When your doctor gives you a prescription, you are told about side effects, allergic reactions, and the potential risks associated with that medicine. Then, your pharmacist will tell you the cost — after which you may need another prescription for your heart palpitations. How about a prescription for something that will help you feel better, live longer, live happier, that has virtually no risks or side effects, and that is free?
It’s called physical exercise.
Today, I want to talk about exercise for older people who want to live to be even older — and fitter. I’m not talking about getting in shape so that you can wear a bikini again or have six-pack abs. Really, who cares? I’m not even talking about living longer (although people who are active do, in fact, live longer) (1). I’m talking about living better. The term “physical fitness” refers to “the ability to carry out daily tasks with vigor and alertness without undue fatigue, and with ample energy to enjoy leisure time pursuits and meet unforeseen emergencies” (2). Isn’t that what it’s all about?
Old people aren’t worried about dying so much a they’re worried about losing their independence and losing their minds. Being physically active is the single best way to prevent those losses. Here’ the science:
- Exercise offers protection against breathing problems (3), heart disease, and more than a dozen different forms of cancer (4,5).
- Exercise prevents and lessens depression and cognitive decline — even dementia — in older adults (6-8).
- Weightbearing exercise helps to prevent and improve osteoporosis (9,10).
- Exercise even increases the diversity of the gut microbiota (11)— and that’s a good thing!
What kind of exercise is best? Aerobic? Strength?
In general, the best exercise is one that you’ll like enough to do regularly. I cannot tell you how much money I have wasted on gym memberships, only to remember each time that I absolutely hate going to the gym. Being a resourceful person, I can always find an excuse not to go. It’s such a setup for failure. But I love hiking with my dog, doing heavy garden work, and doing strength exercises while I watch tv. Just because it’s fun doesn’t mean it doesn’t count.
Having said that, there’s some more interesting science about the best kind of exercise for older people that relates to resistance (strength) exercises. Gretchen Reynolds, an incredible journalist for the New York Times who specializes in health and fitness, has written about a couple of really interesting studies about this in the past year. The first article cites a study (12) which shows that not only does resistance training improve muscle strength and function, but it also actually reverses muscle cell damage in older people.
In the next article, Reynolds cites a study (13) that evaluated the effects of a lower calorie diet, diet plus aerobic exercise, and diet plus strength training exercise in men and women over 60. Everyone lost weight, but the two exercise groups lost significantly more. And the strength training group lost more fat weight and less muscle weight than the aerobic exercise group.
Other studies have also shown that weight training helps prevent the loss of considerable strength and muscle mass that almost all people experience as they get older (10,14).
Aerobic exercise, on the other hand, may have more mood-elevating effects for many people, particularly if the activity is done outdoors. Perhaps a consequence, there seems to be greater adherence to outdoor exercise regimens compared with indoor ones (15.16). Again, though, do whatever you’re likely to stay with.
For aerobic activity, you may want to consider interval walking. Interval training, as a general term, refers to alternating between working harder and less hard during a workout. It builds endurance and helps with weight loss. There is evidence that interval walking may have a similar effect (17). Interval walking is also associated with diminished knee pain in older people than is continuous walking (18).
A recommendation is to walk at a brisk but comfortable pace, the walk as fast as you can, then repeat. Work your way up to the fast walking being 50% of your walk (19). Of course, if you have medical problems, particularly risk factors for coronary artery disease, talk to your doctor before you start an exercise regimen. And be smart: don’t get out of your chair for the first time and try to run five miles.
- Find an activity you like, and make a commitment to do it regularly. Sure, an hour a day is great, but even 20 minutes a day lowers the risk of heart disease (20).
- Consider exercising with a buddy. It’s more fun, and you’ll hold yourself more accountable. My co-conspirator Jay is the best example of this.
- I love to exercise with music. I have a fast playlist for walking (and pray that no one ever notices me singing and bopping along to “Uptown Funk”) and a slower one for weights and floor exercises. Other people find music distracting and annoying. Suit yourself.
- Make physical activity a habit that is part of your routine. That way it becomes automatic. If you ask yourself if you feel like exercising today, you may find yourself having a good reason to say no 90% of the time. So don’t ask that question. Just make it an automatic habit. You get up in the morning and go for a brisk walk before you shower. You stop at the gym on your way home from work. Or you get home, change your clothes, and do some work with weights. You get the idea.
- Use exercise as a tool to think and reflect. Running, cycling, swimming, and gardening are all perfect for this. Or as a tool to not-think — you can’t worry about anything when you’re in a Zumba class gulping for air.
- Start with short-term goals that will end in success. If that means one extra flight of stairs or a 5-minute walk, that’s fine. It’s about not letting exercise — or lack of it — become one more source of shame.
Asking your body to move more is showing it kindness and respect. Being physically active is the best way to stop being angry with your body. And it's a wonderful gift to your brain as well. What a prescription!
I’m not athletic. I’m not graceful. I was the second-to-last one picked for every team in school (the last one had a habit of throwing up on her teammates. No, I do not have an explanation). My body is not beautiful. But I appreciate my body. I appreciate moving my body in ways that allow me to more fully participate in the world. And I can’t tell you how much I appreciate being able to walk faster and further at age 68 than I could at age 58. It's good to be old and appreciative, no?
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2. UTD. The benefits and risk of exercise 2017, US Department of Health and Human Services 2008: www.health.gov/PAGuidelines/guidelines/default.aspx.
3. Spruit MA, Singh SJ, Garvey C, et al. ; ATS/ERS Task Force on Pulmonary Rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13–64.
4. Moore SC et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern med 2016; E1-E10.
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12. Robinson MM et al. Enhanced Protein Translation Underlies Improved Metabolic and Physical Adaptations to Different Exercise Training Modes in Young and Old Humans. DOI: https://doi.org/10.1016/j.cmet.2017.02.009
13. Beavers KM et al. Effect of Exercise Type During Intentional Weight Loss on Body Composition in Older Adults with Obesity. Obesity 2017; (11):1823-1829.
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17. Handa S et al. Target intensity an interval walking training in water to enhance physical fitness in midle aged and older women: a randomized controlled study. Eur J App Physiol 2016; 116(1):203-15.
18.Farrokhi et al. The influence of continuous versus interval walking exercise on knee loading and pain in patients with knee osteoarthritis. Gait & Posture 2017; 56:129-33.
19.Harvard Health Lettre. Put Some Pep in Your Step! 2017; 42(8).
20.Rahman I et al. Relationship between physical activity and heart failure risk in women. Circ Heart Fail 2014; 7:877-81.