“Previous studies have indicated that frequent walking was associated with a lower risk of developing type 2 diabetes in the general population, in a way that those with more time spent walking per day were at a lower risk,” said the study’s lead author Dr. Ahmad Jayedi, a research assistant at the Social Determinants of Health Research Center at the Semnan University of Medical Sciences in Iran.
But prior findings haven’t offered much guidance on the optimal habitual walking speed needed to lower diabetes risk, and comprehensive reviews of the evidence are lacking, the authors said.
The study authors reviewed 10 previous studies conducted between 1999 and 2022, which assessed links between walking speed — measured by objective timed tests or subjective reports from participants — and the development of type 2 diabetes among adults from the United States, the United Kingdom and Japan.
After a follow-up period of eight years on average, compared with easy or casual walking those who walked an average or normal pace had a 15% lower risk of developing type 2 diabetes, the researchers found. Walking at a “fairly brisk” pace meant a 24% lower risk than those who easily or casually walked. And “brisk/striding walking had the biggest benefit: a 39% reduction in risk.
Easy or casual walking was defined as less than 2 miles (3.2 kilometers) per hour. Average or normal pace was defined as 2 to 3 miles (3.2 to 4.8 kilometers) per hour. A “fairly brisk” pace was 3 to 4 miles (4.8 to 6.4 kilometers) per hour. And “brisk/striding walking” was more than 4 (6.4 kilometers) per hour. Each kilometer increase in walking speed above brisk was associated with a 9% lower risk of developing the disease.
That faster walking may be more beneficial isn’t surprising, but the researchers’ “ability to quantify the speed of walking and incorporate that into their analysis is interesting,” said Dr. Robert Gabbay, chief scientific and medical officer for the American Diabetes Association, via email. Gabbay wasn’t involved in the study.
The study also affirms the idea that “intensity is important for diabetes prevention,” said Dr. Carmen Cuthbertson, an assistant professor of health education and promotion at East Carolina University who wasn’t involved in the study, via email. “Engaging in any amount of physical activity can have health benefits, but it does appear that for diabetes prevention, it is important to engage in some higher intensity activities, such as a brisk walk, to gain the greatest benefit.”
Understanding the benefits of brisk walking
The study doesn’t prove cause-and-effect, Gabbay said, but “one can imagine that more vigorous exercise could result in being more physically fit, reducing body weight and therefore insulin resistance and lowering the risk of diabetes.”
Dr. Michio Shimabukuro, a professor and chairman of the department of diabetes, endocrinology and metabolism at the Fukushima Medical University School of Medicine, agreed — adding that “increased exercise intensity due to faster walking speeds can result in a greater stimulus for physiological functions and better health status.” Shimabukuro wasn’t involved in the study.
Walking speed may also simply reflect health status, meaning healthier people are likely to walk faster, said Dr. Borja del Pozo Cruz, principal investigator of health at the University of Cadiz in Spain, who wasn’t involved in the research.
“There is a high risk of reverse causality, (wherein) health deficits are more likely to explain the observed results,” del Pozo Cruz added. “We need randomized controlled trials to confirm — or otherwise — the observed results.”
Lowering your diabetes risk
The overall message “is that walking is an important way to improve your health,” Gabbay said. “It may be true that walking faster is even better. But given the fact that most Americans do not get sufficient walking in the first place, it is most important to encourage people to walk more as they’re able to.”
If you want to challenge yourself, however, using a fitness tracker — via a watch, pedometer or smartphone app — can help you objectively measure and maintain your walking pace, experts said.
If you can’t get a fitness tracker, an easy alternative for tracking exercise intensity is the US Centers for Disease Control and Prevention’s “talk test,” which relies on understanding how physical activity affects heart rate and breathing. If, while walking, you’re able to talk with a labored voice but not sing, your pace is probably brisk.
‘Devastating toll’ of climate change now impacting ‘all regions’ of the U.S., Biden says
The federal government’s fifth National Climate Assessment, released Tuesday, details how climate change is affecting every corner of the country.
Ben Adler, Senior Editor – November 14, 2023
Every region of the United States is now seeing rapid warming due to climate change, according to the federal government’s fifth National Climate Assessment, which was released Tuesday.
“I’ve seen firsthand what the report makes clear: the devastating toll of climate change. And its existential threat to all of us,” President Biden said from the White House Tuesday morning. “I’ve walked the streets of Louisiana, New Jersey, New York, Florida, Puerto Rico, where historic floods and hurricanes wiped out homes, hospitals, houses of worship.”
“This assessment shows us in clear scientific terms that climate change is impacting all regions, all sectors of the United States — not just some, all,” he added.
The report lays out in stark detail how climate change is already harming communities nationwide.
“Climate change is finally moving from an abstract future issue to a present, concrete, relevant issue. It’s happening right now,” the report’s lead author, Katharine Hayhoe, chief scientist at the Nature Conservancy and a professor at Texas Tech University, said in a statement.
Here are the key takeaways from the assessment.
Everyone is feeling the heat
This year is on pace to be the warmest on record globally, and in the U.S., the heat is being felt nationwide, according to the report, which the federal government is required by law to produce every five years:
Every single region has higher average temperatures today than it did between 1951 and 1980.
The U.S. is warming faster than most of the world. Since 1970, the Lower 48 states have warmed by 2.5 degrees Fahrenheit, and Alaska by 4.2 degrees Fahrenheit, compared with the global average temperature rise of 1.7 degrees Fahrenheit.
Phoenix set a record this year with 54 days of high temperatures of 110 degrees Fahrenheit or greater, including 31 straight days over 110.
In Alaska, melting glaciers, thawing permafrost and disappearing sea ice are destroying the hunting and fishing-dependent economy. Some Indigenous communities may need to be relocated to flee rising sea levels.
Since warming is happening faster at higher latitudes, the report projects that the U.S. will warm about 40% more than the global average in the future.
Warmer air holds more moisture, so climate change is throwing the water cycle out of whack, researchers say. Since 2000, the western half of the country has endured a two-decade megadrought that has threatened freshwater supplies for millions of people.
But while annual rainfall has decreased in much of that region, the entire country has seen an increase in heavy precipitation events. As a result, this year saw a series of sometimes deadly flash floods from Californiato Vermont.
Warmer temperatures and dried-out vegetation from drought lead to more frequent and severe wildfires. Wildfires and the smoke they create have been an increasingly prevalent and severe problem in the West in recent years, but this summer the Northeast and Midwest were also at times enveloped in thick smoke from Canada’s record-setting wildfire season.
An economic toll
The report notes a sharp rise in the number of billion-dollar disasters in the U.S., with one occurring every three weeks since 2018. In the 1980s, the country experienced a billion-dollar weather disaster once every four months, according to the assessment.
“Extreme events cost the U.S. close to $150 billion each year — a conservative estimate that does not account for loss of life, health care-related costs or damages to ecosystem services,” the report stated.
The report also identifies frequent flooding due to sea-level rise and more powerful storms as a threat to low-lying regions across the country. Health risks, such as food and water contamination, increased air pollution from smoke, dust and pollen are also expected to worsen.
“Climate change threatens vital infrastructure that moves people and goods, powers homes and businesses, and delivers public services,” the report states.
The U.S. has begun to combat climate change
The report also notes that U.S. greenhouse gas emissions dropped 12% between 2005 and 2019 thanks to the adoption of renewable energy sources like wind and solar energy.
The Biden administration has attempted to build on this progress through regulatory measures, like stiff new fuel efficiency standards for cars and trucks. And Congress approved $369 billion for investments in clean energy and electric vehicles in the Inflation Reduction Act. But those measures are only projected to cut emissions by 40% by 2030, not the 50% Biden has pledged to the international community.
A need to adapt, and to act
States and cities across the country have begun retrofitting infrastructure to meet the challenges of climate change, and measures such as enhanced storm drain capacity and improved forest management have increased in every region since the last assessment in 2018, according to the assessment.
But the report finds that faster, more ambitious adaptation investments are needed to minimize the still-growing costs of climate change.
Reversing your biological age could help you live longer—and reduce dementia and stroke risk. 8 habits to help flip the switch
Erin Prater – November 6, 2023
People whose biological age is greater than their chronological age are at a “significantly increased” risk of stroke and dementia—even when smoking, drinking, BMI, and other risk factors are removed from the equation.
That’s according to a Swedish study published Sunday in the Journal of Neurology, Neurosurgery, and Psychiatry. Researchers examined the data of more than 325,000 UK residents between the ages of 40 and 70—and neurologically healthy—when the study began. They calculated the biological age of each participant via 18 biomarkers, including:
Nine years later, researchers checked to see if participants had developed dementia, stroke, ALS (Lou Gehrig’s disease), or Parkinson’s disease, and if there were any trends in biological age among those who had.
Having a higher biological than chronological age seemingly led to an elevated risk of dementia, especially vascular; ischemic stroke, from a blood clot in the brain; and ALS, a neurodegenerative condition, they found.
There was a weaker apparent association between elevated biological age and Alzheimer’s disease and other motor neuron diseases, which include progressive spinal muscular atrophy and primary lateral sclerosis.
Among researchers’ other findings:
The more air a person can expel during a forced breath, the lower the apparent risk of dementia and ischaemic stroke.
A higher red blood cell count seems to denote an increased risk of dementia.
Women below the age of 60 with an elevated biological age appear to be at the greatest risk of developing dementia.
There did not appear to be a connection between elevated biological age and the development of Parkinson’s disease.
“If a person’s biological age is five years higher than their actual age, the person has a 40% higher risk of developing vascular dementia or suffering a stroke,” Jonathan Mak—a doctoral student in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet in Sweden, and one of two lead authors on the study—said in a news release about it.
While the study was an observational one and can’t prove causation, it shows that it may be possible to reduce the number of age-related diseases one develops, or to delay their onset, by improving biomarkers, the authors assert.
Biological vs. chronological age
Just what is the difference in biological and chronological age? Simply put, chronological age is how long you’ve been alive—the number of candles on your cake—while biological age is how old your cells are.
Biological age is also referred to as the epigenetic age. The epigenome “consists of chemical compounds that modify, or mark, the genome in a way that tells it what to do, where to do it, and when to do it,” according to the U.S. National Institutes of Health.
Those changes—influenced by environmental factors like stress, diet, drugs, and pollution—can be passed down from cell to cell as they divide, and from generation to generation. While chronological age can’t be reversed, biological/epigenetic age can be.
Scientists already knew that advanced chronological age is a risk factor for the development of common neurologic disorders like neuropathy, Alzheimer’s disease, and Parkinson’s disease. But because people of the same chronological age, age at different rates, it’s a “rather imprecise measure” when it comes to the prediction of disease development, Sara Hägg—an associate professor in the Department of Medical Epidemiology and Biostatistics at the Karolinska Institutet, and a lead author on the study—said in the news release.
Prior research had shown an apparent correlation between elevated biological age and increased risk of developing some cancers, depression, anxiety, and death. But little work had been done on the potential impact of biological age on the development of neurologic disorders, the authors wrote, adding that they next plan to study its impact on other diseases.
That’s according to new research released Monday by the American Heart Association. Scientists examined the connection between biological age and the association’s “Life’s Essential 8” checklist, which includes the goals of:
Being more active
Getting healthy sleep
Managing blood sugar
Managing blood pressure
After examining the records of more than 6,500 adult participants, they found that better cardiovascular health—as measured by the above factors—was associated with slower biological aging. Participants with high cardiovascular health had a biological age lower than their chronological age.
For example, the average chronological age of those with high cardiovascular health was 41, but their average biological age was 36, researchers found. Conversely, the average chronological age of those with low cardiovascular health was 53, but their average biological age was 57.
Participants who scored the highest on the aforementioned checklist—and thus were considered to have high cardiovascular health—had a biological age that was, on average, six years younger than their chronological age, researchers said.
“These findings help us understand the link between chronological age and biological age, and how following healthy lifestyle habits can help us live longer,” Dr. Donald M. Lloyd-Jones, chair of the writing group for the checklist and a past volunteer president of the American Heart Association, said in a news release on the study.
“Everyone wants to live longer—yet more importantly, we want to live healthier longer so we can really enjoy and have a good quality of life for as many years as possible.”
A man with Parkinson’s who was unable to walk without falling is enjoying Sunday strolls again thanks to a spine implant
Kim Schewitz – November 6, 2023
A man who has had Parkinson’s for 30 years could hardly walk on his own and had to stay home.
Scientists implanted a device in his spine that stimulates his leg muscles with electrical impulses.
Two years on he can climb stairs, go shopping, and walk almost four miles independently.
A man diagnosed with Parkinson’s disease almost 30 years ago who could barely walk on his own can now climb stairs and go out independently again thanks to a potentially revolutionary device implanted in his spinal cord.
Marc Gautier, 62, from a small town near Bordeaux, France, has lived with Parkinson’s since he was 36, and was forced to stop working as an architect three years ago when his mobility got so bad that he was falling down five to six times a day, meaning he often had to stay at home.
“I practically could not walk anymore without falling frequently, several times a day. In some situations, such as entering a lift, I’d trample on the spot, as though I was frozen there,” Gautier said in a press release.
Two years since the device was surgically implanted, however, he can once again do many things he used to enjoy.
“Every Sunday I go to the lake, and I walk around six kilometers. It’s incredible,” he said.
The implant stimulates sensory fibers connected to muscles
Parkinson’s is a degenerative disease where people don’t have enough dopamine — a neurotransmitter responsible for many bodily functions — in their brain, which can lead to physical symptoms including rigidity and tremors.
Parkinson’s is most common in older people and men, with symptoms typically appearing in those over 50, but it can occur in people under 40, too.
Treatments typically include taking dopamine and deep brain stimulation, where electrodes implanted in the brain produce electrical impulses that affect brain activity. These are usually effective but can stop working as the patient’s condition worsens over time.
Around 90% of people with advanced Parkinson’s experience walking problems, such as gait impairments, balance problems, and freezing-of-gait episodes, which reduce their quality of life, study co-author Jocelyne Bloch, director of the NeuroRestore treatment center that researches implantable neurotechnologies, and senior attending neurosurgeon at University Hospital of Lausanne, Switzerland, said in a press video.
Scientists from Switzerland and France worked to develop the new treatment by designing and implanting a device, known as a neuroprosthesis, into Gautier’s spinal cord.
In healthy people without Parkinson’s, muscles move after being stimulated by sensory fibers. In Gautier’s case, the fibers in his legs were weakened by Parkinson’s, meaning the sensory feedback loop was not strong enough to make them move properly, co-author Grégoire Courtine, professor of neuroscience at the Swiss Federal Institute of Technology in Lausanne, told a press conference. The implant works by stimulating the weakened sensory fibers attached to the leg muscles.
“So if you imagine the stretch reflex, you go to the doctor, there’s a tendon with the hammer, you hit the tendon and then you have a reflex. That’s exactly this pathway that we are mobilizing with the stimulation,” he said. Gautier can turn the stimulation on and off himself, the authors said.
“Instead of focusing on the region of the brain that’s deprived of dopamine, we thought that we could focus on the spinal cord, that ultimately is responsible for the activation of leg muscle in order to walk,” Courtine said.
After the device was implanted, Gautier quickly saw his walking start to improve, according to the study, and following several weeks of rehabilitation, it had nearly returned to normal.
He currently uses his neuroprosthetic for around eight hours a day, only turning it off when sitting down for a long period or sleeping, according to the press release.
The study’s authors are excited about the possibility of turning this proof of concept into a widely available therapy to treat mobility problems in people with Parkinson’s, they told a press conference.
“I really believe that these results open realistic perspectives to develop a treatment that alleviates gait deficits due to Parkinson’s disease and therefore look forward to testing this new therapy in six additional patients,” Bloch said.
The authors said further testing would happen within the next 18 months, but if successful, the treatment would not be commercially available for at least five to ten years.
David Dexter, director of research at Parkinson’s UK, who was not involved in the study, told Insider: “This research is still at a very early stage and requires much more development and testing before it can be made available to people with Parkinson’s, however, this is a significant and exciting step forward and we hope to see this research progress quickly.”
Eduardo Fernández, director of the Institute of Bioengineering at the Miguel Hernandez University of Elche, Spain, who was also not involved in the research, said in a statement that Parkinson’s patients with mobility issues can often respond poorly to standard treatments that focus primarily on the areas of the brain directly affected by the loss of dopamine-producing neurons. He described the new approach as “very innovative” because it involves areas of the nervous system not affected by the disease.
“The future is hopeful, but it is necessary to advance little by little and not to create false expectations that could damage the credibility of this research,” he said.
Including sherpas that accompany climbers, that means about 900 people tried to summit the mountain from the South side during the main 2023 climbing season, which only lasts about eight weeks, each April and May
When people die on Everest, it can be difficult to remove their bodies. Final repatriation costs tens of thousands of dollars (in some cases, around $70,000) and can also come at a fatal price itself: Two Nepalese climbers died trying to recover a body from Everest in 1984.
Lhakpa Sherpa, who is the women’s record-holder for most Everest summits, said she saw seven dead bodies on her way to the top of the mountain in 2018.
“Only near the top,” she told Insider in 2018, remembering one man’s body in particular that “looked alive, because the wind was blowing his hair.”
Her memory is a grim reminder that removing dead bodies from Mount Everest is a pricey and potentially deadly chore.
These days, tourists spend anywhere from $50,000 to well over $130,000 to complete a once-in-a-lifetime Everest summit. It’s difficult to know for sure exactly how many people have died trying to get up and down, and where all those bodies have ended up.
Recent fatality estimates are as high as 322 after an especially deadly 2023 season. A BBC investigation in 2015 concluded “there are certainly more than 200” corpses lying on Everest’s slopes.
As May temperatures warm and winds stall, favorable springtime Everest climbing conditions sometimes only last a few days. These brief climbing windows can create conveyor-belt style lines that snake toward the top of the mountain.
Climbers can be so eager to reach the peak and stake their claim on an Everest summit that they develop what’s called “Summit Fever,” risking their lives just to make it happen.
Other Everest climbers complain about risky human traffic jams in the mountain’s “death zone,” the area of the hike that reaches above 8,000 meters (about 26,250 feet), where air is dangerously thin and most people use oxygen masks.
Even with masks, this zone is not a great place to hang out for too long, and it’s a spot where some deliriously loopy trekkers may start removing desperately-needed clothes, and talking to imaginary companions, despite the freezing conditions.
Getting bodies out of the death zone is a hazardous chore.
“Even picking up a candy wrapper high up on the mountain is a lot of effort, because it’s totally frozen and you have to dig around it,” Ang Tshering Sherpa former president of the Nepal Mountaineering Association, told the BBC in 2015. “A dead body that normally weighs 80kg might weigh 150kg when frozen and dug out with the surrounding ice attached.”
Mountaineer Alan Arnette previously told the Canadian Broadcasting Corporation that he signed some grim “body disposal” forms before he climbed Everest, ordering that his corpse should rest in place on the mountain in case he died during the trek.
“Typically you have your spouse sign this, so think about that conversation,” he added. “You say ‘leave me on the mountain,’ or ‘get me back to Kathmandu and cremate,’ or ‘try to get me back to my home country.'”
For years, Everest climbers often referenced one particular dead body they called “Green Boots” who some spotted lying in a cave roughly 1,130 feet from the peak. It was the body of Tsewang Paljor, a 28 year-old Indian climber who died on the mountain in 1996, during the same storm that inspired Jon Krakauer’s bestseller, “Into Thin Air.”
But in recent years, Everest’s most infamous corpse has been tougher for hikers to spot, leading to widespread speculation that the body was either moved, or covered by rocks, as climber Noel Hanna told the BBC.
Nepalese Sherpas generally consider it inappropriate and disrespectful to their mountain gods to leave dead bodies littering their holy mountain. In 2019, at least four bodies were taken down from the mountain by Nepalese trash collectors.
“There’s sort of this idea that there’s only one mountain that really matters in the kind of Western, popular imagination,” filmmaker and director Jennifer Peedom told Insider when her documentary, “Mountain” was released in 2017.
Peedom had climbed Everest herself four times as of 2018, but said the thrill of summiting Everest is largely relegated to the history books, and for “true mountaineers,” it’s just an exercise in crowd control these days.
“There seems to be a disaster mystique around Everest that seems to only serve to heighten the allure of the place,” she said. “It is extremely overcrowded now and just getting more and more every year.”
This story was originally published in May 2019. It has been updated.
How a Lucrative Surgery Took Off Online and Disfigured Patients
Sarah Kliff and Katie Thomas – October 30, 2023
The bulge on the side of Peggy Hudson’s belly was the size of a cantaloupe. And it was growing.
“I was afraid it would burst,” said Hudson, 74, a retired airport baggage screener in Ocala, Florida.
The painful protrusion was the result of a surgery gone wrong, according to medical records from two doctors she later saw. Using a four-armed robot, a surgeon in 2021 had tried to repair a small hole in the wall of her abdomen, known as a hernia. Rather than closing the hole, the procedure left Hudson with what is called a “Mickey Mouse hernia,” in which intestines spill out on both sides of the torso like the cartoon character’s ears.
One of the doctors she saw later, a leading hernia expert at the Cleveland Clinic, doubted that Hudson had even needed the surgery. The operation, known as a component separation, is recommended only for large or complex hernias that are tough to close. Hudson’s original tear, which was about 2 inches, could have been patched with stitches and mesh, the surgeon believed.
Component separation is a technically difficult and risky procedure. Yet more and more surgeons have embraced it since 2006, when the approach — which had long been used in plastic surgery — was adapted for hernias. Over the next 15 years, the number of times that doctors billed Medicare for a hernia component separation increased more than tenfold, to around 8,000 per year. And that figure is a fraction of the actual number, researchers said, because most hernia patients are too young to be covered by Medicare.
In skilled hands, component separations can successfully close large hernias and alleviate pain. But many surgeons, including some who taught themselves the operation by watching videos on social media, are endangering patients by trying these operations when they aren’t warranted, a New York Times investigation found.
Dr. Michael Rosen, the Cleveland Clinic surgeon who later repaired Hudson’s hernias, helped develop and popularize the component separation technique, traveling the country to teach other doctors. He now counts that work among his biggest regrets because it encouraged surgeons to try the procedure when it wasn’t appropriate. Half of his operations these days, he said, are attempts to fix those doctors’ mistakes.
“It’s unbelievable,” Rosen said. “I’m watching reasonably healthy people with a routine problem get a complicated procedure that turns it into a devastating problem.”
Hudson’s original surgeon, Dr. Edwin Menor, said he learned to perform robotic component separation a few years ago. He said he initially found the procedure challenging and that some of his operations had been “not perfect.”
Menor said that he now performs component separations a few times a week and that, with additional experience, “you improve eventually.” He said he had a roughly 95% success rate. In Hudson’s case, he said, the use of component separation was warranted based on the complexity of her hernia and her history of abdominal surgeries.
Component separation must be practiced dozens of times to master it, experts said. But 1 out of 4 surgeons said they taught themselves how to perform the operation by watching Facebook and YouTube videos, according to a recent survey — part of a broader pattern of surgeons of all stripes learning new techniques on social media with minimal professional oversight.
Other hernia surgeons, including Menor, learned component separation at events sponsored by medical device companies. Intuitive, for example, makes a $1.4 million robot known as the da Vinci that is sometimes used for component separations. Intuitive has paid for hundreds of hernia surgeons to attend short courses to learn how to use the machine for the procedure. The company makes money not only from selling the machines but also by charging some hospitals every time they use the robot.
Many surgeons — even some paid by device companies to teach the technique — haven’t learned how to properly carry out component separation with the da Vinci, the Times found. In fact, at times they are teaching one another the wrong techniques.
The robot comes with a built-in camera that makes it easy for doctors to record high-resolution videos of their surgeries. The videos are often shared online, including in a Facebook group of about 13,000 hernia surgeons. Some videos capture surgeons using shoddy practices and making appalling mistakes, surgeons said.
One instructional video, paid for by another major medical device company, showed a surgeon slicing through the wrong part of the muscle with the da Vinci. Experts said the result could have been devastating, turning the abdominal muscles into what one described as “dead meat.”
Peper Long, a spokesperson for Intuitive, said the company hired “experienced surgeons” to lead its training courses. “The rise in robotic-assisted hernia procedures reflects the clinical benefits that the technology can offer,” she said.
In interviews with the Times, more than a dozen hernia surgeons pointed to another reason for the surging use of component separations: They earn doctors and hospitals more money. Medicare pays at least $2,450 for a component separation, compared with $345 for a simpler hernia repair. Private insurers, which cover a significant portion of hernia surgeries, typically pay two or three times what Medicare does.
Fixing the torn muscles of a hernia is like closing a suitcase: It’s usually not too difficult to bring the two sides together and zip it up. But a large hernia, like an overstuffed bag, doesn’t have enough slack to bring the muscles back together.
Around 2006, surgeons adapted a technique from plastic surgery, called component separation, to close large hernias. On each side of the torso, they carefully cut the muscle to create slack, resulting in something like an extra zipper in expandable luggage.
Other hernia surgeons were initially afraid to try it. They would have to make incisions that ran from the sternum down to the pelvic bone and would have to distinguish between three parallel planes of muscle, each just millimeters wide. And while making tiny cuts, they would have to carefully avoid bundles of nerves and blood vessels. Cut a bundle, and the muscle becomes useless.
Despite its difficulty, the procedure took off — and with it, the opportunity for doctors to make more money.
The federal government assigns a value to everything a doctor does, from an annual physical to a complex surgery, in order to determine how much Medicare should pay. These values — known as relative value units, or RVUs — are also used by private health plans, and therefore dictate most doctors’ earnings. Many hospitals require their doctors to ring up a minimum number of RVUs. Some doctors get bonuses if they exceed that goal or have their salaries docked if they fall short.
Component separation has a high value. A traditional hernia repair earns between 6 and 22 RVUs for the surgeon, which for Medicare patients translates to $200 to $750. Tacking on a component separation for both sides of the torso brings in an additional 34.5 RVUs., or about $1,200 more for the surgeon. (Medicare also pays the hospital for each procedure.)
When the RVU system began, in 1992, component separation was part of a billing category that consisted of plastic surgery procedures such as reconstructing a patient’s torso after a traumatic accident. Because the procedure demanded a high level of skill and took so much effort, it was given a high RVU.
But since 2006, its use for hernias has soared, Medicare data shows.
Part of the rise reflects the fact that some people with small hernias, who don’t need complicated surgery, are nonetheless getting component separations. A study by Dr. Dana Telem, a hernia surgeon at the University of Michigan, found that was happening in about one-third of cases.
Another factor is that some surgeons have been billing insurers up to four times for a single procedure. In 2017, the American College of Surgeons warned them to stop, saying they could bill twice, at most — once for each side of the torso.
Robots on Facebook
As hernia surgeons were dabbling in component separation, a larger shift in surgery was underway: using robots to operate.
Intuitive debuted its da Vinci robot in 2000, with the idea that more precise surgery would shorten recovery times. Surgeons could remotely control the robot’s tiny clamps and scissors, allowing them to carry out complex operations with small incisions.
The company marketed the robot to a variety of specialties, including cardiology and urology. It found notable success in gynecology but faltered in 2013, when an influential study reported that robotic surgery for hysterectomies was no better than a more standard technique.
Around that time, Intuitive made a big push with general surgeons, offering training events around the country where doctors could test out the da Vinci for surgeries like gallbladder removals and simple hernia repairs, one of the most common surgeries in the country.
By 2017, Intuitive brought in more than $3 billion in revenues on the da Vinci, and was trumpeting the largely untapped potential of the hernia market. “We believe hernia repair procedures represent a significant opportunity with the potential to drive growth in future periods,” the company said in its 2017 annual report.
The marketing was “masterful,” said Dr. Guy Voeller, a hernia surgeon in Tennessee and former president of the American Hernia Society. “They made it explode.”
Beyond traditional sales tactics, Intuitive also made inroads into the growing Facebook group, a lively forum where hernia surgeons discussed everything from troubleshooting tricky cases to complaining about their pay.
At first, the group’s members weren’t keen on the robot, questioning whether the flashy new tool was worth its steep price tag. “A lot of added expense with what perceived benefit to the patient?” one surgeon wrote on the Facebook group’s page in 2014.
Around that time, an Intuitive representative placed a phone call to Dr. Eugene Dickens, a general surgeon at a community hospital in Tulsa, Oklahoma.
Dickens had grown up playing video games and was immediately comfortable at the da Vinci’s remote controls, which he used for dozens of gallbladder, appendix and simple hernia surgeries. Intuitive was paying him to be a consultant. (Since 2013 he has received about $1 million.)
Now the company wanted him to jump into the Facebook fray and win over the naysayers, he said.
“We are getting decimated by this little hernia group,” Dickens recalled the company representative saying. “Can you join and help defend us?”
He and other robot enthusiasts began to sing the da Vinci’s praises in the Facebook group, he said. (He said that Intuitive did not pay him for his Facebook posts.)
Over time, the group warmed to the robot, not just for simple hernia repairs but also for more complex operations like component separations. Surgeons began posting videos showing off the new procedure, drawing dozens of positive comments.
Surgeons used the da Vinci for more than 1.3 million hernia repairs between 2016 and 2022, Long said, or about 15% of the total procedures by the company’s robots. Only about 13,000 of those hernia repairs were component separations, she said.
Intrigued by the hype, Dickens taught himself component separation by watching online videos. His first operation went well, he recalled, but a later patient developed a serious complication, necessitating an additional surgery.
Then, at a dinner meeting in Houston, he presented a video of one of his own surgeries to a group of about 50 other doctors, Dickens recalled. A more experienced surgeon interrupted to say he was operating on the wrong part of the muscle. The rebuke felt like a “red flag,” he said, and he stopped doing the procedure, although he is still a proponent of the da Vinci for other operations.
An academic study in 2020 found that “unsafe recommendations often go uncontested” in the Facebook group and warned that “surgeons should be cautious” about using the page for clinical advice.
Dr. Brian Jacob, the hernia surgeon who founded the Facebook group, said that after the study was published, he made an effort to not let bad advice go unchallenged. He said that surgeons have described performing component separations on small hernias. When he sees those posts, he said, he typically comments to say, “That’s not how I would have done it.”
Trashing the Abdominal Wall
In June 2021, W.L. Gore & Associates, a medical device company that makes surgical mesh used in hernia repairs, posted a video tutorial on its website. It promised to be a step-by-step guide to component separation surgery.
A surgeon narrated as he cut the patient’s abdominal muscles, releasing tissue so he could close a hernia. But he was operating in the wrong place and likely created a new hernia, according to four surgeons who reviewed the video.
“It absolutely trashed the abdominal wall,” said Jeffrey Blatnik, who directs the Washington University Hernia Center. “It was so offensive to the point that we reached out to the company and told them, ‘You guys need to take this down.’”
Jessica Moran, a spokesperson for W.L. Gore, said that after surgeons flagged the error, the company removed the video; it had been online for 10 months. “We have investigated what happened here to avoid this happening again in the future,” Moran said.
Dr. Rodolfo Oviedo performed the faulty surgery. Moran said the company had paid him $4,400 for it.
Oviedo acknowledged that he had made mistakes but said he had improved. “At some point I was doing it wrong, and nobody’s perfect,” he said in an interview in June, when he was the director of robotic education at Houston Methodist, a major hospital in Texas. He said it was only at some point after the surgery that he learned of his potentially serious errors.
Four months later, Oviedo offered a new explanation. He said that he had learned of his mistake in real time and had repaired the damage while the patient was still on the operating table. He said the patient, with whom he followed up for 18 months, had not experienced complications. (Oviedo left Houston Methodist for another job in July.)
W.L. Gore’s video had plenty of company: A study of 50 highly viewed hernia repair videos on YouTube found that 84% did not follow all safety guidelines.
In addition to relying on online videos, surgeons also learn new techniques at training sessions paid for by device companies, which typically cover travel and a one- or two-day course. But the companies do little vetting of their instructors, experts said.
Earlier this year, Blatnik fixed a bad component separation surgery where the original surgeon had cut into the wrong muscle plane. The patient’s intestines were bulging out of her sides, another Mickey Mouse hernia.
Blatnik said he immediately recognized the name of the surgeon who had operated on the patient because he had seen that surgeon teach component separation at a course sponsored by a device company. The surgeon has received more than $130,000 in payments over the past decade from companies including Intuitive and Bard, which manufactures hernia mesh, the Times found.
Academic research is only now starting to quantify the complication rate of component separations for hernias.
In 2019, researchers analyzed five studies of patients who underwent the procedure and found that only 4% developed another hernia. But a newer study from the Cleveland Clinic, which followed patients for two years to see if a new bulge had developed, found the number was 26%.
Seven years ago, Sandy Aken said, she had a hernia the size of her fist. A surgeon in Huntington Beach, California, performed a component separation. Three months later, her belly was still protruding, and she felt like her guts were spilling out. She saw another doctor.
“This patient has a significantly compromised abdominal wall with damaged muscle due to the history of component separation,” that doctor wrote in a summary of the visit. Another hernia surgeon told her he could not fix the bulge, she said.
Aken, 64, now looks nine months pregnant. She cannot bend over without pain, a limitation that forced her to leave her job as a caregiver.
In 2018, Dr. Willie Melvin performed a component separation with the da Vinci on Jennifer Gulledge, whose large hernia made her a good candidate for the operation. But he cut into the wrong part of the muscle, leaving new holes on each side of her body and too little slack to close her original hernia, another surgeon concluded after reviewing her case.
Less than a week later, he performed an emergency surgery to close the original hernia. But the side tears remained.
Melvin declined to discuss Gulledge’s case. He said he had a lot of experience with complex hernia cases that other surgeons have referred to him and that he and his partner performed about three component separation surgeries a month. Intuitive paid him more than $25,000 last year to demonstrate his technique to other surgeons and to check the work of doctors who are new to robotic surgery.
In February 2020, Dr. Ajita Prabhu, a Cleveland Clinic hernia surgeon who has studied the frequency of failed component separation, operated on Gulledge. Prabhu told her patient that she would try her best, but that the damage from the original surgery was probably irreparable.
She was right. Even with her abdominal muscles sewed back together, Gulledge lived with intense pain. Routine tasks were difficult: When she changed her granddaughter’s diaper, she had to remind the 2-year-old not to kick “grandma’s bad belly.”
In August, Gulledge drove 700 miles to Cleveland for a follow-up appointment. She spent four days on the road, sometimes stopping every 30 minutes because it hurt too much to remain behind the wheel.
When Prabhu examined her, she confirmed Gulledge’s fear: Another hernia had opened up.
My centenarian dad lived to be 101. Here are his lifestyle tips I’m following to live a long life, too.
Louisa Rogers – October 29, 2023
My centenarian father lived a very healthy life but recently died at 101.
His practices mirrored Blue Zone principles: eating in moderation, exercising, and reducing stress.
I hope to live as long as him, so I’ve incorporated these habits into my life to be healthy.
For as long as I knew him, my father, who died a year ago at 101, lived a very healthy, active life. He ran every morning until he was 70, kept his stress level to a minimum, and enjoyed close bonds with family and friends — three of the principles described by Dan Buettner in his book “The Blue Zones: Lessons for Living Longer From the People Who’ve Lived the Longest.”
Because I also hope to live to become a centenarian, I’m following his example. I’ve incorporated many of the practices I saw him live out — and a few others — into my life.
Eat and drink in moderation
“Breakfast like a king, lunch like a prince, and dinner like a pauper,” Daddy used to intone. He always ate his smallest meal in the early evening. At mealtimes, he followed another rule of Blue Zoners: Stop eating when you’re 80% full.
While I have a history of overeating, I’ve learned to eat healthily and moderately most of the time — I eat a 90% plant-based diet with occasional fish, and I indulge in junk food sparingly. I do tend to have my main meal in the evening, but it’s typically a simple one-pot dish.
As for alcohol, many centenarians do enjoy a glass of wine, but they don’t overdo it. My father, however, was a heavy drinker until the last five years of his life, when, after serious catheter surgery, his doctor ordered him to stop drinking. I have two glasses of wine at night, and I think of it as my guilty pleasure.
My father was a hiker, backpacker, and runner, starting in his college years. At 70, he switched from running outdoors to using an exercise bicycle and a treadmill.
I began running during college with my dad and slowly expanded into loving exercise of all kinds; I call myself an “adult-onset fitness lover.” Being physically active, especially outdoors, gives me great pleasure, whether I’m walking long-distance routes in different parts of the world (my husband, Barry, and I walked the 540-mile Camino de Santiago), riding my bike, or paddleboarding.
I also find ways to incorporate physical activity into my daily routine, like many centenarians, who often don’t exercise in the modern sense but incorporate movement into their daily lives. And unlike my dad, who lived in the suburbs, I live in walkable communities — I split my time between Mexico and California — so I rarely drive, and it’s easy to get a lot of walking in each day.
While my father had a great deal of loss in his life — he outlived not only my mother and two later wives but also two of his five children — he was very resilient. He kept marrying, which was not always easy for me, but now I realize it helped him avoid loneliness, which a surgeon general advisory says is about as deadly as smoking.
As for me, a few years ago I told a friend, “I don’t do Christmas stress.” Gradually, that attitude has expanded into the rest of my life. It’s not always that simple, of course. Naturally, I sometimes experience stressful events, but I’ve learned to mitigate it through walking or other exercise, talking to a friend, journaling, and meditating.
Have a sense of purpose
Centenarians know why they want to get up in the morning. I never asked my dad what his purpose was, but he was very engaged in life. After 9/11, for example, he joined an interfaith group made up of Christians, Jews, and Muslims, and later went to the Middle East on a peace delegation. When he was 80, he volunteered to build houses in Honduras.
I love connecting with people, learning, and being creative. I write, cook, and paint. During the parts of the year when we’re living in Mexico, I also speak Spanish and spend a lot of time volunteering.
Maintain strong connections with family and friends
My dad lived in Pennsylvania. Though none of his children lived in the same state, we visited often and were in frequent contact by phone.
For 30 years, he met with a group of friends every month, and they all shared about their lives and reflected on current issues or a book they’d read.
I don’t live near my family members, either, but I’m in regular touch with them. And while I have friends in both communities where we live, I also regularly “prospect” for new ones because I’ve seen that close connections can unexpectedly end through moves, irreconcilable differences, or death.
Nurture a sense of spirituality
Unlike most centenarians, my dad did not have a strong faith. I’m not a traditional believer, either, but I act as though I am. Call it the placebo effect. I write notes to God and ask for help when I’m struggling, and somehow, it works.
There are no guarantees, of course. Plenty of fit people die young. Still, there’s no harm in improving my chances, especially since I enjoy these activities anyway and they add to my quality of life. What have I got to lose?
Climbing 50 stairs a day may stave off heart disease — while living near a park or lake can keep you mentally well. How to improve your health, according to new studies
Kaitlin Reilly – October 14, 2023
There’s so much health and wellness news out there. Here are some of this week’s health headlines and what you can take away from them to better impact your health.
Cycling may improve mental health
A survey of 1,200 middle school students who participated in a cycling program found improvements in their mental health and physiological well-being. The improvements appeared especially significant in students who were ethnic minorities from low-income families.
Why it matters: Cycling combines transportation, leisure and exercise — three things that can benefit young people greatly once they learn how to ride safely. For older individuals, the same reasoning can be applied to dusting off your own bike: A 2017 study found that people who commuted by bike to work had lower risk for certain cancers and cardiovascular disease.
Climbing stairs may impact heart health
A U.K.-based study published in the journal Atherosclerosis found that people who climbed 50 stairs over the course of a day reduced their risk of atherosclerotic cardiovascular disease and of cardiovascular disease in general by 20% when compared to people who did not climb any stairs daily.
Study author Dr. Lu Qi, director of Tulane University’s Obesity Research Center, told Medical News Today that stair climbing is a “vigorous exercise” which is associated with “lowering body weight, improving metabolic status and inflammation, and reducing other diseases which may increase the risk of heart disease, such as diabetes.”
Why it matters: We know that getting your heart pumping is important for your overall health, yet many people say they struggle to fit exercise into their lives. Choosing to take the stairs wherever you can, as evidenced by this study, is one potentially easy way to reap the benefits of exercise without overhauling your lifestyle.
Living near ‘green’ or ‘blue’ spaces may benefit mental health
A 10-year study out of the U.K. published in the journal Planetary Health found that greater exposure to green and blue spaces — such as living near a park or a lake, respectively — reduced your likelihood of developing a mental health condition.
Why it matters: There’s mounting evidence that suggests natural spaces may benefit mental health. A recent study suggested that fishing benefited mental health in men — but that the correlation had less to do with angling itself, and more to do with access to blue spaces. Whether you live somewhere with access to more natural environments or not, seeking them out whenever possible can allow you to reap some of these benefits.
Your Apple Watch can now tell you how much sunlight you’re getting
A new feature in the Apple Watch series 6 or later tracks how much time in the sun you’re getting, which is made possible by the wearable’s ambient light sensor, as well as its GPS and motion sensors.
Why it matters: If you already track the amount of steps you take each day, you may benefit from also tracking your time in the sun. Morning sunlight, for example, can help improve your sleep later on, and exposure to sunlight in general can help raise vitamin D levels, which are important for boosting immunity and energy. Of course, it’s also important to be aware of the risk of sun exposure, which can lead to skin cancer — so if you’re tracking your sunlight with your watch, you might want to also use it as a reminder to keep the time limited and to reapply sunscreen.
Children may benefit greatly from practicing mindfulness
Researchers at the Massachusetts Institute of Technology found that children who used a mindfulness app at home for 40 days reduced their stress levels, as well as reporting lower negative emotions like fear and loneliness overall. The study, which was conducted in 2020 and 2021 during the height of the COVID-19 pandemic, allowed researchers to see how children with higher levels of mindfulness appeared less emotionally affected by the global crisis.
Many parents are now teaching their children how to be mindful as well. Sarah Ezrin, author of The Yoga of Parenting, previously told Yahoo Life, “I wasn’t taught any self-regulation techniques as a kid. I had to learn them all as an adult and, while they’ve been inordinately helpful, I can only imagine what learning these right out the gate can do for our development, mood regulation and emotional regulation skills.”
Want to live to a healthy 100? Longevity doctor Peter Attia has advice.
Andrea Atkins – October 13, 2023
Do you want to live to 100? Thanks to modern medicine, you have a decent chance of doing so.
But if you want to live well to 100, physician and best-selling author Peter Attia says you may have some work to do so that your last decade of life – your “marginal decade,” as he calls it – is healthful and rewarding, not limited by disease.
If we adopt new ways of looking at our health, we can do a better job of matching our life span (how long we live) to our “health span” (how long we live free from chronic disease or other health problems), says Attia, the author of “Outlive: The Science & Art of Longevity.”
In a phone interview, Attia talked about “the Four Horsemen of Chronic Disease” – cardiovascular disease, cancer, cognitive diseases (such as Alzheimer’s) and metabolic diseases (such as Type 2 diabetes) – and new ways to plan for longevity. The following was edited for length and clarity.
Q: Many people fear living to be 100, imagining loneliness, poor health and solitude. Should living so long be our aim?
A: I don’t think it should, actually. A lot of those fears are really valid. I think a better goal is to maximize health span. When you do that, you will automatically get a longer life span. If you improve your health span, so that when you’re 80, you actually function like a 65-year-old, it’s almost impossible to not also get five to 10 years of life-span extension.
Q: One of the ways to improve health span is through something you call “the Centenarian Decathlon.” What is it, and how do we train for it?
A: It’s a mental model which says that the greater the specificity with which you train for your physical goals, the more likely you are to achieve them.
I think back to the very first goal I ever had, which was to run five five-minute miles. That’s a lot more specific than saying I want to be able to run five miles. If you want to achieve that, you have to train with far greater specificity than if you just want to able to run five miles. And this is true across the board. And it’s what’s necessary to achieve remarkable feats.
I ask patients to think specifically about what they want to be able to do when they are in their 80s or older, and to start training for that when they are in their 40s or 50s or 60s.
Q: You mean, for example, if you want to hike for two miles when you’re 80.
Q: Why won’t just hiking every day in the years leading up to that prepare you to continue walking outdoors?
A: Because as you age, the degradation of strength, stamina, balance, lower leg variability is so profound that it is insufficient to just hike two miles when you’re in your 40s and 50s, and assume that’s going to get you doing the same thing when you’re 80. When you’re 80, you have to aim much higher. . . . The Centenarian Decathlon is asking, “What do you want to do in your marginal decade?” And the more specific you can make it, the better, because you’ll be able to train for it, and increase the odds that you will be ready for it.
Q: And if you want to lift your great-grandchild when you’re 80, you need to do what, exactly, when you’re 50, 60 and 70?
A: To safely pick up a 30-pound child from the floor, you need hip flexibility and abdominal and spinal stability to get into a low squat position, then you need to be able to pick up a 30-pound weight. It’s harder to do a squat with weight in front of you because it requires more core stabilization and more scapular stability [shoulder strength]. This essentially means you need to be able to do a 30-pound goblet squat at the age of 85. . . . By the time they’re 85, most can’t even do the goblet squat, without any additional weight. So just on that one metric of strength, we have something that we need to train for.
Q: You say exercise is the most important tactic for longevity, but more than 60 percent of Americans do not get enough exercise. Can sedentary people undertake the vigorous training that you recommend?
A: If you’re starting from zero, just getting to 90 minutes a week of exercise will result in a 15 percent reduction in all-cause mortality [including the Four Horsemen]. That’s dramatic. I mean, we don’t have drugs that can reduce 15 percent all-cause mortality across the board. And the good news is it’s not just like this abstract thing of “we’re adding a couple of years to your life.” No, no. You’re going to feel better in three months.
Every person who saves for retirement, in my view, is doing something slightly more difficult. Because in the short term, you get nothing out of saving for retirement. . . . And I would say with these other changes that we ask people to make, at least they’re getting a benefit today.
How is anybody supposed to find time for this? I would just say, if you’re not going to make time for this, what are you making time for?
Q: Most of us succumb to one of those Four Horsemen. What do these diseases have in common?
A: Cancer, cardiovascular disease and neurogenerative diseases, Alzheimer’s being the most common, are all exacerbated dramatically by metabolic disease. So, if you have Type 2 diabetes, your risk of those other diseases goes up dramatically.
Q: You suggest getting ahead of these diseases by screening, gene testing or digging deeply into bloodwork to uncover markers that, frankly, most insurance companies won’t pay for. What do you say to patients, and your critics, about why these things are worth doing?
A: I guess the question is, what’s the alternative? The alternative is continuing to do what we’re doing. How is that working out? Not so well. So, if herculean preventive measurements are too expensive, treating them is costlier.
Is it expensive to get a $1,000 CT angiogram when you’re 40? Yes, it is. Do you know what it costs to get a stent placed? Or to get a bypass when you’re 65? Unfortunately, if you really want to take prevention seriously, you’re on the hook for the cost.
Q: Does this mean that only rich people can live healthfully to 100?
A: Screening is simply one small part of this. Far more relevant to increasing your health span is not whether or not you’re getting a CT angiogram, it’s whether you’re doing all of the other things that we talked about vis-à-vis sleep, nutrition and exercise. You don’t have to be wealthy to do those things.
Q: Isn’t it true that even if you do all of this, the Horsemen could still come for you?
A: Isn’t there a chance that if you save for retirement, your investments will sour before you need to draw the money out? Yeah, of course, there is. But if you don’t do these things, you dramatically increase the odds of things not going well.
3 Beginner-Friendly, At-Home Exercises To Blast Fat Over 40
Mariam Qayum – October 6, 2023
As we age, staying fit and maintaining a healthy weight becomes increasingly important. Fat accumulation, especially around the midsection, can be a common concern for individuals over 40. Fortunately, there are effective ways to combat this issue. Whether you’re just starting your fitness journey or looking for new ways to stay active, these exercises can be a valuable addition to your routine, promoting not only fat loss but also overall well-being.
We spoke with Andrew White, certified personal trainer, who shared his insights on the three easy exercises that can be seamlessly incorporated into your home workout routine to help individuals over the age of 40 effectively tackle fat loss. According to White’s expertise, these workouts comprise squats, push-ups, and standing leg lifts. Read on to learn more.
Squats are a fantastic exercise that can be a powerful tool in your journey to blast fat. This simple yet highly effective movement engages multiple muscle groups, including your quadriceps, hamstrings, glutes, and even your core. By incorporating squats into your routine, you not only strengthen these essential muscle groups but also boost your metabolism, which is crucial for fat loss.
“Squats target the large muscle groups of the lower body, like the quads and glutes. As you engage these major muscles, your body burns more calories, aiding in fat loss. As we age, maintaining muscle mass becomes crucial, and squats help in preserving and building that essential muscle,” White says.
How to perform squats: White says to begin by standing with your feet shoulder-width apart. Keeping your chest up and back straight, bend your knees and push your hips back as if you are sitting in a chair. Lower down until your thighs are parallel with the ground, then push through your heels to return to the starting position.
Push-ups are a fantastic beginner-friendly, at-home exercise for individuals over 40 aiming to blast fat and enhance their overall fitness. This classic bodyweight exercise primarily targets the chest, shoulders, and triceps while engaging your core and stabilizing muscles.
White notes that “push-ups are fantastic for engaging the upper body and core muscles simultaneously. They target the chest, shoulders, and triceps while also challenging the abdominal muscles. This compound exercise promotes calorie burn and muscle strengthening, essential for metabolic health as we age.”
In order to effectively perform push-ups, White says to start in a plank position with your hands placed slightly wider than shoulder-width. Engage your core and keep a straight line from head to heels. Bend your elbows and lower your body towards the ground. Once your chest is just above the floor, push yourself back up to the starting position. If traditional push-ups are challenging initially, begin with knee push-ups.
Standing Leg Lifts
Standing leg lifts are a beginner-friendly, at-home exercise that can be a game-changer for those over 40. These simple yet effective leg lifts target your lower body, specifically the quadriceps, hamstrings, and glutes. They also engage your core muscles for stability, which is crucial for balance, especially as we age.
“This exercise targets the outer thighs and hips, strengthening and toning these areas. As a low-impact exercise, it’s excellent for those over 40 as it reduces strain on the joints while effectively engaging the muscles,” White states.
Follow these simple steps to effectively perform standing leg lifts: Stand straight next to a wall or chair for support. Keeping your leg straight, lift it out to the side as high as comfortably possible. Lower it back down slowly. Repeat on the other leg.
These exercises are easy to perform without any special equipment, making them an accessible choice for those looking to maintain or improve their fitness level from the comfort of their own home.