Each year 40% of those over 65 have one or more falls. Certainly, not all of them result in serious, or any for that matter, injuries. But a very real consequence of falls is that the fear of having another more serious one may result in limiting activities to a point of causing isolation and loss of independence. Fear of another fall can motivate one to stay indoors more, and/or limit walking to a cautious shuffle. There is a good chance that a loss of confidence will occur that results in further debilitating habits. Declining health may follow .
Falls tend to increase as one ages, largely because of a decline in sense of balance, a slowing down of reaction time, and a decline in muscle strength. All of these factors combine to lessen overall stability, especially on uneven walking surfaces. Other factors may be reactions to a variety of health problems and related medications.
Some of these other factors are:
Exercise can make aging more "graceful." It is estimated that 70% of the elderly are sedentary, even though it is well known that regular exercise provides a myriad of health benefits - can help prevent hypertension, CAD, diabetes, stroke, depression, some cancers; and reduces the effects of arthritis and osteoporosis.
Improved strength can help prevent falls, and lessen their severity if they do happen - largely from improved balance. You can function better - carry grocery bags, get up out of a bathtub or even a chair, which presents a real obstacle to some seniors. Some of our elderly population avoid exercise because often, in the past, the required intensity of exercise has been oversold. But it has more recently been declared by the Centers for Disease Control and Prevention, the American Heart Association, and the American College of Sports Medicine, among others, that moderate, regular exercise provides physical benefits. Just get moving; frequency and duration of activity outweigh the intensity of the activity. That is not to say that intensity is not important, but that it isn't necessary for some health improvements. Regular walking bestows health benefits; as do normal daily activities like shopping, gardening, mowing the lawn, etc. These activities have a cumulative, positive effect. And it doesn't hurt at all to sprinkle in some formal exercise sessions.
Aging in its unmitigated state leads to loss of bone density and muscle mass, not to mention loss of aerobic capacity (Hmm, I did didn't I?), resulting in significant functional degradation. BUT, we can fight back. Exercise, especially weight training, can lessen or even reverse some of our "curses of aging."
Current exercise guidelines say a minimum of 30 minutes of low to moderately intense activity on most days of the week is sufficient. However, they augment rather than replace older guidelines which called for 30-60 minutes of moderate to vigorous exercise, using the large muscles, three or more times a week to provide the most health benefits. It is now considered acceptable to do exercise (activity) in 5 to 10 minute increments, as long as they total 30 minutes during the day.
Don't overlook the importance of weight training at least twice a week. It not only makes you stronger, but also is a factor in weight control, since muscle tissue is where calories are "burned."
You can start weight training at any age - you're never too old to start. But if you are a man over 40 or a woman over 50, and haven't been exercising, consult with a physician before starting an exercise program. Your visit should include discussion of any medications that you are taking. Some changes in prescriptions may be in order.
Your next step might be to go through an assessment of your current fitness. This is an optional step that can give you a baseline against which you can measure progress, for those of you who like to look at numbers. Some people need to see numbers to validate what they feel and see.
Physical fitness is most often defined as a concatenation of four components: 1) muscular endurance and strength, 2) cardio-vascular/pulmonary (aerobic) fitness, 3) flexibility, and 4) body composition (fat or lean). There are four commonly used tests to assess the four components of fitness, but before launching into them, take some time to warm up (by walking or doing some other aerobic exercise for a few minutes) and then do some stretching.
Keeping in mind that we are talking about older adults, the fitness testing to be described is considerably different from what would be used for 20-year olds, for example.
Aerobic fitness can be assessed by a one-mile walk test. First learn to take your pulse. Find it by placing your fingertips on the thumbside of your wrist. Count the beats for 15 seconds, then multiply by four. Once you have that mastered, find a level spot to walk. A school track is perfect, since they are commonly marked, four laps per mile; and are level. They are often metric nowadays, but it doesn't matter. You are just setting a benchmark for a given distance.
Muscle strength is measured separately for upper and lower body. For lower body, record the number of times you can stand up, without using your hands, from a sitting position on a chair. For upper body, record the number of full push-ups that you can do without stopping. Do wall push-ups if your level of fitness so dictates.
Body fat presents more of a health risk depending on its distribution (i.e., a fat gut is less healthy than wide hips and thighs). Divide your waist size by your hip size, in inches. Risk of heart disease, and maybe diabetes, increases for men with a number greater than 1.0, and a woman's risk increases with a number less than 0.85.
Flexibility is assessed by doing the stretch-and-reach test. This test is accomplished by sitting on the floor with your feet about 8 inches apart (legs are straight), with your heels against a piece of tape. A yardstick is taped to the floor between your legs and perpendicular to the tape line. The yardstick should cross the tape at the 15 inch mark (the highest number should be furthest away from you). Reach forward as far as you can by "walking" your fingers forward without bending your knees. Hold your maximum stretch for two seconds, then record the distance.
It is imperative that you do a thorough warm-up before this test (DON'T STRETCH COLD MUSCLES), and don't do it if you are experiencing any back pain.
Now that a visit to a physician has been done and an assessment of current fitness is completed, it is time to design an exercise program. But first there are some things to consider. Keeping a log helps you keep track of your program - the exercises planned and your progress; develop what can be called a "priority" training system; that is, use low intensity to strengthen weak parts and repair injured ones, along with some higher intensity exercises. Then add some aerobic exercise into your program. Work toward gradually increasing strength and aerobic fitness. Regularity is the key to improvement. It is important to begin at a level that you can maintain. Intensity can be increased when regularity has become the rule. It would be good to work toward incorporating flexibility, aerobic endurance, and strengthening components in your program. And each session should include a warm-up period, the actual work-out, and a cool-down period. Now collect your equipment - this is particularly easy if you choose to work-out at a health club; but, if you don't, select your workout area and gather your weights or exercise machines, and verify that everything is in good working order. Don' forget to include an appropriate pair of shoes.
Now for the ultimate step, GO DO IT.
A sample exercise plan follows, and includes the three components: flexibility, aerobics, and strength.
FLEXIBILITY TRAINING can be part of your warm-up, but should always follow some warm-up activity (5-10 minutes of bicycling, walking, et cetera). This particular plan contains five stretches, and I would like to add one - the "elongation" stretch.
This one has been described before in an earlier Newsletter, but it deserves to be repeated. Start in a relaxed, supine position - stretched out on the floor, a couch, a bed, or whatever; and your elbows and knees are extended as fully as possible. Your body should form a relatively straight line from your toes to your fingers. Once you have melted into this flat position, try to move your hands farther from your head, while simultaneously trying to move your feet in the other direction - you are stretching your middle by extending in opposite directions at the same time. Try to pull yourself apart, but without hurting anything. This stretch feels good - honestly. Hold it about 30 seconds.
Now let's do a lower-back stretch. Still on the floor (??) on your back, with both knees bent and feet flat on the floor, put your hands behind one knee and pull it toward your shoulder. Hold for 30 seconds, then repeat on the other side.
A gentle thigh stretch starts with you lying on your back near the edge of a table or bed. One leg is dangled off the edge. You pull the other knee toward your chest (just as in the previous stretch) until your lower back flattens against the whatever. Hold for 30 seconds, then repeat on the other side.
Next is a calf stretch. This classic stretch is started by standing, facing a wall at arm's length. Lean toward the wall with one foot forward with the knee bent, and the other foot back and flat on the floor. Now move your hips toward the wall, and feel the calf stretch. Hold for 30 seconds, then repeat on the other side. Note that small adjustments may be made as the stretch progresses and the muscle loosens up.
One simple hamstring stretch is begun by sitting in a chair with one leg extended forward from the hip, and resting on another chair. You should be seated with your back vertical, and your knee straight. Now bend forward from the hips while keeping your knee straight and your back flat. Stretch as far as you can without pain. Hold for 30 seconds, then repeat with the other leg.
And finally, one chest stretch that is easy to do and effective is to clasp your hands behind your head, and move your elbows back while inhaling deeply (inflating the balloons, as it were). Hold it for 30 seconds - the position, not your breath (unless of course you wish to turn blue and pass out).
AEROBIC TRAINING should be done at least five days a week for 20-40 minutes, at a fairly easy to fairly hard intensity. The intensity depends on your level of conditioning. Just use the simple "talk test" to regulate intensity. If you can sing an aria, you're going too slow, but if you are gasping for breath you need to slow down. For your entire aerobic session, go as fast as you can while remaining in an aerobic state.
If at first you just aren't up to going for 40 minutes, do as much as you can and gradually increase the pace. One recommendation is to limit aerobic exercise time increases to one to five minute increments over a period of time. Big jumps can increase your risk of injuries. Increase both time and pace gradually.
STRENGTH TRAINING recommendations include four exercises that can be used to start strength training. This list is not meant to be comprehensive; it is just a start; others can certainly be added. The series includes: 1) triceps overhead extension, 2) arm curl, 3) chair dips, and 4) chair squats.
Here are a couple more issues to be cognizant of: 1) danger signals, and 2) post-exercise cool-down.
Danger signals include:
For a cool-down, which should follow each exercise session, you can just walk around for awhile. Or repeat the stretches from the beginning of your program. The point is to let breathing and heart rate slow down to normal, and to let your body slowly cool down to normal.
Isometric exercise was once fairly popular. [This form of exercise involves maximally contracting against an immovable force.] It can involve very intense contractions, but it fell out of favor when it was found that it only increased strength at or near the joint angle exercised. But it has some uses - some physical rehabilitation, for example. Another application where it can be useful is with home exercise - for those with no space or equipment. But to strengthen through a full range of motion, several sets need to be done for the same muscle at different angles. An example is arm curls. Do a set (about 10 seconds per contraction) at 120°, at 90°, and finally at 45°. I prefer the iron game, but isometric exercise can be a viable option.
(Q) Is it worthwhile to eat yogurt for its calcium content, since it is not commonly fortified with vitamin D for calcium absorption.
D.J., San Jose, CA
(A) Yes, it can be worthwhile. Vitamin D is stored in the body, so when you eat something with calcium, it is laying in wait. It produces calcium-binding protein, which allows for calcium absorption. Therefore, calcium-rich foods are healthful whether they contain vitamin D or not. Just make sure you get enough sun exposure or enough food containing vitamin D.
(Q) I am currently doing squats, but they are getting a little too easy, but I workout at home and don't have any equipment. Is there any way I can make then harder?
E.S., Santa Cruz, CA
(A) One way is to do them in a "step" fashion, that is: lower yourself until your thighs are at about a 45° angle, then pause, then lower to 90°, pause again; then start back up and pause halfway before final knee extension. Keep the movements slow and controlled, and vary the pause time according to your desired intensity.
(Q) Do you have any tips for avoiding colds or flu?
S.S., Sacramento, CA
(A) A few:
Cold Wave Linked to Temperatures
and
Study Finds Sex, Pregnancy Link
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Send questions or comments to Michael Fenner: e-mail to Mike Fenner
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