Dr. Jessica Lee – Hong Kong Chiropractor

Information and Thoughts about Chiropractic, Health, and the Human Body.


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“You can do it grandma!” – Exercises to Improve Walking speed in the Elderly

Picture this.  You’re in your car stopped at a red light at an intersection and you see an elderly lady crossing the street.  As she’s slowly chugging along, you take a look at the pedestrian light and it’s starting to flash.  She’s not even halfway across the street.  Your heart starts racing and you think “Come on grandma, you can do it… it’s just a little bit farther. SUMMON YOUR STRENGTH!”  The traffic light is about to turn green…

As we age, an aspect of walking that changes is gait speed.  To walk, more than 1000 muscles need to be working properly to move 200 bones around 100 movable joints (Clark 1995).  Age-associated decrease in gait speed is typically noticeable when a person hits their 60’s.  Once you hit the 70’s, normal gait speed decreases about 12-16% per decade and 20% per decade for fast gait speed (Judge 1996). Normal walking speed is about 1.2-1.4m/s. Once walking speed slows to about 1.0 to 1.2 m/s geriatrics will tend to have trouble crossing the street safely before the traffic light changes (Langlois et al 1997).

Why do older people walk so slow??          

There are several different reasons as to why there is a decrease in gait speed over time.  Some of these factors are:

  • Changes in how big your steps are (stride length),
  • May walk slower to feel more stable
  • Painful joints may hurt when walking so a slower walking speed limits the force absorption at those joints
  • Decreased range of motion from degenerative changes such as osteophytes, etc. in the joints leading to changes in how you walk (motor pattern changes)
  • Decrease in muscle strength due to loss of motor neurons, muscle fibers, and aerobic capacity (ability to use oxygen) leading to decreased mechanical power production
  • Changes in the joint moments and powers so that there is an increase at the hip and decreases at the knee and ankle. [Peak ankle dorsiflexion displacement (moving ankle so toes point to the sky) during gait has been found to be a key discriminating factor between low-performing and high-performing groups of older people living independently.]
  • During normal walking speed, the elderly consume significantly more oxygen (decreased aerobic capacity) for a given distance compared to the younger population, even though the elderly walk significantly slower (Waters et al.)

So what’s so important about Gait Speed anyways? 

It turns out that walking speed has been shown to predict mortality, risk of falls, functional decline, and nursing home placement.

A decrease in gait speed of as little as 0.1 m/s will change a person’s ability to perform their activities of daily living by 10%.  Geriatric people with a walking speed of less than 0.25 m/s are more likely to be dependent on others for 1 or more activities of daily living.  A slowed walking speed may also increase the risk of falls, which can lead to a loss of independent living. Walking speed also has relationships with overall aerobic capacity so it can also be linked to heart health.

An increase in the normal walking speed over a 1-year period strongly predicts survival in the following 8 years.  In this case, there is an almost 60% decrease in relative risk and almost 20% decrease in the absolute risk of death.  This is a big deal as it has been found that this survival benefit still applies even after adjusting for other medical, functional, and psychosocial factors that are known to affect survival, and this effect is very consistent across many different subgroups of people.

What are some exercises to improve gait speed? 

Lower extremity exercises can help to improve muscle force and flexibility, upright balance, and aerobic fitness.  Things like yoga and flexibility training don’t help to increase walking speed, but can increase stride length and hip extension displacement to improve walking in general.

Here are some sample exercises you can try out! [Consult your family physician/chiropractor if you have an existing condition]

RANGE OF MOTION:

Leg Swings 1. Start with left side about 2 feet away from a wall.2. Reach sideways, and place your left hand on the wall for balance.3. Kick your left leg backward and forward repeatedly, balancing on your right foot.

4. Repeat the exercise with your right leg, facing in the opposite direction.

5. Next, face the wall, and place both hands on it for balance.

6. Kick your left leg inward, crossing in front of your right leg, and then outward. Switch legs and repeat.

Knee Sliding 1. Lie down with legs straight and about hip-width apart.2. Bend one knee and slide it along the floor towards the buttock.3. Hold the knee at the maximum range of motion.

4. Return to starting position.  Switch legs and repeat.

Ankle Alphabets
  1. Sit in a chair with your back straight.
  2. Raise your foot slightly off the ground and “write” the ABCs in the air using only your foot and ankle.
  3. Repeat on other side.

STRETCHING:

Calf Stretch
  1. Sit on a flat surface and place a towel around your foot, keeping the leg straight.
  2. With the ends of the towel in each hand, pull your foot so your toes point towards you.
  3. Hold stretch and repeat on other side.
Quadriceps Stretch
  1. Stand and hold a stationary object for balance.
  2. Grasp your ankle or foot from behind
  3. Pull your ankle or foot to your buttocks.  Keeping your thighs parallel
  4. Hold stretch and repeat on other side.
Hamstring Stretch
  1. Sit on a flat surface with one leg straight and one leg bent.
  2. Reach forward to touch your toes on the straight leg. 
  3. Hold stretch and repeat.

STRENGTHENING:

Side Lying Leg Raises 1. Lie on your side with the top leg slightly behind the bottom one.2. Lift your top leg up to about 30 degrees keeping your toes pointed straight ahead.3. Return to start position and repeat.  Switch legs.
Wall Slides 1. Stand with your buttocks and back against the wall.2. Bring feet to 1 foot from the wall, keeping your back against the wall.3. Lower down until your knees are bent to about 60 degrees.

4. Rise back up to starting position. Repeat.

Heel Raises

  1. Stand with your feet apart, hands resting on a chair for support.
  2. Slowly raise your heels off of the floor, keeping your knees straight.
  3. Hold then slowly lower your heels to the floor. Repeat.

These exercises need to be performed on a long-term basis.  Changes won’t be noted right away, but over time you will notice increase in strength and flexibility.  Visiting your chiropractor will help also to improve joint motion so you can perform these exercises and your activities optimally.  A chiropractor can also give you advice on more exercises that you can perform that are customized for you and your goals.

Final Words

Who knew that walking speed is so important?  So teach these moves to your parents, grandparents, great-grandparents, and relatives.  And if you see another elderly lady crossing the street slowly giving you anxiety, give her some tips so she can beat her street crossing time!

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“You already asked that… 5 times…” Alzheimer’s Disease and Chiropractic

Everyone notices that as we get older, there is a decline in our memory abilities.  Suddenly, we forget to buy certain items at the grocery store, we can’t remember where the heck we put our glasses, and what was the name of that person you just met??  While a certain amount of memory decline is expected with age, there is a condition affecting many people nowadays called “Alzheimer’s Disease”.

I recently attended a talk regarding Alzheimer’s Disease that was mainly geared towards understanding what a person with Alzheimer’s may be experiencing and being prepared financially for chronic diseases.  Dr. Lisa Genova, author of “Still Alice” described what it feels like to undergo the disease during the presentation as well.  It made me recall my own grandmother who suffered from Alzheimer’s towards the end of her life and how my mom and sister found it quite tough to care for her.

As this condition is becoming quite common, I have compiled some quick information about it.

What is Alzheimer’s Disease?

Alzheimer’s disease is a brain condition that leads to significant memory loss, making it very difficult for these people to communicate with others.  The circuitry in the brain becomes blocked with clumps of protein called amyloid plaques and neurofibrillary tangles.  It is the most common form of dementia and there is currently no cure.  There are medications available to slow the disease, but nothing that will reverse the damage.  It usually develops after the age of 65; however, there is a genetic type of the disease where people can get it between 30 and 60.  It is much more common in females (72% of cases), and the prevalence is expected to be quite high in the coming years.

Early warning signs include forgetfulness (more than usual and quicker than typical aging), severe feelings of depression, severe mood swings for no reason, confusion, and inability to think and process things as before (such as paying bills).  Other signs include difficulty performing familiar tasks, problems with language, disorientation in time and place, problems with abstract thinking (such as counting), poor or decreased judgment (such as dressing inappropriately), misplacing things in unusual locations (such as watch in the fridge), changes in personality, and loss of motivation.

As a chiropractor, one symptom we may notice of regular patients is a loss of body mass over time.  There is evidence that the loss of BMI in the elderly may clinically predict the development of Alzheimer’s Disease.

There are other conditions that present with dementia as well, so it is important to get checked out early if some of the signs are noticed in order to rule out other causes.

So what are some things we can do to prevent or slow down Alzheimer’s Disease?

  • Long-term physical activity – exercise helps to slow the protein buildup in the brain
  • Engaging in mentally stimulating activities
  • Maintaining social networks and social involvement
  • Don’t smoke!
  • Eat foods rich in antioxidants
  • Eating fish and omega-3 fatty acids
  • Taking heart health boosters such as garlic, coenzyme Q10 and folate

How can your chiropractor help? 

Chiropractors are great at helping you perform at your best.  We can make sure that you are able to exercise and perform your activities without pain and to your fullest ability.  It is important during exercise that your joints and muscles are moving properly in order to prevent injury.  Providing care for any aches and pain that emerge and promoting better body awareness is another role we play.  Acupuncture treatment has been suggested to help with cognitive function, and nutritional advice is something we would be happy to give.

It has been found by Robert Vassar of Northwestern University that when the brain doesn’t get enough of the energy source that it needs, changes occur that leads to the clumps of protein that are the hallmark of Alzheimer’s Disease.  He suggests that improving blood flow to the brain may be an effective therapy to prevent Alzheimer’s Disease.  Based on this information, some chiropractors have suggested that chiropractic neck adjustments may improve the blow flow to the brain and thus, may help prevent/slow this condition.  However, as this correlation has not been studied, we have to be careful before jumping to conclusions and to take this hypothesis with a grain of salt.

For those of you who have a family member suffering from Alzheimer’s Disease, please remember to take care of yourselves as well.  It becomes extremely difficult to watch someone deteriorate in mind and body, so make sure you get the help and therapy you need and to take a rest sometimes.  There are many support groups out there for patients and their caregivers as well.