Hacker News Reader

Comment by hinkley | Hacker News Reader

Recent versions of the health monitoring app on the Apple Watch looks at how much time you spend with a foot completely off the ground while walking. Which is related to this.

I think a yoga instructor said this, but it’s the reason I do tai chi. Death certificates don’t say “died from a fall” but many many people do. Breaking a hip is the beginning of the end for most people. The wound takes so long to heal and you are immobilized for so long that secondary health issues become primary. Many people with a broken hip die from pneumonia. So if you can avoid a broken hip by improving your balance you are better off. If improving your balance improves leg bone density, then you are saved twice over.

We’ve circled around this discovery a number of times. Those exercise programs for retirement homes know this. Water aerobics is just an arthritis- and obesity-friendly way to accomplish the same.

View on HN

Death certificates don’t say “died from a fall” but many many people do. Breaking a hip is the beginning of the end for most people.

My sister is a nurse and told me that we SAY "fell and broke a hip" but ACTUALLY it was "broke a hip and then fell". You can tell that from where the break was, and once the hip breaks you are guaranteed to fall.

The cause of hearing this was that my mother had exactly this accident, broke her hip them fell. In the hospital she got some serious drugs, and this triggered severe dementia for the rest of her life.

Drugs triggered dementia. That's interesting. Is that something that has been thoroughly researched or is it still a hypothesis?

It happens. My grandfather fell off his roof onto concrete and suffered a bad broken arm. His subsequent prescription and continued use of opiate painkillers exactly coincide with the onset of his dementia, one he didn't recover from even after getting off the drugs.

My grandmother was prescribed Wellbutrin for a few months after my grandfather died. A decade later she suffered a fall and was hospitalized. In the hospital the doctors for whatever reason started giving her Wellbutrin again. She spent the next month subject to intense psychosis, not knowing where she was or who was in the room with her, thinking she was being attacked, thinking there was a party going on in the hallway. We were probably less than a week from institutionalizing her when my aunt noticed the unneeded medicine she was being given. After they stopped giving it to her she was back to normal in less than 48 hours.

Pyochosis is not dementia. Very different things. But I hear what you're saying.

They can be conflated, even by professionals.

Something similar happened with my grandma, she had to sell her house and move into a nursing home because what was diagnosed as dementia. Afterwards, a specialist realized that it was her medications causing dementia-like symptoms, and after adjusting them, she became a completely normal again.

Medication causing dementia symptoms is also not psychosis. Psychosis is a very specific state of mind, not something to just describe general mental illness

This is nonsensical reply that misses the key point of this thread.

Nobody here is claiming that psychosis = dementia. Almost the exact opposite.

The only way your comment could be relevant is if you’re trying to claim that nobody has ever been misdiagnosed with dementia due to psychosis-like side-effects from prescription medications.

As per other siblings, not necessarily actual dementia but symptoms of dementia and the people that are supposed to be able to distinguish these can't/won't/don't.

Another not too uncommon one can occur in older people even when they aren't on drugs: dehydration. The tests they do in hospital to see if you have dementia can easily misdiagnose as dementia when you're simply being dehydrated. Now imagine giving this test to a 30 year old vs. a 75 year old. I've personally seen it attributed to "this person is old, must be dementia". Made sure to hydrate regularly while in hospital (which nurses couldn't/wouldn't/didn't) w/ perfect recovery from their "dementia".

https://pubmed.ncbi.nlm.nih.gov/10459729/

Actually in her case it WAS more delirium. At first she had a sense of humor about it - the floating cake she was seeing looked quite delicious and she regretted that she couldn't eat it. But later, well, she honestly believed she was sleeping outside under the stars even though she emphatically wasn't.

I don't know much similarity there is between dementia and schizophrenia in terms of brain chemistry, but there's a lot of overlap of symptoms, and drugs can definitely trigger schizophrenia.

Go on any migraine forum and look at the first treatment doctors give. Topomax.

Some people do well on it. A huge number of people become very stupid on it. (I managed to run myself over with my own car)

Tons of drugs cause cognitive issues.

I actually started taking a simple test daily to map my cognitive ability on various treatments.

Can you share your simple daily test? I've been pondering such a thing for a while now.

in either case, disuse is probably the proximal cause of the hip break. the final straw is nearly always an acute trauma whether a fall or a misstep putting awkward strains on the hip (as might happen in the break-then-fall case). elderly folks who exercise regularly tend to break bones less.

Unfortunately I think if you haven’t internalized fitness as a thing you have to maintain all your life, your chances of suddenly become motivated late in life when your survival depends on fitness related activities are slim. Many people who break a hip simply lose the will to live much more. They don’t really take the rehab seriously, they don’t focus on prevention, they make half hearted efforts. Because they are not used to the pain that comes with exercise, they resist it. They simply shut down slowly until they pass away from whatever cause they become vulnerable to.

Anecdotally: after being sedentary for 35-40 years and having both hips replaced in their early 70s, health quality in one of my parents had degraded such by the time they were 85 that I suggested a mild fitness program of walking 3/4 of a mile each day. Exercise regimes get no milder than that. Improvements in day to day energy and balance, A1c, frailty and sleep quality were so markedly improved after just one month that it became the source of motivation. 7 years later, when weather prevents their daily walk, the difference is obvious to them. Advanced aging is learned helplessness. Exercise can make a difference at any age and is the natural offset to that depressive, learned helplessness of aging. As the saying goes: Exercise is its own reward.

Honestly I suspect that the success of exercise classes in retirement homes speaks more to a lack of other pass times.

This makes me feel better and it kills three hours a week.

Would decades of squats, deadlifts, free weights/kettlebells and a plethora of compound exercises build up enough hip/femoral bone density and muscle to withstand most chances of hip breaks occurring? Or most bone breakages, period?

I’m assuming most of the population does not engage in serious exercise regiments, but we rarely have studies performed solely on a highly athletic/strong cohort, so I have to be the glib one and ask if bodybuilders are exempt from these “frail in old age” studies.

One great study we’ve had done recently is how the heart is sculpted as pertaining to exercises that are done, namely cycling, swimming, lifting heavy weights, and rowing all exhibit their own reconfiguration of heart walls/chambers.

As a former athlete, you would be surprised how much function you lose after a few injuries. Range of comfortable motion can rob you of those benefits in under ten years, and most of us have up to 20 from retirement to the grave.

My first injury was knee cartilage. My last was wrist, which makes lifting and even yoga hard. But tai chi helped stabilize my knee, and made me feel 10 years younger. Also it made me “need” 30 minutes less sleep a night, and I stuck with it once I realized that the time in class paid for itself.

I've never heard that Tai Chi could bea substitute for sleeping, is that what you're getting at?

Or did you mean some second order effect like "the focus granted from half an hour of tai chi allowed me to finish my tasks half an hour earlier"

I mean waking feeling more rested in the morning. The typical stategy for waking up tired is to go to bed earlier, which is less time in the evening to do other things.

I've been intereted in tai chi but haven't found a good place to learn it. Do you do in-person classes or online?

Bodybuilders? Probably follow a U shaped curve. The extreme ones do a lot that is unhealthy that leave them pretty broken later in life.

Thinking about it more, there is probably a more general U curve for exercise. For example, I used to see an ex-NFL running back in the gym sauna. He could barely move most days before 30+ minutes in the heat.

I power lifted for almost 15 years before scaling back because of age. I feel like I ended up hitting a sweet spot, but was always careful. Even before I really cut back I had quit doing singles for awhile.

> I used to see an ex-NFL running back in the gym sauna. He could barely move most days before 30+ minutes in the heat.

This. Anecdotally, I know a retired NFL Offensive lineman. He is on a full NFL disability pension at 35 years old because of knee and shoulder injuries. Moving anywhere is very difficult for him.

There's a major confounding factor for NFL players in that they get repeatedly hit by large, athletic people (running backs especially, but even a kicker gets hit more than a typical bodybuilder).

I doubt it's the exercise that causes most of their health issues.

I've known professional athletes in skating that have had problems as well. Hip replacement in their 20s, joint pain, that sort of thing. Training for hours a day can definitely be problematic later in life, at least with that duration and degree.

Interesting comment about singles. Is that because you felt the massive amount of effort you put in to a single substantially increased your chances of injury compared to doing reps?

Yes. Doing something like 3RM or 5RM for me was less injury prone than singles. Also note, when I mention singles I’m talking close to 1RM. I’ve done single based workouts that were 3RM or 5RM, but I would do 10-20 singles.

I do miss it though. After with computers and abstract complexity all day, there is something relaxing about the simple task of picking up a heavy weight :)

Not unless it is continued later into life. I am experiencing early onset osteoporosis and I spent my late 20's and 30's lifting weights (C&J, squats, DLs, etc). I was told that these kinds of exercises will increase bone density in certain bones, but unless that is continued, bones revert to a "normal" state (as defined by your body, not a population), until loss begins in older age. Just like muscles I guess: they shrink back to "normal" if you don't constantly work them. (E.g., ever take 4-5 months off from lifting and notice how your gains evaporate?)

If anyone can work out how to convince 26-35 year olds that this isn’t a race and nothing grows back anymore, I’d nominate them for a Nobel prize.

The bad thing about tai chi and also a class I took from a PT on biomechanics is how often I have to not blurt out advice. I’ve only just stopped analyzing the gait of people walking in front of me. The sympathetic pains were rough.

Seriously.

I just liked being strong! Fortunately, I managed to avoid any injuries, so I count myself lucky. Now I just jog (not run) for cardio and do yoga for mobility. I look forward to it and don't have to wait in line at a gym (or go at ungodly hours).

I seitched to high volume, low weight, and it has been a game changer. Lifting heavy is just a way to destroy joints and get injuries. One sude effect is hypertrophy — I've added 2cm to my arms, tone is way better, and I don't hurt. I superset, too, so I'm in the gym less, and the workout is better.

This would be seriously confounded by both athletes who push their bodies so far that they die young for other reasons, as well as those who incur injuries and don't maintain the increased strength and bone density into old age if they make it long enough.

But yes, clearly if you manage to maintain a level of strength training that is strenuous enough to promote better than baseline bone density and muscle strength, but not so strenuous as to injure yourself beyond what you can heal from, there are going to be benefits and one of them is likely to be not dying because you can't consistently stand up in old age.

There was a USC running back maybe 15 years ago or so whose name I can't remember any more who somehow managed to drop a barbell loaded to 360 lbs on his throat while bench pressing, and survived. The doctors at the time mentioned that an accident like that would have killed almost anybody, but he survived because his neck musculature was so thick. But I nonetheless suspect, if you survey the average lifespan of everyone who ever makes it to the NFL versus everyone else, the NFL players are not going to come out on top.

Why would anyone think an NFL player would have no issues later in life ? Wouldn’t this just be common sense they’re going to be wrecked in different ways to say a CrossFit athlete who doesn’t get their knees broken in 500 pieces ?

Everyone thinks they’ll be a 60 year old badass. Nobody seems to notice the demographic difference between this fiction and reality.

My impression is the decline of old age is somewhat inevitable without interventions like HRT. Especially for women who after menopause will inevitably develop some form of osteoporosis AIUI.

But before reaching that point you can obviously improve bone density/strength/balance/athleticism in general to raise how high your peak is where you'll start declining from. In lieu of bad injuries I don't think there are any down sides to pushing these variables upwards while you still can.

Isn’t there a link between muscle mass and hormone levels?

lifting weights can distort the natural balance of muscles and ligaments around the body and can create strain-/break-points as well. that's why, especially for the elderly, full-body exercise like walking, yoga, and tai chi are usually better, because it maintains relative balance implicitly without having to manage that explicitly.

the only caveat is that it's really important (even more with age) to also work out your heart, blood vessels, lungs, and abdomen, so you need something that ups the intensity for at least 15-30 minutes 3× a week: running, biking, tennis, etc. for older folks, swimming is really great since it's low impact.

we generally all need both types of exercise (full body and more intense) to maintain fitness throughout our lives. some activities can fulfill both needs at the same time (i still play basketball for this very reason).

lifting weights can distort the natural balance of muscles and ligaments around the body and can create strain-/break-points as well.

Sounds like total cruft to me sorry. How would a full body exercise like a barbell squat do all of this ?

Barbell squats work some muscles more than others. If you do a lot more squats than opposing exercise, you will create imbalanced muscle strength over time.

Of course if you run a careful program, you can make sure to work opposing muscle groups equally and avoid this. But the fact is that a lot of people who lift weights don’t run careful programs.

Another factor is the elasticity of your muscles. If you don’t up your stretching efforts as you up your lifting, you risk trading range of movement for strength. Again—totally manageable but that doesn’t mean everyone does it.

What would be the natural, opposing movement of a barbell squat? Doing force in the inverse? That's a completely unnatural movement pattern. Standing up and carrying weight is about the most common denominator in human movement.

If you break down the muscles involved, it’s not bad. Squats are quad, glute, and back dominant, so you would balance with exercises focused on hamstrings, hip flexors, and abs. Also, tons of stretching.

If executed properly, is a deep squat itself not a form of stretching?

A well executed squat uses hamstrings and abs a ton, unless you believe you don't need to have completely tight abs when squatting 1.5x your bodyweight.

What are you arguing? That a barbell squat works every muscle in the body equally? Do you actually believe that is true?

I'm arguing that there is no such thing as an "opposing" exercise. Squats, deadlifts, lunges, cald raises, you can compliment with some things but a leg program that's 80% squats and deads is going to be very good.

"lifting weights can distort the natural balance of muscles and ligaments around the body and can create strain-/break-points as well."

source?

Naturalmoms.com

There's nothing wrong with walking, tai chi, and yoga but they're insufficient to build and maintain muscle mass for the elderly (or really even younger people). They need some resistance training as well. Muscle isolation exercises can cause imbalances if you don't know what you're doing which is why most people are better off doing compound functional movements.

The other issue is that digestive systems become less effective at extracting protein as we age. So many elderly people ought to increase their protein intake to prevent muscle atrophy.

> but they're insufficient to build and maintain muscle mass for the elderly

How much tai chi have you done? Yoga? I'd invite you to do a couple classes of either and see how much they do or don't kick your ass.

Have you ever done static holds on the chin-up bar? Tai chi is static holds for 45+ minutes out of an hour and a half. My calves are bigger than when I was a cyclist, and my hams are granite. The first time I ever tried a plank, I held for 90 seconds. No gym, no situps, no crunches, just tai chi 90 minutes a week, plus walks and gardening.

Having dated a very competent yoga professor and knowing many very decent yogis, there's definitely a bunch of strength to it but even with my poor genetics and half-assed weight training I was definitely stronger and had an easier time doing yoga than they did lifting, by a substantial margin.

right, i should have led earlier with (1) exercise your body (musculoskeletal) and (2) exercise your heart (cardiopulmonary), which is easier to digest and remember, as both are required for good physical fitness (you get digestive, lymphatic, endocrine, and other systemic benefits for free with this too).

the combination of these two goals should naturally lead to exercise with enough resistiveness for whole-body fitness (like basketball) without having to focus on each system separately[0], as you do with weight training, which primarily focuses on muscle mass. compound athletic movements naturally approximate what we do with our bodies daily anyway, which is what makes it intrinsically more holistic. you're right that walking by itself is probably inadequate[1] for musculoskeletal fitness, but 60+% of americans would benefit from walking daily. add swimming/cycling a few times a week and you're done!

the bigger point might be that good fitness doesn't require heavy equipment (ha) or a gym.

[0]: note that pain is a natural feedback mechanism that tells you where the imbalances are, to stretch, exercise, and/or rest more in that area.

[1]: it depends on what type of walking, yoga, or tai chi you're doing; for instance, competitive walking can be enough for some folks.

I'd love to see a simple infographic that tells us the most important stuff to pay attention (eg. strength vs flexibility) to at different ages and for both genders..

They are linked. Tai chi and yoga both work on hip flexibility, and without that flexibility I don’t think my hams would be as strong as they are. I was always unbalanced to quads, even before I got into cycling which made that worse. And that’s a quick route to chronic knee pain, which makes everything else harder.

Could you expound? Are you saying strong quads + weak hamstrings == knee pain? I recently started using an exercise bike in addition to squats and climbs in order to get in shape and found that I started having chronic knee pain for the first time in my life, which persisted for months even after I stopped using the bike. I don't use clip on shoes, which I would imagine would allow hamstrings to be utilized more.

Very few datapoints right now, but my knees seem to feel better, not worse, after sprinting exercises. I've been very athletic my whole life and never had knee problems before.

Slow down (less interval training), spin more, adjust the bike.

Once upon a time I helped fit people for bicycles. The rule for Chen and bicycles is that there is a little bump of bone below the knee cap, it’s where the tibia flares out and I think a tendon attachment. That should always stay behind the ball of your foot. And your knee should be 95% straight at the bottom of the stroke. Not quite straight, but if you flex your ankle you can just hit fully locked. This engages the lowest bulb of the quad which also helps avoid injury.

The problem with cyclists is the tendency to lean foreword when they walk, which exacerbates the knee over ball problem. You need to lean back a bit, relax the hips. As an experiment, try walking without locking your knees. Also keep your feet farther apart, like there’s a board on the ground, though that help more with fallen arches, and will make some hip muscles sore while they become less atrophied.

And if your knees are sore after a workout, that is cartilage inflammation and you need ice and ibuprofen and think hard about how not to do that next time, because you are doing damage. For me where the tai chi helped here is that by shifting my weight back I’m using cartilage around the injury more, which is still fairly healthy.

You've got to do at least some high intensity interval training with your heart rate near maximum in order achieve any significant performance improvements.

Ice and cold therapy has been largely debunked for the conditions you mentioned. Your advice is generally outdated and not aligned with evidence based medicine or successful endurance sports coaching.

If it wasn't clear from my wording, I'll say it again:

If you're getting sore joints you fucked up, please stop doing that. Take some anti-inflammatories for today and sort your shit out.

Also I'm pretty sure you're wrong about the ice. If anything they're using more of it (but for different reasons).

Nope, I'm not wrong about the ice.

https://wwnorton.com/books/Good-to-Go/

Acute inflammation isn't something to be prevented. It's a helpful part of the healing process. Ice might feel good, but it doesn't produce improved medical outcomes.

so what's the new RICE?

Flexibility isn't something to chase. I warm up by doing a light version of the activity I am doing. My PT disabused me of the primacy of stretching after I got a herniated disc. I stopped stretching and started lifting and doing body weight exercises and stopped doing cross fit and I healed up and never stretch anymore.

The word "flexibility" is not owned by contortionists. Range of motion is still very important, and while yoga can and does tend to the contortionist end of the spectrum, tai chi does not, and yet it still cares quite a bit about flexibility, as an antonym to tightness/stiffness.

> Would decades of squats, deadlifts, free weights/kettlebells ... to withstand most chances of hip breaks occurring

If you look at a lot of competitive athletes and bodybuilders, they tend to be pretty broken in their old age. E.g. Ronnie Coleman - former Mr. Olympia - could barely walk after tons of spinal and back surgeries.

Maybe you have the bone density - but if you are immobile with tons of joint and arthritis issues, it probably will not help.

Lifting weights is not body building.

Lifting weights doesn't mean trying to max it out every session. It's still "lifting weights" to go in and do a half hour of compound lifts with moderate weights. Most people can keep that up for a long time.

Yeah but what about people who are not ultimate freaks of nature like the rest of us? You can't look at a guy like Ronnie Coleman and say that's what most people can achieve with decades of squats, deadlifts and free weights. As far as I've seen, decades of squats , deadlifts and freeweights are super beneficial for keeping strong in your old age and actually reduce the likelihood of joint issues and also reduce the risk of falling.

Would it be be fare to say Ronnie wasn’t a healthy person?

I don’t consider body builders who use steroids to be healthy people, I lift weights everyday.

He is an outlier. He lifted very heavy weights and did tons of peds.

Also to note, he had horrendous form and was victim of the painkiller downward spiral, product of his various back surgeries.

My understanding is that in the typical hip-breaking fall, the fall is the consequence of the bone-breaking, and not the cause.

In other words, osteoporosis causes brittle bones that break at odd times, and that makes you fall. If that's the case, bone-strengthening exercises and diet would be more effective at preventing this catastrophic scenario.

But I'm not a medical doctor.

That's certainly possible, but if you can also just have a leg buckle on you. Sometimes the signals just get lost, especially with certain medications.

There must be at least some death certificates that say fall, because CDC WISQARS shows falls as the 2nd-most-common mechanism of unintentional death - after drug overdose, and before motor vehicle crash - with over 42000 in 2020.

The broken hip is more of a symptom of being very frail than it is a cause of death. Nobody who isn't so frail that a bone break is the final straw is breaking their hip.

You don't need an app to tell you someone is frail.

How many people will fall and break a hip while attempting a 10-sec 1-leg stance?

I'm assuming that people will put their other leg down if they sense they are going to fall.

The paper gives us reason to believe the maximum rate is probably something less than 1 in 1000:

"Anthropometric, clinical and vital status and 10-s OLS data were assessed in 1702 individuals (68% men) aged 51–75 years between 2008 and 2020."

"No adverse medical events or accidents occurred during the 10-s OLS testing."

Reply on news.ycombinator.com