How to approach aging strategy techniques and offerings for patients, including a senior fitness program to keep patients moving
There are several researchers that should be paid attention to for healthy aging updates — Valter Longo, PhD, from the USC Longevity Center; Dale Bredesen, MD, and his Alzheimer’s protocol from the Buck Institute; and Aubrey de Grey, PhD, a biomedical gerontologist. The latter is the chief science officer of the SENS Research Foundation and vice president of new technology discovery at AgeX Therapeutics Inc.
As we age, so do our patient bases, and they end up educating us about healthy aging. It’s like participating in an experiment to see who has aged well and who has not. Whatever you want to call it — neurodegenerative prevention, rejuvenation biotechnology, biohacking or graceful aging — it’s all about improvement of longevity and health span.
Here are a few practical tips coupled with research results to help create and engage a vibrant 55+ (senior) culture within a practice.
Range of motion and movement
Check each and every patient’s active range of motion (ROM) — at minimum cervical, shoulder, thoracic, lumbar and hips. If a patient can’t perform full range of motion (remember that active ROM and passive ROM should be equal) then say, “Let’s get it back and never lose it as you age. If you feel stiff or can’t do full range of motion, then get back in here and I’ll help you re-establish it. That’s part of my healthy aging strategy.”
Use mobilization, manipulation, and all other manual techniques to help achieve re-awakening of lost ROM in any senior fitness program.
Don’t be greedy; tell it like it is
First off, don’t be a greedy doctor. Don’t perform more treatment than patients really need, and only provide suggestions and products that one personally uses. And tell it like it is! If you see a patient who needs to lose weight, stop smoking, de-stress or get active, then be that doctor to lay out a plan. Don’t hesitate to get involved with your patients’ medical doctors. If you need to, refer to MD specialists for clearance before starting an exercise program or a fat-loss program, especially if the patient has a known pre-existing condition. Ask if there are any activities they should avoid in a senior fitness program.
Get a qualified instructor or become that doctor who can regress and progress workouts to every patient’s ability and needs. Ideally you would be able to train patients in-person in your office; if for whatever reason that’s not possible, at minimum get some personal training yourself. A good place to start is the American Chiropractic Association Rehab Symposium in March 2020 in Tempe, Ariz. (ACARehabCouncil.org).
Exercise training done right leads to stronger muscles and bones, which in turn lead to multiple benefits, such as:
- less degeneration of cognitive function
- reversal of muscle wastage
- decreased risk of Alzheimer’s
- control of diabetes
Movement and exercise are the key to staying strong, energetic and healthy as one gets older.
Tips for seniors
Seniors, if they can get down and up off the floor, need to learn some foam rolling. If they can only stand, then do proprioception training and joint mobility exercises, especially at the ankle, knee and hip. Next, instruct them in dynamic warm-ups that are geared toward keeping upright with better posture and maintaining good gait.
Patients enjoy learning the techniques and usually have the required patience. Working with older and de-conditioned populations and doing a little exercise training changes lives in a senior fitness program.
They should know squat
Patients should be able to do their age in bodyweight squats. Then recommend they do the number of bodyweight squats of the age they want to live to be. Squats will help patients maintain ankle, knee, hip and lumbopelvic mobility, and when they do that many in a row (or in sets) there is also a cardio benefit. Older patients don’t lose the desire to move, so with an eye toward avoiding joint problems and poor movement patterns, this will decrease degenerative joint disease.
It may take a lot of practice and time performing the movement correctly to overcome bad patterns. Older people can benefit greatly from simple proprioceptive training, joint-by-joint mobility training, and gait training, but because of old patterns, they have to be approached in a completely different way. Some methods include ELDOA, tai chi, CLX bands and yoga as the most useful exercise tools for all populations. Work toward keeping the brain neurologically “on” and the body “fit” in any senior fitness program.
Watching the diet
Recommending a Mediterranean Diet, cleanses at least once a year, and looking at lab reports to discuss individualized supplements are tips for older patients struggling with weight or health. For fat loss go to the ketogenic diet. Measure a patient’s body composition with a machine, and based on the lean muscle mass number in pounds, that’s the number of grams of protein patients should consume a day.
The researcher Longo, who wrote the book The Longevity Diet, suggests that we eat mostly vegan (notice the plant-based diet movement on the rise?), plus a little fish, limiting meals with fish to a maximum of 2-3 per week.
A protein guide:
Protein below age 65 — keep protein intake low (0.31 to 0.36 grams per pound of body weight).
Protein over age 65 — slightly increase protein intake, but also increase consumption of fish, eggs, white meat, and products derived from goats and sheep to preserve muscle mass.
Along with legume protein sources and whole grains and vegetables, recommend consuming generous amounts of olive oil (3 tablespoons per day) and nuts (1 ounce per day). Follow a diet with high vitamin and mineral content, supplemented with a multivitamin buffer every three days. Select ingredients that your ancestors would have eaten. Confine all eating to within a 12-hour period (ex: Start after 8 a.m. and end before 8 p.m.). Don’t eat anything within 3-4 hours of bedtime.
Breathing — Too many people in the health profession have made breathing a complicated topic and overthink it. Try recommending “contemplative breathing” — in other words, becoming aware of your breath while walking, while in bed, while under stress, etc.
Encourage curiosity — Older patients who maintain a good mind generally have a curious mind. Brain health is not that simple — it includes nutrition, sleep and many other factors — but these patients still read. They love talking about headlines and stories, they seem to engage in lots of topics, they talk to people, and they stay social.
Skin care — Healthy aging is a lot about aesthetics (I have not been a fan of sunscreen my whole life and I’m paying the price in wrinkles and dermatology visits). Every patient I see with nice skin (men and women), I ask them, “What is your beauty tip?” The answer has always been a daily application of sunscreen on the face. Also, do not underestimate the power of proper water hydration. Along with body composition I check patients’ hydration levels. The majority of people are dehydrated.
Modalities — Patients like modalities and hearing about the research and background on devices such as laser for joint issues and brain stim; pulse wave (shockwave) therapy for tendinopathy, adhesions and fibrotic tissue; pneumatic cupping for lymph therapy; muscle vibration and percussion for muscle length changes and blood flow; PEMF for driving nutrition into the mitochondria, etc.
Increased ROM and positive patient stories (easier getting in and out of car, bathtub, up and down stairs, etc.) are indicators of success. These are quality-of-life issues, and are really powerful.
Have a strategy and develop manual techniques that won’t scare an older patient who has been told they have osteoporosis or osteopenia. Blood tests are good biomarkers to focus on, and active and passive range of motion. Think outside of the box. If patients don’t have free weights at home, figure something else out.
Start slowly and go slowly in exercises for older patients, and above all, be consistent with chiropractic care and exercise — it is one of the most effective healthy-aging strategies.
JEFFREY TUCKER, DC, is the current president of the ACA Rehab Council. He practices in Los Angeles, Calif., and can be reached at DrJeffreyTucker.com.