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Key to the Fountain of Youth

Physically Active for Life

Patricia D. Mees

THE PHYSICIAN AND SPORTSMEDICINE - VOL 31 - NO. 12 - DECEMBER 2003


The United Nations, the World Health Organization, and 37 countries have proclaimed 2000-2010 as the Bone and Joint Decade. In the United States, President George W. Bush proclaimed the years 2002-2011 as the National Bone and Joint Decade to promote the importance of a healthy musculoskeletal structure for a lifetime. The number of people older than 50 is expected to double between 1990 and 2020. Advances in medicine have made it possible for more people to live longer, but they also want to live stronger. Each year, musculoskeletal conditions and injuries account for about 102.3 million visits to physician offices, 10.2 million hospital outpatient visits, 25 million emergency department visits, 3 million hospitalizations, and 7.5 million procedures, and they cost an estimated $300 billion.1

As the baby boom generation ages, physicians will be seeing more cases of "boomeritis," a term coined by Nicholas DiNubile, MD, an orthopedic surgeon in private practice in Havertown, Pennsylvania. He means that people in their 50s notice more aches and pains after performing the same activities that were painless in their 40s, and those in their 60s can't do as much as they did in their 50s. Roy Shephard, MD, PhD, professor emeritus of applied physiology at the University of Toronto, adds, "Both aerobic power and muscle strength decline by as much as 10% for every decade of adult life, but a progressive exercise prescription can enhance function by 10% to 20%; thus, in terms of functional capacity, conditioning can reduce biological age by 10 to 20 years." Older patients also require care for conditions that affect the elderly, such as declining cognitive function and Parkinson's or Alzheimer's disease.

Healthy aging. The first major textbook on physical activity for the elderly, written by Shephard, was not published until 1978.2 At first, physicians prescribed exercise to conserve function in well, but elderly, patients. As the value of exercise for treating a wide range of conditions in younger patients became known, exercise prescription was extended progressively to include frail elderly patients and those with serious medical conditions, such as stable congestive heart failure, cardiac transplantation, and renal disease requiring dialysis. According to Robert Petrella, MD, PhD, in the Canadian Centre for Activity and Healthy Ageing at the University of Western Ontario in London, Ontario, there is "provocative evidence that exercise can prevent chronic disease. More fit people with healthy lifestyles have less incidence of type 2 diabetes and hypertension."

In 1998, the American College of Sports Medicine issued its first position statement on aging and exercise,3 in which it recommended strength training for frail older people. Petrella says, "We now know that older patients can perform to very high levels, so exercise prescription does not differ for older and younger persons, and training effects for the elderly can exceed those of younger people at the upper end of VO2max." All those interviewed agreed that exercise is the key to maintaining quality of life, as well as extending the number of years of life expectancy. According to DiNubile "It's never too late to start, and an early start is better. Even 90- and 100-year-olds can do strength training."

Diseases of Aging

As advances in cardiovascular medicine and oncology have extended life expectancy, other problems have become associated with aging.

Hip fracture. In the 1970s, the usual treatment for a hip fracture was bed rest, and it was often a death sentence. Today, a hip fracture is still very serious, but surgery is performed within 24 hours, and the patient is up and walking the day after surgery. Disuse issues are eliminated or lessened, and pneumonia, pressure sores, and death are not inevitable outcomes. People who would have been bedridden 30 years ago now have total joint replacements that keep them moving and maintaining strength and independence.

"We have changed the whole outcome, and exercise is the key component," says DiNubile. Frail patients who have hip fractures are encouraged to strengthen their entire bodies, and many undergo gait training to prevent future injuries. DiNubile added, "We will know we have arrived when hip fractures are preventable by a lifetime of exercise and early screening for osteoporosis. We still have a long way to go."

Arthritis. Whether too much exercise can wear down the joints and leave them vulnerable to osteoarthritis is not definitively known. Genetics, morphologic differences, faulty biomechanics, and injuries sustained in contact sports may also be factors.

What is known is that regular exercise is beneficial in breaking the arthritis cycle (pain leads to disuse, which leads to stiffness and weakness, which lead to more pain). Years ago, pain and inflammation were seen as indications that a joint needed to rest. Patients now accept that working a joint enough to maintain flexibility and strength may hurt a little, but in the long run, it will preserve function and prevent much more pain. "The proper exercise prescription requires a knowledgeable doctor who can monitor progress, adapt exercises to avoid excessive joint stresses, and follow up with the patient on a continuing basis," says DiNubile. Petrella also noted the importance of modifying the exercise prescription to reduce weight bearing, but says he does not prescribe any differently for patients who have a family history of arthritis and those who do not.

Cognitive dysfunction. The role of regular exercise in slowing memory loss, preventing progressive cognitive dysfunction, and delaying the onset of Alzheimer's or Parkinson's disease has not been proven. DiNubile says, "The brain is much like a muscle—use it or it atrophies. To remain sharp, it needs constant challenges." In addition to physical exercise, he recommends doing crossword puzzles, brain teasers, mathematical calculations, and puzzles and studying new subjects as ways to exercise the brain. Shephard says that "it may well be that much of any effect of exercise in conserving mental function comes from new interests and experiences and the opportunities for social interaction that an exercise group affords lonely seniors."

"Regular exercise slows atherosclerosis and controls hypertension," notes Shephard. "Exercise may have more direct effects by raising the blood pressure and, thus, cerebral perfusion, although for most seniors, the changes are probably small and short-lived." According to Petrella, "Good blood flow lowers blood pressure and may reduce Alzheimer's dementia and slow memory loss." Gait training and exercise training improve symptoms and endurance and can reduce some of the side effects of Parkinson's disease medications. "Those who have established disease," says Shephard, "can obtain moderate functional gains from various types of aerobic exercise—walking, cycling, or aqua-fit classes."

What the Future Holds

Patients have little control over their genetics or environmental factors, but the things they can control—diet and exercise—affect their longevity and quality of life. "Exercise may be the closest thing we have to the fountain of youth, but patients are always looking for a doctor or pill to fix them," says DiNubile. He adds, "Doctors need to constantly remind patients that they [the patients] in the long run have a much bigger impact on their own health than anything we can do."

References

  1. Data from the United States Bone and Joint Decade, available at https://www.usbjd.org/index.cfm?pg=nutshell.cfm. Accessed October 14, 2003
  2. Shephard RJ: Physical Activity and Aging. London, Croom Helm, 1978
  3. Mazzeo RS, Cavanagh P, Evans WJ, et al: ACSM position stand on exercise and physical activity for older adults. Med Sci Sports Exerc 1998;30(6):991-1008

Patricia D. Mees is the assistant editor of The Physician and Sportsmedicine.


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