Train Your Brain

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Of all the things I might lose as I age, the scariest one is losing my brain health. Worldwide, more than 54 million people had Alzheimer’s disease and other dementias in 2020, according to the American Heart Association, and that number is expected to grow. The Aquatic Exercise Association listed 10 early signs and symptoms of Alzheimer’s in their 2nd Quarter 2022 issue of Leader Tools:

  1. Memory loss that disrupts daily life.
  2. Challenges in planning or problem solving.
  3. Difficulty completing familiar tasks.
  4. Confusion with time or place.
  5. Trouble understanding visual images and spatial relationships.
  6. New problems with words in speaking or writing.
  7. Misplacing things and losing the ability to retrace steps.
  8. Decreased or poor judgement.
  9. Withdrawal from work or social activities.
  10. Changes in mood or personality.

If there is anything that can be done to prevent or delay the onset of dementia, I definitely want to do it! Scientists long believed that the brain was not capable of producing new neurons, but modern research has revealed that the hippocampus, the part of the brain that allows learning, is capable of generating new cells throughout adult life. The ability of the brain to change and grow is called neuroplasticity. John J. Ratey, MD and Eric Hagerman published a book in 2008 called SPARK: The Revolutionary New Science of Exercise and the Brain. They discussed the research that had been done which shows that aerobic exercise helps the brain as much as it helps the heart. Aerobic exercise stimulates the release of the substance known as brain-derived neurotropic factor (BDNF) which sets in motion the growth of new synaptic connections and bolsters the strength of signals transmitted from neuron to neuron. A study by Dr. Aron Buchman done at the Rush University Medical Center in Chicago was published in the Journal of Neurology. He followed 535 individuals, with an average age of 81, for an average of six years, testing their cognitive functions (thought processes and memory) each year. After their deaths, the researchers took note of the BDNF levels in the brain. The subjects who had exercised had the highest levels of BDNF, and they experienced a 50 percent slower loss of cognitive functions compared with those who had the lowest BDNF levels.

Studies have shown that immersion in water relaxes the blood vessels, which facilitates an increase in the cardiac output of blood throughout the body, including the muscles working during exercise, and the brain. In a 2015 booklet entitled Water Immersion Works, Dr. Bruce Becker, the director of the National Aquatics & Sports Medicine Institute in Spokane, Washington, noted that anecdotal evidence suggests that time spent in the swimming pool has a beneficial effect on people with dementia. Individuals in a study showed improved speech and language function, improved balance and agility, and improved cognitive and memory function, an improvement that persisted after their sessions in the pool.

What about those computer games and puzzles that claim “doctors beg their patients to play these games” in order to keep their brains young? Research has found that these computer games and activities such as Sudoku and crossword puzzles are not as beneficial as originally thought. However, there is neuroplasticity training that can be combined with physical movement to strengthen, improve and even change some brain regions. Putting those neuroplasticity drills into a water fitness class is like using all the tools in your toolbox for reducing the risk of dementia. So how does this work?

Lawrence Biscontini, MA, has been involved in brain training since 1972. As an Advisory Board Member for the International Council on Active Aging, and as an active ager himself, Biscontini dedicates a great deal of time to making practical the most recent research on keeping our brains as young and sharp as possible. Check his website for information on his workshops and to read some of his articles. Below are some examples of neuroplasticity drills to perform out loud (to get more senses involved) while doing exercises in the pool such as jogging, jumping jacks, cross-country ski or any other combination of exercises.

  • Spell your first name forwards and backwards
  • Say the names of the months backwards starting with December and skipping every other month (December, October, August…)
  • Count down from 100 by 3s
  • Teach participants a word in any other language; repeat it and spell it 7 times
  • Say out loud (the whole class together) your first memory, first birthday party, how you met your first friend or some other long term memory
  • Recite the digits of your phone number forward and backward
  • Add the digits of your phone number together, two at a time
  • Give the class math problems to solve (addition, subtraction, multiplication, division)
  • Give each of 5 exercises a number, and call out the number instead of the name of the exercise
  • Spell the name of your state, adding the next letter after each letter, e.g. T (U) E (F) X (Y) A (B) S (T) for Texas
  • When performing an exercise, such as a lunge, with the right leg name a fruit, and with the left leg name a vegetable
  • Name as many green vegetables, cold drinks, names beginning with the letter R, birds, car makes or any other list you can think of

You can have a lot of fun coming up with neuroplasticity drills for your class and your class will have a lot of fun trying to imagine what you will come up with next. You will also be helping them to keep their brain health and reduce their risk of Alzheimer’s. That’s a win for everyone!

See you in the pool!

Author/Instructor Photo
Chris Alexander

Osteoporosis and Water Exercise

Osteoporosis is a disease characterized by loss of bone mass. The image on the left illustrates normal bone and the image on the right illustrates osteoporosis. A loss of bone mass increases the risk of fractures. Osteoporosis affects more than 10 million adults in the United States. The lifetime risk for a fracture due to osteoporosis is 40-50% for women and 13-22% for men. It used to be thought that osteoporosis is a normal part of aging, but it is now understood to be preventable and treatable. The strategies to reduce fracture risk include adequate combined intake of calcium and vitamin D, medications, weight bearing and/or resistance exercise, avoiding tobacco use, moderate alcohol use, and reducing the risk of falls.

The kind of weight bearing exercise recommended by the Bone Health and Osteoporosis Foundation (BHOF) includes high impact exercise such as tennis, running and jumping rope, and low impact exercise such as using an elliptical machine and fast walking. The kind of resistance exercise recommended includes using free weights, elastic bands or body weight. Water exercise is not listed among the recommended exercise. The buoyancy of water seems to be responsible for the idea that exercise in water has no impact and therefore is not beneficial for the prevention or management of osteoporosis. Research on water exercise and osteoporosis has been ongoing since the 1990’s and the evidence increasingly shows that water exercise can indeed be included in the toolbox. Nineteen studies were referenced in an article written by Flavia Yazigi PhD and Mushi Harushi MS entitled “Aquatic Exercise Against Osteoporosis.” It appeared originally in Akwa magazine published by the Aquatic Exercise Association (AEA) in April/May 2016; it was updated in 2019. AEA published four articles on the latest research in various issues of Akwa magazine in 2021. To read the articles you have to be a member of AEA. To join, click on the link to their website and then you can access past issues of Akwa. Below is a sampling of the findings written up in these articles.

Kimberly Huff, MS in her article “HIT It Before You Break It” in the April/May 2021 issue of Akwa, notes that the strength of bone tissue is dependent on the amount of stress placed on the bones. Muscles are attached to bones, so the more forceful the muscle contraction, the more stress on the bones. A combination of high impact training and high intensity resistance training has the greatest effect on bone density, as noted by the BHOF. A combination of high impact aquatic jump training, such as vertical and lateral jumps, tuck jumps and ankle hops, or high intensity interval training (HIIT) in which participants worked at near maximal effort, plus high intensity resistance training performed in water showed improvements in bone density and muscular strength and power nearly as effective as land-based training. Maximal effort was determined using either perceived exertion or by requiring participants to keep pace with a set cadence. Information on aquatic exercises to use for interval training and how to progress them to high intensity is available in my book Water Fitness Progressions. Resistance training should focus on the hip, spine and forearm as those are the areas of the body most susceptible to fractures. Squats, lunges, leg extensions, leg curls, hip extensions, chest presses, shoulder presses, biceps curls and triceps extensions address these areas.

Flavia Yazigi PhD lead a study (Yazigi at al., 2019) that looked at deep water exercise and found that it offers benefits to individuals with osteoporosis when the workout is based on aerobic and resistance exercises. The entire body, except for the head, is subjected to constant hydrostatic pressure in deep water. Water resistance acts in the opposite direction of body motion, therefore greater muscle activity is required. Muscular strengthening is enhanced, particularly when near maximal effort is exerted.

Eduardo Netto, MS, in his article “Osteoporosis – Can Exercise Help?” in the June/July 2021 Issue of Akwa, points out that there is no one specific exercise protocol suitable for everyone. Young or healthy people may engage in activities with high loads such as tennis, running and jumping rope, but older people may need to increase their level of exercise with activities with less impact, such as walking, complemented with resistance exercise using free weights. Since aquatic exercise has presented numerous benefits for the maintenance and prevention of osteoporosis, individuals have the option of choosing the exercise mode that most appeals to them. Interestingly, several studies have observed higher participation in aquatic exercise compared to land-based exercise. The best exercise is, of course, the one you do frequently.

Alex Mong, a student at West Virginia University studying exercise physiology, in his article “Balance Is Key: Aquatic Exercise to Improve Bone Mineral Density” in the June/July 2021 issue of Akwa, points out that falls which can lead to fractures are an issue for people with osteoporosis. According to the National Council on Aging, 1 in 4 Americans over the age of 65 falls each year. Improving balance is the most important thing that can be done to reduce the risk of falling. However, once someone has fallen and broken a bone, they often become inactive out of fear of falling again. Exercise in water reduces the risk of injury from falling while exercising. It also helps with balance because the buoyancy and viscosity of water makes participants who are afraid of falling feel more secure. There are many exercises that can be done in water to improve balance, such as gait training, hip and trunk stabilization, muscular strengthening, exercises focusing on the ankles, and unpredictable commands to improve reaction time.

Brianna Martinez, BS, Eric Leslie, MS, and Len Kravitz, PhD wrote “Exercise for Bone Health: What Can Aquatic Exercise Do?” in the December 2021/January 2022 issue of Akwa. They summarized nine research studies done in the past decade on osteoporosis and water exercise. The authors conclude that research shows water exercise improves bone mineral density, which makes aquatic exercise an exciting alternative to traditional resistance training and land-based exercise for bone health.

The Bone Health and Osteoporosis Foundation may not have any information on water exercise on their website, but they have a lot of additional information about osteoporosis for both healthcare providers and patients. Click on the link to check it out. There are also support groups for people with osteoporosis. Bone Buddies is a free support group that meets on the second Saturday of each month on Zoom at 10:00 AM Central Standard Time. To attend a meeting, go to https://us02web.zoom.us/j/83301196518 The meeting ID is 833 0119 6518. The Passcode is Unity. For more information, you can contact the facilitator, Elaine Henderson, at esenderson214@gmail.com

See you in the pool!

Author/Instructor Photo
Chris Alexander

The Benefits of Water Exercise

Here we are at the beginning of 2021 and not sorry to see the end of 2020. Many of us had to give up our fitness routines last year because COVID-19 closed the gyms and we were sheltering in place. And many of us lost some level of fitness and gained weight as a result. Now we have vaccines, and although we have to continue to wear masks and social distance for awhile longer, we can look forward to the day when it will be safe to get back to working out as we did before COVID. Even if your fitness routine did not previously include water exercise, there are many good reasons to consider working out in the pool. The properties of water provide these benefits.

Buoyancy. Buoyancy is the upward vertical force of water. This force allows you to float and decreases the compression of your joints. As a result, you are able to exercise with greater range of motion, which improves flexibility. People with joint issues experience decreased pain, which is why water exercise is so popular with people who have arthritis. Buoyancy reduces the body’s weight by 90% in neck deep water, by 65-75% in chest deep water, and by 50% in waist deep water. People who cannot exercise on land, where they must bear their full weight, are able to exercise comfortably and vigorously in the water. Water exercise is ideal for the obese who tend to drop out of other forms of exercise because it is too uncomfortable. Buoyancy is responsible for the feeling of fun many people experience in the water, even when they are working hard. It is the reason why so many people who try water exercise end up staying with the program.

Drag Resistance. It is often said that the resistance of water is 12-14X greater than the resistance of air on land. In fact, the resistance depends on how much force you are using when you move your limbs through the water, since the harder you push, the harder the water pushes back. Drag resistance slows movement down. This allows you to perform rebounding moves and other sports-based activities without risk of injury, while at the same time improving skills. Drag is experienced with every movement in every direction, which means you have a constant muscle load provided by water. People who exercise in water see improved muscular strength and endurance. Both of the muscles in opposing pairs are worked equally, which promotes muscle balance. It used to be thought that water exercise was not a good option for maintaining or improving bone density. But when researchers looked at water exercise as resistance exercise instead of weight bearing exercise, they designed experiments in which participants performed strength training exercises with maximal effort and without shortening the range of motion. The results were increased bone formation in post-menopausal women. Similar results were obtained in a study that looked at aquatic high intensity interval training. The key for both is maximal effort and full range of motion.

Hydrostatic pressure. Hydrostatic pressure is the pressure exerted by the molecules of water on an immersed body. This pressure is exerted equally on all surfaces of the body, and it increases with depth. Hydrostatic pressure decreases swelling, especially in the lower extremities which are immersed more deeply. This is one reason why aquatic physical therapy is often prescribed for certain injuries and conditions. Hydrostatic pressure is exerted on the chest cavity, which helps condition the muscles of respiration to inhale deeply and forcefully.

Water exercise improves cardiovascular fitness. Immersion relaxes the blood vessels so that they can carry more blood while presenting less resistance to the heart, which is pumping that blood. This decreases blood pressure. Decreased blood pressure lingers for awhile after you get out of the pool. With regular aquatic exercise, the vessels themselves become more pliant and supple. Since stiffening of the blood vessels is a primary factor that causes blood pressure to increase with age, keeping them pliant reduces the risk for hypertension. The hydrostatic pressure of the water pushes blood out to the extremities, and in combination with more supple blood vessels, stroke volume and cardiac output increases. This means that the heart becomes more efficient, pumping more blood with each stroke. Blood flow to the muscles during water exercise can increase an amazing 250%. With this kind of blood flow, heart rate is lowered. Target heart rates while exercising in shallow water average about 7 beats per minute lower than the same intensity exercise on land. The exact number of beats depends on many factors, including the fitness level of the individual. An added benefit of increased cardiac output is that a greater blood volume is pushed through the kidneys, which in turn improves kidney function and increases urine output.

The working muscles and kidneys are not the only beneficiaries of improved cardiac output. Blood flow to the brain increases progressively with immersion from zero depth to shoulder depth. The blood flow persists throughout the exercise period, delivering oxygen and nutrients which the brain uses to repair and regenerate brain and nerve cells. It is reasonable to assume that this would help slow the deterioration of age-related brain performance.

Conclusion. Water’s properties of buoyancy, drag resistance and hydrostatic pressure have many benefits. Water exercise improves flexibility, decreases pain, allows you to exercise comfortably, slows movement down reducing the risk of injury, improves muscular strength and endurance, promotes muscle balance, increases bone formation in post-menopausal women, reduces swelling, conditions the muscles of respiration, improves cardiovascular fitness, decreases blood pressure, improves cardiac output, improves kidney function, and slows the deterioration of age-related brain function. As if that weren’t enough, most people perceive water exercise as fun. When it is time for you to resume a pre-COVIC exercise routine, I hope to see you in the pool.

Resources: Information for this article comes from Dr. Bruce Becker, Director of the National Aquatics & Sports Medicine Institute and other researchers https://www.playcore.com/programs/water-immersion-works and the Aquatic Exercise Association’s Aquatic Fitness Professional Manual (2018) https://aeawave.org/Shop/Books For more information on water exercise, see my book Water Fitness Progressions available from Amazon.

Author/Instructor Photo

Chris Alexander

Keep Your Muscle Mass

Image result for muscles clipart

Your muscles grow until around age 30 and after that they begin to decline. If nothing is done to prevent this loss of muscle mass, the end result is loss of grip strength, difficulty picking up heavier objects, trouble rising out of a chair, and an inability to get up off the floor. Who wants that?? The good news is that loss of muscle mass in not an inevitable part of aging. Like the saying goes, use it or lose it! Using it means strength training.

The American College of Sports Medicine recommends that every adult perform activities that maintain or increase muscular strength and endurance for a minimum of two days a week. Adults over 65 should strength train two to three times a week. In other words, the older you get the more important strength training becomes.

You can strength train at home using bands. You can perform exercises that use your own body weight such as push ups, planks and wall sits. You can go to a gym and use free weights or weight machines. Most gyms have someone on staff who can show you how to use the weight machines. Or you can hire a personal trainer who can design a personalized strength training program. Ideally you will mix things up and do a variety of strength training routines. Lift the weight quickly but take 3-5 seconds to lower it. Choose 8 to 10 exercises targeting the major upper body, mid body and lower body muscle groups. Healthy adults should do 8-12 repetitions of each exercise with a weight heavy enough to be challenging but not so heavy that you have to strain to lift it. Older adults should do 10-15 repetitions using lighter weights.

You can also do your strength training in the pool. This requires some effort on your part. It is possible to do the exercises in your water fitness class by gently moving through the water, slicing your hand to minimize the resistance, possibly chatting with other exercisers at the same time. There may be benefits to this, but improving strength is not one of them. Instead of slicing, move your fist through the water, or even better, present an open hand with the fingers slightly cupped. Push hard against the water, with as much speed and power as you can. The harder you push, the harder the water pushes back. You want to create turbulence, making white water and waves. This kind of effort requires concentration but it is necessary to overload the muscles so that you can see gains in strength.

Equipment can be added to increase the resistance in water. Choose equipment that you can handle while maintaining good alignment. Then push and pull the equipment through the water with speed and power. Drag equipment, which does not float, can be pushed and pulled in any direction. Buoyant equipment, which floats, needs to be pushed toward the pool floor in order to be effective. The turbulence and waves you create with the equipment lets you know that you are overloading your muscles and improving your muscular strength and endurance.

There are other benefits to strength training. Improving your muscular strength and endurance can help prevent osteoporosis, decrease the risk of heart disease, reduce the risk of falling, and enhance the quality of life. It can postpone the day when you become frail to some time in the distant future. And that’s a very good thing! For more information and lesson plans that have strength training as their objective, see my book Water Fitness Progressions.

See you in the pool!

Chris Alexander

Benefits of HIIT

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HIIT, or high intensity interval training, is popular in all kinds of fitness formats. HIIT was named the #1 Fitness Trend for 2018 according to the American College of Sports Medicine’s world wide survey. During HIIT the goal is to work so hard that it becomes difficult to breathe in enough oxygen to supply the demands of the muscles. You are working at 80-90% of your maximum effort. Once you get to 90% effort, your body’s demand for oxygen exceeds the oxygen supply available. This is called crossing the anaerobic threshold. Your body must now rely on energy sources that are stored in the muscles. Since there is only a limited amount of energy stored in the muscles, this level of intensity can only be sustained for a short time, ranging from a few seconds to 2 minutes, depending on your fitness level. The recovery period in anaerobic exercise is important. If the recovery period is shorter than the high-intensity period, then the body is unable to achieve full anaerobic recovery. Therefore, in most cases the recovery is longer than the work.

HIIT improves both aerobic and anaerobic fitness. It has also been shown to improve blood pressure, cardiovascular health, insulin sensitivity, cholesterol profiles, and abdominal fat and body weight, according to the American College of Sports Medicine. HIIT burns more calories than continuous cardiorespiratory training, especially after the workout. This occurs because the heart and lungs work hard to supply oxygen to the working muscles and after the exercise ends, the body has excess oxygen to consume. About two hours are needed to use up the excess oxygen. This post exercise period adds around 15% more calories to the overall workout energy expenditure.

To increase intensity for interval training in water exercise you can increase the range of motion, increase the speed without decreasing the range of motion, go into the suspended position, and add acceleration by jumping or performing the exercise with power. (See my previous blog post: Make Your Heart Stronger with Intervals.) However to go into HIIT you will need to use two of the intensity variables at once, such as full range of motion with power, or speed with jumping. Try adding power while traveling. Another strategy is to work in two planes at the same time. You can do this by alternating one move in the frontal plane, such as a frog jump, with another move in the sagittal plan, such as tuck ski. A second way to work in two planes is to combine a leg move in one plane with an arm move in a different plane. Examples include kick side to side (frontal plane) with arms sweeping side to side (transverse plane); cross-country ski (sagittal plane) with rotation, hands together (transverse plane); and high kick (sagittal plane) clap over the leg (transverse plane) and under the leg (frontal plane). When you are working at 80% of your maximum effort you are able to grunt in response to questions but can only keep up the pace for a short time. At 90% of your maximum effort you will feel like you can’t do this much longer.

Since periods of high intensity are alternated with periods of recovery, HIIT provides the exerciser the opportunity to experience the extra benefits of intense exercise without creating an experience that is negative or unpleasant. However, not everyone in a class is willing or able to do HIIT. Some may have an injury that prevents them from performing certain moves. Some may have a condition that makes working at that level contraindicated. Some just may not be able to push it hard that day. For safety’s sake, participants should always modify the intensity to a level that is challenging for them rather than trying to keep up with other participants.

My book Water Fitness Progressions has information about HIIT along with sample lesson plans that include high intensity intervals with a variety of ways to configure the intervals. To order the book from the publisher, click on the title. The book can also be ordered from Amazon.com  

See you in the pool!

Chris Alexander