Interview With Physical Therapist Mike Studer

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Mike Studer is a renowned physical therapist who has worked with older adults on preventing falls. He’s been an invited speaker all over the world, including a TED Talk.

We spoke to Mike to discuss fall risk, and the fear many older adults feel about their risk of falling.

First, can you tell us a little about yourself, your background and what you do?

“I’m a physical therapist and I’m a board certified neurologic clinical specialist and have been since 1995. I’ve been a PT since 1991 and I’ve been primarily interested in both matters of the brain, neurologic physical therapy, as well as the rest of the nervous system. And because of what normally comes with that, persons with stroke, Parkinson’s Disease and many other conditions, that normally gives me the opportunity to work with individuals of older age. And so I do have particular expertise in geriatrics as well.”

You’ve talked in your work about debunking myths about aging. What are some of those myths?

“So normally we go way back and we think that retirement age used to be age 65 because that used to be lifespan. We thought people, and again, when this was initially established back in the 1920s, once you were done working, you were actually supposed to be starting to move toward death. So the initial debunks that have to happen are surrounding the myths of what happens after a working life, and how people can be active and productive and traveling and athletic.

And then we start talking about, well, you can’t gain strength once you’re over whatever age you want to insert. And as a matter of fact, that has proven to be wrong. And we start talking about how you can’t gain endurance and you can’t improve your balance and all the rest of those things. And we used to think, well, you can’t make gains in all of these things. And what we weren’t recognizing is that nobody’s already at their personal best max. There’s room to be made and gains to be had. And we’ve learned so much more about performance training and physical therapy that we’ve just really been able to now prove that out in the literature that you can improve strength, power, endurance, balance, reaction, speed, and all that folds into our topic today about fear of falling.”

And those elements require an active lifestyle for older adults. Sometimes maybe that hasn’t been part of their background or part of their lifestyle. How do you get people started on an active lifestyle?

“Yeah, and I love how you phrase that too, because you didn’t say, how do you get people exercising? And there’s one of the biggest myths that we, I could have tagged on there as well is that an active lifestyle doesn’t have to mean an exercising lifestyle…

And what we understand according to the World Health Organization standards, we know that people need about 150 minutes per week. If we spread that out over seven days, you’re talking about 22 minutes on average per day of movement that is considered moderately exertional.

So the first thing we do to answer your question is we say that doesn’t have to be spent in a gym. That doesn’t have to be spent walking around a running track. It doesn’t have to be spent lifting weights. It can be raking, gardening, volunteering, building a home, pushing grandchildren on a stroller. We know that the easiest way to get people to adopt a more active lifestyle is to find things that they enjoy in their life and to be able to create higher levels of exertion within those physical activities that they already do.

The one quick example that I’ll give you is to say, alright, you’re going to be sitting down on your couch watching a couple of hours of television, well when a commercial break happens, stand up five separate times. And that’s just one easy way. We call it an exercise snack to start to find a way to become more physically active.”

When people talk about falling and the fear of falling, so much of it is based on the physical outcomes, but you talk a lot in your work about fear and the mental health part of it. Can you expand on your work in that area and how fear plays into the falling for older adults?

“Sure, absolutely. Even if an individual has never fallen before, statistics tell us that persons over 65 years old, 25% – 49% of them have a fear of falling even if they’ve never fallen before. That goes up if they have fallen. Now let’s just take that example of someone who’s fearful but hasn’t fallen. What happens with that? Well, that’s going to change how I move. Number one, I might take smaller steps. I might choose not to move, not to go to the grocery store, not to go to that party, not to go to that dinner at my grandchildrens’ place.

So I might choose to be less active. I might again move with more paucity or move more slowly. I might not choose to actually move as frequently, or I might actually start to rely on walls and furniture to get around. So all of those things that change my frequency of movement and whether I am actually choosing to move under my own power, and again, relying on somebody else or walls or furniture, those actually cause me to be less physically fit.

So once that fear has caused me to influence how I move, not moving as fast or as often now it changes how capable I truly am, my fitness, my endurance, my strength, my reaction speed because I have not been exposed to things. And now if you go up in that vicious cycle, my capabilities now influence the degree of fear that I’ve got and now I have a reason to be even more fearful because I am more weak, less well conditioned, not as adept or reactive in processing, not as tolerant of distractions, et cetera. So it’s a vicious cycle that starts with fear and then the fear becomes actualized or the prophecy fulfilled.”

So what are some first steps that someone can take if they are fearful of falling and maybe they have fallen? What are the safest ways that they can maybe start to at least start to break that cycle?

“Small wins can accumulate and human beings are very likely to see small wins if we track them. And when we track things and use numbers and we find ourselves more attracted because we’re making gains, we call that gamification…

One thing that can be done is that we could actually start to amass small wins in the number of steps that we take. This is probably one of the easiest because we see the wearables around our wrists, for example they can maybe identify that we’re taking 1100 steps per day, and just trying to see some small wins that are gamified. Now I’m up to 1300 steps per day and maybe one day per week I’m going to try to take 2000 steps…

I’ll give you one more that’s just a real easy off the shelf. Maybe you count the number of times that you go from sitting to standing per day. Now the average individual is going to take something in the neighborhood of about 60 sit-to-stand repetitions per day. If you’re under that number, maybe you set a goal to aspire to increase from where you are. Maybe you’re only taking 24 times that you stand up on a given day. Well, if you add repetitions to that, you’re adding a strength stimulus, so you’re helping your conditioning without any argument whatsoever.

So those would be easy ways that are affordable with no equipment, no copay, and no extra time.”