December 2016 - THE NON-MEDICATED LIFE
PHYSICAL ACTIVITY FOR
By Paul E. Lemanski, MD, MS, FACP
Editor’s Note: This is the 74th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individuals taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death while others may reduce certain types of cancer.
In the first 73 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the prevention and treatment of chronic medical conditions. With respect to healthy aging, however, a healthy lifestyle consisting of a predominantly plant based diet and daily physical activity including muscle strength exercises, aerobic exercise, as well as flexibility and balance training may yield benefits beyond what can be achieved with medication alone.
Medical science has helped contribute to longer life expectancies. As a consequence our population is aging and the proportion of those over 60 is increasing more rapidly than in other age groups. From the perspective of our seniors, a longer life may be desirable but only if the additional years have quality. Thus, an important goal of those over 60 should be aging that preserves the quality of life. Healthy aging involves preserving physical and cognitive functioning, maintaining independence, and continuing to meaningfully contribute to society. Such a goal may also moderate healthcare costs by decreasing hospitalizations, surgical procedures, and chronic custodial and nursing home care.
To be sure, appropriate medications contribute to healthy aging. For example, cholesterol lowering medications and blood pressure medications can significantly reduce the risk of heart attacks, congestive heart failure, aneurysms and strokes. Blood pressure lowering medications can also help avert blindness, kidney failure and dialysis.
Increasingly, however, unhealthy lifestyle choices including lack of physical activity are contributing to medical conditions that medication may not address or may not fully address.
For example, there is evidence that increased aerobic activity can reduce the risk of cardiovascular disease, stroke, hypertension, diabetes, obesity, osteoporosis, colon and breast cancer, depression, and possibly cognitive decline and dementia. Indeed, the marked increase in diabetes over the last 20 years is attributed to the increase in obesity contributed in large part by a lack of physical activity.
For those at risk of diabetes with increased body weight and blood sugar, aerobic exercise, a healthy diet, and a weight loss of only five to 7.5% of body weight has been shown to decrease risk for diabetes by 57%. Moreover, it is never too late to garner the benefits of aerobic activity. Even previously sedentary individuals who begin exercise as late as age 85 demonstrate benefit and survival advantage over individuals who remain sedentary.
Examples of moderate intensity aerobic exercise include brisk walking, swimming and dancing. Examples of vigorous intensity aerobic exercise include running, cycling and rowing. After clearance by your primary care physician, aerobic exercise appropriate to your level of fitness should be increased over several months to 30 minutes five days a week of moderate intensity activity – or 20 minutes three days a week of vigorous intensity activity. A single 30-minute session may be broken down to three 10-minute sessions, and one 20-minute session may be broken down to two 10-minute sessions without significant loss of benefit.
Intensity of effort should be individually adjusted during aerobic activity so that an individual may carry on a conversation using normal length sentences. If the intensity is such that only several words can be spoken at a time then the intensity of exercise should be reduced. Finally, it must be emphasized that any increase in exercise even when not meeting the above recommendations will yield benefits.
Activities that improve muscle strength such as resistance or weight training may reduce the risk of falls and consequent fall related injuries. Such injuries include hip and other bone fractures, and head/brain trauma that can compromise independence, and lead to chronic custodial and nursing home care. There is also some evidence that increasing strength training may improve functionality and the ability to perform activities of daily living.
After clearance from your primary care physician and preferably with the oversight of a physical therapist or personal trainer experienced with seniors, muscle strengthening should be attempted two to three days per week. Absent strength training, there is a progressive loss of muscle mass and strength, beginning in mid-life and progressing with increasing age. The goal for seniors should be to prevent further loss and to strengthen sufficiently to perform activities of daily living, such as getting up out of an armless chair or off of a toilet.
Leg strength is critical to preventing falls as a trip or stumble requires enough strength for the rapid repositioning of one’s leg so as to maintain balance. Typically strength training should involve three sets of eight to 15 repetitions of a specific muscle targeted exercise, with each set separated by three to five minutes of rest. The amount of weight used should be very light at first, and supervised for proper form, and the degree of weight increase over time is essential to avoid serious injury.
Finally, flexibility and balance training are essential to healthy aging. Flexibility training improves the ability to perform activities of daily living, such as bending over to put on ones shoes or trimming toenails. Flexibility training also helps prevent joint injuries and muscle tears especially during a fall or a stumble. Yoga, specifically taught for seniors, is an excellent way to improve flexibility.
Balance training improves stability and helps prevent falls and fall related injuries. Balance training can be accomplished with the help of a physical therapist. Home exercises including standing on one foot (while holding a hand near a chair) and heel to toe walking (with proper precautions) practiced daily will over time improve balance in most seniors. Practicing the martial art tai-chi under supervision has also been shown to improve balance, leg strength, and reduce the risk of falls.
In summary, healthy aging requires not just appropriate medications, but also physical activity that includes aerobic exercise, muscle strength exercises, as well as flexibility and balance training. Such physical activity may help preserve physical and cognitive functioning, prevent medical conditions that can degrade quality of life, and compromise independence. It may also allow seniors to avoid the proverbial bottle of pills as they age, remain engaged, and encourage their continued contribution to society.
Paul E. Lemanski, MD, MS, FACP (firstname.lastname@example.org) is a board certified internist at the Center for Preventive Medicine, CapitalCare Medical Group in Albany. He is medical director of the Department of Community Medicine and Population Health at CapitalCare Medical Group. Paul has a master’s degree in human nutrition. He is an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.