The Art of Aging Well: Build Strength and Muscle Tone

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Photograph of Skeeter Lifting Weight Courtesy of Trish BrakkoBrats

Photograph of Man Lifting Weight Courtesy of Paul Moore

How to Age Well by Building Strength and Muscle Tone

Guest Blog (Part Two in the Strength Training Series) by Kim Miller, American Council of Excercise Personal Trainer

Our muscles have an innate capacity to respond to stimuli by growing in size, density, and strength. Here’s how to smartly proceed in a healthy aging strength training program weeks 4-12.

Weeks 1-3 of a Strength Training Program

The first 3-4 weeks are designed to learn proper technique as well as allow the ligaments, tendons, and muscles to adjust to the increased stress that will be placed on them incrementally in ongoing weeks. These opening 4 weeks lay the foundation not only for the body physically, but for the mind mentally.

Strength Training Weeks 4-12

There are pros and cons of using machine weights and free weights. As a novice, machine weights will be a much better option in weeks 4 through 12 of your strength training program. Since this time period is primarily to build strength progressively, machine weights will offer more convenience increasing your chance of continuing your new program, as well as allow you to focus more intensely on working each muscle group rather than on correct body positioning. With machine weights, once you are set up properly, there is little room for misalignment.

Basic Machine Set Up With a Trainer

If you haven’t already hired a personal trainer to get you set up properly in each machine, then now would be a good time. At a minimum have the trainer show you the appropriate settings. You should write them down and have the trainer allow you to practice setting each machine as well as executing each machine so that he may provide feedback. This feedback will be invaluable in ensuring you will practice correctly on your own thus decreasing injury occurrences.

It will take a minimum of 4- 5 sessions with a trainer to acquire the basics. During these sessions, ask the trainer for detailed specifics on how and when to with weights and reps. A good trainer will not overwhelm you but will help you make sense of these opening 12 weeks of base strength training and will assist you in making adjustments for physical limitations.

Machines For Base Strength Training

• Leg Extension
• Leg Curl
• Hip Abductor
• Hip Adductor
• Leg Press
• Chest Press
• Lattisimus Dorsi Pull Down
• Shoulder Press
• Bicep Curl
• Tricep Press Down

Days of Training

For progressive strength gains aim for training 2-3 days per week implementing all of the above exercises in the order indicated. It will be necessary to take a day or two off in between to allow your muscles to rest.


Perform each exercise one time aiming for 10 – 12 repetitions for upper body and 12 -15 for the lower body. You should strive to use a weight that is heavy enough that by time you get to the 10th -12th repetition for upper body and 12 -15 for lower body, the muscle is moderately fatigued.

After you have been doing the upper repetitions in three consecutively training sessions then move up in weight. Most weight machines will have increments of 5 and 10 lbs. If you can at least perform 8 repetitions for the upper body, and 10 for the lower body then keep the increased weight and proceed from there.


Since your objective during this 12 week period is to gain strength primarily for healthier aging, one set of exercise performed to fatigue, according to research, is the most effective means for increasing strength. (The reason many people need to do multiple sets is that they didn’t perform the first one at maximum intensity.)

Your main priority should be to focus intently on each exercise and fatique each muscle group thoroughly. Quality, not quantity, is paramount in gaining muscle and bone strength, density, and most importantly a body that ages well!

Until the next posting, think about this, “Healthy aging may not imply living longer, but do you think it can mean living with less disease, more fun and more vitality?” If so, make just one healthy aging change in your life today.

Don’t push yourself to change everthing all at once. There’s no hurry. One change is good. We’ll work on others later. Life is good. Call if you need to. 904-501-6002

Kim Miller, American Council of Exercise Certified Personal Trainer, holds a Bachelor of Science degree in Health and Physical Education from Cleveland State University. ACE is one of the top three accreditation groups in the United States. Kim is also certified as a wellness coach with Wellcoaches. Wellcoaches has earned the coveted endorsement of the American College of Sportsmedicine.

Kim is the owner of BodySmart Inc., and has been writing a weekly health e-newsletter for over a year and a half to an ever increasing readership that extends the globe.

Last Updated May 10, 2010 by Dr. Vee

Oh, My Aching Back! (Dr. Vee Contributed to AOL Health Article)

Photograph of Golfer by Elena Weber

Photograph of Woman Exercising on the Beach by Dusan Zidar

10 Questions About Lower Back Pain

By Deborah Huso (AOL Health Writer)

According to the American Academy of Physical Medicine and Rehabilitation, 80 percent of Americans will suffer from back pain at some point in their lives, and for most of us, that means lower back pain. While a fair number of people suffering from chronic lower back pain often end up taking the surgical route, more than half of those surgeries result in no change in pain and sometimes even increase pain.

The reason, according to Mitchell Yass, physical trainer and owner of PT2 Physical Therapy & Personal Training in Farmingdale, N.Y., is that most back pain is the result of muscle weakness or imbalance.

So if you’re suffering from persistent lower back pain and seek a doctor’s advice, here are 10 questions you should ask to help get yourself on the mend, hopefully without surgical intervention:

1. What is causing my lower back pain? It’s best to rule out simple causes first. Those might include muscle weakness or spasms, spinal stenosis or disc pain, all of which can be successfully treated without surgery. Ask your doctor to give you a full physical examination.

2. What are the signs my back pain is dangerous? If you’re experiencing loss of bladder or bowel control or numbness around the anus, you may have a more serious problem, and an MRI may be necessary to diagnose the cause.

3. Could stress be causing my lower back pain? New studies have shown that lower back pain is often linked to stress. This manifestation of stress as physical pain in the body is called tension myoneural syndrome.

Craig Antell, osteopathic physician and founder of New York Rehabilitation & Wellness, says he always recommends that patients with chronic back pain who have an obvious stress factor in their lives read “Healing Back Pain” by John E. Sarno, M.D., which helps patients discover and address the link between chronic pain and mental stress.

By addressing stress, one can often relieve the muscle tension in the back that causes pain.

4. Should I use heat or ice to treat back pain? Ice will help relieve pain in the case of muscle spasm or inflammation. With chronic back pain, heat can help. Neither will treat the pain, however, but they will relieve symptoms and make you more comfortable while you recover.

5. Should I be on bed rest? Vandana Bhide, M.D., who practices internal medicine in St. Augustine, Fla., says bed rest is the worst possible prescription and can actually slow recovery.

6. Should I perform exercises to relieve and address lower back pain? Bhide recommends stretching every day before getting out of bed. While your doctor or physical therapist can recommend exercises for your specific condition, one simple thing you can do before rising in the morning is to lie on your back and pull one leg to your chest and then the other, doing each side 10 times. Then perform the same movement with both legs. Once you get out of bed, perform a cat stretch (curling and flattening your back while on all fours) 10 times.

7. Is physical therapy helpful? Physical therapy is generally the primary and most effective treatment for lower back pain, as it involves hands-on manual exercise in which a therapist will teach you exercises to address your specific pain issue. To be effective, however, you must practice the back exercise regimen at home whenever you experience back pain or to prevent it from recurring.

8. Is any over-the-counter pain medication helpful or necessary? Avoid pain medications if at all possible because they do nothing to address healing. If you need temporary relief, try ibuprofen or naproxen. Your doctor may also prescribe a muscle relaxant or steroids.

9. Should I get an X-ray or MRI? An X-ray or MRI is only necessary if your doctor has ruled out muscle weakness or spasms, bulging disc, or spinal stenosis after a complete physical examination. An MRI is essential if you’ve experienced trauma, have night pain, and or loss of bowel or bladder function, any of which can point to a severe neurological disorder or even cancer.

10. At what point may surgery be necessary, and will it help? Surgery may be necessary if you are experiencing the above symptoms, and it will help in those cases. The reason so many people who have back surgery experience no relief of symptoms is because they have been misdiagnosed. “Always make sure your physician knows the objective cause of the back pain,” says Antell. “Just treating the pain won’t fix back pain for the long-term.”

Last Updated on May 9, 2010 by Dr. Vee

The Tylenol Recall–What a Headache!

This week I went to my sample closet looking for recalled versions of McNeil children’s products. Yes, even some samples were recalled! Fortunately, I found out that I don’t have samples of any of the items. I used to be upset that I rarely received samples of Tylenol or Motrin brands, because it is nice to be able to give some to a parent when their child has a fever (or after immunizations) so that the parent does not have to stop at the store on their way home.

I guess I should be glad that I do not have to track down any patients to whom I have given samples. Since I have received a lot of telephone calls from anxious parents, I thought I better research the recalled items further.

McNeil Consumer Healthcare is initiating this voluntary recall because some of these products may not meet required quality standards. This recall is not being undertaken on the basis of adverse medical events…Consumers can contact the company at 1-888-222-6036 and also at”

McNeil products websites go on to say, “Some of the products included in the recall may contain a higher concentration of active ingredient than is specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles.”

McNeil has also recalled certain forms of Motrin Infant Drops (berry flavored) and Children’s Motrin ® berry flavored, dye free suspension. Remember that the infants’ version of any pain reliever is typically more concentrated than the children’s version, and so should not be used in children over the age of one year.

Even certain hospital versions of Children’s Motrin have been recalled, as well as doctors’ samples. Children’s Motrin Cold Formulas have been recalled as well. Remember, over the counter cold medicines are not safe (and also not found to be effective) in children under the age of nine. I wrote about the 2008 recall of over the counter cold medicines on the American Academy of Pediatrics website.

Other products recalled include Children’s Zyrtec Sugar Free Dye Free Bubble Gum flavor and Zyrtec grape flavored syrup in several size bottles.

To find out if you have the formulation that is recalled, enter the NDC (identification) number from your bottle body=/zyrtec/pages/ndc_finder.jsp here.

Children’s Benadryl and Infants’ Benadryl drops were also recalled.

You can get a refund or coupon for future purchase by filling out the McNeil form here.

Answers to frequently asked questions about the recalled medications, including how to dispose of unused medicine and what to do if you have given these agents to your child, are also available.

The recall brings up some really important points for doctors and parents. First, any medication ingested potentially could have side effects or cause problems. So you should only take a medicine or give it to your child if you absolutely need it. That goes double for medications like antibiotics, which are often prescribed without thought to sick patients.

Second, in some cases, there are generic versions which can be used instead of the brand name Motrin (ibuprofen), Benadryl (diphenhydramine) and Tylenol (acetaminophen). Other non-sedating antihistamines (except brand name Benadryl) such as loratadine can be used instead of Zyrtec (certirizine).

Last Updated May 9, 2010 by Dr. Vee

The Children’s Television Act 1990-2010

Picture of children watching television courtesy of Heartfelt

Photograph of Mr. Rogers Courtesy of Thoth

The Children’s Television Act (CTA) was passed by Congress in 1990 with the goal of providing educational programming to children that “furthers the positive development of the child in any respect, including the child’s cognitive/intellectual or emotional/social needs 1.”  

In return for providing such educational programming, broadcast stations were given free access to public airwaves.  The Act also required that commercials be limited to 10 minutes an hour on weekends and 12.5 minutes an hour on weekdays. It was hoped that major networks would promote educational/academic shows similar to Sesame Street and Mr. Roger’s Neighborhood.  

However, broadcasters reported shows of questionable educational value as their E/I choices.  For example,  The Jetsons was a show promoted as educational because it dealt with the futue and The Flintstones because it dealt with history.  Although the show GI Joe had violent content, it was hearalded by broadcasters as having pro-social themes.  Leave it to Beaver  was also descibed as educational by networks because it had pro-social messages.

In 1991, the Federal Communications Commission (FCC) required the clear separation of commercials  and television show host sales from children’s programming, since children have a difficult time distinguishing commercial content from the educational content of a show.

In 1996, broadcasters were required to provide a minimum of three hours per week of educational and informational shows targeted to children under the age of 16 during their prime viewing hours of 7 AM to 10 PM.  Since that time, most major broadcasters, other than PBS and Nickelodean have limited their educational children’s programming to just three hours per week. Most shows have pro-social themes that promote self-esteem and altruism rather than academic/educational themes.

In 2004, the FCC delineated educational programming requirements as television transitioned from analog to digital.  Broadcasters, who can have up to six channels of programming in digital instead of one channel in analog, were required to provide the commensurate  amount of children’s educational/informational programming on each of the channels.

In 2005, the FCC required that educational/informational children’s shows had to show the “E/I” label on the television screen the entire length of the show.

The Commission, in 2006, restricted the display of internet websites that contain commercial matter during children’s programming.

In 2007, the FCC entered into a consent decree with Univision to resolve petitions by children’s and media organizations to deny the broadcaster’s license renewal applications.  It was alleged that Univision’s children’s programming did not comply with the educational requirements of the Children’s Television Act.   Univision voluntarily paid $24 million and developed a children’s educational programming initiative.

Children Now, a non-partisan children’s media research and advocacy organization, evaluated educational shows broadcast by the four major networks from 1997-2008 (2).  Findings included a significant decrease in the number of shows found to be “high quality” and an increase in “moderate quality” shows during this time period. 

In 2007-2008, only 13 % of programming described by networks as educational and informational were determined to have high quality measure.   Health and nutrition messages, especially those that addressed childhood obesity prevention, were “extremely rare.”

The report concluded that current television programming does not meet the original intentions of the Children’s Television Act.  Eight shows were found to contain highly educational content by Children Now:

Sesame Street (PBS)

Beakman’s World (Commercial)

Between the Lions (PBS)

3-2-1 Penguins (Commercial)

Cyberchase (PBS)

The Suite Life of Zack and Cody (Commercial)

Fetch! with Ruff Ruffman (PBS)

Teen Kids News (Commercial)

On July 22, 2009, Senate Commerce, Science and Transportation  Committee Chairman Jay Rockefeller, D-W.Va., convened a hearing called “Rethinking the Children’s Television Act for a Digital Media Age.”   The Senator said he planned to introduce legislation to regulate children’s media content, citing his “grave concerns about violence and indecency in the media.”

Since 1990, there has developed an array of new screen media available to children–multichannel television such as cable and satellite TV, video games, video programming on mobile phones, interactive video, videos viewed on internet sites such as YouTube and Hulu, texting with pictures attached, digital multicasting of four to five streams of programming, and the potential for interactive programming made possible by the conversion of broadcasters from analog to digital.

At the Senate Commerce Committee hearing in July of 2009, FCC Chairman Julius Genachowski spoke about the new landscape of video broadcasting and television.  He recommended empowering parents with tools and information to determine the appropriate video content for their children and teenagers rather than government regulation of video content. 

At the same hearing, James P. Steyer, CEO and founder of Common Sense Media, a non-partisan, not-for profit organization that advocates for educational children’s media content, said there were ways to regulate children’s media content without limiting broadcasters rights to free speech. 

A full report from the committee is expected to be released at the end of August 2009.

1. “Policies and Rules Concerning Children’s Television Programming Memorandum Opinion and Order,” Federal Communications Commission Record 6,(1991): p.2114.

2.  Executive Summary: Educationally/Insufficient?  An Analysis of the Availability & Educational Quality of Children’s E/I Programming.  Children Now.

Last Updated May 10, 2010 by Dr. Vee

Is It a Wash? Antibacterial VS Regular Soap

Photograph of Child Washing Hands courtesy of Rob Monroe
Photograph of Petri Dish Courtesy of Ruth Rogers

Should you use antibacterial or “regular” soap to wash your hands? Should you use soap at all? I had a teacher in medical school who believed that rinsing hands was as good as using soap. Wrong! Studies show that just rinsing with water may get rid of some superficial dirt, but doesn’t get rid of germs.

So if you have to use soap to remove germs, should you use antibacterial or “regular” soap?

If you are simply trying to prevent the spread of viruses such as rhinoviruses or influenza (cold and flu viruses), regular soap and water work just fine. The additional benefit is that regular soap and water washing does not encourage the development of resistant strains of bacteria.

Most healthcare workers SHOULD use antibacterial soap, because this prevents the spread of bacterial infections. Some important hospital acquired infections include methicillin resistant Staphylococcus aureus, Clostridium difficile and (yikes!) vancomycin resistant Enterococcus. The concern, of course, is that using antibacterial soap will cause more resistant bacterial strains to develop.

These are very scary infections, because they represent highly virulent (hardy, infectious) bacteria which have developed in response to exposure to standard antibiotics. These strains require super antibiotic therapy to treat. Some strains are resistant to all known antibiotics. Healthcare workers definitely want to prevent the spread of these strains to other patients, themselves and other contacts (e.g. our family members!).

The other option when soap and water is not readily available is to use alcohol gel. It prevents the spread of bacteria and viruses. The only exception is to Clostridium difficile (Yikes again!), which is resistant to the alcohol gel.

Remember, hand washing is the most effective way to prevent the spread of any infections. Twenty seconds (Sing Happy Birthday twice while washing) of vigorous hand washing, including the fingernails (which harbor a lot of bacteria) is needed to effectively remove germs from the hands.

And don’t forget the web spaces between the fingers, which are commonly missed areas during handwashing.

Last updated May 2, 2010 by Dr. Vee

No PayDay Loan Needed!

Photographs Courtesy of Renee Rendler-Kaplan

I love American ingenuity. There is always somebody ready to capitalize on somebody else’s misery.

First, thanks for the many kind words from people who had no idea about the “hamster on a wheel” life of a primary care doctor. I discussed how difficult primary care doctors (internists, pediatricians, family practitioners) are finding it to make a living (I am still waiting for that 10 % pay raise from President Obama. I find it hard to believe that is going to solve the primary care crisis!).

I had to laugh though, when I got a “friendly” comment (AKA Smam) telling me that I qualified for a payday loan.

“$1500 Cash Payday pickup Cash Wired to Your Bank in 1 Hour Apply, E-Sign, and Get Cash Today”

Ha! Free money!!!??? Thanks, you made my day. Laughter is always therapeutic (except during an IRS audit, I guess). I could make more money if I knew how to do internet advertising/spam (which I would, of course, never be ethically willing to do).

Last updated May 1, 2010 by Dr. Vee