Dementia and Alzheimer’s: Updates from a Leading Geriatrician

Dementia and Alzheimer’s: Updates from a Leading Geriatrician

Senior Moments Or Something More?

As Baby Boomers continue the inexorable journey deep into their senior years, preserving cognitive function understandably tops the list of worries. While Alzheimer’s Disease and related dementias are seen in just 5% of people over 65, that number jumps to 30% for people age 85 and over. Questions abound: is forgetting a name a sign of normal aging or an indicator of a more serious memory disorder? Are any nutritional supplements or pharmaceutical treatments available that are proven to stave off memory loss? Most importantly, what steps can be taken to modify individual risk?

To better understand how to identify and manage dementia and Alzheimer’s disease, we asked one of the country’s leading experts, R. Sean Morrison, MD, for his informed perspective on this growing concern for seniors, their families and caregivers. A practicing geriatrician, palliative medicine physician and health researcher for almost three decades, Dr. Morrison has earned numerous awards and recognition for his work, and currently serves as the Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and as Director of the Hertzberg Palliative Care Institute.

Is memory loss an inevitable, natural sign of aging?

Dr. Morrison: The good news is that not all cognitive functions decline with age. The ability to maintain attention, language comprehension, usage, and vocabulary does not decrease. Knowledge learned years ago like how to ride a bike, or brush your teeth, also stays intact. Additionally, when you learn something new and can remember it, you won’t forget it any more rapidly than when you were younger.

The not so good news is that it will take greater effort to learn those new things; more attention, repetition and use of memory-enhancing strategies will be needed. The ability to multitask is also diminished, as processing information takes longer and reaction times are slower. People may experience poorer performance when working under time pressure, and find it more difficult to manipulate information in the brain, such as calculating a tip in a restaurant or figuring out a route to travel from one place to another.

How do you distinguish between a “senior moment” lapse in memory and a sign of Alzheimer’s disease?

Dr. Morrison: So many people experience that temporary inability to remember a name. But if you are able to recall things with a cue or can pick it out from a list of possibilities, that’s evidence of a problem with retrieval but not with storage. You can be reassured that it doesn’t indicate Alzheimer’s disease but a “senior moment” because the information has been successfully stored in your memory.

Is routine screening for dementia recommended in older adults?

Dr. Morrison: The U.S. Preventive Services Task Force does not recommend for or against routine screening, saying no interventions are proven to have a significant effect in people with earlier detected cognitive impairment. However, it is required as part of Medicare’s yearly assessments, and most primary care physicians consider dementia screenings an essential part of their annual wellness exam.

What types of screening tests do you recommend?

Dr. Morrison: At least a dozen tests are available, each with their own benefits and drawbacks. I recommend the following for their ease of use and proven sensitivity and specificity in diagnosing cognitive impairment:

  • Mini-Cog is a quick, three-minute evaluation. Patients are asked to repeat three words, draw a clock with hands at a specific time, and then recall the initial three words.
  • Memory Impairment Screen assesses free and cued word recall. Patients are read four unrelated words from four categories (e.g. Red Cross, saucer, checkers, telegram) and after a few minutes of diversion, asked to recall the words in 20 seconds, either with no prompting or cued by category.
  • Animal Fluency Test. Patients are asked to name as many animals as possible in a 60-second period.

Are there any risk factors for dementia and Alzheimer’s disease that can be controlled by patients?

Dr. Morrison: Quite a few risk factors are modifiable with lifestyle changes and non-pharmaceutical treatments. These include:

  • Address hearing and visual impairments, with eyeglasses, hearing aids and other assistance
  • Prevent and manage hypertension and diabetes
  • Maintain a healthy weight
  • Stop smoking
  • Seek treatment for depression
  • Prioritize regular exercise and physical activity
  • Avoid social isolation
  • Explore cognitive training

The best advice I can give to people in their 50s to 70s looking to prevent or delay progression of dementia and Alzheimer’s disease: exercise, exercise, exercise and rigorously control your blood pressure.

How are the symptoms frequently experienced by people with dementia – sleep disturbance, mood disorders, agitation – best addressed?

Dr. Morrison: There are a number of non-pharmaceutical interventions that have proven effective. Use adaptive clothing and assistive devices to help eliminate distress around bathing and dressing. Create a reassuring familiar structure to the day with a regular routine and activities. Optimize the sleep environment with a comfortable temperature, the right amount of light, a warm milky drink and a bath or shower before bed; avoid stimulating medications, drinks containing caffeine and alcohol, and exercise too close to bedtime. Pharmaceutical treatments can also be considered, including antidepressants to improve cognition and ameliorate agitation and aggression, and melatonin and melatonin antagonists to help with sleep disorders. Of note: medications such as benzodiazepines (BZD), non-BZD hypnotics, mood stabilizers and antipsychotics are no longer routinely recommended as side effects can outweigh possible benefits.

Are there any benefits to nutritional supplements or appetite stimulants?

Dr. Morrison: Nutritional supplements can help with weight gain in patients with anorexia or cachexia (‘wasting’ syndrome) but have no meaningful impact on survival. And while appetite stimulants such as cannabinoids and steroids are often given to help patients with dementia, there is no consistent data regarding their safety and efficacy.

What medications are available to treat or stop the progression of dementia?

Dr. Morrison: Until last year, only four medications were approved for treatment of dementia and Alzheimer’s disease, showing only a minimal to modest improvement in cognition. In 2021 a fifth drug was launched – aducanumab – a monoclonal antibody designed to reduce amyloid protein in the brain. Its fast-track approval was quite controversial as the clinical benefits of the drug were not proven during trials, which were stopped early as a result, and some severe side effects were observed. Interestingly, some researchers are now rethinking the idea that targeting amyloid protein plaques will eliminate Alzheimer’s disease, and instead exploring Alzheimer’s as a disease of inflammation. This could be the next fascinating line of research.

How a Memory is Made

Memory begins to form by giving attention to the information received through your senses. Anything that interferes with your ability to pay attention, such as hearing impairment, will affect the formation of a sensory memory. Successful integration of sensory memories into your working memory enables you to temporarily store, organize and manipulate information. These memories are then encoded into long-term memory and finally put into permanent storage.

 

Nourish Body, Brain and Heart with the MIND Diet

Nourish Body, Brain and Heart with the MIND Diet

Mindful Eating for Your Brain

Harkening back to ancient civilizations, the concept of food as medicine represents one of today’s most cutting-edge approaches to prevention and disease management. Inspired by the intricate connection of mind and body wellness, a small, special group of diets have made their way into the mainstream offering benefits far beyond short-term weight loss. Among them are DASH (Dietary Approaches to Stop Hypertension), a low-sodium diet that encourages consumption of foods rich in nutrients such as potassium and calcium and magnesium; the Mediterranean diet for heart health, emphasizing fish, fruits, and vegetables, with olive oil as the main source of fat; and combining both, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, which shows real promise in helping its adherents preserve cognition and reduce the risk of dementia.

Launched in 2015 by researchers at Rush University Medical Center, the MIND diet encourages selecting foods from categories that include leafy greens and vegetables, legumes, fish and seafood, poultry, nuts and berries, while limiting high fat, high sugar and processed foods. Longitudinal observational studies showed the rewards of shifting to this healthier way of eating, with a 53% reduction in the risk of dementia for seniors who rigorously followed the diet, and somewhat surprisingly, a 35% risk reduction even for those who followed it only moderately well.

“This is my favorite feature,” says Jennifer Ventrelle, MS, RD, lead dietitian for the MIND Diet Intervention to Prevent Alzheimer’s Disease at Rush, “you don’t have to be perfect! It’s not necessary to eat from every preferred category to achieve your goals.”

Although it’s not intended as a reducing diet, Ventrelle says people who follow it naturally lose weight by focusing on the preferred categories of foods. “It’s too difficult for many people to consider banishing all sweets or giving up red meat forever, so we haven’t eliminated these foods but allow them with limited frequency and close attention to portion sizes,” she explains.

Additional research pointed to a host of other benefits associated with eating MINDfully for older adults: slower cognitive decline and progression of Parkinsonian signs in aging, and reduced risk of functional disability, depressive symptoms, metabolic syndrome, cardiovascular disease and all-cause mortality. “The literature continues to grow, with new studies that point to the key role diet plays in preventing cognitive decline,” says Puja Agarwal, PhD, nutritional epidemiologist and assistant professor of internal medicine at Rush.

But it is the gold-standard randomized controlled trial begun several years ago by Rush and Harvard School of Public Health that may ultimately establish a causal relationship between diet and dementia. More than 600 participants at higher risk for Alzheimer’s disease – overweight, suboptimal diets and a history of dementia in the family – were enrolled in the study designed to directly measure whether following the MIND diet versus a low-fat diet can prevent neurodegenerative ills – results are expected by the end of 2022. According to Agarwal, who is fully aware of its significance at a time when more than 6 million people in the U.S. are living with Alzheimer’s disease, a number expected to double in the coming decades. “We don’t have a cure for these diseases, so prevention strategies are essential. We’re hoping for intervention trial results for the effect of MIND diet in protecting the brain to further establish the role of diet in healthy aging.”

What a day of meals on the MIND diet might include*:

BREAKFAST
Greek Yogurt Parfait: ½ cup whole grain, high fiber cereal, ½ cup berries, ½ cup low-fat Greek yogurt, 2 tbsps (raw, unsalted) walnuts, almonds or pecans.

LUNCH
Whole Wheat Turkey Wrap: 1 tortilla wrap + 3-5 oz turkey breast lunchmeat or carved white meat + 1 slice reduced fat cheese + lettuce, tomato and veggies of choice.

3-Bean Salad: Mixture of kidney beans, black beans, chickpeas, red onions + 1 tbsp extra-virgin olive oil + 1 tsp balsamic vinegar + Italian seasoning mix such as oregano, parsley, basil, etc.

SNACK
Mediterranean Rice Cake: 1 whole grain rice cake spread with 2 tbsps hummus topped with cucumber slices, tomato slices + fresh lemon juice.

DINNER
Baked Salmon over Spinach and Grains with Asparagus

  • 3-5 oz salmon filet topped with fresh or dried dill or parsley + a squeeze of fresh lemon juice baked on top of 1 cup baby spinach leaves
  • 8 asparagus spears topped with ½ tbsp extra-virgin olive oil + fresh lemon juice + zest
  • 1 cup cooked whole grain such as brown rice, quinoa, or bulgur mixed with ½ tbsp. extra-virgin olive oil

DESSERT
1 oz of dark chocolate (at least 75% cocoa) and ½ cup frozen berries

*Please consult with your physician to determine if these foods are appropriate for you.

In a Pickle and Looking for a New Summer Activity?

In a Pickle and Looking for a New Summer Activity?

Try Pickleball, the Country’s Fastest-Growing Sport

Tired of the same ‘ole routine every summer but find yourself in a pickle and looking for a new summer activity? Well, according to American Council on Exercise (ACE), you might want to consider pickleball.

As everyone from your next-door neighbor to ACE will attest, pickleball is extraordinarily popular. Its rapid rise to ubiquity can be attributed to a number of factors, ranging from easily learned rules and minimal equipment needs to intergenerational appeal and abundant opportunities for socializing.

This blend of badminton, tennis and table tennis can be adjusted to suit the intensity and competitiveness of the players, making it simple enough for beginners but fast-paced enough for more fit or skilled participants.

All of which is to say that if you haven’t yet considered picking up a pickleball paddle and the light, whiffle-like plastic ball, summer 2022 might be the perfect time to do so.

“Pickleball doesn’t require the skill of tennis, so it is easily adapted by most, and provides all the benefits of movement, including calorie burning and enhanced functional capabilities,” says Dr. Cedric Bryant, ACE president and chief science officer.

Already a favorite sport in retirement communities, pickleball has swelled to include more than 4.8 million players in the U.S. – almost double the number from five years ago – earning it the title of fastest-growing sport in 2021 and 2022. According to the Sports and Fitness Industry Association, the spike has been fueled by people ages 54 and younger looking for a friendly yet competitive and lively sport.

“People who play are generally having so much fun they don’t realize how much exercise they’re actually getting,” says Laura Gainor, spokesperson for the USA Pickleball Association.

At 44 x 20 feet, the pickleball court is one quarter the size of a tennis court, so it’s easier to keep the ball in play and achieve a brisk workout. According to ACE, pickleball may provide just what many middle-aged and senior adults are seeking – a safe and effective workout that yields long-term benefits and encourages lifelong participation.

A small research study recently conducted by the organization among people ages 40 to 85 showed that playing four 15-minute pickleball matches three days each week meets exercise intensity guidelines for improving and maintaining cardiorespiratory fitness. Study authors reported the positive impact on cardiometabolic risk factors, with participants experiencing favorable changes in cholesterol levels, systolic and diastolic blood pressure, and peak oxygen uptake after six weeks.

The smaller court also benefits older people or those who have problems with their joints, because less running is needed, resulting in less wear and tear on the joints. One cautionary note: Experts advise learning proper technique to prevent falls. As always, be sure to check with your healthcare provider before beginning any new physical activity.

“Take a few lessons to get started, and you’ll quickly ramp up,” assures Gainor. “After three to five games, you’ll have a very good understanding of how to play, and will become addicted to it shortly after!”

Take It Outside: Keep Moving This Summer

There’s no one-sport-fits-all approach, so if pickleball doesn’t appeal, find your inspiration in one of these activities, spanning the spectrum from low exertion to highly energetic:

  • Stroll through farmers’ markets or art fairs
  • Go produce picking at a local orchard
  • Forest bathe – immerse yourself in nature at a forest preserve
  • Gardening – remember to bend from your knees and waist rather than your back
  • Swim – use a variety of strokes to limber up your whole body
  • Disc golf – a low-impact way to challenge your coordination
  • Yard yoga – take your mat and routine outdoors
  • Hike, jog, run or cycle on an outdoor trail
  • Kayaking – for a vigorous upper body workout
  • Stand-up paddleboarding or Boga – challenging, board-based water workouts

Sources: American Council on Exercise, American Heart Association, USA Pickleball Association

Tips for Safe Summer Fun

Tips for Safe Summer Fun

Stay Safe with Sunscreen, Sunglasses and Plenty of Water

The longer, sunshine filled days of summer are upon us and without a doubt, they are one of life’s unrivaled joys, especially when you protect yourself from the powerful impact of ultraviolet rays. With that in mind, we share our tips for safe summer fun; from choosing and using the right sunscreen to staying hydrated.

The debate around sunscreen safety heated up with last year’s recall of some popular consumer products containing chemicals such as benzene, which is absorbed through the skin and into the bloodstream. Yet according to the FDA, the American Academy of Dermatology and other experts, there is minimal evidence that systemic absorption of these ingredients is toxic or harmful to health. There is, however, a mountain of proof regarding the harmful effects of sunburn – most notably its significant contribution to the risk of melanoma.

“Use of a broad-spectrum, SPF 30 sunscreen effectively blocks UVB and UVA rays to prevent sunburn,” says Dr. Andrea Murina, MD, associate professor of dermatology at Tulane University School of Medicine and director of the University Medical Center’s dermatology clinics. “This not only reduces the risk of developing skin cancer but also decreases signs of early aging on your skin (such as wrinkles, age spots, sagging skin) and stops existing melasma from darkening and new patches from appearing.”

According to Dr. Murina, while we know some ingredients in sunscreen do cross over into the bloodstream, most are rated by the FDA as GRASE, meaning generally recognized as safe and effective.

A bit of background: Earlier studies conducted by the FDA showed that common chemical ingredients used in sunscreen, including oxybenzone are absorbed into the bloodstream.

Further research on whether systemic absorption of oxybenzone was an actual concern was suggested. However, no clear links to any health problems in humans were identified.

Nevertheless, the ingredient has been eliminated from most sunscreens currently being manufactured, making it easy to find an oxybenzone-free product.
When applied correctly, a water-resistant, SPF 30 sunscreen is optimal, blocking 97% of UVB rays. “A higher SPF is fine, but only incrementally blocks more rays, and the time and duration of effectiveness is the same,” says Murina.

The best way to protect yourself is by using a combination of measures:

  • Wear sun-protective clothing, including a lightweight, loose-fitting, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses. Darker colors, densely woven cloth, unbleached cotton and shiny polyesters are recommended by the Skin Cancer Foundation.
  • Judiciously apply broad-spectrum sunscreen every two hours on uncovered body parts, such as top of hands, face, neck and ears.
  • Swap out regular SPF 15 foundation for a tinted sunscreen. “There are so many cosmetically elegant ones available today that mimic the look of makeup but offer much more protection,” says Murina. Tinted sunscreens with an SPF of 30 or higher provide protection that blends well with all types of natural skin tones, and help prevent exposure to both UV rays and visible light from the sun.
  • Seek shade when the sun’s rays are strongest, between 10:00 a.m. and 2:00 p.m.

Like sunscreen, sunglasses are vital in blocking the harmful effects of UV radiation. UVA and UVB rays can cause increased risk of conditions such as cataracts, eye cancers and growths on the eye, as well as premature aging of the delicate skin around your eye. Choose sunglasses that block 99% or 100% of all UV light or are listed as having UV absorption up to 400nm. Wear them even when it’s hazy or cloudy, as UV light can pass right through clouds. And although you’ve undoubtedly heard this piece of advice before, it bears repeating: To protect your retina, never look directly at the sun.

Finally, drink up when you’re out in the sun. Water is the elixir of choice, helping to lower your body temperature and replace the fluids you lose through sweating. This is particularly important for older adults whose body’s fluid reserve becomes smaller and thirst sense decreases as they age. Be aware of the most common signs of dehydration – lightheadedness, fatigue, dizziness, less frequent urination, dark-colored urine – and rehydrate promptly with cool water.

Safe Travels
If your summer vacation includes international travel, we recommend some healthy pre-planning that includes the following:

  • COVID-19: Make sure you are up to date with your vaccines and boosters. Get tested for COVID-19 as close to the time of your departure as possible (no more than three days before travel). Do not travel if you have COVID-19 symptoms, if you tested positive or if you are in quarantine due to possible exposure.
  • Check the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) websites for the most up-to-date travel alerts, advisories and recommendations. Immunizations needed will vary based on your health condition, immunization history, countries and regions on your itinerary, and duration of your visit.
  • Update your routine immunizations to protect against increased risk of exposure to illnesses such as seasonal flu, diphtheria, varicella (chickenpox), measles, mumps and rubella. For quick guidance on additional immunizations you may need, try the online tool at GlobalTravEpiNet.
  • To protect yourself from the serious diseases spread by mosquitos, such as dengue fever and malaria, bring an EPA-registered insect repellent with an active ingredient like DEET or picaridin.
  • Pack your prescription medications and consider bringing over-the-counter medicines, including anti-diarrheal medicine, antacid, antihistamine, hydrocortisone cream, motion sickness medicine, cough medicine, pain and fever medicine, and mild laxative.
  • Also, pack supplies to prevent illness or injury, such as hand sanitizer, water purification tablets, insect repellent and sunscreen; and first aid items such as antibacterial ointment, antiseptic wound cleanser, aloe gel, insect bite cream, a digital thermometer and bandages.

We encourage you to contact your health care provider four to six weeks prior to your trip for personalized guidance … and we wish you a safe and memorable journey!

Sources: FDA, American Academy of Dermatology, Mayo Clinic, American Academy of Ophthalmology, U.S. Centers for Disease Control and Prevention, Skin Cancer Foundation

Summer Fruits and Veggies

Summer Fruits and Veggies

Picking the Season’s Prime Produce

A seasonal bounty of fruits and vegetables is in bloom everywhere from your grocery’s fresh foods section to local farmers’ markets, and in your own backyard garden. The following is advice from experts on how to purchase summer fruits and veggies at its peak, and store them safely, until ready to enjoy.

Berries and Cherries. Look for plump, unblemished fruits with no dark spots or fuzzy white mold; raspberries, blackberries and strawberries should be fragrant. All are shiny when ripe – except for blueberries, which will have a dull matte finish. While most berries can be refrigerated for up to a week, raspberries can start fading more quickly; when that occurs, The Spruce Eats recommends freezing them for use in smoothies and other recipes. To extend their life, do not wash fruit when you unpack your groceries; wait until right before you eat them.

Corn. Choose uncut silks coming out of tightly closed, bright green husks that smell slightly grassy, advises Martha Stewart; and peel back a tad to make sure the kernels look plump and healthy. Refrigerate corn with husks on and use as soon as possible.

Cucumbers and Peppers. Look for firm, shiny vegetables without blemishes, wrinkles or soft spots. According to Have a Plant, cucumbers and peppers can be refrigerated in a plastic bag for up to one week.

Grapes. Choose firm, plump grapes with green healthy stems. They can last up to two weeks when refrigerated. Or try an easy frozen treat: Place on a baking sheet; freeze until firm, and enjoy. Store leftovers in a freezer-safe bag for up to 12 months.

Lettuces. Eliminate those with wilted or broken leaves. Lettuce can be stored for up to four days when refrigerated; darker lettuces tend to last longer than pale, tender varieties. Wash all lettuces just before using.

Melons. Select watermelons without flat sides or dents, and choose ones with a heavy weight for optimal juiciness. Cantaloupe and honeydew melons are best when they have a pale yellow rind and flowery smell at the stem. Harvest to Table recommends storing whole ripe melons in the refrigerator for up to a week to avoid spoiling; cut melons will keep for up to three days.

Plums, Nectarines, Peaches. Opt for vibrant colors, a firm feel, and beautifully fragrant aroma for nectarines and peaches. Store unripe plums, nectarines and peaches in a paper bag until ripe. When ripe, peaches and nectarines can be stored at room temperature for use within a few days; plums can be kept fresh for up to five days in the refrigerator.

Tomatoes. Pick vividly colored, medium-firm tomatoes with smooth, shiny skin. To preserve the freshness and natural flavor of unripe tomatoes, Master Class recommends storing them on a countertop away from direct sunlight. They will last a week on countertops and up to two weeks if stored in the refrigerator.

Zucchini and Summer Squash. Look for smooth-skinned, small to medium size vegetables. Eating Well advises storing zucchini in the crisper drawer of your refrigerator, in either a plastic or paper bag with one end open to ensure good ventilation.

Exercise Is Good Medicine

Exercise Is Good Medicine

Get Up and Join the Movement

As we emerge from the doldrums of winter hibernation and COVID-19-related inertia, it’s important to remember that exercise is good medicine and there’s no better time than now, to get moving again.

“There isn’t a chronic condition that can’t be better managed with an appropriate dose of exercise,” asserts Dr. Cedric Bryant*, President and Chief Science Officer at the American Council on Exercise. “This requires good interaction with your physician, an ability to listen smartly to your body and the realization that some exercise is always better than none.”

He recommends fostering good muscular fitness and enhancing strength, flexibility and balance with the exercise routine shown below. The 15-minute investment of time needed to complete one set of 8 to 15 repetitions for each exercise provides beginners with “the minimum effective dose needed to elicit a very positive response,” says Dr. Bryant.

Add regular rounds of exercise that build endurance, helping improve the health of your heart, lungs and circulatory system. To achieve the best results, you should have enough breath to talk but not enough to sing during aerobic activities such as brisk walking or jogging, dancing, biking, swimming, climbing stairs, or playing basketball, tennis or the uber-popular pickleball. (Learn more about today’s fastest-growing sport in an upcoming newsletter.) Be sure and check with your healthcare provider before beginning an exercise program.

Dr. Bryant’s Essential Seven

1. Pushups

Benefits: Develop the large muscles of the chest and the back of arms
The basic incline pushup is done using a sturdy table or other solid surface about 3 feet high. Stand facing the table and place your hands on the edge (shoulder width apart) arms straight and elbows not locked. Walk your feet backward until your arms and body are in a straight line. Bend elbows and slowly lower chest to the edge of the table while inhaling. Keep body straight and rigid throughout the movement. Push body away from the table until elbows are extended but not locked. Exhale as you push up.

 


 

2. Bodyweight Squat

Benefits: Strengthens and tones the lower body

Stand with your feet slightly more than hip width apart, toes turned slightly outward, hands at sides with palms facing in. Pull shoulders down and back. Stiffen your core and abdominal muscles. Hold chest up and out, tilt head slightly up, shift weight back onto your heels while pushing hips toward the wall behind you.

Downward phase: Shift hips back then down to create a hinge-like movement at hips and knees. Try to control the amount of forward movement of the shinbones. Maintain tension in the core muscles and keep your back straight. Lower yourself until thighs are parallel or almost parallel with the floor. DO NOT go deep enough to cause pain. Make sure your feet don’t move, ankles don’t collapse in or out, knees remain aligned over the second toe, and body weight is evenly distributed between balls and heels of the feet.

Upward phase: Extend the hips and knees by pushing your feet into the floor. Hips and torso should rise together while heels are flat on floor and knees are aligned over the second toe. Continue extending until you reach the starting position.

Remember to inhale on the way down and exhale on the way back up.


3. Bent-Over Row

Benefits: Targets muscles in the upper and middle back and improves stability of the spine

Holding a small weight in each hand and standing with feet hip-distance apart, bend at the waist. Your back should be parallel to the floor with a neutral, not rounded, spine. Extend arms toward floor, keeping knees slightly bent. Engage abs and squeeze shoulder blades together as you bend elbows back and bring weights to your torso. Keep arms close to your torso. Slowly lower the weights back to the starting position.


4. Modified Single-Leg Deadlift

Benefits: Strengthens and tones gluteals and helps improve balance

Position yourself by a wall or chair. Stand straight, with feet aligned with hips, and shift weight to right leg. Slowly bend forward at the waist while raising your left leg behind you until your torso and leg are both parallel to the floor. Keep your head up and arms straight, perpendicular to the floor. Lower your leg as you return to an upright position. Keep your leg straight at all times. Repeat all reps on one side, then switch legs.


5. Overhead Front Press

Benefits: Increases shoulder strength and engages the core for stability

Stand upright and keep the back straight. Note: Beginners or those with back issues can perform this exercise seated. Hold a small weight in each hand at the shoulders, with an overhand grip. Thumbs are on the inside and knuckles face up. Exhale as you raise the weights above the head in a controlled motion. Pause briefly at the top of the motion. Inhale and return the weights to your shoulders.


6. Calf Raises

Benefits: Strengthen lower leg muscles, increase stability, balance and agility

Start by standing 6 to 12 inches away from a wall, facing it, with feet hip width apart. Extend arms to place your palms on the wall, level with chest or shoulders. Exhale and slowly lift heels off the floor, keeping knees extended without rotating your feet. Use your hands on the wall to support your body. Hold raised position briefly. Inhale and slowly lower heels back to the floor.


7. Plank Pose

Benefits: Strengthens the core and abdominals while increasing stability and balance

Modified version: Start in tabletop position with hands and knees on the floor. Walk your hands so your forearms and palms are facing down, keep shoulders and elbows aligned. Walk your knees away from your body until you feel your core and abdominals engaged. Keep torso straight and rigid, your body in a straight line from ears to knees with no sagging or bending, and with shoulders down, not creeping up toward your ears. You may keep your toes on the floor for extra support. Hold position for 10 seconds. Walk your knees back in, repeat. Over time, work up to 30, 45 or 60 seconds.


Sources/refer to these websites for more detailed descriptions on the exercises: American Council on Exercise, Verywell Fit, Women’s Health

*As President and Chief Science Officer at the American Council on Exercise, Cedric X. Bryant, PH.D and Fellow of the American College of Sports Medicine, stewards the organization’s exercise-science and behavior-change education. He earned both his doctorate in physiology and master’s degree in exercise science from Pennsylvania State University, where he received the Penn State Alumni Fellow Award, the school’s highest alumni honor.