Podcasts about clin interv aging

***SUMMER REWIND  - INITIALLY RELEASED ON 31ST JAN 2024*** To get in touch: primarycarepodcasts@gmail.com Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Doctors Lisa and Sara talk to Senior Pharmacist Sarah Hafeez about Polypharmacy. She explains the difference between inappropriate and appropriate polypharmacy before talking through some typical cases that illustrate several examples of common scenarios.  This leads to discussions on prioritising concerns, weaning/stopping medications, counselling patients on the effects of Opioids and Gabapentinoids and involving community teams aiming for successful reductions of addiction forming medications. Other gems include a discussion of the potential long term risks of Proton Pump Inhibitors and advice on weaning, remembering to consider anticholinergic burdens as well as handy resources for tackling Polypharmacy, Structured Medications Reviews and medication reductions. You can use these podcasts as part of your CPD - we don't do certificates but they still count :) Useful resources:  Greater Manchester Medicines Management Group: Inappropriate Polypharmacy Review and Treatment Optimisation: Resource Pack (from Dec 2022, accessed Dec 2023): https://gmmmg.nhs.uk/wp-content/uploads/2023/02/GMMMG-Polypharmacy-resource-pack-v3.0.pdf Scotland Polypharmacy Resources for Professionals and for Patients: https://www.polypharmacy.scot.nhs.uk/for-patients-and-carers/ Scottish Polypharmacy Guidance 2018: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf Lewis T. Using the NO TEARS tool for medication review. BMJ. 2004 Aug 21;329(7463):434. doi: 10.1136/bmj.329.7463.434. PMID: 15321901; PMCID: PMC514207 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC514207/ Toolkit for General Practice in Supporting Older People Living with Frailty (includes a great Appendix of the STOPP/START criteria (2017): https://www.england.nhs.uk/wp-content/uploads/2017/03/toolkit-general-practice-frailty-1.pdf An example of an Anticholinergic Burdon Resource from West Essex CCG 2020: https://westessexccg.nhs.uk/your-health/medicines-optimisation-and-pharmacy/clinical-guidelines-and-prescribing-formularies/04-central-nervous-system/61-anticholinergic-side-effects-and-prescribing-guidance/file Canadian Resource for Deprescribing including reducing medications and some patient information leaflets: https://deprescribing.org/ Resource for help reducing and stopping medications: https://medstopper.com/ Me and My Medicines Resource for Patients to look through their medications before reviews or for information: https://meandmymedicines.org.uk/ Anticholinergic Medications and Risks of Dementia Cochrane Editorial with Reports in Link (Sept 2021): https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000154/full Anticholinergic drugs and risk of dementia: Time for action? British Pharmacological Society. Bell B et al Jun 2021 (9:3). Accessed 15/1/2024:  https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1002/prp2.793 Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder. Clin Interv Aging. 2020; 15: 1493–1503: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457731/ Greater Manchester Medicines Management Group: Management of Overactive Bladder Including a simple Bladder Diary before and after stopping Medications (Jun 2019): https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Management-of-OAB-in-adults-v3-0-approved-Aug-2019.pdf ___ We really want to make these episodes relevant and helpful: if you have any questions or want any particular areas covered then contact us on Twitter @PCKBpodcast, or leave a comment on our quick anonymous survey here: https://pckb.org/feedback Email us at: primarycarepodcasts@gmail.com ___ This podcast has been made with the support of GP Excellence and Greater Manchester Integrated Care Board. Given that it is recorded with Greater Manchester clinicians, the information discussed may not be applicable elsewhere and it is important to consult local guidelines before making any treatment decisions.  The information presented is the personal opinion of the healthcare professional interviewed and might not be representative to all clinicians. It is based on their interpretation of current best practice and guidelines when the episode was recorded. Guidelines can change; To the best of our knowledge the information in this episode is up to date as of it's release but it is the listeners responsibility to review the information and make sure it is still up to date when they listen. Dr Lisa Adams, Dr Sara MacDermott and their interviewees are not liable for any advice, investigations, course of treatment, diagnosis or any other information, services or products listeners might pursue as a result of listening to this podcast - it is the clinicians responsibility to appraise the information given and review local and national guidelines before making treatment decisions. Reliance on information provided in this podcast is solely at the listeners risk. The podcast is designed to be used by trained healthcare professionals for education only. We do not recommend these for patients or the general public and they are not to be used as a method of diagnosis, opinion, treatment or medical advice for the general public. Do not delay seeking medical advice based on the information contained in this podcast. If you have questions regarding your health or feel you may have a medical condition then promptly seek the opinion of a trained healthcare professional.

Curious about your micronutrient status? Wonder if you're still deficient even though you take a multivitamin and eat a whole foods diet? Want to know how a simple blood test can tell you exactly what to supplement with and what foods to focus on? Tune in to learn about micronutrient testing--from the mechanisms of testing, to why you might be deficient in the first place, to how you can use this data to optimize and thrive!    In this episode, we will cover micronutrient testing and what trends of deficiency can tell you about your health. Even if you eat “healthy” you can be deficient based on increased demand, inability to absorb or use, inadequate intake. Testing micronutrients can play a turnkey role in your wellness as we can see beyond the nutrient itself and see the story of the deficiency trends to address the root cause of imbalance. Plus we'll explore case studies, from a postmenopausal woman to a carnivore to someone dealing with chronic fatigue and brain fog and discuss actual interventions that made a world of difference for these clients!    Get the Cellular Nutrient Analysis Micronutrient Panel for only $374 with code MNT25 Includes a customized email review from Ali or Becki with diet, lifestyle & supplement recommendations!   Also in this episode:  Episode 261: Micronutrient Testing and Our Personal Results Episode 177: Why You Need Supplements Episode 178: Why You Need Supplements Part 2 Episode 247: Drug Induced Nutrient Deficiency How the Cellular Nutrient Analysis is different from a serum blood test Why you may be deficient despite a healthy diet and supplementation Case Study #1: Postmenopausal Woman with weight gain, anxiety, disrupted sleepThyroid Optimizer B-12 Boost Grassfed Whey Calm and Clear Force of Nature use code ALIMILLERRD Superfood Chicken Nuggets Case Study #2: Biohacker Carnivore doing everything right but under high stressB Complex Adaptogen Boost Case Study #3: Chronic fatigue and brain fogMultidefense with Iron GI Lining Support CoQ10 Complex Carnitine Complex Apple Cider Vinegar Shooter Noble Origins Organ Blend use code ALIMILLERRD ResearchArulselvan P, Fard MT, Tan WS, Gothai S, Fakurazi S, Norhaizan ME, Kumar SS. Role of Antioxidants and Natural Productsin Inflammation. Oxid Med Cell Longev. 2016;2016:5276130. Epub 2016 Oct 10. Review. PubMed PMID: 27803762; PubMed Central PMCID: PMC5075620. Angelo G, Drake VJ, Frei B. Efficacy of Multivitamin/mineral Supplementation to Reduce Chronic Disease Risk: A Critical Review of the Evidence from Observational Studies and Randomized Controlled Trials. Crit Rev Food Sci Nutr. 2015;55(14):1968-91. doi: 10.1080/10408398.2014.912199. Review. PubMed PMID: 24941429. Liguori I, Russo G, Curcio F, Bulli G, Aran L, Della-Morte D, Gargiulo G, Testa G, Cacciatore F, Bonaduce D, Abete P. Oxidative stress, aging, and diseases. Clin Interv Aging. 2018 Apr 26;13:757-772. doi: 10.2147/CIA.S158513. eCollection 2018. Review. PubMed PMID: 29731617; PubMed Central PMCID: PMC5927356. Rheaume-Bleue, K. Choosing the Right Vitamin K2: Menaquinone-4 vs Menaquinone-7. Clinical considerations of different forms of vitamin K2. Natural Medicine Journal (October, 2015)  Sanders, TAB., Functional Dietary Lipids, 2016. Linoleic Acid, Shichiri, M., Yoshida, Y., Niki E., 2014, Unregulated Lipid Peroxidation in Neurological Dysfunction, Omega-3 Fatty Acids in Brain and Neurological Health, Retrieved March 23, 2019 from    Sponsors for this episode:  This episode is sponsored by Wild Foods, a company that puts quality, sustainability, and health first in all of their products. They have everything from coffee to turmeric to medicinal mushrooms, and every single product is painstakingly sourced from small farms around the globe. They take their mission seriously to fix the broken food system, and believe real food is medicine. They've partnered with us to give you guys an exclusive discount, so use the code ALIMILLERRD for 12% off your order at WildFoods.co! 

Is offsetting bone losses in menopause with high impact safe? Is it recommended? Aren't you more prone to fractures? This episode explores the recent research in honor of Menopause Awareness Month (and Osteoporosis Day October 20, 2021). If you're trying to prevent, if you've been diagnosed, or if you've got younger women in your life who need this information NOW to be better prepared than we could have known to be… this is for you. Episode sponsor: Flipping50 Fitness Specialist (learn more here about how to become one and grow a successful business while you do it) Bone Losses in Menopause Average bone loss is 1.5% per year for the spine and 1.1% - 1.4% for the femoral neck in the first 4-5 years post menopause. Losses slow slightly after this and then increase again in latter decades. Just 6 months into the pandemic research began to emerge about the long-term health effects of short-term muscle loss. The possible devasting disability includes sarcopenia and osteoporosis both, as well as increases in risk of obesity. A combined loss of muscle, strength, bone, with or without increased body fat sets up females specifically for avoidable negative health effects. Osteoporosis & Exercise Exercise is recommended but often with poor and non-specific guidelines for having the most benefit. The purpose of this post is to: Present the continuum of activity results on bone mineral density Present other valuable components of exercise Support prioritization of exercise time for readers Consider a variety of exercises (and non-exercise) interventions and their results Integrating safety Optimal exercise interventions are those favoring a mechanical stimulus on bone both through antigravity loading and the stress exerted on muscles. Two types of activity for osteoporosis prevention and post-diagnosis therapeutic effects: Weight-bearing activities Strength/Resistance exercises What is weight-bearing activity? Defined as any activity one performs on one or more feet. Technically, however it would also include activity weight bearing on the upper body as in a downward facing dog. Where bone density is concerned, there are levels of weight-bearing. Standing in tree pose is weight bearing. Using an elliptical is weight bearing. Neither of those however has any striking force involved as when there is a heel strike in walking. The greater the strike the greater the force to bone. What is resistance exercise? Technically, resistance exercise is anything that provides additional overload to the muscle (and bone) beyond activities of daily living. Resistance exercise includes use of machine and free weights, body weight, tubing, bands, even water exercise or swimming is viewed as resistance training. Each activity falls along a continuum of benefits. As you might guess, use of machine or free weights will surpass swimming or water exercise for bone density benefits. Use of weight training also surpasses benefits from bands and tubing. Though use of bands and tubing may be a first step, an only option depending on access to dumbbells, or machine weights, or support lateral movements unachievable from free-weights alone, the application of heavy resistance is most beneficial and more closely mimics activity of daily life. Of the two activities for osteoporosis prevention and therapeutic effects, strength/resistance exercise have the greatest benefit. This is due to the overload and what is referred to as Minimal Effective Stress (MES). Minimum Effective Stress Walking alone does not improve bone mass. It may have a limited contribution to slowing bone losses. The limit to benefits of walking occurs due to an effect called Minimal Effective Stress. For example, if you walk 2 or 3 miles several times a week, neither walking more days a week or walking 4 or 5 miles offers more bone benefit. You're already adapted to the stress of your own body weight. What would potentially change or increase bone benefit would be jogging or adding a weighted vest during the walk. (Note: not handheld weights). Similarly, with jogging, once you can jog or run, you don't get greater benefits by running longer or more frequently. In fact, long distance runners who find low body fat, low body weight, may be at greater risk for low bone density. Older runners who do no resistance training with heavy weight are prone to fractures as much (or more if lower body weight) as general population. It's Not All Bone Strength There is also more than the strength of the bone and of the muscle in consideration of activity. As aforementioned, the balance or stability-enhancing benefit of an activity also plays a part in reducing risk of falls. Where heavy resistance exercise is not possible, lighter weight and balance activities alone will still be beneficial, though not to bone, to improved stability and balance. It's important that balance is specific to balance practice. Agility, balance and coordination don't come from strength alone, but must be practiced. For anyone seeking bone density and muscle strength, exercise selection should match those goals. For anyone limited by conditions, injuries, or access, a greater emphasis should be placed on balance and stability, each of which require less equipment. In either case, balance and agility/reaction skills are specific and need to be trained. They aren't just added benefits from strength training. The Research Women in menopause transition are susceptible to muscle and bone losses that lead to sarcopenia and osteoporosis, respectively. That makes them more prone to falls, fractures, and then increasing bedrest and instability leading to frailty and early death. How Much Muscle is Typically Lost? Traditionally, loss of muscle can be about 8% per decade beginning at age 30. There's an annual decline in total body LM during 4 to 5 years of the menopausal transition accelerates. The rapid acceleration of losses over a short period of time sets of alarms. If this isn't countered with sufficient resistance training during that time, or mitigated soon after, it leads to a cascade of events including bone losses.   The accelerated losses do slow again after the surge in early post menopause. Yet, in another decade or more they again accelerate to nearly 1% annual decline in leg LM among women between the ages of 70 and 79. Start at the Beginning The early research for exercise in osteoporosis prevention and treatment was conservative. The list of contraindications for those diagnosed with osteoporosis was long or at least limiting. Recent studies however, explore the intensity of exercise that does more than slows bone losses in favor of that which -even after menopause- where once thought game over, bone density can be improved. Conservative Start Early research scared many women who may have been avid exercise enthusiasts with a passion for downhill skiing or golf, into thinking they couldn't potentially participate any longer. It suggested they suddenly come with a “fragile” label and are resigned to light and safe exercise. One particular study in the Clinical Interventions in Aging journal I've spoke of before but bears mentioning as I kick off this section of a review of studies suggests otherwise. Post- diagnosis, there are considerations, and you have unique needs. You can however, and possibly should, find high intensity exercise that will start and wisely progress that includes both high impact weight bearing exercise and high intensity weight training. That is, includes jumping, as well as heavy weight training. A study intended to be 18 months long was cut short by Covid at 13 months when supervision was no longer possible in March 2020, revealed even without getting to the most intense phase of the program, bone density was improved. In addition, compliance was high, injuries were non-existent.  12-month high impact programs Significantly better results were found in women who did high impact exercise and medication and dietary changes than medication and dietary changes alone. High impact- jumping, hopping, explosive movements was safe and effective 24-week aerobic dance programs Another study in Medicine published in 2019 showed 3 times per week high impact exercise with women not taking HRT, improved bone density. Site-Specific Benefits High intensity exercise is a more effective stimulus for lumbar spine BMD than low or moderate intensity, but not femoral neck BMD, however, the latter finding may be due to lack of power in the exercises performed. Additional Proof for High Intensity High Impact for Bone Losses in Menopause A 2020 study published in the International Journal of Behavioral Nutrition and Physical Activity looked at women 65 and older. For them too higher doses of activity and particularly those involving resistance training are significantly more effective. Let's talk about dose where exercise for bone density is concerned. It's important to know increasing frequency beyond 2-3 times a week is not the best way to increase volume. The better application of volume is increased amount of resistance, and increased sets. This will result in a decreased number of repetitions. While muscle can benefit from greater repetitions (performed with smaller weights), bone cannot. If you are able to lift heavy (defined as reaching fatigue in 10 or fewer repetitions) you will have the most bone benefits. Recent Research is Most Specific While you may choose to believe that yoga, that pilates, that walking improves bone density, you'll want to keep this in mind. In a review of literature including 75 articles, published from 1989 to 2019, results were too variable to conclude exercise effects on osteoporosis. This is proof that some protocols DO and some DO NOT benefit bone density. This makes the statement, “something is better than nothing” questionable if you have a specific goal. You can't do your boyfriend's, your daughters, or your best friend's exercise program and expect the specific results you want without checking the match for your priorities. What we need is an exercisematch.com so you can sort through the prolific options and be sure that if your goal is bone density, or weight loss, or reducing arthritic pain, you are doing the right exercise to match this goal and any limitations. Flipping50's mission is to make this a little easier for you. Other Health Benefits High intensity aerobic activity in a small co-hort of post menopausal women increased HDL, decreased body fat, and improved VO2 (cardiovascular fitness) but did nothing to lean muscle mass. Now, at first glance this is good. At second you might not think entirely. Even with a loss of body fat, because of the decrease in overall weight, metabolism will be lower. Without adjustments in dietary intake ultimately weight regain is likely. A 2018 study in the Journal of Bone Mineral Research employed a protocol of high intensity loads (5 reps to fatigue x 5) for 4 different exercises, including high impact drop jumps. This study too had a high compliance level, one/100 adverse effects (low back spasm), and positive bone density improvements. Yoga Poses for Bone Density Some holes in the yoga study make it difficult to discern if the yoga was exclusively responsible for bone density improvement. There wasn't enough control in the activity and habits of the participants. Monthly gain in BMD was significant in spine (0.0029 g/cm2, P = .005) and femur (0.00022 g/cm2, P = .053). At 22, 22, and 24 months, respectively, 72, 81, and 83 of these subjects reported mean gains of 0.048, 0.088, and 0.0003 g/cm2 per month which is the equivalent 1.152 (22 mos) and .0072 (24 mos). Compare to 24 weeks strength training that include 3.1 ± 4.6%. There's a significant difference both in results. Yoga and Pilates for Bone Density A 2021 study published in PLoS One showed only non-significant results on BMD. Benefits do occur for balance and stability. As a means of risk reduction from fall-related fractures there is value in these activities. What we each need to do is determine what is our realistic time spend and co-create a program based on the most influential exercises for each of our unique goals. It is possible to create a program that is inclusive of the high intensity strength training, the high impact (where a wise choice) activity, and the balance and stability building movements. This doesn't have to mean many and separate sessions weekly. Minutes of balance and stability work regularly can be included in warm ups and cool downs. Whole Body Vibration for Bone Density Best indicated for the frail unable to perform other resistance exercises. For greatest effectiveness must contain a component of strength training. There is a degree of improvement in balance and stability from WBV. However, the biggest benefit is from resistance training combined with WBV, not in performing WBV alone. The additional benefit if the platform is available is worth it. The investment in the equipment for home, may not be the best or wisest use of time. There you have it. This summary of recent bone losses and menopause research (provided during Menopause Awareness Month) is intended to get you pointed in the right direction for your exercise journey. References Mentioned: 28 Day Kickstart Fitness Trainers & Health Coaches MasterClass Ageless Woman Summit Stop the Menopause Madness Summit References: Kirwan R, McCullough D, Butler T, Perez de Heredia F, Davies IG, Stewart C. Sarcopenia during COVID-19 lockdown restrictions: long-term health effects of short-term muscle loss. Geroscience. 2020 Dec;42(6):1547-1578. doi: 10.1007/s11357-020-00272-3. Epub 2020 Oct 1. PMID: 33001410; PMCID: PMC7528158. Sipilä S, Törmäkangas T, Sillanpää E, et al. Muscle and bone mass in middle-aged women: role of menopausal status and physical activity. J Cachexia Sarcopenia Muscle. 2020;11(3):698-709. doi:10.1002/jcsm.12547 Hettchen M, von Stengel S, Kohl M, Murphy MH, Shojaa M, Ghasemikaram M, Bragonzoni L, Benvenuti F, Ripamonti C, Benedetti MG, Julin M, Risto T, Kemmler W. Changes in Menopausal Risk Factors in Early Postmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: The Randomized Controlled ACTLIFE-RCT. Clin Interv Aging. 2021 Jan 11;16:83-96. doi: 10.2147/CIA.S283177. PMID: 33469276; PMCID: PMC7810823. Ilinca, Ilona & Avramescu, Taina & Shaao, Mirela & Rosulescu, Eugenia & Zavaleanu, Mihaela. (2010). The role of high - impact exercises in improve bone mineral density in postmenopausal women with osteopenia or osteoporosis. Citius Altius Fortius. 27. Yu, Pei-An MDa,b; Hsu, Wei-Hsiu MD, PhDa,b,c; Hsu, Wei-Bin PhDb; Kuo, Liang-Tseng MDa,b; Lin, Zin-Rong PhDd; Shen, Wun-Jer MDe; Hsu, Robert Wen-Wei MDa,b,c,∗ The effects of high impact exercise intervention on bone mineral density, physical fitness, and quality of life in postmenopausal women with osteopenia, Medicine: March 2019 - Volume 98 - Issue 11 - p e14898doi: 10.1097/MD.0000000000014898 Kistler-Fischbacher M, Weeks BK, Beck BR. The effect of exercise intensity on bone in postmenopausal women (part 2): A meta-analysis. Bone. 2021 Feb;143:115697. doi: 10.1016/j.bone.2020.115697. Epub 2020 Dec 24. PMID: 33357834. Pinheiro, M.B., Oliveira, J., Bauman, A. et al. Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act17, 150 (2020). https://doi.org/10.1186/s12966-020-01040-4 https://www.frontiersin.org/articles/10.3389/fphys.2020.00652/full https://www.frontiersin.org/articles/10.3389/fragi.2021.667519/full Watson, S.L., Weeks, B.K., Weis, L.J., Harding, A.T., Horan, S.A. and Beck, B.R. (2018), High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. J Bone Miner Res, 33: 211-220. https://doi.org/10.1002/jbmr.3284 Lu YH, Rosner B, Chang G, Fishman LM. Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss. Top Geriatr Rehabil. 2016;32(2):81-87. doi:10.1097/TGR.0000000000000085 Fernández-Rodríguez R, Alvarez-Bueno C, Reina-Gutiérrez S, Torres-Costoso A, Nuñez de Arenas-Arroyo S, Martínez-Vizcaíno V. Effectiveness of Pilates and Yoga to improve bone density in adult women: A systematic review and meta-analysis. PLoS One. 2021;16(5):e0251391. Published 2021 May 7. doi:10.1371/journal.pone.0251391

High impact during menopause? Are you thinking that might get you hurt? With the wrong start and progression, it might. If you’re extremely fragile, or have co-existing conditions, it’s also not advised. But for other women transitioning through menopause, you need to look closely at what you’re doing, and what you believe. Two Groups: High Impact weight-bearing + high intensity velocity resistance training 3x a week Or to a control group that performed low intensity work So I’ll ask again, high impact during menopause? With a safe start, a safe progression, and criteria to know what to expect – to feel to not feel, high impact during menopause has it’s place in a quest for longevity. In other words, if you want a “healthspan” that matches your lifespan you need to find some high intensity movement. You can’t wait. You can’t just “walk.” Hear it in the podcast today. (link in bio) Results from a 2021 study featuring postmenopausal women with osteopenia – intended to be 18 mos. which was cut short due to COVID (6 mos. Short). Researchers suspected that for Bone Mineral Density [BMD] results the last 6 months when training would have been most intense, would have reflected even greater changes. The Methods: The Exercise Group performed High Impact activity include jumps and a variety of high impact moves included in an aerobic fitness manner that imposed interval training, and separately performed progressive intense resistance training [RT] to muscular fatigue. The Control Group: performed Low impact walking/marching and stretching and isometric conditioning exercises. Use Code: Pandemicfix for 15% off select digital videos, plus DVD specials at flippingfifty.com (link in bio) Researcher’s reminder: “The most prominent bone decline might occur during the 3-year phase of transmenopause…one year before and two years after the final menstrual period” LIMITED TIME OFFER:  Hip Bone Mineral Density increases didn’t have as much opportunity for change because the most intense training was cut (COVID). *Strength & Power results & differences were also believed less than expected because of abbreviated study (COVID). The unintended early termination of the study due to COVID was unfortunate, but still offers positive effects of high intensity exercise, as suggested in other emerging research studies. You, my dear are not delicate, and treating yourself as if you are, shortchanges your results. Source: Hettchen M, von Stengel S, Kohl M, Murphy MH, Shojaa M, Ghasemikaram M, Bragonzoni L, Benvenuti F, Ripamonti C, Benedetti MG, Julin M, Risto T, Kemmler W. Changes in Menopausal Risk Factors in Early Postmenopausal Osteopenic Women After 13 Months of High-Intensity Exercise: The Randomized Controlled ACTLIFE-RCT. Clin Interv Aging. 2021 Jan 11;16:83-96. Food Flip... last chance! Through Wednesday eve 10pm Mountain

Good lifestyle habits lead to better memory health Even small changes to improve your life, building good habits, can have effects that add up to a point of...  Better health, better cognitive function, and a better life. Your choices will bear fruit. Just like my mango tree. Who doesn’t love mangoes? The sweet smelling fruit is just so good. My family’s mango tree is an old tree, about 90 years old. The tree stopped bearing fruit a few years ago.  It’s been neglected. Fungal growth is spreading around. So we pruned. We planted. We attacked the fungal growth. We made changes here and there. Fortunately, it wasn’t too late to do something about it. Then things started to get better. No, much better! The tree started producing so many fruits that I’ve more mangoes than I‘ve chutney jars, Thai salads and gelato boxes. Yum! Your cognitive fitness is much like the mango tree.- But don’t leave it before it’s too late To be at your peak, to help prevent memory loss starts with the right nurturing, personalised to your situation The small changes in your lifestyle really do matter. Our daily habits add up to a bumper crop of memory health later in life. Habits are powerful. You probably don’t even realise you were doing them. That’s because they’ve been ingrained in your life, in your routine. Harness that power. Imagine being armed with habits that reduce your risks for memory loss. You become more confident. You go into battle ready armed to live life fiercely- on your own terms. Raar! What an image, right? But how do you go about creating and living with those good, daily habits? It’s hard to consistently make good choices that stick. There’s a way though. A way to learn how to successfully build new habits. Six principles that will lead to new, powerful habits. As long as you’re resolute. As long as you’re willing to keep at it. As long as you’re willing to keep grinding. You have your goal, your vision. And I know you can reach it. It is never too late to start. Do you really want to deprive your community of ALL that you can be? In today’s show, you will learn the 6 facets of how to build successful habits. Find out also what is the most often neglected element key to habit formation. Episode Highlights It’s Never Too Late For Change Setting The Right Goals For Developing Behaviour Repetition Leads To Successful Habit Formation 6 Principles For New Habit Success Quick Exercise For Finding Purpose The Biggest Takeaway about Key Lifestyle Factors For Better Health DOWNLOAD THE PDF TRANSCRIPTION   About Our Host David Norris is an occupational therapist who has been in this practice for 20 years. He has dealt with a lot of clients who seek help with their memory loss problems. David began asking himself about how these people can get ahead of these problems. It is then that he started teaching his clients how to improve their brain health to prevent memory loss. David Norris is also the director and founder of Occupational Therapy Brisbane.   Building New Habits It’s Never Too Late For Change My family's 90+ year old mango tree was able to bore fruits after years of not doing so. The tree had been neglected and was experiencing some fungal growth. Support and some tending helped it to thrive again. There is still the opportunity for your body to be primed to achieve as much as possible. Poor conditions increase the likelihood of memory loss happening again. It is never too late to start correcting your illness. Changing our diet can have a dramatic impact on your gut microbiome resulting in improved health and being.  Short exercises will release endorphins and give you improved endurance and focus. Meditation can easily be used to tackle stress. Setting The Right Goals For Developing Behaviour Goals are amazing. But set it too high and you set yourself up for failure. When you fall short of your goals, it’s easy to turn back to what you were doing before and give up. Not having goals though is like going on bushwalker track under dark conditions without a torch. The key is to narrow your vision and take each step at a time.  The step-by-step, methodological activity will help embed that new behaviour. Repetition Leads To Successful Habit Formation Old habits can sneak in and make you undermine your commitment to developing good behaviour like eating healthy. You feel guilt and shame. It erodes your sense of purpose, self, and strength to keep going. You want good behaviour to transform into good habits.  Committing to repetitive action will set you up for success. Habits can deal with anything. You do them even unconsciously. 6 Principles For New Habit Success Setting up supportive environments allows you to build things that trigger the new behaviour. Leverage context by keeping things simple. Do not overcomplicate things.  Eliminate friction or resistance by removing other choices or tasks. Put in place reward systems to support behaviour. Practice and repetition makes a habit stick. Having a sense of meaning to why you’re doing something is a powerful motivator. Quick Exercise For Finding Purpose Before starting, it’s important to be non-judgmental about yourself and be open. Think about what your family member will say about you at your funeral. Think about what your co-worker or community member will share about your impact in their lives. Think about what a stranger who has heard about you would say about you. This exercise will help you figure out what is the most important thing for you. What are the changes that need to be made for you to become that person they all talked about? You can still grow into the person you want to be at the end of your life.   Previously Recommended Resources Articles   The Science of Habit, October 2015. David Neal, Ph.D. Jelena Vujcic, MPH Orlando Hernandez, Ph.D. Wendy Wood, Ph.D. http://www.washplus.org/sites/default/files/resource_files/habits-neal2015.pdf  Exercise dose and quality of life: Results of a randomized controlled trial., Arch Intern Med. 169(3): 269–278. Corby K. Martin, Timothy S. Church, Angela M. Thompson, Conrad P. Earnest, Steven N. Blair (2009)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2745102/ Effects of interval training on quality of life and cardiometabolic risk markers in older adults: a randomized controlled trial. Clin Interv Aging. 2019;14:1589–1599. Published 2019 Sep 4. doi:10.2147/CIA.S213133 Ballin M, Lundberg E, Sörlén N, Nordström P, Hult A, Nordström A. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732517/  Regular exercise and the trajectory of health-related quality of life among Taiwanese adults: a cohort study analysis 2006-2014. BMC Public Health. 2019;19(1):1352. Published 2019 Oct 23. doi:10.1186/s12889-019-7662-8 Chang HC, Liang J, Hsu HC, Lin SK, Chang TH, Liu SH. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806516/ Long-Term Impact of Caregiving and Metabolic Syndrome with Perceived Decline in Cognitive Function 8 Years Later: A Pilot Study Suggesting Important Avenues for Future Research. Open J Med Psychol. 2013;2(1):23–28. doi:10.4236/ojmp.2013.21005 Brummett BH, Austin SB, Welsh-Bohmer KA, Williams RB, Siegler IC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952276/#!po=65.0000  Gonzalez, C. (2006). The European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutrition, 9(1a), 124-126. doi:10.1079/PHN2005934 https://www.cambridge.org/core/journals/public-health-nutrition/article/european-prospective-investigation-into-cancer-and-nutrition-epic/F506B4D995930AD84F74289B5F16D132#  The Microbiome and Mental Health: Looking Back, Moving Forward with Lessons from Allergic Diseases. Clin Psychopharmacol Neurosci. 2016;14(2):131–147. doi:10.9758/cpn.2016.14.2.131 Logan AC, Jacka FN, Craig JM, Prescott SL. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857870/   Books Atomic Habits: The life-changing million copy bestseller by James Clear  Want to get 1% better everyday? Then this book may be just the next step for you. "A supremely practical and useful book, James Clear distils the most fundamental information about habit formation, so you can accomplish more by focusing on less." -Mark Manson   https://amzn.to/2twTRnB    Podcast Episodes Podcast Ep 005: Food, Mood, Microbiome and Your Memory with Dr Amy Loughman Podcast Ep 008: How Your Gut Health Affects Your Brain and Memory Health with Scott C Anderson   The Biggest Takeaway about Key Lifestyle Factors For Better Health Memory Health and making changes to help your body to achieve as much as it can is still possible. Remember the fruitless mango tree that bore again even when it was over 90+ years old. Quotable “Success takes time. Building these habits into your life takes time. These habits that make you into the gorgeous human being that you will be and are, will take time” - David Norris   What was your BIGGEST takeaway from this episode?      All the best  David  P.S. Did you get the free guide?  If not, here’s the link.    Disclaimer: Always seek the advice of your doctor or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

#SRPreqs is on board with strength training too! Tune in for a discussion regarding use of strength training for patients with Parkinsons’s disease.   Ramazzina I, Bernazzoli B, Costantino C. Systematic review on strength training in Parkinson's disease: an unsolved question. Clin Interv Aging. 2017;12:619-628. PRISMA Guidelines Episode   ------------ This episode is sponsored by the Academy of Geriatric Physical Therapy. Check out their FREE resources they've given you, listeners of SRP -http://GeriatricsPT.org/SRP ------------ SRP is brought to you by the generous support of the SRP Game Changers. If you want to Join SRP, Crush Mediocrity, Join the Monthly Meetups, & Get some free swag!...go to

Dr. David Smith. M.D., FAAFP, CMD Dr. Smith is President at Geriatric Consultants of Central Tx, P.A., an Area MHMR Board Member. He serves on various state committees and stakeholder taskforces. He is a Texas Medical Directors Assn. Board Member, and Past President of the American Medical Directors Assn.     References: Dr. David Smith, Documented, Systematic and Individualized Communication With the Attending Physician for Fall Risk Reduction/Injury Mitigation Care Planning, JAMDA 8/18 Tinetti, ME, “Risk factors for serious injury during falls by older persons in the community”, JAGS, 1995 Soriano, TA, et al, “Falls in the community-dwelling older adult: a review for primary-care providers” Clin Interv Aging, 2007

Erinn and Tali talk about multi-domain interventions for frailty as a part of SRP’s Fraily Series, inspired by YOU!   Dedeyne L, Deschodt M, Verschueren S, Tournoy J, Gielen E. Effects of multi-domain interventions in (pre)frail elderly on frailty, functional, and cognitive status: a systematic review. Clin Interv Aging. 2017;12:873-896.   Treating Frailty-A Practical Guide   Methodological Index for Nonrandomized Studies (MINORS) criteria   PROSPERO Page SRP is brought to you by the generous support of the SRP Game Changers. If you want to Join SRP, Crush Mediocrity, Join the Monthly Meetups, & Get some free swag!...go to http://SeniorRehabProject.com/Join

For the Show Notes, see the gemcast website: http://gempodcast.com/2015/11/11/high-risk-medications-and-adverse-drug-events/ Adverse drug events (ADEs) are a major problem among older adults who present to the Emergency Department. ADEs come in 5 types. 1 in 6 hospitalizations among older adults involves an ADE, and half of the hospitalizations for ADEs are deemed preventable. What medications should be used with caution or avoided in older adults? What are safer alternatives? In this podcast we discuss the types of ADEs, which patients are at greatest risk, the highest risk medications, alternatives to the high-risk medications, and ways to prevent ADEs. Leah Hatfield, an ED pharmacist, shares her wisdom. References: 1. By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American geriatrics society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015. 2. Hanlon JT, Semla TP, Schmader KE. Alternative medications for medications in the use of high-risk medications in the elderly and potentially harmful drug-disease interactions in the elderly quality measures. J Am Geriatr Soc. 2015. 3. Alhawassi TM, Krass I, Bajorek BV, Pont LG. A systematic review of the prevalence and risk factors for adverse drug reactions in the elderly in the acute care setting. Clin Interv Aging. 2014;9:2079-2086. 4. Pretorius RW, Gataric G, Swedlund SK, Miller JR. Reducing the risk of adverse drug events in older adults. Am Fam Physician. 2013;87(5):331-336. 5. Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: Inappropriate prescription is a leading cause. Drugs Aging. 2005;22(9):767-777. 6. Saedder EA, Lisby M, Nielsen LP, Bonnerup DK, Brock B. Number of drugs most frequently found to be independent risk factors for serious adverse reactions: A systematic literature review. Br J Clin Pharmacol. 2015;80(4):808-817. Image credit: https://pixabay.com/en/pill-capsule-medicine-medical-1884775/ Sound credits: sounds from freesound.org by Jobro and HerbertBoland