Health maintenance guidelines

1. Co-workers Health Maintenance Guidelines
Sections
1. General Health Screening
2. Physical Activity and Exercise
3. Immunization and Preventative Care
4. Nutrition and Vitamin Supplementation
5. Sleep and Sleep Hygiene
6. Travel Habits: Jet Lag, Airplanes, Meals, and Sleep
7. Prescription Medications and Supplements (Herbals)
8. Weight loss and Weight Maintenance
9. Avoiding Unnecessary Risk, Injury Prevention, and Emergency
Preparedness when Traveling
10.Medical Insurance and Travel Insurance
Section 1 - General Health Screening
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/007465.htm
Health screening - men - ages 40 to 64
You should visit your health care provider regularly, even if you feel healthy. The
purpose of these visits is to:
1.
2.
3.
4.
5.
6.
Screen for medical issues
Assess your risk of future medical problems
Encourage a healthy lifestyle
Update vaccinations
Help you get to know your provider in case of an illness
Information
Even if you feel fine, you should still see your health care provider for regular checkups.
These visits can help you avoid problems in the future. For example, the only way to
find out if you have high blood pressure is to have it checked regularly. High blood sugar
and high cholesterol levels also may not have any symptoms in the early stages. Simple
blood tests can check for these conditions.
There are specific times when you should see your provider. Below are screening
guidelines for men ages 40 - 64.

2. BLOOD PRESSURE SCREENING
1. Have your blood pressure checked every 2 years. If the top number (systolic
number) is between 120 - 139 or the bottom number (diastolic number) is
between 80 - 89 mm Hg then have it checked every year.
2. Watch for blood pressure screenings in your area. Ask your provider if you
can stop in to have your blood pressure checked. Or check your blood
pressure using the automated machines at local grocery stores and
pharmacies.
3. If the top number is greater than 140 or the bottom number is greater than 90,
schedule an appointment with your provider.
4. If you have diabetes, heart disease, kidney problems, or certain other
conditions, you may need to have your blood pressure checked more often.
CHOLESTEROL SCREENING AND HEART DISEASE PREVENTION
5. If you have high cholesterol levels, diabetes, heart disease, kidney problems,
or certain other conditions, you may need to be checked more often.
6. Some men should consider taking aspirin to prevent heart attacks. Ask your
provider before you start aspirin because aspirin can increase your risk for
bleeding.
DIABETES SCREENING
7. If you are over age 45, you should be screened every 3 years.
8. If you are overweight, ask your provider if you should be screened at a
younger age.
COLON CANCER SCREENING
If you are under age 50, you should be screened only if you have a strong family
history of colon cancer or polyps, or if you have had inflammatory bowel disease
or polyps.
If you are between ages 50 - 75, you should be screened for colorectal cancer.
This may involve:
1. A stool test done every year
2. Flexible sigmoidoscopy every 5 - 10 years along with a stool guaiac test
3. Colonoscopy every 10 years
4. You may need a colonoscopy more often if you have risk factors for colon
cancer, such as:
Ulcerative colitis
A personal or family history of colorectal cancer
A history of large colorectal adenomas
DENTAL EXAM
Go to the dentist every year for an exam and cleaning.
EYE EXAM
Have an eye exam every 1 - 3 years if you have vision problems or glaucoma risk.

3. IMMUNIZATIONS
1. You should get a flu shot every year.
2. Your doctor may recommend other vaccinations if you have certain medical
conditions, such as diabetes.
3. You should have a tetanus-diphtheria booster vaccination every 10 years. If
you have not received a tetanus-diphtheria and acellular pertussis (Tdap)
vaccine as one of your tetanus-diphtheria vaccines, you should have it once.
4. You may get a shingles or herpes zoster vaccination once after age 60.
OSTEOPOROSIS SCREENING
If you are between ages 50 - 70 and have risk factors for osteoporosis, you
should discuss screening with your provider.
Risk factors can include long-term steroid use, low body weight, smoking, heavy
alcohol use, or a family history of osteoporosis.
PHYSICAL EXAM
You should have a preventive health visit every 2 years until age 50, and then
once a year.
Routine diagnostic tests are not recommended.
Your height, weight, and body mass index (BMI) should be checked at every
exam.
During your exam, your provider may ask you about:
Depression
Diet and exercise
Alcohol and tobacco use
Safety, such as use of seat belts and smoke detectors
PROSTATE CANCER SCREENING
1. Most men age 50 or older should discuss screening for prostate cancer
with their provider. African American men and those with a family history of
prostate cancer should discuss screening at age 45.
2. The potential benefits of PSA testing have not been shown to outweigh the
harms of testing and treatment. If you choose to be tested, the PSA blood
test is most often done every year.
3. Prostate examinations are no longer routinely done on men with no
symptoms.
TESTICULAR EXAM
The U.S. Preventive Services Task Force (USPSTF) now recommends against
performing testicular self-exams. Doing testicular self-exams has no benefit.
LUNG CANCER SCREENING
The USPSTF recommends annual screening for lung cancer with low-dose
computed tomography (LDCT) in adults aged 55 - 80 years who:
Have a 30 pack-year smoking history AND

4. Currently smoke or have quit within the past 15 years
Alternative Names
Health maintenance visit - men - ages 40 - 64; Physical exam - men - ages 40 -
64; Yearly exam - men - ages 40 - 64; Checkup - men - ages 40 - 64; Men's
health - ages 40 - 64; Preventive care - men - ages 40 - 64
References
American Diabetes Association. Standards of medical care in diabetes -- 2014.
Diabetes Care. 2014;37 Suppl 1:S14-S80.
Atkins D, Barton M. The periodic health examination. In: Goldman L, Schafer AI, eds.
Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 14.
Centers for Disease Control and Prevention. Recommended Immunization Schedule for
Adults, United States, 2014. Available at http://www.cdc.gov/vaccines/schedules/
downloads/adult/adult-schedule.pdf. Accessed July 24, 2014.
Gaziano M, Ridker PM, Libby P. Primary and secondary prevention of coronary heart
disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease:
A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders; 2012:1010.
Handler J, et al. 2014 evidence-based guideline for the management of high blood
pressure in adults: report from the panel members appointed to the Eighth Joint
National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-520.
Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001
US Preventive Services Task Force Review. Rockville (MD): Agency for Healthcare
Research and Quality (US); 2008 Jun.
Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al.
Screening and surveillance for the early detection of colorectal cancer and
adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the
U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of
Radiology. CA Cancer J Clin. 2008;58:130-160.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in
Oncology (NCCN Guidelines): Colorectal cancer screening. Version 2.2013. Available at
http://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. Accessed
July 24, 2014.
National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of
Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2013.
Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension:
what are the right goals and purposes? JAMA. 2014 Feb 5;311(5):474-476.

5. Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American
College of Gastroenterology. American College of Gastroenterology guidelines for
colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-750.
Screening for Prostate Cancer. U.S. Preventive Services Task Force web site. Available
at http://www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm.
Accessed July 24, 2014.
Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the
United States, 2010. A review of current American Cancer Society guidelines and issues
in cancer screening. CA Cancer J Clin. 2010; 60(2):99-119.
Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz N, Blum CB, et al. 2013 ACC/AHA
Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic
Cardiovascular Risk in Adults. Circulation. 2014 Jun 24;129(25 Suppl 2):S1-S45.
U.S. Preventive Services Task Force. Screening for osteoporosis: recommendation
statement. Am Fam Physician. 2011;83:1197-1200.
Whitlock EP, Lin J, Liles E, Beil T, Fu R, O'Connor E, Thompson RN, Cardenas T.
Screening for Colorectal Cancer: An Updated Systematic Review [Internet]. Rockville
(MD): Agency for Healthcare Research and Quality (US); 2008 Oct.
http://www.ncbi.nlm.nih.gov/books/NBK35179/. Accessed July, 24, 2014.
Update Date: 8/8/2014
Health screening - men age 65 and older
You should visit your health care provider regularly, even if you feel healthy. The
purpose of these visits is to:
•
•
•
•
•
•
Screen for medical issues
Assess your risk of future medical problems
Encourage a healthy lifestyle
Update vaccinations
Help you get to know your provider in case of an illness
Information
Even if you feel fine, you should still see your health care provider for regular checkups.
These visits can help you avoid problems in the future. For example, the only way to
find out if you have high blood pressure is to have it checked regularly. High blood sugar
and high cholesterol levels also may not have any symptoms in the early stages. A
simple blood test can check for these conditions.
There are specific times when you should see your provider. Below are screening
guidelines for men age 65 and older.

6. ABDOMINALAORTIC ANEURYSM SCREENING
If you are between ages 65 - 75 and have smoked, you should have an ultrasound to
screen for abdominal aortic aneurysms.
Other men should discuss this screening with their provider.
BLOOD PRESSURE SCREENING
Have your blood pressure checked every year.
If you have diabetes, heart disease, kidney problems, or certain other conditions, you
may need to be checked more often.
CHOLESTEROL SCREENING AND HEART DISEASE PREVENTION
Your cholesterol should be checked every 5 years if levels are normal.
If you have high cholesterol, diabetes, heart disease, kidney problems, or certain other
conditions, you may need to be checked more often.
LUNG CANCER SCREENING
The U.S. Preventive Services Task Force recommends annual screening for lung
cancer with low-dose computed tomography (LDCT) in adults until age 80 who:
Have a 30 pack-year smoking history AND
Currently smoke or have quit within the past 15 years
COLON CANCER SCREENING
Until age 75, you should have one of the following screening tests:
A stool test done every year
Flexible sigmoidoscopy every 5 - 10 years, along with a stool guaiac test
Colonoscopy every 10 years
You may need a colonoscopy more often if you have risk factors for colon cancer, such
as:
Ulcerative colitis
A personal or family history of cancer of the colon or rectum
A history of large growths called adenomas
DIABETES SCREENING
If you are age 65 or older and in good health, you should be screened for diabetes
every 3 years.
If you are overweight and have other risk factors for diabetes, ask your doctor if you
should be screened more often.
DENTAL EXAM
Go to the dentist every year for an exam and cleaning.
EYE EXAM
Have an eye exam every 1 - 2 years if you have vision problems or glaucoma risk.

7. HEARING TEST
Have your hearing tested if you have symptoms of hearing loss.
IMMUNIZATIONS
If you are age 65 or older, get a pneumococcal vaccine if you have never had one, or if
it has been more than 5 years since you had the vaccine.
You should get a flu shot each year.
Get a tetanus-diphtheria booster every 10 years.
You may get a shingles or herpes zoster vaccine after age 60.
OSTEOPOROSIS SCREENING
If you have risk factors for osteoporosis, you should check with your provider about
screening. Risk factors can include long-term steroid use, low body weight, smoking,
heavy alcohol use, or a family history of osteoporosis.
PROSTATE CANCER SCREENING
Talk to your provider about prostate cancer screening. The potential benefits of PSA
testing have not been shown to outweigh the harms of testing and treatment.
If screening is done, a PSA test is the best method.
Routine prostate exam for men without symptoms is not recommended.
PHYSICAL EXAMS
Have a yearly physical exam.
Your provider will check your weight, height, and body mass index (BMI).
During the exam, your provider will ask you questions about:
Your medicines and risk of interactions
Alcohol and tobacco use
Diet and exercise
Safety, such as using a seat belt, or smoke alarms
Depression
Alternative Names
Health maintenance visit - men - over age 65; Physical exam - men - over age 65;
Yearly exam - men - over age 65; Checkup - men - over age 65; Men's health - over age
65; Preventive care exam - men - over age 65
References
American Diabetes Association. Standards of medical care in diabetes -- 2014.
Diabetes Care. 2014;37 Suppl 1:S14-S80.
Atkins D, Barton M. The periodic health examination. In: Goldman L, Schafer AI, eds.
Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 14.
Basch E, Oliver TK, Vickers A, et al. Screening for prostate cancer with prostate-specific
antigen testing: American Society of Clinical Oncology provisional clinical opinion. J Clin
Oncol. 2012 Aug 20;30(24):3020-5.

8. Centers for Disease Control and Prevention. Recommended Immunization Schedule for
Adults, United States, 2014. http://www.cdc.gov/vaccines/schedules/downloads/adult/
adult-schedule.pdf. Accessed July 24, 2014.
Gaziano M, Ridker PM, Libby P. Primary and secondary prevention of coronary heart
disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease:
A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders; 2012:1010.
Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of
cardiovascular risk in asymptomatic adults: a report of the American College of
Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
Circulation. 2010;122(25):e584-e636.
Handler J, et al. 2014 evidence-based guideline for the management of high blood
pressure in adults: report from the panel members appointed to the Eighth Joint
National Committee (JNC 8). JAMA. 2014 Feb 5;311(5):507-520.
Helfand M, Carson S. Screening for Lipid Disorders in Adults: Selective Update of 2001
US Preventive Services Task Force Review. Rockville, MD: Agency for Healthcare
Research and Quality (US); 2008 Jun.
Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al.
Screening and surveillance for the early detection of colorectal cancer and
adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the
U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of
Radiology. CA Cancer J Clin. 2008;58:130-160.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in
Oncology (NCCN Guidelines): Colorectal cancer screening. Version 2.2013. Available at
http://www.nccn.org/professionals/physician_gls/pdf/colorectal_screening.pdf. Accessed
July 24, 2014.
National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of
Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2013.
Peterson ED, Gaziano JM, Greenland P. Recommendations for treating hypertension:
what are the right goals and purposes? JAMA. 2014 Feb 5;311(5):474-476.
Rex DK, Johnson DA, Anderson JC, Schoenfeld PS, Burke CA, Inadomi JM; American
College of Gastroenterology. American College of Gastroenterology guidelines for
colorectal cancer screening 2009 [corrected]. Am J Gastroenterol. 2009;104:739-750.
Screening for Prostate Cancer. U.S. Preventive Services Task Force Web site. http://
www.uspreventiveservicestaskforce.org/prostatecancerscreening.htm. Accessed July
24, 2014.

9. Stone NJ, Robinson J, Lichtenstein AH, Bairey Merz N, Blum CB, et al. 2013 ACC/AHA
Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic
Cardiovascular Risk in Adults. Circulation. 2014 Jun 24;129(25 Suppl 2):S1-S45.
U.S. Preventive Services Task Force. Recommendations for adults. Rockville, MD:
Agency for Healthcare Research and Quality; 2013. Accessed July 24, 2014.
U.S. Preventive Services Task Force. Screening for osteoporosis: recommendation
statement. Am Fam Physician. 2011;83:1197-1200.
Whitlock EP, Lin J, Liles E, Beil T, Fu R, O'Connor E, Thompson RN, Cardenas T.
Screening for Colorectal Cancer: An Updated Systematic Review [Internet]. Rockville,
MD: Agency for Healthcare Research and Quality (US); 2008 Oct.
http://www.ncbi.nlm.nih.gov/books/NBK35179/. Accessed July, 24, 2014.
Wolf AM, Wender RC, Etzioni RB, et al. American Cancer Society guideline for the early
detection of prostate cancer: update 2010. CA Cancer J Clin. 2010;60:70-98.
Update Date: 8/8/2014

10. Section 2 - Physical Activity and Exercise
Physical fitness should be approached with a program that is balanced, repeatable, and
flexible to meet the need of each individual. Co-existing medical conditions, starting
fitness level, and physical environment should be considered.
General a program should include a combination of five categories of conditioning.
1. Cardiopulmonary - Aerobic and Anarobic
2. Resistance and Strengthening
3. Flexibility and Stretching
4. Proprioception and Balance
5. Breathing Control and Concentration
20 Practical Recommendations to Improve Physical Fitness
http://www.nia.nih.gov/sites/default/files/nia_exercise_and_physical_activity.pdf
2. Plan six weeks to develop a habit
After 6 weeks you start to see visible changes in your body and you appreciated how
much better you feel and how much clearer you think.
3. Find an activity you like
All forms of fitness aren't for everyone. Find an activity that enables you to pray and
tune out all the stress. This can help to give you a release from your anxiety. Don't think
of it as exercise because that suddenly gives it a negative connotation. You may say, "I
am going for a run" or "Let's go for a walk".
4. Get professional assistance to begin or advance
Whether you're a total newcomer to a fitness program or you just need a little motivation
and guidance, a personal trainer can help you set goals and develop a plan to make
them happen. A good trainer will hold you accountable and will motivate you to work
your hardest. This is positive reinforcement.
5. Joining the YMCA or a community recreation center
There is value in having a support system, which should be an integral part of any
workout plan. Your exercise club could be an entire gym full of people, a regular fitness
class where everyone knows your name, or just one exercise companion who makes
sure you meet for your morning walks. When a public gym is not for you or if getting to a
gym every day isn't conducive to your schedule or you just hate the idea of going to a
public place, don't force it. There are workout DVDs, streaming online classes, and
home exercise systems to get a great workout without even leaving your house. Many
people prefer exercising in the privacy of their own homes.

11. 6. Make it convenient
Think about when, where, and how your workout can best (and most easily) fit into your
daily routine. Don't travel far to get to a gym or the likelihood of going will decrease
immensely. Working out at home or at a gym near your house is more convenient. Plan
ahead to make sure you can get everything you need—like clothes and shower supplies
—to and from your workouts.
7. Join a group
The right teacher can motivate a fitness class and feel more like an enjoyable activity
than a difficult workout. Popular fitness instructors see their classes fill up fast, and
maintain loyal followings even when they switch class times and locations.
8. Be accountable
Invest in a fitness regimen, if you can afford it. Joining an gym or taking a fitness class
could be just the thing you need to force yourself to actually go. Positive reinforcement
may include rewarding yourself with new pair of gym shoes or a fitness watch..
9. Do not over-exert
This is a sure way to put a stop to your new exercise habit before it even gets off the
ground. Getting hurt. Beginners (or people just returning to fitness after a long break)
need to be careful about trying to do too much, too soon, which can leave you sore and
exhausted—or worse yet, with an injury that will keep you sidelined for even longer. It's
normal to have some muscle aches and stiffness a day or two after working out muscles
you haven't used in a while, but if you start to feel sick or overly tired, you could be
training too hard. Following a training plan (like a Couch to 5K program) or working with
a personal trainer can help you make sure you're progressing at a reasonable pace.
10. Use technology
If you thrive on statistics and numbers, you may find that using apps, computer
programs, or wearable pedometers and fitness trackers can help you stay on track with
a new routine. Whether you're counting your daily steps or the number of calories
you've burned, technology can help you challenge yourself to new personal bests every
day. Plus, many of these programs can be integrated with social networks, making it
easy to let your friends or family know that you just ran 3 miles or checked in at the
gym.
11. Count your calories
Keeping a food and fitness diary or using a calorie-tracking app can also remind you of
how a few more minutes on the elliptical can help balance out your calorie intake and
output. A 2013 Stanford University study found that people who adopt a diet and
exercise program together are more likely to stick with both new habits than those who
tackle an individual goal by itself. "Lose it" is a good app for tracking calories,
cholesterol, fat, etc. as well as exercise.

12. 12. Set attainable goals
Do not be too ambitious with goals that cannot be qualified. Work toward smaller
benchmarks. When you reach an end goal you will change and reset to the next mark.
13. Utilize cardiac and resistance training
Most fitness workouts should include both cardiac exercises such as walking or jogging
and resistance training such as weight lifting. The balance of these two forms of
exercise will keep your heart and lungs in better condition and help prevent excessive
loss of muscle and flexibility with age. A general rule is three days of cardio and 2 days
of resistance every week.
14. Write out your fitness plan
A 2002 British study found that when adults were told to keep track of how much they
worked out over the next two weeks, those who were first asked to formulate a plan on
exactly when and where they would exercise were more likely to exercise at least once
a week—91%, versus just 38% of those who hadn't planned ahead. Having a schedule
and figuring out the logistics ahead of time will give you fewer obstacles.
15. Develop a habit that cues your brain.
The most important thing about establishing a regular routine, whether it's exercise is to
truly make it a habit. This will come with time, but you can help hurry the process along
by creating daily rituals that center around your workout: cues will signal your brain that
it's time to work out—not time to make excuses.
16. Charity events can motivate you
Charity fitness events—runs, walks, bike rides, even mountain climbing trips—can do
double duty when it comes to motivation: Not only are you training for a concrete goal,
but you're also doing it for a good cause. Some charity-oriented fitness programs will
even set you up with a coach and a training program, at no or little cost to you besides
what you're required to fundraise.
17. Get into a competitive but safe program
Fitness competitions may sound pretty boring to some people but others need the
sense of friendly competition to be motivated. Perhaps a regular 5K doesn't quite do it
for you, so sign up for something with a bit more competitive. Many competitive events
aren't even timed, and they welcome runners and walkers of all ages and fitness levels.
18. Plan a (fitness-focused) vacation
Combining a vacation with exercise can be rewarding. Spending time with family while
hiking, biking, or canoeing can create lasting memories and strengthen both the
physical body and family ties. Yu can also blend with saints from other places. Go
biking in Holland or hiking in Germany and canoeing in Arkansas.
19. Go to sleep earlier
If you're going to start getting up earlier (see tip No. 1), it's important to make sure
you're still getting enough sleep. Most of us need seven to eight hours of sleep.

13. Research has shown that working out during the day can help you fall asleep faster and
sleep better, overall, so your new exercise habit may actually make this easier. To make
a permanent change in your sleeping patterns, begin shifting your bedtime up 15
minutes every night and setting your alarm for 15 minutes earlier, until you've reached
your goal times.
20. Rise in the morning earlier
Set your alarm and lay out everything you need for your morning workout . Switch on a
lamp as soon as your alarm goes off. Working out at the same time every day may help
you improve more quickly, a study from the University of North Texas found, and other
research has shown that people who exercise in the morning are more likely to stick
with their workout than those who exercise later in the day. Do not use the snooze
button: Research suggests that those extra few minutes in bed may actually make you
more tired.
Recommended App for Physical Fitness Program
7 MINUTE WORKOUT
This recommendation is from a program that is scientifically based and has
flexibility and intensity for all levels of fitness and age groups.
The app is available, free and reputable. It is called the 7 Minute Workout and is
sponsored by Johnson and Johnson.
Go to the App Store and look for The Official 7 Minute Workout.
The beginner workout is the best place to start. The warm up and cool down
sections are also important to reduce injury and add flexibility to the fitness
benefit.
Basic Exercises (30 seconds each with 10 sec rest intervals)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Jumping Jacks or Jump rope
Wall sit
Push up
Abdominal crunch
Step up or stairs
Squats
Triceps dip
Plank
High knees
10. Lunge
11. Push up with rotation
12. Side Plank

14. • This work out can be done in 7-10 minutes. If you repeat the routine and add the cool
down and stretching it will be a thirty minute time commitment. This kind of workout is
superior to jogging or treadmill because it will not only give you a cardio workout but
will strengthen muscles and increase flexibility and balance.
•
•
•
The workout should be done most days each week.
There a many alternative exercises with more or less demand. These are in the app.
You may progress at your own pace. The key is in consistency and commitment.
Additional cardio workout is good if you have time and you do not have limiting
orthopedic problems. Cardiac workout greater than 40 minutes may be considered
supplemental and can assist in increasing cardiopulmonary fitness and in weight loss
programs.

15. Section 3 - Immunization and Preventative Care
Immunizations:
• You should receive a flu vaccine every year.
• Your doctor may recommend other vaccinations if you have certain medical
conditions, such as diabetes.
• You should have a tetanus-diphtheria booster vaccination every 10 years. If you
have not received a tetanus-diphtheria and acellular pertussis (Tdap) vaccine as
one of your tetanus-diphtheria vaccines, you should have it once.
• You may get a shingles or herpes zoster vaccination once after age 60.
•
Osteoporosis screening:
All men ages 50 to 70 with risk factors for osteoporosis should discuss screening with
their doctor.
Preventive health visit every 2 years until age 50, and then once a year, should include:
Checking height and weight
Screening for alcohol and tobacco use
Screening for depression
Routine diagnostic tests are not recommended.
Prostate cancer screening:
Most men age 50 or older should discuss screening for prostate cancer with their health
care provider. African-American men and those with a family history of prostate cancer
should discuss screening at age 45.
During screening, a PSA blood test is done.
Section 4 - Nutrition for Aging Adults
This web site from the National Institute of Health is a very inclusive and reasonable
approach to good nutrition.
http://www.nia.nih.gov/health/publication/healthy-eating-after-50
Vitamin Supplementation
To be added

16. Section 5 - Sleep and Sleep Hygiene
How much Sleep Do I Need?
Age-related Recommended Amount of Sleep
Newborns
16 – 18 hours a day
Preschool-aged
11 – 12 hours a day
School-aged
At least 10 hours a day
Teens
9 – 10 hours a day
Adults (including the elderly)
7 – 8 hours a day
Sleep needs change with age. Below are sleep guidelines from the National Heart,
Lung, and Blood Institute, although there is no “magic number” as individual sleep
needs vary.
References
http://www.nhlbi.nih.gov/health/health-topics/topics/sdd/howmuch.html
Sleep Hygiene
Poor sleep habits (referred to as poor sleep hygiene) are among the most common
problems encountered in our society. Below are some essentials of good sleep habits.
While many of these points seem like common sense, they are often ignored.
Personal Habits:
Keep a regular fixed sleep schedule – The body “gets used” to falling a sleep at a
certain time, but only if the schedule is fixed. Have the same bedtime and wake time
every day.
Avoid naps during the day – Many people are sleepy by the late afternoon and take
naps during this time. Naps are generally not a bad thing to do, provide you limit the nap
to no more than 30-45 minutes and can sleep well at night. However, in the context of
insomnia, it is recommended to avoid napping to facilitate sleepiness at night.
Avoid television or computer use before bedtime – Television and computer usage are
engaging mediums and do stimulate brain activity which generally delay falling asleep. It
is recommended that television not be in the bedroom. Before bedtime, television and
computer usage should be avoided.
Avoid alcohol 4-6 hours before bedtime – While alcohol has an immediate sleep-
inducing effect, a few hours later as the blood alcohol levels drop, there is a stimulant/

17. wake-up effect. There are also a number of additional health risks associated with
alcohol.
Avoid caffeine 4-6 hours before bedtime – Caffeine is a stimulant. Avoid caffeinated
beverages such as coffee, tea, and sodas, as well as chocolate. Also avoid so-called
energy drinks.
Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime – These affect the ability
to stay asleep.
Exercise regularly, but not immediately before bedtime – Regular exercise can help
deepen sleep. In addition to other health benefits, exercise greatly reduces inflammation
in the body. Although there is little evidence that vigorous exercise immediately before
bedtime may adversely affect sleep. If one suffers from insomnia, try avoiding strenuous
exercise within 2 hours before bedtime.
Sleep Environment
Use comfortable bed/bedding – This may be obvious, but can prevent good
sleep.
Find a comfortable temperature – A cool temperature is often more conducive for
sleep, but too cold or too hot can keep you awake.
Block out ambient light – Eliminate as much light as possible. If people night shift
workers and must sleep during the day, bedroom windows must be blacked out
and a rolled out towel might be used to block light from under the bedroom door
to eliminate ambient light.
Block out distracting noise – Although obvious, some may need to use earplugs
or devices that provide “white noise.”
Reserve the bed for sleep – Do not use the bed as an office, workroom, or
recreation room. The body must be trained to know that the bed is associated
with sleeping. If unable to sleep within 15-20 minutes, do not remain in bed
“trying to get to sleep.” Get out of bed, leave the bedroom, read, have a light
snack, or do some quiet activity. You may find that you can get back to sleep 20
minutes or so later. Do not engage in challenging activity, office work, housework,
etc. Do not watch television.
Getting Ready for Bed
Try a light snack before bed.
Practice relaxation techniques before bed.
Establish a pre-sleep ritual.
Do not take your worries to bed.
Get into your favorite sleeping position.

18. Other Factors
Medical conditions – Conditions like diabetes, obstructive sleep apnea, arthritis,
headaches, acid reflux, and many others can hinder sleep.
Psychological problems – Depression, anxiety, stress, and other psychological
conditions can hinder sleep.
Medications – Many medications can interrupt or hinder sleep.
For any of the above, you may want to consult with a qualified physician.
To help facilitate sleep, a physician may prescribe sleep medications for short-
term relief.
References
Sleep Hygiene. University of Maryland Medical Center, 31 July 2013. <umm.edu/
programs/sleep/patients/sleep-hygiene>

19. Section 6 - Travel Habits: Jet Lag, Airplanes, Meals, and Sleep
Travel and Jet Lag
Symptoms of Jet-Lag
• fatigue
• insomnia
• loss of appetite
• disorientation
• reduced concentration
• reduced aerobic fitness
• reduced anaerobic fitness
• nausea
• GI distress
• joint swelling and stiffness
• muscle pain and stiffness
Jet lag originates in the nerve cells of the hypothalamus, the region of our brain that
regulates temperature, sleep, circadian rhythms, appetite, and hunger.
This part of the brain evolved long before air travel and it responds slowly to changes in
external time and light levels.
Scientists estimate that it’ll take you one full day to recover for every hour of time
difference. So, if you travel from London, UK to New York, USA, expect about five days
until you feel right.
Interestingly, the direction you travel can affect the severity of your jet lag symptoms.
Traveling east is more difficult on the body than traveling west. It seems to be easier for
our bodies to delay our internal clocks than to speed them up.
A 1994 New Zealand survey of international flight attendants found that while they were
used to long-haul travel
90 percent suffered from tiredness over the first five days of arrival;
94 percent experienced a lack of energy and motivation;
93 percent reported broken sleep; and
70 percent had ear, nose or throat problems.
Set your expectations
.
Accept the fact that if you’re crossing several time zones, it will play a role in your travel
no matter what you do, so plan accordingly.
Realize that you may not be at your best for a few days following a long trip, especially if
you flew east. Set your expectations appropriately.

20. Nutrition
In 2002, researchers put fasting to the test with 186 National Guard personnel deployed
across nine time zones. In particular, they tested the Argonne diet protocol (see below)
for its effects on jet lag symptoms.
95 participants used the diet in preparation for their deployment, and 39 used it in
preparation for their return. The rest just followed their regular routine.
Upon deployment, those who followed the Argonne fasting diet were 7.5 times less
likely to experience jet lag upon arrival. Of the 39 who followed the protocol upon their
return, they were 16.2 times less likely to experience jet lag symptoms!
The protocol adopted by this study is a little intense, and can require alternate feasting
and fasting for up to four days before travel, which isn’t necessarily feasible for
everyone.
But Dr. Clifford Saper created a simplified version, which PN’s own Dr. John Berardi has
followed several times when he has to fly across multiple time zones in order to give
presentations.
Modified Argonne Diet Protocol
On your day of travel, eat a normal breakfast and normal lunch. Then fast immediately
before and especially during the flight, while drinking plenty of water to stay hydrated.
Upon arrival, eat soon after landing, as close to local meal time as possible. Then
initiate a normal meal schedule based on local time. Fasting should last at least 14
hours but can last as long as 24 hours. You may need to adjust actual meal times
based on your flight time.
Exercise
Along with carefully timed food intake, exercise can also affect our circadian rhythms.
And when used appropriately, exercise can help to alleviate the symptoms of jet lag.
The best kind of exercise is any kind that you can do outdoors during daylight hours.
Light is the most powerful regulator of our internal biological clocks, so we can use light
cues to help minimize jet lag. Bright light tells the body it’s time to be awake, especially
when combined with movement.
Try to train at the same time you train at home. Interestingly, training at the same time
every day may have little effect on the brain’s biological clock. The main benefit seems
to be that it helps our muscles and peripheral tissues synchronize with the new time
zone.
Supplementation for Jet Lag Correction and Prevention
Melatonin
Melatonin is a hormone secreted by the pineal gland in the brain. One of melatonin’s
key jobs is controlling the body’s circadian rhythm — the internal clock that plays an
important role in when we fall asleep and when we wake up.

21. Melatonin release is tied to the amount of light you experience. Light suppresses its
release. When it gets dark at night and we turn out the lights, melatonin release is
stimulated.
Crossing time zones, we may suddenly find ourselves exposed to excessive light when
ordinarily, it would be our bedtime. Even a three-hour time difference can be significant.
When this happens, our melatonin cycles become disrupted and we experience jet lag
until our circadian rhythms adjust to the new environment.
Research suggests that taking melatonin before leaving for a trip makes jet lag
symptoms even worse. So wait until you land in the new time zone to supplement; this
will significantly reduce jet lag symptoms, improve sleep quality, and increase alertness
and recovery.
Since we know that both light exposure and melatonin supplementation can be used to
shift the human circadian clock, you might wonder what happens when the two
techniques are used together.
One study combined a gradually advancing sleep schedule (where each participant was
wakened one hour earlier each morning for three days) with light exposure upon waking
(to simulate morning light in a new time zone),along with afternoon melatonin (or a
placebo, for those in a control group).
The result? A gradually advancing sleep schedule, morning light exposure, and placebo
caused a 1.7 hour per day shift in participants’ circadian rhythms.
But when melatonin was added to the regime, participants gained a full hour per day in
circadian adjustment, up to ~2.6 hours per day.
Of note, 3 mg of melatonin was no more effective than 0.5 mg of melatonin. In other
words, a very small amount of melatonin could have powerful effects.
Dosage: take from 0.5 mg up to 5 mg of melatonin for three nights (or until adjusted);
one hour before a normal bedtime; and only after you’ve reached your travel
destination.
Pycnogenol
Pycnogenol is another supplement that has been studied for its ability to decrease jet
lag symptoms.
When participants took 50 mg of pycnogenol three times per day for seven days,
starting two days prior to travel, the average duration of jet lag symptoms decreased
significantly.
A control group suffered for 39.8 hours, while those who supplemented with pycnogenol
endured their symptoms for only 18.2 hours.
Why? Perhaps because pycogenol significantly reduced cerebral edema or swelling, as
well as edema of the limbs.
As a result, those who supplemented with pycnogenol had fewer short- term memory
problems, fewer problems with cardiac function and blood pressure, and also reported
far less fatigue
Interestingly, pycnogenol supplementation has also been shown to decrease deep vein
thrombosis and superficial vein thrombosis – common side effects of long flights.

22. Conclusion
Light. Get bright light during your day. You can use an artificial light box if you own one,
or better yet, you can get outdoors. At minimum, you can sit near a window.
Fasting.If you choose to fast, start about 14-24 hours before your next planned meal in
your new time zone.
Melatonin 0.5 mg one hour before sleep after arriving at the destination.
Pycnogenol 50mg three times a day, starting two days before your trip.Continue taking
50 mg of pycnogenol three times per day for up to five days after landing (up to a total
of seven days).
Exercise. Higher intensity workout before your flight to burn some calories and prevent
travel stress. If possible, do this at your usual workout time. Even a few brisk laps
around the airport before boarding will work just fine.Try to exercise outdoors at your
usual workout time. If you prefer to lift weights, you can always lift weights at your usual
time, but try to follow up with a walk outside to get the best of both worlds.
Hydration. Stay well hydrated and continue your fast.
Move during the flight. If possible, get up and move about the cabin often, at least once
every hour to promote blood flow and inhibit swelling.
Avoid alcohol and caffeine because these may affect your circadian rhythms.

23. Section 7 - Prescription Medications and Supplements (Herbals)
Greg Downs
Prescription Medications
All normal prescribed medications should be planned ahead of time of
travel. This should included:
Enough medications in the event of airline disconnect or extended stay at
locations that you may not have access to these medications
Unless there is an unusually large number of medications that you are taking
daily, it would be good to keep them with you as your carry on luggage and not
potentially lost or delayed with your checked in baggage.
You should try to keep on a normal 24-hour cycle with you medications that
require this (for example, Blood Pressure medicines, blood thinners etc). Should
you miss a dose (forgot to take, gastrointestinal issues), do not double up on the
next dose.
If possible, purchase a weekly pill container. This way during your stay, you will
not have to remember if you took a medication,or at what time. The container will
show you. These can be purchased inexpensively at Walgreens or CVS.
However, it is still a good idea to carry you original medication bottles with you as
some customs agents may want to see the pills and prescribing information.
Non-prescription Medications/herbals
Carry non-prescription medications for travel such as:
Anti-gas strips (more light weight than Tums) or acid blockers (Pepcid)
Anti-diarrheal pills such as Imodium (Follow instructions carefully)
Acetameniphen (Tylenol), Enteric-coated Aspirin
Throat lozenges
Antihistamine such as Zyrtec
If you develop diarrhea related to contaminated food or water, please seek
medical help before taking anti-diarrheal pills.
If you have head or nasal congestion before a flight use a nasal decongestant
like Afrin before the cabin doors and shut and prior to the initial decent into an
area. This will equalize congestion between the nose and the ear canal.
CAUTION. For those with elevated blood pressure whether on medications or
not, should use these medication sparingly because this kind of medication can
raise blood pressure precipitously.
Most herbal medications are relatively safe. However, limit the use herbal
medicine to those with well established benefits. Use caution when taking herbal
medicine during travel. If medical assistance is needed please make all
medication including herbals known to the medical providers.
Section 8 - Weight loss and Weight Maintenance - David Vinson
Section 9 - Avoiding Unnecessary Risk, Injury Prevention, and Emergency
Preparedness when Traveling - David Cuthberson
Section 10 - Medical Insurance and Travel Insurance -