By Erica Lesperance, RD, LD

Why don't we start with a little bit about your background and what made you interested in becoming a physical therapist.

I started out originally in education, because most of my generation did. I had a college professor who was a physical therapist, and he suggested I volunteer at what was then the New York State Hospital in Haverstraw, which I did for the summer, and really liked it. So the following September, I was back in school and enrolled in the Physical Therapy Program at New York University. I have been incredibly happy ever since in making that decision.

And was the program different then, in that you did not have to become a doctor in physical therapy?

It was very different then. The majority of my generation came from physical education/education backgrounds before we went into physical therapy, so we had a very strong exercise background and a very strong education background. As the field evolved, we were expected to be the persons of first jurisdiction, where patients and clients could come to us without referral of the physician. Now our educational requirements include a baccalaureate degree with a heavy science concentration and three years of physical therapist education after that, leading to a Doctor of Physical Therapy degree.

You mentioned being able to come to you without referral from a doctor. Many people may perceive going to a physical therapist as something you do for healing from an injury. Do you recommend that people do physical therapy as a preventative measure?

Absolutely. And the preventive aspect of physical therapy services was one of the very strong motivating forces that both I and my coauthor, Carol Lewis, had in getting this book out into the public. If you are trying to get yourself in shape at a later age without knowledge of what you should be doing, you often get yourself in trouble.

So you should see a physical therapist first?

Yes. The physical therapist is the one who has a very solid grounding in all the anatomical and biological sciences and also in the patho-physiological processes of what goes on with ageing and what we need to be careful about when we start an exercise program.

How would you say that the media is responding to your book?

The response has been wonderful. We were very fortunate to have Jane Brody mention our book in the New York Times; we have also appeared in multiple cities across the country. I recently did an interesting interview for a music performers' website. Whether you are a musician, an athlete, or whatever you do that requires physical activity, you really need to condition yourself for that activity and not use the activity for conditioning. So instrumentalists, pianists, bass players, and others should be well-conditioned for their activities.

Let's move on to the main crux of your book, the five domains of fitness. Can you give me a brief explanation of all five domains?

Absolutely. The first one is posture. We know that posture changes over time. Just look at people walking along the streets in any area of the country and you will see forward heads and rounded shoulders at all ages. These changes obviously get worse as we get older unless we concentrate on good posture. A lot of that has to do with alterations that occur in our boney structure and in our muscle tone, and if we don't stand in that beautiful upright posture on a regular basis, we may potentially wind up with a dowagers hump and faulty posture.

I am interested in hearing how poor posture can wear you out or contribute to a lack of energy.

I think if people happen to have the book, they can certainly take a look at some of those very easy things we did in the very beginning that will give them an immediate understanding of what poor posture does. The first thing we have them do is stand up, move the head forward, and round the upper back (just basically assume a slumped posture). And then, we have the reader try to take three deep breaths. Then the reader stays in that same awful slump position, and turns the head from side to side, tries to raise the arms up over head, and then tries to tap the teeth together. Then, we have the reader pull the chin in, straighten himself/herself up as much as possible, drop the shoulders slightly down and back to totally straighten the spine. Then we ask the reader to do the same four things again in good postural alignment. When they take in that deep breath, they will see that they have opened up the chest cage and are able to expand the lungs so much more. Turning the head in good postural alignment will allow for greater degrees of range of motion. Raising the arms up over head will also be easier, and they will go further up.

Very interesting. I think people don't understand the effect posture can have; they think it's something that looks bad.

Exactly. As opposed what it is physiologically doing to the body.

And the next domain?

Next is strength. One of the greatest problems that we are facing with the elderly is sarcopenia, which is a reduction in muscle size and changes in the muscle fibers. Strength loss occurs as we age, unless we pay attention to strengthening on a regular basis. We experience about a thirty percent decline in strength between the ages of thirty and eighty years. So we have to be attuned to the fact that these changes are starting in our thirties. Obviously, they become more and more noticeable as we get older, unless we intervene. To continue to be able to stand up from a chair, climb stairs, get on a bus, and carry groceries, we must maintain appropriate strength. Strength decline doesn't really have to occur with ageing if we do the things that we need to do to keep up our muscles really strong.

That's interesting because a lot of people say that's just what happens when you age.

That is true. That's what people have believed for ages. Yet there are so many things that we can do to preclude these changes from occurring. It may take a lot more work to get the same strength gains the older we get, but it does not mean that we can't strength train. There are many studies that have been done in nursing homes and senior centers, on individuals ninety years and over, who have been able to significantly increase their strength with a strength training program that appropriately and correctly overloads the muscles.

That's amazing. So the next domain is balance?

Yes, and the age-related changes that affect balance are in multiple systems. Obviously, our vision tends to go and vision is very involved with balance. One of the things I always have people do if they are not convinced about the vision/balance connection is rise up on their toes and then lift one foot off the floor, hold on with one finger of one hand on a solid supporting surface, and balance themselves. And then I ask them to do the same thing with their eyes closed. They will see an incredible difference in how much more difficult it is to do with the eyes closed. So our vision has a lot to do with our balance. In addition, if we do not have appropriate muscle strength in our lower legs, maintaining balance is extremely difficult. From my perspective, this whole domain is one that we pay the least amount of attention to, and as we get older we should be paying more and more attention to balance. I try to make it easy by telling my clients just to practice standing on one foot when they are brushing their teeth. Anytime they are at their desk on a long telephone call, I tell them just to stand up and do some balance work. Because the more you do it, the stronger the balance component gets.

Right. And certainly, declining balance leads to falls.

Right. And falls are probably one of the most costly problems that we face here in the United States.

Now let's move on to flexibility.

Most people don't spend as much time stretching as they should, and all of a sudden they wake up in their forties and fifties and they are not quite as loose as they used to be. Many times one of the first signs comes when driving a car. They try to turn their head to see out the rear or to look to the side to see if anything is coming, and they think, Oh my goodness! I can't turn my head that far anymore and they wind up turning their whole body around or asking their spouse who happens to be sitting next to them to please look and see if the road is clear. So again, the flexibility changes certainly come as we age. Connective tissue is probably the key thing as far as flexibility is concerned. Connective tissue is a collagen protein substance that is found in the coverings of all of our body parts, foremost in our tendons and joints. It covers our muscles, it's in our ligamentous structures, and it's also in our skin. Instead of collagen being nice and soft, it becomes less pliable, less elastic as we get older. In order to keep ourselves stretched out, we have got to do flexibility exercises.

There is controversy over whether or not you should stretch before you exercise. What are your thoughts on the timing of stretching?

All the data really show that the greatest ability to stretch comes after the aerobic activity. The body and the tissues are warmed up, so they are going to be more pliable. But I never like anybody to go out cold. If they are going to go out and start jogging, they should do some warm up, like an easy fast walk, swing the arms around, do a knee to chest, maybe do a little hamstring stretch. You don't need to do a lot, just enough so that you're warm when you start the activity. But certainly, the greatest stretches are always going to come after the aerobic activity.

And what's the danger of going out cold?

You can tear a muscle or pull something. The body is better warmed up a little bit before you engage in any kind of more strenuous activity.

And the final domain is endurance?

That's right. The age changes that occur with endurance are related to our heart, lungs, and muscles. But you can also preclude a lot of those changes with a good aerobic endurance activity. And my concern with any kind of aerobic endurance activity is that you have got to love what you are doing. I do not care what it is. If you want to step, you can climb stairs. I have patients who use the stairs in their apartments. If they do not have time to do aerobic activity, I ask them what floor they live on, and if they tell me the eleventh floor, I say Okay, I want you to build up to walking up eleven flights and down eleven flights. I don't care whether they would do it outside or inside, or if they go to a health club or not. Whatever works within their lifestyle is what they should do to effectively incorporate the endurance activity into their life.

As a runner, I have often been warned that this high impact version of an endurance activity is too hard on my body. But I noticed you cited a study that concluded that high impact exercise improves bone mineral density, muscle strength, and balance with no increased risk of fracture. So how do you respond that charge that running is too hard on the body?

It depends on how much you do and the surfaces you run on. Runners should have superb sneakers, and I suggest that they put in a gel insert in the sneaker as well. If they have any tendency towards flat arches, they should have an arch support. Increasing flattened arches can eventually lead to placing abnormal stresses on the knees. They should also do strength training of their legs, so that their legs can withstand the impact. And if at all possible, it's always better to run on softer surfaces such as a grassy track or even a soft track, rather than on hard cement pavement. If they use the treadmill, many treadmills nowadays have soft tracks, so they actually have a little bounce to the track.

So it seems like there are a lot of exercises we should be doing to keep all five domains in check. I can just hear people arguing that they are too busy. How would you respond to that?

You have to fit the program in to your life. I have an incredibly busy life. I basically have three jobs and probably about six other responsibilities on the side. Do I love to get up at quarter to six in the morning and jog around Washington Square Park? Not always. Do I do it? Absolutely.

Because you understand the importance of it.

Correct. I do my stretching when I am cooling down. I am sure people think I am nuts walking around the park as my head is turned and my neck has been tilted to the right or left, but I do not care. Because it enables me to multitask. The same thing when I am at the office, I will walk on my toes, on my heels, and do a tandem walk as I am going from place to place for balance. I also do other balance activities during the course of my day. I leave my weights underneath my desk, and when I take a break for five minutes, I lift some weight. So there are tons of ways that you can build these things into your life.

Right. You've got to be prepared for it.

Certainly with the aerobic activity, people may find it easiest to do if they can find a partner. Because if you have to meet somebody to walk, or jog, or bike, or whatever it is, you are much more likely to get up and do it.

So the bottom line is nobody is too busy. It is just a matter of whether or not they have made activity a priority.

Right.

Finally, can you give me an example of a client who has really turned a corner by following your advice?

A former patient of mine, who is now about ninety-five years old, has major osteoporosis and multiple arthritic problems. Her daughter called me about eight months ago and said, Help. I do not want to be like my mother. She has a slight scoliotic curve and she said, I just see my mom, and I see my scoliosis and I am osteopenic so I have got to start. And eight months later, she is in fabulous shape. She is lifting eight-pound weights three days a week, and she is doing her aerobic program four days a week. Her postural alignment is as straight as it can possibly be, considering her scoliosis, and she looks fantastic when she walks in the room.

Wow!

But it took taking a look at her mom, and I think that's we all need to do. We need to look at our mothers and fathers. We inherit those genes whether we like it or not, but that doesn't mean we can't influence our aging process.

Your book seems like a great way to do that. I found it very easy to follow.

We have certainly heard that comment from hundreds of people, and I give all the credit in the world to Peachtree Publishers for enabling this to happen. We were so pleased with the final product.

Well, I think that's all I have for you. It was very nice talking to you and very motivating.

Well, you know I love what I do. I try to practice what I preach in a big way, and I hope this will give thousands of people the opportunity to really begin to get their bodies in shape in a very sane, sensible way.