La diabetes ocurre cuando los niveles de glucosa o azúcar en la sangre permanecen elevados. Los alimentos que comemos nos dan glucosa y la hormona insulina ayuda a transportar esta glucosa a nuestras células para que puedan obtener energía de ella. Si el cuerpo tiene muy poca insulina o si no puede usar la insulina adecuadamente, se produce un nivel alto de azúcar en la sangre o diabetes.

Aparte de su dieta y medicamentos, practicar yoga puede ser de gran ayuda para controlar su diabetes. Himalayan Siddhaa Akshar, fundador, Akshar Yoga Institutions, Himalaya Yoga Ashrama, World Yoga Organisation, comparte: “Las asanas de yoga estiran los órganos internos con una variedad de posturas retorcidas. Como resultado, aumenta el flujo sanguíneo y los órganos reciben más oxígeno, lo que mejora su funcionalidad. Como resultado, el sistema endocrino funciona mejor”.

Nivel alto de azúcar en la sangre: aquí hay algunas asanas de yoga para practicar si tiene diabetes

El experto en yoga Himalayan Siddhaa Akshar enumera las siguientes asanas de yoga para la diabetes:

1) Marjariasana (postura del gato y la vaca)

Asana Urdhva Mukhi Marjari

Arrodíllate con las rodillas debajo de las caderas y las palmas de las manos debajo de los hombros. Respira profundamente, arquea la espalda y mira hacia arriba.

Adho Mukhi Marjari Asana

Exhala, arquea la espalda y mete la barbilla en el pecho. Fija tu atención en tu ombligo.

Lea también: Control de la presión arterial alta: asanas de yoga para controlar la hipertensión: practique regularmente

2) Paschimottanasana (Inclinación hacia adelante sentado)

Lo primero que debe hacer es extender las piernas hacia adelante. Al hacer esto, asegúrese de que sus rodillas estén ligeramente dobladas. Levanta los brazos hacia arriba mientras mantienes la columna recta. Comience a inclinarse hacia adelante en las caderas mientras exhala, colocando la parte superior del cuerpo sobre la parte inferior del cuerpo. Coloque las yemas de los dedos en todos los lugares que pueda alcanzar, como los dedos gordos de los pies.

Palabra de precaución: Los practicantes que están embarazadas, tienen discos deslizantes, sufren de ciática, tienen asma o tienen una úlcera no deben realizar Paschimottanasana.

3) Ado Mukha Svanasana (Perro hacia abajo)

Comience colocándose a cuatro patas y colocando las rodillas debajo de las caderas y las palmas de las manos debajo de los hombros. Extienda los codos y las rodillas mientras eleva las caderas. Aplique presión en las palmas de las manos mientras abre los omóplatos. Trate de plantar sus talones firmemente en el suelo. Mantenga su enfoque en los dedos gordos de los pies.

Palabra de precaución: Evite hacer esta posición si tiene diarrea o síndrome del túnel carpiano. Evite mantener esta posición si está embarazada o está a punto de quedar embarazada. Evite esta asana si se mueve lentamente, tiene presión arterial alta, tiene dolor de cabeza o tiene una lesión reciente o persistente en el brazo, la cadera, el hombro o la espalda.

4) Balasana (postura del niño)

Arrodíllate sobre la colchoneta mientras te sientas erguido sobre los talones. Exhala mientras levantas los brazos por encima de la cabeza y doblas la parte superior del cuerpo hacia adelante. Apoya la frente en el suelo mientras apoyas la pelvis sobre los talones. Asegúrate de que tu espalda no esté arqueada.

5) Postura de rana

Mientras te sientas en Vajrasana, extiende los brazos frente a ti. A medida que cierra el puño, los cuatro dedos restantes deben colocarse sobre los pulgares. Dobla los brazos por los codos y pon los puños cerrados sobre el ombligo. Debes tener la parte superior del cuerpo inclinada y por encima de la parte inferior del cuerpo. Mirar hacia adelante mientras se extiende el cuello.

Palabra de precaución: Las mujeres embarazadas deben evitar realizar esta pose. Si una persona tiene dolor o lesión en el tobillo o acaba de someterse a una cirugía de ligamentos, debe evitar esta posición. Si uno tiene problemas de úlceras, se debe evitar esta postura. Si tiene problemas de rodilla o espalda, por favor absténgase de realizar esta postura.

Mantén cada posición durante tres series de 30 segundos. Practique cada una de estas posiciones deliberadamente, tómese su tiempo y concéntrese en su respiración mientras sostiene cada una.

(Descargo de responsabilidad: las opiniones expresadas en este artículo son las del experto citado y no reflejan las opiniones de Zee News. Siempre consulte a un médico o profesional médico antes de comenzar cualquier nuevo régimen de ejercicios).

La diabetes fue la séptima causa principal de muerte en los Estados Unidos en 2019 según 87,647 certificados de defunción en los que la diabetes figuraba como la causa subyacente de muerte, según la Asociación Estadounidense de Diabetes. En 2019, 37,3 millones de estadounidenses, o el 11,3 % de la población, tenía diabetes.

La última encuesta realizada por la Unión Internacional de Diabetes encontró que uno de cada cuatro pacientes diabéticos entrevistados informó que no recibió información adecuada sobre la enfermedad. Como resultado, muchos pacientes no atendieron adecuadamente las complicaciones, lo que entorpeció seriamente su vida diaria.

La diabetes causa neuropatía periférica

Los pacientes diabéticos a menudo desconocen la relación entre la neuropatía periférica y la diabetes. Por lo tanto, pueden malinterpretar las sensaciones de parálisis física como parte del envejecimiento. Dado que los síntomas de la diabetes no siempre son evidentes en las primeras fases, cuando algunos pacientes buscan tratamiento médico, la enfermedad puede haber progresado sustancialmente.

El Dr. Tsang Man-wo, médico especialista en endocrinología y diabetes del United Christian Hospital, señala que la diabetes es la causa principal de la neuropatía periférica. Las fibras nerviosas del sistema nervioso circundante se dañan, lo que provoca lesiones en los nervios periféricos o disfunción microvascular debido a los niveles elevados de azúcar en la sangre.

La neuropatía periférica puede generar múltiples riesgos para la salud, incluida la pérdida sensorial, la atrofia muscular y los temblores, lo que aumenta el riesgo de lesiones y convierte las actividades cotidianas en un desafío. Los pacientes diabéticos son propensos a otras condiciones de salud graves, como úlceras en la piel y amputación inducida por diabetes mellitus.

¿Cómo prevenir la neuropatía periférica?

Tsang sugiere que la mejor manera de prevenir lesiones o un mayor deterioro por la diabetes es controlar los niveles de azúcar en la sangre. Además del control del azúcar en la sangre, los pacientes deben mantener niveles normales de presión arterial y colesterol, evitar fumar y consumir alcohol, y hacer ejercicio con regularidad.

Además, los pacientes deben tomar suficientes vitaminas B1, B6 y B12 para un mantenimiento más eficaz de la salud de los vasos sanguíneos y el sistema nervioso.

La deficiencia de vitamina B1 afecta el corazón y los pies, daña los nervios y probablemente cause beriberi, también conocido como deficiencia de tiamina. La falta de vitamina B6 afecta la sangre y el cerebro, señalando la transducción del sistema nervioso. La deficiencia de vitamina B12 afecta la regeneración de la sangre y del sistema nervioso, o peor aún, causa escorbuto, anemia maligna, pérdida sensorial y demencia.

La metformina es un medicamento común para tratar la diabetes. Sin embargo, cuanto mayor sea la dosis y el uso prolongado, especialmente durante tres años o más, puede afectar la absorción de vitamina B12 en los intestinos, lo que resulta en neuralgia periférica.

Tsang dice que al aumentar la ingesta de vitaminas B específicas para el sistema nervioso, como B1, B6 y B12, los síntomas de la neuropatía periférica pueden aliviarse y prevenirse.

El médico sugiere que siempre que los pacientes experimenten entumecimiento en las extremidades, en particular los diabéticos, no deben pasar por alto la posibilidad de una neuropatía periférica y confundirla con artritis o ciática.

LOS ANGELES — It wasn’t exactly an emergency, but Michael Reed, a security guard who lives in Watts, had back pain and ran out of his blood pressure medication. Unsure where else to turn, he went to his local emergency room for a refill.

Around the same time, James Woodard, a homeless man, appeared for his third visit that week. He wasn’t in medical distress. Nurses said he was likely high on meth and just looking for a place to rest.

In an overflow tent outside, Edward Green, a restaurant cook, described hearing voices and needing medication for his bipolar disorder.

The three patients were among dozens who packed the emergency room at MLK Community Hospital, a bustling health care complex in South Los Angeles reincarnated from the old hospital known as “Killer King” for its horrific patient care. The new campus serves the 1.3 million residents of Willowbrook, Compton, Watts, and other neighborhoods — a heavily Black and Latino population that suffers disproportionately high rates of devastating chronic conditions like diabetes, liver disease, and high blood pressure.

Arguably, none of the three men should have gone, on this warm April afternoon, to the emergency room, a place intended to address severe and life-threatening cases — and where care is extremely expensive.

But patients and doctors say it is nearly impossible to find a timely medical appointment or receive adequate care in the impoverished community, where fast food is easy to come by and fresh fruits and vegetables are not. Liquor stores outnumber grocery stores, and homeless encampments are overflowing. A staggering 72% of patients who receive care at the hospital rely on Medi-Cal, the state’s Medicaid program for low-income people.

“For some people, the emergency room is a last resort. But for so many people who live here, it’s literally all there is,” said Dr. Oscar Casillas, who runs the department. “Most of what I see is preventable — preventable with normal access to health care. But we don’t have that here.”

The community is short 1,400 doctors, according to Dr. Elaine Batchlor, the hospital’s CEO, who said her facility is drowning under a surge of patients who are sicker than those in surrounding communities. For instance, the death rate from diabetes is 76% higher in the community than in Los Angeles County as a whole, 77% higher for high blood pressure — an early indicator of heart disease — and 50% higher for liver disease.

But dramatic changes are afoot that could herald improvements in care — or cement the stark health disparities that persist between rich and poor communities.

Gov. Gavin Newsom is spearheading a massive experiment in Medi-Cal, pouring nearly $9 billion into a five-year initiative that targets the sickest and costliest patients and provides them with nonmedical benefits such as home-delivered meals, money for housing move-in costs, and home repairs to make living environments safer for people with asthma.

The concept — which is being tested in California on a larger scale than anywhere else in the country — is to improve patient health by funneling money into social programs and keeping patients out of costly institutions such as emergency departments, jails, nursing homes, and mental health crisis centers.

The initiative, known as CalAIM, sounds like an antidote to some of the ills that plague MLK. Yet only a sliver of its patients will receive the new and expensive benefits.

Just 108 patients — the hospital treats about 113,000 people annually — have enrolled since January. Statewide, health insurers have signed up more than 97,200 patients out of roughly 14.7 million Californians with Medi-Cal, according to state officials. And while a growing number of Medi-Cal enrollees are expected to receive the new benefits in the coming years, most will not.

Top state health officials argue that the broader Medi-Cal population will benefit from other components of CalAIM, which is a multipronged, multiyear effort to boost patients’ overall physical and mental health. But doctors, hospital leaders, and health insurance executives are skeptical that the program will fundamentally improve the quality of care for those not enrolled — including access to doctors, one of the biggest challenges for Medi-Cal patients in South Los Angeles.

“The state is now saying it will allow Medicaid dollars to be spent on things like housing and nutritious food — and those things are really important — but they’re still not willing to pay for medical care,” Batchlor said.

Batchlor has been lobbying the Newsom administration and state lawmakers to fix basic health care for the state’s poorest residents. She believes that increasing payments for doctors and hospitals that treat Medi-Cal patients could lead to improvements in both quality and access. The state and the 25 managed-care insurance plans it pays to provide health benefits to most Medi-Cal enrollees reimburse providers so little for care that it perpetuates “racism and discrimination,” she said.

Batchlor said the hospital gets about $150, on average, to treat a Medi-Cal patient in its emergency room. But it would receive about $650 if that patient had Medicare, she said, while a patient with commercial health insurance would trigger a payment of about $2,000.

The hospital brought in $344 million in revenue in 2020 and spent roughly $330 million on operations and patient care. It loses more than $30 million a year on the emergency room alone, Batchlor said.

Medicaid is generally the lowest payer in health care, and California is among the lowest-paying states in the country, experts say.

“The rates are not high enough for providers to practice. Go to Beverly Hills and those people are overdosing on health care, but here in Compton, patients are dying 10 years earlier because they can’t get health care,” Batchlor said. “That’s why I call it separate and unequal.”

Newsom in September vetoed a bill that would have boosted Medi-Cal payment rates for the hospital, saying the state can’t afford it. But Batchlor isn’t giving up. Nor are other hospitals, patient advocates, Medi-Cal health insurers, and the state’s influential doctors’ lobby, which are working to persuade Newsom and state lawmakers to pony up more money for Medi-Cal.

It’ll be a tough sell. Newsom’s top health officials defend California’s rates, saying the state has boosted pay for participating providers by offering bonus and incentive payments for improvements in health care quality and equity — even as the state adds Medi-Cal recipients to the system.

“We’ve been the most aggressive state in expanding Medi-Cal, especially with the addition of undocumented immigrants,” said Dustin Corcoran, CEO of the California Medical Association, which represents doctors and is spearheading a campaign to lobby officials. “But we have done nothing to address the patient access side to health care.”

———

The hospital previously known as Martin Luther King Jr./Drew Medical Center was forced to shut down in 2007 after a Los Angeles Times investigation revealed the county-run hospital’s “long history of harming, or even killing, those it was meant to serve.” In one well-publicized case, a homeless woman was writhing in pain and vomiting blood while janitors mopped around her. She later died.

MLK Community Hospital rose from its ashes in 2015 as a private, nonprofit safety-net hospital that runs largely on public insurance and philanthropy. Its state-of-the-art facilities include a center to treat people with diabetes and prevent their limbs from being amputated — and the hospital is trying to reach homeless patients with a new street medicine team.

Still, decades after the deadly 1965 Watts riots spurred construction of the original hospital — which was supposed to bring high-quality health care to poor neighborhoods in South Los Angeles — many disparities persist.

Less than a mile from the hospital, 60-year-old Sonny Hawthorne rattled through some trash cans on the sidewalk. He was raised in Watts and has been homeless for most of his adult life, other than stints in jail for burglary.

He hustles on his bike doing odd jobs for cash, such as cleaning yards and recycling, but said he has trouble filling out job applications because he can’t read. Most of his day is spent just surviving, searching for food and shelter.

Hawthorne is one of California’s estimated 173,800 homeless residents, most of whom are enrolled in Medi-Cal or qualify for the program. He has diabetes and high blood pressure. He had been on psychotropic medicine for depression and paranoia but hasn’t taken it in months or years. He can’t remember.

“They wanted me to come back in two weeks, but I didn’t go,” he said of an emergency room visit this year for chronic foot pain associated with diabetes. “It’s too much responsibility sometimes.”

Hawthorne’s chronic health conditions and homelessness should qualify him for the CalAIM initiative, which would give him access to a case manager to help him find a primary care doctor, address untreated medical conditions, and navigate the new social services that may be available to him under the program.

But it’s not up to him whether he receives the new benefits.

The state has yielded tremendous power to Medi-Cal’s managed-care insurance companies to decide which social services they will offer. They also decide which of their sickest and most vulnerable enrollees get them.

One benefit all plans must offer is intensive care management, in which certain patients are assigned to case managers who help them navigate their health and social service needs, get to appointments, take their medications regularly, and eat healthy foods.

Plans can also provide benefits from among 14 broad categories of social services, such as six months of free housing for some homeless patients discharged from the hospital, beds in sobering centers that allow patients to recover and get clean outside the emergency room, and assistance with daily tasks such as grocery shopping.

L.A. Care Health Plan, the largest Medi-Cal managed-care insurer in Los Angeles County, with more than 2.5 million enrollees, is contracting with the hospital, which will provide housing and case management services under the initiative. For now, the hospital is targeting patients who are homeless and repeat emergency room visitors, said Fernando Lopez Rico, who helps homeless patients get services.

So far, the hospital has referred 78 patients to case managers and enrolled 30 other patients in housing programs. Only one has been placed in permanent housing, and about 17 have received help getting temporary shelter.

“It is very difficult to place people,” Lopez Rico said. “There’s almost nothing available, and we get a lot of hesitancy and pushback from private property owners not wanting to let these individuals or families live there.”

Patrick Alvarez, 57, has diabetes and was living in a shed without running water until July, when an infection in his feet grew so bad that he had several toes amputated.

The hospital sent him to a rehabilitation and recovery center, where he is learning to walk again, receiving counseling, and looking for permanent housing.

If he finds a place he can afford, CalAIM will pay his first month’s and last month’s rent, the security deposit, and perhaps even utility hookup fees.

But the hunt for housing, even with the help of new benefits, is arduous. A one-bedroom apartment he saw in September was going for $1,600 a month and required a deposit of $1,600. “It’s horrible, I can’t afford that,” he said.

Hawthorne needs help just as badly. But he’s unlikely to get it since he doesn’t have a phone or permanent address — and wouldn’t be easy for the hospital to find. The homeless encampments where he lives are routinely cleared by law enforcement officials.

“We have so many more people who need help than are able to get it,” Lopez Rico said. “There aren’t enough resources to help everyone, so only some people get in.”

———

L.A. Care has referred about 28,400 members to CalAIM case managers, roughly 1% of its total enrollees, according to its CEO, John Baackes. It is offering housing, food, and other social services to even fewer: about 12,600 people.

CalAIM has the potential to dramatically improve the health of patients who are lucky enough to receive new benefits, Baackes said. But he isn’t convinced it will save the health care system money and believes it will leave behind millions of other patients — without greater investment in the broader Medi-Cal program.

“Access is not as good for Medi-Cal patients as it is for people with means, and that is a fundamental problem that has not changed with CalAIM,” Baackes said.

Evidence shows that basic Medi-Cal patient care is often subpar.

Year-over-year analyses published by the state Department of Health Care Services, which administers Medi-Cal, have found that, by some measures, Medi-Cal health plans are getting worse at caring for patients, not better. Among the most recent findings: The rates of breast and cervical cancer screenings for women were worse in 2020 than 2019, even when the demands that COVID-19 placed on the health care system were factored into the analysis. Hospital readmissions increased, and diabetes care declined.

“The impact of COVID is real — providers shut down — but we also know we need a lot of improvement in access and quality,” said State Medicaid Director Jacey Cooper. “We don’t feel we are where we should be in California.”

Cooper said her agency is cracking down on Medi-Cal insurance plans that are failing to provide adequate care and is strengthening oversight and enforcement of insurers, which are required by state law to provide timely access to care and enough network doctors to serve all their members.

The state is also requiring participating health plans to sign new contracts with stricter quality-of-care measures.

Cooper argues CalAIM will improve the quality of care for all Medi-Cal patients, describing aspects of the initiative that require health plans to hook patients up with primary care doctors, connect them with specialty care, and develop detailed plans to keep them out of expensive treatment zones like the emergency room.

She denied that CalAIM will leave millions of Medi-Cal patients behind and said the state has increased incentive and bonus payments so health care providers will focus on improving care while implementing the initiative.

“CalAIM targets people who are homeless and extremely high-need, but we’re also focusing on wellness and prevention,” she told KHN. “It really is a wholesale reform of the entire Medicaid system in California.”

A chorus of doctors, hospital leaders, health insurance executives, and health care advocates point to Medi-Cal reimbursement rates as the core of the problem. “The chronic condition in Medi-Cal is underfunding,” said Linnea Koopmans, CEO of the Local Health Plans of California.

Although the state has restored some previous Medi-Cal rate cuts, there’s no move to increase base payments for doctors and hospitals. Cooper said the state is using tobacco tax dollars and other state money to attract more providers to the system and to entice doctors who already participate to accept more Medi-Cal patients.

When Newsom vetoed the bill to provide higher reimbursements primarily for emergency room care at MLK, he said the state cannot afford the “ tens of millions ” of dollars it would cost.

MLK leaders vow to continue pushing, while other hospitals and the powerful California Medical Association plot a larger campaign to draw attention to the low payment rates.

“Californians who rely on Medi-Cal — two-thirds of whom are people of color — have a harder time finding providers who are willing to care for them,” said Jan Emerson-Shea, a spokesperson for the California Hospital Association.

For Dr. Oscar Casillas at MLK, the issue is critical. Although he’s a highly trained emergency physician, most days he practices routine primary care, addressing fevers, chronic foot and back pain, and missed medications.

“If you put yourself in the shoes of our patients, what would you do?” asked Casillas, who previously worked as an ER doctor in the affluent coastal city of Santa Monica. “There’s no reasonable access if you’re on Medi-Cal. Most of the providers are by the beach, so emergency departments like ours are left holding the bag.”

———

(KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation. This story is part of a partnership that includes WLRN, NPR and KHN.)

©2022 Kaiser Health News. Visit khn.org. Distributed by Tribune Content Agency, LLC.

I blame it all on Robert Preston — my dislike of exercise and fitness, that is. Now that I’m 65 and unretired and someone with Type 2 diabetes, I’m trying to change my attitude and habits about exercising (with mixed success). If you’re in your 60s or so, I’m here to tell you how and why you might want to become more active, too.

Back to Robert Preston. I loved him in “The Music Man,” but if you’re around my age, odds are that when you were a kid in gym class, you, too, were subjected to Preston’s 1962 recording of the song “Chicken Fat.”

Composed for President Kennedy’s Council on Physical Fitness by “The Music Man” creator Meredith Willson, it played relentlessly while elementary, junior high and high school kids touched their toes, and did jumping jacks, push-ups and pull-ups to lines like this:

“Push up every morning. Ten times! Push up starting low.

Once more on the rise, nuts to the flabby guys, go you chicken fat, go.”

Turns out, I’m not the only one whose fear and loathing of exercise has a link back to childhood.

Bad memories from gym class

A 2018 Iowa State University study of phys ed memories found that embarrassment from being made to feel incompetent by the PE instructor or other classmates or lacking perceived competence in the activity or sport “may have powerful, long-lasting effects on attitudes and behavior.”

Loretta DiPietro, 65, who chairs our current president’s Physical Activity Guidelines Advisory Committee’s Aging Subcommittee, understands.

“You’re not the only one,” she told me. “When we ask older people, ‘Why aren’t you physically active?’ they say, ‘I’m not good at it.’”

It’s one reason DiPietro, a professor in George Washington University’s department of exercise and nutrition sciences, suggests we try to get more “physical activity,” not “fitness” or “exercise.”

Fitness and exercise, she says, “are scary words.”

Think ‘physical activity,’ not ‘exercise’

But physical activity, notes DiPietro, is “basically everything you do that uses your muscles and results in some ambulatory activity.” (That, I can do.)  

“So, walking across the room, lifting, carrying, raking leaves, doing laundry, it’s all good,” says DiPietro. And, she adds, “one of the best pieces of evidence that came from doing the recent [federal physical activity] guidelines is that it doesn’t have to be vigorous, physical activity to count.”

Richard Ashworth, president and CEO of Tivity Health, which owns the nationwide SilverSneakers community fitness program for people 65+ with Medicare Advantage plans, says: “The number one most impactful way you can live a higher quality life is to be physically active. If you want to live the longest, the best thing you can do is have more friends. But if you want to live the highest quality life, what you want to do is be physically active.”

The current federal guidelines say that, for substantial health benefits, adults should do at least 2 ½ hours to 5 hours a week of moderate-intensity physical activity (it doesn’t have to be all at once) or 1 hour and 15 minutes to 2 ½ hours a week of vigorous intensity aerobic physical activity or — and here’s the important part — an equivalent combination of moderate-and vigorous-intensity aerobic activity.

Plus, the guidelines advise, adults should also do muscle-strengthening activities of moderate or greater intensity on two or more days a week.

New thinking about the right physical activities

In fact, the U.S. government guidelines suggest what’s known as “multicomponent physical activity” to help reduce the risk of injury from falls or injury from falls. This means including more than one type of physical activity, such as aerobic, muscle strengthening and balance training.”

DiPietro says that in the past, experts “thought the only thing that mattered for health was vigorous physical activity.” But now, she notes, analysts have discovered that moderate-intensity activity, light-intensity activity and vigorous physical activity “all counts.”

Think of daily physical activity as a glass of water, DiPietro says.

“What you want to do is fill that glass of water. You could turn on the tap and get a real vigorous flow of water, which would fill it up quickly. Or you could do a little vigorous and then some moderate and then a weak stream that will fill it up over the course of the day. It doesn’t matter how you fill your glass,’ she notes. “You should just try and fill it every day.”

Any physical activity, DiPietro says, is better than sitting.

The biggest gain in benefits, the government says, happen when you go from no physical activity to being active for just 60 minutes a week or roughly eight minutes a day.

Troubling numbers for older Americans

Problem is, many of us — especially those of us around 65 — aren’t doing anywhere close to what the government recommends.

In fact, according to the U.S. Department of Health and Human Services’ Healthypeople.gov site, 31% of Americans 65 to 74 engage in no leisure-time physical activity. Overall, just 28% of men and 21% of women in the U.S. meet the government’s aerobic and muscle-strengthening guidelines.

You know, of course, all the bad things that can happen to you and your health if you’re an older adult and don’t exercise…er, get physical activity: an increased risk of falls, injuries, stroke, heart- and other chronic conditions and depression.

But the Centers for Disease Control and Prevention (CDC) also says people who do little or no physical activity are more likely to be hospitalized or die from COVID-19 than those who are more physically active.

But what exactly does the government mean by moderate intensity, vigorous intensity aerobic and muscle-strengthening activities and how can you do them?

A guide to types of physical activities

Let me take them one at a time:

Moderate intensity aerobic activities: These are ones that produce a noticeable increase in your breathing rate and heart rate. You can talk, but not sing, while you do them. Examples: walking briskly, riding a bike on level ground, pushing a lawn mower or playing doubles tennis or pickleball.

Vigorous intensity aerobic activities: These are ones that produce large increases in your breathing and heart rate. When you do them, you can’t say more than a few words without pausing for a breath. Examples: running, jogging, swimming laps, riding a bike on hills and playing singles tennis or basketball.

Muscle-strengthening activities: These involve all the major muscle groups and include things like using exercise bands, weight machines, hand-held weights; doing push-ups, pull-ups, planks, squats and lunges (Robert Preston!); gardening chores such as digging, lifting and carrying things as well as some yoga postures and some forms of tai chi. According to the Physical Activity Guidelines for Americans, 2nd Edition, these exercises “should be performed to the point at which it would be difficult to do another repetition.”

If you’ve been largely sedentary like me, the key is to increase the amount of physical activity gradually.

According to the government’s physical activity guidelines report, “it can take months for those with low fitness to gradually meet their activity goals.” It’s best to start muscle-strengthening activities one day a week at a light or moderate intensity, for example, and then raise the level to two or more days a week, increasing the intensity slightly along the way.

What I’m doing — or trying

I’ve started to take DiPietro’s advice and am trying to get more physical activity into my life and build my stamina.

Aside from walking my dog, I’m now also trying to walk stairs rather than take escalators or elevators and park my car further away from my destination to force myself to get in more steps.

The weekend volunteering I’ve begun for the Furniture Assist nonprofit entails lifting and carrying pieces of furniture and heavy bags of clothes from owners’ cars into the warehouse or from the warehouse to recipients’ trucks.

And I’ve just become a member of my local YMCA so I can start taking twice-a-week, 50-minute “Lite Total Body Fitness” classes.

My wife, Liz, and I recently rode bicycles on the Atlantic City boardwalk from, and to, the town of Ventnor — roughly 5 miles each way. (Biking against the wind was harder for me.)

We’ve also just started taking up pickleball, which is a cross between tennis and Ping-Pong. I enjoyed getting my heart pumping, but confess I had to sit down a few times due to heat exhaustion (a problem that’s not uncommon for people with diabetes).

DiPietro’s advice: hydrate, hydrate, hydrate. 

Passionate for Pickleball

“Pickleball is great for so many reasons,” DiPietro says. “It’s aerobic, it’s impact because you’re running on a court and it’s strategic, so it helps keep those marbles upstairs rolling around perfectly.”

A friend who’s roughly my age, public relations manager Rebecca Theim of College Park, Md., began playing pickleball a year ago. Now, she’s rabid about it.

“My goal is always to do at least a minimum of four to five days a week,” she told me.

Theim, who had a tennis scholarship while attending Northwestern University, now regularly enters pickleball tournaments. In fact, she and her partner were the second-best team from Maryland in the 2021 Maryland Senior Olympics.

Pickleball, she says, “is much more manageable than tennis — the court’s 40% of the size and the net’s about 6 inches lower.” Plus, she adds, it’s a lot less strenuous.

But playing pickleball is one reason Theim will be having surgery to replace both her knees in coming months. “I think it certainly accelerated it,” she says.

She also has Achilles tendinitis, which according to the Therapeutics Associates Physical Therapy website, “is often caused by a sudden increase in the amount or type of repetitive activity, such as going from never playing pickleball to playing it 4 times a week.”

How to get started becoming more active

I asked SilverSneakers’ Ashworth what retirees can do to become more physically active. His response: “If their doctor clears them to get started [with physical activity], walking is amazing,” Ashworth said. “Walking is a full-body activity — your arms, your core is engaged.”

DiPietro’s walking advice for older adults with diabetes: “Do that walking after each meal.”

Ashworth has three other suggestions to begin getting physical activity into your life in retirement: hiking, cycling and gardening. But, Ashworth says, “We all have different limits and capacities; knowing your own limitations is an important concept.”

DiPietro also recommends launching a walking plan, building up to a half-hour a day every day, especially if you don’t want a performance-based activity.

“Then, go to something fun like pickleball or a dance class or complementary exercises like tai chi,” she suggests.

Fitness and your finances

Ashworth mentioned a hidden benefit to getting regular physical activity: you can save money. By becoming healthier, you may be able to eliminate or reduce some of your prescriptions for ailments.

DiPietro says that for some people, physical activity means “I don’t have Type 2 diabetes anymore or I can go off my medication for hypertension.”

One CDC study found that people who attended a SilverSneakers gym or fitness class at least twice a week spent $1,250 less on healthcare in their second year of the program than those attending just once a week. The American Diabetes Association research showed that people with diabetes in SilverSneakers activities saved more than $1,600 in medical expenses their first year compared with others; they also had fewer hospitalizations.

Junking the old definition of retirement

DiPietro says trashing the traditional definition of retirement could help people in their 60s and older get more physical activity in their lives.

“I grew up in an era where older people were told, especially upon retirement, to relax and take it easy. And that is probably the worst advice we could have given,” she says. “The advice I have to give is: Use it or lose it. And that becomes especially so in older age.”

The National Institute on Aging has three free, helpful online tools to help you get started and keep going. There’s the Find Your Starting Point Activity Log; its guide to the four types of exercise (endurance, balance, flexibility and strength) and the Monthly Progress Test.

Remember, as the Chinese proverb says: a journey of 1,000 miles begins with a single step.