One of the common concerns post-spinal fusion surgery is how to maintain core strength despite limited mobility in the fused area. Understanding the limitations and focusing on specific exercises can help individuals maintain a strong core. This article and video demonstrate a series of safe and easy core exercises designed for people with a fused spine. It is essential to note that these exercises are suitable for individuals beyond the initial six weeks of their surgery and only if they do not cause or exacerbate pain. You can go through the four exercises below like a circuit and repeat each three times.

**Glute Bridge**

The glute bridge exercise targets your buttocks and lower back muscles, enhancing core stability without straining the fused spine. To perform this exercise:

• Lie on your back with your knees bent and feet flat on the ground.
• Slowly lift your hips toward the ceiling while engaging your glutes.
•  Ensure you do not overextend your lower back during the movement.
•  Hold the bridge position briefly before lowering your hips back down.
•  Focus on controlled movements rather than height, keeping the core engaged.
• Aim for 10 bridges repeated 3 times. 

**Supine Leg Lowers**

Supine leg lowers are excellent for strengthening your lower abdominal muscles without compromising your fused spine. Here’s how to do it correctly:

• Lie on your back with your thighs extended straight up toward the ceiling and your knees bent at 90 degrees so your shins are parallel to the floor.
• Lower one leg toward the ground without arching your lower back.
• If comfortable, progress by lowering the opposite arm simultaneously, engaging your core.
• Return to the starting position, ensuring a smooth, controlled movement.
• Aim to lower each leg 10 times and repeat 3 times through. 

**All Fours Kneeling with Knees Off the Ground**

This exercise focuses on balance and stability, engaging your core muscles effectively. Follow these steps to perform it safely:

• Start on all fours with your hands directly under your shoulders and knees under your hips.
• Lift your knees off the ground so only your toes and hands touch the floor. 
•  Lift one leg off the ground, maintaining a stable spine and avoiding overarching or rounding your back
•  If this is manageable, progress by lifting the opposite hand and leg at the same time while keeping your balance.
•  Engage your core muscles throughout the exercise to stabilize your spine.
• Hold each arm and leg off the ground for 30 seconds and repeat 2-3 times. 

**Crawling**

Crawling is a functional and dynamic exercise that challenges your core muscles while promoting coordination and balance. To perform crawling safely:

• Begin on your hands and knees with your back parallel to the ground.
  Lift your knees off the floor about an inch (2-3cm). 
• Move your opposite hand and knee forward simultaneously, keeping your core engaged.
• Ensure your movements are smooth and controlled, maintaining a neutral spine position.
• Focus on coordinating your limbs and stabilizing your core muscles.
• Move forward and back about 3 meters, taking your time to do this, about 30 seconds.

Maintaining a strong core after spinal fusion surgery is crucial for overall stability and well-being. Incorporating these specific exercises into your routine can strengthen your core muscles without putting undue stress on your fused spine. Remember, listening to your body and avoiding any movements that cause pain or discomfort is essential. Always consult your healthcare provider or a qualified fitness professional before starting any new exercise regimen, especially after surgery. With proper care and attention, you can maintain a strong and stable core, promoting better posture, movement, and decreased wear on your spine.

The growing field of lifestyle medicine holds the key to maintaining brain health and reducing the risk of dementia. In a recent podcast episode, Dr. Tommy Wood, assistant professor of pediatrics at the University of Washington, provided an enlightening discussion about the power of lifestyle choices in preserving cognitive function.

In the podcast, we did deep dives into:

Nutrition
Physical Activity
Sleep
Community

Nutrition
Nutrition plays a crucial role in cognitive health. Dr. Wood emphasizes the importance of a nutrient-dense diet, one that avoids ultra-processed foods and focuses on the overall quality of food. High-nutrient foods and a quality diet have been linked with long-term brain health. For example, essential nutrients like B vitamins, choline, and creatine may affect long-term dementia risk. Dr. Wood also discussed some fascinating research that indicates our belief in what we’re eating could impact our blood sugar levels, adding a psychological aspect to nutrition’s role in cognitive health. To illustrate this, he references a paper where 2 groups of diabetes were given a protein drink and were allowed to read the label.  One group noticed a higher spike in their blood glucose levels even though both groups had the same drink!  The difference is that one group had a label that referenced a high sugar content!

Physical Activity
We also discussed the importance of physical activity for brain health. Regular physical activity helps regulate blood sugar levels, which is essential as we age, especially after the age of 40. Tommy noticed that the more physically fit and strong you are, the better your cognitive function will be. A combination of aerobic and resistance training has been associated with improvements in brain structure and function, and he goes into detail about what that could look like; it might be less than you think.

Sleep
Sleep and its effect on cognitive health cannot be understated. Dr. Wood shed light on the consequences of sleep deprivation and sleep apnea on brain function. He also discussed the potential benefits of sleeping with a sleep mask to reduce the impact of light exposure during sleep. Additionally, he touched upon the fascinating aspect of how the perception of time can influence our sleep and stress levels. He quotes a study where people were allowed to sleep for 8 hours but were told they only had 5. Cognitively, they performed as though they had 5 hours of sleep. Conversely, people who did have 5 hours of sleep but were told they had 8 performed better!

Community
The episode also underscored the role of social interaction in reducing dementia risk. Research shows that social support and stress can directly impact our physiology, which in turn can increase our risk of developing chronic diseases in the long term. Social interaction helps to build and repair the brain, especially in early development and in the elderly. Moreover, cognitive function peaks around the time formal education ends, underscoring the significance of mental stimulation in preserving brain health.

Concussion
Creatine, choline, and omega-3s were highlighted as potentially beneficial for concussion prevention and recovery. These nutrients can help improve outcomes after a concussion and improve overall cognitive health. It is recommended that those with early symptoms of cognitive impairment get tested and supplement these essential nutrients that may be difficult to obtain on a plant-based diet.

Lifestyle medicine offers a wealth of strategies for enhancing cognitive function and preventing dementia. A combination of nutrition, physical activity, adequate sleep, and social interaction can significantly impact brain health and reduce the risk of cognitive decline. With lifestyle medicine, we can all hold the keys to preserving our cognitive health and adding healthspan to our lifespans.