Dr. Don Jewett of the University of California-San Francisco (UCSF), a medical school/hospital that's on many "best in the world" lists, was kind enough to share some expert fitness advice in response to yesterday's entry Health Is Wealth: Prevention, Fitness and Strength.

"I'm a retired Orthopaedic Surgeon who was Director of Physical Therapy for 10 years at Univ. of Calif. Medical School, San Francisco. I was on the full-time faculty for 27 years.

1. Your muscles have both "fast" fibers and "slow" fibers. Each is specialized for the named action, and the proportion changes, depending upon what your persistent activities are. Long Distance runners have almost all slow fibers. You can exercise the slow fibers with Tai Chi.

2. However, you will not get stronger unless the muscle is "tired". Body builders and those with equipment go to the point of exhaustion. That works. But another way is to hold a given position such that the muscle trembles. Hold it that way as long as possible. In this way you can reach the "tired" state quickly.

3. If you don't have weights, then save plastic gallon jugs that have a big handle (for most of your fingers). Fill them with the amount of water that you can lift and hold, say with the elbow bent to 90 degrees, with the muscle trembling. As you get stronger, increase the water. You may need different pairs with different amounts of water, for strengthening different positions and/or muscles.

4. You can do push-ups, and hold the position. If you aren't strong enough to do a full push up, then make it easier: a) put your knees down on the floor, instead of your feet. b) lean against a wall. Again, you don't need to "do" push-ups, just get your arms bent at the point where your muscles tremble.

5. Strengthen leg muscles by a partial squat to the point of trembling. If you aren't strong enough, then lean your back against a wall after putting a dining-room chair on either side of you. Put your feet away from the wall, and descend slowly to the point that your leg muscles tremble. As they tire, you may have to put your hands on the chairs to get up again. As you get stronger, move your feet closer to the wall and/or bend the knees more.

6. Holding onto the back of a dining-room chair, then balance for some minutes on one foot. Move the leg your not standing on to different places around you. This helps keep the body feedback sensors "tuned up" (as you lose some when you age). Bend the leg you are standing on to the point where the leg muscles tremble. YOU CAN SAVE TIME BY DOING THIS EXERCISE WHILE WAITING IN LINE AT THE STORE--- holding on to the shopping cart!

7. The abdomen strengthens by partial sit-ups, held part-way up--- it takes longer to make these muscles tremble--- they are all slow fibers. It may help to bend your knees a bit--- this flattens your back so that it doesn't hurt.

8. The back can be strengthened by lying on your stomach and arching your back. If it is too easy when lying on a bed, then move your head and shoulders off the bed, into space. You can rest with your hands on the floor, and then exercise by lifting your hands and keeping your back straight. Again, the back muscles are completely slow fibers, and may not tremble.

9. Know the difference between good pain and bad pain. Bad pain comes on immediately when you hurt yourself, or reach a certain position, and it feels "sharp". Good pain comes on gradually, often several hours after you exercise. It is "dull" and "aching". If you have $10 worth of good pain when you go to bed, then good pain the next night (24 hrs later) will be clearly less-- say $7, and in another 24 hrs it will be $4.

GOOD PAIN IS A SIGN THAT YOUR BODY IS GETTING STRONGER. YOU MUST WELCOME IT. DON'T TAKE Aspirin, Steroids, Tylenol, Motrin, or any other non-steroidal anti-inflammatory drug BECAUSE THESE DRUGS ACT TO SLOW HEALING! Good pain can be in muscle, tendons, ligaments, joint capsule. Welcome it, you WILL be stronger soon.

10. Make your exercises varied and interesting--- so that you will keep it up. Walking, swimming, bicycling are all "low impact" exercise that you can do with others, or go to some new, interesting places."

Thank you, Dr. Jewett, for sharing your hard-earned knowledge and experience.

In related news, Otis Brawley, M.D. recently laid bare the ill health of our healthcare system in his book How We Do Harm: A Doctor Breaks Ranks About Being Sick in America (Kindle) (print)

"I blame patients, I blame doctors, I blame hospitals, I blame drug companies, I blame insurance companies. Our health care system is messed up because the system is designed to fail, and everybody is responsible for health care failing as it is now." Dr. Otis Brawley

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