In this rollicking episode, physical therapist Brittany Denis joins host Melinda Blau, a self-confessed exercise avoider. Denis, who admits she doesn’t like the gym either, discusses lifestyle changes she teaches her older clients in order to stay agile as they age. Sit on the floor every day, she suggests, or put dishes on a higher shelf where you have to stretch to reach them. Denis shares lots of other helpful suggestions for integrating “mindful movement” into your day. Read Brittany Denis’ writing on staying active here.
Crow’s Feet Podcast with Melinda Blau and Brittany Denis, PT, DPT
Air date March 8, 2023. Series 2, Episode 6
Announcer: And now here is a man who will show you how to feel better, look better: Jack Lalanne.
Jack Lalanne: Thanks very, very much for letting me come into your home. My name is Jack Lalanne and I'm here for one reason and one reason only, to show you how to feel better and look better so you can live longer.
Jack Lalanne: Keep your dial right where it is because we are going to learn together. I like to consider myself as your personal physical instructor and your health consultant. You say, Jack, I know I know. I know that I need exercise, but well, it's too boring and isn't any fun and I can't do it or I'm too old. These are all excuses because I'm going to be here to show you how much fun and how easy exercise really can be. And I want to show you ...
Melinda Blau: Sorry, Jack Lalanne, even when I watched you as a kid, exercise was not fun. Years later, Jane Fonda tried to make it fun too. Not to me, I don't like to sweat or wear spandex.
Intro: This is Crow's Feet, a place where we ponder the question. Are these our golden years, or does aging just suck? Well, yes, getting older is not for the faint hearted. But aging also brings wisdom and humor, a finely tuned perspective on life. In our podcast, you'll meet writers and others rethinking our later years, people who inspire us to reimagine our future.
I'm Melinda Blau. I'm an editor and journalist, author of 15 books, and now a Crow's Feet writer. I've been lucky in love and in my career, but I have one big problem. Perhaps you can identify. I've always had a love-hate relationship with exercise. The only thing I do regularly is walk. And that's because I have a dog and I have to.
So it's with great enthusiasm, that I welcome Brittany Denis, a licensed and certified physical therapist, and restorative exercise coach. Brittany specializes in older clients. And if she can motivate me, there is hope for the rest of you. Welcome, Brittany,
Brittany Denis: Thank you very much for having me here today.
Melinda: Could you just tell me a little bit about your life? And also what I'm most interested in, is of course, how you ended up specializing in older clients.
Brittany Denis: I spend most of my days working with older adult clients in their homes, try to help them improve their day-to-day movement, live without pain, improve their valence state. I'm also the mom of three children that we homeschool and I live on a working farm with my husband. So, I actually help him with some of the day-to-day farm activities.
Melinda: So you have no problem building movement into your day.
Brittany: So I am a fellow exercise hater, so this is where, you know, kind of my other specialty areas working with those who have had a lifelong aversion to exercise. But yeah, if you live an active lifestyle, it's possible to not have to have an exercise routine.
Melinda: Well, that's music to my ears. But what motivated you I mean, most people don't necessarily choose to work with older people?
Brittany: I was very much inspired by my grandparents. I was lucky enough to have all four of them in my life until I was almost 30 years old. And it was really wonderful to have so much time with them and their final few decades of life, and really get to talk to them about what aging was like for them, to kind of see how they handled their later years. They all looked at the end of their lives as a chapter of their lives, that there was still a lot of value and good quality of life left to live. So they all really made the most of those final final years.
Melinda: Well, that's that's certainly the mission of Crow's Feet is to tell stories like that. Brittany also writes for Crow's Feet, and she's written some wonderful articles. And you talk about a growth mindset, which I found really interesting because I've never heard it apply to adults, especially older adults. So could you explain a little bit about that?
Brittany: I came across Carol Dweck book Mindset. Carol Dweck found that people tend to have two sort of main mindsets, growth versus fixed. So those with a fixed mindset tend to view their characteristics, traits, their abilities as something that is unchanged. They either come naturally to you or they don't. You know, you're either good at them or you're not. So, if you try something for the first time and you're not good at it, then you're not destined to be good at it and there's nothing to be done about it. Versus a growth mindset.
Those who have a growth mindset view challenges or things that they can't do well on the first time as an opportunity for practice and learning. And so, as I started to look into this work, it really gave me the words for the things that I already observed both in my own life and with my older adult clients. And then much to my delight, I actually found other writers who were talking about this concept of growth mindset in older adulthood. So I knew I was not alone in that thought process. But it's really looking at again, we can maintain a growth mindset throughout the lifespan, I think that we do tend, by the time we finished our formative school years, to think I'm done, I'm arrived, I'm in adulthood, I'm going to know what I'm going to know. It's just so far from the truth.
Melinda: One of the things I found that makes for a better aging process is to try new things to be open to new things. And I think that's part of a growth mindset. You also talk about that you don't like exercise. You talk about movement as mindful movement, really just a prettied-up word, a phrase for exercise. Tell us what you mean by it.
Brittany: No, I guess you can can look at it a little bit like that. I was motivated to become a therapist because I was fascinated by the medical field. And as I kind of decided what area I wanted to go into, this is what held the most interest for me, but I was bored out of my mind in the gym. And I remember having a year in college after I was done dancing, I felt well, I have to find something to do, right, to stay active. So, I had a lot of roommates who were joggers, and I thought, okay, well this is probably what I should do, right? I hated every minute of it.
Melinda: This is the runner's high, you kept waiting for that.
Brittany: Yes! It never got easier, I never improved my distance. So, after I became a therapist, I thought, well, I need to find a path. I'm so bored by just basic exercise, or what most of us think is basic exercise, when I stumbled across a woman named Katie Bowman, who is a bio-mechanist. And she was talking about something called of movement-based lifestyle -- that exercise in the way that most of us think of it is only a small subset of available human movement. And that if we look at our physical health in this broader context of movement, instead of exercise, we can live a movement-based life without the need to go to the gym and have the formal exercise routine. So we're mindful movement comes in, that is the practice of reconnecting the mind and the body when we are moving.
So, people talk about, well, you just got to go hop on an elliptical and you'd have to do the physical activity and get it out of the way. And it's supposed to be this miserable thing. And it doesn't have to be like that. And if we combined kind of a mindfulness practice, along with physical movement, that not only gives us an opportunity to learn and be curious to learn to set aside judgment about our own bodies, but it also helps facilitate that mind-body connection that so many of us lose over time. And that becomes vital when we have a health event if we have that deep self-awareness of our own body in that really helps facilitate the recovery process. So mindful movement, at least the way I interpreted or practice it, is this very slow approach to movement. I will say it does not work for everyone. And that's okay. But that I found for those those of us who have always hated exercise, it actually becomes a really good approach.
Melinda: I identify a lot, and it really warms my heart to hear you say you don't like exercise. For example, I had lunch with a contemporary, she said, "Oh, my God, my body is failing me". And I looked at her and I said, Wait, wait, wait, wait, stop. Wouldn't it be better and nicer to yourself? If you said, my body is changing, and you must see this with your clients, the misconceptions, the things that we automatically assume are going to happen when we get older, our body is going to fail us. So tell me about some of the common misconceptions you find with your clients.
Brittany: I've definitely found, you know, when I first started to work with somebody that I need to spend much more time listening the first hour that I'm with somebody and I can pick up on that language and you're right, we all have this internal narrative whether we realize it or not. So yeah, just that general thought of "my body is going downhill" is really common. Another common one is that I have arthritis, it's causing pain, and there's nothing I can do about it. I've seen this in my clients.
And there's a large body of research behind this at this point, that there's actually a really poor relationship between arthritis and pain. I have worked with people who have very advanced arthritis, and they have no pain, maybe some stiffness. I have worked with people who have very little arthritis, but they have a lot of pain. So it's a really complex picture. Pain perceptions change over time. So, say you have an old knee injury. 30 years later, now it's becoming painful, and it's "oh, I’ve damaged my knee, and now it's causing pain." The brain is actually telling you have pain when there's no damage there. It's like a smoke detector that's going off, even though there's no smoke in the house.
So, I think the real danger in all of these misconceptions is that they don't get brought up to even members or healthcare provider, they all go on under-treated, because they're accepted as normal.
Melinda I feel like right now, I have to interject something I know, you're considerably younger, how old are you? Brittany: I am 36. Melinda: This begs the question: how can you really help somebody? When you have an experience that I mean, in no universe are you old, you know, even though you didn't like to exercise your whole life, I don't imagine that you have a fear of falling or loss of balance, you know, you're running around after three little kids and running a farm. So, I'm assuming that these are not your problems. So how do you how do you deal with that?
Brittany: This is something that I struggle with, I do know that I'm working at a disadvantage. So I try to make sure I keep that in mind every time it was my client. And I think sometimes as health care providers, we know everything. We're going to tell you, you got to do XY and Z and if you can't do that, you're gonna be labeled noncompliant. But oftentimes, we're giving advice that doesn't work because we haven't lived that person's experience. We haven't spent enough time listening. So, I think that's what trying to continue to educate myself. But most importantly, listen.
Melinda: Let me ask you, how do you work with somebody like me? I know movement is good for me, I'll stop using the word exercise, that movement is good for me. I know enough. I've taken enough classes over my life in Pilates and yoga, I could probably lead a yoga class, but do I do it on my own? No. So talk to me a little bit about motivation.
Brittany: Motivation is one of the things I get asked about the most often. Well, that's great that there are these restorative exercises that can help me or if I go for a walk, it's gonna help me well, what if I'm just not motivated to do it. And motivation is very fleeting. It's not good for any of us to rely on motivation. And it takes so much energy, to have to motivate yourself to do something day in and day out. It'd be really easy to talk ourselves out of habits that we know are good for us. Right? So my usual recommendation, and this is what I do in my own life, is to have things set up that I don't, I don't have a choice, it's just there.
There are so many simple things like electric can openers, or really a lot of handy kitchen devices that minimize the amount of work we have to do, right. But now we've taken away that opportunity from ourselves. So even making that switch from this electric can opener to a hand one. Now you've got to work on upper body and grip strength every time you go to open a can. Things like carrying groceries -- that's your resistance training, and you're good with that.
Melinda: One of the reasons I resonated with your whole philosophy, is that it's doing what you do anyway. In fact, today doing this podcast, I'm sitting on the floor because one of your pieces of advice is sit on the floor and get up and down 10 times a day. But these things seem easier to somebody like me, because in a way it's a fun challenge. What do you hear from other people that makes it difficult for them to really adopt a movement lifestyle?
The nice thing about something like a movement-based lifestyle is your infinite options for this. So how you were talking about reaching up into the cabinet thinking, Oh, this is a good stretch, what tends to happen more often than not, when somebody starts to notice I'm having a hard time reaching into the cabinet, I should move my dishes down lower, where I can reach them. So now we've taken away an opportunity to work on that shoulder motion. So you can have your dishes up higher, I mean, keep them in a safe range where you can reach. My other recommendation is usually to put them down below countertop level. So now you've got a squat to get to them.
Brittany: One thing we've already mentioned, it's those stories we hold on to those things that we tell ourselves that while if I can't change this, this is really going to make a difference. What I do. I think sometimes people hold on to a lot of guilt and shame for previous attempts to establish exercise routines that just weren't working. It's unconventional advice to tell somebody, don't sit in the chair, go sit on the floor to watch your favorite TV show. It's shocking sometimes to hear these things. And I'll get people that look at me, like, you know, that can't be it, it's almost like it's too, it's too insignificant. You know, we live, unfortunately, in a society where we, you know, go big or go home, no pain, no gain these kinds of things. If you're not doing it big enough, it's not making a difference. We don't spend enough time celebrating those small things or looking at those small opportunities.
Melinda: I used to hate when people would say feel the burn, I don't want to feel burn is that the only way to be healthy to feel a burn? It just seems a little sadomasochistic to me. But, you know, a lot of my contemporaries are starting to have knee injuries or their breathing is not as good as it used to be. How do you convince somebody who's kind of given up, I'm too old, I'm too damaged, I'm too worn out. I'm too lazy. Whatever the reasons, I'm too sick.
Brittany: Those are usually the people who get sent prescription for physical therapy, because this is my typical clients, I would say, somebody who has had these medical events happen, they're struggling. And they really have kind of given up. It's really important that I spend the first few sessions with somebody, once again, listening, but to finding out what makes them happy, what brings them joy. It might be spending time with great children and might be doing puzzles, it might be they loved photography at one point in their lives. No matter what your interests are, there are some opportunity to work movement into that. And usually, where I start with somebody who really feels like they've given up is we have to start where they are comfortable and help them build confidence before we try to make any kind of physical gain. So looking at the small things that they can do, to try to break down some of those barriers.
Melinda: Give me an example of a real person.
Brittany: Yes, a client several years ago, in their early 70s, who very advanced arthritis, a long history of back pain. They had a lot of breathing problems that came along with shortness of breath, lived in so much pain, and she actually told me, "If I wake up and I don't have pain, my first thought is, when is it going to hit me." I mean, if that's your thought process, and your brain is gonna find somewhere that there's pain. And the first activity that I gave her to do was every time you go to stand up from a chair, you sit down and you do it again, by the end of the day, you have done double, that's basically a squat that's getting halfway to the floor, getting in and out of that chair. So that's where we started, it was something that was not hard to remember to do. It doubled her activity. And one of the times that I came, she said to me, "you know, I don't know if you believe that I can get better. But now I believe that." We found a place to start with someone like that. I think it was one of the most powerful things somebody could have ever told me. And I really helped me realize that that's at the heart of what I do. It doesn't matter what I think. The only thing that matters is if I can help them see that there is potential for improvement and believe in themselves.
Melinda: You're listening to the Crow's Feet Podcast. I'm Melinda Blau, with physical therapist, Brittany Denis, and we're talking about how to get more movement in your life, energy, vitality, and even longevity.
Melinda: I read that you can train for falling, one of my fears. It's a serious thing. And when I was a kid, and you heard "so and so fell," usually with someone's grandmother, they'd say, That's it. That's the beginning of the end.
Brittany: So first thing to know about falls is that they are going to happen. So falling is a normal part of life. I know I can say I fall it more than once in the last year. So we need to train as much as we can for it to happen. So there's a few levels to that. And the first level is talking about what do we do in the event of a fall? So do you have somebody that you could call do you think you'd be able to get yourself off the floor? What are you going to do if you're injured? So we kind of talk through the scenario and start to play out the thought in their mind. But then the next part of that is actually doing a fall simulation and fall training. One of my usual questions for somebody is when is the last time you've gotten on the floor on purpose?
This is why getting on and off the floor, if you're able to do so, practice it every day, because research shows that even having the confidence to know that you can get on and off the floor makes you less likely to fall to begin with. The more variety of ways you have to get out and off the floor, the better off you're going to be in the event of a fall. I never do this on the first visit, I make sure I have their trust before we do this. If it's somebody who is really apprehensive about getting on the floor, I will physically lower them to the floor. And we go through how they would get up. And then we have to practice that again and again and again. The third level is actually practicing the fall itself. So if we do practice falling.
Melinda: You say practice falling, what do you mean, just like make believe you're following?
Brittany: Yeah, pulling out a cushion and just falling right on over. I mean, that's a big motion to go through, right? That can be really alarming. So usually where I start with people is we stand in front of a wall, maybe and we practice falling forward to the wall and trying to catch with hands. Just very gentle, we start gentle and slow, until we can work up to the point that I have a cushion. I bring it in and we practice falling onto the cushion. But there are ways that you can try to protect yourself in the event of a fall and make it less likely that you will injure yourself.
Melinda: So I guess if you've practiced a little bit, then it's not so scary, especially if it's at home.
Brittany: That's a good point. So a lot of falls do happen at home because that's where we spend most of our time. However, most of us are familiar with our home environment, balance tends to be better in an environment that's familiar. So one of my recommendations for people is to make sure they get out outdoors for a walk. Because that is a completely different experience. That's an environment that is unfamiliar to you. There's a lot of input coming in, there are things to see, there are sounds to hear. There's unevenness on the ground, though.
I usually tell people try to get out there for a walk, but pay attention to what you do. How do you react to noises? How do you react to lights or you can't control the people moving around you? How do you react to sudden movements? Are you avoiding obstacles in your path? It's both a good physical exercise, but also good brain health.
Melinda: I think it was in one of your pieces you said, "Senior gait is really scared gait." Some people in their 60s are so tentative. They almost look scared when they're walking, can you train that out of somebody?
Brittany: So, usually where I start with is we have to purposefully expose somebody to obstacles, right and build that confidence, usually and try to objectively show somebody their improvement. So we might do a balance test that gives a score. And maybe I'll make a video of them walking, and then we do it again in a month and they can see their progress. And sometimes that's enough for people. But sometimes I'll get people who improve astronomically. But they'll tell me, "I don't feel like I've improved at all. And I'm still afraid." And I actually recommend that they go to counseling. So then I know we've got to bring in extra resources. Yeah, itregardless of age, we develop these fearful patterns.
Melinda: You know, even when we talk about old, yes, the scientist put it at 65. But this vast difference between one 65 and another 65. And between two 40 year olds, I mean, in terms of their psychological makeup, their physical makeup, their talents, you know, all my old ladies say that the key to aging well, is luck. But I also think that you hold the other key to aging, the work that you do, which is independence, to be independent, you have to keep moving, you have to keep using your body. And for me, it's it's the greatest challenge of aging. And I love to know that there are people like you out there. So how do you interview somebody who's a potential physical therapist or a trainer, an exercise coach, whatever it is that you're looking for, someone who's going to help you with movement?
Brittany: I go through this too, if I, say, have somebody who's done with physical therapy, and maybe they would need a personal trainer, so I spend a lot of time observing and talking to trainers. They're not all equipped to work with older adults. There are some who are really wonderful and specialize in that so they have to be found. I think one thing that is a big red flag, if you are on a first time visit with really any health care provider, if they are not listening, if they are spouting out advice right out of the gate, then that's usually not a good sign. The second thing there's nothing wrong especially if it's a trainer or therapist, is asking if you can maybe observe.
For a little bit, that's how I find trainers to recommend people to. I have gotten an observed group exercise classes, I have gotten observed trainers, especially somebody who really cares about their work, they're going to be more than willing to to allow that.
Melinda: That's a really great suggestion. You've written a lot for Crow's Feet, and you have a lot of good information. But what are the things that you want to leave, you know, exercise avoiders like me with, and what's the most important thing that that we can think about as we we look at our horizon, whatever our horizon is, which, of course, none of us know?
Brittany: I think it's focusing on things that are joyful, meaningful in some way. And not looking at using our bodies as "this it has to be miserable, it has to be hard. If I'm not suffering while I'm doing this, then it's not worthwhile." It's finding those small ways that we can move. It's celebrating the small things, keeping that perspective on what we're able to do and what we maybe would like to be able to do but aren't at the moment. I just think there's not enough of this, though. Use your physical movement to help you learn and just stay curious and open-minded to new potentials.
Melinda: Thanks, Brittany, this was great. And I'm sure that a lot of people are going to be helped and they'll have a different perspective. And I strongly advise you to read Brittany's pieces on Crow's Feet and not give up like my friend. I hope she's now saying, Oh, I'm changing as opposed to I'm failing. So thanks again. And this has been terrific.
Brittany: It's really been wonderful to talk to you but Melinda, so thank you.
Melinda: No need to feel the burn or beat up on yourself. Now I can finally throw out those old Jane Fonda cassettes I never watched.
Today's episode was produced by me, Melinda Blau. Our executive producer is Nancy Peckenham. Editing and sound designed by Rich Halten. This podcast would not be possible without the support of our Crow's Feet team, including Jean Feldeisen, Jan M. Flynn, Warren Turner, Lee Bentch, Betsy Allen, Nancy Franklin and Cathy Dunn Gilbert.