Bernadette Keefe

MD; Focus: Aging, Mobility, AgingTech, AgeTech, HealthyAging, AssistiveDevices, AssistiveTech

[Howard Luks MD @hjluks]

Most gym training happens in a straight line. Squats, deadlifts, rows, presses. Forward and backward, up and down, all in the sagittal plane.

But… life doesn't stress you in a straight line. You step off a curb at an angle, shuffle sideways on a crowded sidewalk, pivot in the kitchen with a heavy pot of water in hand, or a dog that pulls you mid-walk. Every one of these is a test of rotational or lateral strength, power, and quickness.

Preventing falls in our 70s and 80s starts in our 40s and 50s.

This week's Saturday session is a lateral and rotational training plan with videos, coaching cues, and an Enough, Better, and Optimal tier for every exercise.

https://t.co/pWubchWqEL

[The Desk Athlete @the_deskathlete]

Exercise selection should not change according to your age.

Good exercise selection depends on whether the exercise works a specific muscle group efficiently through a range of motion. Nothing else. The same exercises that were good when you were 20 will be good when you’re 50.

Train for your body, not your birthday.

[Howard Luks MD @hjluks]

Midlife and Master's Athlete Training:
The Biological Realities We Face
For the better part of 15 years, I have been training in the gym, running, cycling, climbing, and more. But the biology of aging and the physiological changes that come with it are real. We cannot outrun them, and we should not pretend they aren't happening. What we can do is adapt to them.
My experience watching patients in my office for nearly 30 years, combined with my own curiosity about why some people thrive, and others don't, has shaped how I train now at 62. I use that clinical wisdom to change my approach, to work with the biology of aging rather than against it. This post and the long article below is the result...

[Sama Hoole @SamaHoole]

In 1946 the British government introduced free school milk for every child in the country. One third of a pint, every school day, from the age of five to the age of fifteen.

The milk was whole. Full-fat. From British dairy herds. It was delivered to the school gate in small glass bottles with foil caps and left on the doorstep in metal crates, where it sat in the sun until morning break if the weather was warm and developed a slightly suspect taste that an entire generation of British adults can still describe with uncomfortable precision.

The generation that grew up on school milk was, by every anthropometric measure, the healthiest generation of British children ever recorded.

Average height increased. Bone density improved. Dental health, despite the sugar in everything else, improved. Iron deficiency rates among school-age children dropped. The growth charts that the Ministry of Health had been keeping since the war showed a consistent, measurable, year-on-year improvement that tracked precisely onto the introduction of the milk programme.

In 1971 Margaret Thatcher, then Education Secretary, cut free school milk for children over seven. The tabloids called her Thatcher the Milk Snatcher. She was vilified. She kept the policy.

The next generation of British children, the ones who grew up without the daily third of a pint, were measurably less healthy than the one before.

The growth charts show it. The dental records show it. The conscription medicals, while they lasted, showed it. The thing the milk had been providing, the calcium, the vitamin D, the vitamin A, the complete amino acid profile, the conjugated linoleic acid, the fat-soluble nutrients that a growing skeleton requires in order to reach its genetic potential, was no longer arriving at morning break in a glass bottle with a foil cap.

It was replaced, eventually, by nothing. Or by a carton of fruit juice. Or by a packet of crisps from the vending machine that appeared in the school corridor in the 1990s.

The generation that drank the milk is now in its seventies and eighties. They are, on average, taller, stronger-boned, and longer-lived than the generation that came after them.

The milk was not magic.

The milk was milk.

It was the thing the body needed, delivered at the time the body needed it, at a cost the government considered acceptable until it didn't.

The cost of not providing it has been rather higher.

[Reid Wiseman @astro_reid]

On the helicopter leaving the ship right now. This planet is impossibly beautiful from every altitude I’ve seen it…surface to 250,000 miles

[Bernadette Keefe @nxtstop1]

@dogwoodblooms Cc @Cjaques4

[Howard Luks MD @hjluks]

Load Management:

When I talk about load management in the office, I can see the moment it lands the wrong way. People often hear “don’t do too much.” They hear restriction, caution, and many hear weakness. That is not what I intended.

Load management is not about doing less. It is about doing the right amount — and then building from there.

Tendons do not heal because we protect them indefinitely. They adapt because we challenge them. But they adapt on their timeline, not ours. When the load exceeds the capacity, they breakdown and become painful. When load is too low for too long, their capacity shrinks and they’re more susceptible to overuse injury. The sweet spot lives in between.

That middle ground is not avoidance. It is progressive exposure.

If your Achilles hurts, the answer is rarely “stop moving.” It is also rarely “push through it.” It should almost never be put in a boot! The answer is to adjust the load so the tendon can tolerate it, then gradually increase that demand. That might mean temporarily reducing volume, slowing down tempo work, or modifying range.

Think of it like strength training. You do not walk into a gym and deadlift your lifetime goal on day one. You pick a weight you can manage, stress the system, recover, and come back slightly stronger. Tendons are no different. The stimulus has to be enough to matter, but not so much that it overwhelms your ability to recover.

What I am trying to teach when I talk about load management is durability. It is the skill of matching stress to capacity and then expanding capacity over time. That requires honesty about where you are today, not where you were ten years ago or where you wish you were.

In midlife, especially, recovery becomes the governor. Aging is associated with a higher price for intensity and longer recovery time frames.

Cardiovascular systems adapt quickly. Connective tissues adapt slowly. If we ignore that reality, pain becomes the teacher instead.

Load management is not about shrinking your world. It is about expanding it safely. It is the difference between repeatedly flaring the same tendon for years and building the kind of resilience that lets you run, lift, hike, and play for decades.

The goal is never to do less. The goal is to build the capacity to do more.

[Bernadette Keefe @nxtstop1]

Excellent program on controlling/combatting chronic inflammation via ⁦@PeoplesPharmacy⁩ https://t.co/ZqWe201OnB

[Bernadette Keefe @nxtstop1]

Jumping exercises are invaluable. Key: make controlled and supervised as needed. Wisdom from @hjluks ⬇️

[Howard Luks MD @hjluks]

I’m seeing a lot of fear in the comments about “blowing out an Achilles” when it comes to jumping.

That fear is understandable. Achilles injuries are real. No one wants one.
But avoiding jumping altogether doesn’t make the Achilles safer. If it becomes weak enough, it'll give out on the stairs or while walking up a curb.

The Achilles tendon was engineered to store and release elastic energy. That's it. That’s its job. Walking, running, hopping, jumping—these aren’t extreme behaviors. They’re human ones.

If you want to avoid an achilles injury, you will:
- train it
- fix your metabolic health
-fix your LDL level
-fix your uric acid levels
-sleep well
- not drink
and more...

When a tendon is never exposed to elastic loading, it doesn’t become protected.
It becomes weaker, stiffer, and less tolerant of force. When the tendon contains cholesterol and urate crystals, it becomes inflamed and weaker.

Disuse increases injury risk. Yes, injuries can occur with exercise. That’s true of strength training, running, and even walking.

Exercise is the risk you take to avoid the consequences of being still.

And the consequences of being still are not subtle:
– loss of tendon capacity
– poorer balance and reaction time
– weaker bones
– higher fracture risk
– injuries from simple, everyday movements

This is especially important as we age.

Avoiding impact and power training doesn’t protect people. It quietly makes them fragile.
But wait... let’s be clear about what jumping doesn’t mean.
It does not mean random, high-volume plyometrics.
It does not mean fatigued, sloppy reps.
It does not mean everyone is doing the same thing.
What it does mean is progressive exposure:
– small jumps
– controlled landings
– appropriate surfaces
– adequate recovery
– supervision and coaching when needed
The research on structured jumping and impact programs—especially in older adults and postmenopausal women—shows extremely low injury rates when these movements are taught and progressed properly.
Fear-based advice sounds cautious, but it has consequences.

Telling people to avoid jumping “to be safe” often sets them up for something far worse: tissues that are never trained to handle real-world forces. That’s how injuries happen from a curb, a misstep, or a slip.

The goal is not zero risk.
The goal is resilience.

We don’t make people safer by telling them to stop moving.
We make them safer by teaching them how to move well, at the right dose, at the right time.

Fear makes people fragile.
Thoughtful training makes them durable.
There's a HUGE difference.

[Bernadette Keefe @nxtstop1]

#ultraprocessedfood

[Bernadette Keefe @nxtstop1]

{Ultra}Processed Food:Just Too Sexy {For Health} https://t.co/DygS7CHCHx Dyin' from luvin' food engineered 2 hook us

[Bernadette Keefe @nxtstop1]

{Ultra}Processed Food:Just Too Sexy {For Health} https://t.co/DygS7CHCHx Dyin' from luvin' food engineered 2 hook us

[Bernadette Keefe @nxtstop1]

New Pyramid:
10% calories from fat limits top Lt corner (meat, cheese) Fruits & veges still unlimited. The glaring omission is fish (very healthy). Also beans/ legumes ( budget friendly & loaded w/ protein). This is essentially, though, a carb, sugar, salt limiting diet.

[evie @Eviemagazine]

The US has unveiled an updated food pyramid, and it’s a clear shift toward simpler, more whole-food eating 👏 The new guidelines encourage more protein, fewer added sugars, and less reliance on ultraprocessed foods, while embracing healthy fats and nutrient-dense meals. ⁠
⁠
Officials say the streamlined approach is designed to help prevent chronic disease and make healthy choices easier to understand. ⁠
⁠
At its core, the message is refreshingly straightforward: eat real food, and let food be part of the solution.⁠
⁠
The old food pyramid was never about keeping you healthy. It was about making corporations money. ⁠
⁠
Click to read all about its controversial history 🥦🥣🍞 https://t.co/Z3ofEbsmGI

[Jake Scott, MD @jakescottMD]

Denmark and Japan have universal health care, robust social safety nets, and national registries that track every patient. Denmark has 6 million people. Japan has a homogeneous population with some of the lowest health disparities in the developed world. The U.S. has 330 million people, 27 million uninsured, massive health disparities, and a fragmented system where millions of families move between providers and screening falls through the cracks. Our schedule was designed as a safety net for this reality.

And yes, American children have been at risk. Before the hepatitis B birth dose, 18,000 children a year were infected. Before rotavirus vaccination, 55,000 to 70,000 children were hospitalized annually. Before Hib vaccination, it was the leading cause of bacterial meningitis in American children. These diseases didn’t disappear on their own. Vaccination made them rare. The question isn’t whether American children have been at risk. The question is why we’re abandoning the protections that reduced that risk.

[Bernadette Keefe @nxtstop1]

Talk to your pediatrician about all the necessary childhood vaccinations to keep your child and other children they come in contact with safe.

[Bernadette Keefe @nxtstop1]

The new CDC vaccine schedule:

[Dr. Kat Lindley @DrKatLindley]

New CDC Recommendations (if in red box not recommended anymore)

“Changes to the vaccine schedule
Federal health officials reduced the number of diseases prevented by routine shots, narrowing recommendations for certain vaccines to only high-risk children or after consultation with a health care provider.”

[Bernadette Keefe @nxtstop1]

@JeremyFrisch Cc @hjluks : re: youth sports you’ve been saying this for years! And not to mention the premature overuse injuries.

[James Lucas @JamesLucasIT]

The Canadian Pacific Christmas Train is travelling across Canada

[Howard Luks MD @hjluks]

Workout cheat codes I know at 60 that I wish I knew at 25:

Consistency beats intensity. One hard week won’t change your life. Thirty years of steady effort will.

Strength is the fountain of youth. Muscle protects joints, maintains metabolism, and slows aging far more than I realized.

Muscle is a significant determinant of human trajectory. Your muscles are not decoration, they’re engines. If you ignore them, they’ll betray you.

Power and quickness fade fast...and first—train them. Jump, sprint, throw, push explosively. Even in small doses, it keeps you athletic... and if it prevents a fall, it will save your life.

Sleep is training. Recovery is the multiplier. Ignore them, and every gain is short-lived. Pursue sleep actively... like exercise and nutrition.

Pain is feedback, not failure. Learn the difference between “working hard” and “breaking down.” Not all pain implies harm... and... pain isn't necessary for your training sessions. I spent a decade hurting myself. Be better than me.

Mobility is freedom. Hips, shoulders, ankles—guard them like gold. Once lost, everything else shrinks. Look at @gmbfit programs. They're awesome. Awesome.

Chasing numbers is a trap. Longevity comes from movement you can sustain, not personal records that wreck you. Don't ignore a sense of purpose, or your friends and family. Those are HUGE longevity levers.

Small wins compound. 20-30 minutes a day is better than 0.

Fuel matters. Protein isn’t just for bodybuilders—it’s protection against frailty. And ...Don’t fear carbs. And 1.6 is fine for most of you. Ignore the noise.

Enough is the goal for most of you. Train to live fully, not to prove something. Your VO2max can be high enough, and you can be strong enough. Enough is great.

[Bernadette Keefe @nxtstop1]

#lifetimefitness

[Bernadette Keefe @nxtstop1]

A solid aerobic foundation is key to lifetime fitness. It’s a daily endeavor. Details below.
Superb post from Howard Luks MD.

[Howard Luks MD @hjluks]

7 Things This 62-Year-Old Runner Would Tell His 40-Year-Old Runner Self

Slow down. Pace isn’t the goal. Heart rate isn’t even the goal. The physiological adaptations in the zone you are running in are the goal. Most runners never get fast because they never got slow. Your aerobic engine only grows when you give it the low-intensity time it needs.

Your base will be the most important thing you ever build. Base building takes much longer than you think. It’s super frustrating at first, then boring, then, if you stick with it… magic. Nothing will pay you back more in your 50s and 60s than a massive aerobic floor built decades earlier.

Run more often, not necessarily longer. Six shorter runs per week beat two or three longer ones. Consistency/frequency build durability, teach your tissues to tolerate load, and keep your aerobic system turned on all week long. It’s better for a longevity approach as well.

Intensity. You don’t need much of it. A little bit goes a long way, especially as you age. Save the hard work for when it matters and spend most of your time building capacity, not frying your system.

Manage load like your future depends on it. Because it does. Overuse injuries are preventable, but only if you respect your tendons and connective tissue. Most runners’ injuries are training errors due to poor load management. Tendons don’t care about your watch or your training plan. They care about consistency and smart progression. Tendons don’t like rest either… when a tendinopathy occurs, they want heavy resistance loads… see a therapist very early.

Lift and stay powerful. If you want to keep running well in your 60s, start lifting in your 40s. Strength and power fade faster than endurance. Train strength and power…. both for living longer and performing well.

Recovery is training. The adaptation occurs during the recovery phase. Recovery time is not optional. Sleep, down weeks, and truly easy days are what allow the adaptations you’re chasing to happen at all. Never let today’s workout ruin tomorrow’s.