Catch yourself

Practical advice, planning ahead

I want to do something in this column I haven’t done before and that is share a conversation between myself and Dr. John Thompson (@thefalldoc on Instagram and on YouTube).

John’s perspective is sensible, informed, and direct - attributes I appreciate in any professional.

Here we go:

First, how do you like to be addressed? John or Dr. Thompson? Tell us about your background and how you became interested in work with older clients? You have what seem to me to be fairly unique, even surprising, opinions. I wonder if you can speak to each.

John is fine.

I began working with older adults as a personal trainer in 2012, then graduated with my Doctorate in Physical Therapy from MGH (in Boston, MA) in 2018. After a few years working with young healthy athletes, I transitioned to doing homecare. Now I primarily work with older adults, generally 60+, all of whom were just discharged from the hospital and need to regain their strength. I quickly realized a few things with this patient population: falls are extremely common, almost everyone sits down in their recliner way too much which only accelerates weakness, and even the ones who do exercise often don't focus on the correct things to improve longevity, get stronger, decrease fall risk, etc. Over the years, I've continued to be shocked by how many of these patients fall and the numbers back it up: 14 million adults over the age of 65 fall each year in the US alone, 3 million plus ER visits related to these falls, 1 million hospitalizations…the list goes on. I truly believe that so many of these falls could be stopped by the most minimal, consistent amount of exercise.

You say “Walking isn’t enough.” Many older women, myself included, walk as much as they can for fitness. It is accessible, something we all know how to do without training, and easy to integrate into our days. Why is lots of walking not enough?

This topic gets more debate on my social media feeds than almost anything else. Here's my take: walking is great, and something everyone must do. BUT, it's not improving leg strength compared to doing specific exercises that do improve leg strength and here's why. To make a muscle stronger, we need to challenge that muscle against an appropriate resistance through a range of motion. (Think about if you want to get a bigger bicep: you need to do a bicep curl! Everyone knows that). So when we walk there are two main problems. Number one, your knee and thus your quad muscle (front of your thigh), doesn't bend enough to get challenged. Look how much your knee bends when getting off the toilet and how much it bends while walking. Very different. Number two, walking can be done for thousands of reps. You generally can't get stronger from something that is performed for thousands of reps. I see countless patients who tell me how much they walk, yet still fall and break a hip and are shocked this happened. So keep walking, but add in some simple strength training and your fitness program will become more well rounded and you'll decrease your chances of a future fall.

John, you also say, “Don’t go to the gym.” This was a surprise. Most of us feel that if we don’t do formal exercise classes or belong to a gym, we can never be as fit or able as we should be. And of course, because gyms and classes are expensive, sometimes hard to get to, or not something we have done before in our lives, don’t do it, and feel like failures. Can a person be as fit as required for an independent life with only home exercises?

There's nothing wrong with the gym, and I'll always encourage the gym if someone can get there consistently and is able to focus on the correct exercises. However, from what I've seen over the last 15 years working with clients, most adults over 60 (the ones who aren't already lifelong gym goers) are either intimidated by the gym, don't have the time for the gym, or go to the gym and waste time doing the wrong things because they don't know what they should be doing. And the gym has unlimited options, so how do you decide what to do!? If someone isn't already strength training, it doesn't make sense to spend time doing the elliptical, bike, etc-yet most people don't think that way. Strength training needs to be the priority, especially for women, who are at a higher risk for osteoporosis, falls, and hip fractures. The only weight that most people need as resistance is their own bodyweight, which doesn't require a trip to the gym. So when I say, "don't go to the gym," I'm trying to be realistic and improve the average adult's chances of engaging in year round, consistent exercise, that can be repeated for a lifetime.

I really appreciate your simple, direct and no nonsense way of addressing these issues. My mother had to leave her much loved home to go into assisted living because she was a fall risk, and died there because of a fall, once said to me “3-4 people in here are here because of falls.” All of us and her doctor were careful to monitor her meds and her tests, but no one, not once, helped her deal with her fall risk. The chair yoga program in her facility didn’t either. So, I feel your work is very important.

Two last questions for you.

Social media is full of getting up off the floor videos. You know some incredibly fit younger person doing the cross-legged sit-to-stand without any hands. Like most of my peers, I used to do this easily years ago but can’t now. However once kneeling I can get up hands-free no problem, but finding moving from a sit to my knees impossible. That said I can do a fast and strong sit to stand by rotating, using with one hand. This is true for a lot of us. Question. How important is it sit to stand from the floor hands-free?

If you can get up from the kneeling position hands free, that's what counts. First, it means that you will be able to get up if you do happen to fall and you won't be stuck on the ground somewhere, alone. And second, from my experience, someone who can efficiently get up from the kneeling position without needing to use their hands also has the requisite leg strength to get up from any chair/toilet, negotiate stairs safely, and is far away from losing their independence and ending up in a nursing home. Most people have a good idea if they can do this, and if they don't have an idea it's usually not a good sign because it means they haven't been on the ground in a long time! The good thing is that just like anything when it comes to fitness and aging, this is something that can be improved with practice and strength training.

Overwhelm is huge in the fitness space. I feel sometimes like I am carrying around hundreds of recommended exercises in my head and doing few of them. Can you, or are you planning, to provide a simple checklist of exercises that we can all do everyday to increase chances of living independently as we age? That would be so helpful.

Here's the 3 exercise at home checklist/workout I recommend:

1. Sit to stand from a chair.

2. Get up and down off the ground.

3. Go up and down the stairs.

These can be completed as a circuit one after the other, or broken up and done throughout the day. Get creative and find different ways to get off the ground. Sometimes take the stairs one step at a time and sometimes take them two steps at a time. Here's the key. This seems simple, but just doing 10 sit to stands every day is 3,500 over the course of the year and 35,000 over the next decade. And it takes 15 seconds per day. It's not what you do in any one workout, class, or day but what you can accumulate and stick with over the years.

John this is great! Thank you for this,

Barbara