chapter 8

EXERCISE

I have to exercise in the morning before my brain figures out what I’m doing.

—Marsha Doble

In the course of writing this book, I interviewed dozens of practitioners—doctors, naturopaths, holistic health practitioners, and hormone researchers—and almost every single expert said that there is one important thing that women can do to feel and look better through perimenopause and beyond: move our bodies.

It may sound simplistic, but there is a great deal of evidence that physical exercise—that includes everything from basic movement to walking to yoga—can help with both the physical and mental symptoms associated with hormonal changes.

Dr. Jocelyne Eberstein emphasizes that it’s important that we move the body every day,

even if just a few minutes a day. Everybody has fifteen minutes for a walk, just to get the lungs moving, your breathing going, and allow your nervous system to discharge. Then there’s a coherence in the body.

Gynecologist and menopause expert Risa Kagan, MD, says that women between forty-five and fifty-five often exercise less and eat in a different way, due to lifestyle, aging, kids, career, and so on.

It gets harder and harder as you get older, so women need to move. Exercise is essential for feeling good, for bone strength, and for balance. We need some form of exercise every day.

Besides generally improving quality of life, research has shown that exercise can benefit perimenopausal/menopausal/hypothyroid women in a number of specific ways:

• Reduced number, intensity, or duration of hot flashes and night sweats
• Improved mood
• Less depression
• Reduced anxiety
• Better sex drive
• Better sleep
• More energy, less fatigue
• Weight control, less weight gain
• Help in redistributing weight that is shifting due to hormones
• Fewer body aches
• Better bone density
• Better heart health

Ob-gyn and hormone expert Dr. Jan Shifren says that exercise is one of the most important things that women can do. “It’s clear: women who exercise are physically and psychologically healthier,” she says. In studies that compared exercise and hormone therapy for menopausal symptoms, while the symptoms were reduced by both approaches, the quality of life was improved only for women who exercised.

If you are athletic and already have an exercise program in place, then you’ve already laid the foundation for a healthier, happier hormonal change. Whatever exercise you’re doing, make sure that it is meeting three key criteria:

• Are you getting enough exercise?
• Does your exercise program build muscle?
• Does your exercise program improve lymphatic function?

Let’s take a look at these key issues.

First, as far as the amount of exercise is concerned, you probably need more exercise than you think. Keep in mind that experts are now saying that to maintain weight, we need 150 minutes of exercise per week, but to lose weight, we need an estimated 275 minutes each week. That’s four and a half hours each week, optimally spread out over five or more days.

Second, in terms of building muscle, with metabolism slowing each year during perimenopause and beyond (and an underactive thyroid slowing the metabolism even further), a key to preventing weight gain is muscle-building exercise. Muscle is metabolically active, a fancy way of saying that muscle burns more calories than fat. So let’s say you compared two friends, both of them 150-pound women. If one of these women has 20 percent body fat, and the other has 28 percent body fat, compared with her friend, the woman with less fat can actually eat more calories without gaining weight. (Or, if they are trying to lose weight, the woman with less fat and more muscle won’t need to cut quite as many calories, or exercise as much as her friend, to achieve weight loss.)

Third, exercise should help improve lymphatic function. Your lymphatic system’s purpose is to absorb excess fluid, fat, toxins, and waste products, filter them out, and return the filtered liquid (known as lymph) to the bloodstream. The body’s lymph vessels—which are like blood vessels in a way—are found throughout the body. So, in many ways, the lymphatic system is like the circulatory system, but with one key difference. The circulatory system has a pump—the heart—to move fluid. The lymphatic system has no pump; the only way lymph fluid is moved through its vessels is through movement, massage, and deep breathing. Some of the best ways to move lymph are activities that involve muscle contraction and deep breathing, including skipping, running, trampolining, rebounding (on a mini trampoline), and an exercise approach known as T-Tapp that I’ll discuss a bit later in this chapter.

According to naturopathic doctor, nutritionist, and weight loss expert Ann Louise Gittleman, proper lymphatic function is critical, because if the liver can be viewed as the body’s filter, lymph channels are the body’s drainage system. Says Gittleman:

The lymphatic system needs a better press agent, because, despite its crucial importance, many women aren’t aware of it. Healthy lymph is pumped, and what pumps the lymph is exercise. This is one way that we know nature intended us to be active, because the lymphatic system only works when we are moving. It’s not involuntary, like our heart pumping blood. But Mother Nature didn’t count on eighty-hour work weeks and sedentary jobs at desks.

When we don’t move, the lymphatic system is unable to operate, and it can get clogged, backed up, and sluggish. This, says Gittleman, causes us to bloat and swell; tissues can become waterlogged, even adding as much as five to fifteen pounds of extra water weight that is hard to shed. It can also make your immune system less effective and worsen fatigue. According to Gittleman, poor lymphatic function also translates into poor absorption, because if tissues are already full of liquid, they are unable to properly absorb nutrients.

Besides a lack of movement, other things that can negatively affect lymphatic function are poor posture, tight clothes, and sitting for long periods.

Choosing Your Exercise

The type of exercise or physical activity you get is less important than making sure you build it into your life on a regular basis. And that, for many of us who are not athletic or naturally drawn to exercise, is the challenge. Some of the things that can help you make exercise a regular part of your life:

• Exercise with a friend.
• Join a gym or health club.
• Exercise earlier in the day.
• Schedule your exercise on your calendar or personal digital assistant (PDA).
• Take advantage of gyms at your workplace: schedule early morning, lunch, or after-work workouts.
• Free up time by watching one less TV program, and use that time for exercise.
• Entertain yourself: listen to audiobooks or watch TV or movies while exercising. (Some people even tell themselves they can only listen/watch when they’re working out.)
• Sneak activity into your day: park farther away, take the stairs, go for a walk at lunch, do housework and yard work, play with children, get a dog, clean vigorously.
• Don’t use thyroid problems as an excuse not to exercise, unless your doctor has told you specifically that you can’t.

As for exercise, the key is consistency. You have to find something that you love and that works well for you, and stick to it.

Holistic nutritionist Irma Jennings has some thoughts:

Finding the exercise program that best fits your personality is key. Personally, I am not attracted to the gym, but I use it on days of inclement weather. I love fast walking outside along the river with small hand weights. Many of my clients enjoy yoga, qi gong, Nia movement, belly dancing, dancing, swimming, water aerobics, and bike riding. Daily movement keeps the body alive, the joints lubricated, and the mind active.

If you’re not the least bit interested in an “exercise program,” then take the advice of Jacob Teitelbaum, MD, an expert on thyroid disease, metabolism, and chronic fatigue syndrome. Says Dr. Teitelbaum, “Just go outside, get sunshine, and get walking.”

According to Teitelbaum:

Walking as exercise helps support hypothalamic and autonomic function, which can help to balance sex hormones, reduce hot flashes, and improve sleep quality. And walking outdoors raises vitamin D levels. Vitamin D is not only a vitamin, but a critical hormone that is essential for immune function.

Dr. Jan Shifren agrees:

You don’t need to go to the gym, and you don’t need expensive equipment. Really, you can get out and walk a half hour a day. Add music or a friend to walk with, and you get an even better boost of well-being.

Walking is inexpensive and requires no special equipment besides a decent pair of walking shoes. Even beginners can start. We’ve all heard the success stories of people who start out walking around the block, then gradually increase the distance until they’re walking miles each day or even running a marathon.

If you’re just getting into walking for fitness, you might want to follow a simple walking schedule, with five walking sessions each week, as follows:

• Week 1: start with fifteen-minute walks that include five minutes of slow walking, five minutes of brisker walking, and five minutes of slow walking.
• Week 2: add two minutes of brisk walking in the middle, for a total of seventeen minutes of walking.
• Week 3: add two minutes of brisk walking in the middle, for a total of nineteen minutes of walking.
• By adding only two minutes a week, you’ll be taking forty-minute power walks after only twelve weeks.

Music may help you keep a good pace. With an iPod, MP3 player, or portable CD player, you can listen to your own customized play-lists of energizing music. You may even want to try an audio walking program. Fitness expert Joanie Greggains has a terrific one-hour walking program called Pacewalk, which is available on a CD or by download from the Internet. With Joanie’s CD, after a warm-up segment, the music sets the pace, and you follow the beat for ten minutes, twenty minutes, sixty minutes or longer, based on your fitness level. A number of other audio walking programs, featuring different styles of music, are available by CD or download.

A great way to balance out walking is to add yoga. Yoga has been found to be helpful to perimenopausal women and to thyroid patients. Even eight weeks of regular yoga practice was found in some studies to reduce hot flashes, stress, and anxiety in women.

Certain yoga poses, known as inversion poses, can be especially helpful. Says holistic practitioner Dr. Jocelyne Eberstein: “I recommend inversion poses, because they give blood to the thyroid area to help regenerate the thyroid. Inversion poses also help increase serotonin and aid in digestion.”

You don’t have to be a yogi doing headstands, however. “Even propping your legs up on the wall is enough,” says Eberstein.

My Favorite Exercise Program: T-Tapp

I’ll be honest: I’m not the least bit athletic, and I have little skill when it comes to exercise. But as a writer, I’m chained to my desk too many hours a day, my back frequently gets creaky and stiff, and as a thyroid patient, my metabolism isn’t optimal, so I absolutely need to exercise. For about four years straight, I had been doing Pilates—not especially well but regularly—thanks to a trainer who came to my home and worked out with my best friend and me. For me, the convenience of having the trainer at my house, plus the social incentive of working out with my friend—and the fun of a meal and chatting afterwards—was the motivation I needed to stay with the program. Pilates helped my energy a bit and kept my legs and arms toned, but the main physical benefit was that it kept me flexible and free of back pain. It didn’t really do much in terms of slimming or changing my body shape. But my trainer moved away, my friend started exercising with her husband, and I was cast adrift, in search of a new exercise program.

This was not an easy prospect. There was a hilarious attempt at dance aerobics. (I’m one of those utterly uncoordinated people who trip over their own feet when the instructor calls “Grapevine! Grapevine!”) And you don’t even want to hear about my experiences with step aerobics and “hot” yoga.

So when I kept getting e-mails from readers telling me about T-Tapp, I was interested. The readers were sharing their stories about being hypothyroid and trying to lose weight and tone up. Nothing had been working until they started doing this program called T-Tapp. (Seriously, when I first head the name, I thought it must be some sort of tap dancing exercise program.)

One reader, Denise, wrote:

I have been diagnosed as hypothyroid for a number of years, but have never felt normal and have continued to gain weight until I don’t know who that is in the mirror. Over the last three months I have worked out an hour a day, T-Tapping. It is a fabulous workout. I forced myself to do it because I had become nothing but flab and had no energy. I was desperate to find a way to build some muscle, hoping it would help to reduce the fat. In three months, I have actually lost ten inches. The T-Tapp team is great and very encouraging. I was told to do the routine less often for a better result (!), and it works. Amazing!

After receiving a number of similar e-mails, I decided I had to find out more. I learned that T-Tapp was created by exercise physiologist and rehabilitative fitness specialist Teresa Tapp; hence the name. There was no tap dancing at all; instead, T-Tapp was a series of unique movements designed to improve spinal alignment, flexibility, and strength, as well as to build muscle, improve lymphatic function, raise metabolism, and control glucose levels. Plus, T-Tapp had a built-in focus on rehabilitation. You didn’t need to be an athlete to get started. The program promised results.

In my own case, the first week I T-Tapped, I did the routine, which is easy to follow, three times, about forty minutes each session. I lost twelve inches in that first week alone, with three inches of it at my waist. It wasn’t hard to convince me to keep T-Tapping. (Needless to say, after that first week’s loss, I’m not losing twelve inches a week, but as long as I do my T-Tapp workout several times a week, I’m making progress.) Meanwhile, everything is firming up, I wake up without aches and pains, and my body is far more flexible. Going up and down the stairs, my legs feel lighter, stronger.

I didn’t understand how even a week of T-Tapp, compared with months of Pilates, could have such an immediate effect on my body in terms of inches lost. Teresa Tapp explained it:

While T-Tapp has some elements similar to Pilates and even yoga, I specifically designed the sequence of exercises in T-Tapp to provide a comprehensively nonimpact, aerobic conditioning workout that activates muscles at various points, for maximum effectiveness. But with T-Tapp, your muscles don’t bulk up. My approach helps you develop longer, leaner, denser muscles, and these muscles act like girdles to support and cinch in key areas.

An additional benefit of T-Tapp is that Teresa Tapp designed it to specifically optimize lymphatic function. According to Tapp, T-Tapp is not only isotonic (like most exercise) and neurokinetic, or communicating mind to muscle (like Pilates and yoga), but

with T-Tapp I add leverage isometrics. These are acupressure points to intensify the mind-to-muscle nerve transmission, which optimizes isometric activation. Using small added components—even something as simple as changing the position of your thumb, or keeping your knee to your little toe—activates muscles better than if you are just thinking about it.

T-Tapp features a variety of workouts, including exercises you can do lying on the floor, seated in a chair, using a broom for balance, and walking, as well as a number of routines and approaches. I particularly like the availability of the T-Tapp More program, which is, as Tapp describes it, for people with more to lose, more physical limitations/injuries/health issues, or more candles on the cake. If you haven’t been working out regularly, T-Tapp More is a wonderful way to ease into exercising and enjoy results. And you don’t end up flat on your back for two days, exhausted, after doing a workout.

If you don’t have an exercise program that you regularly follow, I would encourage you to find out more about T-Tapp and adopt it as your program. Even if you participate in regular exercise, adding T-Tapp to your exercise regimen can help improve your overall fitness and the results you get from your workouts.

Mindful Movement for Menopause Management by T-Tapp

For several decades, Teresa Tapp has worked with perimenopausal and menopause patients, as well as women with a slowed metabolism due to thyroid problems, so she knows what works for us. I was thrilled when Teresa offered to develop the following special sequence of T-Tapp exercises to help us with hormonal balancing, blood sugar management, and toning of key areas.

In addition to this wonderful program Teresa Tapp has created and I’ve featured here in the book, Teresa has developed a companion instructional DVD on Mindful Movement for Menopause Management. To find out more about the menopause DVD, Teresa’s best-selling book, Fit and Fabulous in 15 Minutes, and all the helpful T-Tapp exercise DVDs and products, see Appendix A and my Web site, www.menopausethyroid.com, or visit www.t-tapp.com.

A SPECIAL MESSAGE FROM TERESA TAPP: “YES, YOU CAN!”

Have you ever heard the saying “When you put your mind to it, anything is possible?” It’s true! In fact, that’s one of the reasons I say and think, Yes, You Can all the time.

Yes, You Can has always been my mantra, not only to deliver positive energy and endurance, but to help others improve their mental focus and create mindful movement. I believe optimizing mind-to-muscle transmission is one of the primary reasons why T-Tapp workouts help women rebuild metabolic function, improve hormonal balance, and sleep better. Using mindful movement during regular activity can also help your body burn more calories and control blood sugar throughout the day.

Along with burning calories and fat, the following sequence of mindful movement is designed to help your body improve mental clarity, lymphatic function, and lessen inflammation too. Sequence is important so your body can progressively develop strength and flexibility, as well as provide protection and spinal support. Each exercise works five to seven muscles, from origin to insertion, layer by layer, to cinch in your frame. This is why T-Tappers can target trim areas of concern and report dramatic inch loss.

Application of form is very important, so read all the instructions and study the photos before trying each exercise. You should feel heat radiate through your spine and all through your body as you progressively warm up. Best of all, the more neurokinetically connected your body becomes (mind to muscle), the faster you will feel this, even to the back of your hands and tops of your feet. Neurokinetic transmission is the foundation of mindful movement that empowers your muscles to increase intensity without increasing repetitions or using equipment.

Last, always perform each exercise to your best ability so you can achieve optimal results. Understanding how to move your body to maximize physiological function, in addition to calorie expenditure, is the secret to looking and feeling better. Remember, it’s not what you do but how you do it!

SOME DEFINITIONS

KLT—knees to little toe, a key T-Tapp position that involves pushing your knees out toward your little toes Lats—the latissimus dorsi muscles, the large, flat muscles on the trunk, posterior to the arm, and partly covered by the trapezius muscles (“traps”) Traps—the trapezius muscles

Photo 1

Step 1
SET-UP SEQUENCE/T-TAPP STANCE

The ability to create mindful movement starts by putting your body into alignment and activating internal muscles with the T-Tapp stance. Stand with your feet hip width apart and toes forward.

Bend your knees. Tuck your butt under and press your lower back against your hand at the same time you push into your stomach with your other hand. You should feel your abdominal core muscles tighten, as well as your hip and gluteal muscles. Now lift your ribs and align your shoulders with your hips, but do not arch your back. (See Photo 1.)

Photo 2

By now you should feel every muscle activate throughout your body. Push your knees out toward your little toes. (See Photo 2.) In addition to feeling increased muscle activation on the outside of your hip and thighs, you should feel deep lower abdominal activation (transverse abdominus).

Proceed to step 2.

Photo 3

Step 2
WARM-UP SHOULDERS WITH TRAP/LAT STRETCHES

Inhale deeply and lift your shoulders up as high as you can with your arms straight down, palms forward, and fingers stretching wide (counts 1 to 4). (See Photo 3.) Then exhale deeply while your hands reach down close to the sides of your body with fingers folded and thumbs pointing back (counts 5 to 8). Repeat for a total of four sets, eight counts each.

Proceed to step 3.

Step 3
WARM-UP SPINE WITH PROGRESSIVE TUCK, CURL, AND SCOOP

Push your hands into your knees with your thumb on the inside and fingers on the outside of each knee. While pushing, tuck your butt under and curl your back until your arms are straight. Inhale deeply during the curl (counts 1 to 4) and exhale as you reverse, scooping out your spine and arching your butt up (counts 5 to 8).

Repeat, but this time reach your shoulders up toward your ears during the tuck/curl aand stretch your chin up on when you scoop.

Repeat two more tuck, curl, and scoops but with the following variation:

Photo 4

Tuck/curl with shoulders up (counts 1 and 2) and pull your shoulders back without bending your arms (counts 3 and 4). (See Photo 4.)

Then lift your shoulders up without bending your arms (counts 5 and 6) and scoop (counts 7 and 8).

Form check. Push thumbs and squeeze hands into your thighs to increase neurokinetic flow (mind-to-muscle transmission) during curls and aim your elbows forward during scoops. Keep your knees bent in KLT at all times with weight off the ball joint of your big toe.

Proceed to step 4.

Photo 5

Step 4
TUCK, REACH, AND CURL SPINE

Inhale, tuck, and curl one more time without reaching shoulders up (counts 1 to 4), but flip your palms forward and tuck your butt under at the same time you reach down (counts 5 to 8) during exhale. Inhale again (counts 1 to 4), but this time during exhale, tuck and reach your arms forward (counts 5 to 8). Hold this position and inhale again (counts 1 to 3), then tuck and use your lats to pull your shoulders back (count 4) and continue to exhale as you roll your spine up one vertebra at a time (counts 5 to 8). (See Photo 5.)

Form check. Drag your little finger along the outside of your thighs, but bend your elbows and lift your ribs before you lift your chin. Keep your knees bent and pushing out at all times (KLT).

Proceed to step 5.

Step 5
TRAP/LAT SHOULDER ROLLS

 

Inhale as you reach your shoulders up (count 1), back (count 2), and down (count 3, hold 4) for a total of four sets, four counts each. (See Photo 6.)

 

Form check. Maintain lat activation and keep your hands below your waist or hips during the shoulder roll. Keep your thumbs turned back as far as you can and really reach up to release tension in your traps.

 

Most common mistake. Overreaching down can create imbalanced muscle activation in your shoulders, especially the traps.

Photo 6

Proceed to step 6.

Step 6
SPINE ROLL-UP WITH TOWEL

Resume T-Tapp stance (bend it, tuck it, ribs up, knees out). Hold a towel with your palms up and thumbs away. Your wrists should be aligned with your shoulders. Inhale (counts 1 to 4), then during exhale, pull towel tight (counts 5 to 8).You should feel your ribs lift up, your shoulders pull back, and all the muscles in your back tighten. I call this leverage isometric muscle activation. Keep pulling on the towel while you curl down. Then inhale deep until you feel your back muscles stretch (counts 1 to 4), and exhale all the way until you feel your ribs pull together (counts 5 to 8). (See Photo 7.)

Form check. Keep your head relaxed and your knees bent and pushing out (KLT) at all times.

Photo 7

Inhale (counts 1 to 4) with your shoulders reaching up and maintain this position while you exhale (counts 5 to 8). Inhale again with your shoulders up (counts 1 to 4), butt tuck/curl, and bring your shoulders back down during exhale (counts 5 to 8). Inhale again (counts 1 to 4), but this time, tuck and reach out during exhale (counts 5 to 8). Inhale again while reaching (counts 1 to 4), but tuck and curl until the towel touches above your knees during exhale (counts 5 to 8). Keep tucking, curling, and pulling the towel while you curl up one vertebra at a time. Finish with four shoulder rolls reaching shoulders up (counts 1 and 2), back (count 3), and down (count 4).

Form check. Never release or relax towel. Keep it tight.

Drop towel, kick the legs several times to shake them out, and take a water break.

Proceed to step 7.

Photo 8

Step 7
PLIÉ SQUAT–ARMS UP

Starting position: place your feet shoulder width apart, with your toes turned out at a thirty-degree angle or less. Bend your knees, tuck your butt under to press your lower back flat, lift your ribs to activate your lats, and push your knees out until you feel your weight shift off the ball joint of your big toe. Your shoulders should be in alignment with or inside your heels and back in alignment with your hips. Now extend your arms out with your wrists, elbows, and shoulders in alignment. (See Photo 8.) Your palms should be up with your thumbs pointing back to your best ability. Your hands should be reaching out with the elbows locked.

Inhale deeply (counts 1 to 4) and exhale deeply (counts 5 to 8) with your arms extended two times.

Tuck a little bit more and bend your knees deeper as you extend your arms straight up (counts 1 and 2). Now reach your hands up and out until your arms are level with your shoulders with palms up and thumbs back (counts 3 and 4).

Repeat for a total of four sets, four counts each.

Proceed to step 8 without stopping.

Step 8
PLIÉ SQUAT–ARMS DOWN

Inhale again (counts 1 to 4) with your arms extended, then exhale while you lower them down (counts 5 to 8). Repeat.

Form check. Focus to keep your ribs up when your arms lower down and extend your hands out and up when you lift your arms to shoulder level (it should feel as if you are lifting something heavy).

Keep your arms at shoulder level. Inhale/exhale. Then repeat the same sequence with two counts at each position for a total of four sets, four counts each.

Photo 9

Lower arms (counts 1 and 2), and lift/extend your arms up (counts 3 and 4). (See Photo 9.)

Form check. Maintain the lower body position with knees out, shoulders back, and lower back flat (no arch) at all times.

Proceed to step 9 without stopping.

Photo 10

Step 9
PLIÉ SQUAT–FLIP SEQUENCE

Inhale (counts 1 to 4) and exhale (counts 5 to 8) with your arms extended, palms up, and thumbs back once before starting. (See Photo 10.)

Tuck and bend your knees deeper as you extend your arms straight up (counts 1 and 2), then lift your ribs and flip your palms down as you lower your arms to shoulder level in one count (count 3, hold count 4). Tuck and lift your ribs a little more as you lower your arms down in one count with palms facing inward (count 5, hold 6). Then lift your arms up to your shoulders (count 7) and flip your palms up (count 8). Repeat for a total of four sets, eight counts each.

Without stopping, repeat again, but with quick arm movement: arms up (counts 1 and 2), flip down (counts 3 and 4).

Form check. Tuck and press your lower back flat every time your arms go up, and lift your ribs each time your arms move up and down. Keep elbows straight.

Kick left and right legs four times to shake them out, alternate knee lifts four times, and take a break for water.

Proceed to step 10.

Step 10
PLIÉ SQUATS–REACH PULLS

Resume plié squat stance (shoulders back, ribs up, butt tucked, lower back pressed flat, and knees out). Place your arms into a big W position with your palms facing center and your fingers stretching wide. Now push your elbows forward and pull your hands back. You should feel ribs lift and every muscle in your upper back tighten. This push/pull action will also help you maintain correct linear alignment (wrists, elbows, and shoulders) as well as maximize mind-to-muscle activation. (See Photo 11.)

Photo 11

Inhale deeply and while you tuck, bend, and push your knees out more, extend your arms straight up (counts 1 to 4). Then, while exhaling, pull your arms back down into the W position with elbows forward and hands back in alignment with your shoulders (counts 5 to 8). Repeat.

Repeat again, but this time hold two counts in each position for a total of four sets, four counts each.

Proceed to step 11 without stopping.

Photo 12

Step 11
PLIÉ SQUATS–LATERAL PULLS

While maintaining the plié squat position, extend your arms at shoulder level with palms up and fingers wide. Make sure that your wrist is in alignment with your shoulder and behind your ear. Inhale first (counts 1 to 4) while your arms are extended. Then, while exhaling, pull your elbows down to the sides of your body with your elbows pushing forward and your hands pulling back (counts 5 to 8). Repeat. (See Photo 12.)

Form check. Maintain alignment of your elbows and hands with your shoulders or ears while pulling into the W position, and exhale deep while you pull your ribs in.

Inhale again as you extend your arms back out in alignment with your shoulders (counts 1 and 2) and exhale while pulling them into the W position (counts 3 and 4) for a total of four sets, four counts each.

Proceed to step 12 without stopping.

Photo 13

Step 12
PLIÉ SQUAT–LATERAL COMBO

While maintaining the plié squat position, focus on your form and continue to do the following combo sequence: extend your arms out at shoulder level with your palms up (count 1, hold 2). Then pull your elbows down into the W position (count 3, hold 4) and extend your arms back out at shoulder level (count 5, hold 6). Lower your arms with the elbows straight and palms up (count 7, hold 8). (See Photo 13.)

Form check. Always lift your ribs up when lowering your arms and pulling into the W position.

Repeat the combo sequence for a total of four sets, eight counts each.

Proceed to step 13.

Photo 14

Step 13
REPEAT TUCK, CURL, AND SCOOP

Repeat for a total of two sets, eight counts each. (See Photo 14.)

Proceed to step 14.

Step 14
REPEAT TUCK, REACH, AND ROLL

Photo 15

Repeat step 4 (Tuck, Reach, and Curl Spine) and finish with two shoulder rolls.

Form Check. Focus on activating your lats to pull your shoulders back as you roll up one vertebra at a time and keep knees out. (See Photo 15.)

Proceed to step 15.

Photo 16

Step 15
STANDING LAT WARM-UP

While maintaining your lower body in the T-Tapp stance, extend your arms at shoulder level with hands together in the dive position. Inhale deeply (counts 1 to 4), then, while exhaling, tuck and reach straight out for three counts (counts 5 to 7). Lift your ribs and pull your shoulders back in one count (count 8). (See Photo 16.)

Form check. Keep knees out (KLT) and isolate your lower body position. Focus on upper body muscle activation, especially your lats, and keep your wrist and shoulder aligned.

Repeat, but change the count sequence as follows: reach for two counts (counts 1 and 2), pull back for two counts (counts 3 and 4). Repeat for a total of four sets, four counts each.

Proceed to step 16A without stopping.

Step 16A
OIL WELLS

Place your feet shoulder width apart with toes forward and knees bent pushing out. Assume a flat back position with your shoulders and back level with your hips and with your butt arching up toward the ceiling (not tucked). You should feel as if your back is scooping out.

Keep your butt arching up and knees pushing out as you reach/pulse for three counts between your legs with your arms straight and hands together in the dive position (counts 1 to 3). Return to a flat back position (count 4) without bending your arms. (See Photo 17A.)

Photo 17A

Form check. Use your lats to pull your shoulders back to a flat back position. Additionally, your head should stay relaxed and your hands should stay together while reaching through your legs.

Repeat for a total of four sets, four counts each.

Proceed to step 16B without stopping.

Photo 17B

Step 16B
OIL WELLS

Continue the same movement, but change the sequence to single counts. Reach (count 1) and pull back (count 2). Do four sets, two counts each, for a total of eight counts. (See Photo 17B.)

Proceed to step 17.

Photo 18

Step 17
OIL WELLS ROLL-UP

Inhale while maintaining the flat back position (counts 1 and 2). While keeping your knees out and your hands together in the dive position, reach down as you tuck your butt (counts 3 and 4), and slowly roll up one vertebra at a time (counts 5 to 8). Lift your head and your arms with bent elbows and do four arm pumps (counts 1 to 4). Finish with one big shoulder roll (counts 5 to 8). (See Photo 18.)

Form check. Keep your back muscles tight to help stabilize your shoulders when you pull your hands back above your head. It’s important to keep your butt tucked and knees out too. (See Photo 19.)

Photo 19

Take a break for water and proceed to step 18.

Photo 20A

Step 18
T-TAPP TWIST STRETCH

Resume the T-Tapp stance (toes forward, knees bent, butt tucked under, ribs up, shoulders back, and knees out in KLT). Place your right elbow up level with your shoulder or slightly higher with your wrist slightly lower. While keeping your left shoulder back in alignment with your hips, reach your left arm under your chest until your left fingertips are able to touch your right hand knuckles. It is important to lift your ribs and maintain isometric activation of your upper back and shoulder muscles at all times, especially the latissimus dorsi and traps. Not only will this accelerate results, it provides spinal support and helps offset muscle imbalance. (See Photo 20A.)

Inhale deeply and push your left knee out even more to help stabilize your hips while you exhale and push your right hand to twist and move your right elbow back as far as you can and hold four counts (counts 1 to 4). Relax and release your twist, but do not lower your right elbow or release your T-Tapp stance (counts 5 to 8). Then inhale deeper, but this time during the exhale, increase the intensity of your tuck, knees out and ribs up while you twist and look back as far as you can.

Photo 20B

Form check. Really focus to maintain alignment of your right elbow to shoulder when twisting back. Try to pull your ribs together during the exhale and never allow your right elbow to drop lower than your shoulder.

Most common mistakes. Allowing your right elbow to drop below shoulder level and not keeping your butt tucked can create unsafe conditions for your spine. Allowing your left knee to release inward or your right elbow to reach too high will inactivate many muscles and lessen the effectiveness of this exercise. (See Photo 20B.)

Repeat the twist stretch to the other side with your left elbow up for a total of two sets, eight counts each.

Proceed to step 19.

Photo 20C

Step 19
T-TAPP TWIST SEQUENCE

Twist your upper body to the right and pulse for three counts without moving your lower body. Then in one count, tuck, lift ribs, and twist quickly back to the front position (counts 1 to 4). Repeat (counts 5 to 8). (See Photo 20C.)

Reset your upper body position with the left elbow up and repeat the twist sequence to your left for a total of two sets, four counts each.

Continue doing two twisting sets per side for an overall total of four sets. Count one set as follows: Twist/pulse right (counts 1 to 3), tuck center (count 4), twist/pulse right again (counts 5 and 6), tuck center (count 7), switch arms (count 8). Repeat left. Repeat three more times for a total of four sets, eight counts each.

Form check. Keep pressing your hands together and try to maintain pressure between them during this exercise to maximize muscle activation. This will help keep your ribs up and create balanced isometric activation of your lats and oblique muscles.

Most common mistake. Having too wide a stance makes it more difficult to create full fiber activation of the muscles that attach from your lower spine to your hip. Comprehensive, compound activation of these muscles not only helps protect your spine, it also helps your body develop more core muscles with greater density so you can lose inches quicker. (See Photo 21.)

Proceed to step 20.

Photo 21

Step 20
REPEAT OIL WELLS, PART 1

Repeat two sets of step 16A (Oil Wells, Part 1), four counts each for a total of eight counts.

Inhale deeply until you feel your ribs expand and exhale deeply until your feel your ribs pull together without relaxing your shoulders forward. (See Photo 22.)

Proceed to step 21.

Photo 23

Step 21
LAT ROLL-UP

This sequence is like step 17, but with extra focus on using your shoulder and upper back muscles to initiate the roll-up. Also it’s important to keep tucking and reaching down while rolling up to maximize stretch and muscle activation of all your back muscles, especially the lats. Then finish with one big shoulder roll and take a break for water before starting step 22—Hoedowns. (See Photo 23.)

Photo 24

Step 22
HOEDOWNS–FRONT LIFT/TOUCH

Starting position: assume the T-Tapp stance, but shift your weight to your left leg. Keep your left knee bent in the KLT position, your butt tucked under, and your ribs up while you extend your hands out to the sides of your body with palms up and thumbs back. Now push your elbows forward and pull your hands back to your best ability. You should feel your shoulders pull back, your ribs lift higher, and every muscle tighten in your upper back. Inhale deeply until you feel your ribs expand, and exhale deeply until you feel your ribs pull together without relaxing your shoulders forward. Now that every muscle in your body is isometrically activated, you’re ready to start.

Lift your right knee up in alignment with your right shoulder (count 1), then tap your toes to the floor (count 2). Repeat for a total of four lifts and four taps (8 counts). (See Photo 24.)

Form check. Try not to move your upper body when lifting your knee. Keep your butt tucked and your left knee bent in KLT at all times. Also, point your toe with each lift to increase activation of the abdominal muscles.

Proceed to step 23 without stopping.

Step 23
HOEDOWNS–SIDE LIFT/TOUCH

Without stopping, lift your right knee up and out to the right side as you bring your right hand across your body to the left (count 1) and tap your toes to the floor (count 2). Repeat for a total of four lifts and taps (eight counts). (See Photo 25.)

Photo 25

Form check. Linear alignment is important during lifts and taps. In addition to aiming your knee toward your shoulder while lifting, keep your ankle in alignment with your knee. (See Photo 26A.)

Photo 26A

Photo 26B

Most common mistake. Allowing your foot to shift out of alignment while lifting your knee (front and side) creates inactivation of the abdominal muscles and lessens effectiveness. (See Photo 26B.)

Repeat front and side lift/touch sequence as follows:

Two sets of four lifts and taps (eight counts front, eight counts on right side, twice), two sets of two lifts and taps (counts 1 to 4 front, counts 5 to 8 right side, twice), and two sets of four single lifts and taps (counts 1 and 2 front, counts 3 and 4 right side, four times)—all without stopping.

While inhaling and exhaling, do one shoulder roll back and reset starting position to repeat the same sequence on the other side (two sets of four, two sets of two, and one set of four single lifts and taps with left knee).

Inhale deeply, exhale deeper, and repeat the entire sequence (right side, then left side) for a total of two sets of Hoedowns.

“YOU DID IT!”

Now take a break for water and have a great day.

A Final Note about Exercise

One word of caution: don’t go overboard with exercise. I realize that this is not a problem for many of us (myself included!), but for those of you who throw yourselves into fitness, sports, or exercise, keep in mind that overexercising can create added stress, which can cause inflammation, deplete your adrenal glands, and further aggravate your hormonal imbalances.

Acupuncturist and Chinese medicine practitioner Dr. Jocelyne Eberstein has some thoughts:

Excessive exercise stresses the adrenals, and causes inflammation. You can’t go to the gym, work out ninety minutes, and not stress your adrenals. So it’s best to divide up your exercise, allowing time to rest in between.

How will you know if you are overexercising?

• You feel fatigued to the point of needing a nap after an exercise session.
• You have excessive pain during or after exercise.
• You feel flulike symptoms after exercise.
• You are sluggish in the hours or day after exercise.
• You feel mentally exhausted in the hours or day after exercise.
• You are quick to develop aches, pains, and injuries during and after exercise and are slower to recover.

Remember that whatever exercise you choose, in your forties and beyond, it’s easier to injure your body than when you were younger. You may find that joints and muscles are not as strong or as flexible as they once were. So when you’re getting back into exercise, remember some safety tips:

• Always warm up and stretch before exercising.
• Try for moderate activity every day if possible, rather than being a “weekend warrior.”
• Take lessons, or work with a trainer, to learn the proper form and how to prevent injury.
• Balance your exercise program with a combination of cardio/aerobics, strength, and flexibility cross-training to work out the entire body and avoid injuries due to overuse.

If you just can’t bear the thought of any exercise program, then put on a pair of sneakers and, as Dr. Teitelbaum said, “Go outside, get sunshine, and get walking!”