs!

Treats

Yes, treats. Gotta have treats! At nearly 65 and not aiming to appear on the cover of Vogue anytime soon, I’m not going to be a martyr.

At the moment I am alternating between two treats I allow myself, ONE treat a day.

20 grams of this:

or 67 grams of this:

The 20 grams of chocolate is basically 50% sugar – not really a good choice, I’m eating 2 teaspoons of sugar. But we have to cut ourselves a little slack!

The ice cream (comes in chocolate too) is a much healthier choice as you can see from the label. This is a serving (on a bread and butter plate).

If I am out going to the doctor or the pharmacy I may well indulge in a skinny flat white and a sweet treat – but that would be once a week at the most. More likely once a month under our current #StayAtHome rules and doctors doing telehealth!

One-liners

  • Drink plenty of water – helps you feel full
  • Watch how many coffees you have – can be 50 calories an instant coffee (4 grams raw sugar)
  • Get enough sleep (lack of sleep affects cortisol levels)
  • Eat breakfast
  • Eat slowly (mindful eating is a thing)
  • Eat ice cream with a teaspoon
  • Use smaller plates, the meals I have pictured here are on my entree plates
  • No or at least very minimal alcohol – empty calories
  • No soft drinks (unless used as a small treat)

In Conclusion

I’m reiterating: this current regime of mine is for a particular set of circumstances: minimal activity, isolation, age, pending replacement knee surgery (so very important I not gain weight), pain management requires weight management.

This is certainly not how I eat when I am weight training three or four times a week and swimming two or three times a week. It would not be how I would eat if I was 25.

Some of my weight loss this last month will have been muscle, which concerns me, but there is little I can do about that at the moment.

ALWAYS check with your health care professional for your specific circumstances!

Please ask questions in the comments, as anything you are wondering about may be a question other readers have as well.