NIH MedlinePlus Magazine Winter 2021

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WINTER 2021Trusted HealthInformation from theNational Institutesof HealthIN THIS ISSUEBreakthroughsin palliative careresearch6 exercises for lowback painHow to improve yourcholesterol levelsIdentifying commonskin conditionsCopingwithisolationthis seasonCOVER STORYFormer NFL player DeMarcus Ware is in the bestshape of his life. Learn how he embracesPHYSICAL ACTIVITY

In this issueWHO WE AREThe National Institutes of Health (NIH) is the nation’spremier medical research agency, with 27 differentinstitutes and centers. The National Library of Medicine(NLM) at NIH is a leader in research in biomedicalinformatics and data science research and the world’slargest medical library.NLM provides free, trusted health information toyou at and in this magazine. Visit us atmagazine.medlineplus.govThanks for reading!Gary H. Gibbons, M.D., is the director of theNational Heart, Lung, and Blood Institute.older Americans, kids, and teens.During American Heart Month, use #OurHeartson social media to show your community howcommitted you are to staying heart healthy. We wishyou a happy and healthy start to 2021!Gary H. Gibbons, M.D.Director, NHLBICONTACT 000CONNECT WITH USFollow us on /Follow us on [email protected] NewsNIH MedlinePlus magazine is published bythe National Library of Medicine (NLM) inconjunction with the Friends of the NLM.Articles in this publication are written by professionaljournalists. All scientific and medical informationis reviewed for accuracy by representatives of theNational Institutes of Health. However, personaldecisions regarding health, finance, exercise, and othermatters should be made only after consultation withthe reader’s physician or professional advisor. Opinionsexpressed herein are not necessarily those of theNational Library of Medicine.IMAG ES: COVER, COURTESY OF DEMARCU S WARE; TOP, COU RTESY OF NATIONAL HE ART, LUNG, AND BLOOD INSTITUTETHE NATIONAL HEART, LUNG, ANDBLOOD INSTITUTE (NHLBI) is excited towork with the National Library of Medicine onNIH MedlinePlus magazine to highlight importantresearch on physical activity and heart health.The magazine's cover star is DeMarcus Ware, aformer National Football League player who hastranslated his passion for fitness off the field. Inaddition to lifting weights and working out in thegym, Ware gets moving with his two kids and hascut a rug in “Dancing with the Stars,” blendingfitness with family time and fun.In this issue, we share new research funded byNHLBI on how physical activity can do more thanget you in shape. Combined with a healthy diet,physical activity may help prevent future heartissues by improving your cholesterol and bloodpressure, and lowering your risk of type 2 diabetes.As we celebrate American Heart Month thisFebruary, it’s important to recognize how you don’thave to be an athlete to get moving and help yourheart. Just 30 minutes of activity each day can goa long way to preventing heart-related diseases inthe future. The Physical Activity Guidelines forAmericans can provide more specific guidance for

Trusted HealthInformation from theNational Institutesof HealthinsideWINTER 2021Volume 15Number 412IMAG ES: TOP, JA MES D. SMITH, COU RTESY OF THE DALL AS COWBOY S FOOT BALL CLUB; RIGHT, ADOBE STOCKFormer Dallas Cowboys defensive star DeMarcus Ware is stillcommitted to staying fit and eating healthy.F E AT U R E SD E PA RT M E N T S08 How to manage low back pain04 To your healthbefore it gets worseResearchers work to find better waysto diagnose pain.12 DeMarcus Ware is in the bestshape of his lifeExercise isn’t just for athletes—it’s for everyone.18 Comfort care for kids and their familiesNew NIH research on palliative care.24 What you do now can prevent heartdisease laterLearn about cholesterol levels and howto improve them.News, notes, & tips from NIH28 From the labLatest research updates from NIH30 NIH on the webFind it all in one place!31 Contact usNIH is here to helpStudy showskidney transplantsbetween peoplewith HIV are safe.28

toyourhealthNEWS,NOTES,& TIPSFROM NIHHow to cope with the stressof social isolationLoneliness and lack of contact canhave long-term health effectsYOUR HEALTH Social isolation, or being physicallyseparated from others, can lead to loneliness andincreased stress, especially during a pandemic.Loneliness has been associated with higher ratesof depression, anxiety, and suicide. It can alsoweaken our immune systems, which help protect usfrom getting sick. Luckily, understanding stress andloneliness and how to manage them can help.How stress affects usWhile some stress is normal, too much of it can interferewith daily activities, relationships, and work. Symptoms ofstress and anxiety include:ɠ Feeling irritable, restless, and on edgeɠ Feeling overwhelmed and unmotivatedɠ Muscle tensionɠ Fatigue or tirednessɠ Difficulty concentratingCombating stressTo combat stress, make sure to eat a diet full of hearthealthy fruits, vegetables, and grains. Get enough sleep (foradults, that is usually between 7 and 8 hours) and seek outphysical activity.Connecting with nature can lower levels of stress andreduce symptoms of anxiety and depression. A walk or bikeride may make you feel better and stay physically fit. Just 30minutes of physical activity a day can make a big difference.4Winter 2021 NIH MedlinePlusVirtual exercise classes can combat stress and keep you connected.Remember to wear a mask even when you are outside. Also,keep 6 feet of space between yourself and people who donot live in your home.Combating lonelinessAvoiding in-person social gatherings will help keep youand others safe. But you can stay in touch with peoplein other ways:ɠ Connect with loved ones through online games, videocalls, or messaging apps.ɠ Look online for virtual exercise classes, religiousservices, and cultural events.ɠ Try at-home, guided yoga, mindfulness, ormeditation through a mobile app.ɠ Consider adopting a pet. Pets can provide comfortand lower blood pressure, according to the NationalInstitute on Aging.

Is it time to getyour colon checked?Reach out to a health careprofessionalStress and social isolation can worsenexisting mental illness. Consult yourhealth care provider if your feelings aregetting in the way of your daily life.“For those with mental illnesses,be sure to continue your treatmentregimens,” says Joshua Gordon, M.D.,Ph.D., director of the National Instituteof Mental Health. “Consider developinga plan for telehealth sessions with yourprovider if you (or your provider) arequarantined or must avoid exposuresto the public for any reason. And reachout to friends and family for support,virtually if necessary.” TSOURCES: National Institute of MentalBY THE NUMBERS Colorectal—or colon—cancer is one ofthe most common cancers in the U.S. It’s also one of themost treatable, especially if detected early. Screening cannot only detect colon cancer early but also can reduce yourrisk of developing colon cancer by finding and removingcolon polyps, some of which can progress to cancer. Mostmedical groups recommend that people at average risk ofcolorectal cancer get screened regularly beginning at age 50with either a colonoscopy or an at-home test. However, youmay be advised to start earlier if you or a close relative havehad colon polyps, an inflammatory bowel disease, coloncancer, or other risk factors. Check with your health careprovider to learn when—and how—you should get checked.Colorectal cancer is thethird most commoncancer diagnosisamong men andwomen combined.Aboutof colon cancers occurin people who are50Health; National Institute on Aging; JoshuaGordon, M.D., Ph.D., Director's MessageDID YOU KNOW?and older.IMAG ES: AD OBE STOCKLoneliness andsocial isolation havebeen linked to poorercognitive functionand higher risk fordementia, includingand especially forAlzheimer’s disease.About nine out ofevery 10 people withcolon cancer found andtreated early are stillalive five years later.21.7 millionadults age 50 to75 have neverbeen screenedfor colon cancer.SOURCE: Centers for DiseaseControl and PreventionSOURCES : National Institute of Diabetes and Digestive and Kidney Diseases;National Cancer Institute; Centers for Disease Control and PreventionWinter 2021 magazine.medlineplus.gov5

6ways tocommunicate betterwhile you wear a maskQuieter environments and textingcan make connecting easierHEALTH TIPS Social distancing and face masks are necessary for preventing the spread of COVID-19. Butthey can also make communication more difficult for the 37.5 million U.S. adults with hearing problems.Masks make it difficult for individuals who are hard-of-hearing to read lips and see facial expressionsthat help them understand what others are saying. Masks and social distancing also muffle or softenvoices, making it tough to understand speech even for people with normal hearing.The National Institute on Deafness and Other Communication Disorders has a helpful guide on bestpractices for communicating during COVID-19. Below are a few key takeaways:123456Consider a face mask with a clear window. These masks use aclear insert, so a person’s mouth and lips are visible, which makes lipreading easier.Be loud and clear. Is the person you’re talking to having troubleunderstanding you? Speak slower and louder (without shouting) thanyou normally would. Focus on speaking clearly.Be patient. Masks and social distancing decrease the sound andobscure the visual cues that help us communicate. It’s frustratingeven for those with normal hearing and more so for those who arehard-of-hearing. Be compassionate.Turn down the background volume. Background noise can makeconversation especially hard to understand. When possible, move to aquieter spot or turn down the sound.Use another method. If speech is too hard to understand, useanother method—a smartphone or paper and pen—to get yourmessage across.Bring a friend or be a friend. If it’s essential that you understandspoken details—for example, during a discussion with a health careprovider—consider bringing a friend or family member with you tolisten and take notes. Or offer to accompany a friend with hearingdifficulties to an important appointment or meeting and be theirsecond set of ears. TSOURCE: National Institute on Deafness and Other Communication Disorders6Winter 2021 NIH MedlinePlusAbout 1 in 500babies in theU.S. are borndeaf or hard-ofhearing.SOURCE: Centers for DiseaseControl and Prevention

Skin 101: Identifyingcommon conditionsWhat do your bumps, blisters, andblotches mean?HEALTH TIPS Skin: It’sour body’s largest organ. Itprotects us by keeping fluidsin and harmful microbesout. Sometimes, due to ourenvironments and genes,our skin gets, well, unhappy.But how can you tell thedifference between a minorrash and a more seriouscondition? Read our quickrundown of five common skinconditions and what they looklike. Also, be sure to talk to adermatologist, a doctor whospecializes in skin conditions,or other health care providerfor a full diagnosis and care.Have dry skin?Lotions and creams, ahumidifier, and avoidinghot showers can help.IMAG ES: AD OBE STOCKSOURCE: National Institute on AgingHivesHives are pink, itchy bumps that can appear anywhere onthe skin and last for less than 24 hours. They may be causedby some food allergy, infection, or medications. Hives arecommon and often go away on their own.EczemaEczema, or atopic dermatitis, often begins before age 5 andmay continue as kids get older. For some people, the raw,sensitive, and inflamed skin may cause severe itching at night.It often happens on the face, inside the elbows, behind theknees, and on the hands and feet.Contact dermatitisContact dermatitis may have well-defined borders andappears when your skin touches a foreign substance (dyes,soaps, latex, poisonous plants). The resulting rash may beitchy and red, and oozing blisters may develop. The reactionmost often occurs 24 to 48 hours after the exposure.PsoriasisPsoriasis consists of thick patches of rough, scaly skin, mostcommonly on the scalp, elbows, knees, and lower back. Thesepatches can be itchy and painful and may bleed when scratched.Psoriasis sometimes runs in families and can be associated witharthritis that often involves the fingers or toes or spine.Dry skinDry skin occurs when your skin loses too much water and oil.It can happen at any age. The rough, cracked, and itchy skinmay be caused by cold, dry air; washing your hands often;harsh soaps or detergents; and aging. As we get older, ourskin makes less natural oil. TSOURCE: National Institute of Arthritis and Musculoskeletaland Skin DiseasesWinter 2021 magazine.medlineplus.gov7

L O W B A C K PA I NHow to managelow back painbefore it gets worseWalking and yoga can offer relief and comfortLow back pain is often hard to avoid. Manyjobs require long periods of sitting or othertypes of activities that can stress our backs.However, there are things you can do toavoid more serious injury.National Institutes of Health-supported researcherJonathan Lurie, M.D., provides a few recommendationsfor people with low back pain. Dr. Lurie is a physicianresearcher at the New Hampshire-based DartmouthInstitute for Health Policy and Clinical Practice.Stay activePhysical treatmentDr. Lurie encourages movement for people with low backpain, instead of staying on the couch or in bed. “There isevidence to show that bed rest for acute back pain does notimprove things and leads to greater disability,” he explains.Walking is a helpful low-impact activity that most peoplecan do on a daily basis.Other forms of exercise such as tai chi or yoga can alsobe helpful for low back pain. The best stretches and otherexercises for low back pain will vary from person to person,so consult with your health care provider to make sure theyare right for you.Dr. Lurie explains that acupuncture, spinal manipulation,or physical therapy are other potential treatment options,depending on your type of low back pain. There arealso behavioral treatments like biofeedback and nervestimulation, which use electric pulses to help people learnhow to manage pain. This type of care is recommended as afirst line of treatment before medication.Work smarterLow back pain can get worse if you sit for prolongedperiods, Dr. Lurie explains. He encourages individualsto “evaluate their work environment and ensure thatthey are able to practice good posture and ergonomics.”Ergonomics is about making people’s work environmentsas efficient and safe as possible.Some tools that may be helpful are standing desks andergonomic chairs, which help put your spine in a betterposition. It is important to stand often throughout theworkday and stretch at your desk if possible. Check outthe guide on the next page for back exercises you can doat work.8Winter 2021 NIH MedlinePlusMedicationPainkillers, such as acetaminophen and aspirin, can alsohelp at times when pain is worse. Alternating betweenheat (with a heating pad or warm bath) and ice may alsobe helpful. Other medications, which are prescribed by ahealth care professional, could include muscle relaxers,antidepressants, or opioids. Opioids are strong painmedicines that can be highly addictive. People usingopioids must be closely monitored by their provider.Serious or long-lasting painSerious low back conditions, such as herniated discs orspinal deformities, may be best addressed with surgery,depending on the case, Dr. Lurie says. Make sure to checkwith your health care provider if you are experiencing painthat gets in the way of your daily life. T

LOW B AC K PA I N5 exercises you cando in your officeMoving throughout the workday can lessenchronic back painWhile seated:Neck stretchErgonomics isabout adjustingthe work site to becomfortable, safe,and efficient.Tilt your head to one side and hold for 15 seconds.Repeat this on each side, three times per side.Shoulder shrugShrug your shoulders up to your ears and hold for threeseconds. Roll them back and down. Repeat this 10 times.Executive stretchWhile seated, put your hands behind your head andlace your fingers together. Bring your elbows back andtoward each other, as far as you can. Inhale and hold for20 seconds. Exhale and relax, and repeat one more time.On the floor:PlankFAST FACT25% of adultsin the U.S. reporthaving low back painin the last 3 months.SOURCE : Centers for DiseaseIMAG ES: AD OBE STOCKControl and PreventionPut your elbows on the floor directly underneathyour shoulders with your feet hip-width apart.Keep your back flat and neck neutral as youdrive your elbows into the floor, engaging yourabdominal, leg, and buttock muscles. Hold as longas you can up to a minute then repeat. If there ispain, stop immediately.BridgeLie on your back with your knees bent and yourarms at your sides. Raise your hips using yourstomach and buttock muscles. Hold for fiveseconds, and lower. Repeat up to 20 times.SOURCE : National Institutes of Health: Division of OccupationalHealth and SafetyWinter 2021 magazine.medlineplus.gov9

L O W B A C K PA I NWhy does your back hurt?NIH researchers work to find betterways to diagnose low back painGwendolyn Sowa, M.D., Ph.D.An opportunity for change“It’s also one of the areas that we have thebiggest opportunity to change the way we care forpatients,” Dr. Sowa explained.One of those opportunities is around identifyingcontributors to back pain.“The findings on traditional imaging such as X-raysand MRIs often have a very poor correlation withpatient symptoms,” Dr. Sowa explains. She says thatmany people who might have physical damage totheir low back may not experience any symptoms.On the other hand, some individuals mightexperience a great deal of low back pain but couldhave little visible damage.Through her work supported by the NationalInstitute of Arthritis and Musculoskeletal andSkin Diseases, Dr. Sowa and her collaboratorsstudy better ways to treat people based on theirindividual symptoms and medical history. Thisincludes looking at factors like genetics, stress,lifestyle, behaviors, and activity levels.10Winter 2021 NIH MedlinePlusHolistic health for low back painRather than treating one symptom or only looking at oneaspect of a person’s pain, Dr. Sowa says she and her team aimfor a more well-rounded approach.“We want to develop precision medicine approaches to theirtreatment that we hope will be more effective and prevent atrial-and-error type of approach to treating these patients,”Dr. Sowa says.She adds that the ultimategoal of her research is“The findings onto decrease unnecessarytraditional imagingtreatments and increase thechance of finding the rightlike X-rays and MRIstreatment the first time.often have a very poor“If we don’t improve[patients’] function and getcorrelation with patienttheir pain under control,symptoms.”they’re more likely toprogress to chronic back— Gwendolyn Sowa, M.D., Ph.D.pain,” she says.Addressing chronic painDr. Sowa also studies how to better address chronicback pain through the Back Pain Consortium (BACPAC)Research Program of the Helping to End Addiction LongtermSM Initiative, or NIH HEAL InitiativeSM. The NIH HEALInitiative’s goal is to help advance research that will addressthe national opioid public health crisis. Opioids are oftenprescribed for low back pain. They are strong and sometimesaddictive painkillers that have been overused and sometimesmisused, and not currently indicated for use in chronic lowback pain.To tackle this complex and common problem, teamwork iskey, she notes.“It’s a complex problem, and one that one individual field isnot going to solve,” Dr. Sowa says. “As we bring physicians andscientists from all different backgrounds together, I’m hopingwe can move the needle on it.” TI MAGE: COU RTESY OF GWEND OLYN SOWA M. D., PH.D.Identifying the cause of low back pain has become afrequent challenge for medical professionals. It is alsowhat has encouraged Gwendolyn Sowa, M.D., Ph.D.,of the University of Pittsburgh to study the topic.Low back pain is a widespread issue in the U.S.It affects more than 25% of workers, according to arecent national health survey. An injury, working in aphysically demanding job, or working in a job whereyou sit too much can all contribute to back pain.“It’s one of the most common causes of disabilityboth from a quality of life perspective but also froma productivity perspective,” Dr. Sowa says. “It has ahuge impact on how patients can function in theireveryday life, whether that’s their work, their homerelated activities, or their leisure activities.”Because of how widespread it is, low back painalso presents an opportunity for researchers.

LOW B AC K PA I NBiking, Pilates, and yoga:How one woman stays activeLow back pain doesn’t stop young professionalApril is always on the go. Sheloves to hike and ride her biketo and from work, andwent skiing for the first time last year.She also suffers from low back pain.It’s been 20 years since her first backinjury, which she distinctly remembers.“My entire back just froze up and Isuddenly was in tremendous pain,”she says. April, who was in collegeat the time, believes that her bodyhad been sending herP E R S O N A L warning signs longS T O R Y before that moment.When her back firstbegan to hurt because of extensivesitting and hunching over books, sheattempted to stretchthe muscles.She knows now, after talking withher physical therapist and doctor, thatshe was stretching improperly, whichlikely contributed to her initial injury.IMAG ES: COURTESY OF APRILPhysical therapy and stretchingAfter her first injury, April did physicaltherapy and made sure to do approvedstretches and exercises at home.Her low back pain was manageableuntil about three years ago, when sheexperienced a second significant backinjury after twisting too deeply duringa yoga class.She went to her doctor, whorecommended she do more physicaltherapy.Even though her pain comes andgoes, April’s experience with low backpain has had a major impact on herlife. She avoids high-impact exercises,like dance fitness classes, which sheApril on a recent hike.“I think just those day-to-daymotions play such an importantrole in keeping us flexible.”once loved doing. And as an avidtraveler, she now feels more anxiouswhen she goes on trips since carryingluggage and long airplane and carrides can make her pain worse.“I prepare myself for travel to bephysically painful,” she says.Daily work to manage painTo help address her pain, April has astanding desk in her office and doesPilates as often as she can. She’s alsostarted doing yoga again but is takingit one step at a time.“I’ve found basic Pilates movesto be very helpful,” she says. Herphysical therapist suggested that shework on strengthening her abdominalmuscles, hips, and thighs. “I usuallydo a set of various [physical therapy]and Pilates-related moves daily. Thelist of useful moves is long enoughthat I can regularly mix it up.”April’s advice for fellow low backpain sufferers is to get up and movetheir bodies when they can.“Try to move between standingand sitting throughout the day,” Aprilsays. “It’s far too easy to find thatyou’ve spent hours at your computerin pretty much the same position. Ithink just those day-to-day motionsplay such an important role inkeeping us flexible.” TWinter 2021 magazine.medlineplus.gov11

FACBTEILV I T YPEHATY SUI CRAELLARETIRED NFL S TARDeMarcus Wareis in the bestshape of his lifeWare shares his passion forstaying fit and healthyRetired National FootballLeague (NFL) defensivesuperstar DeMarcus Ware wonmillions of fans with his abilityto conquer and defeat opposingteams. Now, the former DallasCowboy and Denver BroncoAll-Pro has a new starringrole: helping others improvetheir fitness and health. Hespoke about what keeps himmotivated, his favorite healthysnack, and how he and hisfamily lead healthy lives.You have said that you are inbetter shape now in retirementthan when you were playing inthe NFL. Why is that?Retiring from the NFL hasallowed me to have a healthierlifestyle. I get more rest andrecovery time between workoutsand my body doesn’t get beatenup and bruised every week. I’vealso cut in half the number ofcalories I take in. Some peoplesay that your life stops when youretire. For me it has started!12Winter 2021 NIH MedlinePlus

IMAG ES: L EF T, COURTESY OF DEMARCUS WARE; RIG HT, COU RTESY OF THE AMER ICAN BROADCASTING COMPANIES, INC. ALL RIGHTS RESER VEDPHYSICAL ACTIVITYTell us about your diet.I eat three healthy meals a day anda few healthy snacks. For example, Iusually eat oatmeal with blueberriesbefore my 45-minute morningworkout. After that I have a fullbreakfast with things like brownrice, eggs, chicken sausage, and aprotein shake. For lunch I’ll havefish, broccoli, and whole-grain rice.And for dinner I’ll have a lean meat,vegetables, and sweet potato. Also,one day every week I treat myselfto food I can’t have the other days.If I’m tempted to eat something Ishouldn’t, it helps to be able to tellmyself I can have it, just not that day.When did you start yourhealthy habits?As a kid, I played four sports andalways made a priority of stayingfit. I looked into the diets of thesports stars I wanted to be like. So,I started eating healthier then. Icouldn’t afford much of the freshfoods that these stars were eating,but I got the frozen versions, whichwere still healthy.How are you instilling healthy dietand exercise habits in your kids?Giving your kids a positiveexperience with healthy foods isimportant. If I were to tell my kids Idon’t like how sweet potatoes taste,they won’t like sweet potatoes. Butif instead I put a little bit of brownsugar and cinnamon on them and sayit tastes like sweet potato pie, they’lllove it. Regarding fitness, my sonand daughter didn’t enjoy exercise atfirst. But now they love to go out anddo any kind of exercise because wedo it together and we make it fun. Itis a staple of our family routine.“Some peoplesay that your lifestops when youretire. For me ithas started!”—DeMarcus WareWhat motivates you to get movingwhen you don’t feel like it?We all need help with motivationfrom time to time. I like to use bothsound and visual imagery. I’ll makemyself a playlist of upbeat musicor listen to motivational speeches.I also like to look at pictures ofhealthy role models who inspire meabout what I’d like to achieve withmy workouts. That helps me create amental image of what I’d like to looklike, like having a toned, fit job, I had to move guys who were6 feet 5 inches tall and 365 pounds.For “DWTS” I had to have sweet feet,twinkle toes! I had to train myselfvery differently, with a real focuson mental quickness. I’m still doingsome dancing now as part of myfitness routine because it requiresyou to think while you are moving.What does the future look like forDeMarcus Ware?My ultimate goal is to help motivatepeople to improve their fitness.Recently, I opened a gym in Texas,where I live. I’m also launchinga new digital fitness app. I was acomputer science major in college,so I enjoyed applying that knowledgeto my expertise in fitness. TWhat other healthy habits do youtry to keep up?I do stretches and I use a foam rollerto relieve tension in my muscles inthe morning and night before I go tosleep. I am also sleeping and restingmore now. I used to go to bed atmidnight and wake up at 6 a.m. NowI go to sleep at 10:30 p.m. I feel morefit as a result.You were on the 27th season of“Dancing with the Stars.” How didyour fitness play into that?Competing on “Dancing with theStars” (DWTS) was one of the mostchallenging things I’ve ever done. Infootball I played defensive line, andI was known as a body mover. To doLeft, DeMarcus Ware; Above, Ware dances withpartner Lindsay Arnold on ABC’s “Dancing withthe Stars.”Winter 2021 magazine.medlineplus.gov13

PHYSICAL ACTIVITY4physical activity tipsfor older adultsDon’t forget strength and balance trainingRegular physical activity is great for your mental and physical health. It also helps you stay independentas you age. The Physical Activity Guidelines for Americans recommend that you aim to exercise atleast 150 minutes every week at a moderate pace, or 75 at a more vigorous pace. The guidelines alsorecommend that older adults do muscle-strengthening activities at least two days a week.Not sure how to get started? These tips can help.2TALK WITH YOUR DOCTOR. Almost anyone, atany age, can exercise safely. If you’re concerned aboutstarting an exercise routine, talk with your doctor.Ask whether there are activities you should avoid andwhether any health conditions you have might affectwhat exercises you can do safely.DEVELOP A WELL-ROUNDED ROUTINE.Include the four main types of exercise.ɠ Endurance exercises increase your breathing andheart rate. Brisk walking is a good option.ɠ Strength exercises, like lifting weights or using aresistance band, make your muscles stronger.ɠ Balance exercises can help prevent falls.This includes standing on one foot.ɠ Flexibility exercises, like yoga, stretch yourmuscles and help you stay limber andmaintain mobility as you age.START GRADUALLY.Begin with low-intensityexercises like walking.Be sure to drink plentyof water before, during,and after your workout.3MOVE THROUGHOUT THE DAY. Every daypresents opportunities to move more. For example,use the stairs instead of taking the elevator. Or parkfar away from the grocery store entrance instead ofin the closest spot.4SOURCE: National Institute on Aging14 Winter 2021 NIH MedlinePlusIMAG ES: AD OBE STOCK1

PHYSICAL ACTIVITYPersonal story: Sara SantiagoA gym’s strong community helped her get fitSARA SANTIAGO, 40, was never anathlete. She joined gyms and exercisedon occasion, but never found a routineshe could maintain.“I felt intimidated because I didn’tknow how to use a machine at thegym and awkward because I was theoverweight girl trying to work out,”she says. “I assumed that I couldn’tbe an athlete or physically fit. I hadaccepted that was the way I wasmeant to be.”In February 2019,

Avoiding in-person social gatherings will help keep you . and others safe. But you can stay in touch with people in other ways: ɠ Connect with loved ones through online games, video calls, or messaging apps. ɠ Look online for virtual exercise classes, religious services, and cul