Month: July 2021

A healthy life requires balance — and not just in a metaphorical sense. Being able to maintain physical balance is crucial to performing everyday activities from going up and down the stairs to reaching for an item on a shelf at the supermarket. But while many people squeeze in a daily walk and may even do some strength training exercises a few times a week, exercises to build balance don’t always make the workout list. They should, according to experts.

As you get older, the physical systems inside your body that help you maintain your balance aren’t as responsive as they were when you were younger. Maintaining balance is actually a complex task for your body, requiring coordinated action from not only your muscles, but also your eyes, ears, tendons, bones, and brain.

In addition, health problems that become more common with age, such as inner ear disorders, decreased sensation in feet, or postural hypotension (low blood pressure with standing) may leave you feeling unsteady.

Practicing exercises designed to improve your balance can help keep you upright and prevent a fall that causes injuries.

Building balance three ways

You may wonder, what exactly is a balance exercise?

Standing on one foot? Yes, that qualifies. It falls into a category called static balance exercises. These improve your balance when you’re standing still. But a good balance workout should also include dynamic exercises, which are aimed at building balance when you are moving. Ideally, you should try to incorporate a few of these exercises two or three times a week.

Below are three simple exercises that you can get use to get started. The first is a static balance exercise and the other two are dynamic balance exercises. For additional ideas, read this blog post on the BEEP program.

Tandem standing

Reps: 1
Sets: 1 to 3
Intensity: Light to moderate
Hold: 5 to 30 seconds

Starting position: Stand up straight, feet hip-width apart and weight distributed evenly on both feet. Put your arms at your sides and brace your abdominal muscles.

Movement: Place your left foot directly in front of your right foot, heel to toe, and squeeze your inner thighs together. Lift your arms out to your sides at shoulder level to help you balance. Hold. Return to the starting position, then repeat with your right foot in front. This completes one rep.

Tips and techniques:

• Pick a spot straight ahead of you to focus on.
• Tighten your abdominal muscles, buttocks, and inner thighs to assist with balance.
• Keep your shoulders down and back.

Make it easier: Hold on to the back of a chair or counter with one hand.

Make it harder: Hold the position for 60 seconds; close your eyes.

Braiding

Reps: 10 to each side
Sets: 1 to 3
Intensity: Light to moderate
Tempo: Slow and controlled

Starting position: Stand up straight, feet together and weight evenly distributed on both feet. Put your arms at your sides.

Movement: Step toward the right with your right foot. Cross in front with your left foot, step out again with the right foot, and cross behind with your left foot. Continue this braiding for 10 steps to the right, then bring your feet together. Hold until steady. Now do 10 steps of braiding to the left side of the room. This completes one set.

Tips and techniques:

• Maintain neutral posture throughout.
• Look ahead of you instead of down at your feet.
• Don’t turn your feet out.

Make it easier: Take smaller steps.

Make it harder: Pick up your pace while staying in control of the movement.

Rock step

Reps: 10 on each side
Sets: 1 to 3
Intensity: Moderate to high
Tempo: 2–2–2–2

Starting position: Stand up straight, feet together and weight evenly distributed on both feet. Lift your arms out to each side.

Movement: Step forward with your left foot and lift up your right knee. Hold. Step back with your right foot and lift up your left knee. This completes one rep. Finish all reps with the left foot leading, then repeat by leading with the right foot. This completes one set.

Tips and techniques:

• Tighten the buttock of the standing leg for stability.
• Maintain good posture throughout.
• Breathe comfortably.

Make it easier: Hold on to the back of a chair with one hand for support; lift your knee less.

Make it harder: Hold each knee up for a count of four.

Exercise photos by Michael Carroll

If dementia is a general term that means thinking and memory has deteriorated to the point that it interferes with day-to-day function, what are the top three disorders that cause dementia in older individuals?

Did you think of Alzheimer’s disease? Good! Alzheimer’s is the most common cause of dementia. Did you also think of vascular dementia or strokes? Excellent! Vascular dementia is the second most common cause. What about the third?

It’s not Lewy body dementia, although Lewy body dementia (encompassing both dementia with Lewy bodies and Parkinson’s disease dementia) is the fourth most common cause. Individuals with this disorder often have features of Parkinson’s disease, visual hallucinations of people and animals, fluctuations in attention and alertness, and they may act out their dreams in bed.

It’s not frontotemporal dementia. Individuals with this disorder are often in their 60s or younger. They generally have problems with behavior or language.

So what’s the answer? It’s LATE, which stands for limbic-predominant age-related TDP-43 encephalopathy.

What’s LATE?

In LATE, a protein called TDP-43 (which stands for transactive response DNA binding protein of 43 kDa) accumulates in brain cells. Once it accumulates, it injures and ultimately destroys the cells.

LATE generally damages many of the same areas affected by Alzheimer’s disease. These regions include

• the amygdala, involved in emotional regulation
• the hippocampus, involved in learning and memory
• the temporal lobe, involved in words and their meanings
• portions of the frontal lobes, involved with keeping information in mind and manipulating it.

What are the symptoms of LATE?

Because LATE affects many of the same brain regions as Alzheimer’s disease, it often presents with similar symptoms, including

• memory loss (impairment in episodic memory)
• trouble finding and understanding words (impairment in semantic memory)
• trouble keeping information in mind (impairment in working memory)

How common is LATE?

By itself, LATE is estimated to cause about 15% to 20% of all dementias. Many people with dementia also have LATE pathology in addition to one or more other pathologies in their brain. For example, an individual may have the plaques and tangles of Alzheimer’s pathology, plus LATE pathology, plus ministrokes (vascular pathology). It turns out that about 40% of people with dementia have at least some LATE pathology in their brain. All of this means that LATE is, indeed, very common.

How is LATE diagnosed and why haven’t you heard of it before?

LATE can only be diagnosed with certainty at autopsy. However, we can get a hint that LATE might be present when an older individual shows the memory loss and word-finding problems common in Alzheimer’s disease, but special tests used to confirm the diagnosis of Alzheimer’s come up negative.

The reason that you — and most clinicians — haven’t heard about LATE before is that we didn’t realize just how common it is. It was only when we began obtaining results of special tests to diagnose Alzheimer’s disease in living individuals (such as with a lumbar puncture or amyloid PET scan) that we began seeing the prevalence of LATE.

Can LATE be treated?

Because LATE was (and still is) often confused with Alzheimer’s disease, it is almost certain that when the main drugs that are FDA-approved to treat Alzheimer’s disease were evaluated, individuals with LATE were included in those studies. This means that there is every reason to believe that drugs like donepezil (brand name Aricept), rivastigmine (Exelon), memantine (Namenda), and galantamine will all be effective for individuals with dementia due to LATE.

How can you find out more about LATE?

There has been an explosion of scientific papers about LATE in just the last few years. If you have a science background, you might want to peruse them or watch the wonderful scientific symposium on this disorder held by the National Institute on Aging (NIA). If you don’t have a science background, take a look at the NIA or Wikipedia pages on LATE.

In a perfect world, indulging in a daily portion of French fries instead of almonds would be a simple choice, and no negative consequences would stem from selecting the salty, deep-fried option.

But a Harvard expert says we should take the findings of a new study supporting this scenario with, er, a grain of salt. This potato industry-funded research suggests there’s no significant difference between eating a 300-calorie serving of French fries and a 300-calorie serving of almonds every day for a month, in terms of weight gain or other markers for diabetes risk.

Perhaps snacking on fried potato slivers instead of protein-packed almonds won’t nudge the scale in the short term, but that doesn’t make the decision equally as healthy, says Dr. Walter Willett, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. Crunchy, satisfying almonds deliver health benefits, including lowering “bad” LDL cholesterol. Over the long haul, they’re a far better option to help ward off chronic illnesses — including diabetes — or delay their complications.

“We’ve learned from many studies over the past two decades that weight loss studies lasting less than a year are likely to give misleading results, so a study lasting only 30 days is less than useless,” Dr. Willett says. “For example, studies of six months or less show that low-fat diets reduce body weight, but studies lasting one year or longer show the opposite.”

What health-related factors did the study measure?

The study was published in the American Journal of Clinical Nutrition. The researchers randomly split a group of 165 adults (average age 30; 68% women) into three groups for 30 days and assigned them to eat a daily 300-calorie portion of one of the following:

• almonds, roasted and salted (about 1/3 cup)
• plain French fries (medium serving)
• French fries seasoned with herbs and spices (medium serving).

Researchers provided participants with 30 single-day portions of their food item, telling them to incorporate it into their daily diet but offering no additional instructions to change diet or activity levels to offset the 300-calorie intake.

The amount of fat in participants’ bodies was measured, along with total weight, blood sugar, insulin, and hemoglobin A1C (a longer-term reflection of blood sugar levels) at both the start and end of the month. Five participants from each group also underwent post-meal testing to evaluate short-term blood sugar responses.

Weight isn’t all that matters to health

After 30 days, changes in the amount of body fat and total body weight were similar among the French fry and almond groups. So were glucose and insulin levels measured through blood tests after fasting.

One key difference emerged, however: participants in the French fry sub-group had higher blood glucose and insulin levels just after eating their fries compared with the almond eaters.

It’s tempting to conclude there’s not much difference between fries and almonds — it’s the calories that count. But closer reading reinforces the notion that two items generally placed on opposite ends of the healthy food spectrum are still farther apart than study findings might have us believe.

“The one clear finding was that consumption of French fries increased blood glucose and insulin secretion much more than did almonds,” Dr. Willett says. “This is consistent with long-term studies showing that consumption of potatoes is associated with an increased risk of type 2 diabetes, especially when compared to whole grains.”