Move or Die: Exercising As We Age
This month I will be 57 years old. ("No way," some of you may say. "You look like you are in your 40s!")
Well, at least that is the story I tell myself as I write this. The one thing (of many!) I have come to realize as I age is how your body reminds you that you are no longer in your 20s or 30s. It’s the little things like trying to go out for a run and noticing that you can’t push it as hard without feeling like your heart is going to explode.
For about five years, I participated in triathlons, and the word compete never entered into the vocabulary! The mere fact that I was able to cross the finish line was personally inspiring. I remember seeing athletes out there at 65-70 (since they write the age group on the back of your leg) and was in awe. I wanted to be like them then, though not anymore. While in theory being able to compete as we age seems a net positive, the intensity of endurance training does come with some drawbacks as I’ll discuss below. That does not, however, give us an excuse not to move, as 99% of us will not be training for our next marathon in our 60s. Increasing movement is a prescription most of us must follow as we get older.
As I’ve researched the aging athlete and us mere mortals, I’ve come to realize there are a few things all of us should do as we continue to age. Maintaining movement means maximizing cardiovascular health and strength while minimizing the potential for injury. If I were to rank order priorities they would be as follows:
Focusing on continuing to build aerobic capacity over the years for cardiovascular health.
Structuring an approach to stemming the loss of muscle.
Attending to injury prevention through a combination of balance and flexibility routines.
1. Focus on continuing to build aerobic capacity
Aerobic capacity refers to using the greatest amount of oxygen as efficiently as you can. This efficiency naturally declines with age. According to a piece from Harvard, maximal heart rate declines by one beat per minute per year after 25 to 30 years of age. The end result is a 25-30 year-old can pump 2 ½ quarts of blood per minute. This declines to about one quart at 80 years old even if you are disease-free. Does this mean we are all doomed to being feeble as we age? Of course not! The highest benefit of an aerobic movement program falls to those over 70 years of age, according to a study of 122,000 patients based on exercise treadmill tolerance followed over a 22 year span. These data and studies like it reinforce the need to continue to be active as we age.
While the increasing activity leads to better outcomes, I am skeptical of the concept of continually pushing yourself to higher levels of aerobic performance, especially as we age. One study referenced a 2- to 10-times increase in the rate of atrial fibrillation in endurance athletes (runners, bicyclist and cross-country skiers). Atrial fibrillation is a common condition as we age with many causes. That said, the higher incidence in endurance athletes is a concern. Atrial fibrillation reduces overall life expectancy by two years. It requires treatment with lifelong anticoagulation to reduce the risk of strokes or cardiac ablation to surgically treat the area causing the irregularity.
The best exercises to increase your aerobic capacity are exercises like running, biking, swimming and rowing to name a few. Brisk walking and hiking can also qualify. You want to do these continuously (not stopping) and at 80% of maximum heart rate. A simple way to calculate your maximum heart rate is to take 220 minus you age.
While we do not know the exact right intensity and volume of aerobic exercise consensus states two sessions a week for 30-60 minutes seems reasonable.
2. Structured approach to stemming the loss of muscle mass
As we age, we lose muscle mass. By 65 years old, that can be up to 25% of total muscle mass. The medical term is sarcopenia. We have all witnessed this in our parents and elders. So why is this happening and does it matter?
Muscle mass declines as a result of gradual changes in our hormone levels over time. Its cause is widely regarded as multifactorial, with neurological decline, hormonal changes, inflammatory pathway activation, declines in activity, chronic illness, fatty infiltration, and poor nutrition, all shown to be contributing factors.
Muscle mass is important for many functions of your body but let’s focus on two. The first is maintaining our ability to perform tasks of daily function like lifting objects from groceries to wheel barrels to grandchildren. The second is its key role in maintaining insulin sensitivity over time. Insulin sensitivity is critical to overall health. Your muscles are one of the major places where glucose moves as it shifts from your bloodstream in response to insulin release. This second function has become more appreciated as according to the CDC over 50% of all people over 65 years old are diabetic or pre-diabetic.
The good news is the loss of muscle mass can be reversed at any age. A structured approach to building muscle mass is focused on your core body areas. These include abdominal and pelvic floor muscles as well as the erector spinae (muscles which run along our spine). These core muscles function to provide support for most activities. They transfer force throughout our bodies and prevent back, hip, knee and neck pain.
The importance of these core muscle movements can’t be overstressed. The great news is many core exercises do not need any special equipment. Here is a great link to 20 core exercises anyone can do. Adding in some upper body and lower body strength movements are a good strategy. You should be building muscle mass two to three days per week. In 30 minutes, you can get a great core/upper body or core/lower body workout.
One of the best ways to build and maintain muscle mass is through brisk walking. Look at the changes to a 65 year old based on an MRI of thigh muscles. The dark gray is the muscles. This compares a 24-year-old, a 66-year-old walking 3,141 steps per day, and another 66-year-old walking 12,445 steps per day. The white represents fat and connective tissue which accumulates as we age. The donut in the center is the femur in black with bone marrow in white.
In the same article there’s a fascinating statistic that the all cause mortality (death from all reasons) is double in people over 60 year old in the lowest muscle strength group in comparison to those with the most muscle strength.
3. Injury prevention through a combination of balance and flexibility routines
The third area that we need to address as we age is balance and flexibility. Both of these minimize the likelihood of injury as we age. Dedicating time to working in these areas would seem to be less important. However, in my career as an emergency physician I treated thousands of patients who fell as a result of losing their balance or a lack of flexibility to protect themselves from a fall. The resulting hip or head injury hastens mortality and dramatically reduces quality of life. In this study the mortality (death) rate after hip fracture for those over 50 years old is a shocking 33% at 12 months!
The best exercises for stability involve movements which isolate a single leg. Think of balancing on one leg while leaning forward. Start with using a chair to maintain your balance and gradually lessen dependence on the chair as a crutch overtime. Some great demonstrations of these type of movements can be found here.
Flexibility declines as we age related to loss of elasticity of our connective tissue. Stretching should be part of your daily routine as we age. Taking five minutes a day to do dynamic (gently moving back and forth at the limit of the stretch) or static (holding at limit) stretching should be incorporated into everyone’s routine. Evidence has accumulated that static stretching is best done after exercise as there is a higher risk of injury when done before.
In summary, each of us should continue to move every day. Incorporating a routine of the following is a reasonable way to maximize movement and exercise for optimal health and longevity.
Aerobic exercise two times a week for 30 minutes
Strength training focused on core two to three times a week for 30 minutes
Stretching routine five minutes per day
One leg stability movement once or twice a week can be incorporated into strength training
When all else fails take a walk! It is the best all-around activity and requires no equipment. As I have said before it is a 3-fer. It enriches the body, mind and soul when done with a friend or loved one.
Like any movement or exercise routine all of this should be approached gradually and incrementally over time. The important thing is to start building small habits on a daily basis connected to normal routines like brushing your teeth or making a cup of coffee. Start out taking five minutes a day and build up from there. As we get older, we typically have more free time available and we should be cognizant of the importance of prioritizing maintaining movement and the reasons to do so for optimal health and longevity.
At Dignity Integrative Health and Wellness movement is one of the Four Pillars of Health. We are happy to structure a program for you to reach your health and wellness goals.