Wednesday, March 30, 2016

Exercise Makes Our Muscles Work Better With Age - by Gretchen Reynolds - NY Times, March 30 2016

To keep our muscles healthy deep into retirement, we may need to start working out more now, according to a new study of world-class octogenarian athletes. The study found substantial differences at a cellular level between the athletes’ muscles and those of less active people. 

Muscular health is, of course, essential for successful aging. As young adults, we generally have scads of robust muscle mass. But that situation doesn’t last. 

Muscles consist of fibers, each attached to a motor neuron in our spinal column by long, skinny nerve threads called axons. The fiber and its neuron are known as a muscle unit. 

When this muscle unit is intact, the neuron sends commands to the muscle fiber to contract. The muscle fiber responds, and your leg, eyelid, pinky finger or other body part moves. 

However, motor neurons die as we age, beginning as early as in our 30s, abruptly marooning the attached muscle fiber, leaving it disconnected from the nervous system. In younger people, another neuron can come to the rescue, snaking out a new axon and re-attaching the fiber to the spinal cord.

But with each passing decade, we have fewer motor neurons. So some muscle fibers, bereft of their original neuron, do not get another. These fibers wither and die and we lose muscle mass, becoming more frail. This process speeds up substantially once we reach age 60 or so.

Scientists have not known whether the decline in muscular health with age is inevitable or whether it might be slowed or altered.
There have been encouraging hints that exercise changes the trajectory of muscle aging. A 2010 study of recreational runners in their 60s, for instance, found that their leg muscles contained far more intact muscle units than the muscles of sedentary people of the same age. 

But whether exercise would continue to protect muscles in people decades older than 60, for whom healthy muscles might be the difference between independence and institutionalization, had never been examined. 

So for the new study, which was published last week in the Journal of Applied Physiology, researchers from McGill University in Canada and other schools contacted 29 world-class track and field athletes in their 80s and invited them to the university’s performance lab. They also recruited a separate group of healthy but relatively inactive people of the same age to act as controls.
At the lab, the scientists measured muscle size and then had the athletes and those in the control group complete a simple test of muscular strength and function in which they pressed their right foot against a movable platform as forcefully as possible. While they pressed, the scientists used sensors to track electrical activity within a leg muscle. 

Using mathematical formulas involving muscle size and electrical activity, the scientists then determined precisely how many muscle units were alive and functioning in each volunteer’s leg muscle. They also examined the electrical signal plots to see how effectively each motor neuron was communicating with its attached muscle fiber. 

Unsurprisingly, the elite masters athletes’ legs were much stronger than the legs of the other volunteers, by an average of about 25 percent. The athletes had about 14 percent more total muscle mass than the control group.

More interesting to the researchers, the athletes also had almost 30 percent more motor units in their leg muscle tissue, and these units were functioning better than those of people in the sedentary group. In the control group, many of the electrical messages from the motor neuron to the muscle showed signs of “jitter and jiggle,” which are actual scientific terms for signals that stutter and degrade before reaching the muscle fiber. Such weak signaling often indicates a motor neuron that is approaching death. 

In essence, the sedentary elderly people had fewer motor units in their muscles, and more of the units that remained seemed to be feeling their age than in the athletes’ legs. 

The athletes’ leg muscles were much healthier at the cellular level.
“They resembled the muscles of people decades younger,” said Geoffrey Power, who led the study while a graduate student at McGill and is now an assistant professor at the University of Guelph in Ontario. 

Of course, this type of single-snapshot-in-time study can’t tell us whether the athletes’ training actually changed their muscle health over the years or if the athletes were somehow blessed from birth with better muscles, allowing them to become superb masters athletes. 

But Dr. Power, who also led the 2010 study, said that he believes exercise does add to the numbers and improve the function of our muscle units as we grow older.

Whether we have to work out like a world-class 80-year-old athlete to benefit, however, remains in question. Most of these competitors train intensely for several hours every week, Dr. Power said. But on the plus side, some of them did not start their competitive regimens until they had reached their 50s, providing hope for the dilatory among us.

Saturday, March 26, 2016

How I Rationalize My Athletic Failures

As I age (and age and age) I have a new ally in my many shortcomings: rationalization

"I'd do better but I'm an `older athlete,' so that's o.k."

And then a patient, Cheshire smile.  (Now slowly blink your eyes and pat your belly).

Greying hair turning silvery white adds a sort of distinction to getting worse and worse and worse. Isn't that a dirty trick!

While wishing I were in the Olympics but searching for a way to let myself off the hook I came upon this interesting essay:
------
Against Athletic Pride

 
Brian Jay Stanley

Watching Olympic swimmers paddling through the water with gangly legs and arms, heaving their heads up for air, unequipped with fins or gills, I question the pride of the champions.

Goldfish in an aquarium move more gracefully.

Is not a contest of humans swimming like a contest of fish running?

If animals competed in the Olympics, few humans would win medals.
  • An elephant or rhinoceros would hurl our strongest wrestlers from the mat like plastic dolls.
  • Our fastest sprinters would lose the 50-meter dash to their cats.
  • Schools of sardines would dominate synchronized swimming.
Feats of intellect should be accorded more honor than feats of athleticism.

To be an Einstein is to comprehend more of physics than any other mind in the known universe. But to win a gold medal in the Olympics is merely to stand atop one's narrow class of competitors, human beings, who share the same evolutionary handicaps.

The Olympics are really the Special Olympics.


------

Being old enough to find one's own history filed away in a folder in the National Archives (true) puts a new spin on cycling event records. When I turned 60 I was elated. Now I could be at the back of the pack and still be `first' in my age-category. "(F)or his age category" always followed "And a new record was set by Dan Fallon."

Like I have said many times in the past: I'm special. (Given my age).

`Getting old' vs. Aging

The community in which I live has a `common house' that we jointly fund and use for many good purposes. When we moved here last year I brought all my indoor training equipment and set it up in a designated room in the `common house.' My motives were self-interest and communitarian. That is, I didn't want to take up space in my own house with this armamentarium of equipment but wanted it to be nearby and free to use.

The community neighbors were delighted to have the equipment: Concept2 indoor rower, Solex Elliptical, indoor bicycle on a wind-resistance trainer, a set of free weights, and a bunch of mats, etc.

They wanted assistance in learning how best to use the equipment.

We have a lot of kids and their working parents here. The kids don't use the stuff. Their parents use it irregularly when time permits. But the older, often semi- or fully retired folks have a real interest in the equipment.

None of the community users are athletes. They use the equipment for 30 minutes every other day or so. They asked me for an `orientation' to the equipment and if I'd be the community person available for instruction, etc....

As folks age their `parts' start to give them trouble. Unless there is deliberate and disciplined attention to working to stay fit we will all just seize up and become sedentary.

And that is the very definition of `getting old' to 99% of us: seizing up and becoming sedentary.

That is, an increasingly submissive giving-in to predictable physical impediments. 


 The `getting old' spiral cycle is as follows:

  1. Ouch! that hurts!
  2. I won't do THAT again.
  3. Next time I have to get up to do something I won't do it because it hurts.
  4. I sit more.
  5. I move less.
  6. I become known to myself as `not able.'
  7. I eat more.
  8. I drink more.
  9. I shuffle around more.
  10. I lose fitness (muscle mass, flexibility, cardiovascular capacity, stamina).
  11. My body decides on it's own that I want to slowly `die' down.
  12. I get sick.
  13. I take `fake it' pills (that trick my organs into not dieing so fast).
  14. I get fat.
  15. Now that I'm fat it's even harder to move!
 
And so the descent into the spiraling cycle of decrepitude  continues.

It's a `psychology' of voluntary withdrawal from life. And the emotional anxiety it generates within us requires effort to deal with.

In otherwords, `getting old' and decrepit is hard work and we earn every debility we accomplish!   It is NOT a simple function of the passage of time.   We `choose' decrepitude. 
 
Aging is not for sissies. It requires clear-headed vigilance and a more mature commitment than just coasting along on the inertia that youth gives us. 


Aging isn't about getting weak and fragile. It's an opportunity! We can exploit this opportunity and gain enormous satisfaction in doing so.  Goals. Methods. Discipline. Consistency. The strength and resilience to persist through predictable setbacks.

You just can't ask for anything better.

And here is recent scientific support for the proposition that endurance activity makes for 
an ever-smarter brain.

So, when I orient and `coach' the older neighbors I tell them that they should get the hell out of the exercise room and use the immensely challenging terrain around us.  

BUT, when they do need to use the indoor equipment their focus should be on: building balance, cardiovascular capacity, muscle and stamina.

So ... indoor training on rollers is good for aging folks because it trains our
balance and the vestibular system. 

Same with the elliptical. Get on the elliptical and don't use your hands or arms. Just use your legs. You'll find that you'll need all the micromuscles in your legs and core to stay balanced and upright while you're `ellipting' along.

The indoor rower adds upper body strength, `lubricates' and `flexibilizes' the feet, ankles, knees, hips, core, lower back, chest, hands, wrists, elbows, shoulders, arms. 

More on motivation ...

(I ride without music.  Part of it has to do with safety.  Part of it has to do with the fact that, after a while, it's like chewing dead chewing gum.  At least half my reason for no music is because I get a chance to think about things.) 

Yesterday, on an 8 hour ride, a few things came together for me about my own motivation. 

I entered three 24 hour races in the past 12 months and finished none of them.  If nothing else, I spent a lot of money traveling places just to DNF. 

I didn't feel the least bit `bad' about DNF'ing three big events in a row.  THAT is what really got me thinking about motivation.

Why did I put all that time and money into something that, when I DNF'd, it wasn't a problem?

On two of the 24 hour events my DNF was, what I consider, `legitimate.  That is I didn't have the physical resources to finish (another story).  However, this last February was different.  I stopped after 14 hours because `it wasn't worth it.' 

Not `worth' it?!

And no sense of disappointment in myself after DNF'ing?!

Here is where you, the reader, may want to stop reading.  Although this is about `motivation' it has to do with MY motivation.  Maybe generalizable to you.  Maybe not.

-----------

Work in process.  That's how I consider myself these days. 

First, I've learned not to be so vulnerable to other's opinion of me or my actions.  We can call it  many things but `maturity' is probably the most accurate. 

Second, my own temperament.  We each have a `temperament' and psychological research suggests that there is a great deal of heritability to temperament.  I have a low tolerance for most people, despite my profession.  When younger I tended to try to change people.  Now, older and more mature, I realize that is disrespectful and pointless.

Finally, I am concerned about what only a very few people think of me or my actions.  (And, if their opinion of me is based on my cycling performance ... we've both made a mistake).

--

Several years ago I gave an interview about why I was doing the Race Across the West - RAW (which I ultimately didn't finish).  The interviewer stated that it was a certainty that I would finish.  I corrected him, stating that "if I knew I could do it I wouldn't."  ?!!

RAW, to me, was an unanswered question.  Did I have it in me to finish?  I found out that I did not have sufficient training to finish.  The lesson was that Ultracycling is harder than I thought.  And if I wanted to be successful at it I would have to devote more time and resources to training.

I subsequently put in more time and devoted more resources to my training.  I completed a few events (including a 24 hour race) that had never been before on a recumbent. 

More important, however, I learned what it takes to successfully complete significant Ultracycling events. 

--

The 24 hour event that I ended after 14 hours because it wasn't `worth it' confirmed to me what I said several years earlier: If I knew I could do it I wouldn't.  I knew that I could successfully complete the 24 hour event.  So I stopped when the `pain v. benefit' equation became apparent. 

Why, then, did I devote so much time and effort to the 24 hour event?

--

So this is what I have learned about myself, so far. 

  • My real motive for the race was `social.' 
  • I wanted to meet the people I had communicated with for years but never `saw.' 
  • I wanted to spend time with a few old friends I missed. 
  • I wanted to see the 24 hour course that so many people had talked about. 
--

What a surprise. 

Surprised because I recognized that the core source of motivation for me is consistent: Only a challenge that is mammoth, the outcome of which I am uncertain, is `worth it.'  ("If I knew I could do it I wouldn't.")

Surprised that I was interested in the people of the event.  A `social' appeal?!  This realization is counter to all the psychological defenses I have built to keep from being hurt by other's opinion of me.  It counters my `hermit' temperament. 

--

So, what am I going to do differently, now that I have conscious awareness of the topography of my motivation?

Well, first, I'm going to admit that I am more social than I have allowed.  Deconstructing some defenses is scary, but `worth it.'

Then I'm going to be more careful about choosing cycling challenges.  It turns out that I live in a location that has no end to cycling challenges.  Is it `worth it' to me to attempt these challenges knowing that social approval and prestige are unlikely to be gained?   A `private' challenge.

Then there is, for me, the moral component of this.  Training for and spending money on events that I ultimately don't really care about has implications. 

An intense training plan means that I short-change family and friends.  When I'm training I'm absent. When I'm not training I'm tired and not much of a friend or husband. 

Money is not for free.  Without going into detail it is a moral `thing' for me to not `waste' money that other people deservedly need.  Hotels, gasoline and road food ... these are not socially appropriate uses of money. 

`Complaining' vs. `Whining'

When there are problems somebody has to identify them and describe them.

Problems cannot be `fixed' unless they are known and worked on.

When someone senses a problem they should bring that problem to people who have the ability or resources to fix it. This process can be referred to as a `complaint.'

Complaints are essential to fixing problems.  Without complaints problems persist and worsen.

The motive behind complaining is to eliminate a problem.
--

When someone identifies and describes a problem but does not bring it to the parties who have the resources to `fix' the problem this is called `whining.'

The motive behind whining is to draw attention to oneself (pity, sympathy, etc) and/or to bad mouth / denigrate another.
--

When we make a good faith effort to not `whine' about things we will find that we don't have much to say.   When we eliminate whining in our lives we may find that the silence can be unbearable.

So, the take home message here is to complain more and whine less.
--

If all your friends knew the difference between complaining vs whining ... would you have less to say?  Would they? 



I Need Something Hard To Do.

The active cycling season closed out for me on November 3rd with a 52 mile race.  Literally, the next day I began what will be a 6 week dental repair process.  Some things just have to get taken care of or they will have bad outcomes.

I really didn't mind sitting in the dentist's chair for 6 hours over 3 days this past week.  And I'm not dreading the rest.  Frankly, at this point, I'd be fine if it were compressed into consecutive 10 hour days.  Get it over with.

Here's the problem: I have nothing to be tired from!

Sleep is less deep and fulfilling.  My appetite remains but it is clear that I'm taking in more calories than I'm using.  I'm experiencing a sense of `anxiousness' that is quite uncomfortable.  But my mood and temperament are good. 

I have made `to do' lists and completed many of the tasks long delayed, neglected and deferred.  Although the tasks I've identified are meaningful and important (and in some cases challenging) they don't really get my full attention.  Why is that?

"Compared to what?"  Compared to cycling. 

Cycling has become something of a `major process' for me over the past few years.

To say that I have learned from my cycling is an emphatic understatement.  To say that cycling engages me physically, athletically, intellectually and emotionally is, as well, an emphatic understatement. 

At this point I recognize that this blog post could become unwieldy and boring to read.  So I'll `suspend' this monologue for a while. 

Characteristics of Emotional Maturity

An admired acquaintance recently experienced a complicated and painful cycling accident.  He is an avid and accomplished cyclist in his 50s.  The effect of such injuries requires that he (we) call upon our experiences and capacity for managing (sloppily, we all admit) stress, `dead' time, handling boredom, too much self-reflection, overthinking every damned thing. 

So here is something I have read and re-read to remind me (and hopefully others) of what it means to be a grown-up.

--------

Maturity: noun. 1. a being full-grown or ripe, 2. a being fully developed, complete, or ready, 3. a becoming due (Webster's New World Dictionary).

1. The ability to experience and understand our own deepest feelings and needs, and to be able to act on and express these feelings and needs in appropriate and constructive ways. This is opposite from "acting-out" our needs in unconscious, destructive patterns of behavior. This aspect of maturity includes the ability to experience and tolerate especially intense feelings - which inevitably occur in life - and to be able to appropriately express these feelings, or contain them until an appropriate and responsible means for expressing them is available.

2. The ability to act on and react to life circumstances with intelligence, sound judgment and wisdom. This aspect of maturity is opposite the tendency to act impulsively, without taking the opportunity to think through our actions or consider their consequences. (Wisdom: having the quality of good judgment, learning and erudition, soundness.)

3. The ability to recognize, empathize with, and respect the feelings and needs of others. This is opposite from a selfish and chronic preoccupation with our own needs, with no awareness of, or sensitivity to, the needs of others.

4. The ability to delay the immediate satisfaction of our own needs, so that we may attend to other more pressing needs or actions. This is opposite from a condition in which our immediate needs always take precedence over all other needs.

5. The ability to love - to allow another's needs, feelings, security, and survival to be absolutely paramount - just as if these were our own.

6. The ability to adapt flexibly and creatively to life's changing circumstances and conditions. This is distinct from the tendency to respond to life's challenges in rigid, outmoded behavior patterns that are no longer particularly effective or appropriate.

7. The ability to channel our energy, both positive and negative, into constructive contributions to ourselves, to others, and to our communities.

8. The willingness and ability to be responsible and accountable for our own circumstances and actions in life, and the ability to differentiate our responsibilities from those of others. This is distinct from blaming others and seeing ourselves primarily as the victim of other's behavior, or from maintaining a sense that we are somehow responsible for the happiness and well-being of all those around us. Responsibility arises from a stance of strength and competence; it does not include pronouncements of blame, shame, guilt, or moral inferiority/superiority, as all these are judgments added to the basic condition of responsibility.

9. The ability to relate comfortably and freely with others, to like and be liked by others, and to maintain healthy and mutually satisfying relationships.

10. The ability to choose and develop relationships that are healthy and nurturing, and to end or limit relationships that are destructive or unhealthy.

©Maryland Institute, 1998

Friday, March 25, 2016

Doctors With A `God' Complex

I wrote this blog post about the doctor with a god complex in May of 2012.  Since that time I've met many physicians who more than favorably balance the equation.  That is, they are humble, conscientious and place a premium on listening.  I'll lead with a recent New York Times interview with one of them:   Dr. Laurie Glimcher

------------------------------------------------------------------------------------------------------

(May 2012)

New to this area I sought out a doc just to have one on hand in the event I needed one. This guy came well recommended by some acquaintances. I met with his Nurse Practitioner a few weeks ago Monday. She takes my history (did a decent good job) and set me up to see the doc himself that Friday.  



You know the drill. They get you undressed and cloaked in a butt exposed `gown.' This of course, has nothing to do with setting the scene so that the doc is top dog and the patient is a vulnerable sot. -;

 
The guy comes in, doesn't even look at me. Sits at a little table and opens his laptop. Starts barking numbers and concludes: "We're gonna put you on a diet. Your BMI is too high." I tell him I lost 20 lbs in the last six months, ride 200 miles and climb 18,000 feet on a bike every week, that muscle is heavier than fat, and no longer eat meat, and refer him to the BodPod results I submitted when I met with the NP. 

 
He ignores that and keeps looking at his laptop. Then he says that the prostate exam and full urological workup I had just last May (biopsy that showed NO evidence of enlargement or cancer) was worthless and that nothing is as good as ... and then he just sticks his index finger in the air and waves it.

I didn't respond because this was so stump stupid on his part that I was (believe it) speechless.

I tilted my head, smiled, got my Irish up and said "... and then what? A biopsy and blood work that I just had 6 months ago?!"

He then slammed down his laptop and said: "I'm not accepting you as a patient. I'm not going to argue with you."

I was, again, taken aback and surprised at the crude arrogance. Then he tells me to get dressed and a nurse will tell me what to do next.

I left a few minutes later and pondered deeply as to what this meant. Finally, I found another doc. A few days later I sent this idiot the following letter:

---

Dr. X:

I understand your prerogative to decline accepting patients.

I am in agreement with you that it is better that you recognized what would certainly have been apparent at a later time. Being most generous in my description there is an incompatibility between us.

Candidly, I was surprised and am mildly distressed at your behavior.

Having been the Clinical Director of a psychiatric hospital for abused and neglected children and adolescents I have many, many times been reminded of the importance of listening to my patients and staff.

It is my conclusion that you emphatically failed your profession in this regard.
---

So, my advice to all of us: don't be intimidated by physicians who are so arrogant that they suffer from a God complex.

From a psychological perspective such people lack confidence in their ability to maintain a interactive and candid relationship with the client / patient.

More, several recent `gold standard' research reports conclude that arrogant and self-absorbed physicians have a much higher `fail' rate and more malpractice allegations than others.

Word to the wise.

The Only People Without Problems ...

... are either gone from this earth or on their way in. 
 
The rest of us have to get up every morning and figure out how to make it to the end of every day. 
 
Problems are essential to the athlete.  And to the rest of us. 
 
We can `react' to a problem in an impulsive, emotion-encumbered way.  Or we can `respond' to a problem from the `neck up.' 
 
When the bike goes off the road or gets caught in a road crevice we have to `react' fast in order to be safe and survive. 
 
When we approach a traffic-heavy intersection we have time to `respond,' to consider the best solution to potential danger. 
 
In both cases we are called to deal with a problem and come out the other side. 
 
As for `training' (the name of this blog). 
 
Joe Friel shouldn't be an unfamiliar name to competitive athletes.  I've read his many books and followed him on his blog for years.  What many may not realize is that he is in his 70's and suffered a serious bicycling accident and injuries in January of 2014. 
 
"The biggest consumer of my time in the last nine weeks was related to recovering from a bike crash on January 24. That resulted in seven broken bones including the clavicle and scapula, a concussion, blood clots in both legs and lungs, a partially torn rotator cuff and shoulder labrum, and what docs call “adhesive capsulitis” (also called “frozen shoulder”). After six days in the hospital trauma center, all of these injuries required numerous trips to various medical specialists, X-rays, CT scans and an MRI. Then there have been three weekly visits to my physical therapist going on since late February. All of this left little time for anything else." (Link)
 
I strongly recommend his work.
 
Training involves `problems.'  Not all of them have to do with finding the time to train, deciding on the best nutrition and diet, getting your workout plans implemented, or fitting yourself with the equipment that helps you achieve your goals. 
 
In Joe's case it involved dealing with a major injury, the impact that age has on his recovery, and, I'm certain, his own assessment of himself now that he is truly among the `elderly.'  (As am I).
 
As I write this blog entry I'm probably within 15 minutes of his home nearby Scottsdale, Arizona.  My wife is dealing with a problem she has had for many, many years that is in another stage of solution / management: knee replacement.  A talented and experience surgeon spent 50 minutes cutting, sawing, gluing and hammering to `install' a new knee joint. 
 
Joe's problem required a rapid and urgent `reaction.'  My wife's problem required a thoughtful and deliberate `response.' 
 
Both Joe and my wife are now engaged in a form of `remaking' of themselves in pursuit of the challenges ahead. 
 
Lucky they have problems.  Think of how empty life would be without problems. 
 

The Hardest Part of Training

Yesterday saw me ending a six (6) week aerobic base training period.  Due to a winter of little physical activity (work and a sports injury) I was 20 lbs overweight and in poor fitness. 

From this point I will be ramping up the time and intensity of my training.  I have set several target cycling events in each of the next five months.  This anchors my training plans.  But `time' and `intensity' have a cost: there is only so much juice in an orange.  That is, I must be careful not to unbalance the rest of my life: family, work, friends. 

I think I got involved in athleticism as a way to modulate a certain `manic' aspect of my personality, a tendency to become overinvolved.  I notice this partly because of a self-reflective bent of mind and partly because of my profession (clinical psychologist).  I'm sure that many of us have such a `manic' propensity, though it may take a different form (job, sports, cooking, etc).

It is `easy' to push aside the more complex and anxiety producing issues associated with maintaining a balance in life.  Other person's needs are complex and require maintaining a disciplined sensitivity from me.  Not so with training.  `Training' can take on an addictive quality: wake up, train, rest/sleep, do it all over again. 

So now training has entered the `hardest' part: maintaining a civil balance in life. 

Wednesday, March 23, 2016

Cross Training (When You Don't Really Want To)

 

Three weeks ago I pulled a muscle (left gluteus medius) by `sitting too much.'  (Don't ask.)

Wisdom is knowing when it is not smart to try to `work through it.'  Even though I sort'a tried.  The onliest way to get this behind (pun) me is with rest and consistent exercising of the affected muscle.  (Just `rest' is like shutting down the power plant while you change a bulb). 
 
In this blog post I'm describing a few workout variations with the elliptical machine.  They have more to do with balance and gait than `power.' 
 
Next time you're on the elliptical consider trying these.   
  1. After a few minutes of easy `walking' remove your hands from the elliptical `arms.' 
  2. First hold on to the vertical bars for a few minutes and get used to holding your upper body stationary. 
  3. Then keep your eyes focused on something stationary while you remove your hands from both the `arms' and the vertical bars. 
  4. Hold your arms at your sides, ready to grasp the vertical bars or `arms' if you feel unsteady;
    • Clasp your hands together behind your back;
    • Clasp your hands together and hold them over your head;
    • Let your arms move back and forth at your side, as if you were walking on the elliptical.
Doing this recruits little muscles in your legs and hips, improves the `connection' between those muscles and your brain.  The more you are able to use the elliptical in this manner the more improvement you may expect in terms of gait and balance.  In my situation it is gentle rehabilitation of the muscle while it heals.  Stress and strength training comes later. 

Another variation: The Elliptical Moonwalk

Holding on to the elliptical arms or vertical bars start `walking backwards.'  You will find that this is both somewhat odd and difficult.  Be gentle and take your time.  Don't push it if you feel any pain in your legs, knees or hips.  Keep at it for a few minutes, extending the time you `moonwalk' in successive training sessions.  Your legs will strengthen, balance and gait will be improved.