You can still exercise even if you have a health condition like heart disease, arthritis, chronic pain, high blood pressure, or diabetes. In fact, physical activity may help. For most older adults, physical activities like brisk walking, riding a bike, swimming, weightlifting, and gardening are safe, especially if you build up slowly. You may want to talk with your doctor about how your health condition might affect your ability to be active.

Researchers are assessing the benefit of exercise to delay mild cognitive impairment (MCI) in older adults and to improve brain function in older adults who may be at risk for developing Alzheimer’s disease. Older adults with MCI may be able to safely do more vigorous forms of exercise, similar to older adults without MCI, provided there are no other underlying health concerns.

Being active and getting exercise may help people with Alzheimer’s or another dementia feel better and can help them maintain a healthy weight and have regular toilet and sleep habits. If you are a caregiver, you can exercise together to make it more fun.

Tips for helping a person with dementia stay active

Take a walk together each day. Exercise is good for caregivers, too!

Use exercise videos or check your local TV guide to see if there is a program to help older adults exercise.

Dance to music.

Be realistic about how much activity can be done at one time. Several short “mini-workouts” may be best.

Make sure he or she wears comfortable clothes and shoes that fit well and are made for exercise.

Make sure he or she drinks water or juice after exercise.

Even if the person has trouble walking, they may be able to:

Do simple tasks around the home, such as sweeping and dusting.

Use a stationary bike.

Use soft rubber exercise balls or balloons for stretching or throwing back and forth.

Use stretching bands.

Lift weights or household items such as soup cans.

Exercising with Arthritis

For people with arthritis, exercise can reduce joint pain and stiffness. It can also help with losing weight, which reduces stress on the joints.

Flexibility exercises such as upper- and lower-body stretching and tai chi can help keep joints moving, relieve stiffness, and give you more freedom of movement for everyday activities.

Strengthening exercises, such as overhead arm raises, will help you maintain or add to your muscle strength to support and protect your joints.

Endurance exercises make the heart and arteries healthier and may lessen swelling in some joints. Try activities that don’t require a lot of weight on your joints, such as swimming and biking.

If you have arthritis, you may need to avoid some types of activity when joints are swollen or inflamed. If you have pain in a specific joint area, for example, you may need to focus on another area for a day or two.

Your heart keeps your body running. As you grow older, some changes in the heart and blood vessels are normal, but others are caused by disease. Choices you might make every day, such as eating healthy, maintaining a healthy weight, and aiming to be more physically active, can contribute to heart health. Inactive people are nearly twice as likely to develop heart disease as those who are active. A lack of physical activity can worsen other heart disease risk factors as well, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes, and prediabetes, being overweight and obesity. Being physically active is one of the most important things you can do to keep your heart healthy. Aim for at least 150 minutes of moderate-intensity aerobic activity a week.

by the NIH

You’ve made a plan to be more active, and you’re ready to go outside and get started. But before you do, make sure that you can exercise safely in your neighborhood. Here are a few tips that can help you stay safe as you get moving.

Think ahead about safety.

Carry your ID with emergency contact information and bring a small amount of cash and a cell phone with you, especially if walking alone. Stay alert by not talking on the phone as you walk and keeping the volume low on your headphones.

Let others know where you’re going and when you plan to be back.

Stick to well-lit places with other people around.

Be seen to be safe. Wear light or brightly colored clothing during the day. Wear reflective material on your clothing and carry a flashlight at night. Put lights on the front and back of your bike.

Wear sturdy, appropriate shoes for your activity that give you proper footing.

Walk safely in rural areas.

If possible, walk during daylight hours.

Choose routes that are well-used, well-lit, and safe. Choose routes with places to sit in case you want to stop and rest.

Stay alert at all times. If you’re listening to music as you walk, turn down the volume so you can still hear bike bells and warnings from other walkers and runners coming up behind you.

Always walk facing oncoming traffic.

Walk on a sidewalk or a path whenever possible. Watch out for uneven sidewalks, which are tripping hazards.

Look for a smooth, stable surface alongside the road.

Walk safely in urban areas.

If the road has guardrails, see if there’s a smooth, flat surface behind the barrier where you can walk. If you need to walk on a paved shoulder, stay as far away from traffic as possible.

Watch for bridges and narrow shoulders.

Cross at crosswalks or intersections. Jaywalking increases your risk of a serious accident. Pay attention to the traffic signal. Cross only when you have the pedestrian crossing signal.

Never assume a driver sees you crossing the street. Try to make eye contact with drivers as they approach. Before you start to cross a street, make sure you have plenty of time to get across. Rushing increases your risk of falling.

Look across ALL lanes you must cross and make sure each lane is clear before proceeding. Look left, right, and left again before crossing. Just because one driver stops, don’t presume drivers in other lanes will stop for you.

Check out city parks. Many parks have walking or jogging trails away from traffic.

If you don’t feel safe exercising outdoors, be active inside.

Find local stores or malls large enough for you to walk around.

Walk up and down your stairs a few times in a row. Be sure the stairwell is well-lit and has railings for safety.

At home, do strength, balance, and flexibility exercises.

Try exercises on the National Institute on Aging YouTube channel.

Bicycle Safety for Older Adults

Riding a bicycle is not only a fun family activity, it’s also a great way to exercise. Some people even use their bicycle to commute to work, go to the grocery store, or visit friends and family. When you’re out and about on your bike, it’s important to know how to be safe.

For more information about biking safely, visit the National Highway Traffic Safety Administration.

For More Information About Exercise and Physical Activity

Centers for Disease Control and Prevention (CDC)
1-800-232-4636 (toll-free)
1-888-232-6348 (TTY/toll-free)
[email protected]
www.cdc.gov

by Kenneth E. Thorpe

President Trump recently delivered on a central promise of his presidency — making prescription drugs more affordable. His new “Part D Senior Savings Model” will reduce out-of-pocket costs for millions of Medicare beneficiaries to just $35 a month.

In middle of a pandemic, this is a much welcome effort to save seniors money on their necessary medicines and boost overall health outcomes.

The newly announced policy specifically affects Medicare’s prescription drug benefit, Part D. Part D is unique in that it is subsidized by the federal government, but its plans are administered by private insurers. And thus far, it’s proven a success.

During its first decade in existence, Part D cost nearly $350 billion less than the Congressional Budget Office initially anticipated. Currently, Part D premiums are at a seven year low. 

Part D keeps premiums low for patients by having supply chain middlemen design its benefit plans. Insurers typically hire pharmacy benefit managers, or PBMs, to negotiate with pharmaceutical companies and decide which drugs a plan will include and how much patients will have to pay. 

Given the leverage PBMs hold, companies offer steep discounts in return for preferred placement on the plan’s formulary. In the case of insulin, rebates often exceed 70 percent of the drug’s list price.

Unfortunately, patients rarely see those savings reflected in their pharmacy bills. That’s because PBMs keep a significant portion of the rebates for themselves and pass what remains to insurers, who use them to lower premiums across the board. This modestly reduces monthly plan premiums, but doesn’t move the needle on the high co-pays patients face each time they visit the pharmacy.

Since rebates secured by PBMs are negotiated in secret, insurers still tie patients’ out-of-pocket responsibilities to the retail price of a drug — not the discounted price.

For instance, take a brand of insulin with a list price of $300. With a 70 percent rebate, that drug costs insurers just $90. But a patient whose insurance requires a 25 percent copay will pay $75 out of pocket — rather than $22. 

Fortunately, President Trump just announced a plan that will offer some relief. Under his plan, a Part D patient’s co-pay for a 30-day supply of insulin will be capped at $35. Thanks to this adjustment, millions of American seniors can expect to save an average of $446 on insulin annually. Already, 1,750 Part D plans are prepared to offer the new insulin benefit. Seniors enrolled in non-participating plans will have the opportunity to opt-in during this fall’s open enrollment season. And they can rest assured that with the nation’s top three insulin producers — Eli Lilly, Sanofi and Novo Nordisk — participating, the benefit will cover a wide range of insulin products, including pen and vial forms.

Such relief is overdue. Diabetes is the most expensive chronic disease in the United States — patients living with diabetes experience medical costs 2.3 times higher than those without. And for seniors on a limited income, high medical costs can mean the choice between accessing needed medications and paying for groceries.

With the COVID-19 pandemic already straining our health system, managing chronic disease — and keeping vulnerable seniors out of the hospital — is all the more imperative. The Trump administration’s new plan is an important step toward achieving these goals during this unprecedented moment.

Kenneth E. Thorpe is a professor of health policy at Emory University and chairman of the Partnership to Fight Chronic Disease

by Patty Jenkins

If you or someone you know has recently been diagnosed with Parkinson’s Disease, please know that you are not alone and there are many resources that might help you, especially during this pandemic. Although we are not having meetings in person at this time, the Ventura Parkinson’s Disease Support Group is still very active in reaching out to our Group members with lots of great information and sponsored webinar and zoom meetings by our many supportive associates, including some presentations by Movement Disorder Specialists. Theses meetings cover a variety of topics that might be of help, especially if you are newly diagnosed.

We always suggest to our new members (and current if they haven’t yet done so!) to look into the web sites of three very credible sources and sign up to receive their emails: The Michael J. Fox Foundation for Parkinson’s Research; The Parkinson Foundation and the Davis Phinney Foundation. These three foundations have a wealth of information and support for people with Parkinson’s Disease (PD) in all stages and they also address the many different symptoms of PD we may be experiencing during the course of this disease. We have other local resources like Neuroboxing that are holding “virtual exercise sessions” we can put you in touch with and are also able to connect you with other PD Support Groups in Ventura County.

When “things get back to normal”, the Ventura PD Support Group expects to be able to resume our monthly meetings that alternate between various speakers and round table discussions. Until then, if you’d like to be on our email list to receive information on the various webinars and zoom meetings, (and be informed when we finally have the green light to meet in person!) please feel free to call Patty Jenkins at 805-766-6070 to be added to the Group. We are an independent and completely volunteer-organized group not affiliated with or a part of any other organization or group.

Can eating a specific food or following a particular diet help prevent or delay dementia caused by Alzheimer’s disease? Many studies suggest that what we eat affects the aging brain’s ability to think and remember. These findings have led to research on general eating patterns and whether they might make a difference.

Mediterranean diet, the related MIND diet (which includes elements designed to lower blood pressure), and other healthy eating patterns have been associated with cognitive benefits in studies, though the evidence is not as strong as it is for other interventions like physical activity, blood pressure and cognitive training. Currently, researchers are more rigorously testing these diets to see if they can prevent or delay Alzheimer’s disease or age-related cognitive decline.

Changes in the brain can occur years before the first symptoms of Alzheimer’s appear. These early brain changes suggest a possible window of opportunity to prevent or delay dementia symptoms. Scientists are looking at many possible ways to do this, including drugs, lifestyle changes and combinations of these interventions. Unlike other risk factors for Alzheimer’s that we can’t change, such as age and genetics, people can control lifestyle choices such as diet, exercise and cognitive training.

How could what we eat affect our brains? It’s possible that eating a certain diet affects biological mechanisms, such as oxidative stress and inflammation, that underlie Alzheimer’s. Or perhaps diet works indirectly by affecting other Alzheimer’s risk factors, such as diabetes, obesity and heart disease. A new avenue of research focuses on the relationship between gut microbes — tiny organisms in the digestive system — and aging-related processes that lead to Alzheimer’s.

One diet that shows some promising evidence is the Mediterranean diet, which emphasizes fruits, vegetables, whole grains, legumes, fish, and other seafood; unsaturated fats such as olive oils; and low amounts of red meat, eggs, and sweets. A variation of this, called MIND (Mediterranean–DASH Intervention for Neurodegenerative Delay) incorporates the DASH (Dietary Approaches to Stop Hypertension) diet, which has been shown to lower high blood pressure, a risk factor for Alzheimer’s disease.

Ingredients of the MIND Diet

The MIND diet focuses on plant-based foods linked to dementia prevention. It encourages eating from 10 healthy food groups:

• Leafy green vegetables, at least 6 servings/week
• Other vegetables, at least 1 serving/day
• Berries, at least 2 servings/week
• Whole grains, at least 3 servings/day
• Fish, 1 serving/week
• Poultry, 2 servings/week
• Beans, 3 servings/week
• Nuts, 5 servings/week
• Wine, 1 glass/day
• Olive oil

The MIND diet limits servings of red meat, sweets, cheese, butter/margarine and fast/fried food.

Some, but not all, observational studies — those in which individuals are observed or certain outcomes are measured, without treatment — have shown that the Mediterranean diet is associated with a lower risk for dementia. These studies compared cognitively normal people who ate a Mediterranean diet with those who ate a Western-style diet, which contains more red meat, saturated fats and sugar.

Evidence supporting the MIND diet comes from observational studies of more than 900 dementia-free older adults, which found that closely following the MIND diet was associated with a reduced risk of Alzheimer’s disease and a slower rate of cognitive decline.

Not all studies have shown a link between eating well and a boost in cognition. Overall, the evidence suggests, but does not prove, that following a Mediterranean or similar diet might help reduce the risk for Alzheimer’s dementia or slow cognitive decline. To find out more, scientists supported by NIA and other organizations are conducting clinical trials—considered the gold standard of medical proof—to shed more light on any cause and effect.

While scientists aren’t sure yet why the Mediterranean diet might help the brain, its effect on improving cardiovascular health might in turn reduce dementia risk. Two recent studies suggest that, as part of this diet, eating fish may be the strongest factor influencing higher cognitive function and slower cognitive decline. In contrast, the typical Western diet increases cardiovascular disease risk, possibly contributing to faster brain aging.

In addition, the Mediterranean diet might increase specific nutrients that may protect the brain through anti-inflammatory and antioxidant properties. It may also inhibit beta-amyloid deposits, which are found in the brains of people with Alzheimer’s or improve cellular metabolism in ways that protect against the disease.

For the first time in a randomized controlled trial, brain exercises were shown effective in addressing depression in treatment-resistant older patients, who had previously used anti-depressive drug therapy without success. The exercises were shown to improve not only mood, but also the often-unaddressed cognitive deficits associated with geriatric depression. The study used neuroplasticity-based exercises from BrainHQ, the brain training app from Posit Science, plus two new exercises designed for the study.

“These study results seem particularly relevant at a time when a record number of seniors are being asked to maintain social distance, which we know is not good for mood, nor for cognitive performance,” said Dr. Henry Mahncke, CEO of Posit Science. “This study joins a half-dozen prior studies in showing that neuroplasticity-based brain exercises can improve mood and address depressive symptoms.”

“This study also provides promising new evidence that patients who could not be helped by drug therapy may be helped by this very different kind of intervention,” Dr. Mahncke continued. “Depression can drive cognitive deficits, and cognitive deficits can drive depression, feeding on one another in a downward spiral. Here, there’s evidence of gains in both areas generating an upward spiral to improve quality of life.”

This double-blind study was led by researchers at the Weill Cornell Institute of Geriatric Psychiatry and enrolled 36 older (aged 60-89) patients with major depressive disorder, who had failed to achieve remission after at least eight weeks of treatment with anti-depressive drugs. Participants were randomized into a neuroplasticity-based brain exercise intervention group or into an active control group engaged in computerized education with equivalent time demands and support. Each group was asked to complete 30 hours of their activity within 4-5 weeks.  The results were published this week in The American Journal of Geriatric Psychiatry.

The researchers found that 58 percent of the treatment-resistant patients in the brain exercise group showed remission in depression as compared to eight percent in the control group.

“We’ve come to recognize the role of brain chemistry and brain plasticity in depression,” Dr. Mahncke noted. “These exercises are designed to stimulate the neuro-modulatory systems that naturally control mood. The exercises are attentionally demanding and filled with novelty and rewards in an effort to stimulate the production of acetylcholine, norepinephrine and dopamine, which help with brain plasticity, learning, and mood.”

The researchers also found the intervention group improved significantly in cognitive performance measures as compared to the control group. In addition, the intervention group also experienced a significant reduction in a measure of their disability resulting from the depression.

There are more than 100 published studies of the exercises in BrainHQ which have shown benefits, including gains in standard measures of cognition (attention, speed, memory, executive function, social cognition), in standard measures of quality of life (mood, confidence and control, managing stress, health-related quality of life) and in real world activities (gait, balance, driving, everyday cognition, maintaining independence). BrainHQ is now offered, without charge, as a benefit by leading national and 5-star Medicare Advantage plans; by the Department of Defense to every soldier, sailor, airman, and marine; and by hundreds of clinics, libraries, and communities. Consumers can also try BrainHQ for free at http://www.brainhq.com.

Research has shown it’s important to get all four types of exercise: endurance, strength, balance, and flexibility. Each one has different benefits. For example, endurance exercises help to improve the health of your heart, lungs, and circulatory system while strength exercises keep muscles strong, which can help with balance and prevent falls and fall-related injuries. Practicing all four types of exercise helps reduce boredom and risk of injury. Here are some examples of exercises you can do while practicing physical distancing:

1. Endurance exercises to increase your breathing and heart rate:

• Brisk walking or jogging
• Yard work (mowing, raking, growing)
• Dancing
• Biking
• Climbing stairs or hills

2. Strength exercises help build and maintain muscles. Try:

• Lifting weights — you can use common objects from your home, such as bottled water or soup cans.
• Using a resistance band

3. Balance exercises can help prevent falls and fall-related injuries. Try:

• Tai chi

Balancing on one foot. Use a sturdy chair or counter for support as you get started.

4. Flexibility exercises improve your ability to move freely.

• Yoga
• Flexibility exercises with a chair or the wall

Many fitness classes are currently being offered online, for free or at reduced rates, to help you exercise while still practicing physical distancing. Check out your local library, YMCA, JCC, or fitness center webpage to see what classes they’re offering.

No matter your age, you can find activities that meet your fitness level and needs!