Aging Happily And Healthfully

JeffreyBergMDEveryone wants to age gracefully. Living to an old age, being financially and physically independent, and having lived a life well-lived, is on everyone’s bucket list. How to achieve all of this is way beyond my area of expertise. It involves focusing on many things that I am not qualified to advise you on. Among them are your mental and physical health, financial security, familial issues, social networks, achieving goals, and a slew of other things.

What I can advise you on is how to get and stay physically independent as you age. Don’t underestimate the importance of this on aging “successfully”. Without physical independence, it will be challenging, if not impossible, to achieve the rest. So how do you do it? Come, let me show you.

There are six things that you must do to ensure your physical independence as you age. Think about it – just six things. I can’t make it any simpler. Read. Do. Enjoy.

1) Control Body Weight

There probably is nothing that you can do to maximize your health and prolong your life quite like maintaining a healthy weight. Carrying extra weight is a strain on nearly every organ system. Multiply those effects times many years, and you have a recipe for significant damage to your body. Obesity has shown to increase the risks of heart disease, diabetes, stroke, high blood pressure, several forms of cancer, depression, musculoskeletal pain, arthritis, and death. If you want the one “pill” that gives you the best chance of having a healthier older age, keeping your weight at a modest level is it. 

Not only does being overweight cause all the adverse effects discussed above, but it also makes complying with the other factors discussed below even more difficult. 

Additionally, having a healthy weight will help you stay away from doctors. As a physician and surgeon, I can tell you there is a basic law of good health – The less medical evaluations and care you get, the less you will need. And the less you need, the safer you will be. The medical industry is well-meaning but can be very dangerous. There is a tremendous amount of overtesting, over-diagnosing, and over-treating. All of this adds to your risk of complications and the need for recuperation, which can lead to further functional deterioration, particularly as we age..

2) Exercise Aerobically

It seems clear that if you tire just walking up the stairs, it will limit the activities you can do to care for yourself and enjoy your older years. But having improved capacity for movement is not the only benefit of higher aerobic capacity. Aerobic and endurance training are among the best ways to improve your cardiovascular function. Nearly every aspect of your cardiovascular system benefits from endurance training.  

Foremost, aerobic exercise strengthens the heart muscle. Your heart, therefore, doesn’t have to pump as often and so this type of exercise will lower your resting heart rate. It increases good cholesterol (HDL) and reduces the bad stuff (LDL and triglycerides). These changes help “clean out” your blood vessels and make them more pliable. All of this reduces how hard your heart works and lowers your blood pressure.  

Aerobic exercise also can reduce body weight, particularly your body fat. This protects against diabetes by improving your sensitivity to insulin and lowering your blood sugar.  

Furthermore, aerobic activity can help you sleep better by improving mood through increased endorphin secretion and just plain making you more tired. Proper sleep and exercise both have been shown to improve cognitive function, reduce the incidence of depression, improve reaction time, and stave off mental deterioration and the development of Alzheimer’s syndrome.

 There is no upper limit to the benefits of aerobic conditioning. The fitter you are, the lower your risk of dying – Even in patients in their 70s. So walk your dog, run more frequently, swim more, dance, bike further…and live longer.

3) Maintain Muscle Mass

Starting after age 30, we all begin to lose muscle mass. In fact, if we are relatively inactive, we can lose as much as 3-5% of our muscle mass a year. The speed of loss increases as we age, particularly around age 75. Loss of muscle mass is called sarcopenia

Sarcopenia is bad for many reasons. It is associated with an increased risk of falls, impaired quality of life, increased disability, and higher mortality. All of these obviously can affect your quality of life and health.  

Since the loss of muscle mass leads to loss of strength and stamina, even simple activities can become more difficult. This can make living an independent and enjoyable senior-life less likely. Shopping, taking care of yourself, gardening, or nearly any of your self-care and leisure activities might become more challenging, if not impossible.

Not only does sarcopenia adversely and directly effect our function, but reduced muscle mass can make staying at a healthy body weight, maximizing proper metabolism and maintaining safe bone strength, avoiding osteoporosis, that much more difficult.

And not to make things worse, the less you do, the more muscle mass you lose. Consequently, sarcopenia promotes more sarcopenia. This then leads to even more significant disability and reduced independence. 

Sarcopenia has many causes…

The cause of sarcopenia is not just due to inactivity. Although that is a large part of the problem. Sarcopenia also results from a loss of nerves that signal the muscles to move. As well as arising from poor nutrition, hormonal changes, including less growth hormone and testosterone, which are critical in muscle development, and finally, a reduction in the capability to turn protein into energy. 

Despite the apparent multitude of causes, the primary preventative solution and treatment is exercise, specifically resistance training. What is resistance training? Pushing, pulling and carrying objects. A structured program, guided by a trained physical therapist or trainer, is advisable for many to target the correct areas and minimalize injuries. However, such a formal regimen is not necessary for everyone. Even moving furniture, cutting your lawn with a push mower, carrying groceries, and gardening can all serve as forms of resistance exercise. 

Medications and nutritional supplements are being evaluated to supplement the benefits of resistance training. Still, at this time, lifting, carrying, pushing, and pulling are the best ways known to maintain muscle mass and stay strong. Strengthening any muscles is beneficial. But what muscles are most important? If you have to choose…

4) Increase Leg Strength

Why leg strength? There are several reasons strong legs are so important as we age. Your legs are your means of independent motion. As we mentioned above, as you age, you will ultimately get weaker. Imagine if your legs are not strong enough to support you and move you around or if you are unable you to walk downstairs or to squat down…and then get yourself up. If you can’t move from place to place by yourself – if you can’t get yourself to the bathroom or shop for yourself, the likelihood of living independently is significantly reduced. Additionally, without strong legs, the chance of you not requiring assistance or at least not being able to participate in meaningful leisure activities is lessened considerably.

But that is not the entire reason that strong legs are beneficial and essential as you age. Above I mentioned the importance of maintaining muscle strength and the dangers of losing muscle mass. Well, your legs are made up of your largest muscles. So any effects resulting from your muscle mass is going to be even more greatly impacted by the status of your leg muscles. The stronger your legs, the higher the metabolic benefits, and the greater the fat and calorie burning.

And while you get all those benefits, you get many others as well. Your legs are the base for your pushing and pulling. Try lifting something while sitting with your feet off the ground. It will be much more difficult, and the amount that you can raise or push will be much significantly less than if your legs were firmly planted on the ground. This exemplifies how vital leg strength is to our overall strength. The stronger your legs, the stronger and healthier you will be overall.

Avoid falls…

Stronger legs can also prevent injuries. Falls are the leading cause of nonfatal injuries in the elderly. One in four people over 65 years of age will fall each year. At this age, a fall can be much more significant than in the young. Older folks’ bones are frequently brittle due to osteoporosis. Unlike more youthful people, when they fall, they don’t bounce. They break. And breaks in the elderly can have devastating consequences.

Twenty-five percent of those sustaining a hip fracture will die within a year, and another 50% will lose at least one level of function. And it’s not just your legs that are at risk. Falls often result in wrist, shoulder and spine fractures, rotator cuff tears, and even significant head injuries. Any one of these can lead to temporary and even permanent disability. All could require surgery or extensive rehabilitation. Thus affecting your independence and quality of life. 

Falls in the elderly result from several factors: delayed reaction time, changes in equilibrium, vision impairments, and several others. But one of the modifiable factors is leg strength. The stronger your legs, the more sturdy your stance and gait. The stronger your legs, the better your corrective ability should you begin to fall. If your legs are strong, the less likely they are to fatigue. That means, the higher you will raise them while walking, lessening your risk of tripping over the edge of a carpet or a shoe left on the floor. 

It’s no wonder that those who can successfully sit down and stand up independently have been shown to have greater longevity. Yes, having strong legs is a must if you wish to live long, healthy, and enjoy those years. So stand up, squat down…and then do it again and again. 

5) Improve Balance

For many of the same reasons that strong legs are essential as we grow older, so is balance. Without proper balance, your ability to move in different directions, on different surfaces, and to squat down and get up, will be significantly impaired…and can even be dangerous. 

As we age, our proprioception, our sense of where we are in space, our vision, and our reaction time all worsen. Add poor balance to this equation, and you have a perfect storm for falling. We’ve already discussed how dangerous falling can be as we age. So we need to do everything that we can to prevent falls. And maintaining, or better yet improving our balance, is a big part of this. 

Depending on your physical condition, there are several ways to maintain or improve your balance. For those who may be older and not as fit, Tai Chi is a great option. Those in somewhat better shape may prefer yoga. For those in even better physical condition, resistance training with only one foot planted on the ground or while sitting on an exercise ball can be even more challenging.

6) Maintain Flexibility

I’ve left a discussion about flexibility for last. Flexibility often gets a lot of focus, but its impact alone on one’s quality of life is controversial. We indeed lose elasticity in our joints as we age, but it’s not clear that this makes us unhappy. After all, it is not uncommon for us to have less overall needs as we age and so the loss of motion may go unnoticed for many. Our capabilities and needs meet. This may be why we are not overly affected by the loss of our movement. 

With that said, however, maintaining our flexibility, helps us comply with the other recommendations above. Looser joints and better range of motion will make strengthening, aerobic conditioning, and balance exercises more natural and safer to perform. All of these will enable us to watch our weight.  

So, although not an apparently critical component of an exercise program as we age, it is still advisable to incorporate some stretching and range of motion exercises into your plan.  

Flexibility can be improved with static stretching. These are the classic “reach and hold” exercises that we have all been taught since childhood. It can also be enhanced by ballistic activities. These are more fluid motions. Think of a boxer getting into the ring or a swimmer waiting poolside for their race to begin. These exercises use gravity to stretch our limbs. Ballistic activities may put less strain on the older and stiffer joints in the elderly. Yoga and Tai Chi incorporate components of both static and ballistic stretching. These are excellent ways to improve your range of motion, and they can be fun too! 

You can do it…

Staying physically independent as we age is an essential component of having a satisfying senior life. Achieving this takes focus and, like everything else worthwhile, some effort. You don’t want to enter your senior years too out of shape.  Correction at that point can be very difficult, more dangerous, and possibly not as successful. So start early. Start now. Make daily exercise or at least increased activity just another part of your life. If you start early enough and you focus on the six recommendations above, aging gracefully is within your grasp.

A word of caution though, particularly for those who don’t regularly exercise, all new exercise programs should be preceded by a discussion and possibly an evaluation by your doctor. He or she knows your medical status best. You don’t want to set out to fix one health problem and cause other, potentially worse ones. So first, get yourself evaluated and then start working towards a more independent, healthier, and safer you.

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