THE PHYSICIAN AND SPORTSMEDICINE - VOL 28 - NO. 6 - JUNE 2000
Healthy Aging or Anti-Aging? Diverse Philosophies Emerge
The concept of "healthy aging" is changing. Mainstream medicine has become more aggressive in treating age-related conditions such as osteoarthritis, and practitioners of "anti-aging medicine" incorporate new treatments, many of which are still in the research lab, that attempt to stop or reverse the aging process.
Simple demographics are driving the anti-aging medicine trend. The US Census Bureau reported that the number of Americans age 65 or older grew 74% between 1970 and 1999 (1). In 1999 one in eight Americans were age 65 or older—by 2010 that number will rise to one in five. The fastest-growing subgroup among the older population is the oldest old (age 85 or older), whose numbers have tripled since 1970 and are expected to rise as baby boomers age.
The 'Anti-Aging Medicine' Trend
Anti-aging medicine, an outgrowth of the life extensionist movement that began in the 1960s, appears to be coalescing into its own medical specialty. In 1993, the American Academy of Anti-Aging Medicine (A4M), based in Chicago, was formed to bring together healthcare professionals who take a nontraditional, aggressive approach to medical care for older people (https://www.worldhealth.net). A4M president Ronald Klatz, MD, DO, a sports medicine physician, says that public demand is the driving force behind anti-aging medicine. "Baby boomers don't want to stop being young and vital," he says. "The public is demanding this, and there's a need for academic recognition."
In 1999 the A4M established a specialty board (the American Board of Anti-Aging Medicine) to begin certifying physicians in anti-aging medicine. (The certification is not currently recognized by the American Board of Medical Specialties, an umbrella group of 24 medical specialties that sets and maintains professional and educational standards for physician specialists.) Klatz says that the educational requirements for the anti-aging medicine specialty are rigorous, the test is biometrically based, and that it should take physicians about 2 to 3 years to complete the coursework before testing. He notes that about 500 physicians have taken the first part of the exam.
Proponents of anti-aging medicine believe that successful aging is a four-strategy approach: diet, exercise, early detection of degenerative conditions, and pharmacologic interventions that influence metabolism. Klatz says that physicians who are members of A4M are likely to put into practice therapies—including off-label pharmacologic treatments—that show promise in slowing or reversing the aging process. Examples include human growth hormone, nutritional supplement-based hormonal treatments, and calorie restriction (shown to reduce mitochondrial free radical production in rodents).
Some view A4M's nontraditional medical approach with skepticism. A4M is on Quackwatch's list of questionable professional organizations (2). (The list also includes the American Academy of Osteopathy.) Klatz acknowledges that physicians who practice anti-aging medicine base some of their treatments on empirical evidence and intelligent observation. "The critics say that this [anti-aging therapy] is too new," Klatz says. "But we're dealing with a terminal disease. Most people don't have 30 years to wait and see what the data says."
Klatz predicts that anti-aging medicine will become a major primary care medical specialty. He says A4M has 8,500 physicians members, and that the membership number doubles every year. He notes that the most recent A4M conference drew 3,000 physicians and researchers.
What's piquing physician interest in anti-aging medicine? "This is an exciting way to do medicine," Klatz says. "Most primary care physicians sign on to practice medicine like this—to treat each patient as an Olympic athlete."
Parallels With Sports Medicine?
Klatz points out that anti-aging medicine has many similarities to sports medicine. "Until the 1970s, sports medicine did not exist in mainstream medicine," he says. "Before that there was fitness and the Olympics. Preventive medicine and nutritional medicine were almost unknown."
Sports medicine came into prominence with the rise of the fitness boom, "and anti-aging medicine is the next wave," he says. "Both movements seem to be driven by baby boomers." Klatz points out that senior athletes have long been role models for healthy aging.
Anti-aging medicine, which has no formal textbook, is still evolving, Klatz says. "This is where sports medicine was about 25 years ago," he claims.
A Less Aggressive Approach to Healthy Aging
Not all physicians who work on healthy aging issues have embraced the A4M's aggressive approach. Instead, they tailor their patient recommendations on critically evaluated research results and from the lifestyles of others who have maintained good function into old age (table 1).
Kenneth L. Minaker, MD, chief of the Geriatric Medicine Unit at Massachusetts General Hospital in Boston, reviewed several proposed modulators of the aging process (eg, antioxidants, selegiline hydrochloride, hypophysectomy, dehydroepiandrosterone), some of which are used by A4M physicians, in a presentation at the annual meeting of the American College of Physicians in Philadelphia in April. He noted that the only therapy that has been definitively proven to modulate an age-related effect is vitamin C; 250 to 500 mg per day has been shown to defer cataract development by 40% to 60%, Minaker says. He added that the effect of vitamin E on cancer and coronary artery disease is unclear, and that "vitamin A is now removed from the list."
Robert N. Butler, MD, medical editor of Geriatrics, says the divergent medical approaches to aging have been evolving since the 1950s. "There's been a steady effort to differentiate aging from disease, but it's clear that they're connected," he says. Though Butler says he is very much in favor of research on anti-aging interventions, treatments based on the research should not be used in the clinical setting until efficacy and safety have been established. "Some day we may be able to retard certain aging effects," says Butler who is also chief executive officer of the International Longevity Center-USA, Ltd, an organization based in New York City that studies the implications of aging-related demographic trends. "We're already doing this to some degree—for example, gravity exercise, calcium, and estrogen to retard bone loss." Butler notes that sedentary lifestyles may also influence people's aging process. "How much is truly aging, and how much is the result of our own deconditioning?" he asks.
Even Andrew Weil, MD, a proponent of alternative medicine who is highly visible on the Internet and in the lay press, holds that the aging process should be accepted and adapted to with healthful tactics rather than fought. "I don't believe in anti-aging," he said in a recent article in Modern Maturity magazine (3). "Healthy aging is having the physical faculties, mental faculties, and energy to do what you want as you move through life and being comfortable with the aging process," he said.
As baby boomers age, physicians who treat older people can expect to field more and more questions from patients about purported anti-aging therapies, says Patrick P. Coll, MD, a family medicine physician who is associate director of the Center on Aging at the University of Connecticut Health Center in Farmington, Connecticut. "I don't think it's inappropriate to search for ways to successfully age, but we have a long history of people being susceptible to unsupported recommendations," he says.
Priscilla M. Clarkson, PhD, is the new president and Angela D. Smith, MD, is president-elect of the American College of Sports Medicine (ACSM). Their 1-year terms began in June at the ACSM meeting in Indianapolis.
Clarkson is associate dean of the School of Public Health and Health Sciences and a professor in the Department of Exercise Science at the University of Massachusetts. Smith is a pediatric orthopedic surgeon at Children's Hospital of Philadelphia and adjunct professor of medicine/sports medicine at the University of Delaware in Newark, Delaware. She will become ACSM president at the 2001 annual meeting in Baltimore. Smith is an editorial board member of The Physician and Sportsmedicine.
Promising Lyme Vaccine Results in Children
The results of a randomized, double-blind, multicenter trial were to be presented on May 14 at the Pediatric Academic Societies (PAS) meeting in Boston, according to a press release from the PAS. The trial, led by researchers from the Johns Hopkins School of Public Health in Baltimore, included 3,063 children who received the Lyme disease vaccine and 1,024 who received a placebo at 0, 1, and 12 months. For 4 days after each injection, parents were asked to note and record any postinjection reactions in their children.
Parents of children who received the vaccine reported slightly higher rates of injection-site reactions, fever, fatigue, headache, and joint pain than those who received a placebo. Such events lasted 2 to 3 days and were mild in most children. No unusual or severe reactions were noted. The study was partially supported by SmithKline Beecham Biologicals, the maker of the LYMErix vaccine.
In the efficacy arm of the trial, researchers collected serum samples from a subgroup of 301 children. By month 2 after two injections, seroprotection rates and antibody levels in children ages 4 to 14 were as high as those found in adults at month 13 after three injections.
The press release states that the US Food and Drug Administration will review the data from the study to determine if the vaccine should be approved for use in children.
Intellectual and Physical Workouts May Help Prevent Alzheimer's
In a press release from the AAN, lead author Robert Friedland, MD, a neurologist at Case Western Reserve University School of Medicine and University Hospitals in Cleveland, said that people who were less active were three times more likely to develop the disease than those who were more active. The study involved 193 people with Alzheimer's disease and 358 people without the disease.
Researchers, using a questionnaire to collect data about participation in 26 activities, examined activity patterns from at least 5 years before Alzheimer's symptoms appeared. Passive activities were defined as watching television, partaking in social activities, and attending church. Pursuits defined as active ranged from reading to woodworking and from gardening to racket sports. Healthy participants had been more active in intellectually and physically challenging activities between ages 40 to 60 when compared with Alzheimer's patients, even when the data were adjusted to account for differences such as age, income, gender, and education.
The study builds on previous work showing that people who had Alzheimer's disease were less physically active and had lower educational and occupational levels. Though the research suggests that brain stimulation associated with intellectual and physical activities works against neurodegeneration, researchers could not rule out the possibility that lower activity levels are symptoms of the disease in its early stages. Friedland said he believes that to be unlikely because the study examined activity levels from at least 5 years before the onset of dementia.
Workout Device Causes Pain With No Gain
Electrical muscle stimulation (EMS) is successfully used in physical therapy settings to stimulate specific muscles, according to an ACE press release. ACE hired a group from the Human Performance Lab at the University of Wisconsin, La Crosse, to investigate weight loss and strength claims for the in-home EMS units.
The group recruited 29 college-aged volunteers to test marketers' claims for EMS. Subjects' weight, body fat, body size, and strength were measured before beginning the study. Participants were also photographed, reviewed, and graded for firmness using a 10-point scale. EMS units from Body Shapers International were bought for study use. The machines cost $519 apiece. John Porcari, PhD, lead author of the study, noted in the press release that the purpose of the study was to determine the effectiveness of in-home EMS, not a specific brand of stimulator.
Seventeen students were placed in the EMS group, and 12 were placed in the control group. The machines in the control group were altered to prevent the delivery of any electrical current. Subjects underwent treatment with the machines three times per week for 8 weeks following the manufacturer's recommendations.
After 8 weeks of "training," no significant changes were noted in weight, body fat percentage, strength, or overall appearance. Researchers also noted that electrode application was difficult and time-consuming and that some subjects reported that EMS was painful with high levels of stimulation. "In the time it took to attach electrodes and do the stimulation, the subjects could have easily completed an effective cardio or strength training workout," Porcari said in the press release.