Co-workers Health Maintenance Guidelines

Sections1. General Health Screening2. Physical Activity and Exercise3. Immunization and Preventative Care4. Nutrition and Vitamin Supplementation5. Sleep and Sleep Hygiene6. Travel Habits: Jet Lag, Airplanes, Meals, and Sleep7. Prescription Medications and Supplements (Herbals)8. Weight loss and Weight Maintenance9. Avoiding Unnecessary Risk, Injury Prevention, and Emergency

Preparedness when Traveling10.Medical Insurance and Travel Insurance

Section 1 - General Health Screening

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/007465.htm

Health screening - men - ages 40 to 64You should visit your health care provider regularly, even if you feel healthy. Thepurpose of these visits is to:

1.2.3.4.5.6.

Screen for medical issuesAssess your risk of future medical problemsEncourage a healthy lifestyleUpdate vaccinationsHelp you get to know your provider in case of an illnessInformation

Even if you feel fine, you should still see your health care provider for regular checkups.These visits can help you avoid problems in the future. For example, the only way tofind out if you have high blood pressure is to have it checked regularly. High blood sugarand high cholesterol levels also may not have any symptoms in the early stages. Simpleblood tests can check for these conditions.

There are specific times when you should see your provider. Below are screeningguidelines for men ages 40 - 64.

BLOOD PRESSURE SCREENING1. Have your blood pressure checked every 2 years. If the top number (systolic

number) is between 120 - 139 or the bottom number (diastolic number) isbetween 80 - 89 mm Hg then have it checked every year.

2. Watch for blood pressure screenings in your area. Ask your provider if youcan stop in to have your blood pressure checked. Or check your bloodpressure using the automated machines at local grocery stores andpharmacies.

3. If the top number is greater than 140 or the bottom number is greater than 90,schedule an appointment with your provider.

4. If you have diabetes, heart disease, kidney problems, or certain otherconditions, you may need to have your blood pressure checked more often.

CHOLESTEROL SCREENING AND HEART DISEASE PREVENTION5. If you have high cholesterol levels, diabetes, heart disease, kidney problems,

or certain other conditions, you may need to be checked more often.6. Some men should consider taking aspirin to prevent heart attacks. Ask your

provider before you start aspirin because aspirin can increase your risk forbleeding.

DIABETES SCREENING7. If you are over age 45, you should be screened every 3 years.8. If you are overweight, ask your provider if you should be screened at ayounger age.

COLON CANCER SCREENINGIf you are under age 50, you should be screened only if you have a strong familyhistory of colon cancer or polyps, or if you have had inflammatory bowel diseaseor polyps.

If you are between ages 50 - 75, you should be screened for colorectal cancer.This may involve:1. A stool test done every year

2. Flexible sigmoidoscopy every 5 - 10 years along with a stool guaiac test3. Colonoscopy every 10 years4. You may need a colonoscopy more often if you have risk factors for coloncancer, such as:

Ulcerative colitisA personal or family history of colorectal cancerA history of large colorectal adenomas

DENTAL EXAMGo to the dentist every year for an exam and cleaning.

EYE EXAMHave an eye exam every 1 - 3 years if you have vision problems or glaucoma risk.

IMMUNIZATIONS1. You should get a flu shot every year.

2. Your doctor may recommend other vaccinations if you have certain medicalconditions, such as diabetes.

3. You should have a tetanus-diphtheria booster vaccination every 10 years. Ifyou have not received a tetanus-diphtheria and acellular pertussis (Tdap)vaccine as one of your tetanus-diphtheria vaccines, you should have it once.

4. You may get a shingles or herpes zoster vaccination once after age 60.

OSTEOPOROSIS SCREENINGIf you are between ages 50 - 70 and have risk factors for osteoporosis, youshould discuss screening with your provider.Risk factors can include long-term steroid use, low body weight, smoking, heavyalcohol use, or a family history of osteoporosis.

PHYSICAL EXAMYou should have a preventive health visit every 2 years until age 50, and thenonce a year.

Routine diagnostic tests are not recommended.Your height, weight, and body mass index (BMI) should be checked at everyexam.

During your exam, your provider may ask you about:DepressionDiet and exerciseAlcohol and tobacco use

Safety, such as use of seat belts and smoke detectors

PROSTATE CANCER SCREENING1. Most men age 50 or older should discuss screening for prostate cancer

with their provider. African American men and those with a family history ofprostate cancer should discuss screening at age 45.

2. The potential benefits of PSA testing have not been shown to outweigh theharms of testing and treatment. If you choose to be tested, the PSA bloodtest is most often done every year.

3. Prostate examinations are no longer routinely done on men with nosymptoms.

TESTICULAR EXAMThe U.S. Preventive Services Task Force (USPSTF) now recommends againstperforming testicular self-exams. Doing testicular self-exams has no benefit.

LUNG CANCER SCREENINGThe USPSTF recommends annual screening for lung cancer with low-dosecomputed tomography (LDCT) in adults aged 55 - 80 years who:

Have a 30 pack-year smoking history AND

Currently smoke or have quit within the past 15 yearsAlternative Names

Health maintenance visit - men - ages 40 - 64; Physical exam - men - ages 40 -64; Yearly exam - men - ages 40 - 64; Checkup - men - ages 40 - 64; Men'shealth - ages 40 - 64; Preventive care - men - ages 40 - 64

ReferencesAmerican Diabetes Association. Standards of medical care in diabetes -- 2014.Diabetes Care. 2014;37 Suppl 1:S14-S80.

Atkins D, Barton M. The periodic health examination. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 14.

Centers for Disease Control and Prevention. Recommended Immunization Schedule forAdults, United States, 2014. Available at http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule.pdf. Accessed July 24, 2014.

Gaziano M, Ridker PM, Libby P. Primary and secondary prevention of coronary heartdisease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease:A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders; 2012:1010.

Handler J, et al. 2014 evidence-based guideline for the management of high bloodpressure in adults: report from the panel members appointed to the Eighth JointNational Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-520.

Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001US Preventive Services Task Force Review. Rockville (MD): Agency for HealthcareResearch and Quality (US); 2008 Jun.

Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al.Screening and surveillance for the early detection of colorectal cancer andadenomatous polyps, 2008: A joint guideline from the American Cancer Society, theU.S. Multi-Society Task Force on Colorectal Cancer, and the American College ofRadiology. CA Cancer J Clin. 2008;58:130-160.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines inOncology (NCCN Guidelines): Colorectal cancer screening. Version 2.2013. Available athttp://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. AccessedJuly 24, 2014.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment ofOsteoporosis. Washington, DC: National Osteoporosis Foundation; 2013.

Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension:what are the right goals and purposes? JAMA. 2014 Feb 5;311(5):474-476.

Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; AmericanCollege of Gastroenterology. American College of Gastroenterology guidelines forcolorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-750.

Screening for Prostate Cancer. U.S. Preventive Services Task Force web site. Availableat http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm.Accessed July 24, 2014.

Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in theUnited States, 2010. A review of current American Cancer Society guidelines and issuesin cancer screening. CA Cancer J Clin. 2010; 60(2):99-119.

Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz N, Blum CB, et al. 2013 ACC/AHAGuideline on the Treatment of Blood Cholesterol to Reduce AtheroscleroticCardiovascular Risk in Adults. Circulation. 2014 Jun 24;129(25 Suppl 2):S1-S45.

U.S. Preventive Services Task Force. Screening for osteoporosis: recommendationstatement. Am Fam Physician. 2011;83:1197-1200.

Whitlock EP, Lin J, Liles E, Beil T, Fu R, O'Connor E, Thompson RN, Cardenas T.Screening for Colorectal Cancer: An Updated Systematic Review [Internet]. Rockville(MD): Agency for Healthcare Research and Quality (US); 2008 Oct.http://www.ncbi.nlm.nih.gov/books/NBK35179/. Accessed July, 24, 2014.

Update Date: 8/8/2014

Health screening - men age 65 and olderYou should visit your health care provider regularly, even if you feel healthy. Thepurpose of these visits is to:

••••••

Screen for medical issuesAssess your risk of future medical problemsEncourage a healthy lifestyleUpdate vaccinationsHelp you get to know your provider in case of an illnessInformation

Even if you feel fine, you should still see your health care provider for regular checkups.These visits can help you avoid problems in the future. For example, the only way tofind out if you have high blood pressure is to have it checked regularly. High blood sugarand high cholesterol levels also may not have any symptoms in the early stages. Asimple blood test can check for these conditions.

There are specific times when you should see your provider. Below are screeningguidelines for men age 65 and older.

ABDOMINALAORTIC ANEURYSM SCREENINGIf you are between ages 65 - 75 and have smoked, you should have an ultrasound toscreen for abdominal aortic aneurysms.

Other men should discuss this screening with their provider.

BLOOD PRESSURE SCREENINGHave your blood pressure checked every year.

If you have diabetes, heart disease, kidney problems, or certain other conditions, youmay need to be checked more often.

CHOLESTEROL SCREENING AND HEART DISEASE PREVENTIONYour cholesterol should be checked every 5 years if levels are normal.

If you have high cholesterol, diabetes, heart disease, kidney problems, or certain otherconditions, you may need to be checked more often.

LUNG CANCER SCREENINGThe U.S. Preventive Services Task Force recommends annual screening for lungcancer with low-dose computed tomography (LDCT) in adults until age 80 who:

Have a 30 pack-year smoking history ANDCurrently smoke or have quit within the past 15 years

COLON CANCER SCREENINGUntil age 75, you should have one of the following screening tests:

A stool test done every yearFlexible sigmoidoscopy every 5 - 10 years, along with a stool guaiac testColonoscopy every 10 yearsYou may need a colonoscopy more often if you have risk factors for colon cancer, suchas:

Ulcerative colitisA personal or family history of cancer of the colon or rectumA history of large growths called adenomas

DIABETES SCREENINGIf you are age 65 or older and in good health, you should be screened for diabetesevery 3 years.

If you are overweight and have other risk factors for diabetes, ask your doctor if youshould be screened more often.

DENTAL EXAMGo to the dentist every year for an exam and cleaning.

EYE EXAMHave an eye exam every 1 - 2 years if you have vision problems or glaucoma risk.

HEARING TESTHave your hearing tested if you have symptoms of hearing loss.

IMMUNIZATIONSIf you are age 65 or older, get a pneumococcal vaccine if you have never had one, or ifit has been more than 5 years since you had the vaccine.You should get a flu shot each year.

Get a tetanus-diphtheria booster every 10 years.You may get a shingles or herpes zoster vaccine after age 60.

OSTEOPOROSIS SCREENINGIf you have risk factors for osteoporosis, you should check with your provider aboutscreening. Risk factors can include long-term steroid use, low body weight, smoking,heavy alcohol use, or a family history of osteoporosis.PROSTATE CANCER SCREENINGTalk to your provider about prostate cancer screening. The potential benefits of PSAtesting have not been shown to outweigh the harms of testing and treatment.If screening is done, a PSA test is the best method.Routine prostate exam for men without symptoms is not recommended.

PHYSICAL EXAMSHave a yearly physical exam.Your provider will check your weight, height, and body mass index (BMI).During the exam, your provider will ask you questions about:

Your medicines and risk of interactionsAlcohol and tobacco useDiet and exercise

Safety, such as using a seat belt, or smoke alarmsDepression

Alternative NamesHealth maintenance visit - men - over age 65; Physical exam - men - over age 65;Yearly exam - men - over age 65; Checkup - men - over age 65; Men's health - over age65; Preventive care exam - men - over age 65

ReferencesAmerican Diabetes Association. Standards of medical care in diabetes -- 2014.Diabetes Care. 2014;37 Suppl 1:S14-S80.

Atkins D, Barton M. The periodic health examination. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 14.

Basch E, Oliver TK, Vickers A, et al. Screening for prostate cancer with prostate-specificantigen testing: American Society of Clinical Oncology provisional clinical opinion. J ClinOncol. 2012 Aug 20;30(24):3020-5.

Centers for Disease Control and Prevention. Recommended Immunization Schedule forAdults, United States, 2014. http://www.cdc.gov/vaccines/schedules/downloads/adult/adult-schedule.pdf. Accessed July 24, 2014.

Gaziano M, Ridker PM, Libby P. Primary and secondary prevention of coronary heartdisease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease:A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders; 2012:1010.

Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment ofcardiovascular risk in asymptomatic adults: a report of the American College ofCardiology Foundation/American Heart Association Task Force on Practice Guidelines.Circulation. 2010;122(25):e584-e636.

Handler J, et al. 2014 evidence-based guideline for the management of high bloodpressure in adults: report from the panel members appointed to the Eighth JointNational Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-520.

Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001US Preventive Services Task Force Review. Rockville, MD: Agency for HealthcareResearch and Quality (US); 2008 Jun.

Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al.Screening and surveillance for the early detection of colorectal cancer and

adenomatous polyps, 2008: a joint guideline from the American Cancer Society, theU.S. Multi-Society Task Force on Colorectal Cancer, and the American College ofRadiology. CA Cancer J Clin. 2008;58:130-160.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines inOncology (NCCN Guidelines): Colorectal cancer screening. Version 2.2013. Available athttp://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. AccessedJuly 24, 2014.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment ofOsteoporosis. Washington, DC: National Osteoporosis Foundation; 2013.

Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension:what are the right goals and purposes? JAMA. 2014 Feb 5;311(5):474-476.

Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; AmericanCollege of Gastroenterology. American College of Gastroenterology guidelines forcolorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-750.

Screening for Prostate Cancer. U.S. Preventive Services Task Force Web site. http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm. Accessed July24, 2014.

Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz N, Blum CB, et al. 2013 ACC/AHAGuideline on the Treatment of Blood Cholesterol to Reduce AtheroscleroticCardiovascular Risk in Adults. Circulation. 2014 Jun 24;129(25 Suppl 2):S1-S45.

U.S. Preventive Services Task Force. Recommendations for adults. Rockville, MD:Agency for Healthcare Research and Quality; 2013. Accessed July 24, 2014.

U.S. Preventive Services Task Force. Screening for osteoporosis: recommendationstatement. Am Fam Physician. 2011;83:1197-1200.

Whitlock EP, Lin J, Liles E, Beil T, Fu R, O'Connor E, Thompson RN, Cardenas T.Screening for Colorectal Cancer: An Updated Systematic Review [Internet]. Rockville,MD: Agency for Healthcare Research and Quality (US); 2008 Oct.http://www.ncbi.nlm.nih.gov/books/NBK35179/. Accessed July, 24, 2014.

Wolf AM, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the earlydetection of prostate cancer: update 2010. CA Cancer J Clin. 2010;60:70-98.

Update Date: 8/8/2014

Section 2 - Physical Activity and Exercise

Physical Fitness

Physical fitness should be approached with a program that is balanced, repeatable, andflexible to meet the need of each individual. Co-existing medical conditions, startingfitness level, and physical environment should be considered.

General a program should include a combination of five categories of conditioning.1. Cardiopulmonary - Aerobic and Anarobic2. Resistance and Strengthening3. Flexibility and Stretching

4. Proprioception and Balance5. Breathing Control and Concentration

20 Practical Recommendations to Improve Physical Fitness

1. Visit this web site.http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf

2. Plan six weeks to develop a habitAfter 6 weeks you start to see visible changes in your body and you appreciated howmuch better you feel and how much clearer you think.

3. Find an activity you likeAll forms of fitness aren't for everyone. Find an activity that enables you to pray andtune out all the stress. This can help to give you a release from your anxiety. Don't thinkof it as exercise because that suddenly gives it a negative connotation. You may say, "Iam going for a run" or "Let's go for a walk".

4. Get professional assistance to begin or advanceWhether you're a total newcomer to a fitness program or you just need a little motivationand guidance, a personal trainer can help you set goals and develop a plan to makethem happen. A good trainer will hold you accountable and will motivate you to workyour hardest. This is positive reinforcement.

5. Joining the YMCA or a community recreation centerThere is value in having a support system, which should be an integral part of anyworkout plan. Your exercise club could be an entire gym full of people, a regular fitnessclass where everyone knows your name, or just one exercise companion who makessure you meet for your morning walks. When a public gym is not for you or if getting to agym every day isn't conducive to your schedule or you just hate the idea of going to apublic place, don't force it. There are workout DVDs, streaming online classes, andhome exercise systems to get a great workout without even leaving your house. Manypeople prefer exercising in the privacy of their own homes.

6. Make it convenientThink about when, where, and how your workout can best (and most easily) fit into yourdaily routine. Don't travel far to get to a gym or the likelihood of going will decreaseimmensely. Working out at home or at a gym near your house is more convenient. Planahead to make sure you can get everything you need—like clothes and shower supplies—to and from your workouts.

7. Join a groupThe right teacher can motivate a fitness class and feel more like an enjoyable activitythan a difficult workout. Popular fitness instructors see their classes fill up fast, andmaintain loyal followings even when they switch class times and locations.8. Be accountableInvest in a fitness regimen, if you can afford it. Joining an gym or taking a fitness classcould be just the thing you need to force yourself to actually go. Positive reinforcementmay include rewarding yourself with new pair of gym shoes or a fitness watch..

9. Do not over-exertThis is a sure way to put a stop to your new exercise habit before it even gets off theground. Getting hurt. Beginners (or people just returning to fitness after a long break)need to be careful about trying to do too much, too soon, which can leave you sore andexhausted—or worse yet, with an injury that will keep you sidelined for even longer. It'snormal to have some muscle aches and stiffness a day or two after working out musclesyou haven't used in a while, but if you start to feel sick or overly tired, you could betraining too hard. Following a training plan (like a Couch to 5K program) or working witha personal trainer can help you make sure you're progressing at a reasonable pace.

10. Use technologyIf you thrive on statistics and numbers, you may find that using apps, computerprograms, or wearable pedometers and fitness trackers can help you stay on track witha new routine. Whether you're counting your daily steps or the number of caloriesyou've burned, technology can help you challenge yourself to new personal bests everyday. Plus, many of these programs can be integrated with social networks, making iteasy to let your friends or family know that you just ran 3 miles or checked in at thegym.

11. Count your caloriesKeeping a food and fitness diary or using a calorie-tracking app can also remind you ofhow a few more minutes on the elliptical can help balance out your calorie intake andoutput. A 2013 Stanford University study found that people who adopt a diet andexercise program together are more likely to stick with both new habits than those whotackle an individual goal by itself. "Lose it" is a good app for tracking calories,cholesterol, fat, etc. as well as exercise.

12. Set attainable goalsDo not be too ambitious with goals that cannot be qualified. Work toward smallerbenchmarks. When you reach an end goal you will change and reset to the next mark.

13. Utilize cardiac and resistance trainingMost fitness workouts should include both cardiac exercises such as walking or joggingand resistance training such as weight lifting. The balance of these two forms ofexercise will keep your heart and lungs in better condition and help prevent excessiveloss of muscle and flexibility with age. A general rule is three days of cardio and 2 daysof resistance every week.

14. Write out your fitness planA 2002 British study found that when adults were told to keep track of how much theyworked out over the next two weeks, those who were first asked to formulate a plan onexactly when and where they would exercise were more likely to exercise at least oncea week—91%, versus just 38% of those who hadn't planned ahead. Having a scheduleand figuring out the logistics ahead of time will give you fewer obstacles.

15. Develop a habit that cues your brain.The most important thing about establishing a regular routine, whether it's exercise is totruly make it a habit. This will come with time, but you can help hurry the process alongby creating daily rituals that center around your workout: cues will signal your brain thatit's time to work out—not time to make excuses.

16. Charity events can motivate youCharity fitness events—runs, walks, bike rides, even mountain climbing trips—can dodouble duty when it comes to motivation: Not only are you training for a concrete goal,but you're also doing it for a good cause. Some charity-oriented fitness programs willeven set you up with a coach and a training program, at no or little cost to you besideswhat you're required to fundraise.

17. Get into a competitive but safe programFitness competitions may sound pretty boring to some people but others need thesense of friendly competition to be motivated. Perhaps a regular 5K doesn't quite do itfor you, so sign up for something with a bit more competitive. Many competitive eventsaren't even timed, and they welcome runners and walkers of all ages and fitness levels.

18. Plan a (fitness-focused) vacationCombining a vacation with exercise can be rewarding. Spending time with family whilehiking, biking, or canoeing can create lasting memories and strengthen both thephysical body and family ties. Yu can also blend with saints from other places. Gobiking in Holland or hiking in Germany and canoeing in Arkansas.

19. Go to sleep earlierIf you're going to start getting up earlier (see tip No. 1), it's important to make sureyou're still getting enough sleep. Most of us need seven to eight hours of sleep.

Research has shown that working out during the day can help you fall asleep faster andsleep better, overall, so your new exercise habit may actually make this easier. To makea permanent change in your sleeping patterns, begin shifting your bedtime up 15minutes every night and setting your alarm for 15 minutes earlier, until you've reachedyour goal times.

20. Rise in the morning earlierSet your alarm and lay out everything you need for your morning workout . Switch on alamp as soon as your alarm goes off. Working out at the same time every day may helpyou improve more quickly, a study from the University of North Texas found, and otherresearch has shown that people who exercise in the morning are more likely to stickwith their workout than those who exercise later in the day. Do not use the snoozebutton: Research suggests that those extra few minutes in bed may actually make youmore tired.

Recommended App for Physical Fitness Program

7 MINUTE WORKOUTThis recommendation is from a program that is scientifically based and hasflexibility and intensity for all levels of fitness and age groups.

The app is available, free and reputable. It is called the 7 Minute Workout and issponsored by Johnson and Johnson.Go to the App Store and look for The Official 7 Minute Workout.

The beginner workout is the best place to start. The warm up and cool downsections are also important to reduce injury and add flexibility to the fitnessbenefit.

Basic Exercises (30 seconds each with 10 sec rest intervals)1.2.3.4.5.6.7.8.9.

Jumping Jacks or Jump ropeWall sitPush upAbdominal crunchStep up or stairsSquatsTriceps dipPlankHigh knees

10. Lunge11. Push up with rotation12. Side Plank

• This work out can be done in 7-10 minutes. If you repeat the routine and add the cooldown and stretching it will be a thirty minute time commitment. This kind of workout issuperior to jogging or treadmill because it will not only give you a cardio workout butwill strengthen muscles and increase flexibility and balance.

••

•

The workout should be done most days each week.There a many alternative exercises with more or less demand. These are in the app.You may progress at your own pace. The key is in consistency and commitment.Additional cardio workout is good if you have time and you do not have limitingorthopedic problems. Cardiac workout greater than 40 minutes may be consideredsupplemental and can assist in increasing cardiopulmonary fitness and in weight lossprograms.

Section 3 - Immunization and Preventative Care

Immunizations:• You should receive a flu vaccine every year.

• Your doctor may recommend other vaccinations if you have certain medicalconditions, such as diabetes.• You should have a tetanus-diphtheria booster vaccination every 10 years. If you

have not received a tetanus-diphtheria and acellular pertussis (Tdap) vaccine asone of your tetanus-diphtheria vaccines, you should have it once.

• You may get a shingles or herpes zoster vaccination once after age 60.•

Osteoporosis screening:All men ages 50 to 70 with risk factors for osteoporosis should discuss screening withtheir doctor.

Preventive health visit every 2 years until age 50, and then once a year, should include:Checking height and weightScreening for alcohol and tobacco useScreening for depressionRoutine diagnostic tests are not recommended.

Prostate cancer screening:Most men age 50 or older should discuss screening for prostate cancer with their healthcare provider. African-American men and those with a family history of prostate cancershould discuss screening at age 45.

During screening, a PSA blood test is done.

Section 4 - Nutrition for Aging Adults

This web site from the National Institute of Health is a very inclusive and reasonableapproach to good nutrition.

http://www.nia.nih.gov/health/publication/healthy-eating-after-50

Vitamin SupplementationTo be added

Section 5 - Sleep and Sleep Hygiene

How much Sleep Do I Need?

Age-related Recommended Amount of SleepNewborns

16 – 18 hours a dayPreschool-aged11 – 12 hours a daySchool-agedAt least 10 hours a dayTeens9 – 10 hours a dayAdults (including the elderly)7 – 8 hours a day

Sleep needs change with age. Below are sleep guidelines from the National Heart,Lung, and Blood Institute, although there is no “magic number” as individual sleepneeds vary.

Referenceshttp://www.nhlbi.nih.gov/health/health-topics/topics/sdd/howmuch.html

Sleep Hygiene

Poor sleep habits (referred to as poor sleep hygiene) are among the most commonproblems encountered in our society. Below are some essentials of good sleep habits.While many of these points seem like common sense, they are often ignored.

Personal Habits:Keep a regular fixed sleep schedule – The body “gets used” to falling a sleep at acertain time, but only if the schedule is fixed. Have the same bedtime and wake timeevery day.

Avoid naps during the day – Many people are sleepy by the late afternoon and takenaps during this time. Naps are generally not a bad thing to do, provide you limit the napto no more than 30-45 minutes and can sleep well at night. However, in the context ofinsomnia, it is recommended to avoid napping to facilitate sleepiness at night.

Avoid television or computer use before bedtime – Television and computer usage areengaging mediums and do stimulate brain activity which generally delay falling asleep. Itis recommended that television not be in the bedroom. Before bedtime, television andcomputer usage should be avoided.

Avoid alcohol 4-6 hours before bedtime – While alcohol has an immediate sleep-inducing effect, a few hours later as the blood alcohol levels drop, there is a stimulant/

wake-up effect. There are also a number of additional health risks associated withalcohol.

Avoid caffeine 4-6 hours before bedtime – Caffeine is a stimulant. Avoid caffeinatedbeverages such as coffee, tea, and sodas, as well as chocolate. Also avoid so-calledenergy drinks.

Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime – These affect the abilityto stay asleep.

Exercise regularly, but not immediately before bedtime – Regular exercise can helpdeepen sleep. In addition to other health benefits, exercise greatly reduces inflammationin the body. Although there is little evidence that vigorous exercise immediately beforebedtime may adversely affect sleep. If one suffers from insomnia, try avoiding strenuousexercise within 2 hours before bedtime.

Sleep EnvironmentUse comfortable bed/bedding – This may be obvious, but can prevent goodsleep.

Find a comfortable temperature – A cool temperature is often more conducive forsleep, but too cold or too hot can keep you awake.

Block out ambient light – Eliminate as much light as possible. If people night shiftworkers and must sleep during the day, bedroom windows must be blacked outand a rolled out towel might be used to block light from under the bedroom doorto eliminate ambient light.

Block out distracting noise – Although obvious, some may need to use earplugsor devices that provide “white noise.”

Reserve the bed for sleep – Do not use the bed as an office, workroom, orrecreation room. The body must be trained to know that the bed is associatedwith sleeping. If unable to sleep within 15-20 minutes, do not remain in bed“trying to get to sleep.” Get out of bed, leave the bedroom, read, have a lightsnack, or do some quiet activity. You may find that you can get back to sleep 20minutes or so later. Do not engage in challenging activity, office work, housework,etc. Do not watch television.

Getting Ready for BedTry a light snack before bed.Practice relaxation techniques before bed.Establish a pre-sleep ritual.

Do not take your worries to bed.Get into your favorite sleeping position.

Other FactorsMedical conditions – Conditions like diabetes, obstructive sleep apnea, arthritis,headaches, acid reflux, and many others can hinder sleep.Psychological problems – Depression, anxiety, stress, and other psychologicalconditions can hinder sleep.

Medications – Many medications can interrupt or hinder sleep.For any of the above, you may want to consult with a qualified physician.To help facilitate sleep, a physician may prescribe sleep medications for short-term relief.

ReferencesSleep Hygiene. University of Maryland Medical Center, 31 July 2013. <umm.edu/programs/sleep/patients/sleep-hygiene>

Section 6 - Travel Habits: Jet Lag, Airplanes, Meals, and Sleep

Travel and Jet Lag

Symptoms of Jet-Lag• fatigue• insomnia• loss of appetite• disorientation• reduced concentration• reduced aerobic fitness• reduced anaerobic fitness• nausea

• GI distress• joint swelling and stiffness• muscle pain and stiffness

Jet lag originates in the nerve cells of the hypothalamus, the region of our brain thatregulates temperature, sleep, circadian rhythms, appetite, and hunger.This part of the brain evolved long before air travel and it responds slowly to changes inexternal time and light levels.

Scientists estimate that it’ll take you one full day to recover for every hour of timedifference. So, if you travel from London, UK to New York, USA, expect about five daysuntil you feel right.Interestingly, the direction you travel can affect the severity of your jet lag symptoms.Traveling east is more difficult on the body than traveling west. It seems to be easier forour bodies to delay our internal clocks than to speed them up.

A 1994 New Zealand survey of international flight attendants found that while they wereused to long-haul travel

90 percent suffered from tiredness over the first five days of arrival;94 percent experienced a lack of energy and motivation;93 percent reported broken sleep; and70 percent had ear, nose or throat problems.

Set your expectations.

Accept the fact that if you’re crossing several time zones, it will play a role in your travelno matter what you do, so plan accordingly.Realize that you may not be at your best for a few days following a long trip, especially ifyou flew east. Set your expectations appropriately.

Nutrition

In 2002, researchers put fasting to the test with 186 National Guard personnel deployedacross nine time zones. In particular, they tested the Argonne diet protocol (see below)for its effects on jet lag symptoms.

95 participants used the diet in preparation for their deployment, and 39 used it inpreparation for their return. The rest just followed their regular routine.Upon deployment, those who followed the Argonne fasting diet were 7.5 times lesslikely to experience jet lag upon arrival. Of the 39 who followed the protocol upon theirreturn, they were 16.2 times less likely to experience jet lag symptoms!The protocol adopted by this study is a little intense, and can require alternate feastingand fasting for up to four days before travel, which isn’t necessarily feasible foreveryone.

But Dr. Clifford Saper created a simplified version, which PN’s own Dr. John Berardi hasfollowed several times when he has to fly across multiple time zones in order to givepresentations.

Modified Argonne Diet Protocol

On your day of travel, eat a normal breakfast and normal lunch. Then fast immediatelybefore and especially during the flight, while drinking plenty of water to stay hydrated.Upon arrival, eat soon after landing, as close to local meal time as possible. Theninitiate a normal meal schedule based on local time. Fasting should last at least 14hours but can last as long as 24 hours. You may need to adjust actual meal timesbased on your flight time.

Exercise

Along with carefully timed food intake, exercise can also affect our circadian rhythms.And when used appropriately, exercise can help to alleviate the symptoms of jet lag.The best kind of exercise is any kind that you can do outdoors during daylight hours.Light is the most powerful regulator of our internal biological clocks, so we can use lightcues to help minimize jet lag. Bright light tells the body it’s time to be awake, especiallywhen combined with movement.Try to train at the same time you train at home. Interestingly, training at the same timeevery day may have little effect on the brain’s biological clock. The main benefit seemsto be that it helps our muscles and peripheral tissues synchronize with the new timezone.

Supplementation for Jet Lag Correction and PreventionMelatonin

Melatonin is a hormone secreted by the pineal gland in the brain. One of melatonin’skey jobs is controlling the body’s circadian rhythm — the internal clock that plays animportant role in when we fall asleep and when we wake up.

Melatonin release is tied to the amount of light you experience. Light suppresses itsrelease. When it gets dark at night and we turn out the lights, melatonin release isstimulated.Crossing time zones, we may suddenly find ourselves exposed to excessive light whenordinarily, it would be our bedtime. Even a three-hour time difference can be significant.When this happens, our melatonin cycles become disrupted and we experience jet laguntil our circadian rhythms adjust to the new environment.

Research suggests that taking melatonin before leaving for a trip makes jet lagsymptoms even worse. So wait until you land in the new time zone to supplement; thiswill significantly reduce jet lag symptoms, improve sleep quality, and increase alertnessand recovery.Since we know that both light exposure and melatonin supplementation can be used toshift the human circadian clock, you might wonder what happens when the twotechniques are used together.One study combined a gradually advancing sleep schedule (where each participant waswakened one hour earlier each morning for three days) with light exposure upon waking(to simulate morning light in a new time zone),along with afternoon melatonin (or aplacebo, for those in a control group).The result? A gradually advancing sleep schedule, morning light exposure, and placebocaused a 1.7 hour per day shift in participants’ circadian rhythms.But when melatonin was added to the regime, participants gained a full hour per day incircadian adjustment, up to ~2.6 hours per day.Of note, 3 mg of melatonin was no more effective than 0.5 mg of melatonin. In otherwords, a very small amount of melatonin could have powerful effects.Dosage: take from 0.5 mg up to 5 mg of melatonin for three nights (or until adjusted);one hour before a normal bedtime; and only after you’ve reached your traveldestination.

Pycnogenol

Pycnogenol is another supplement that has been studied for its ability to decrease jetlag symptoms.When participants took 50 mg of pycnogenol three times per day for seven days,starting two days prior to travel, the average duration of jet lag symptoms decreasedsignificantly.A control group suffered for 39.8 hours, while those who supplemented with pycnogenolendured their symptoms for only 18.2 hours.Why? Perhaps because pycogenol significantly reduced cerebral edema or swelling, aswell as edema of the limbs.As a result, those who supplemented with pycnogenol had fewer short- term memoryproblems, fewer problems with cardiac function and blood pressure, and also reportedfar less fatigueInterestingly, pycnogenol supplementation has also been shown to decrease deep veinthrombosis and superficial vein thrombosis – common side effects of long flights.

ConclusionLight. Get bright light during your day. You can use an artificial light box if you own one,or better yet, you can get outdoors. At minimum, you can sit near a window.

Fasting.If you choose to fast, start about 14-24 hours before your next planned meal inyour new time zone.

Melatonin 0.5 mg one hour before sleep after arriving at the destination.Pycnogenol 50mg three times a day, starting two days before your trip.Continue taking50 mg of pycnogenol three times per day for up to five days after landing (up to a totalof seven days).

Exercise. Higher intensity workout before your flight to burn some calories and preventtravel stress. If possible, do this at your usual workout time. Even a few brisk lapsaround the airport before boarding will work just fine.Try to exercise outdoors at yourusual workout time. If you prefer to lift weights, you can always lift weights at your usualtime, but try to follow up with a walk outside to get the best of both worlds.Hydration. Stay well hydrated and continue your fast.Move during the flight. If possible, get up and move about the cabin often, at least onceevery hour to promote blood flow and inhibit swelling.Avoid alcohol and caffeine because these may affect your circadian rhythms.

Section 7 - Prescription Medications and Supplements (Herbals)Greg DownsPrescription Medications

All normal prescribed medications should be planned ahead of time oftravel. This should included:Enough medications in the event of airline disconnect or extended stay atlocations that you may not have access to these medicationsUnless there is an unusually large number of medications that you are takingdaily, it would be good to keep them with you as your carry on luggage and notpotentially lost or delayed with your checked in baggage.You should try to keep on a normal 24-hour cycle with you medications thatrequire this (for example, Blood Pressure medicines, blood thinners etc). Shouldyou miss a dose (forgot to take, gastrointestinal issues), do not double up on thenext dose.If possible, purchase a weekly pill container. This way during your stay, you willnot have to remember if you took a medication,or at what time. The container willshow you. These can be purchased inexpensively at Walgreens or CVS.However, it is still a good idea to carry you original medication bottles with you assome customs agents may want to see the pills and prescribing information.

Non-prescription Medications/herbalsCarry non-prescription medications for travel such as:

Anti-gas strips (more light weight than Tums) or acid blockers (Pepcid)Anti-diarrheal pills such as Imodium (Follow instructions carefully)Acetameniphen (Tylenol), Enteric-coated AspirinThroat lozenges

Antihistamine such as ZyrtecIf you develop diarrhea related to contaminated food or water, please seekmedical help before taking anti-diarrheal pills.If you have head or nasal congestion before a flight use a nasal decongestantlike Afrin before the cabin doors and shut and prior to the initial decent into anarea. This will equalize congestion between the nose and the ear canal.CAUTION. For those with elevated blood pressure whether on medications ornot, should use these medication sparingly because this kind of medication canraise blood pressure precipitously.Most herbal medications are relatively safe. However, limit the use herbalmedicine to those with well established benefits. Use caution when taking herbalmedicine during travel. If medical assistance is needed please make allmedication including herbals known to the medical providers.

Section 8 - Weight loss and Weight Maintenance - David Vinson

Section 9 - Avoiding Unnecessary Risk, Injury Prevention, and EmergencyPreparedness when Traveling - David Cuthberson

Section 10 - Medical Insurance and Travel Insurance -