Reduce the Risk of Falls
Nicole Rennie is regarded as an expert in the realm of older adult fitness and has over 20 years of experience as a Physical Therapist and is a Geriatric Certified Specialist in physical therapy.
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Frank Samson We have a wonderful guest today. Her name is Nicole Rennie, who is regarded as an expert in the realm of older adult fitness with over 20 years of experience as a physical therapist. She is a geriatric certified specialist in physical therapy. In 1999, Nicole founded Senior Abilities Unlimited, LLC, officially known as SAU. SAU is the exclusive provider of tandem strength and balance, a unique approach to strengthening older adults and helping them improve their quality of life. Nicole and her team at SAU are creating new norms for ageing everyday. Nicole has been featured in the Star Tribune, the Twin Cities Business Journal, and the National Advanced Physical Therapy Magazine. She is located in the great state of Minnesota, in the Minneapolis area, so Nicole, thank you so much for taking the time to join us on the Ageing Boomers today.
Nicole Rennie: Well thank you for having me.
Frank: Yes, Tandem strength and balance, tell us a little bit more about that. I know that's apretty open ended question, but help our listeners understand a little more.
Niccole: Well the truth is that when people age, they start losing strength. People always say that 40 is bad, but we all start losing strength at age 30. Unless we're actively building strength, we're losing strength every single day. The one quote that always scares people when I talk to them is that a typical 70 year-old woman has lost between 50 to 70% of the strength she had at age 30. Just think about how strong you were at age 30 and then 70 you've lost 50 to 70% of that strength. Really what that means is that's why people need walkers. They can't get out of their chairs! That's just age 70. When you reach your 80s and 90s, which is the new norm now, people don't have the strength to function, and that is a misconception. My goal, my passion in life, is to get people to increase and maintain their leg strength. That will allow them to have a good life and do the things that they want to do whether they're 80, 90, or even 100.
Frank: What was the catalyst that made you specialize with seniors, mainly, on this concept?
Niccole: To be honest, I was working in nursing homes, and I noticed the revolving door. I'd send someone home with an exercise program, and then within two to three weeks, they would be back in my facility. Another misconception is once you have built strength, it stays. You actually start to lose strength within three to five days of stopping. That is why you see so many people after they're done with their rehab, they start declining within 30 days. That's pretty typical. If you just build up enough strength to be able to walk, you start losing that strength within three to five days unless you're doing the right things to maintain it.
Frank: Okay, so help settle something for me. Is it more important to do cardio or do the strength exercises?
Niccole: Strengthening. That's the thing that frustrates me. People aren't being told to do the right things. That's the sad part. People are looking for the right information, but they're not being told what effective strength training is. They're being told that walking is strength training. Don't get me wrong. It's great for your heart, but you can't walk well and pick up your feet if you don't have the leg strength. You need to maintain those leg muscles so you can do more cardio, so you can go into the pool and walk. There's a good balance between the two, but if you don't have good leg strength, you can't do cardio.
Frank: Do you think it's ever too late for someone to start building strength in their legs, doing what you're talking about?
Niccole: Actually the older you are, the more important it is to do. The oldest person I've ever helped get stronger was 107. I love telling this story. I started her at age 104. She didn't want anybody to see her backside. The only man who ever saw her tush was her husband. She didn't want any care. She wanted to remain independent. We worked with her for three years. She took care of herself, took showers by herself, until she died at 107. The second oldest person I worked with was 105. Now I'm starting with a 103 year-old this week who doesn't want to die in bed. She wants to walk. She's wanting strength.
Frank: You said strong legs are the key. Is that the key to balance (and everything else)?
Niccole: It really is. Strength helps with so many things. It helps with diabetes. It helps with high blood pressure. It helps with endurance. Your leg muscles control everything. From the perspective of a physical therapist, to say you have good balance, you have to be able to stand on one leg. That's how we test balance. If you don't have strong legs, you can't stand on one leg, therefore, you score poorly on the balance test. You have to use your arms to support yourself. That's not poor balance. That's actually not having enough leg strength and using your arms to support yourself. I've been a PT for close to 24 years. I think in my career I've met less than five people who actually have balance disorders. Most of the people lack leg strength, which is causing them to have poor balance. As soon as we improve their leg strength, their balance issues disappear.
Frank: I want you to be brutally honest, all right? Right now I'm interviewing you and I'm standing. I try to stand, because I work behind my desk most of the time. I try to stand as much as I can. I have a standing desk. Is that just going to give me a bad back or could that really help strengthen my legs?
Niccole: It has nothing to do with leg strength. It's great that you're up on your legs. It's great that you're standing, but you're not building muscle. Strength training, the definition of strength training, is that it has to be resistant. You have to be stimulating the muscles with resistance. It has to be done twice a week. It has to be progressive. Don't get me wrong. I think it's great that you're standing, but you are still losing muscle. Are you losing muscle more slowly than someone else who isn't standing? Yes, but you're still losing muscle.
Frank: There is a term that you use. I was able to get a little bit of information but would like to hear more. You call it “strength bank”. What exactly is that?
Niccole: Strength bank basically means you need a certain amount of strength in your legs to be able to be independent, to be able to get out of a chair, to walk without a walker. Say you're 90 years old and you're getting by on a walker, then all of a sudden, you get a bladder infection. That is when so many people end up going into the hospital. Then they end up in a nursing home. They didn't have enough of strength bank to withhold or to tolerate that little blip in the road. When you get a bladder infection, it causes you to lose strength. If you get a cold or a bladder infection, and you don't have enough strength in the bank, so to speak, you can't function. My idea is that I like to give people a big enough strength bank, so that if they get sick, they can still tolerate the injury, and not end up going to the hospital or nursing home.
Frank: Talk to us about how your concept would help somebody reduce the chance of not only falling, but broken hips. I've heard this many times, “she fell and broke her hip”. How does your concept help somebody reduce the chances not only of falls but of sustaining a serious injury?
Niccole: We can't always prevent things that happen. People trip and then unfortunately break a hip. What we can do is to have a better strength bank - by having strong legs, it speeds up your recovery. Oftentimes, it actually can save the person's life. I'll just tell you a quick story. I had a woman who was a stroke survivor. She was lifting eight pounds with her leg exercises. She was walking with us, had a massive stroke, had a freak accident, and broke her hip. The doctor called me after the surgery and said, "What have you been doing?" He struggled with the hip surgery because her leg muscles were so strong. He had a hard time getting to the broken bone. I took that as a compliment! She was back home walking again within two weeks, which is not a normal pattern if you're a stroke survivor and break your hip. Usually you don't get the chance to go back home.Because she was strong and healthy, she recovered quickly and then lived for another 10 years and had a good, positive life.
That's what we're trying to do. If you're strong, you can withstand issues in your life. If you're weak, you likely cannot withstand them. You can't live through them. I'm not saying I can extend someone’s life, but I can give them a better quality of life and help them live the way they want to just by increasing their leg strength.
Frank: Do people who were athletes in their younger days and were always in pretty good shape, and then start slowing down into their 50s and 60s, - either stopped exercising or just maybe went on walks. That's probably pretty typical of a lot of people. Would you say somebody that even at a younger age was an athlete, that they can come around faster, or does it really not matter in the 80s and 90s?
Niccole: To me, it doesn't matter. It depends on how many times you've been sick or had surgeries. Just spending one day in bed, you lose 6% of your muscle mass. That can be as much as you lose in a decade. It really has to do with even being really strong, if you get sick and you spend a lot of time in bed, you're losing muscle mass everyday. You still lose leg strength every day that you're not using those muscles. If you're 30 and in really good shape, by the time you're 70 and you haven't done anything in 40 years, you’ve still lost leg strength. You're losing it every single day. If you have diabetes or you have hypertension and it's limiting your mobility, you're losing leg strength even faster.
Frank: I know that you conduct this program either at your facility or in people's homes. Those that are in your area, in Minnesota, hopefully, you'll hear from them, if they are listening. Those who are living in other parts of the country, other parts of the world, any suggestions for them?
Niccole: We call it functional strength training. We always joke that you can actually improve your leg strength in just seven minutes, twice a week. I always ask, and say, "Can you find seven minutes in your schedule?" The strengthening can be done laying down on the bed. It can be done in a recliner as long as you're actually doing it. It's seven minutes of four leg exercises. Everyone who's been to a physical therapist has done these. They're called straight leg raises, hip abduction, hip flexion and bridging. The different concept is you have to use weights. People start feeling better when they can lift four pounds. Their ability to get up from a chair improves. They're not as reliant on their walkers. They have more energy. When people can get up to lifting four pounds, their function starts to improve. Most of my clients lift between seven to ten.
Again, that goes back to the strength bank concept that we're giving them more strength so if something occurs, they can get through it. It's basically 7 minutes, twice a week. When they start doing that, we add in the arm exercises so it becomes a total of 15 minutes, twice a week. That's where, Frank, you can start adding in the cardio. Your cardio would actually get easier if you had stronger legs.
Frank: That does make sense. If someone listens to this show, and think, "I’ve got to start doing this." Would you say have them go to a physical therapist initially or where should they start?
Niccole: That's the hard part for me. A lot of people don't understand what strengthening is. These exercises are not as good when they are done seated. You need four times as much weight. They need to be done lying down. You need to have weights. They need to be done twice a week. If you can find a PT who understands that, then that's great. If not, please just trust me, this is the way that it's supposed to be done. This is my passion.
This may sound silly, but go to our website. The exercises and exercise program are on there. If you can't get it that way, you can always email us and we’ll send it out to you for free because we want people to do it on their own. If you need more help, you can turn to a PT or a personal trainer. The key is that they need to do those four exercises because those are the functional muscles that actually keep people going.
One of my employees, who's 40 years old and is a yoga guy and lifts weights, does these strengthening exercises with seven pounds. When he first started he tried to put on 10, and he was laughing, because they're so hard. He does these exercises plus does yoga twice a week, plus goes to the gym twice a week, plus runs. He feels the benefit of these exercises. If these can help him at 40, they'll help anybody, because they really work on the core muscles that keep you stead on your feet.
Frank: I'll ask for your website and contact information before we sign off again, but as long as you brought it up, why don't you share with people where they can get this on your site?
Frank: Do you ever work with younger people, those that can't get senior discount at the movie theater, that age group?
Niccole: Yes. My youngest client was 16. She was actually in a car accident. She's now 28. She's a C1, C2 quadriplegic. For her to live 12 going on 13 years without having injury is pretty impressive. We keep her healthy. We do have some young folks, but most of our folks, average about 80. 82 is our median age. Like I said, the oldest person was 107. To be honest, my philosophy is “get strong, stay strong”. Anyone can get better regardless of their age or diagnosis. It doesn't matter what the what the diagnosis might be. You can get better. That's just the truth and what all the science prove. If you want to do it, you can get better.
Frank: Speaking about diagnosis, as you probably know, people are living longer. They're beating other diseases, as you know, but then people that are living longer, they also are at greater risk for cognitive issues like dementia, Parkinson's. What's been your experience in working with people that have various types of dementia like Alzheimer's and others. How can this help them?
Niccole: Dementia and Parkinson's are some of our favorite diseases to work with. If someone has dementia ... picture this: If you're walking, it takes a lot more energy to turn and sit in a chair. You and I just think about it and just do it naturally. For someone with dementia, they can't think how to turn and sit in a chair. What they do is what I call “the dementia dive”, where they just kind of dive into the chair. Because they're tired, they can't problem solve, so they see the chair and they dive. When people with dementia have strong legs, they have more energy to wait for assistance, for someone to come help them. They have more energy to pick up their feet and turn. They don't need a walker just because they have memory issues. You don't remember to use your walker. If you have strong legs, you don't need a walker. So many of clients have dementia and they're walking until the day they die.
We're helping them get through the process of keeping their legs strong, which then means they can walk, which means that their memory may improve. They eat better. Executive function is improved by strength training. They're more alert. They're more interactive. It's one of the biggest populations we assist with. I hate seeing people in wheelchairs. I detest walkers. Most of my clients over 70, 75% of my clients who used to need walkers no longer do. That's a good thing for me. If they use a walker, I want them to kind of have it just to carry their things, but not to have that death grip on it to support them. It's so interesting and I know people get surprised by this. Anyone can get better. You just have to work on really those four specific muscles and then you practice moving.
For people with dementia, if they can follow one step directions, they can get better. It has to be progressive. It has to be ongoing, because as soon as they stop exercising, they start regressing. That's the hard part about what I do. It's a long-term fix. Typically PT is two to six weeks. You have to keep exercising and strengthening twice a week for the rest of your life. That's the hard part about it. If people do exercise or strength train twice a week, they can get better and then maintain that for the rest of their life, which makes their overall function better.
Frank: That's great to know. We're talking about people with cognitive issues. What about those that have physical issues, maybe those with Parkinson's, stroke, MS, things like that? Is that a little more challenging? Tell us your experience there.
Niccole: I wouldn't say challenging. I’d say rewarding because they've been told that this is what happens when you have Parkinson's. You can't pick up your feet. You're going to start shaking. You're going to start shuffling. Half of that is actually leg strength loss. They can't pick up their feet because they don't have enough strength to do it. If someone with Parkinson's freezes and they don't have leg strength, then they fall. If someone with Parkinson's has strong legs, they can have confidence. (“Hey, I'm safe”) It gives them that confidence that they are okay. The other problem, which is really hard to convey, is that people can't tell you that they feel weak. People can't tell you, "You know, I'm scared when I feel my legs shaking." We kind of bring that out of them, so then they realize when their legs get stronger, they feel more confident. Their risk of fall decreases. If you're fearful of falling, your risk of falls increases by three times. It's really going back to the basics of strengthening and getting comfortable moving again. So many times in facilities and even what you tell your parents, "Don't fall. Don't fall." That's all they hear. My thing is, "You're safe. I want you to move big. You can move bigger. You're safe." They get that contradiction, but then they start feeling and then doing better.
Frank: Nicole, this has been enlightening, very informative. Go ahead, and again, tell people how they can learn more about your concepts and your website, whatever contact information you'd like to share with people.
Niccole: Our website is tandemsb.com. My email is Nicole@sauhome.com. I love to help people so I don't care if you're in California or anywhere else. If you have a specific question, I like to inform people. I have exercise packets that we send out for free. Like I said, they're also on our website, but if you want a hard copy, I'm happy to send it out. I'm all about education.
A quick story. My mom died of breast and lung cancer six years ago. She wanted never to have to use a commode or anything similar. I told her she had to lift weights. It took me two years to convince her to do it. Then when we started, she yelled at me for not making her do it sooner. Even with three diagnoses of cancer, she walked until the day she died without a walker. I know I've been effective with it personally. Please, I just want to help anyone, or help family members who want to live a better life.