A Good Old Age

Dr. Robert E. Roush

I've never met any one who wouldn't want to have a good old age, and since the title implies that attaining this goal is a possibility, just maybe you can. Read on.

Population experts are uncertain whether there will be 35 or 36 million people 65+ years of age in the year 2000. What is certain is that there will be more older people than at any time in human existence. The 77 million baby boomers are turning 50 at the rate of 10,000 more per day every day for the next 10 years. And the first of those boomers start turning 65 in May 2011. By the year 2020, one in every five Americans will be over 65. These statistics may have something to do with your having a good old age since we may not have enough health professionals specially trained in geriatrics – we're not even close to having that now – and our Medicare and Social Security programs may not be adequately funded to provide health and economic benefits to all those older people, of whom I will be one. Well, there's not much we can do about those external factors except write our congressional representatives and use the ballot box wisely.

So what's all this got to do with exercise? Well, short of being able to pick your ancestors who lived past 85 and watching out for the proverbial Mack truck, exercise is probably your best bet to enjoy however many years you're going to have. (On the practical side, it won't hurt to have saved and invested enough money to ensure that you can purchase whatever services you may need to live well.)

When older people say "Dr. Roush, is it too late for me to start exercising?" My reply is this: "It's never too late to start an exercise program; the key is how to start." Indeed the very nature of the individual's question is indicative that they are somewhat motivated to start. They just need some help. Doing it without instruction and by themselves, can be dangerous and is a lonely prospect that will probably not be continued very long. In fact, we now have a wonderful video on the subject; it's entitled "It's Never Too Late: The Surprising Benefits of Exercise as We Age" which will soon be available on research channel.com. We'll let you know the date of the premier.

My first suggestion is for you to see a health care provider to make sure you don't have some underlying condition that would be aggravated by exercising. Then find an individual or group that is knowledgeable about the proper way to begin and to maintain an exercise regimen. Almost every library has information on the subject, as do YMCAs, health clubs, senior centers, and medical school departments of family, internal, and physical medicine. More recently, almost every managed care organization or HMO has a wellness program, including exercise. Also, there are tons of information on the Internet. If readers have access to the World Wide Web, they could log on the Huffington Center on Aging's Website at http://www.hcoa.org and go to our Links section and surf the ‘Net using many of our links and the several search engines.

So why do you want to exercise? Don't you want to have stronger muscles and increased bone density so you can climb stairs, enjoy outdoor pleasures, work, and avoid falls and fractures? Don't you want to have improvements in your immune system to help ward off certain infections, or at least minimize the length and severity of them? Don't you want to lower your cholesterol level and blood pressure to reduce your risk of a heart attack or stroke? Don't you want to be able to effectively treat depression without drugs? Don't you want to minimize some of the stiffness and pain of arthritis? Don't you want to perhaps lose some weight and look and feel better? Don't you want to sleep better, and yes, some say even have better sex? And don't you want to experience that wonderful feeling of accomplishment and control over your health? Well, research findings suggest that if you start exercising and do it throughout your life, or as long as you can, then many of these "good outcomes" can happen. In fact, studies published in major medical journals and the experience of wellness centers like Dr. Cooper's in Dallas, Texas, all show that moderate, sustained exercise will produce many of these benefits. More vigorous aerobic exercise, that which burns 2000 K/cal per week, can indeed protect against heart disease.

In fairness, I should also say this: exercise alone will not do the trick of producing the healthy changes, including weight loss, that most people start exercising for in the first place. A diet low in fat and total calories proportionate to your weight must accompany your exercise program, because you only burn off about 100 calories per mile if you're running at a 10-minute/mile pace or walking briskly at about 15 minutes per mile. One rule is that you should not consume more than 15 calories/pound of your desired weight, e.g., if you want to weigh 150 lb., then 15 X 150 = 2250 calories a day. Since one pound of body fat = about 3600 unburned calories, you can figure how much you need to burn off over what you take in and how long it will take for you to have a net reduction of 3600 calories, inclusive of those burned off during exercise. And one should consume fewer than 60 grams of fat since fat grams have 9 calories, vs. protein and carbohydrates each with 4 calories, e.g., 60 x 9 = 540 divided by 2250 total calories = 24% of calories from fat. And you should try to do better than that. Now, you should also be aware of the P/S ratio, i.e., polyunsaturated (like olive oil and other vegetable oils) vs. saturated fat from animal sources (red meat and organ meat vs. chicken and fish). You want a P/S ratio of better than 2/1 (2 or more grams of a polyunsaturated fat for every gram of a saturated fat). Remember, for every gram of fat you replace with a gram of protein or carbohydrate, you save 5 calories. Fortunately, almost all food labels provide this information, and one can even ask restaurants if they can tell you these values when you choose from the menu. Then there are great sources of information like the Help Your Heart Eating Diet written by my Baylor colleagues – Drs. Michael E. DeBakey, Tony Gotto, John Foryet, and Ms. Lynne Scott – where one can learn these important values as well as delicious recipes to prepare your favorite foods healthfully. On another note, exercisers usually engage in other healthy practices like not using tobacco products and not consuming more than 2 oz. of alcohol per day.

Going back to getting started, the rule is start low and go slow. Exercise is a very broad term, and one should not think that they must run or play a vigorous sport like racquetball, although those are great forms of exercise. After seeking professional advice -- and this piece should not be construed to be medical advice --one should begin something simple like walking. But before you do that, take 5 minutes to warm-up by stretching and going through the full range of motion of your joints by slowly swinging your arms in a wide circle to rotate the shoulder joints. Then, with arms outstretched, twist your upper body to the right, then to the left several times. You might want to lie down and with legs uplifted, bend the knees several times, and then swing the legs out and in, and then in a scissor-kick movement. Everything is slow and smooth. Do not overdo this warm-up. Then, the most important step is to stretch the Achilles by leaning against the wall with palms touching the wall and feet flat on the floor and hold that position for 30 seconds or so while you feel the calf muscles below the knee stretch all the way to your heels.

Most exercise prescriptions, and you should think of them as just that – like a doctor or nurse writing an Rx on a pad – stipulate that you do whatever you plan to do 3-5 times per week for at least 30 minutes each time whether you're walking, running, riding a bicycle, using a rowing machine, swimming, etc. Then, just as important as the warm up is the cool down and another stretch and range of motion activity. Before we leave the exercise prescription, some recent research findings also suggest that resistance training like weight lifting – preferably with a calibrated machine vs. free weights unless you have a spotter – confers not only increased muscle mass, but bone remineralization as well. These benefits, along with those from such other alternative exercises like the Chinese martial art,Tai Chi, have been shown to prevent falls in frail, older nursing home residents. If it's good for them, wouldn't they be good for us?

Again, the key is to choose something you like, and start with modest goals, e.g., if you're going to walk, then measure a mile using the odometer on your car in your neighborhood or on a marked trail in a park. Starting from scratch, I'd try to do it in 20 minutes, if you can. Your objective is to slowly increase the distance by about 10-15% per week and pick up the pace so that in about a month you can walk 2 miles in about 35 minutes. Then, you want to extend your walk to 3 miles in 45 minutes. Before you start, use a good watch and count your pulse rate either, at the wrist or at the carotid artery in the neck, for 10 seconds and multiply by 6. Keep a record of this because your resting pulse rate and your maximum rate are important values. To compute your maximum pulse rate, subtract your age from 220 and multiply by 75%. I'm 58, so 220-58 = 162 x .75 = 122, which is my maximum, age-adjusted heart rate. This is my target: I want to walk or run briskly enough to attain my maximum heart rate. At this level of exercise, your heart and lungs are experiencing aerobic effects, and since they are just muscles like your biceps, they get stronger when they are exercised. This may take you several weeks, even months. If you can't achieve the level of aerobic exercise, don't quit. Anything is better than nothing. One tip is to do this with someone or a group. Set individual goals, but share them with the group and help reinforce each person's hard work and share in their joy of attaining their goals.

One popular way of maintaining motivation to continue is to work with a personal trainer. Everyone could benefit from a good coach. If several people went in to share the cost, it would probably be worth it, at least to get started and to work through those first hard times and when you just want to stay home. Now, regarding keeping track of your pulse rate, you will be surprised at how much your resting pulse rate will drop after you've become conditioned to working at the highest level. With normal pulse rates in the 72-90 range, well conditioned marathoners have rates in the 40s. Yes, their hearts only beat 40 times per minute to pump the same amount of oxygenated blood through their bodies as your heart does at almost twice that. When you become fit, you will probably have rates in the 60s. Your blood pressure will also probably go down, so have that checked before you start and keep tabs on it as you progress. These two physiological markers will tell you you're fit, especially the quicker that your heart rate returns to baseline after maximum effort. But you will know it anyway, because you are just going to feel better and have more get up and go. There's just nothing like that good "tired" feeling following a brisk workout.

I would also start and end each exercise activity with a little "mind over body" session of sitting in a chair with your head down and arms in your lap and legs outstretched comfortably with eyes closed and, while breathing deeply and exhaling slowly 5 or 6 times, envision yourself having a great workout and feeling good about having done so because you deserve it.

That's the good news. Now for the bad. If you don't warm up and cool down and stretch and don't drink a lot of clear water before, during, and after, and if you go out in too hot or too cold temperatures without taking reasonable precautions, you're going to sustain an injury to a joint or a muscle. If you don't wear the correct type of shoe and other gear, then you may sustain a stress fracture. If you don't rest properly between exercise sessions or if you over do it, then you will experience the overuse syndrome of stress, burnout, and feelings of tiredness and lack of motivation.

If any of these things happen, do you quit? Certainly not: just go back to your health provider, preferably one who has a gym bag in his or her own office (that they actually use themselves!) and get on a rehab program and a modified exercise regimen until you can resume what you were doing before the injury. If you can't get in to see a doctor, physical therapist or other qualified professional, then the rule of thumb is to "ice it and stay off it" until you can. Also, if your doctor says it's ok, then taking an over-the-counter anti-inflammatory drug containing ibuprofen in the correct dosages can lessen the damage caused and shorten the recovery time.

The other bit of bad news is this: exercise is something that you just have to keep at. It doesn't take but a few days of bedrest for one to become deconditioned. Well, so much for that, because the benefits clearly outweigh the risks.

After reading all of this, I can hear you asking, "But Dr. Roush, isn't doing what you say easier said than done?" Yes, it is. I've been through the highs – four marathons – and lows of long periods of inactivity and higher blood pressure and feeling sluggish. Do I practice what I preach? I try. In fact, I'm on my way out the door for my 3-mile, 15-minute/mile walk with my headset tuned to KUHF 88.7 for "Saturday Afternoon at the Met" for a little culture and a little exercise. And I hope I'll have the willpower at dinner tonight to order broiled shrimp with rice pilaf rather than fried shrimp with french fries, which I dearly love.

So what are you going to do? I hope you go get some good sound medical advice and information, start your exercise program, and stay with it through thick and thin, no pun intended. Happy trails to you, and let me know how you're doing. "On your mark, get set, go!"