ankylosing spondylitis – a long-term inflammatory condition that mainly affects the bones, muscles and ligaments of the spine, leading to stiffness and joints fusing together. Other problems can include the swelling of tendons, eyes and large joints
cervical spondylosis – also known as degenerative osteoarthritis, cervical spondylitis affects the joints and bones in the neck, which can lead to pain and stiffness
fibromyalgia – causes pain in the body’s muscles, ligaments and tendons
lupus – an autoimmune condition that can affect many different organs and the body’s tissues
gout – a type of arthritis caused by too much uric acid in the body. This can be left in joints (usually affecting the big toe), but can develop in any joint. It causes intense pain, redness and swelling
enteropathic arthritis – a form of chronic inflammatory arthritis associated with inflammatory bowel disease (IBD), the 2 main types being ulcerative colitis and Crohn’s disease. About 1 in 5 people with Crohn’s disease or ulcerative colitis will develop enteropathic arthritis. The most common areas affected by inflammation are the peripheral (limb) joints and the spine
reactive arthritis – this can cause inflammation of the joints, eyes and the tube that urine passes through (urethra). It develops shortly after an infection of the bowel, genital tract or, less frequently, after a throat infection
secondary arthritis – a type of arthritis that can develop after a joint injury and sometimes occurs many years afterwards
polymyalgia rheumatica – a condition that almost always affects people over 50 years of age, where the immune system causes muscle pain and stiffness, usually across the shoulders and tops of the legs. It can also cause joint inflammation
Symptoms of arthritis
There are lots of different types of arthritis.
The symptoms you experience will vary depending on the type you have.
This is why it’s important to have an accurate diagnosis if you have:
joint pain, tenderness and stiffness
inflammation in and around the joints
restricted movement of the joints
warm red skin over the affected joint
weakness and muscle wasting
Arthritis and children
Arthritis is often associated with older people, but it can also affect children.
In the UK, about 15,000 children and young people are affected by arthritis.
Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA).
JIA causes pain and inflammation in 1 or more joints for at least 6 weeks.
Although the exact cause of JIA is unknown, the symptoms often improve as a child gets older, meaning they can lead a normal life.
The main types of JIA are:
Oligo-articular JIA is the most common type of JIA. It affects up to 4 joints in the body, most commonly in the knees, ankles and wrists.
Oligo-articular JIA often goes away without causing long-term joint damage.
But there’s a risk that children with the condition may develop eye problems, so regular eye tests with an eyecare specialist called an ophthalmologist are recommended.
Polyarticular JIA (polyarthritis)
Polyarticular JIA, or polyarthritis, is the second most common type of JIA and affects 5 or more joints.
It can affect a child of any age and may come on suddenly or develop gradually.
“Whatever you can do, or dream you can, begin it. Boldness has genius, power and magic in it” W.H.Murray – The Scottish Himalayan Expedition
Over the past year whilst researching for this book, I have spoken to many of my contemporaries about the plans they have for the rest of their lives. Did they see their older age as a time of retirement and well-earned rest, or did they view it as a time of opportunity and challenge? As the Millennium drew nearer I sensed from their responses that the traditional image of ageing was being shaken off, and was being replaced by a far more encouraging picture. I discovered that most of my friends were feeling very positive about growing older, particularly my women friends. I enquired further as to what they wanted to achieve in their final years. Many women friends had a practical approach to the future, which they perceived with a positive mental attitude. They were realistic about their limitations and many were busy making preparations as to how best to enjoy the rest of their lives. Most were determined not to waste the predicted extra years of longevity, which they all viewed as a bonus. This optimistic approach appears to be keeping many older folk young at heart.
Speaking personally I find that being involved with younger people helps me to have a youthful outlook on life. I try to listen to my offspring, their children and their friends, in order to keep an open mind and to avoid getting too set in my ways. I sense that it pays to keep up to date with current trends, fashions and attitudes in order to understand the aspirations and frustrations of youth. It enables us to help youngsters sort out their problems, although we don’t necessarily have to agree with them!
Notice how older men and women who have regular contact with young people have a more relaxed and accommodating way about them when dealing with youngsters. Many of these people are teachers or organisers who are active in their social life, running youth clubs or sport or hobby orientated events. They appear to be more satisfied and fulfilled in their own lives than other older folk, many of whom have become bigoted and disillusioned with the antics of a some of today’s youth. Taking a broader well-informed overview of life creates a healthier mental attitude. Surely it’s better to live for the day, to take an interest in current affairs and to be generous in your opinions. When dealing with youngsters, it can go a long way to bridging that generation gap. Young people have a lot to learn from the experience and wisdom of older people, and many are prepared to respect their seniors, so long as they are not bigoted, opinionated and dismissive of youth!
Let’s now concentrate on the positivity of growing older, and here I believe that women are faster in learning how to control the march of time than most men are. For example women take more care of their physical appearance by looking after their general health, and their hair and skin. Women today are well informed and encouraged by books and specialist magazines. Many seek advice from health and beauty consultants. From advertisements and advertorials, older women have been made aware that with a little help from skin care and beauty products, and by making slight changes in their diet and exercise, they can effectively delay some of the visible signs of ageing. However, an increasing number of women are resorting to plastic surgery, which they see as the most positive method of superficially holding back the years. Many others less fortunate would love to be able to afford it, while others won’t admit to wanting it. Many women just cringe at the thought of cosmetic surgery and rely on nature being kind to them!
With this dramatic change in the attitude to ageing, the thought of “retiring” becomes more attractive. Retiring from work, and retiring from the traditional concept of ageing, leaves us free from the constraints that have bound and gagged previous generations, particularly women. With no written criteria or acceptance of being old, we now have the unique opportunity to break with traditions and re-write the rules! It’s exciting, and we must grasp the unique opportunity presented to us. If we have good health and adequate financial provision, we could find to our pleasant surprise, that the world is our oyster.
Over the past few years the words used to describe older people have changed too – for the better. Today words such as “retired”, or “mature” or “older person” are commonly used, whereas in my youth any person over 60 years of age was described as an “old age pensioner” or ” a senior citizen”. The changes are encouraging, but for me the most amusing label is one I heard at a celebration of older people in Gloucester Cathedral, when an elderly gentleman described himself as being “chronologically advantaged.” To date this is still my favourite – or do you have a better one?
Now dear reader, in the sincere hope that you have benefited from the advice given in previous chapters, this could be the moment to take control of the rest of your life. Remember “It’s never too late to be what you might have been”
The 50 plus group is fast becoming a group to be reckoned with both socially, economically and socially. As a group it’s numbers are increasing rapidly. It’s group members are healthier, more active and involved in society than previous generations, and have a disposable income estimated at £155 billion pounds a year. Far from sitting down taking life easy, women (and men) in this group are likely to be on the move. Many are off to seek adventures abroad, others are going back to university to improve their education, whilst others are contemplating setting up a new business venture.
There could be something far more interesting and rewarding. Even though I exist on my pension I manage toand live within my means and my voluntary work gives me a sense of pride that I am putting something back into society.
You have a responsibility to yourself and your family to look after yourself. Who wants to be a burden to others?
Families can try to be supportive but early on I decided to take a conscientious effort to look after myself as best I can
What’s wrong with spoiling yourself a little? Why not have an aromatherapy, massage etc
Redundancy is devastating I felt numbness and incredulity and an initial sense of isolation – it affected my self esteem
I hadn’t expected it, I was so shocked. I felt disappointed and cheated.
Going from two wages to one is very hard for any family. Redundancy can put a strain on any family but if you have been together a long time it may be easier to understand each other and work the problems out. Not being a person who can sit still, the idea of sitting around the house for hours on end is horific. Having worked conscientiously for 30 years or more the thought of signing on for unemployment benefit horrified me
One of our biggest worries is whether or not we will have enough money to survive. The only person who can rebuild your ego is you. There is still a huge bias against older people when it comes to employment.
It seems grossly unfair that the Government spends billions of pounds helping young people find employment and only a fraction to assit older people who really do need help to find another job. These people are desperate to work, they have family and commitments and yet employers shun them. Younger bosses should be discouraged from shunning older job seekers. They need to realize they are turning away experience and knowledge, both valuable assets. Maybe it’s time for the Government to bring in legislation to outlaw age disrimination by employers.
Local Education Authorities cater for every need from DM TO EXPAND ON THE FOLLOWING;
Wonderful new found freedom
Time to travel
Maybe it’s time to search for your inner self
Time to explore religions of the world and to take comfort from you new discoveries
Religion and Faith
Activities addresses etc
Many of your new found activities could benefit your health as well as providing you with social contact which can help lift your spirits. Let’s look in more detail at how some of these activities will improve your strenght,stamina and suppleness and help you retain your physical independence. For example:
For further information contact;
?The Ramblers Assn,
1-5 Wandsworth Road,
London SW8 2XX
Tel 0171 582 6878
For further information contact;
?The Amateur Swimming Assn,
Harold Fern House,
Tel 01509 230 431
EXERCISE TO MUSIC
For further information contact;
Fitness Industry Training
112 Great Russell Street
London WC1B 3NQ
020 7343 1850
For further information contact
The Bicycle Assn
A5 SAE please,
Tel 01203 553 838
For further information contact
?The Badminton Assn of England,
National Badminton Centre.,
Bucks MK8 9LA.
Tel 01908 568 822
For further information contact
?The Lawn Tennis Assn
The Queens Club
London W14 9EG
0171 381 7000
For further information contact
?Veteran Squash Raquet Club of GB
26 Leatherhead Road
Surrey KT22 8TL
Tel 01442 232 222
A personal trainer can encourage you to look after your body and motivate you to be more active in the privacy of your own home. The National Register of Personal Trainers (NRPT) has over 1,000 teachers on their list and refer enquiries to fully qualified and insured Personal Fitness Trainers throughout the country. After an initial assessment a plan of action is drawn up and varies greatly from person to person. Dependending on physique, ability, and personal requirements. The advantage of having a personal trainer is the total flexibility, they will fit into your timetable and come to your home. You can have the programme tailored to your level of fitness and physical abilities, go at your own pace, and under supervision you can confidently build up your level of fitness.
For further information contact
The National Register of Personal Trainers
London SW19 4NG
Tel 020 8944 6688 USEFUL NAMES AND ADDRESSES
The Open University
01908 653 231
University of the Third Age (U3A)
26 Harrison Street
London WC1H 8JG
020 7692 5440
Local Education Authority
Contact your Local Adult Education College
Workers Educational Association
17 Victoria Park Square
London E2 9PB
020 8983 1515
National Institute for Adult Continuing Education
Learner of the Year
Older and Bolder
0116 204 4258
Feeling good is about having a positive attitude to life. We should never look back and dwell on our failures or have regrets We must always look forward with optimism. It’s never too late to ajust your lifestyle. You’re never too old to change your habits – or to help yourself to better health. Take good care of your body and your looks. Be more active and eat a well blanced diet. Be aware of your finances. Nuture your relationships, love and respect your family and friends. Continue to listen and learn, and always keep an open mind. Enjoy the rest of your life!
“We can’t beat Old Father Time… no – but some women drive a mighty close bargain with him”
Most of us from time to time will have experienced a bloated tummy and know the uncomfortable feeling that accompanies water retention. This is when excess fluids build up in your circulatory system or within tissues and cavities. Called oedema, water retention can cause your hands, feet, ankles and legs to swell but more seriously could be a symptom of an underlying health condition like kidney disease, heart failure, chronic lung disease, thyroid or liver disease. If water retention is sudden, severe or without explanation see your doctor. Self treating at home can delay the diagnosis of potentially serious health conditions.
Fortunately, much of the time water retention is not serious. Some women experience water retention during pregnancy and other women feel their stomach is full of liquid before their monthly period. Being inactive, bedridden or sitting on long journeys can cause fluid retention in your limbs. Overeating and particularly too much highly salted food may cause water retention in your abdomen, but simple lifestyle changes like being more active can combat both bloating and fluid retention.
If swelling is mild and there’s no underlying health condition try reducing water retention by watching what you eat and drink. Alcohol is thought to contribute to the problem so avoid or use sparingly. Cut down on meals that are high in salt, processed foods are a big dietary source of salt.
Decreasing salt intake is thought to help in reducing water retention but there have been few studies, and many remedies are only supported by anecdotal and not medical evidence. Some people claim increasing your magnesium intake may help reduce water retention. Good sources include nuts, whole grains, dark chocolate and leafy, green vegetables, and it’s also available as a supplement. Other women claim foods rich in vitamin B6 including bananas, potatoes, walnuts and meat may help, and particularly for those women with pre-menstrual tension.
Natural diuretics may help reduce water retention by making you spend a penny more often. These include celery, parsley, corn silk, hawthorn, ginkgo and green tea. Potassium rich foods such as bananas and some herbs and spices are natural diuretics, and appear to help, by decreasing the amount of sodium in the body and increasing the production of urine. Dandelion and nettle have been used in folk medicine over the years as natural diuretics to combat the symptoms and signs of water retention.
My Bone Boosters programme consists of a set of easy movements designed specifically to strengthen and preserve bone thickness. They are exercises you can do in your everyday life, around your home or workplace or in the garden. You need no more than 20-30 minutes a day, for three days a week, though we do ask that you build up to this slowly to avoid possible injury or over-tiring.
Bone Boosters are intended especially for women of 40-plus who are approaching the menopause, but the earlier you start incorporating them into your life, the better. There is also a special Osteo-Relief section of exercises for those who already suffer from osteoporosis.
But before you start this or any exercise programme, please check with your doctor if you suffer from heart disease, have high blood-pressure, joint problems, back problems, if you are very overweight, have any serious illness, or are convalescing.
If you already have osteoporosis, do not attempt the main Bone Boosters section and, check with your doctor before starting on the special Osteo-Relief.
It is essential that you check the support and equipment you will be using before performing any of the following exercises in your home or even out in the garden, to make sure they are strong enough to take your weight.
How much exercise should we do?
To be effective exercise must be done on a regular basis. Some physical activity should be undertaken for an hour at least once a week, but preferably more often, up to 5 times a week. Ideally a generally more active lifestyle must be aimed for, because all exercise and activity is good for us – but inactivity isn’t.
Why is weight bearing exercise so beneficial?
We know that it’s a natural process for women (and men) to lose some density from bone after about the age of 35. Research over the past 10 years or so has shown that through regular, weight-bearing exercise it is possible to prevent some of the dramatic loss which often occurs in women over 50. This is largely due to the fall in levels of the female hormone oestrogen at the time of the menopause (or earlier if there has been a premature menopause brought about by hysterectomy). Genetic inheritance and other factors can also contribute to bone loss.
Weight-bearing exercises or movements that use the bodies own weight will help preserve and even build bone, but the effect only occurs when the weight is repeatedly exerted. Muscles that are attached to either end of the bone force it to twist and bend in response to strike action and jarring movements. This stress-strengthening effect on bone is boosted if sufficient calcium and Vitamin D are available in the diet – more on this in our chapter on nutrition……
Simple brisk walking, skipping or running all use a hard, vibrating strike action with the weight of the upper body borne by the spine hips, legs and feet. A push up uses whole body weight and can strengthen shoulders arms and wrists. Studies by Dr Joan Bassey at the University of Nottingham Medical School Nottingham showed that pre-menopausal women who were encouraged to do a series of little jumps for a controlled period of time on a regular basis, significantly increased the bone density of their ankles, knees and femoral head.
Can you target specific bones?
Introducing additional weights can target specific bones still further. For example, exercising with dumb-bells puts extra demand on the arms and wrists. So too does carrying heavy bags of shopping (as long as you keep a straight back and don’t stoop). Lifting household objects, like heavy cooking pots or the vacuum cleaner, has a similar Bone-Boosting effect. However care must be taken when carrying awkward and heavy objects to avoid a falls that might cause a fracture. Twisting off the tight lid of a jar helps wrists and forearms too.
Once you’ve followed my bone boosting exercise programme you will be able to adapt other everyday objects and activities and turn them into your own Bone Boosters.
My Bone Boosters programme targets hips, wrists, and spine particularly, these being most vulnerable to the painful, crippling and sometimes fatal fractures caused as a result of osteoporosis. So go ahead, enjoy the sessions and make them part of your life. And may the power they bring be with you.
BONE BOOSTERS EXERCISE PLAN
Before you begin my special Bone Boosters exercise plan it is essential to warm-up by putting your major joints through their natural range of movement. This will help to maintain mobility, warm up major muscles and raise the pulse. By adding some stretches to your warm up you will be ready and prepared to continue exercising without the risk of injury. But the less fit you are, the longer your warm-up needs to be. An average warm-up should take 5-10 minutes.
So, let’s make a start. You need to be wearing loose, comfortable clothes and sports shoes if possible. Clear enough space and use furniture and fittings around the house, like tables, chairs, banisters and the kitchen sink, for support. Or better still you could exercise outside in the fresh air. But before performing any exercises in your home or garden, it is essential to check that the support is secure and strong enough to take your weight, and that the ground surface you are working on isn’t wet or slippery. Don’t exercise until at least an hour after meals, and keep drinking water near at hand to avoid becoming dehydrated.
1. STAND TALL
Check your posture by standing with your feet comfortably apart, your shoulders back but down and relaxed. (Don’t poke your head forward.) Pull in your tummy muscles, tighten your bottom and tuck your tail under. This will tilt your pelvis forward. Your knees should be soft (relaxed).
2. WRIST CIRCLE
To mobilise wrists sit in your chair or stand up. Tuck your elbows into your waist or place them on a table for support and simply circle your hands, working the wrists first 8 times in one direction, then 8 times in the other direction.
To mobilise shoulders and release tension, place your fingertips on your shoulders. Bring your elbows together in front of you, then take them up, and back, and draw imaginary circles with your elbows, pulling your shoulder blades apart. 8 times clockwise then 8 times anti-clockwise.
4. HEAD ROLL
To mobilise neck and release tension, look over your right shoulder with chin parallel to floor. Slowly drop your chin to your chest and roll it on around to look over your left shoulder. Return your chin to your chest and roll back up to the right side. Continue with control, 8 times. Do not roll your head backwards.
5. ANKLE CIRCLE
To mobilise ankles and toes, stand with your feet comfortably apart, hands on your hips or hold on to a table unit or chair back for support. Place the toes of your right foot on the ground. Keep them in place, heel up. Circle your ankle 8 times clockwise, then 8 times anti-clockwise. Repeat with your left foot.
6. SIDE TWIST
To mobilise your upper body, stand with your feet apart, lift your arms up to shoulder level. Bend your elbows and bring your fingertips together. Keep your hips facing forward and twist your upper body and head around to the right side only. Come back to face centre, then take your upper body around and look to the left. Repeat 8 times.
7. SIDE REACH
To mobilise the sides of your body, stand with your feet apart and knees relaxed. With your right arm, reach up and over your head, bending your left knee. Bring your arm down and transfer your weight on to your right leg and reach up and over with your left hand. (As if you are climbing up a rope.) Repeat 8 times to alternate sides.
Walking is wonderful but it will not improve all four aspects of fitness which all begin with the letter S:
The muscles of the lower limbs are obviously strengthened by walking, but it also strengthens the muscles of the lower back which can reduce the probability of back-ache. To complement the benefits of walking to the lower limbs, it is useful to exercise:
the upper limbs with a set of weights; a small set of weights bought from any store or retail warehouse can help strengthen upper limbs and chest muscles. Try press-ups; people aged 60 should be able to do ten press-ups to start with but every man should aim to do the same number of press-ups as his age;
the core muscles of the body, the muscles round the spine and abdomen: lie on your back and raise your legs from the floor; now criss-cross them 60 times. Now roll over on to your tummy, clasp your hands behind your head, and try to lift your head and shoulders off the carpet; do this 20 times.
Nordic walking also provides excellent exercise to the upper body.
No one understands what causes stiffness. You might find that your legs are stiff after your first long walk, especially if you do an hour of brisk walking, but it will soon pass. The best way of preventing stiffness is to take exercise more frequently. Neither ‘warming up’ is necessary before starting to take your Vital Steps, nor ‘warming down’ after you have finished. That is one of the many good things about walking as a form of exercise.
Walking helps maintain the suppleness and flexibility of the lower limbs, but because the act of walking rarely stretches the muscles and other soft tissues, it is not particularly good as a means of improving suppleness. For this reason, it is good to supplement your walking with other exercises to improve suppleness.
If you want to improve your health, it could be useful to join an introductory class for Yoga, Alexander Technique or Pilates, or consult a Shiatsu teacher. Such a course will give you exercises that you can, and should, perform everyday, not just for your legs but for your shoulders, arms and spine. This requires you to build a five minute routine into your day and, like the change needed to find time for extra walking, is just a matter of time management. All these will undoubtedly improve your posture.
Brisk walking can increase your stamina. When you start your Vital Steps programme, you may find it difficult to do brisk walking for more than 1,000 steps, but as you walk more frequently, your stamina will improve. It is, however, often difficult to measure your improvement. For example, you may feel less breathless, or be able to walk briskly for longer, or feel less breathless after brisk walking, but it may simply be the result of slowing down. An article in the British Medical Journal called “How fast does the Grim Reaper walk?” came to the conclusion that the optimum walking speed to outpace the old chap is 1.36 mph! (1).
The best way to ensure that you keep walking briskly to maintain and improve your stamina is to walk against the clock. Walk 1,000 steps, and measure the time it has taken. A more practical approach is to walk briskly for a constant distance, for example, between certain bus-stops, or from your home to the bus-stop, and make that your test track. At least once a week, walk the track briskly and measure how long it has taken, preferably to the nearest second. The best equipment for increasing stamina is a flight of stairs or, better, four flights.
Death to lifts or they will be the death of you!
‘Physical activity programmes can help reduce the risk of falling, and therefore fractures, among older people’
At Least Five a Week – Evidence on the Impact of Physical Activity and its Relationship to Health, Department of Health, 2004
The effects of ageing are to reduce the body’s ability to cope with challenges, and one challenge is lack of exercise. Similarly, even though you remembered how to ride a bicycle, your ability to regain your balance gets less good as you age unless you keep cycling. This may not seem relevant to walking because people retain the skill of putting one foot in front of the other. However, the skills that are lost are those that are more subtle but equally important, such as how to:
judge how far to lift your foot to clear the kerb or a bump; or
recover your balance if you do stumble, particularly if you cannot see where you are putting your feet.
The more you walk the better are these skills preserved but you should try other forms of exercise. Dancing is particularly good, any sort, Scottish country, ballroom or ballet, and of course dancing has many social benefits. For people who enjoy sport and television, try the amazing Wii – the technological development that allows you to play dance, box or compete in many other ways in your living room.
The main objective of this book is to help you change your lifestyle so that you walk more on most days of the week but it is strongly recommended that you complement and supplement the additional walking by taking up, or increasing
Pilates or Yoga or the Alexander technique for suppleness
Tennis or dancing for skill
The use of weights or an exercise band for strength
Increased strength and balance skills are essential in reducing the risk of falling (2)
(1) Stanaway FF et al (2011) How Fast Does the Grime Reaper Walk? Brit Med J 343,
(2)Morris M.E. (2012) Preventing Falls in Older People Brit Med J 345;14
We monitor the evidence base for the benefits and harms of walking and funded two comprehensive reviews which are reproduced below. In 2012 William Buckland, the Director of the National Campaign for Walking produced a report for Public Health England and the Ramblers which reinforced the strength of the evidence base – the evidence is very strong that the benefits are considerable and the risks negligible
HEALTH BENEFITS OF WALKING – THE EVIDENCE BASE Prepared by Nick Cavill and Charlie Foster
For the National Campaign for Walking funded by the Department of Health, NHS London and Knowledge Into Action
Charlie Foster & Nick Cavill
Charlie Foster & Nick Cavill
2 papers by Allender added
HEALTH BENEFITS OF WALKING – THE EVIDENCE BASE “Walking is the nearest activity to perfect exercise”. Professor J Morris and Dr Adrianne Hardman, 1997[i]
There is now overwhelming evidence about the associations between regular physical activity and a reduction in risk of death, and risk of major diseases like CVD, stroke and diabetes. It contributes to well being and is essential for good health. The considerable evidence base for the links between physical activity and health were reported in the Chief Medical Officer’s (CMO) report[ii].
In many studies, walking is merged with other activities to generate an overall composite measure of physical activity. As walking is one of the most common types of physical activity, we could refer to the evidence that links total physical activity to health outcomes assume that it can be extrapolated to walking. However, there is now sufficient evidence on the independent benefits of walking to health outcomes.
In this report we therefore do not rely solely on evidence about the relationship between physical activity and health and apply that to walking. Wherever possible, we rely on evidence that specifically links walking and health outcomes.
2. The impact of walking on fitness, strength, flexibility and stability of joints
Walking gently stresses the body’s key systems (heart and lungs, muscles, joints and circulation). This stress leads to the body adapting to accommodate the increased demands on it – i.e. becoming fitter. Walking stresses the body at a level that is considered very beneficial to overall health and fitness but is within the reach and ability of all adults and children.
It is important to remember that walking at 3 mph uses up only 30% of the maximum energy consumption of a person aged 25. But, as this decreases by 10% a decade, a person aged 75 walking at the same speed uses up 60% of his / her maximum energy. This principle is central to walking advice or prescription.
Brisk walking can improve cardiovascular fitness[iii]. Even 10-minute brisk walks can increase fitness. One study reported that women walking continuously for 30 minutes on 5 days a week had almost identical increases in fitness as women who split their 30 minutes into three 10-minute walks[iv]. Some younger men and most other adults would improve their fitness if they took up regular brisk walking[v].
We have estimated that encouraging the adult population to walk at 3 mph instead of their slower usual pace would be sufficient to improve their levels of cardiovascular fitness. This message would be appropriate for approximately 6.3 million English adults or 23% of all adults aged 16-74 years (using data from the 1990 National Fitness Survey[vi]. Figure 6 illustrates this.
Figure 6: Average levels of fitness for both genders at different age groups with the reach of brisk walking and its potential impact on improving fitness
Brisk walking would improve fitness for these adults
As muscle strength declines with aging, regular brisk walking can maintain functional capacity and muscle strength. For both men and women there is a strong relationship between stronger muscle strength and brisker preferred walking speed[vii].
Walking and other physical activities can increase joint range of motion, particularly for older adults. Stronger muscles, joints and general flexibility developed and maintained by walking can reduce the likelihood of fallsii. The risks of injury by participating in walking are extremely small[viii].
3. Mortality and walking
Walking more can bring substantial benefit to health. This benefit is quantified by comparing the risk of specific diseases between people who walk with people who don’t walk. There is a clear dose-response relationship between walking and all-cause mortality[ix]. A physical activity energy expenditure of 500-1,000 kcals per week (about 6-12 miles of walking for an average-weight individual, compatible with the current physical activity recommendations for adults) reduces the risk of premature death by 20-30%ii.
From a public health perspective, helping people to move from a low level of walking to increasing walking levels will produce the greatest reduction in risk. These considerable health benefits hold for both women and men and are evident even up to the age of 80 years. The reduction in relative risk of mortality for adults walking more than 12.4 miles per week compared to adults who walked less than 3 miles per week is 16%[x].
Regular walking across the life course (from childhood to old age) will reduce risk of disease and pre-mature deathi. Figure 7 shows the difference in risk between an active / regular walker and less active / non-walker. The top line (unhealthy non-walker) shows the negative and cumulative effects of inactivity, low fitness and a higher risk of premature illness across the life course.
4. Prevention of diseases and risk factors for disease
Walking reduces the risk of many diseases.
The benefits of physical activity can be gained from activities that can be incorporated into everyday life, such as regular brisk walking…Physical activity does not need to be vigorous to confer protectioniv
Figure 8: Schematic representation of the dose-response relationship between walking and physical activity level and risk of diseaseii
Walking and recovery from illness
Walking is now commonly recommended by doctors as part of recovery from illness or post operative. For example using walking as an exercise therapy can improve long term conditions such as for people with peripheral vascular disease[xi].
5. Long-term conditions
There are 15 million people in England with a long-term condition[xii]. These conditions account for 80% of the NHS Budget, 80% of GP workload and 60% of hospital inpatient activity. Those over 75 years of age make up 7.6% of the population. 75% of these have a long-term condition.
The main long-term conditions seen in primary care respond to physical activity both in prevention and treatment. These are outlined below:
Coronary Heart Disease
CHD causes over 101,000 deaths per year, one in five deaths in men and one in six deaths in women. It causes 20% and 11% of premature deaths in men and women respectively.
There are 2.6 million people living with CHD (i.e. angina, MI) in the UK.
The total cost of CHD to the economy is £7.9 billion, with 45% due to direct healthcare costs, 40% in productivity losses and 16% due to the costs of informal care.[xiii]
The cost of ischaemic heart disease to the NHS due to physical inactivity has been estimated at 23% of a total spend of £2.3 billion[xiv]. The Foresight report [xv] estimates direct NHS costs of CHD in 2007 to be £3.9 billion, suggesting the total NHS cost of CHD due to physical inactivity to be just over £1 billion.
Protection from triggering an MI from vigorous activity >6 METS
For a healthy, young or middle-aged person, walking at a ‘normal’ to ‘brisk’ walking pace is enough to reduce the risk of cardiovascular disease and to improve risk factors for cardiovascular diseaseii.
Walking more than four hours per week reduces the risk of hospitalisation for cardiovascular disease by 30% compared to walking less than one hour per week[xvii]. The incidence of CHD is halved by walking over 1.5 miles a day in men compared to men who walked less distance per day[xviii]. Women who walked for exercise for about hours per week enjoyed a 35% reduction in their risk of CHD events compared to women who walked infrequently[xix].
Brisk walking of more than 3.5 hours a week may slow an atheroma, and walking five hours a week may slowly reverse its formation[xx].
Regular brisk risk walking reduces diastolic blood pressure but appears to have no effect on systolic blood pressureii.
Brisk walking for 8-15 miles per week for 6-9 months can increase good cholesterol levels (HDL) and reduce triglyceride levels in the blood[xxi]. Regular stair climbing has been reported to cause increases in HDL cholesterol, and a reduced ratio of total cholesterol to HDL cholesterol[xxii].
There are about 900,000 people with heart failure in the UK, with a steep increase in age from 1% in those under 65 to 15% of those over 85[xxiii].
The total cost of treating heart failure in the NHS is £628.6 million, with the 86,000 hospital admissions accounting for over 60% of these costs[xxiv].
There are over 7.6 million GP consultations every year for heart failure, costing £103 million[xxv].
Most of the symptoms of heart failure are due to poor perfusion in the peripheral muscles secondary to limited cardiac output. Exercise limitation is usually from leg weakness due to lactate accumulation, leading to shortness of breath because of resulting acidosis. Regular walking therefore improves the peripheral muscle metabolism more than it affects the cardiac output. Regular walking as part of a rehabilitation programme significantly enhances quality of life, helps to retain independence and reduces hospital admissions.
There are 68,400 strokes each year in the UK, causing 55,000 deaths and costing the NHS £1.36 billion.
Patients who have had a stroke are usually highly de-conditioned, with half the average VO2 maximum.
After a stroke regular walking can increase self-selected walking speed, reduce dependence on external aids (so maintaining independence), and reduce fatigue.
One study reported a decreased risk for stroke across increasing categories of walking pace in women[xxvi].
Most patients who have had a stroke will be encouraged to walk through their physiotherapy-led rehabilitation. There appears to be less structured walking programme for stroke patients. NICE will publish guidelines on stroke rehabilitation in 2009
There are 2.2 million people with diabetes in England (4.48% of the population) [xxvii]
This will increase to 3.6 million by 2025 (64% increase)
Half this increase is from the rise in obesity.
The effects of walking on diabetes include:
Improvement in blood sugar control
Improved insulin sensitivity
Reduction in body fat
Stress reduction (Stress can disrupt diabetes control by increasing counter-regulatory hormones, ketones and free fatty acids)
Prevention of diabetes in those at high risk[xxviii].
Walking and cycling levels are also associated with reduced risk of type 2 diabetes: those who walk or cycle more are less likely to get type 2 diabetes[xxix]. Walking and other changes can be a better option for helping to manage diabetes in some patients than drugs. The lifestyle changes in diet and increases in daily walking were found to be more effective in reducing the incidence of type 2 diabetes than treatment with the drug metformin (58% versus 31% reduction in risk)[xxx].
Chronic Obstructive Pulmonary Disease (COPD)
900,000 people have a diagnosis of COPD, with half as many again living with COPD without a diagnosis.[xxxi]
There are 109,000 COPD admissions, contributing to one million bed days costing the NHS £600 million, with a total cost to the NHS of about £1 billion.
COPD causes 24 million lost working days per year.
COPD patients who undertake more walking halve their risk of being admitted as an emergency admission.[xxxii] NICE guidance requires that all COPD patients who can walk attend Pulmonary Rehabilitation (PR). Patients in PR are recommended to walk regularly but there are only isolated schemes that link with organised walking groups. Regular exercise in groups reduces breathlessness and anxiety and increases confidence and independence.
Depression and Anxiety
Every day, 25,000 people see their GP with a psychological problem.
7% of the population suffer from Depression and Anxiety at any one time.
In 2005, 27.7 million antidepressant prescriptions were written in England, costing £338 million.
The cost of depression in lost economic output is £12 billion a year[xxxiii].
There is doubt whether most anti depressants are any better than Placebo.[xxxiv]
The Chief Medical Officer states that ‘Physical activity is effective in the treatment of clinical depression and can be as successful as psychotherapy or medication’ii.
NICE recommends that patients with mild depression follow a structured and supervised exercise programme of up to three sessions per week of moderate duration (45 minutes to one hour) for between 10 and 12 weeks. Walking might contribute to this type of regime[xxxv].
Walking can improve self-esteem, relieve symptoms of depression and anxiety, and improve mood[xxxvi]. There is an inverse relationship between daily walking and the reporting of depressive symptoms[xxxvii]. Shorter bouts (10-15 minutes) of brisk walking can induce significant positive changes in mood.
Osteoarthritis of the knee and hip is the single most important cause of disability in retirement years, affecting up to 25% of those over 65.
The annual cost of treatment to the NHS is £675 million.
There are 36 million days lost due to osteoarthritis, costing the economy £3.2 billion in lost earnings.
Regular walking to build up the quadriceps muscles and help reduce weight is the cornerstone of both preventing and reducing symptoms of osteoarthritis of the hip and knee. Three 40-minute walks a week may help to halt the progression of knee osteoarthritis[xxxviii]. Regular walking and other moderate physical activities may be associated with a lower risk of subsequent osteoarthritis, especially among women.[xxxix]
Ironically, most GPs we spoke to said that the most frequent reason why overweight patients with osteoarthritis of the knee could not walk more was because of pain.
24% of the population is obese and by 2050 60% of males and 50% of females will be obese.
In men, 18% of social class I and 28% in social class V are obese.
In women 10% of social class I and 25% in social class V are obese.
The current NHS cost is £1 billion with a projection of £6.5 billion in 2050.
The wider cost of obesity is £7 billion, rising to £45.5 billion in 2050.
Obesity is associated with diabetes, hypertension, asthma, osteoarthritis, depression and hyperlipidaemia. All of these are independently improved by regular walking.
Walking uses up about 100kCal per mile regardless of pace. Abdominal weight gain has been reported to be less than peripheral gain for women who walked >4 hours a week than women who walk less than 2 hours.
Below two hours a week walking there appears to be no weight loss.
Walking one hour a day for five days a week at 50-70% VO2 max can promote regional fat loss in the abdominal sites[xl]. This is critical in reducing the risk of diabetes and coronary heart disease. Overall weight may change little as lean body mass increases with exercise. Brisk walking reduces BMI and body weight,and also reduces body compositionii.
Any walking will help children and young adults to maintain energy balance[xli]. Any consistent movement of body weight by regular walking or stair-climbing will contribute to energy expenditure and may help with weight management.
Obesity is the single most common reason for GPs to refer patients for walking schemes and exercise referral schemes.
Walking and Cancer
Fewer studies have examined this relationship compared to other diseases, and the majority has only looked at physical activity rather than walking alone. However there is evidence that physical inactivity is associated with increased risk of colonic, breast (postmenopausal) and endometrium cancer. A faster reported walking pace was associated with a reduced risk of colorectal cancer in men compared to men with a slower walking pace than others[xlii].
6. Walking and children’s health
The Chief Medical Officer has pointed out that there is a strong justification for encouraging young people to be physically active. Physical activity provides an important vehicle for play and recreation, learning physical and social skills,
developing creative intelligence and stimulating growth and fitness.
However, there is relatively little direct evidence (compared with adults) linking physical inactivity in children with childhood health outcomes. The chronic diseases described above require long incubation periods, and children and adolescents very rarely have lifestyle-related diseases such as hypertension, diabetes, osteoporosis or cardiovascular disease.
Promotion of physical activity and walking in childhood does have strong justification however. It:
Promotes healthy growth and development of the musculoskeletal and cardio-respiratory systems
Helps maintain energy balance and hence healthy weight
Lowers risk of hypertension and high cholesterol
Generates opportunities for social interaction, achievement and mental well-being.
Walking is an excellent activity for all of these benefits. In addition, it may be that walking patterns track better into adulthood than do sport and leisure pursuits.
7. Economic value of walking
There is currently no economic evaluation of walking.
WHO has recently published guidance on including health effects in economic appraisals of transport interventions[xliii]. This was designed primarily to help transport economists estimate the mortality (and therefore economic) benefits of interventions that increased walking and cycling (such as new footpaths, policies or programmes). The rationale for this work is that 35% of all energy demand is from transport and 80% of this is in road transport. The transport sector is projected to be responsible for 90% of the increase in CO2 emissions until 2010.
The WHO guidance covered walking and cycling but the subsequent Excel model focused only on cycling. WHO is now proposing to extend this model to include walking to provide a practical tool that can be used at local, national and international level to make the case for walking.
This represents an opportunity to strengthen the approach taken to provide an economic appraisal and provide a strong, evidence-based arguments to advocate walking to key policy-makers.
[i] Hardman AE, Morris JN. Walking to health. British Journal of Sports Medicine 1998 Jun;32(2):184
[ii] Department of Health (2004). At least five a week: a report from the Chief Medical Officer. London, Department of Health.
[iii] Murphy MH, Nevill AM, Murtagh EM, Holder RL. The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomized, controlled trials. Preventive Medicine 2007; 44:377-385.
[iv] M Murphy and A E Hardman 1998, ‘Training effects of short and long bouts of brisk walking in sedentary women’ in Medicine and Science in Sports and Exercise 30:1:152-7
[v] Killoran AJ, Fentem P, Caspersen C. Moving on: an international perspectives on promoting physical activity. London: Health Education Authority, 1994.
[vi] Sports Council, Health Education Authority, 1992. Allied Dunbar national fitness survey. Health Education Authority, London.
[viii] Sandolin J, Santavirta, Lattila R, Vuolle P, Sarna S. Sport injuries in a large urban population: Occurrence and epidemiological aspects. International Journal of Sports Medicine 1988; 9:61-66.
[ix] Lee IM, Skerrett PJ. Physical activity and all cause mortality: what is the dose-response relation? Medicine and Science in Sports andExercise 2001; 33: S459-S471; discussion S493-S494.
[x] Lee I, Paffenbarger R. Physical activity and stroke incidence: the Harvard Alumni Health Study. Stroke 1998;29:2049-54.
[xi] Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain. A meta-analysis. Journal ofthe American Medical Association 1995; 274: 975-980.
[xii] Our Health, Our Care, Our Say (2006) Department of Health
[xiii] Allender S, Peto V, Scarborough P, Kaur A, Rayner M. Coronary heart disease statistics 2008. London: British Heart Foundation, 2008.
[xiv]Allender S, Foster C, Scarborough P, Rayner M. The burden of physical activity related ill health in the UK. Journal of Epidemiology and Community Health 2007; 61:344-348.
[xv] Tackling Obesities: Future Choices – Modelling Future trends in obesity & their impact on Health. A Foresight report for Government Office for Science.
[xvi] ACSM’s Exercise management for persons with chronic diseases and disabilities. Durstine JL Moore GE 2002.
[xvii] LaCroix AZ, Leveille SG, hecht JA, Grothaus LC, Wagner EH. Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? Journal of American Geriatric Society 1996; 44: 113-120.
[xviii] Hakim AA, Curb JD, Petrovitch H, Rodriguez BL, Yano K, Ross GW, White LR, Abbott RD. Effects of walking on cornary heart disease in elderly men: The Honolulu Hart Program. Circulation 1999;100:9-13.
[xix] Manson JE, Hu FB, Rich-Edwards JW, Colditz GA, Stampfer MJ, Willet WC, Speizer FE, Hennekens CH. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. New England Journal of Medicine 1999; 341:650-658.
[xx] Hambrecht R, Niebauer J, Marburger C, Grunze M, Kalberer B, Hauer K, Schlierf G, Kubler W, Schuler G. (1993) Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol; 22 (2):478-9.
[xxv] Gnani S et al (2001) Health Statistics Quarterly; Netten et al (1999) PSSRU, University of Kent.
[xxvi] Hu FB, Stampfer MJ, Colditz GA, Ascherio A, Rexrode KM, Willett WC, et al. Physical activity and risk of stroke in women. Journalof the American Medical Association 2000; 283: 2961-2967.
[xxvii] Yorkshire and Humber PHO. Diabetes – key facts, Yorkshire and Humber PHO, 2005.
[xxviii] ACSM’s Exercise Management for persons with Chronic Diseases and disabilities. Human Kinetics 2002.
[xxix] Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, et al. Walking compared with vigorous physical activity and risk of type 2 diabetes in women. Journal ofthe American Medical Association 1999; 282: 1433-1439.
[xxx] Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention of metformin. NewEngland Journal of Medicine 2002; 346: 393- 403.
[xxxi] NICE Guidelines on COPD management. Thorax 2004;59(suppl 1); 1-232.
[xxxii] Garcia-Aymerich J, Farrer E, et al Risk factors of readmission to hospital for a COPD exacerbation: A Prospective Study. Thorax 2003;58:100-105.
[xxxiii] LSE The Depression Report The Centre for Economic Performance’s Mental Health Policy Group June 2006
[xxxiv] Moncrieff J, Kirsch I Efficacy of antidepressants in adults. BMJ 2005, 331 155-9
[xxxvii] Mobily, K. E., L. M. Rubenstein, J. H. Lemke, M. W. O’Hara, and R. B. WALLACE. Walking and depression in a cohort of older adults: the Iowa 65+ rural health study. J. Aging Physiol. Activ. 4:119-135, 1996
[xxxviii] Ettinger Jr WH, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). Journal of the American Medical Association 1997; 277: 25-31.
[xxxix] Rogers LQ, Macera CA, Hootman JM, Ainsworth BE, Blair SN. The association between joint stress from physical activity and self-reported osteoarthritis: an analysis of the Cooper Clinic data. Osteoarthritis and Cartilage 2002; 10: 617-622.
[xl] ACSM Exercise Management for persons with chronic diseases and disabilities Ch 23
[xli] The Health of Children and Young People 2003. Chapter 4: Physical Activity
[xlii] Davey Smith G, Shipley M, Batty G et al. Physical activity and cause-specific mortality in the Whitehall study. Public Health 2000;114:308-315.
[xliii] Cavill N, Kahlmeier S, Rutter H, Racioppi F, Oja P. (2008) Economic assessment of Transport Infrastructure and Policies: Methodological guidance on the economic appraisal of Health effects related to Walking and cycling. Rome. World health organization. Http://www.euro.who.int/transport/policy/20070503_1
You’re never too old to improve bone and muscle strength, even if you actually suffer from osteoporosis. Before-and-after research with very elderly people has demonstrated the benefit of bone-loading exercise and also shown how mobility and muscle power enhance even simple activities like getting up from a chair, lifting parcels or going up stairs. Of course these benefits also reduce the risk of falling and suffering a fracture. Should you have the bad luck to fall, you’re less likely to suffer serious consequences.
One study showed that 30 exercising women with an average age of 84 showed bone gains of over 2% compared to an inactive group who lost over 3% of bone thickness when monitored by researchers for three years. What makes this study remarkable is that they did it sitting down! Their routine included knee lifts, toe taps, arm lifts, sideways bends, leg spreads. The exercisers worked out for 30 minutes a day, 3 days a week.
Thin old people are more likely to fracture their hips when they call than their plumper contemporaries. Some researchers suspect that the fat acts as a kind of shock absorber. Hence the arrival of the energy-absorbent hi-protector, a padded device developed in Denmark that can be worn by anyone frail and elderly and at risk of damaging falls.
An 8-week programme of ‘high resistance’ training followed by 10 elderly people in an American residential home resulted in spectacular gains in muscle strength. Muscles were more flexible afterwards too, another vital weapon in the fight against falling.
Improvements in muscle strength can come within weeks of doing regular daily exercise, but bone-building takes longer. There may even be an initial period when bone gets slightly thinner, but after a year, improvement should be discernible.
If you already suffer from osteoporosis, there’s no need for us to remind you of the discomfort and pain you experience.
If you have the disease in your spine, particularly in your lower-middle back below the ribs, you may be permanently bent over and unable to hear weight through your spine. In this case, we know, exercises are difficult and in some cases impossible to perform.
The best treatment for sever sufferers is pain-relieving drugs prescribed by the doctor and rest in bed with a pillow under the head for support. One pillow if possible though we know some people can only find relief with more. Add a pillow under the knees and relax with legs straight if you find that more comfortable.
Most people, however, can benefit from some exercise, and I have designed our Osteo-Relief Bone Strengthening specifically for osteoporosis sufferers. Do them on a regular basis for at least 3 months before you expect to see any improvement. Don’t be discouraged if you feel initial discomfort. After a fall or operation, it is often difficult to overcome the pain barrier – the fear of pain, in fact. But remember the rewards in terms of regaining mobility, strength and independence, and try to stick it out.
If you have any doubts, show the exercises to your doctor or consult a trained physiotherapist. The extra stress on bones during exercise is not appropriate for people with advanced osteoporosis and could result in fracture. Seek medical advice if you think you are at risk before attempting Osteo-Relief Bone Strengtheners.
People without osteoporosis who have been actively exercising during their middle years can, and indeed do, continue at a high level of physical activity through out life, but late-starters need to take it nice and easy, putting the emphasis on walking, swimming, dancing and low-key routines like the one we suggest here.
A brisk daily walk is healthy and beneficial for anyone and everyone. Not only does it increase our stamina, strengthen our heart, improve circulation and tone up our muscles, but it’s a Bone Booster too. A simple walk costs nothing and gives excellent results – so off your bottom and get those boots walking. Keep to a brisk pace and walk for at least 20 minutes. You should puff a bit!
THE EXERCISE PROGRAMME
The following 5 exercises are particularly beneficial if you already suffer from osteoporosis. They will help strengthen your spine and correct your posture
Lie on your bed with your knees bent and a small pillow to support your head. Fix your eyes on a spot above you, and simply push with your neck and stick your chin up and out. Retract your chin and pull it down into your chest as far as you can. Continue with this ‘chicken neck’ exercise for 1 minute. As you progress over the weeks, remove the pillow but keep your knees bent and continue the exercise for 1 minute. Aim eventually to lie out on the floor without the pillow and with legs straight to do the exercise.
Lie on your bed, preferably without a pillow, with both knees bent and arms out to your sides, opalms down. Keep your feet in contact with the bed and roll both knees together over to your right side as far as comfortable. Try to look over to your left hand. Hold 2-4 seconds. Slowly bring your knees back to the centre, and carefully roll them over to your left side and try to look right. Hold 2-4 seconds. Keep your upper back, shoulders and arms in contact with the bed throughout the exercise. Aim to do 4 rolls to each side, and eventually to do the exercise on the floor.
To strengthen your tummy muscles like on your bed with your head supported by a small pillow. Bend your knees up, feet down flat on the bed. Place your left hand behind your head (or neck), and extend your right hand on to your right thigh. Breathe out and lift your head and shoulders up, sliding your hand up to your knee. Breathe in and relax back down. Continue 4 times, then change hands and repeat 4 more lifts with your left hand on your left thigh. Aim eventually to do this exercise on the floor without a pillow, but always with your knees bent.
Lie on your bed without a pillow, with your knees bent and feet flat down. Place yur hands up on your thighs. Clench your bottom and lift it up off the bed. Hold for 2-4 seconds and carefully relax back down. Repeat 8 times, and try eventually to do this exercise on the floor.
This exercise is best performed on the floor. Lie out on your tummy, chin to floor. Place your hands under your shoulders with your fingers turned slightly inwards. Breathe out and push yourself back to lift your shoulders and chest up off the floor. Breathe in and relax back down. (Keep your chin facing down as you lift up,) Repeat this exercise 8 times.
When you first start this exercise you may need several pillows under your tummy in order to get comfortable and completely straight before attempting to bend backwards.
Lie on your back with your head supported by one pillow, (more may be necessary in severe cases). Place another pillow behind your knees and thighs to help relieve pain. Place your hands comfortably on your rtummy. Breathe deeply, taking the breath into your abdomen, and feel the rise and fall of your tummy with your fingers. Close your eyes and relax.
It is often difficult for those who have vertebral factures, with painful, tender spines and limited mobility, to lie on their backs. You may find it easier to try an alternative starting position for some of the exercises, such as sitting, from which you can do head and upper back exercises.
People who have already fractured their vertebrae can also benefit from exercise, to strengthen the muscles around the hips and knees – strong muscles in the legs help to prevent falls, which may well lead to fractures.
For information and further specific illustrated exercises for osteoporosis sufferers, contact the National Osteoporosis Society for their booklet Exercise and Physiotherapy in the Prevention and Treatment of Osteoporosis.
DAILY LIVING MAKING IT EASIER
Walk tall is tough advice if you suffer from a curved upper spine, but, nevertheless, it’s exactly what you need. Get into he habit of checking that your shoulders are down and back, your chin pulled in and your weight evenly distributed. Hold your abdomen in if you can. Check your posture by standing against a wall:heels touching it, no hollow back. If you can’t get your head straight against the wall at first, keep practising.
Don’t slump when you sit, get your bottom well back into the chair. A soft, low armchair may seem like luxury, but if it makes you sink too low and rounds your back, change to something more upright with a high, firm back. A rolled towel at he back of your neck and another supporting the small of your back will enhance comfort and remind you to sit upright when reading. Make sure your feet are resting easily on he floor, and when you get up, resist bending forward. Keep as upright as possible and then stand up straight. You may find that at first you need to hold on to something as you get up, but gradually you’ll be able to do it without the help.
A supporting mattress doesn’t have to be iron-hard, and you don’t need special orthopaedic types. On the other hand, it shouldn’t sag. Buy a new one if yours shows signs of wear, and if it feels a bit on the hard side after that comforting sag, put a quilt over it and sleep on that to soften the blow.
Practise getting up and down from the floor once a day. It will help lessen the impact should you accidentally fall.
Start by standing beside a steady, upright chair, holding the back with the left hand. Get down on your left knee, keeping your back straight, then take the right knee down, letting go of the chair and go down on all fours. Swing your bottom over to the floor on the right and sit down, Stand up in your own time, using the chair as support.
Guard your back when lifting anything heavy. Get as close to the object as possible, go down on one knee to pick it up, hug the load to your abdomen and lift with the strength from your legs by pushing down firmly with both feet. Don’t try to take on too-heavy loads.
Remember, calcium helps reduce bone loss in older women. Recommended daily allowances are give on page… and calcium supplements have been shown to have a protective effect.
Poor diet not only leads to malnutrition and muscle weakness, it can also mean shrunken jaws and loose-fitting false teeth. Cooking for one doesn’t have to be a chore. Even if someone else does the shopping for you, when it’s cold and wintry outside, make sure you give them a shopping list that includes daily helpings of fresh fruit and vegetables, fish and dairy produce, and not too much fried food.
How to prevent falls
Get rid of loose rugs, avoid slippery floors.
Get better lighting, especially in hall and on stairs.
Have a good grip handle on bath, and a non-slip mat in it.
Get eyesight checked regularly.
Keep a hall or landing light on at night.
Watch out for uneven pavements – use a walking stick to help keep your balance.
The good news is men are more likely to have body odour and sweat more than we women! However when girls reach puberty they produce body odour when the apocrine sweat glands develop.
Apocrine sweat is produced in the groin, armpits, and the areola of the nipples, mouth, feet and hair. Bacteria on your skin feed and break down the acids in your sweat, and bacterial by-products cause a change in body odour (bromhidrosis). Excessive sweating and body odour is unpleasant and can affect a person’s confidence and self-esteem. So what can we do to help ourselves?
Being overweight can make sweating worse. Spicy foods such as curry or garlic can make your sweat smell, and eating a lot of red meat tends to make body odour unpleasant. Also some types of medication such as antidepressants and certain medical conditions can produce odours. A fruity smell may sometimes be a sign of diabetes, while a bleach-like smell can indicate liver or kidney disease.
Smelly feet (bromodosis) are usually caused by wearing shoes and socks that prevent sweat, which attracts bacteria, from evaporating or being absorbed. Some people sweat excessively, much more than the body needs to regulate temperature, this could be due to a condition called hyperhidrosis.
Dear Diana I am in my 60’s and trying hard to maintain my physical fitness. However, I’m a bit overweight and not as supple as I’d like to be. My problem is getting up after doing my floor exercises. Have you any tips to make it easier? Janet Evans …Bournemouth
Oh Janet, you are not the only one who has difficulty. A lot of people don’t want to do floor exercises for this reason, the fear of getting stuck down there! Fortunately there’s a technique to help get you up off the ground! Begin by rolling onto your side (whichever side is most comfortable). Now place both hands on the floor and with straight arms push your upper body up. Then twist onto your knees and at the same time lift your hip off the ground. You should now be in a kneeling position with both hands and knees on the floor. Next bring one foot and place it forward. From that position you will be able to safely push off and carefully stand up.
Should you have difficulty getting up out of a chair try this technique. Sit upright on your chair feet flat on floor, lean forward from your hips. Keep your head up, look up and with nose over your toes, push and stand up. To begin with use your hands on seat to push up, but aim to keep hands on your thighs and use the power of your front leg muscles (quadriceps) to propel you. Strong muscles help maintain mobility.