Vagus Nerve Stimulation Boosts Post-Stroke Motor Skill Recovery

Vagus Nerve Stimulation Boosts Post-Stroke Motor Skill Recovery

Summary: Vagus nerve stimulation coupled with physical therapy following a stroke can significantly help to boost motor skill recovery, researchers report.

Source: University of Texas at Dallas.

Researchers at The University of Texas at Dallas have demonstrated a method to accelerate motor skill recovery after a stroke by helping the brain reorganize itself more quickly.

In a preclinical study, the scientists paired vagus nerve stimulation (VNS) with a physical therapy task aimed at improving the function of an upper limb in rodents. The results showed a doubled long-term recovery rate relative to current therapy methods, not only in the targeted task but also in similar muscle movements that were not specifically rehabbed. Their work was recently published in the journal Stroke.

A clinical trial to test the technique in humans is underway in Dallas and 15 other sites across the country.

Dr. Michael Kilgard, associate director of the Texas Biomedical Device Center (TxBDC) and Margaret Forde Jonsson Professor of Neuroscience in the School of Behavioral and Brain Sciences, led the research team with Dr. Seth Hays, the TxBDC director of preclinical research and assistant professor of bioengineering in the Erik Jonsson School of Engineering and Computer Science, and postdoctoral researcher Eric Meyers PhD’17.

“Our experiment was designed to ask this new question: After a stroke, do you have to rehabilitate every single action?” Kilgard said. “If VNS helps you, is it only helping with the exact motion or function you paired with stimulation? What we found was that it also improves similar motor skills as well, and that those results were sustained months beyond the completion of VNS-paired therapy.”

Kilgard said the results provide an important step toward creating guidelines for standardized usage of VNS for post-stroke therapy.

“This study tells us that if we use this approach on complicated motor skills, those improvements can filter down to improve simpler movements,” he said.

Building Stronger Cell Connections

When a stroke occurs, nerve cells in the brain can die due to lack of blood flow. An arm’s or a leg’s motor skills fail because, though the nerve cells in the limb are fine, there’s no longer a connection between them and the brain. Established rehab methods bypass the brain’s damaged area and enlist other brain cells to handle the lost functions. However, there aren’t many neurons to spare, so the patient has a long-lasting movement deficit.

The vagus nerve controls the parasympathetic nervous system, which oversees elements of many unconscious body functions, including digestion and circulation. Electrical stimulation of the nerve is achieved via an implanted device in the neck. Already used in humans to treat depression and epilepsy, VNS is a well-documented technique for fine-tuning brain function.

The UT Dallas study’s application of VNS strengthens the communication path to the neurons that are taking over for those damaged by stroke. The experiments showed a threefold-to-fivefold increase in engaged neurons when adding VNS to rehab.

“We have long hypothesized that VNS is making new connections in the brain, but nothing was known for sure,” Hays said. “This is the first evidence that we are driving changes in the brain in animals after brain injury. It’s a big step forward in understanding how the therapy works — this reorganization that we predicted would underlie the benefits of VNS.”

In anticipation of the technique’s eventual use in humans, the team is working on an at-home rehab system targeting the upper limbs.

“We’ve designed a tablet app outlining hand and arm tasks for patients to interact with, delivering VNS as needed,” Meyers said. “We can very precisely assess their performance and monitor recovery remotely. This is all doable at home.”

Expanding the Possibilities for Therapy

The researchers are motivated in part by an understanding of the practical limitations of current therapeutic options for patients.

“If you have a stroke, you may have a limited time with a therapist,” Hays said. “So when we create guidelines for a therapist, we now know to advise doing one complex activity as many times as possible, as opposed to a variety of activities. That was an important finding — it was exciting that not only do we improve the task that we trained on, but also relatively similar tasks. You are getting generalization to related things, and you’re getting sustained improvement months down the line.”


For stroke patients, the opportunity to benefit from this technology may not be far off.

“A clinical trial that started here at UTD is now running nationwide, including at UT Southwestern,” Kilgard said. “They are recruiting patients. People in Dallas can enroll now — which is only fitting, because this work developed here, down to publishing this in a journal of the American Heart Association, which is based here in Dallas. This is a homegrown effort.

“The ongoing clinical trial is the last step in getting approved as an established therapy,” Kilgard said. “We’re hopefully within a year of having this be standard practice for chronic stroke.”


Funding: his research was funded by the National Institutes of Health. Other UT Dallas researchers involved include Dr. Robert Rennaker, director of the TxBDC, Texas Instruments Distinguished Chair in Bioengineering and chairman of the Department of Bioengineering; research assistant and Green Fellow Elaine S. Lai, research assistant Bleyda R. Solorzano BS’14 and neuroscience senior Justin James.

Source: Stephen Fontenot – University of Texas at Dallas
Publisher: Organized by
Image Source: image is credited to Manu5. Licensed CC BY SA 4.0.
Original Research: Abstract for “Vagus Nerve Stimulation Enhances Stable Plasticity and Generalization of Stroke Recovery” by Eric C. Meyers, Bleyda R. Solorzano, Justin James, Patrick D. Ganzer, Elaine S. Lai, Robert L. Rennaker, Michael P. Kilgard, Sand eth A. Hays in Stroke. Published online January 25 2018.


University of Texas at Dallas “Vagus Nerve Stimulation Boosts Post-Stroke Motor Skill Recovery.” NeuroscienceNews. NeuroscienceNews, 28 March 2018.


Vagus Nerve Stimulation Enhances Stable Plasticity and Generalization of Stroke Recovery

Background and Purpose—Chronic impairment of the arm and hand is a common consequence of stroke. Animal and human studies indicate that brief bursts of vagus nerve stimulation (VNS) in conjunction with rehabilitative training improve recovery of motor function after stroke. In this study, we tested whether VNS could promote generalization, long-lasting recovery, and structural plasticity in motor networks.

Methods—Rats were trained on a fully automated, quantitative task that measures forelimb supination. On task proficiency, unilateral cortical and subcortical ischemic lesions were administered. One week after ischemic lesion, rats were randomly assigned to receive 6 weeks of rehabilitative training on the supination task with or without VNS. Rats then underwent 4 weeks of testing on a task assessing forelimb strength to test generalization of recovery. Finally, the durability of VNS benefits was tested on the supination task 2 months after the cessation of VNS. After the conclusion of behavioral testing, viral tracing was performed to assess synaptic connectivity in motor networks.

Results—VNS enhances plasticity in corticospinal motor networks to increase synaptic connectivity to musculature of the rehabilitated forelimb. Adding VNS more than doubled the benefit of rehabilitative training, and the improvements lasted months after the end of VNS. Pairing VNS with supination training also significantly improved performance on a similar, but untrained task that emphasized volitional forelimb strength, suggesting generalization of forelimb recovery.

Conclusions—This study provides the first evidence that VNS paired with rehabilitative training after stroke (1) doubles long-lasting recovery on a complex task involving forelimb supination, (2) doubles recovery on a simple motor task that was not paired with VNS, and (3) enhances structural plasticity in motor networks.

Connie’s comments at

Observations with one of our clients (65 yr old female hispanic) where we sent caregivers for her to help with daily living after a stroke:

We massage (softer in the neck) her head, neck, legs and arms with rosemary and coconut oil. We serve soup daily. We ensured that when she walked , we are at her side. We taught her to move her legs in sitting position. Calming music and soft lights are used.

We ensured that family members give her a hug and kiss and avoid fights and verbal abuse.

She is thriving slowly.

If she was my mom, I would buy whole foods rich in folate and Vitamin B complex, probiotic, CQ10 and omega 3 supplements , sunshine exposure early morn and late afternoon, clean water, and a routine with less clutter, obstruction, confusion and calming environment.

And to remind her deep breathing exercises and bed exercises similar to Pilates.

Email as your health coach ($500 per year, family plan) and to order essential supplements for your heart delivered at your door monthly from Life Extension. Paypal or mail check at 1708 Hallmark Lane San Jose CA 95124. Chase Bank is still processing our merchant service account.

Criteria for Patients to be Discharged from Post-Operative care

•  The patient is fully conscious, responding to voice or light touch, able to maintain a clear airway and has a normal cough reflex
•  Respiration and oxygen saturation are satisfactory (10-20 breaths/minute and SpO2>92%)
•  The cardiovascular system is stable with no unexplained cardiac irregularity or persistent bleeding
•  The patient’s pulse and blood pressure should compare with normal pre-operative values or should be at a level corresponding to planned post-operative care
•  There should be adequate control of pain and vomiting with suitable analgesic and anti-emetic regimens prescribed
•  Temperature should be within acceptable limits (>36°C)
•  Oxygen and fluid therapy should be prescribed when required


Monitoring of patients allows routine data to be collated and trends established, therefore making it more straightforward to detect any clinical deterioration. It also allows a patient’s response to treatment to be evaluated. Common parameters include temperature, pulse rate, blood pressure, respiratory rate, urine output, peripheral oxygen saturation and pain scores [2].

These variables should be measured multiple times during the day, depending on the type of surgery involved. Other examples of monitoring include ECGs, arterial blood gas analysis (ABGs) and central venous pressure (CVP) monitoring [23]. In addition, assessment of drainage and bleeding should also be performed routinely [24].

Cardiovascular Monitoring

As the main significant post-operative complications in general surgical patients are cardiovascular and respiratory in nature, it is sensible that cardiorespiratory monitoring be made a priority [25]. In general, maintaining a patient’s heart rate and blood pressure within normal limits will result in a satisfactory outcome. However, there are no clinical studies to indicate what is normal with respect to heart rate and blood pressure for individual patients in the post-operative period [2].

Hypertension is common post-operatively and can be due to various causes including pain, anxiety and discontinuing antihypertensive medication. Guidelines by The American College of Cardiology/American Heart Association [26] recommend deferring surgery if the diastolic pressure is above 110 mm Hg and systolic is above 180 mm Hg. No such guidelines exist in the UK however.

Hypotension is also common post-operatively and has been defined as a systolic blood pressure below 90 mmHg [27]. Causes include hypovolaemia due to bleeding or dehydration, or drug therapy.

Myocardial ischaemia in the first 48 hours after an operation is the single most important predictor of serious cardiac events, including cardiac death, myocardial infarction, unstable angina, congestive heart failure and serious arrhythmias [2]. High risk procedures with a risk of cardiac event greater than 5% include cardiac and vascular surgery, or major pelvic/GI surgery in the presence of pre-existing vascular disease. The majority of elective orthopaedic surgery is classed as intermediate risk, with a cardiac risk of less than 5% [28].

Respiratory Monitoring

Pulmonary complications are an important and common cause of post-operative morbidity and mortality and are particularly common after major abdominal and thoracic surgery. Risk factors for the development of post-operative pulmonary complications include high body mass index (BMI), smoking status and the presence of COPD [29]. Others include pre-operative respiratory illnesses, Intensive Care Unit (ICU) stay and mechanical ventilation in the post-operative period [30]. In order to adequately observe respiratory function and to identify post-operative respiratory complications the respiratory rate, heart rate and conscious level should be monitored routinely. Indicators of respiratory complications include respiratory rate <10 or >25 breaths per minute; pulse rate >100 beats per minute and reduced conscious level.

Patients in whom there is a suspicion of post-operative pulmonary complications should have an arterial blood gas analysis, a sputum culture and ECG. A CXR should be performed on suspicion of major collapse, effusions, pneumothorax or haemothorax. Generally accepted diagnostic criteria for respiratory failure, pulmonary infections and acute respiratory distress syndrome (ARDS) are summarised in Table 33 [2].

Table 3.

Diagnostic Criteria for Certain Respiratory Complications

Post-operative pulmonary complications can therefore be recognised early if vital signs are recorded accurately in the post-operative period. Any deterioration in these values should then necessitate the need for further investigations such as x-rays and ABGs.

Fluids & Electrolytes

The standard principles of fluid balance in the post-operative patient are to correct any pre-existing deficits, to replace unusual losses (e.g. from surgical drains, pyrexia) and to use the oral route wherever possible as there is not infrequently a delay in commencing oral intake after surgery. Particular patient groups susceptible to fluid or electrolyte disturbances include the elderly, those with pre-existing cardiovascular/cerebrovascular/renal disease and patients who have suffered a peri-operative myocardial ischaemic event [2].

In order to detect fluid and electrolyte abnormalities, patients must have their vital signs checked regularly. Hypotension, tachycardia, oliguria, confusion and tachypnoea may all be indications of hypovolaemia but also have other causes, including sepsis. Whenever a post-operative patient is hypovolaemic, it is important that haemorrhage be considered and to actively exclude this before attributing hypovolaemia to another cause [31].

Potential causes of hypovolaemia include haemorrhage, diarrhoea and vomiting, polyuria and fluid losses via drains. On the other hand, causes of fluid overload include excessive intravenous fluid administration and poor renal or cardiac function [32]. This should be avoided as consequences may include pulmonary oedema. It is thus important to regularly check patients’ vital signs when administering intravenous fluids, so that it can be recognised early if the patient is getting too much or too little.


Sepsis is the systemic inflammatory response to infection and represents a progressive response to infection leading to a generalised inflammatory reaction and eventually end-organ dysfunction and/or failure [2]. The development of systemic sepsis in a post-operative patient marks a serious decline in their condition. Therefore, early identification of patients at risk of developing sepsis and subsequent management is paramount [2] (see Table 44). Matot et al. [33] explain that some of the clinical features to look out when identifying sepsis include fever, signs of peripheral vasodilation, altered mental state, leucocytosis/neutropenia and unexplained tachycardia, tachypnoea or hypotension. Early identification and appropriate treatment of sepsis improves outcome [34]. Without prompt intervention, severe sepsis may ensue, which has a mortality rate of 20-50% [35].

Table 4.

Systemic Inflammatory Response Syndrome: SIRS

Neurovascular Assessment

Following shoulder surgery, particularly highly invasive procedures such as total shoulder arthroplasty, reverse shoulder arthroplasty, or hemiarthroplasty, a thorough neurovascular assessment should be conducted. Circulation, sensation and movement (CSM) are evaluated by assessing the shoulder, elbow and wrist [20]. Motor and sensory examination findings may be difficult to determine in the immediate post-operative period however, as regional blocks are frequently used. As a result, regular assessments are encouraged to demonstrate return of function. Assessment of all major nerves of the upper limb should be conducted, including the axillary nerve which is the most common nerve to be injured during shoulder surgery [36].

Pain Control

Post-operative pain can have a significant effect on patient recovery. Since the introduction of Patient-Controlled Analgesia (PCA) in the early 1980s, the daily management of post-operative pain has been enhanced. Patients using PCAs administer and titrate the dose to their own needs using a small microprocessor-controlled pump. Morphine is the most commonly used intravenous drug for PCA, however other opioids have been used. The most frequently observed adverse effects of opioid-based PCA are nausea and vomiting, pruritus, respiratory depression, sedation, confusion and urinary retention [37].

Other options available for post-operative analgesia include intrathecal and epidural analgesia. These may be provided either by using opioids, local anaesthetics or a combination of both. Intrathecal opioids are relatively straightforward to administer and can provide pain relief for twenty four hours or more after a single injection of intrathecal morphine. Epidural analgesia has been shown to be more effective than parenteral opioid administration and intravenous PCA for major surgery [38]. However, this route of administration increases the risk for complications related to the indwelling epidural catheter, including dislodging, kinking or migration within the epidural space.

Opioids are commonly used in the post-operative period. Commonly used agents include morphine, fentanyl and pethidine. Intravenous infusion administration results in a more constant blood level however [39]. Oral opioids can be very effective and can be used to rapidly wean a patient off parenteral therapy, thereby allowing earlier discharge from the hospital. Oxycodone as a controlled-release tablet can provide good pain control for up to 12 hours.

Other methods of providing analgesia also exist. A Cochrane review in 1998 concluded that paracetamol can be used for post-operative pain relief. Several reviews have since supported this, suggesting that paracetamol can provide effective pain relief for up to four hours post-operatively with few adverse side effects [40, 41]. Non-steroidal anti-inflammatory drugs (NSAIDs) can also be added to opioid treatment post-operatively as this can reduce morphine requirements and opioid-related side effects in the early post-operative period [42].

Wound infiltration with a local anaesthetic is a simple, safe, and attractive technique in the control of post-operative pain. Several randomised, controlled studies involving minor surgical procedures have discovered that wound infiltration with local anaesthetic provides superior analgesia, better pain scores, and superior reduction in opioid consumption compared with placebo [43, 44]. Long-acting local anaesthetics such as ropivacaine or bupivacaine are preferred as the analgesic effect is longer.

Interscalene brachial plexus blocks, either alone or combined with a general anaesthetic, are also a useful technique which can be employed to provide excellent post-operative analgesia for patients undergoing shoulder surgery [45]. Fredrickson et al. in 2010 [46] discovered during their review that continuous interscalene block incorporating a local anaesthetic infusion combined with PCA is the most effective analgesic technique following both major and minor shoulder surgery.


Thromboprophylaxis after elective shoulder surgery is a debatable issue as venous thromboembolic events (VTE) are so rare. There are no large-scale randomised trials published on rates of VTEs, although these are thought to be very low. The risk of a pulmonary embolism (PE) ranges from 0.2% to 2% in the literature with mortality rates of 1% [47]. Jameson et al. [47] discovered that since the introduction of NICE guidelines in 2007 recommending the use of chemical agents in shoulder surgery, rates of VTE events did not change. As such, chemical VTE prophylaxis may not be required in shoulder surgery. Despite this, NICE continues to recommend thromboprophylaxis for high-risk shoulder surgery, extrapolating data from hip and knee replacements.

Exercise beyond menopause: Dos and Don’ts

With a significant number of women belonging to the status of menopause and beyond, it is imperative to plan a comprehensive health program for them, including lifestyle modifications. Exercise is an integral part of the strategy. The benefits are many, most important being maintenance of muscle mass and thereby the bone mass and strength. The exercise program for postmenopausal women should include the endurance exercise (aerobic), strength exercise and balance exercise; it should aim for two hours and 30 minutes of moderate aerobic activity each week.

Every woman should be aware of her target heart rate range and should track the intensity of exercise employing the talk test. Other deep breathing, yoga and stretching exercises can help to manage the stress of life and menopause-related symptoms. Exercises for women with osteoporosis should not include high impact aerobics or activities in which a fall is likely.

The women and the treating medical practitioner should also be aware of the warning symptoms and contraindications regarding exercise prescription in women beyond menopause. The role of exercise in hot flashes, however, remains inconclusive. Overall, exercising beyond menopause is the only noncontroversial and beneficial aspect of lifestyle modification and must be opted by all.


The most remarkable demographic change observed in the new millennium is the increased life expectancy of women in India. It is estimated that by the end of 2015, there will be 130 million elderly women in India, necessitating a substantial degree of care.[1] Menopause brings in a whole lot of changes in the body of women and in most of them leads to troublesome symptoms namely vasomotor, sleep disturbances, fatigue, aches and pains, altered cognitive functions, genitourinary problems like vaginal dryness, irritation, recurrent urinary tract infections, and weakness of connective tissue supporting the pelvic viscera.[2] All these short and medium-term effects influence the quality of life of these women adversely. Long-term sequelae, such as, osteoporosis, sarcopenia, pathological neurological problems and cardiovascular events also tend to increase.[3] The lack of estrogen beyond menopause also compounds the cardiovascular disease risk factors from a female to a male pattern. This puts these women at an equal risk of coronary heart disease as their male counterparts.

The problems arising due to the hypo-estrogenic status should be managed by planning a good health program strategy, involving lifestyle modifications. A short-term hormone therapy in minimum doses is recommended exclusively for symptomatic women, after proper counselling.[4,5] It is the mainstay of the treatment of vasomotor symptoms and is proclaimed to be comparatively safe in women of 50 to 59 years of age.[6] The same may not hold true for older women. There has been a marked controversy in the menopausal hormone therapy following the publication of Heart and Estrogen/progestin Replacement (HERS),[7] Women’s Health Initiative (WHI)Trial[8] and Million Women Study (MWS).[9] This has led to polarization of opinion regarding hormone therapy all around the world. The acceptance of hormone therapy is quite low in India.

The social scenario of senior women in our country is sadly that of reduced activity. Women often exercise less when they enter menopause, which can lead to weight gain. To further complicate matters, the metabolism is also decreased. One reason of this metabolism decline with age is the loss of muscle mass (about half-a-pound a year). Muscle burns more calories than fat, so whenever the muscle is not preserved with weight training exercise, the body simply does not burn as many calories. There is also a tendency to increase the intake of calories. As the metabolism drops, many women do not adjust their calories accordingly, which often leads to weight gain. The prevalence of the metabolic syndrome is reported to be significantly higher in postmenopausal women in India.[10] Finally, the role played by the genetics has also got to be emphasized. The genetic makeup and the site predisposed to inches gain and storage of fat also plays a role in weight gain, making it more difficult to control.

Despite all the physiological changes, menopause should not be viewed as a sign of impending decline, but rather a wonderful beginning of a good health program including lifestyle changes in diet, exercise, including yoga and limiting smoking as well as alcohol.


The most important, noncontroversial and simple thing everybody can and should do is to exercise. The benefits are-

  1. Exercise increases the cardiorespiratory function. If done regularly, it reduces the metabolic risks associated with declining estrogen. It increases HDL, reduces LDL, triglycerides and fibrinogen. There is an additional benefit of a reduced risk of high blood pressure, heart attacks, and strokes.
  2. Exercise can help create a calorie deficit and minimize midlife weight gain.
  3. It increases the bone mass. Strength training and impact activities (like walking or running) can help to offset the decline of bone mineral density and prevent osteoporosis.[12]
  4. It also reduces low back pain.[13]
  5. It is proven to help reduce stress and improve the mood.[14]
  6. It may help to reduce hot flashes, thereby minimizing the “Domino effect.”

Although no conclusive evidence was derived from randomized controlled trials on whether exercise is an effective treatment for reducing hot flushes and night sweats in menopausal women, the latest Cochrane review did find a weak trend for exercise to be more effective than no intervention.


It is never too late to start exercising. The key is to start slowly and do things one enjoys such as walking, cycling, vigorous yard work, swimming, cardio machines or attending group fitness classes. Regular exercising can help in improving the overall wellbeing. Even moderate physical activity like simply moving the body enough to get the heart pumping brings great health benefits including more energy. The activity should be fast enough to get the heart pumping without being out of breath or exhausted.

To determine the maximum heart rate for exercise one has to subtract the woman’s age from 220. For the target heart rate range, multiply maximum heart rate by 50/100 and 80/100. When starting an exercise program, aim at the lowest part of the target zone (50 percent) during the first few weeks. Gradually build up to the higher part of the target zone (75 percent). After six months or more of regular exercise, one may be able to exercise comfortably at up to 85 percent of one’s maximum heart rate.

Women on antihypertensive drugs should be cautioned of the fact that few high blood pressure medications, especially beta blockers, lower the maximum heart rate and thus the target zone rate. Such women should consult their physicians to find out if they need to use a lower target heart rate.

The talk test provides a convenient alternative for tracking the exercise intensity. Moderate intensity exercise, for example walking at 3.5 mph, allows a woman to talk, but not sing and should not be breathless. During vigorous aerobic exercise, such as step aerobics, she should be able to speak a few words, but not carry on a conversation. The benefit of exercising at the target heart rate increases the fitness and conditions the lungs, heart, circulation, and muscles.


Exercises that can help in building and maintaining the bone density and mass are as follows:

Weight bearing, high impact exercises: Includes dancing, high impact aerobics, running / jogging, jumping rope, stair climbing, and sports like tennis, basketball, volleyball or gymnastics. These are best for those who are not osteoporotic, not have low bone mass, and are not frail.

Weight bearing, low impact exercises: Are walking (treadmill/outside), elliptical training machines, stair step machines, and low impact aerobics. This group of exercises may be opted to build bones, by women who cannot do high impact exercises.

Weight or strength training or resistance training exercises: Include lifting weights, using elastic bands or weight machines for exercise, using simple functional movements such as standing or lifting the own body weight.

Nonweight bearing, nonimpact activities: Are cycling, swimming, stretching, and flexibility exercises. These should be included as components of a comprehensive exercise program. Alone these do not help building up the bones.

NonImpact exercises: Involve exercises that help in the balance posture and attitude,for example, T’ai Chi.

Menopause friendly exercise prescription: The exercise program for postmenopausal women should include, endurance exercise (aerobic), strength exercise, and balance exercise. Out of these aerobics, weight bearing, and resistance exercises are all effective in increasing the bone mineral density of the spine in postmenopausal women.[17]

An effective exercise prescription may be resistance and weight bearing exercise three days a week (on alternate days). Care should be taken to do the exercise for all the muscle groups by rotation preferably with a trainer. Brisk walking at the speed of five to six kilometres per hour, cycling, treadmill, gardening or dancing may be done on the remaining days of the week.[18]

Warming up beforehand can help to reduce exercise related injuries and pain following exercise. One should aim for two hours and 30 minutes of moderate aerobic activity each week. Other deep breathing, yoga, and stretching exercises can help to manage the stress of life and menopause-related symptoms.


Step 1: Stretch, walk on a treadmill for five minutes or go for a brisk walk to get ready for exercise. As owing to age, the body becomes less flexible, it is important to warm up the body before a work out.

Step 2: Engage in aerobic activity that elevates the heart rate and burns fat. Whether it is a dance class, aerobics class, going for a run or a bike ride, signing up for kickboxing or taking time on an elliptical machine, each helps to benefit the large muscle groups and helps the cardiovascular function.

Step 3: Lift weights, use resistance bands or try body weight strength training in order to keep the bones strong. Menopause is a common time for women to experience a loss of bone density or osteoporosis. They have to aid in keeping their bones strong by keeping the muscles strong. Strength training also can help to rev up the decreasing metabolism and help in burning the fat, even while resting, to avoid the dreaded menopausal weight gain.

Step 4: Foster better flexibility by trying workouts that cause the stretching of muscles, such as yoga and Pilates. This can promote better muscle function. The woman must take time for yoga and meditating each night to reduce some of the anxiety that also is a common symptom of menopause.

Step 5: Cool down at the end of a workout by walking for a few minutes and stretching to relieve any pain as a side effect from a particularly gruelling workout. This gives the body a chance to relax and promotes regular breathing and a slowing of the heart rate as one finishes exercising for a healthy end to this menopausal friendly workout.

The best regimen

A regimen of twice a day calcium citrate supplementation (800 mg) and resistance training three times a week improves bone density in postmenopausal women, whether or not the women is taking estrogen. By taking simple steps including eating a balanced diet with plenty of calcium and Vitamin D, and engaging in weight bearing exercise, the risk of osteoporosis can be reduced in the typically vulnerable areas of the spine and hip using six core exercises:

  1. Wall or smith squat
  2. Lat pull down
  3. Leg press
  4. One arm military press
  5. Seated row
  6. Back extension

Description of a few important exercises is as follows:

The squat

The squat is one of the best ways to build and display raw strength. Slap a few plates of iron on the bar, put it across your shoulders, squat until the thighs are parallel to the ground, then stand back up. It sounds simple, but it is one of the most intense exercises there is for increasing bone density. Although many casual lifters prefer a higher rep range, it turns out that alternating between moderate and heavy lifting of six to eight and four to six reps gives the biggest results.

Shoulder press

The shoulder press, lifting a barbell straight over your head, is another way to display impressive strength. The shoulder press is also one of the exercises that most increases bone density. Although doing shoulder presses with dumbbells helps to strengthen the stabilizer muscles. When one is trying to build bone density, weight is what matters most, so find a shoulder press station or a power cage and use a barbell.

Lat pull down

The lat pull down exercises the lats, biceps, and forearms. At the top of the movement, one should feel a good stretch in the lats, just under the arms. Once one gets strong enough, they may consider switching to pull ups, and even weighted pull ups.

Leg press

The leg press allows to test the true strength of the quads, hamstrings, glutes, and calves, without worrying about balance or the lower back. A lot of weight can be moved with this exercise, and that stress, results in an increase of bone mineral density.

Seated row

The seated row includes exercising the similar muscles to the lat pull-down, but also uses the lower back and glutes as stabilizers, and hits the traps. The key to performing this exercise safely is to not sway as one performs the movement. The buttock should lock the body into a comfortable angle at the hips, and that angle should not change.

In each session of workout atleast seven to ten minutes of cardiovascular weight-bearing activity, such as weighted walking, stair climbing, and jogging, and small muscle group exercises involving thera-bands and physio-balls round out the study regimen. The key to achieving the goal of improved bone health is in the intensity of the weight-bearing workout and the level of the resistance training. Progressively increasing the weight lifted and consistently exercising two to three times a week are essential for success.

T’ai chi

This is the most commonly practiced balance exercise. T’ai Chi Ch’uan techniques are said to physically and energetically balance yin (receptive) and yang (active) principles: ‘From ultimate softness comes ultimate hardness.’

The core training involves two primary features: the first being the solo form, a slow sequence of movements that emphasize a straight spine, relaxed breathing, and a natural range of motion; the second being different styles of pushing hands, for training sensitivity in the reflexes through various motions from the forms, in concert with a training partner, in order to learn leverage, timing, coordination, and positioning, when interacting with another.

The participants are taught not to fight or resist an incoming force, but to meet it in softness and ‘stick’ to it, following its motion, while remaining in physical contact until the incoming force of attack exhausts itself or can be safely redirected the result of meeting yang with yin. Done correctly, achieving this yin/yang or yang/yin balance in combat (and, by extension, other areas of one’s life) is the primary goal of T’ai Chi Ch’uan training. ‘The soft and the pliable will defeat the hard and strong.’ There is also an emphasis in the traditional schools on kindheartedness. One is expected to show mercy to one’s opponents.

T’ai chi training may help those suffering from osteoarthritis by strengthening the joint musculature and increasing the range of motion and flexibility, and may be used as an adjunct to the standard treatment.[20]

Impact of exercise on bone mineral density

Bones become strong when the muscles attached to them become strong. Bone changes are slow, much slower than strength changes. If high load and low rep routines of compound exercises are used, these stimulate muscle development around the hips, spine, and arms, building bone strength in those vulnerable areas and throughout the body. Even if the BMD is not improved as measured by the dexascan, resistance training with adequate intensity will dramatically lower the lifetime fracture risk.

The maximal load is most relevant in BMD changes, not the load frequency. A small number of loading cycles work best. The trabecular bone of the spine remodels more rapidly than the cortical bones of the hip and wrist.[21,23] The intensity with which the exercise is performed bears a direct correlation to the increase in the BMD.[24] It can take four to six months or more for the bone to remodel under the best conditions, and the measurable effects of exercise may only be apparent years later.[25] On the other hand BMD increases have been reported using just five resistance exercises, hip extension, knee extension, lateral pull-down, back extension, and abdominal flexion (3 × 8 at 80% 1RM) twice a week for one year.[26]

In India, the Indian Council of Medical Research (ICMR) has reported a significant centerwise difference in BMD.[27] The paradox of lower fracture rates among the IndoAsian population than those in caucasian women, despite lower skeletal mass at maturity in the former group, has also been noted.[28] This has led to the suggestion of the potential need of measuring bone mineral apparent density (BMAD) in Indian Women.[29]

What not to do

Although all postmenopausal women should be encouraged to employ lifestyle practices including appropriate exercises that reduce the risk of bone loss and osteoporotic fractures, these exercises for women with osteoporosis should not include high-impact aerobics or activities in which a fall is likely, such as exercising on slippery floors or step aerobics. Activities requiring repeated or resisted trunk flexion, such as sit-ups or toe touches, should also be avoided because of the increased loads placed on the spine during such activities that may result in spine fracture.[30]

Another factor for consideration is when to stop exercising? This is indeed a warning to all the women. Senior women should know how to read the signs of their body. One should make it a point not to ignore the signals of overwork, which may lead to major issues like heart attack and injury. If there is any problem while exercising, it is better to stop exercising and change the exercises. Care should also be taken not to practice excessive exercise without adequate caloric and protein intake.

When should they avoid exercise? Certain medical conditions absolutely negate exercise. These conditions include:

  • Recent electrocardiogram changes or recent myocardial infarction
  • Uncontrolled arrhythmia
  • Unstable angina
  • Third degree heart block
  • Acute progressive heart failure

There are other conditions that would contraindicate exercise on a case by-case basis, and should not be done unless there is medical approval. These conditions include:

  • Elevated blood pressure
  • Cardiomyopathy
  • Valvular heart disease
  • Complex ventricular ectopy
  • Uncontrolled metabolic disease.


Women can enjoy a good quality of life after menopause even without hormones. Research indicates that postmenopausal women who engage in the comprehensive exercise program, benefit by maintaining a healthy body, bone density levels, and good mental health. Osteoporosis, the greatest ailment in older women, can be kept under control with exercise. Even a moderate exercise schedule can not only keep the weight in check, but it also lowers the risk of stress, anxiety, and depression, all of which tend to show up liberally during and beyond menopause. Exercise works by improving muscle mass, strength, balance, and coordination. Therefore, unlike treatment with medicine, exercises work simultaneously on various aspects of one’s health. The role of exercise in hot flashes, however, remains inconclusive.

Connie’s comments: I love my coaches at NC Fit in the bay area for my 30-minutes cross-fit training every day. Join and do mention my name. It is worth it. You sweat, have a coach, and I only do it for 30min every day for $60 per month with a coach.

Why women between ages 40-60 wanted to look young

Women between the ages of 40-60 yr old wanted to look young.  It is also during this time that they experience pre and post menopausal years. Menopause years is between 48-52 yrs old , plus or minus 4 yrs depending on the woman’s health and stress levels. During this time, 40-60 yr old women experience loss of love one, caring for their parents, divorced, raising teens, in menopause and doing volunteer work or working more than 2 jobs if they live in the bayarea or other third world countries.

It is not a joke that many women do more during these years because their hormones are experiencing the high and low of hormonal changes.  The brain is also in high overdrive, especially when bombarded with medications, diet, stress, lack of sleep and brain chemicals that changes as we age. Our levels of melatonin, sleep hormone, is also lower.

We try to please everyone, accomplish at lot of things in a short amount of time and getting another college education or going after a new career. Our children are also demanding more of our time and energy.

With all these factors affecting the aging women of today, many women flock to spa and salon for facial, skin detox, weight loss, and other ways to feel good.

So, if you feel like looking young, here are some of the things that other women does:

1. anti-aging skin care for face

2. shark liver oil, sesame oil , calendular oil and avocado for skin

3. body and foot massage

4. hours in the gym, yoga, bellydance, ballroom and pilates juices, fasting, detox with veggies only and dieting

6. and many more


Connie Dello Buono, anti-aging skin care independent consultant



PS. Women put their emotion in most things they do. Giving and positive intention provide happiness for them. Women believe that life without emotion (love and hate) is dull and boring and not worth living for.

Tips for sleep: valerian tincture, melatonin, calcium and magnesium with Vit D and C
for hormonal balance: evening primrose oil, multi-vitamin, green juice with beets, cherries and colored fruits and veggies
for brain: coconut, nuts, olive oil and fish
for skin: Vit E, D, A and C
for hair: biotin and protein
for sexual energy: protein, nuts (pine, pistaccio, pecans and peanuts), cassava, amino acids, probiotics
for bones: zyflamend, yellow foods, lemon grass, herbs, MSM and glucosamine , Vit D and C
for heart: garlic, yellow and sulfur containing foods, fish oil, red and colorful foods, lemon, Vit C and D, calcium and magnesium, greens

To reduce stress:
Vow to think only happy thoughts and make yourself happy each day.
Simplify your life, avoid clutter, lessen responsibilities and tasks, delegate and live in practical and simple ways.
Be debt-free, spend less, save more and be with people who are practical and happy.