Broken Hips: Preventing A Fall Can Save Your Life. December 01, 2014 3:36 AM LAUREN SILVERMAN NPR Repost
Last October, Jeanette Mariani was an independent 87-year-old, living alone in Dallas and getting around with a walker. Then one night she switched off the light and tried to make her way into bed. A chair was in the way. And she fell.
"There I was, lying on the floor," she recalled. "I pulled down one of my pillows. I didn't reach very high, just pulled it down, put my head down on it and thought: 'Well, I'll wait until morning.' "
The next day, she called for help.
Jeanette Mariani landed in a Dallas rehabilitation facility after she fell and broke her hip last October. She died a month after leaving the hospital.
A fall from a chair or a bed may not seem like a death sentence — but for an older person it can be. Falls are the leading cause of death from an injury for older Americans. For women, it's especially bad: Three quarters of those with hip fractures are women. For many, the broken hip starts a chain reaction — usually because older people also suffer from underlying conditions such as diabetes, arthritis, hypertension or dementia.
Every moment counts after a fall, says Dr. Amy Moss, an assistant professor of geriatrics at the University of North Texas Health Science Center in Fort Worth. When you're bedridden or hospitalized, your odds of developing everything from bed sores to pneumonia increase dramatically.
Studies show that delaying surgery after a fracture for just 24 hours increases the chance of complications and death. "The most common scenario is they die of pneumonia after a hip fracture," Moss says.
After spending the night on the floor, Jeannette Mariani called her daughter Janet, who took her to the hospital.
"After her fall, I knew that she was going to decline," Janet said. "You had that sixth sense, you know."
That sixth sense is backed up by real numbers. Almost 1 out of 10 people over the age of 50 will die within a month of surgery for a broken hip. That rises to 1 in 5 if the patient already has an acute medical problem.
Jeanette worked hard in rehab to become stronger, but underlying health problems caught up with her. Previous lung problems got worse, and her lymphoma returned.
"After she left the hospital, she died within a month," Janet said.
“The greatest predictor of a future fall is a previous fall.
- Chris Ray
More than 90 percent of hip fractures are caused by falls. But falls can be prevented. Common-sense steps like removing rugs, installing better lighting, and getting an updated prescription for your glasses are a good start. So is addressing the physical and psychological side to falls. It might sound silly, but it turns out that people who are afraid of falling are actually more likely to fall.
Nine years ago, Joyce Powell was in hospital, on her way to the bathroom, when she fell and broke her hip. She recovered, but she hasn't gotten over the fear of falling.
"It stays with you," says Powell, who is 80 and lives in Arlington, Texas. "You're aware that you can't function like you once did."
That's why Powell attends a fall-prevention class at the University of Texas, Arlington — not just to get stronger but also to face her demons. Participants are in their 70s, 80s and 90s, and their workouts involve everything from balancing on exercise balls to playing Wii games.
"The greatest predictor of a future fall is a previous fall," says Chris Ray, director of the Center for Healthy Living and Longevity at UT-Arlington.
The greatest risk for older people who've fallen is that they'll simply stop exercising, Ray says.
One of the keys to preventing a fall is improving balance. As we age, Ray says, natural changes make it hard to stay upright: changes in hearing, vision and proprioception, what you feel in your hands and toes. If seniors can learn to use these senses better, they will be less likely to fall.
To help them learn, Ray tests them using something that looks like a photo booth at an amusement park. The machine assesses how well someone can use the senses to maintain balance. The walls shift, the screen changes, and the floor tilts.
"In daily life, when we see seniors who fall, it's usually during multitasking," Ray explains. "We pipe in loud noises, city sound or music, pipe in visual distractors on the screen or a test on the screen, as they're trying to maintain their postural control while the walls are moving in concert."
The goal, Ray explains, is to identify the best intervention for each individual. For some, a regimen of tai chi might be enough. For others, it might be weightlifting or even practicing walking with their eyes closed.
For Joyce Powell, the exercise classes have made her more confident in getting around and traveling. Still, she's cautious. "When I walk, I look to see where I am, particularly if I'm on uneven ground," she says.
Freedom from falls is never guaranteed. But dedication to an exercise program can help seniors keep their balance without giving up the activities they love.
"It's one of the things I've learned you just have to do in order to protect yourself to remain upright," Powell says. "I guess I could use a walker to do it, but I don't want to. I want to be free."
Walking is a simple thing that becomes really, really important as we age. Being able to get around on our feet for extended periods of time not only makes everyday life easier, it'slinked to fewer hospitalizations and greater longevity. As we get older, though, the body takes about 15 to 20 percent more energy to cover the same terrain.
And that can be a problem, says Justus Ortega, a kinesiologist at Humboldt State University in Arcata, Calif. "If people have more fatigue, they have less desire to participate" in walking, he tells Shots.
It's easy to see how this becomes a downward spiral of feeling too tired while walking, then not walking and getting even more out of shape.
Here's something that can prevent that slide: running. Older people who regularly ran for exercise had "walking economy" similar to much younger people, according to a study by Ortega and colleagues at Humboldt State and the University of Colorado, Boulder.
The study, published Thursday in PLOS ONE, took 15 men and 15 women with an average age of 69 who were already consistent runners or walkers. Participants walked on special treadmills at three different speeds and had their oxygen consumption and carbon dioxide production measured during their sessions.
"If your car is using more gas to get down the road, you check to see if your brakes are rubbing, or if there's anything mechanical that might explain what we're seeing," explains Justus.
It's not 100 percent clear that's what's going on here. Another possible factor is muscle co-activation: older adults tend to use more muscles to perform the same movement than do younger people, perhaps to stabilize the joints. It's quite possible that runners, who are used to spending more time on one foot, use fewer muscles to perform a given movement than the walkers. That might contribute to their lower use of energy, says Justus.
So the next step, he says is to analyze their data to see how muscle co-activation might be a factor. Other future experiments might look at other activities that are also more aerobically intense than regular walking, such as cycling or even very fast walking, to see if they might offer some protection.
It's really important to mention that this research can't prove that running actually caused the better walking economy. Study subjects were already doing their preferred form of exercise before they entered the study, and it's possible that the runners had greater walking efficiency for some other reason.
And by no means should this turn anyone off walking, says Ortega. "The health and social benefits you reap from walking are enormous," he says. But older folks who run may be getting a leg up on at least one element of walking performance
Repost from NASM :Trainer Q&A: Can caffeine really boost sports performance? Posted on November 8, 2014 by National Academy of Sports Medicine
Can caffeine really boost sports performance?Posted on November 8, 2014 by National Academy of Sports Medicine
A: Yes. Research shows that caffeine is ergogenic—it targets the brain and nervous system to resist fatigue during a workout. The key is using it correctly and not overdoing it, which can lead to jitters, anxiety, a racing heart, and trouble sleeping at night.
The performance benefits max out at 3 milligrams of caffeine per kilogram (2.2 pounds) of body weight. That means a 150-pound person could have around 200 milligrams of caffeine before or during activity to postpone fatigue. (That’s about the amount in a 16-ounce coffee from a cafe, or two small cups of homemade, regular-strength coffee or tea.) Not everyone responds the same way, so test lesser amounts first.
Also factor in any earlier intake. Caffeine peaks in the bloodstream in 10 to 30 minutes, then is reduced by half within four hours (also keep in mind that it’s a mild diuretic). If you had a morning coffee, you may only need a little bit to get a boost without side effects.
Expert: Jennifer Ketterly, MS, RD, CSSD, LD, is the director of sports nutrition at the University of Georgia. She played varsity basketball at Cornell University as an undergraduate.
NASM’s The Training Edge, Nov/Dec 2014
- See more at: http://blog.nasm.org/nutrition/trainer-qa-can-caffeine-really-boost-sports-performance/#sthash.GJcQKYbq.dpuf
Diving Deeper into the Squat: Common Misconceptions Posted on October 23, 2014 by National Academy of Sports Medicine
By Fabio Comana, MA, MS, NASM-CPT, CES, PES, NASM Faculty
To this day, we still hear certain squat rules echoed over and over throughout gyms and health clubs by many fitness professionals that often sound contradictory. While some rules emerged through research, the origins of others may lie in folklore and myth. The squat is one such example where we hear an endless list of cues: keep the knees behind the toes, align your knees over your second toe, open your stance, keep your head up, and many more. Which do we trust as evidence-based and which present as more myth than fact?
Furthermore, when we watch a fitness professional squat, we oftentimes notice that many are incapable of squatting correctly on account of inadequate levels of mobility or stability throughout their kinetic chain (e.g., ankle mobility), they fail to follow their own rules and resort to compensated movement (dyskinesis), or need to update their knowledge and understanding of proper form given some updated research on human movement.
With that said, let’s examine some of these common squat rules:
Although many variations of the squat exist, some truths will always prevail – maintain your knee/foot alignment, ensure hinging and timing of forward knee translation, facilitate adequate ankle mobility to avoid dysfunction, maintain a rigid pelvis (sacrum, thoracic spine and head) and aim to achieve parallel alignment between your tibia and trunk. With proper form, the likelihood of a repetitive-type injury reduces and performance improves.