Ageing Focus - Make Balance a Habit!

Introduction

Last week’s post, though perhaps an amusing romp, wasn’t very responsible. I mean, why showcase my bad habits? Whose idea was that, anyway? I hope I didn’t come across as condoning any of those behaviors (though honestly, as odd as they are, you’d have to be some kind of kook to adopt them). This week I hope to provide a whole-grain, high-fiber, wholesome corrective. I’m offering up sincere and helpful advice here and I will try my best to make it amusing somehow.

Some background

My younger daughter is home for the summer and perhaps being around her vivacious youthfulness emphasizes how fricking old I’ve gotten. I guess I’ve reached the age where I worry more about my advancing decrepitude than reveling in whatever vigor I still have left. Sure, I can still make my bike go pretty fast when I dig deep, but I also dread the prospect of, say, my back going out for no good reason. (A buddy of mine, though he is still athletic and does all kinds of yoga, threw out his back putting on a sock.) I contemplate how to preserve my physical faculties over the last few decades of my life.

Strength and heart health are all well and good, but I lately I’m putting more focus on balance. Seventeen years ago I read a fascinating New Yorker article about the role balance plays in graceful ageing, and I’ve been thinking about it ever since. The article, by the doctor/professor/writer Atul Gawande, is called “The Way We Age Now.” (My friend P— and I have a running joke about Atul Gawande. P— is a doctor, and I fancy myself a writer, and we complain to each other how Gawande is a better doctor and writer than both of us, and is also better looking; we naturally assume he’s even seduced our wives at some point.) In the article Gawande describes how he tagged along with a Dr. Bludau, a geriatrician, during a routine physical exam of an 85-year-old woman:

It seemed to me that, with just a forty-minute visit, Bludau needed to triage by zeroing in on either the most potentially life-threatening problem (the possible metastasis) or the problem that bothered her the most (the back pain). But this was evidently not what he thought… The danger for her was losing what she had. The single most serious threat she faced was not the lung nodule or the back pain. It was falling. Each year, about three hundred and fifty thousand Americans fall and break a hip. Of those, forty per cent end up in a nursing home, and twenty per cent are never able to walk again. The three primary risk factors for falling are poor balance, taking more than four prescription medications, and muscle weakness. Elderly people without these risk factors have a twelve-per-cent chance of falling in a year. Those with all three risk factors have almost a hundred-per-cent chance.

What is to be done?

How do I address these three risk factors?

1. Being an athlete is a non-negotiable part of my lifestyle, because cycling is a) fun, b) something I have enough experience in that it’d be a shame not to do it, and c) my number-one way to burn off stress. Cycling addresses the strength part of my ageing, to a point. (I know that ideally I should do core exercises, join a gym, do yoga, etc. and I’m trying to muster the resolve to take those things up.)
2. In terms of prescription medications, I’m not sure how feasible it is for any of us to avoid needing them when we’re old. It’s not like we can just resolve to go without. I’m lucky enough to be blessed with low cholesterol, and my blood pressure is decent, and so far I have no risk factors for diabetes, but you just never know what I may need for this or that ailment in my codger years.
3. Balance: this is the area where I think I can make the biggest difference.

How can we improve our balance?

I’d like to think that being a cyclist automatically gives me great balance, and of course it can’t hurt, but I don’t think it’s actually enough. I learned this when I was doing physical therapy after breaking my femur. As we began my regimen, my physical therapist asked me what my goal was for the therapy. As I’ve explained in these pages, I’m not actually that into goals, but this time I had one. “I want to come out of this better than I was before,” I declared. After all, I had a gym to work in and an expert to guide me … why not dream of shoring up some of the classic deficiencies of the pure cyclist?

To start with I had to learn to walk all over again, and realized in the process just how complicated walking is. With every step, the back leg has to swing forward, the knee bent so your foot doesn’t hit the floor, and then you have to plant that foot and swing the other leg forward, and that swinging is more rhythmic when we realize. But because I didn’t trust my bad leg to bend properly, I was kind of swinging it around sideways so I could keep it straight, and thought I was doing pretty well until my physical therapist, laughing, told me to walk toward a mirror and watch myself. I looked like a drunken zombie.

After relearning how to walk, one of the toughest things I did in that gym was a toe-tapping exercise on a fairly unstable platform. It was basically a square plank of wood with a half-cylinder under it (i.e., a half-circle cross section), kind of like a teeter-totter that you stand on. I would start by standing on the plank, balancing so it wouldn’t tip forward or back. Then I’d tip the plank forward until its front edge tapped the floor, and then rock back until the plank was level again, the slower the better. I’d do this ten times, and then I’d switch to rocking back, to tap the back edge of the plank on the floor, return to level, and do that ten times. Once I mastered that with both feet, I learned how to do it standing on just one foot. Oddly, I was no better at this with my good leg than my recently healed one, but in time I went from incompetent to totally proficient, even after adding in a barbell in one hand to put me slightly off balance. I cannot tell you how stoked I was to have learned a new trick that I couldn’t have done before my accident. I actually was better than before.

So now, with Gawande’s article in mind, I want to continue that trajectory of actually improving my balance. The fun way is to ride indoors with my bike on rollers, when it’s too dark and/or wet to ride outdoors. The less fun, but logistically easier, way—and, more importantly, the way I can recommend to you, albertnet reader—is to do the PT balancing trick on a balance saucer. You can buy one of these (one manufacturer’s product name is “Wobble Balance Board”) for about $20. This is even harder that what I did in physical therapy.

The regimen

The great thing about the balance saucer is that you can do your whole routine in 5-10 minutes. (I suppose this duration will vary as you become more proficient, and based on how much you want to do.) My current regimen consists of the following exercises, in sets of 10 repetitions each:

• Standing on both feet, tap the front edge of the saucer on the floor
• Standing on both feet, tap the rear edge
• Standing on one foot, tap the front edge
• Standing on one foot, tap the rear edge
• Standing on both feet, tap the right edge
• Standing on both feet, tap the left edge

I hold a barbell in one hand, and after the first five reps I pass it to the other hand. If I feel like it, I pump the barbell in the air for extra exercise and instability. (I plan to figure out other cool things to do on this saucer, maybe even incorporating my upper body.)

Since a picture is worth a thousand words, and five movies totaling two minutes at 60 frames per second is therefore worth about 7.5 million words, here are videos showing the exercises:

(Video credit to my daughter, expertly wielding her superfly non-phone camera.)

Don’t be surprised if it takes a while to get good at this. When I started up again (over a decade after my physical therapy days), I was pretty wobbly and struggled for a while.

Make it a habit

Did you notice in that video that I wasn’t in a fancy studio with mirrors and mats, wearing PrAna yoga pants and fancy workout shoes and headphones and a fitness tracker? All you need for this is the saucer and a pair of shoes with good, grippy soles. With worn-out or loose-fitting shoes, I have a lot of trouble, and if I try to do this barefoot my feet slide off. But other than that, no special gear or preparation is required, not even a warm-up. That said, this activity is oddly strenuous given how low-impact (actually, zero-impact) it is. During winter, when I’m working from home and stuck at my desk with my blood congealing, almost like suspended animation, I like to take a break and do my balance regimen to get my blood flowing. It really warms me up.

Making this a habit is key. Initially you’ll need plenty of repetition to develop the balance needed for these exercises, and then you’ll want to maintain that consistency so that five, ten, and twenty years from now you won’t have lost the ability. It’s kind of interesting to ponder how well we could maintain this, if we do it daily … can you imagine having this kind of balance at 80? Assuming we don’t, at least we’d be declining from a pretty decent height of capability. I think that’s well worth pursuing.

Postscript

A few more notes, as I have used this thing for a couple years now:

Make sure your shoes are not only grippy enough not to slide, but are completely dry before doing your balance regimen. I started in on my routine once, months ago, when my shoes were a bit wet (though I thought I had wiped them enough on the mat). My saucer squirted out from under me and I fell, wanging my wrist. Not all saucers have the same anti-slip texture; my brother has one (from the same manufacturer as mine, but newer) that is much grippier. I will probably buy some of that sandpapery-textured tape you put on stairs and add it to my saucer. So be careful!

Not all these saucers have the same depth, so get one that is appropriate for your balance level (which may have a lot to do with your age). I recently tried my mom’s saucer and it’s far shallower than mine, which makes the exercises vastly easier (too easy in my case, but probably much better for, say, an octogenarian). Mine is four inches deep; I have seen three-inch versions and even 1.5-inch versions available online.

This article (also available in a schlockier form here if you get blocked by a paywall) suggests that a good measure of your body’s effective age is how long you can stand on one leg, especially your non-dominant one. The doctor who wrote the article cites Mayo Clinic research and concludes (as paraphrased by ChatGPT), “While balance tests offer a simple method to gauge physical aging, incorporating balance training into regular exercise routines is crucial for sustaining overall health and mobility.” Running the calculation cited in the article, I have determined that a typical person my age ought to be able to stand on his or her non-dominant leg for about 22 seconds. That seemed way low to me, so I tried it out. I stood on my left leg for a couple of minutes, no problem, and then I started to get bored so I passed the time by doing the Wordle, then added stickers to my Wordle snapshot before sending it to my daughter, and finally, after over eight minutes on one foot, I was really bored and my leg and foot were starting to hurt so I bagged it. Needless to say, this balance regimen really works!

Another postscript

More recently I came across an article suggesting that a good balance challenge is to tie your shoe while standing on one foot. This capability is said to bode well for preserving balance into old age. I didn’t find this much of a challenge, and decided that tying my shoe while standing on the balance saucer would be a better trick. It is, and now I’ve incorporated it into my saucer regimen. Check it out:

If you perceive that the above video ran a bit long—i.e., that it took me longer than necessary to tie my shoe—it’s because of the role vision plays in balancing. As it turns out, where we look has everything to do with balance. If you close your eyes while on the saucer it’s almost impossible to do the taps, etc. described in this post. And I’ve found that looking at my shoe while balancing on the saucer totally messes me up. Something about locating ourselves in space is instrumental to balance. Only if I look out into the room can I tie my shoe while on the saucer.

Give it a shot and let me know how it goes!

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Cycling, Suffering, and the Cold-Pressor Test

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Introduction

A couple days ago, preparing for a big bike team party, I filled a cooler with beer and ice. I like to use a lot of ice, so no two bottles are touching. The beers are all surrounded and ensconced in the ice, like fruit in Jell-O. My wife said, “If you use so much ice people will have to dig through it, which is painful.” I replied, “Yeah, but these are all cyclists.” At that moment I remembered that, when I threw a similar party a few years ago, I actually administered the “cold-pressor test,” a standard test for measuring pain thresholds.

I also remembered that I’d written about that experience then, in the context of suffering in general and bike suffering in particular. I had tried to work this all in to a story I wrote about a Coors Classic bike race reunion I’d attended in December of 2006. It didn’t fit, though, and I had to scrap it. (The actual reunion story is here.)

Since I’m way behind on blogging, I found this old scrap and worked it into something I think is worthwhile. (By the way, I have a bunch of other posts in the works which will reach albertnet shortly.)

The value of suffering

At a party I attended in Boulder, a reunion of bike racing people, I chatted briefly with Dale Stetina, one of my childhood cycling heroes. Stetina had won the Red Zinger Bicycle Classic stage race in Colorado in 1979 before retiring a year or two later. In 1982, he began coaching a number of young racers in the Boulder area, including me. Then, to our delight, he returned to racing in 1983, and in a stunning breakaway on the last day of the Coors Classic managed to win the whole thing.

I recalled that breakaway victory to him at the party, and he described it modestly. “I wasn’t doing anything that ambitious, I was just being careful because of the strong crosswind. Wind like that can really break up the pack so I made sure to stay near the front. When the group fragmented, Bauer wasn’t paying attention and got caught out. All I did was capitalize on his mistake.” I commented on the importance of that lesson—pay attention!—and Stetina replied, “Actually, that’s not one of the more important lessons from cycling. The most important thing about cycling is that it teaches you how to suffer. And once you know how to suffer, you can do anything.”

I imagine that anybody who has raced bikes for any length of time, or pursued any difficult athletic endeavor, has contemplated suffering at length, but nobody had ever spoken to me about it as simply, and yet profoundly, as Stetina had with that comment. The point is not so much that success requires suffering, but that suffering is something you must learn how to do. It’s instinctive to avoid suffering whenever we can. Avoiding suffering is perhaps the most primal reflex we have, and in a privileged society this avoidance can become a bad habit.

Fear of suffering causes all kinds of laziness; it’s why people stand on escalators, and it’s why they coast when they could pedal. But beyond mere physical discomfort, fear of emotional or psychological suffering is why people delude themselves into complacency instead of looking inward and challenging themselves to be better. Of course bike racing isn’t the only way to learn how to suffer, but it’s got to be one of the best ways.

How I learned about suffering

When I got interested in racing bikes I was totally ignorant of what it would require of me. I imagined speed, and fun, and glory, and above all a way to distinguish myself from the masses. That’s all we saw when we’d watched the original Red Zinger Bicycle Classic, which is what turned my brothers and me on to bicycle racing to begin with.

Our first race was a nine-day stage race for kids called the Red Zinger Mini Classic (modeled, of course, after the pro-am Red Zinger). In 1981, very few kids knew anything about bike racing, so the organizers of this race required that all riders participate in a bicycling clinic they put on a few weeks before the race. We all met at The Spoke, a Boulder bike shop. People I knew from school were there, which felt like an insult—weren’t these the same guys who teased me for wearing a cycling cap to school? On our way out of the parking lot, I tipped over because I’d just gotten toe clips and straps, so I felt like a complete dork and the ride hadn’t even really started yet.

We made our way to the base of a climb, and once it started, I immediately got dropped. It didn’t occur to me to put up a struggle. The leader of the clinic was an honest-to-God racer (if memory serves it was Dag Selander). He dropped back and rode next to me, trying to encourage me. He suggested I get out of the saddle and go a little harder. He told me it was okay if it hurt. This concept seemed completely foreign to me. What this guy was asking me to do was to suffer—to knowingly and willingly inflict suffering upon myself. This just didn’t make any sense.

He left me alone and cruised back up to the group, and I pondered his words as I continued picking my lone way up the road. I eventually began to understand what he was saying. Don’t get me wrong, I had been well aware that there was suffering in the athletic world, but on some level I viewed the willingness to suffer as an idiosyncrasy of certain competitors, not the whole point of sport. Of course you can laugh at my naïveté, but take a moment to think back on what a typical eleven-year-old has seen of sports first-hand: mainly it’s ball sports in gym class, where the physically talented rise to the top automatically, without any special effort. (And I mean talented in motor skills and fast-twitch muscles; there is exactly zero opportunity for an uncoordinated and/or slow-twitch kid to distinguish himself.)

For the first time, I entertained the idea that all athletes suffered. Why else would this guy encourage a nothing kid like me to make it painful? Maybe winners weren’t just intrinsically better; maybe they simply suffered more. I decided this must be the case. So did I follow this advice? Did I get out of the saddle and push myself, and close the gap to the rest of the kids? Of course not. This wasn’t an ABC After-School Special, it was real life and I was a loser. I understood the coach’s point intellectually, but lacked the drive to take any action. It would be many months before I developed the psychological mettle to actually make use of his lesson. But this was the starting point.

How I learned to suffer

I got crushed in my first Mini Zinger (I finished second-to-last, thus failing even to earn the dubious honor of Lanterne Rouge). For some reason, though, I didn’t give up the sport. That fall and the next spring, I learned a lot about cycling. For one thing, I learned how to draft. My brother Geoff taught me how, first explaining the principle and then heckling me during rides if I didn’t do it. Eventually he didn’t even need to use words: if he thought I wasn’t drafting closely enough he’d hold back his hand, thumb and forefinger an inch apart, to remind me how close our tires should be. And of course he’d ride really fast, being three years older than I, so really I was getting two lessons: how to draft, and how to suffer. If I failed to keep up, he wouldn’t ride with me anymore.

The next year, I was much stronger in the Zinger, but couldn’t figure out why I still didn’t crack the top ten. Later that summer was when Dale Stetina started his coaching. This was less structured than what he went on to do with his 7-Eleven junior team a few years later; in ’82, he simply charged a monthly fee (something like $30 I think) to informally coach any kid who was interested. I don’t frankly remember anything in particular that Stetina taught us; rather, the training rides we kids did with him gradually impressed upon me how complicated a sport this was. There were different types of training rides; different types of racing; even descending could be viewed as a discipline unto itself. I began to see the sport as a giant assembly of small details; getting enough of them right could add up to a margin of victory. But the foundation, I still believed, was the willingness to suffer, hard and often. And little by little, I embraced the ethos of suffering and started dipping into the red, ever more deeply and more frequently.

Of course, it’s well and good to claim that cycling taught me how to suffer, but suffering is a highly subjective matter. Could I have learned suffering even better through another sport? I’m sure any cyclist would tell you it’s among the very hardest sports out there, but what’s to keep a golfer or baseball player from making the same claim about his sport? Well, I had no reason to doubt that Stetina was authoritative about suffering, and that cycling was among the most painful sports, because a few months before I’d conducted a pain threshold experiment that gave me objective proof.

The cold-pressor test

During an orientation for my wife’s first childbirth, I learned that the medical community is beginning to consider pain as a vital sign, just like heart rate, blood pressure, or temperature. Of course pain is a more elusive sign than something objectively measurable, but it’s getting plenty of attention. Back in 1998, I read a fascinating article about pain by Atul Gawande, a surgeon, assistant professor at Harvard, and popular writer. He described a simple pain threshold experiment called the cold-pressor test in which subjects immerse a hand in ice water and keep it in as long as possible, before the pain becomes too great and they can’t help but pull out. The duration of submersion is the subject’s pain threshold. The test is limited to two minutes “to prevent injury.”

Countless researchers have used this study; the one Gawande cites compared ballet dancers to university students. The female students pulled out, on average, at thirty-seven seconds. Female dancers lasted almost three times as long (though they didn’t last the full two minutes). This result doesn’t surprise me; ballet dancers are known for high pain thresholds, given the rigors of their activity. Gawande tried the test himself and lasted the full two minutes, which he attributes to the toughness that he developed in medical school. I found another incidence of this study in which thirty-six men and thirty-six women averaged 56 seconds in the ice water. The obvious question: how would a cyclist do?

Cyclists take the cold-pressor challenge

When I hosted a party for the Berkeley area cycling community, I saw a perfect opportunity: I had a giant tub of ice water (for the beer) and a house full of bike racers, stuffed full of green enchiladas and ready for any challenge. When the party had thinned out to maybe half a dozen guys, I suggested the test. Of course not a single guy declined. My wife manned the stopwatch and we all plunged our hands in at once. Thirty seconds in, someone asked, “So, is anybody feeling some pain?” There were a few nods. “Yeah, I guess it hurts,” someone admitted. We passed the minute mark.

It hurt—in fact, it hurt plenty—but nobody was fazed (at least outwardly). It wasn’t enough to keep the hand in; each guy felt the need to show how conversational he could still be. We chatted merrily away about how the pain was unmistakable but totally manageable. Ninety seconds in, I swear somebody affected a yawn. Another thirty seconds passed. “Two minutes, you’re done!” my wife called out. She and somebody’s girlfriend looked a bit relieved for a moment, until they realized we weren’t pulling out. We all just sat there. “Theoretically you’re supposed to take your hand out at two minutes to prevent injury,” I mentioned casually. But nobody wanted to be first. We went at least another half a minute until, citing boredom, somebody withdrew, and the rest of us unhurriedly followed.

I thought I had my answer—cyclists really are particularly good at suffering—but the next morning, hung over and tackling the horrendous mess from the party, I spied the beer cooler and second-guessed the pain experiment. Sure, it had hurt, but not intolerably by any means. Could our success have simply been the result of alcohol? I had to know. I made sure the tub was still frigid (there were tons of ice cubes still) and repeated the experiment. Three minutes, no problem.

Pain vs. suffering

So how painful was it? If zero is no pain, and ten is a perforated eardrum (the most pain I’ve ever suffered), cold-pressor (with hangover) is about a six. Whacking my funny bone is about a three (brevity being a mitigating factor). Having a cavity filled without Novocain is about a five. A hard punch to the biceps by a big brother, a four. A hard climb during a bike race, at least a seven. But here is a crucial distinction among painful stimuli: control.

The reason that the perforated eardrum was so painful is that the pain came from outside of me, represented unknown damage to a sensitive organ, and couldn’t be made to go away. It was a physical sensation compounded by strong emotional responses: fear and alarm. The ability to back down the pain makes all the difference in the world. Before getting a cavity filled, I tell the dentist I’ll raise my right hand if the pain gets too great; then he’ll stop and give me Novocain. (I’ve never needed to raise my hand but I always give myself the option.) With cycling, it’s even easier: relief is just a downshift away.

Before I became a bike racer, all pain was alarming. I didn’t differentiate between external and internal sources until I became competitive. Learning to suffer meant learning how to ratchet up self-inflicted pain through sheer will, tolerating it because I knew I could back it off. I experimented, over the years, with just how hard I could push myself, just how miserable I could become, before I faced the consequences of having ignored my body’s signals. I developed, as does every bike racer, the ability to recognize that terrible suffering is not just an unavoidable by-product of riding hard, but also a vital sign, like a gauge on your dashboard. Pain is something you mete out strategically instead of something you flee from. In this way, mastering the suffering actually becomes a strange source of liberation.

Why suffering is so important

Let’s return to the other point Dale Stetina made: once you know how to suffer, you can do anything. This is a natural extension of what I’ve described regarding pain: what difference does it make if suffering is emotional or psychological versus physical? Once you’ve learned to differentiate between external and internal sources of suffering, you can take an abstract view of suffering, taking it beyond just the physical realm.

Consider the case of a junior sales rep assigned to make cold calls. I think it’s extremely rare to find somebody who enjoys cold calling, but it’s absolutely necessary for a sales rep. Those who make it in sales have learned to appreciate the difference between making a cold call and fielding a call from a telemarketer. They suffer through cold calls, but it’s a suffering they choose, a part of a greater goal, and most of all, they control when and how they make the calls—so it’s tolerable. They can decide beforehand to stop after twenty calls or five appointments, whichever comes first.

Robert Pirsig, in Zen & the Art of Motorcycle Maintenance, writes about “gumption traps,” his term for anything that disrupts a person’s gumption. When you set out to ride a bike fast, pain is the first and most basic gumption trap there is. Overcoming this pain, and mastering the ability to endure suffering on the bike, is a solid lesson in building gumption. My dictionary defines “gumption” as “boldness of enterprise; initiative or aggressiveness; guts; spunk.” Suddenly this humble word—gumption—comes to represent the foundation of what makes anybody successful at anything.

Looking back at my own difficult childhood, I see how my growth in cycling—that is, in suffering—tracked right along with my growth in everything else. Once I learned to make myself suffer on the bike, I did better with boldness, initiative, and confidence in general. I stopped trying to serve a volleyball underhand, like a girl, and found I could nail my serves overhand. I stopped being the last picked for basketball. I pushed past my shyness, making forays into social situations that eventually paid off, so that many of my current friends who didn’t know me as a kid refuse to believe I’m essentially an introvert. It’s all because I learned, through suffering, how to overcome my own weakness. So I completely agree with Dale Stetina: cycling teaches you how to suffer, and once you know how to suffer, you can do anything.

Postscript

Rereading this post years later, I note that at the time I wrote it, the most painful injury I had suffered was a perforated eardrum, so that was my 10. Well, years later, I suffered a third-degree separation of my shoulder, which became the new 10 and knocked the eardrum down to about an 8. Years after that, I broke my femur which took over as 10, making the shoulder about a 5 and the eardrum a 4. That lowers the cold pressor to about a 2.5. Cavity filled without Novocain becomes a 2.