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Expectations

Health and Fitness Expectations After 40: Can I Live Absolutely Pain Free?

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During my twenty-five plus years in medicine, most of that focused on the conservative (non-surgical) management of musculoskeletal injuries (roughly 70% spine-focused) and trauma, I had the pleasure of interacting with an astoundingly varied assortment of patients presenting with a host of aches, pains, and pathologies. No day was ever quite the same, and there was (and is) always something new to learn every day.

My principle task was of course helping figure out what the heck was the main problem at hand (diagnosis), because frankly it’s impossible to articulate an effective and cogent treatment plan unless you really understand the underlying issue(s). Only then could an effective treatment plan be customized to optimally fit a patient’s needs; that process typically also involved laying out a list of best choices in terms of treatment options and potential outcomes.

I believed then, and still do adamantly today, that a caregiver’s most critical tasks are making an accurate assessment of the issues at hand (there’s that diagnosis issue again) AND educating their patient (or client if you will) about a host of things – the problem itself, options to make things better, consequences of not dealing with the problem, and finally – managing expectations about recovery and the future.

Though it took several years to really appreciate all the moving parts in play here, over the long haul one of the more challenging aspects of that entire process was managing expectations patients brought to our relationship – the most challenging of all was the expectation that there was some magic pill, potion, therapy, surgery, or other treatment that could and would make them “pain free”.

The Pain Free Life After 40: Myth or Reality?

No doubt some will disagree, but after spending the better part of four decades studying human physiology, focused both on response to injury and normal degeneration (let’s call it wear and tear), along with ways to mitigate the problem(s) and improve function using a variety of approaches – I’m convinced it’s nigh on impossible to live an active, healthy lifestyle and NOT experience a host of aches and pains along the way, particularly for those of us who have invested four decades or more living our lives.

My rationale is pretty simple, and of course is colored in part by my own personal experience.

First, no matter if you come from the intelligent design or the evolution camp, there’s no question that the human body we see wandering the earth today experiences wear and tear changes along the way. This is of course common sense, something that we see all around us, and feel ourselves, just about every day, and yet several interesting points apply.

The longevity of the human body is critically impacted by how you care for it along the way. There are a host of great examples, but here’s the easiest one – living for years overweight increases joint loading (think hips, knees, ankles/feet, and spine) and accelerates degenerative changes in vital joint structures.

Or how about that combination ACL/MCL tear on the high school sports field or the ski slope (actually pick your major joint here – the other common example I see over and over again is a shoulder/AC joint/rotator cuff problem that starts at a very young age) that almost always leads to accelerated degenerative joint changes down the road.

Even some of the fitness activities that we all laud and encourage – jogging, running, cycling at a high level, hours spent in the pool swimming, some would even include CrossFit here – stress joints and other parts of the musculoskeletal system mechanically and probably do, at some level, indeed accelerate inevitable wear and tear.

We continue to do those fitness activities because the myriad benefits far outweigh the wear and tear we’re inducing, however there’s still a wear and tear component to the process.

Those changes wear and tear changes accumulate over the months and years, and now and again will inflame and generate what we all perceive as aches and pains. Don’t forget that typical age-related muscle and strength losses happen too, impacting joint support and mechanics; throw in a sedentary lifestyle and even worse overall physical conditioning, and joint changes worsen even more – and so do the inflammatory-driven aches and pains.

So Being Absolutely Pain Free After 40 Is Indeed a Myth?

What I suggested to patients for years and now for coaching clients is simply this – I think it’s virtually impossible to be absolutely free of aches and pains after 40 living an active and functional lifestyle.

Perhaps even more importantly, I’d argue that there are some “aches and pains” that are unquestionable a good thing; probably the best example is DOMS (delayed onset muscle soreness) after a new workout or pushing your game a little.

Wear and tear of the human body (sometimes referred to as the degenerative cascade) just happens; part of your musculoskeletal longevity might be genetically influenced, but the most critical impacts are related to how well you care for yourself over the long haul.

There’s no question whatsoever than you can dramatically influence inflammation levels in your body via diet (we’ll be looking at detail in inflammatory impacts from diet in a several post series shortly). Moving closer to whatever you consider your ideal body weight will have dramatic impacts as well, as will rebuilding (or working hard to maintain) practical levels of functional conditioning – getting into, and staying, in “fighting trim” will itself invoke some soreness and aches along the way.

Your body has amazing recuperative powers.

Is it theoretically possible to live a pain free life? Sure it is, it’s just not very probable.

Instead, embrace the occasional joint tweak, morning stiffness, and sore muscle group – it’s going to happen again and again. And relish those days when everything feels pretty good, modify on the days that it doesn’t, and just keep moving.

Health and Fitness Expectations after 40: Managing the Timeline Game

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Last week I introduced a series to come focusing on managing expectations, in particular expectations that those of us working to maximize our health and fitness after our 40th birthdays create for ourselves.

Given what we know about athletic performance, I’m thinking here of the old rule of thumb that your VO2max (think of VO2max as a measure of your body’s ability to utilize oxygen) declines by about 10% every decade post age 30, we probably should really be talking about expectations we create for ourselves post age thirty. (And this old study shows that the traditional 10% per decade decline doesn’t hold true for fit people actively exercising, even in their 7th decade).

And of course, the absolute crux of the timeline expectation game is damned simple – the time it’s going to take you to get from your starting point to your fitness, or weight, or metabolic health target depends on a host of factors unique to you, and critically where – relative to your targets – you’re starting from.

An Embarrassing Example from my Own Experience

When I first made the decision now just about three years ago to do what ever it might take to reclaim my health and fitness, I was a physical and metabolic disaster. In a full blow metabolic syndrome (I could have been a poster boy), I had just finished a round of treatment for renal cancer, had developed an idiopathic thrombocytopenia (low platelet count), weighed 412 pounds, and had so many aches and pains I could hardly walk through a store without the aid of a cart, and on the worst days, needed help tying my shoes.

A mentor helped me take the first steps in terms of revamping my diet and beginning at the most basic level in terms of rebuilding my fitness, and drilled into me the importance of setting attainable and rational short and intermediate term goals (incentives, and success, are huge helps). He also challenged me to set “reach for the stars”, seemingly at the time almost crazy goals as well; we can talk about structuring goals in detail sometime in detail – the psychology is fascinating – for sake of this story let’s just say I did set some seemingly unreachable long term goals (most of which I’ve now surpassed at the almost two year mark).

My mentor, wise friend that he is, hammered into me week after week that part of the process is indeed expecting life to get better (fitness to improve, weight to drop, etc), but he cautioned every single time that trying to pair my fitness and weight loss goals with a timeline I’d pulled out of thin air was a fool’s errand. He (correctly) harped on the principle that our expectations (especially when it comes to timelines) need to be tempered and tied to our reality unfolding day by day.

For Every Year a Couch Potato a Month in Recovery?

My mentor repetitively hounded me with another rule of thumb that he swears he learned from Dr. Phil Maffetone (I’ve yet to find it expressly stated on his site or any of his books), basically saying that after 40 (arguably 30 or 35 as well), for every year you’ve spent not exercising and overweight, you’ll spend at least a month of consistent fitness and healthy eating to reverse and overcome the damage and deconditioning done on your way back to a healthy baseline.

To be perfectly honest, I despise most rule of thumb discussions in health and fitness in general, as there’s simply too much variability in human physiology and experience to make them conform meaningfully to an individual’s reality.

That said, I’ve used this principle in advising clients and patients for years now – for every year a couch potato you’ll spend a month eating healthy and exercising consistently to restore a healthy baseline – and I’ll be damned if it doesn’t ring ring true more often than not. And note I’m talking about a healthy baseline here – becoming a masters cyclist or runner might take a little longer.

The Bottom Line: Play to Win the Long Game

In particular for those of us over 40, restoring optimal health and fitness after a period of…let’s say any time living with less than optimal nutrition and shunning exercise…is going to be a long game; accepting that reality will make the process immensely more rewarding, enjoyable, and sustainable.

Amazingly I still have people contact me for help in “easily dropping 50 pounds in three months”; most of the time we don’t mesh and work together – unrealistic expectations at the start are a huge hurdle to overcome. (Can somebody drop 50 pounds in three months? While possible, it’s sure as hell not probable, but it depends on where you’re starting from and how you want to get there; I dropped 50 pounds in four months myself at one point in my journey. )

By 40, most of us have accumulated at least a few dings and bruises, we don’t recover as quickly from aggressive workouts or injury, we often have very demanding work and family responsibilities, and we’ve often accumulated some damned harmful and deeply ingrained habits too. These things won’t prevent you from coming back, but they’ll impact your approach, and the timeline.

Have a long way to go to rebuild your health and fitness? It can be done; embrace the longer journey, savor the victories along the way, and build a lifestyle to take you into later years, remaining active, vital, and engaged.

Health and Fitness After 40: Managing the Expectation Game

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The Cambridge Dictionary defines the word expectation in several ways, and there’s a slight twist when comparing the US vs. the British definitions…

US: the feeling or belief that something will or should happen

UK: the feeling that good things are going to happen in the future; the feeling of expecting something to happen, what you believe or hope will happen in the future

At the risk of sounding a little too old school, I’d venture that – when it comes to personal health, wellness, and fitness – many of us have allowed the impatient, “I want it right now, dammit” tone dominating society now to impact how we view our own approach to, and our progress in, an effort to up our game and live healthier.

The longer I actively practiced medicine the more convinced I became that, for a variety of reasons we’ll talk about over the next several weeks, most of us have expectations regarding health, fitness, and function that are hugely divergent from our own personal realities, and if you’re not a thoughtful steward of expectations – lousy results often follow, many times leading to failure and disaster.

Here’s an example of what I’m talking about. During the last fifteen or so years in practice, I focused on the conservative management of spine disease and injury. Most of the patients I treated were older than thirty-five, overweight – some massively, poorly conditioned, sedentary or close to it, consumed some variation of the Standard American Diet, and many engaged in some other high risk health behavior, smoking and recreational drug use being the most common.

Most of the patients I treated stepped into my office with the expectation that, with some wave of the technological magic wand helped by some pharmacologic sorcery, their pain would somehow be resolved with minimal effort otherwise on their part.

Managing these expectations was in reality perhaps my biggest challenge in the medical game; it required patient, consistent, endless education, helping people understand what was wrong, why it happened, how recovery and restoration of function actually happens, and what the potentials were down the road for improvement and gains.

You can guess how the story unfolded; a minority really dug in, listened, learned, made life and activity changes, and genuinely improved. A bigger group went through the motions, did the minimum to quiet the problem at hand, and resumed their destructive lifestyle to return with another back pain crisis a few months down the road. Another minority refused to engage, and went off seeking the holy grail of a no-effort recovery, usually unhappy, bitter, and disparaging on the way out the door.

Health and Fitness After 40: Managing the Expectation Game

Over the next few weeks we’re going to tackle some of the expectations those of us over 40 (you could argue over 30 for most in America today) have regarding our own personal health, wellness, and fitness; of course we all want to be more fit, closer to our best weight, sharper, more engaged and energetic, and live as long as a highly functional – and happy – human as we possibly can.

Before your expectations derail your progress on your journey, let’s spend some time looking in more detail at some common areas where our expectations can quickly breed frustration. We’ll start with a fairly candid look at weight loss expectations next week, followed by a number of other topics in the weeks to come.