• Begin your exercise program slowly with low-intensity exercises.
• Warm up before exercising and cool down afterward.
• Pay attention to your surroundings when exercising outdoors.
• Drink water before, during, and after your workout session, even if you don’t feel thirsty. Play catch, kickball, basketball, or soccer.
• Wear appropriate fitness clothes and shoes for your activity.
• If you have specific health conditions, discuss your exercise and physical activity plan with your health care provider.

Download and fill out the Find Your Starting Point Activity Log (PDF, 904K) to document your starting point. You’ll find space to track your normal activity levels for a few days — try to choose a few weekdays and one weekend day.Share this infographic to learn about the real life benefits of exercise.Don’t forget to test your current fitness level for all four types of exercise — endurance, balance, flexibility, and strength. You may be in shape for running, but if you’re not stretching, you’re not getting the maximum benefit from your exercise. Write down your results so you can track your progress as you continue to exercise.Make notes about how these test exercises feel. If the exercises were hard, do what’s comfortable and slowly build up. If they were easy, you know your level of fitness is higher. You can be more ambitious and challenge yourself.Once you start exercising, use the Monthly Progress Test (PDF, 675K) to check in and see how you are improving, and celebrate your successes!Four questions to ask your doctor about exerciseAre you considering adding exercise to your daily routine or significantly increasing your level of activity? Talk with your doctor about the exercises and physical activities that are best for you. During your appointment, you can ask:

1. What types of exercise would work for me? Your medical history and current activity level will help your doctor recommend exercises that are doable and safe. Your doctor can also help you come up with a plan to gradually increase the intensity or duration of your physical activity. This information might be part of an exercise prescription, which indicates how you should exercise and for how long. You can “fill” this prescription by yourself or coordinate with a personal trainer or exercise medicine specialist.
2. Are there any exercises or activities I should avoid?Your doctor can make recommendations based on your health history, keeping in mind any recent surgeries or ongoing health conditions such as arthritis, diabetes, or heart disease. This would be a great time to check with your doctor about any unexplained symptoms you’ve been experiencing, such as chest pain or pressure, joint pain, dizziness, or shortness of breath. Your doctor may recommend postponing exercise until the problem is diagnosed and treated.
3. How does my health condition affect my ability to exercise?Some health conditions can affect your exercise routine. For example, people with arthritis may need to avoid some types of activity, especially when joints are swollen or inflamed. Those with diabetes may need to adjust their daily schedule, meal plan, or medications when planning their activities. Your doctor can talk with you about any adjustments you need to make to ensure that you get the most out of your new exercise routine.
4. Is my preventive care up to date?Your doctor can tell you if there are any tests you might need. For example, women over age 65 should be checked regularly for osteoporosis.

How to set fitness goalsRead and share this infographic to learn about tips to stay motivated to exercise.Many people find that having a firm goal in mind motivates them to move ahead on a project. Goals are most useful when they are specific, realistic, and important to you. Be sure to review your goals regularly as you make progress or your priorities change.Download and use the Goal-Setting Worksheet (PDF, 691K) to document where you want to be in both the short- and long-term.Write down your short-term fitness goalsShort-term goals will help you make physical activity a regular part of your daily life. For these goals, think about the things you’ll need to get or do in order to be physically active. For example, you may need to buy walking shoes or fill out an Activity Log so you can figure out how to fit physical activity into your busy day. Make sure your short-term goals will really help you be active. Here are a few examples of short-term goals:

• Today, I will decide to be more active.
• Tomorrow, I will find out about exercise classes in my area.
• By the end of this week, I will talk with my friend about exercising with me a couple of times a week.
• In the next two weeks, I will make sure I have the shoes and comfortable clothes I need to start walking for exercise.

Write down your long-term goalsAfter you write down your short-term goals, you can go on to identify your long-term goals. Focus on where you want to be in six months, a year, or two years from now. Long-term goals also should be realistic, personal, and important to you. Here are a few examples:

• By this time next year, I will swim one mile three times a week.
• Next summer, I will be able to play pitch and catch with my grandchildren.
• In six months, I will have my blood pressure under control by increasing my physical activity and following my doctor’s advice.

Carl’s storyFor Carl, 75, being able to do the things he enjoys motivates him to exercise every day. “I lift weights with my personal trainer at my gym twice a week and do stretching exercises. I also like bowling and fishing. I exercise so I can stay fit. It also helps keep my muscles strong and I have more energy to get going each day.”Write a plan to add exercise and physical activity to your lifeSome people find that writing an exercise and physical activity plan helps them keep their promise to be active, while some people can plunge into a new project without planning ahead. If you choose to make a plan, be sure the plan is realistic for you to do, especially as you gain experience in how to be active. You might even make a contract with a friend or family member to carry out your plan. Involving another person can help you keep your commitment.Check out the interactive Activity Planner from the U.S. Department of Health and Human Services’ Move Your Way campaign. It lets you build a weekly physical activity plan and then print it out. You can choose from a variety of fun and exciting endurance (aerobic) and strength exercises, personalize your activities by location and purpose, and indicate how much of each exercise you will do. Once you create your plan, don’t forget to add in balance and flexibility exercises.Review and update your exercise plan regularlyRegularly review and update your plan and long-term goals so that you can build on your success. Adjust your plan as you progress or if your schedule changes. You may find that things like vacations or illness can interrupt your physical activity routine. Don’t get discouraged! You can start exercising again and be successful. You can use a Weekly Exercise and Physical Activity Plan (PDF, 345K) to write down your activities.Read about this topic in Spanish. Lea sobre este tema en español.Sign up for e-alerts about healthy agingTop of FormEmail AddressBottom of Formhttps://www.nia.nih.gov/health/how-older-adults-can-get-started-exercise?utm_source=nia-eblast&utm_medium=email&utm_campaign=healthyaging-20230123#started

• Think big, start small. Make long-term goals that will be obtainable then make small, short-term goals that will lead up to the long-term goal. For example, if you want to lose 30 pounds by the end of the year, you should have a set weight loss goal for each month 2.5.
• Priority. Everything you do in life is based on your priority system. If it is important to you then you will do it without question. Make your New Year’s fitness resolutions a priority because there is always time in your day for your top priorities.
• Accountability. Being held accountable is a powerful tool thus telling your family and friends will help with obtaining your New Year’s fitness resolutions. Added, meal prepping and set out your fitness attire ahead of time will also aid in your success.
• If you do not make it, you do not eat it. The saying, “you are what you eat” is very true. Making your meals will make you more aware of what you are putting in your body thus the better you will eat and, ultimately, the better you will feel.
• Life. There will be times in which you are unable to make it to the gym or unable to stick with your meal plan because of life. Do not let this get to you!
• Have fun! This is the most important part of setting a New Year’s Fitness Resolution. Find something that you enjoy and stick with it. It takes approximately one moth for a new habit to be created thus you are more likely to stick with your new lifestyle after that time frame. You can do it!

Joseph Sudimack, MS, CSCS, *D, NSCA-CPTProgram Director, Physical Therapy TechnologyCarrington College, Mesa (www.carrington.edu)Joseph Sudimack has more than 15 years of experience in the health and fitness industry. He received a bachelor’s degree in Kinesiology from Arizona State University and a master’s degree in Health Science with an emphasis in Sports Performance from Rocky Mountain University of Health Professions. He is a NSCA-Certified Personal Trainer (NSCA-CPT), a certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association, Functional Movement Screen (FMS) Level 1 certified, and a certified Basic Life Skills (BLS) instructor with the American Heart Association. Contributions

• Flynn, C. (2019, June 25). Shedding Extra Weight Is More Than Just Diet and Exercise – Here’s What Else You Need to Do – PopSugar: https://www.popsugar.com/fitness/Natural-Ways-Lose-Belly-Fat-44829622
• Kuzma, C. (2018, August 26). In or Out – Choose the Best Scene for Your Fitness Routine – USA Today: https://issuu.com/studiogannett/docs/best_years_e911bf06c60cd2
• Malacoff, J. (2018, May). Simple Ways to Avoid Summer Workout Dangers – Reader’s Digest: https://www.rd.com/health/fitness/summer-workout-dangers/
• Pajer, N. (2018, July 13). 12 Genius Hacks For Becoming A Better Runner – Huffington Post: https://www.huffingtonpost.com/entry/how-to-become-a-better-runner-if-youre-a-beginner_us_5a68c9aee4b002283008ca7e
• Steber, C. (2021, August 13). 6 ways to use an Ab roller for core Strength, straight FROM TRAINERS – Bustle: https://www.bustle.com/wellness/ab-roller-workouts-core-strength.
• Steber, C. (2022, May 17). 6 Full-Body Tabata Workouts, Straight From Trainers – Bustle: https://www.bustle.com/wellness/full-body-tabata-workouts
• Steber, C. (2022, June 3). 10 Low-Impact Cardio Workout Ideas – Bustle: https://www.bustle.com/wellness/low-impact-cardio-workouts
• Steber, C. (2022, June 24). 11 Stretches for Mid-Back Pain – Bustle: https://www.bustle.com/wellness/stretches-mid-back-pain

 Publications

• Sudimack, J., IV. (2019, February). Simple Tips to Stick with Fitness Resolutions. Arizona Health & Living, 8(102), 37.

Split Second Foundation, a non-profit that provides resources, including inclusive gyms for the disabled and geriatric communities, shares tips inclusive health and wellness tips as well as a few exercises that can be done from the comfort of your own home.

Set goals and show up. The biggest challenge of setting up a health and fitness routine is getting started and being committed to achieving your fitness or recovery goals. If you need to start small and just incorporate one workout day into your weekly schedule or even just one exercise, do it. You can use that as your launchpad and keep adding days or exercises to your routine until you get to a place you feel comfortable. It’s also important to commit to your health and fitness routine and stick with the plan you create for yourself.

Commit to 30-60 minute workouts. Everyone should aim for at least 30 minutes of moderate physical activity every day. That’s the length of a TV show, so take a break from the couch to focus on you. Or if you just can’t miss your shows, do your exercises while watching your shows. Not only will it help you stick to the 30 minutes of exercise per day, but it can also take your mind off the exercises you are doing.

You don’t need machines or equipment. One of the biggest misconceptions about working out is that you need to have access to a ton of equipment or space. You don’t need a special area or the ability to get into certain positions to exercise. You can find exercise that can be performed sitting, standing, or lying down. Just get started!

Your smartphone really is smart. The internet really is a treasure trove for health and fitness goodies. Search YouTube and other platforms for exercise videos that break down each move and demonstrate how to properly execute them. You can also check out trusted social media accounts for fitness and health tips and tricks.

Don’t forget to stretch daily. Stretching is important for decreasing muscles stiffness and increasing range of motion. Additional benefits to stretching includes reducing stress, reducing risk for injury abs decreasing pain in some circumstances.

Recommended Exercises:

1. Ankle Pumps. This exercise can be performed lying down, sitting in a chair, or standing up. If you don’t have the ability to move your feet on your own, you can get help from a partner or use a strap positioned around the ball of your feet.

To perform ankle pumps sitting or lying down: point your toes down towards the ground as if pressing on a gas pedal then lift your toes in the opposite direction up towards your body. Repeat 25 times. Three sets of 25 repetitions is recommended. Take 30 second breaks between each set to allow muscles to rest.To perform ankle pumps standing: position yourself next to a sturdy surface to help with balancing, lift your heels off the ground so that you are standing on your toes. Then slowly lower your heels back to the ground. Three sets of 25 repetitions is recommended taking 30 seconds rest breaks between each set.

2. Torso Push Ups. This exercise should be done sitting up in a chair either with legs bent or seated on a firm surface with your legs extended.

If you can use your hands, place them on the armrests of your chair or on the surface where your body is positioned and push directly down, extending your elbows and pressing your shoulders down towards the floor. Your torso may rise from your seat. Slowly lower your torso and relax your arms. Repeat 10 times. Three sets of 10 repetitions is recommended.If you cannot use your hands, position yourself in a chair with armrests. Place your forearms on the armrests, then push down through your elbows and depress your shoulders down towards the floor. Your torso may or may not raise from your seat. Slowly lower your shoulders and/or torso and relax your arms. Repeat 10 times. Three sets of 10 repetition is recommended.

3. Prone Press Ups. An alternative to this chair push-up is called a prone press up. To do such, position yourself lying on your stomach with your hands in the direction of your head. Your elbows should be bent and positioned on either side of your torso. Push down through your elbows and depress your shoulders down towards the floor. Lift your head and shoulders away from the surface you are lying on. Slowly lower your shoulders and/or torso and relax your arms. Three sets of 10 repetitions is recommended, taking 30 second breaks between each set to allow the muscles to rest.

About Split Second Foundation 20.6 million Americans live with some form of ambulatory disability, requiring a mobility device. Many of these people face an isolated world with few social interactions, health complications, a higher risk of suicide, a shorter life expectancy and few places to turn to for assistance. Split Second Foundation, a Louisiana-based non-profit 501(c)(3), helps provide support, recovery tools and tactics, ongoing fitness exercise, education, and answers to people living with a disability or medical condition.

What types of exercise would work for me? Your medical history and current activity level will help your doctor recommend exercises that are doable and safe. Your doctor can also help you come up with a plan to gradually increase the intensity or duration of your physical activity. This information might be part of an exercise prescription, which indicates how you should exercise and for how long. You can “fill” this prescription by yourself or coordinate with a personal trainer or exercise medicine specialist.

Are there any exercises or activities I should avoid? Your doctor can make recommendations based on your health history, keeping in mind any recent surgeries or ongoing health conditions such as arthritis, diabetes, or heart disease. This would be a great time to check with your doctor about any unexplained symptoms you’ve been experiencing, such as chest pain or pressure, joint pain, dizziness, or shortness of breath. Your doctor may recommend postponing exercise until the problem is diagnosed and treated.

How does my health condition affect my ability to exercise? Some health conditions can affect your exercise routine. For example, people with arthritis may need to avoid some types of activity, especially when joints are swollen or inflamed. Those with diabetes may need to adjust their daily schedule, meal plan, or medications when planning their activities. Your doctor can talk with you about any adjustments you need to make to ensure that you get the most out of your new exercise routine.

Is my preventive care up to date? Your doctor can tell you if there are any tests you might need. For example, women over age 65 should be checked regularly for osteoporosis.

To ‘connect’ these runs, or reproduce the ease of motion and speed felt in one workout with the next, many things can be done. First is of course the standard recovery tactics like stretching after the runs, getting sustenance soon after the workout, taking an ice bath or foam rolling key areas of stress as needed. All paramount and should be standard for those able to work to high levels of exertion during training. Along with these tactics, however, let’s add in a few techniques to ensure the muscles, tendons, ligaments, and fascia are remaining supple, strong, and flexible during the recovery process and the recovery runs.

The following suggestions are based on standard drills and stretch positions. These are to be done while running and involve simply altering your stride slightly for 3-6 steps at a time, then repeating as desired. There are certainly more to be found so be creative and look for your own ‘secret steps’ to keeping your legs loose and responsive.

1. Butt-kicks: A controlled pull of your foot towards your glutes during the flight phase and done by primarily flexing at the knee. When done during a run this standard drill can be done with one leg at a time and with as many regular strides in between.

2. Foot-flicks: A controlled snap of your foot forward done right before the foot hits the ground and accomplished with a quick contraction of the quadriceps, this resulting in a very brief full extension (straightening) of the leg.

3. Side-steps: Slightly rotate one leg outwards by having the foot facing more towards the side than straight ahead.

4. Pigeon-steps: Very slightly rotate one leg inwards by having the foot facing more inwards than straight ahead.

5. Cross-overs: Have the feet cross over each other when landing.

6. Bowlegged-steps: Run as if a small stream of water is directly underneath you and right along your path, i.e. so that your steps have to be 4-8 inches wider apart than normal.

7. Carioca or grapevine: Running sideways by first having the right leg cross in front of the left and then behind.

8. Backwards running: Plain and simple.

Only runners 100% healthy should explore and work with these techniques. For those with right and left strength or flexibility imbalances these can be quite helpful but more caution should be taken. Given the initial awkwardness of these movements be sure to do this on a flat, obstruction free area.

If you want to know more about how to run smarter and better, check out my book Pliability for Runners.

Joseph McConkey, MS, is a running coach and exercise physiologist, specializing in injury-prevention. He has worked with the full spectrum of running athletes, from first-time runners, to marathoners around the world, to Olympic athletes at the elite high altitude training camps of Ethiopia and Kenya. He has coached at the club, college, and pro levels and has been the director of the Boston Running Center’s Gait Analysis Lab for more than a decade. Joseph holds the highest accreditation by the USA Track and Field Association and the IAAF, as well as a Masters in Exercises Science with a focus on Injury Prevention and Sports Performance. He is the author of Pliability for Runners.

“Many studies have identified potential risk factors for dementia, but we wanted to know more about a wide variety of lifestyle habits and their potential role in the prevention of dementia,” said study author Huan Song, MD, PhD, of Sichuan University in Chengdu, China. “Our study found that exercise, household chores, and social visits were linked to a reduced risk of various types of dementia.”

The study involved 501,376 people from a UK database without dementia with an average age of 56.

Participants filled out questionnaires at the beginning of the study, including one on physical activities. They were asked how often they participated in activities such as climbing a flight of stairs, walking, and participating in strenuous sports. They were also asked about household chores, job-related activities, and what kind of transportation they used, including walking or biking to work.

Participants completed another questionnaire on mental activities. They were asked about their education level, whether they attend adult education classes, how often they visit with friends and family, visit pubs or social clubs or religious groups, and how often they use electronic devices such as playing computer games, watching TV, and talking on the phone.

Additionally, participants reported whether they had any immediate family members with dementia. This helped researchers determine if they had a genetic risk for Alzheimer’s disease. Study participants were followed an average of 11 years. At the end of the study, 5,185 people had developed dementia.

After adjusting for multiple factors such as age, income, and smoking, researchers found that most physical and mental activities studied showed links to the risk of dementia. Importantly, the findings remain after considering the high correlations and interactions of these activities. People who were highly engaged in activity patterns including frequent exercises, household chores, and daily visits of family and friends had 35%, 21%, and 15% lower risk of dementia, respectively, compared to people who were the least engaged in these activity patterns.

Researchers also looked at dementia incidence rates by identified activity patterns. The rate in people who exercised frequently was 0.45 cases for every 1,000 person-years compared to 1.59 for people who rarely exercised. Person-years take into account the number of people in a study as well as the amount of time spent in the study. Those who frequently did household chores had a rate of 0.86 cases for every 1,000 person-years compared to 1.02 for people who rarely did household chores. People who visited family daily had a rate of 0.62 cases for every 1,000 person-years compared to 0.8 cases for those who only visited friends and family once every few months.

“Our study has found that by engaging more frequently in healthy physical and mental activities people may reduce their risk of dementia,” Song said. “More research is needed to confirm our findings. However, our results are encouraging that making these simple lifestyle changes may be beneficial.”

The researchers found that all participants benefited from the protective effect of physical and mental activities, whether or not they had a family history of dementia.

A limitation of the study was that people reported their own physical and mental activity, so they may not have remembered and reported these activities correctly.

The study was supported by National Natural Science Foundation of China, West China Hospital, Sichuan University, and National Clinical Research Center for Geriatrics.

Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

Physical and mental activities, such as household chores, exercise, and visiting with family and friends, may help lower the risk of dementia, according to a new study published in the July 27, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology. The study looked at the effects of these activities, as well as mental activities and use of electronic devices in people both with and without higher genetic risk for dementia.

“Many studies have identified potential risk factors for dementia, but we wanted to know more about a wide variety of lifestyle habits and their potential role in the prevention of dementia,” said study author Huan Song, MD, PhD, of Sichuan University in Chengdu, China. “Our study found that exercise, household chores, and social visits were linked to a reduced risk of various types of dementia.”

The study involved 501,376 people from a UK database without dementia with an average age of 56.

Participants filled out questionnaires at the beginning of the study, including one on physical activities. They were asked how often they participated in activities such as climbing a flight of stairs, walking, and participating in strenuous sports. They were also asked about household chores, job-related activities, and what kind of transportation they used, including walking or biking to work.

Participants completed another questionnaire on mental activities. They were asked about their education level, whether they attend adult education classes, how often they visit with friends and family, visit pubs or social clubs or religious groups, and how often they use electronic devices such as playing computer games, watching TV, and talking on the phone.

Additionally, participants reported whether they had any immediate family members with dementia. This helped researchers determine if they had a genetic risk for Alzheimer’s disease. Study participants were followed an average of 11 years. At the end of the study, 5,185 people had developed dementia.

After adjusting for multiple factors such as age, income, and smoking, researchers found that most physical and mental activities studied showed links to the risk of dementia. Importantly, the findings remain after considering the high correlations and interactions of these activities. People who were highly engaged in activity patterns including frequent exercises, household chores, and daily visits of family and friends had 35%, 21%, and 15% lower risk of dementia, respectively, compared to people who were the least engaged in these activity patterns.

Researchers also looked at dementia incidence rates by identified activity patterns. The rate in people who exercised frequently was 0.45 cases for every 1,000 person-years compared to 1.59 for people who rarely exercised. Person-years take into account the number of people in a study as well as the amount of time spent in the study. Those who frequently did household chores had a rate of 0.86 cases for every 1,000 person-years compared to 1.02 for people who rarely did household chores. People who visited family daily had a rate of 0.62 cases for every 1,000 person-years compared to 0.8 cases for those who only visited friends and family once every few months.

“Our study has found that by engaging more frequently in healthy physical and mental activities people may reduce their risk of dementia,” Song said. “More research is needed to confirm our findings. However, our results are encouraging that making these simple lifestyle changes may be beneficial.”

The researchers found that all participants benefited from the protective effect of physical and mental activities, whether or not they had a family history of dementia.

A limitation of the study was that people reported their own physical and mental activity, so they may not have remembered and reported these activities correctly.

The study was supported by National Natural Science Foundation of China, West China Hospital, Sichuan University, and National Clinical Research Center for Geriatrics.

Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

Since Botox® was approved almost thirty years ago, the medical community has found that the mechanism that makes it so effective in treating wrinkles and lines is equally effective in treating conditions as varied as chronic migraines, excessive sweating, and eye spasms. What these disparate conditions have in common is that they are caused by the action of muscle cells, which are found throughout the body. Botox® acts on muscle cells and, as we’ve learned over time, there are almost endless applications for its beneficial effects.

The active ingredient in Botox®, “botulinum toxin A”, is a naturally-occurring toxin that works by blocking the interaction between nerve and muscle cells, temporarily paralyzing the muscle cells and preventing them from contracting. In its most popular usage, for facial wrinkles, a Botox® injection temporarily weakens the muscle cells that control facial expression causing the muscles to relax, contractions to diminish, and the skin to become noticeably smoother. In large doses, this toxin is responsible for botulism, which can cause paralysis and even death, but in tiny doses injected by a licensed medical professional, Botox® and similar products safely reduce the muscle contractions that produce undesirable effects. 

While Botox® and similar products continue to grow in popularity as the “go-to” treatment for facial wrinkles and lines, we continue to develop new and innovative uses that address cosmetic and medical concerns in surprising ways. Here are just a few of them:

• Chronic migraines: In 1992, a plastic surgeon in California noticed that his patients who had been given Botox® injections for forehead wrinkles reported fewer headaches. The drug was later tested on people with chronic migraines and was approved for that purpose in 2010. Sufferers who experience migraines fifteen or more days each month are given multiple injections in targeted areas of the head and neck; the preventive effect lasts about three months.
• Excessive sweating (hyperhidrosis) can be caused by genetics, stress, or exercise. Wherever it occurs on the body – underarms, scalp, forehead, palms of the hands, soles of the feet – it can be uncomfortable and embarrassing. Injection of a neurotoxin like Botox® into these areas blocks the transmission of signals to the sweat glands and stops the release of excess sweat. 
• Eyelid twitching (blepherospasm) can be incessant and can affect the upper, lower, or middle part of the eyelid. Botox® injections relax the muscles around the eye and reduce spasms.
• Crossed eyes (strabismus): Using Botox® to relax the muscles around the eyes and correct their alignment was one of the first approved therapeutic uses of the drug. Its effects last three to four months and are often as effective as surgery.
• Neck spasms: A condition called cervical dystonia, characterized by abnormal head position and severe neck pain, is caused by the neck muscles contracting involuntarily. Botox® works by blocking the nerve signals from reaching the affected muscles, thus preventing the involuntary spasms.

There are many more proven uses for Botox®. Its use for cosmetic purposes also extends well beyond the treatment of forehead wrinkles to include crows’ feet around the eyes, frown lines between the eyebrows, lines around the corners of the mouth, neck bands, sagging eyebrows, and more. Whatever its application, Botox® must be administered by a licensed, experienced doctor who will advise you on what will work for you and will use the utmost care in ensuring that you achieve your goals. I also advise to being careful of Med Spas where Botox is offered very inexpensively. Often this is because they are using fake Botox or it’s from sources where quality is not assured.

BOTOX® is a registered trademark of Allergan, Inc., an AbbVie company.

Cybele Fishman, MD, is a board-certified dermatologist, a fellow of the American Academy of Dermatology. She is in practice at Advanced Dermatology PC at 111 Broadway, Suite 1000 NY NY 10006.

Advanced Dermatology P.C. and the Center for Laser and Cosmetic Surgery (New York & New Jersey) is one of the leading dermatology centers in the nation, offering highly experienced physicians in the fields of cosmetic and laser dermatology as well as plastic surgery and state-of-the-art medical technologies. www.advanceddermatologypc.com.

For these maps, physical inactivity for adults is defined as not participating in any physical activities outside of work over the last month – activities such as running, walking for exercise, or gardening.

State and territory-level estimates of physical inactivity range from 17.7% of people in Colorado to 49.4% in Puerto Rico. In seven states and one territory (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Oklahoma, West Virginia, and Puerto Rico), 30% or more of adults were physically inactive. By region, the South had the highest prevalence of physical inactivity (27.5%), followed by the Midwest (25.2%), Northeast (24.7%), and the West (21.0%).

“Getting enough physical activity could prevent 1 in 10 premature deaths,” said Ruth Petersen, MD, Director of CDC’s Division of Nutrition, Physical Activity, and Obesity, in a CDC news release. “Too many people are missing out on the health benefits of physical activity such as improved sleep, reduced blood pressure and anxiety, lowered risk for heart disease, several cancers, and dementia (including Alzheimer’s disease).

The new maps published by the CDC are based on combined 2017-2020 data from the Behavioral Risk Factor Surveillance System (BRFSS), an on-going state-based telephone interview survey conducted by CDC and state health departments. This is the first time that CDC has created state maps of physical inactivity for non-Hispanic American Indian/Alaskan Native and non-Hispanic Asian adults.

The maps point to notable differences in physical inactivity levels by race and ethnicity. Overall, Hispanic adults (32.1%) had the highest prevalence of physical inactivity outside of work, followed by non-Hispanic Black (30.0%), non-Hispanic American Indian/Alaskan Native (29.1%), non-Hispanic White (23.0%), and non-Hispanic Asian adults (20.1%).

The maps also show that:

Two states (Alaska and Montana) and Guam had a physical inactivity prevalence of 30% or higher among non-Hispanic Asian adults.*

Five states (Arkansas, Kentucky, Mississippi, Oklahoma, and West Virginia) had a physical inactivity prevalence of 30% or higher among non-Hispanic White adults.

27 states had a physical inactivity prevalence of 30% or higher among non-Hispanic American Indian/Alaska Native adults.*

23 states and the District of Columbia had a physical inactivity prevalence of 30% or higher among non-Hispanic Black adults.*

25 states and Puerto Rico had a physical inactivity prevalence of 30% or higher among Hispanic adults.

*49 of 52 jurisdictions had sufficient data to be included in these results.

Physical activity can benefit everyone.  Lack of access to safe and convenient places to be physically active may contribute to the observed racial and ethnic disparities.

CDC is working with communities and partners across the country as part of the Active People, Healthy Nation initiative, to make it easier, safer, and more convenient for people to be active where they live, learn, work and play. The overall goal of the initiative is to help 27 million Americans become more physically active by 2027 to improve overall health and quality of life and to reduce healthcare costs. The initiative helps community leaders take advantage of proven strategies to make physical activity safe and enjoyable for people of all ages and abilities. Building active and walkable communities may also help support local economies and create more cohesive communities.

The Physical Activity Guidelines for Americans, 2nd edition, recommends that adults get at least 150 minutes of moderate-intensity physical activity each week. This can be broken into smaller amounts such as 22 minutes every day or 30 minutes/five times a week. Individuals and families are encouraged to build physical activity into their day by going for a brisk walk or a hike, walking the dog, choosing the stairs instead of the elevator or escalator, parking further away in the parking lot and walking the rest of the way, walking or cycling to run errands, and getting off the bus one stop early and walking the rest of the way. The key is to move more and sit less.

Community leaders can also encourage school and youth physical activity programs, educate, and support families and individuals to be more active. They can create activity-friendly routes to everyday destinations such as home, work, school, and grocery stores. Together, leaders and community members can work with various populations to design and implement culturally relevant solutions to reduce disparities in physical inactivity.

To learn more from the CDC about physical activity, click here. Maps and data tables are available here.

Researchers have tested many strategies to increase physical activity. But these studies tend to be small, says the article, written by Sharon Reynolds. Variation in populations, locations, and other factors also makes it hard to compare results. And what works in one setting may not work in another.

To overcome these limitations,  Reynolds writes, researchers led by Drs. Katherine Milkman and Angela Duckworth from the University of Pennsylvania tested dozens of different ways to boost exercise using a novel approach they developed called a megastudy. The research team included 30 scientists from 15 universities. They enrolled more than 60,000 members—with an average age of about 40—of 24 Hour Fitness gyms, a national fitness chain. Members are required to check in electronically before using the gym, allowing researchers to track how often people exercised before, during, and after the study.

The researchers created 53 different 4-week programs designed to encourage exercise. All programs included planning when workouts would occur, text message reminders before planned workouts, and micro-rewards—points redeemable for small credits on Amazon. Additional strategies and incentives were then stacked on top of these three elements.

Because of the study’s size, the article says, each intervention could be tested in hundreds to thousands of people. The researchers compared the interventions against the baseline program for their ability to boost the number of gym visits during four weeks of intervention and for ten weeks afterward. An additional control group received no intervention except for an Amazon credit when they enrolled in the study equal to the expected earnings in most programs ($1.08).

The study was funded in part by NIH’s National Institute on Aging (NIA). Results were published on December 8, 2021, in Nature.

Overall, the study found, 45% of the interventions boosted the number of weekly gym visits during the four-week study period compared with the control group. These increased exercise from around 9% to 27%.

Five of the interventions stood out for being especially effective. One provided higher overall rewards for workouts. Two provided bonus rewards for returning to the gym after a missed workout. One let participants choose whether they wanted their rewards framed as losses or gains (that is, losing or earning reward points). And another sent text messages informing participants that most Americans exercise, and that this fraction is growing.

To explore the value of the megastudy approach, the researchers surveyed more than 300 experts in the field about which programs they thought would most effectively boost exercise, the article says. Those predictions did not match up with the interventions that resulted in the most gym visits.

“These results show how difficult it is to predict which interventions to increase exercise will work,” says Duckworth.

“They also highlight the value of megastudies,” Milkman adds, “which allow researchers to test many different approaches to changing behavior at once in order to determine what interventions are most effective.”

Negative results from small studies often get little to no attention. Megastudies have the additional advantage of being able to rule out, all at once, many interventions that don’t work. They’re now being used to test other public health interventions, such as encouraging vaccination.

Take It Easy

Don’t overdo it when you return to the gym, your trainer, or wherever you exercise. You can’t expect to snap back to your pre-pandemic level of fitness right away. It takes time and must be done gradually. Doing too much too soon will overwhelm you, you will risk injury and possibly burnout.

One of the safest ways to get started is to try brisk walking (or some other low-impact activity) for 10 minutes.  Aim for a pace where your breathing and heart rate are elevated but you can still speak in sentences. This is called moderate intensity.

Then try building up from one round of 10 minutes a day to two rounds of 10 minutes. You can do it all at once or break it into two sessions during the day.  Start doing this every other day and work your way up. If 10 minutes a day seems too easy, start with longer, but you should still move up gradually. You can increase the time, intensity or both if you’re up to it.  Ultimately your goal should be to do 150 to 300 minutes of moderate intensity exercise every week, unless you were doing more than that pre-pandemic.  If you can include some higher intensity exercise once you have increased your endurance, you will reap even more health benefits.

As always, before starting a routine, check with your doctor about what level of exercise is right for you, especially if you haven’t been exercising for the past year.

Schedule Your Workout

Not everyone is a morning person who can be up and exercising at 6 A.M. If that’s not your rhythm, attempting that schedule as a lifestyle will fail. Perhaps your workouts need to be scheduled at a lunch hour or post-work. Maybe it’s not practical for you to do 4 days a week. but 3 is doable. Think about your life and the free time it realistically affords, and schedule in the frequency and times of day/evening that best suit your life.  Keep in mind that the body responds to consistency over time.  Results will be achieved more rapidly if you keep a regular frequency and pattern.

Know Your Exercises

It’s also always a wise idea to make sure you have the basics down before easing back into a regular workout routine. Basic strength training exercises like planks, lunges and squats have many different variations.  Make sure you know the fundamentals of these exercises. If you don’t have a personal trainer, you can google how to do them properly with illustrations, watch Youtube videos, learn them from fitness apps, or ask a trainer on duty in your gym to show you proper form.

Yoga is a great way to start an exercise program, and you can perform it at various levels of intensity.  Stretching and other moves improve flexibility and strength. Yoga is also a great form of stress relief.

Keep Your Weight in Mind

Many of us have put on weight due to the pandemic and that is nothing to feel ashamed of.  If you are resuming exercise with added pounds, be mindful of the fact that depending on the amount you have gained, this can place greater strain on joints, especially the knees, back, and ankles.  At first, it might be best to include exercise that reduces weight-bearing, such as stationary bikes, water exercise, or rowing machines. Once you’ve lost some weight and improved your cardio function, then you can add more walking or jogging to your exercise routine. Again, don’t rush yourself. Getting back to your pre-pandemic fitness level is a goal that you’ll reach with moderation and consistency

Warm-up, Stretching and Cool Down Are Key

Your body can’t go from a full stop to a sprint. It must be “loosened” and warmed up. Proper warm-up and cool down are vital for your workout in order to prevent injury and delayed muscle soreness. A good warm-up should include the entire body, even if the actual workout is going to focus on one area, such as legs or shoulders. The idea is to get the entire body warmed up and loose, and to get the blood flowing to all areas.  A five- to 10-minute cool down, consisting of light aerobic activity, helps the heart gradually return to its resting rate and the body return to its resting temperature. The lack of a cool-down period can lead to lightheadedness and dizziness, which is caused by blood pooling in the lower extremities. You don’t want to abruptly end a workout. You need to stay in motion while gradually winding down. Stretching is more beneficial after the workout than it is before because the muscles are warm and more pliable, which offers the best chance for maintaining and improving flexibility.

Mistakes to Avoid

The biggest thing to keep in mind is to take it slow.  For people who were in peak condition before the pandemic, it is human nature to want to “get back there” right away.  This impatience and tendency to overdo it, will cause injury. A year with little to no exercise is a long time and it’s going to take time to get back to where you were before the pandemic. After a week or two of consistent exercise, you can bump up the intensity provided you’re not losing form or feeling serious pain. Be patient with yourself in the process.

Finally, many facilities will still have COVID-19 precautions in place. Be sure you follow them, not only to keep yourself safe, but to protect others.