TODAY’S DOSE OF HONESTY

My fitness Rx for your 40s, 50s, 60s, and 70s!

Now that I’m in Month 5 of my 6-month fitness and wellness experiment with trainer Korey Rowe, I’ve fully realized how important this process has been, not just for me but for YOU too. Not a day goes by—literally—when I do not hear from dozens of you, of all ages, about how you want to start your own 6-month experiment but don’t know how. Many of your questions are tagged to your age...so, fitness-by-age/decade is on the AJenda for this week!

Before we dive into each decade, let me start with a few caveats.

• ONE: These are just broad suggestions, based on my 20 years of experience as a practicing physician and on my 55 years living on this planet. That said, I am not a professional trainer, so please consult one or try to follow someone with good credentials. At the beginning and end of the day, you are your own “n of 1,” as we say in science. Whether it’s where you’re starting from or where you want to get to, it’s you and ONLY you who matters.

• TWO: There are always special circumstances and/or pre-existing health conditions that need to be taken into account re: your workouts. You may have chronic knee issues or restrictions from a past injury or accident. Or maybe you work nights, or have to care for an older adult during the day. You do YOU. 

• THREE: Age, as the saying goes, is just a number. My 55-year-old brother just finished the New York City Marathon this past weekend with a time of 3:36:24—faster than many people half his age. Truly, anything is possible—so let’s go!

Your 40s: Give it all you got!

Think of this decade as elite training for menopause! Everything and anything you do in your 40s will literally pay dividends in your 50s. You want to be building lots of muscle mass, fine-tuning your eating and sleeping habits, and keeping serious track of your alcohol intake. 

When it comes to optimal fitness, this decade is not just about one type of exercise—you need it ALL. This means lifting weights; low-intensity, long-duration cardio; high-intensity interval training (HIIT); and flexibility and stability work. The American Council on Exercise (ACE) recommends incorporating compound movements into your routine; these are exercises that activate several muscle groups at once, such as squats, pushups, dips, lunges, and others. These help to build that muscle mass we begin losing around age 35—about 3% to 8% per decade! Strive to work out 6 days a week for an hour each day. Rest one day a week, even if you don’t feel you need it.

Your 50s: The menopause transition.

These years can really throw a monkey wrench into the best-laid fitness routine. The monkeys are NOT insurmountable, though. The game changer: weight training (yes, again). If you focus purely on cardio to burn calories and don’t lift weights, you’ll miss out on a key opportunity to lay a strong foundation for your 60s, and you will likely not feel or look your best. In your 50s, it’s not just your estrogen that plummets, but your testosterone too, which can leave you feeling weak and sapped of energy as well as contribute to the midsection weight gain that’s almost universal. Muscle mass is a strong predictor of longevity. Yet muscle loss—also known as sarcopenia—affects more than 45% of older adults in the U.S.

So, your fitness in your 50s MUST be holistic. This means a week’s workout schedule should look something like this:

• 2 days of “pure” cardio for 45-60 minutes at moderate to vigorous intensity. One of these days could be walking on a treadmill incline of 9-10% at an easy pace of 3 mph (aka Zone 2-3 cardio), while the other day could be alternating walking for 2 minutes with sprinting for 30 seconds for a total of 30 minutes, building up to 45 minutes.

• 4 days of resistance training aka lifting weights; the weights should be as heavy as you can manage. This does NOT mean lifting a number so light that you can do 15+ reps. If you can do that many reps, you need to increase the weight. 

• 1 of these 4 days: Do yoga, Pilates, Barre class, etc., that works on balance and flexibility while building strength. Start to incorporate jumping into your exercises; it’s important not just for stimulating bone density, but to develop balance that will protect against falling. (More on this later.)

Your 60s: Muscle-&-bone up!

If you have prioritized being thin up to this point, there’s a good chance you may have osteopenia (reduced bone density) or even osteoporosis—bone loss. More than 80% of U.S. adults with osteoporosis are women, and the incidence of the disease increases from 12.6% of women in their 50s to over 27% of those in their 60s. So, it is now CRITICAL that you eat enough protein and lift weights often enough to put power on your frame and strength in your muscles and movements. (Bonus: Your skin will look better over more muscle than less.) You should still work out 6 days a week; remember to do both cardio (sprints and endurance) AND weightlifting.

Your 70s: Never say “never!”

I cannot emphasize this enough: Even if you’ve never lifted weights and feel slightly intimidated around this part of a gym, it’s not too late to get at it! In fact, studies have shown that older women (and men) CAN build muscle mass with a combination of resistance training and a high-protein diet—and it doesn’t take that long to do it either!

In this decade, if you are of normal weight or slightly underweight, your goal should be to gain 5 pounds of muscle through diet and exercise. If you are slightly overweight, the goal should still be to build muscle, but your week should be divided between a range of exercises that address strength, cardio, balance, flexibility, and agility. Jumping exercises are key too, to protect against injury if you fall. Falls are common, costly, and ironically, mostly preventable. Anyone of any age can fall, of course, but falls are the leading cause of injury, and a major precursor to frailty and even death, for adults aged 65 and older; over 14 million—that’s 1 in 4—older adults report falling every year.

As always, I recommend you check in with your doctor first before starting a regular exercise routine. If you get the green light, don’t delay! Take advantage of programs for older adults, for women specifically, or that are otherwise age-appropriate. The personal attention of a trainer creates accountability and allows for a more customized program that caters directly to your specific needs. It’s a bit more expensive, but aren’t a strong body and a healthy life worth the cost?

So, your dose of honesty for today: Age is NOT an excuse. Whatever your “number,” the sooner you start making your body strong for the long haul, the better!

SYMPTOM SOLUTIONS

Protect these joints from causing low back pain.

These would be the sacroiliac joints in the lower back, and, boy, do I know them well! Pain in these joints seems to show up without warning: You can feel fine, then sacroiliac pain hits and just stops you in your tracks. And unfortunately, SI joint pain tends to show up—or get worse—during the menopause transition. I asked our Core Expert, orthopedic surgeon Dr. Andrew Pearle, to explain what causes this miserable pain and what we can do about it.

Located in the lower back, the sacroiliac (SI) joints connect the sacrum—the triangular bone near the bottom of the spine—and the ilium, one of the three hip bones at the uppermost point of the pelvis. Two SI joints on either side of the sacrum connect to the left and right iliac bones. The SI joints act as shock absorbers; they have limited motion, but they play an important role in providing stability to the pelvis and spine.

Pain in these joints can be caused by many factors. SI pain can appear after pregnancy and childbirth and is generally thought to be caused by the increased ligament laxity that allows the pelvis to expand for childbirth. Chronic SI injury can occur with trauma such as after a fall or accident, or from repetitive stress and overuse, as in gymnastics. In some cases, the pain has been associated with inflammatory disorders such as ankylosing spondylitis, rheumatoid arthritis, and even degenerative conditions. Finally, poor posture and ergonomic factors have also been associated with SI pain.

To get adequate treatment for this pain, proper evaluation and diagnosis are essential. I often see lumbar spine facet-mediated pain (another common cause of low back pain) misdiagnosed as SI joint pain, so make sure that you get a proper workup, which may require imaging tests to help pinpoint the problem.

The mainstay of treatment for SI pain is targeted physical therapy to strengthen and stabilize the muscles around the joint(s), such as the core, glutes, and pelvic floor muscles, which helps reduce strain around the joint. Additional therapies include stretching of the hamstrings, hip flexors, and lower back muscles to reduce tightness around the SI joint. Injections are another option but are used rather sparingly. Surgery is an absolute last resort for this condition. Again, before starting any type of therapy or treatment, make sure the cause of your pain has been accurately diagnosed.

The best way to prevent SI pain is by maintaining good core stability and glute/hip strength. Proper posture and body mechanics, particularly when lifting weights or playing sports, are essential. Neuromuscular training, which is also essential for ACL injury prevention, helps to build good body mechanics and body control during sports activities. Regular stretching of the hip flexors, hamstrings, glutes, and lower back muscles can help maintain flexibility around the SI joint. Maintaining a healthy weight and avoiding excessive high-impact exercises also helps unload our joints and prevent pain.

OUR CORE EXPERT

Andrew D. Pearle, M.D., is Chief of the Sports Medicine Institute at the Hospital for Special Surgery and professor of orthopedic surgery at Weill Cornell Medical College; he is also a team physician for the New York Mets. In 2007, Dr. Pearle performed the first robotic partial knee replacement in the New York region and is the world’s leading expert in the use of robotic technology for partial and total knee replacement. Dr. Pearle is passionate about prevention of ACL injuries, particularly in high school athletes; he helped form the National ACL Injury Coalition. @dr.andrewpearle

COMMUNITY

“How do I fall asleep and
STAY asleep?”

I’ll be honest: This is a problem I’ve rarely experienced in my life. Early in my medical career, when we had to work 12-hour shifts and longer, my colleagues coveted my ability to fall asleep just about anywhere and wake up refreshed and ready for more work. It’s truly a gift!

But I hear you, and I know it’s maddening. Nighttime wakeups are the hallmark of insomnia, which can be triggered by a number of factors (sometimes all working in unison to keep you awake), such as what you eat or drink, or activity you did/didn’t do during the day or near bedtime. Insomnia is often brought on or made worse by stress. And—surprise!—the hot flashes of menopause can make falling back to sleep seem impossible. To help you sleep through the night, try these tips, some of which are from my best-selling book, The Self-Care Solution. Buy it here!

• Create a soothing bedtime routine. Drink a cup of decaf tea, take a warm bath, or listen to relaxing music. Don’t use electronic devices with screens, such as laptops, tablets, smartphones, or e-books, for an extended time just before bed. The blue light from these screens can disrupt sleep.

• Relax your body. Gentle stretching or muscle relaxation exercises can ease tension and help tight muscles to loosen up.

• Make your bedroom an optimal sleep environment. Keep light, noise, and temperature at comfortable levels so they won't mess up your rest. And limit bedroom activities to sleep and sex, which will help your body understand that the room is for sleeping.

• Keep clocks in your bedroom out of sight. Clock-watching is stressful and makes it harder to go back to sleep if you wake up during the night.

• Don’t have caffeine after noon, and limit alcohol to 1 drink at least four hours before bedtime. Caffeine and alcohol can both disturb sleep.

• Don’t smoke. It’s a major health risk anyway, but nicotine use can also disrupt sleep.

• Get regular physical activity and exercise. Not too close to bedtime, though; it may make falling and staying asleep difficult.

• Go to bed only when you’re sleepy. If you aren’t sleepy at bedtime, do something relaxing that will help you wind down.

• Wake up at the same time every day. Even if you’ve had a restless night, resist the urge to sleep in.

• Avoid daytime napping. Napping can throw off your sleep cycle.

• If you wake up and can’t fall back to sleep within 20 minutes or so, get out of bed. Go to another room and read or engage in other quiet activities until you feel sleepy.

You’ll notice that sleeping pills are not on the list above. Here’s the problem as I see it: What you can buy without a prescription rarely offers effective or long-term help for this problem. As for Rx sleep aids: Prescription drugs are safe and effective as a temporary fix. But long-term, they can cause more harm than good, and what’s sneaky is that you probably won’t realize it’s happening.

Some drugs prescribed for sleep have been associated with disturbing behavior changes, during which some people have demonstrated bizarre nighttime behaviors like preparing food and even driving while asleep. Others have been linked to a host of potential health risks, including addiction, cognitive impairment, dementia, accidents that cause bone fractures, and even death. Once in a while—if you’re upset or traveling and jet-lagged, let’s say—taking prescription sleeping pills is fine. Every night is NOT fine, though, and the risks far outweigh any benefits.

Insomnia may also be the result of a medical condition, such as sleep apnea, restless legs syndrome, or long-term pain, or a mental health condition such as depression. You may need treatment for one of these underlying conditions before your sleep improves. Also, treating insomnia may help depression symptoms improve faster. If you continue to experience sleep problems, talk to your healthcare provider.

Something to try for a good night’s
rest: Nightcap from Alice Mushrooms. 

These delicious little chocolate bites contain functional mushrooms that can help gently lull you to sleep without side effects. I take one every night! Visit Alice Mushrooms for more info on this product. Then use this code—AJENDA20—when making a purchase, and you’ll receive a 20% discount on your order. Sleep tight!

ABOUT DR. JEN

In her former roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She is founder and CEO of AJenda, a company that focuses on helping women enjoy optimal fitness, health, and well-being, and has authored several books, including the national best-seller, The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

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