Transcription:
Improving Flexibility and Balance

Intro: This is BayCare HealthChat, another podcast from BayCare Health System.

Caitlin Whyte (Host): Welcome to BayCare HealthChat. I'm Caitlin Whyte. And in this episode, we are talking about improving your flexibility and balance with Dr. Patrick Couchot, a third year Family Medicine Resident at BayCare. To start off our conversation, Doctor, what should we do when starting any exercise plan?

Patrick Couchot, MD (Guest): Yeah. So, the first thing to do before starting an exercise plan is to talk to your physician about what plan is going to be right for you. Your physician will be able to assess what level you're at in terms of physical activity. And what the next steps are going to be for how you can initiate and then continue that exercise plan. It's important before you get started with those to think of some of the barriers you might encounter as you progress and how you can overcome them and sort of plan ahead to try to stay on top of it. And also what is motivating you to start this exercise program? Are you trying to manage a chronic disease or are you trying to avoid having chronic disease?

Is there a family history of something you want to avoid? Those personal goals, keeping those in mind, will help keep your motivation up and help keep you going when things get a little bit tougher.

Host: Now, what are the major types of exercise and what are some examples of each?

Dr. Couchot: Yeah. So, there are four major types of exercise that we can partake in. First one being aerobic and endurance training. These are mainly where the body's larger muscle groups are moving in some sort of rhythm. Good examples of this are walking, stationary bike, any sort of aquatic exercise. You're sustaining that rhythmic pattern for a longer period of time building up endurance in those muscles.

Next, we have resistance and strength training. This is going to be more using your muscles against an applied force. So, examples of this would be using weight machines or resistance bands, handheld weights, even carrying groceries are a good example of resistance training where we're working against some applied force.

Another type is balance. This is a combination of activities that really rely on your core stabilization and your lower body strength, and then basically help you not fall. So, it's a little bit harder to define in terms of balance exercises, but those are the pretty much the gist of it. It is increasing your lower body strength and keeping you upright.

And the last major type of exercise is going to be flexibility. So, these activities are designed to preserve or extend range of motion around a joint. And we'll get into a little bit more detail about what flexibility exercises look like.

Host: And then off that let's break down those major types. What are the current recommendations regarding amount, type and intensity of exercise?

Dr. Couchot: The important thing to remember obviously, is that when we start an exercise plan, we'd have to individualize that exercise plan. It needs to be specific to what you need and what your goals are. Now, the gross recommendations for adults that are put out by the American Academy of Family Physicians and the American Heart Association as well; they recommend at least 150 minutes of moderate intensity activity or 75 minutes of vigorous activity at least a week, as well as two or more days of muscle strengthening exercises a week. That being said, any amount of exercise is better than none. So, this should be your goal is to get to that 150 minutes of moderate intensity activity.

But of course we can't all start at that level. So, you need to sort of tailor the exercise program to what better suits you. Now, what is moderate intensity activity? That's going to be something where, whatever exercise you're doing, you're going to need to work a little bit harder to breathe, your heart rate's going to be a little bit faster. You should be able to hold a conversation relatively well. But you should not be able to sing or scream or do things like that where you're using a little bit more air movement. Good examples of this are a brisk walk, not a slow leisurely walk, a little bit of a brisker walk, doing water aerobics. Some forms of dancing can be this as well. Whereas your vigorous intensity activity, that's going to be where you are not able to hold the conversation. You shouldn't really be able to say more than a few words. Examples of this are more intense versions of moderate intensity. So, things like jogging, running, aerobic dancing, heavy gardening, that's going to be more of your vigorous activity.

Host: So let's focus on flexibility exercises, what kinds are available and how can we improve on them?

Dr. Couchot: There are two main types of flexibility exercises. One is called static and the other is called dynamic. Your static flexibility exercises are holding a single position and then your dynamic or actively moving in whatever moves that you're going to be doing. So, the data is not a hundred percent clear about which one is better than the other. Certainly, if we do partake in static stretching prior to any sort of other exercise, it actually has been shown to decrease the power and strength of the exercise that you're then going to do. So, this is in terms of, you know, thinking more along the lines of performance athletes and professional athletes; this static stretching might not be the best idea prior to some sort of activity or competition where you need to be at peak performance. Now for the weekend warriors or for the recreational athletes; more than fine to do some static stretching prior to exercise. The amount of decrease in performance is very small. Studies show it's 1 to 3%. So, not very much, but if you're in a high intensity competition, of course, those 1 to 3% can make a big difference. But recreationally, it's not going to make as much of a difference. And there are definitely long-term benefits to continuing with static stretching. These mainly are involved with increased flexibility, likely injury reduction and long-term increase in strength. So, although you have that short-term decrease in strength, the long-term increase in strength is likely directly related to this increased range of motion that you'll get. Now, the American College of Sports Medicine actually has guidelines on stretching and flexibility.

And they provide a great resource for different exercises that you can do at home. They recommend doing flexibility and stretching exercises, at least two or three times per week, daily being likely the most effective at improving your range of motion. They recommend stretching to the point of feeling tightness but not pain. So, you want to feel a little bit of discomfort, but you don't want to have any pain. And then for static stretching, they recommend holding that stretch for 10 to 30 seconds, longer if possible. If your goals are to become more and more flexible, than obviously holding these positions longer will increase your range of motion over time, and you should be stretching each of your major muscle tendon groups daily. Now, the more we do the stretching, the better we'll be. So, stretching isn't so much of a short-term goal, but a long-term goal. And that's why it's important to build that into your daily or weekly routine so that you can continue and continue to improve and see the results over weeks and months, as opposed to over days.

Host: And then let's look at balance exercises. Tell us about those.

Dr. Couchot: Yeah. Balance exercises are a little bit more difficult to pin down because it's just more of a broad category, but basically what it's going to involve is improving your muscular strength, your gait speed and your physical performance. And this is going to be focused on your core stabilization as well as your lower muscle strength.

So, lower extremities, think legs and glutes and walking. The American College of Sports Medicine, the ACSM, actually does recommend performing daily neuro motor exercises to improve your balance. And that can be as simple as walking, or it can be as complex as working with a physical therapist, working on single leg stances and tandem stances.

Those are going to be your higher level or advanced balance type training. Now something that's accessible to a lot of people that I love to recommend to all my patients are three-dimensional exercises. The most common two that you hear about are yoga and Tai Chi. These have exercise programs all over the internet, whether it be on YouTube or Spotify, you can find a lot of different programs that go through yoga and Tai Chi and they have been shown to improve both balance and likely reduce the risk of falls specifically in our elderly adults. So, I highly recommend both of those. Of course, keep in mind, you need to start where you're at. So, it's important to know what your exercise limitations are and then speak to your physician or your physical therapist in order to see what those limitations are and work within those limitations.

But Tai Chi is a very gentle form of movement that is usually accessible, especially to our elderly adults, where we tend to lose our range of motion as we get older. And so doing exercises like Tai Chi can help keep our muscles active and help keep our flexibility up.

Host: Wonderful, well Doctor, when it comes to flexibility and balance, is there anything else you'd like to add? Any other tips to share?

Dr. Couchot: I think that one of the most important things about flexibility and balance is to keep at it almost every day, if you can. Things like this will improve over time. It's going to be harder to see day-to-day progress. It's going to be calculated more in weeks and months. So, one of the most important things when starting any exercise plan, but specifically with flexibility and balance is to build it into the daily routine. That way you are constantly reaffirming that what you're doing is helpful and you're constantly improving your strength and your range of motion and your balance. When I'm talking to patients about doing this, I recommend really integrating it into your daily routine, whether that be after every morning cup of coffee, while you're making your coffee, you're doing some stretching or some balance exercises. Associating it with something you do every day is going to help you in the long run, improve your range of motion, improve your balance, reduce risk of falls. The benefits are numerous. And so really keeping at it, I think is one of the most important things to do.

Host: Well Doctor, we so appreciate these tips and your time today. Thank you. Head on over to our website at BayCare.org for more information, and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all of the other BayCare podcasts. For more health tips and updates, you can follow us on your social channels as well. This has been another episode of BayCare HealthChat. I'm Caitlin Whyte. Stay well.