Use it or loose it is an admonition we hear often when it comes maintaning lean tissue (muscle and bone). It It is probably one of the better examples of a a cliche, but the saying does communicate an important truth: our bodies are made for activity, not passivity, and will deteriorate at a surprising rate during inactivity. This is especially true for older adults, who lose lean tissue much more rapidly than the young during periods of physical inactivity.
Loss of muscle mass due to prolonged (which may be defined as as little as a week or two during bed rest) inactivity predominantly affects the largest muscles of the body, the muscles of the legs and buttocks.
Inactivity also poses a significant threat to our health in other ways, and contributes to everything from cancer to heart disease. It has been even estimated that physical inactivity causes as many deaths as smoking, hence the recent jingle “sitting is the new smoking”.
In the population of people 65 years of age and older, decreased levels of physical activity contribute greatly to the epidemic of falls and subsequent injuries. A third of all individuals 65 and older fall each year, and in half of these folks the falls are recurrent
During this time, when the entire population has been encouraged to practice social distancing and work from home, and gyms have closed and everyday movement been minimized, we risk limiting our physical activity and exposure to fresh air and sunlight to levels that pose a threat to our fitness, health and safety.
Physical inactivity also increases pain levels in patients with chronic pain. In all individuals, but especially in those with hypermobility disorders it is imperative to not allow the system of stabilizing muscles to atrophy and weaken due to inactivity, as this is a common turning point for increased pain and dysfunction.
Exercise has a multitude of amazing effects on our body and mind, and we’d do well to harness these benefits at a time
when we all need to support both our mental and physical health.
Movement and resistance training to the rescue
Physical activity has an effect on almost every organ and tissue in the body. It supports immune system function, is important for mood and general wellbeing and, when performed outdoors, strongly contributes to circadian rhythm entrainment (ie our daily sleep-wake cycle). The best intervention to prevent and treat loss of lean tissue is resistance exercise, which simply means that your muscles are straining against an external force, be it a weight, an exercise band or the weight of your own body moved against gravity, when coupled with an appropriate protein intake. However, sitting all day and only moving once a day for exercise may not do the trick, either, as there is some proof that sitting 13 hours a day or more, easily accomplished, especially during social distancing, may undo all the metabolic effects of the exercise and leave you with the elevated levels of triglycerides and blood sugar that exercise normally counteracts.
For those aged 65 years and older, it is also recommended that protein
intake be increased from 0.8g/kg/day to 1,2 g/kg/day in order to maintain lean body mass.
So how much activity is enough to confer beneficial effects? Is picking one activity that you like enough? Think about it this way: what we call exercise is our way of compensating for the lack of spontaneous movement and hard work that evolution has prepared us for, and consequently expects. Therefore, engaging in only one type of movement, such as walking, is not enough in order to emerge from temporary isolation and inactivity unscathed. Instead, we need variety. All types of physical activity have distinct effects and benefits.
The best intervention to prevent and treat loss of lean tissue is resistance exercise, which simply means that your
muscles are straining against an external force, be it a weight, an exercise band or the weight of your
own body moved against gravity.
DAILY EXERCISE ROUTINE
What follows is a program that will help meet your body’s need for frequent movement through the day, movement for circulation, cardiovascular health and immune system support, and maintenance of lean body mass. It is divided into three sections, with the section for strengthening divided into two subcategories. The sections offer activities of varying levels of difficulty and a chance for variety. Choose the most appropriate levels for you --you should be working hard but be able to maintain good form, or quality of movement,-- and make sure to pick one choice from each group. All exercises should be pain free, but mild soreness at the beginning of an exercise is fine. Follow the traffic light guidelines to distinguish between innocuous soreness and pain as a sign to stop.
Two exeptions to be aware of: perform all three stretches daily, but perform strengthening exercises only every other day if you are able to perform them at an intensity that gives you a bit of exercise soreness the following day.
GROUP 1- Frequent movement through the day
- Briefly stand up every 15 minutes.
- Putter around often through the day. In scientific circles this is known as non-exercise movement and constitutes an important signal to the body to maintain lean tissue.
GROUP 2 - “Aerobic exercise” or prolonged higher intensity movement
Best if performed outdoors when practical and appropriate (note that future directives for social distancing may include avoiding time outdoors, and even in the absence of such directives you should follow the advice calling for keeping a distance of at least 6 feet between yourself an others).
- Walking
- Run- walk (alternating between running and walking)
- Running
- Use of exercise equipment such as stationary bike, elliptical trainer, rowing machine
- Running or bicycling
GROUP 3- Strength training
The most important muscles to strengthen are the muscles of the buttock and legs.
Stabilization exercises:
- Specific stabilization exercises prescribed by your physical therapist
- Push-ups, keeping trunk stable
- Planks
- Trunk stabilization: lying on your back, keeping back stable against the floor, moving legs to add resistance
- Squats
- Lunges
GROUP 4 - Flexibility
- Chest stretch
- Hip flexor stretch
- Back extension, lower and mid back
All types of physical activity have distinct effects and benefits.
IMAGE GALLERY FOR THE EXERCISE PROGRAM
Trunk stabilization exercises
 |  |
| Push-ups: can be performed at varying angles to adapt to your fitness level. | Plank: Tuck tailbone under to keep back flat. Hold for 10-60 seconds at a time. |
Trunk stabilization: lie on your back, pace a pillow under your head as needed. Gently tighten pelvic floor, keeping hips and knees bent as shown in first photograph. While making sure to not allow low back to arch, slowly move one leg at a time away from the body, and return. Emphasize correct form, not moving the leg so far out that you arch your back. (Second photo shows advanced progression, initially lower your leg only few inches. Progression depends on your ability to keep your low back stable against the floor)
 |  |
| Squats: initiate movement from the hips, "sticking butt out". Bending at the hips and knees, keeping trunk relatively upright, lower your body as far (or as little!) as your strength and range of motion allows. The lower you squat, the more the buttock muscles work, while a more shallow squat works the front of the thigh. Use a chair to squat into if needed for safety. | Walking (or stationary) lunge: Step forward, lunge straight down, as low as your leg strength allows. Important: Knee must track over the foot, not inside it! This feels as if though you are gently moving your knee outward as you are lower your body.These are also fun to do outdoors while running or walking. |
The single leg squat is a progression of the above lunge shown in the previous photo. Place one leg on a
bench, sofa or chair and lunge down, again keeping in mind that the knee must track in line with the foot,
not to the inside of it it! Prioritize correct form over trying to squat more deeply.
Stretching or "Strelaxing" (aka a relaxed stretch)
Succesful stretching means relaxing muscles, not pulling them. The stretching position allows you to feel the muscle, the stretch itself consists simply of your conscious relaxation of the muscle. Think
"melting', or imagine the body part growing heavy. Hold stretches for 2 minutes or more.
bench, sofa or chair and lunge down, again keeping in mind that the knee must track in line with the foot,
not to the inside of it it! Prioritize correct form over trying to squat more deeply.
Stretching or "Strelaxing" (aka a relaxed stretch)
Succesful stretching means relaxing muscles, not pulling them. The stretching position allows you to feel the muscle, the stretch itself consists simply of your conscious relaxation of the muscle. Think
"melting', or imagine the body part growing heavy. Hold stretches for 2 minutes or more.
 |  |
Chest stretch (specifically for the small chest Mobilization of the upper back. Roll up a yoga
muscle, pectorals minor, that greatly contributes mat, and place it under your upper back (you
to limited shoulder movement). Lie down as can vary the exact position for bets effect).
shown, place a pillow/pillows under your arm as Bend back to straighten the convexity of your
needed. The arm must be supported.Tip hips upper back as shown. This is a back and forth
towards opposite side to increase stretch motion, not a static stretch.
as needed.
A comfortable variation is
simply placing a folded up towel
under this part of your back and relaxing
with arms stretched out
and hips and knees extended,
or, if needed, bent.
muscle, pectorals minor, that greatly contributes mat, and place it under your upper back (you
to limited shoulder movement). Lie down as can vary the exact position for bets effect).
shown, place a pillow/pillows under your arm as Bend back to straighten the convexity of your
needed. The arm must be supported.Tip hips upper back as shown. This is a back and forth
towards opposite side to increase stretch motion, not a static stretch.
as needed.
A comfortable variation is
simply placing a folded up towel
under this part of your back and relaxing
with arms stretched out
and hips and knees extended,
or, if needed, bent.
 |  |
Hip flexor stretching. Choose either option as illustrated above. The stretch is diffuse and felt
across your groin area. Remember to remain comfortable and relaxed. Stretching is about relaxing
muscles, not pulling or forcing.
Those hypermobile individuals whose hips joint tend to subluxate forward should be careful not to lunge forward to far and too deeply while performing a single leg squat or walking or stationary lunge, and should keep their upper leg supported by the bed in the image above, completely avoiding hip stretch option number two.
*****
Remember: there is still much to enjoy, and stressful times can also contain good times. Enjoy the things you can do, things you perhaps now have the time to do. Enjoy the time with, and exercise together with, your family members. By balancing activity with relaxation you will support both your musculoskeletal system and your emotional health
across your groin area. Remember to remain comfortable and relaxed. Stretching is about relaxing
muscles, not pulling or forcing.
Those hypermobile individuals whose hips joint tend to subluxate forward should be careful not to lunge forward to far and too deeply while performing a single leg squat or walking or stationary lunge, and should keep their upper leg supported by the bed in the image above, completely avoiding hip stretch option number two.
*****
Remember: there is still much to enjoy, and stressful times can also contain good times. Enjoy the things you can do, things you perhaps now have the time to do. Enjoy the time with, and exercise together with, your family members. By balancing activity with relaxation you will support both your musculoskeletal system and your emotional health
Related note: the significant difficulty I experienced finding photos for this newsletter, correctly demonstrating a particular exercise or stretch, reminded me of how much incorrect advice is circulating on the internet. Be discerning when taking in such information, and always consider the source.
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