The Healthy Librarian

The Healthy Librarian

Posted January 29, 2010

Published in Health

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Archives of Internal Medicine--Seven Good Reasons to Exercise and Increase Your Chances for Healthy Aging

Read More: Benefits of exercise, bone health, brain health, cognitive impairment, DASH diet, healthy aging, hypertension, physical activity, strength training, weight lifting

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Exercising Ladies in their Eighties



Weight Machine Workout for Muscles and the Mind

"Exercise is better than any drug or anything else we have for aging.  There's no downside.  If this were a drug, it would be the safest, most effective drug in the universe."

Dr. James O. Hill, Director of the Center for Human Nutrition at the University of Colorado at Denver


Seven articles--count them!  All in the January 25, 2010 issue of the Archives of Internal Medicine.  

All of them saying the same thing, "Exercise works. Just do it.  Whatever your age.  Start now!"  click here for the Table of Contents.

I must be an exercise geek, because honestly, I find this kind of news exciting, encouraging, and hopeful.  It shows how we really can change our health.  Sure diet is an important partner in health--but exercise has a dual, and synergistic role in the equation.

Why Exercise?  What We Can Learn from Six New Studies & One Editorial?

  • Weight-lifting improves the brain. "Resistance Training and Executive Functions,"  Liu-Ambrose, Teresa et al, University of British Columbia.   The Study: Women aged 65-75 who spent 1-2 hours a week on progressive strength/resistance training with dumbbells and weight machines significantly improved their cognitive function after 12 months.  They improved their performance by 10.9-12.6% on the most important brain function: executive ability They saw improvements in their decision making, their ability to resolve conflicts, and they were better able to focus on subjects without becoming distracted by competing stimuli.  But alas, no improvements were seen in 2 skills: keeping numbers in their working memory, and shifting from one task to another. The strength training group's skills were measured against a control group who only did balance & toning exercises.  As for the balance and toning group--their scores on executive ability deteriorated by .05%.  The added bonuses found in strength-training?  It counteracts the inevitable muscle loss of aging while improving bone density and strength.  The Canadian group also improved their walking speed--which is a predictor of substantial reduction in mortality.  Big Point: The cognitive benefit showed up after 12 months of training--but not after 6 months.  Those who lifted weights 2 x a week experienced less muscle discomfort than those who lifted only once a week.  No surprise!  Take Away Message: Add strength-training to your exercise routine.  2 or 3 times a week is best.
  •  Start exercising at middle-age if you want to stay healthier as you age.  "Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older,"  Sun, Qi et al, Harvard School of Public Health and Harvard Medical School.  Click here for the article.  Harvard researchers looked at the health of over 13,000 women from the well-known Nurses' Health Study who had reached 70 years of age without any physical or mental impairment. Those who had higher levels of physical activity beginning at midlife were less likely to have chronic diseases, heart surgery or any physical, cognitive or mental impairments as they aged.  Take note: regular moderate-intensity (not wimpy) midlife physical activity made all the difference in the world to one's health after age seventy! Those who regularly walked at a moderate pace starting from midlife had a better chance of exceptional health than those who walked at an easy leisurely pace.  Picking up the pace made a huge difference in health--the fastest walkers significantly increased their odds of successful aging over the lollygaggers!  And don't despair, moderate walking improved later-life health in both lean and overweight women.  But those who kept their weight down (BMI range of 18.5-22.9) and exercised more vigorously than moderate walking improved their odds the most. 

Understanding METS.   For women, these are the METS for 1 hour of activity: 12 for running, 8 for stair-climbing; 7 for jogging; bicycling; lap swimming; and playing tennis; 6 aerobics or calisthenics; 2.5 to 4.5 for walking, depending on the pace--easy (<2 mph) normal (2-2.9 mph) brisk (3-3.9 mph) very brisk (4 mph or more)  To get over 15 METS a week you would need to walk 3.5 hrs./week at 4 mph or more.  Example: 30 METS=2.5 hrs of running; 30 METS=6.6 hrs of walking at a pace of 4 mph or more

  • Exercise for stronger bones, a better heart, less chance of falls, and to decrease your health care costs. "Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women-the Randomized Controlled Senior Fitness and Prevention (SEFIP) Study," Kemmler, Wolfgang et al, the Friedrich-Alexander University of Erlangen Nuremberg, Germany. 

"Contrary to pharmaceutical agents, which are typically dedicated to specific diseases, physical exercise affects a variety of risk factors and diseases and therefore plays a vital role in general disease prevention and treatment of the elderly."

In this randomized single-blinded controlled German study, 227 women over age 65 participated in an either an 18 month group exercise program, or in a wellness program (the control group).  The exercise program included 2 60-minute group exercise classes, and 2 20-minute at-home sessions--including aerobic exercise at 70%-85% maximum heart rate, balance training, isometric floor strength training for the lower body, stretching, and upper body thera-band strength training.  The wellness group participated in low-intensity exercise,walking at 50%-60% maximum heart rate, very low-moderate intensity strength training, and progressive relaxation exercises.  Results: Compared to the wellness group, the exercise group significantly improved their bone mineral density in both the lumbar spine & hip; their fall risk decreased with a 50% lower fracture incidence; and both groups (wellness & exercise) significantly reduced their 10-year coronary heart disease risk, mainly because both groups lowered their blood pressure.  Interesting Finding: Participation and adherence was much better in the group exercise classes than with the home exercise component.  Not a surprise to me at all.  I prefer group exercise, hands-down.  Take Away Point:  Even starting after age 65, exercise has a tremendous impact on one's health--and strength training definitely improves bone density.

  • Moderate physical exercise reduces the risk of cognitive impairment. "Physical Activity and Incident Cognitive Impairment in Elderly Persons. The INVADE Study,"  Etgen, Thorleif et al, Technische Universitat Munchen, Germany.  This study followed a large group of Bavarians (3,903) age 55 and older for two years.  At the end of the period they compared the incidence of cognitive impairment in the group with their levels of physical activity. The researchers adjusted for all the usual vascular risk factors that might contribute to cognitive impairment.  The Results:  Moderate or high physical activity was associated with a reduced incidence of cognitive impairment after the 2 year follow-up.  For those with no physical activity the incidence of cognitive impairment was 13.9%.  In those with moderate physical activity (less than 3 x a week) the incidence of impairment was 6.7%.  The high physical activity (greater or equal to 3 x a week) seniors had a 5.1% incidence of impairment.  Take Away Point: Exercise can the lower the risk of cognitive impairment--and the more days the better!
  • Even in a nursing home exercise can improve the quality of life--but not by that much. "Effects of Exercise Programs to Prevent Decline in Health-Related Quality of Life in Highly Deconditioned Institutionalized Elderly Persons," Dechamps, Arnaud et al, Universite Victor Segalen, Bordeaux, France.  This study included 160 institutionalized out-of-shape elderly (average age of 82) who were still able to understand basic motor instructions & who could move from one position to another.  They were divided into 3 groups: adapted tai chi for 30 minute sessions 3x a week; a cognitive action program which is a type of exercise that is related to everyday actions--from 30-40 minutes 2x a week; and a control group which had no exercise program.  Results:  After 12 months, the non-exercising control group experienced a greater decline in the activities of daily living than the exercisers.  Those in the  exercise programs slowed their health quality decline, however, the improvements experienced by the elderly exercisers weren't considered clinically significant.  Bottom Line:  Although exercise programs in nursing homes can slow down health decline, expecting actual physical improvements may be too much to ask. Don't wait until your eighties to start that exercise program.  You will have a much better shot if you start young--or at middle-age.
  • Add exercise and weight loss to the DASH Diet and you will see even greater improvements in blood pressure. "Effects of the DASH Diet Alone and in Combination with Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women with High Blood Pressure," Blumenthal, James et al, Duke University Medical School, North Carolina.  The DASH Diet emphasizes moderate calorie, low fat, low sodium, whole grain foods, along with 6-12 servings of fruits & vegetables a day.  Click here to learn more. The Study: 144 participants with an average age of 52, with an average blood pressure of 138/86 mm Hg, and not on any BP medication were enrolled in the study, and divided into 3 groups: 1. DASH Diet alone with counseling, 2. DASH Diet with a behavioral weight loss program & a supervised exercise program 3x a week at a level of 70%-85% heart rate, or 3. The  "usual diet control" group.  The study lasted 4 months.  Results: The DASH diet + weight loss & exercise group did the best, of course.  Their blood pressure was reduced by 16.1/9.9 mm HG.  Those on the DASH diet alone reduced their blood pressure by 11.2/7.5 mm HG, and those in the  "usual diet control group dropped theirs by only 3.4/3/8 mm Hg. Weight loss: The DASH Diet + exercise & weight management group lost an average of 19.1 pounds.  The DASH Diet alone group lost .7  of a pound.  The "usual diet group" gained 2 pounds.  Cardiovascular Markers:  The DASH Diet + exercise  weight loss group had the greatest improvements in this area-- including less arterial stiffness as measured by pulse wave velocity, an average of 19% improvement in their aerobic capacity (VO2 max), improved baroreflex sensitivity of 33% (less stiffness in the arteries--which is an early side effect of hypertension), and decreases in the size of the left ventricle--a side effect of high blood pressure (increases in the muscle tissue that makes up the wall of the heart's main pumping chamber-the left ventricle).  TAKE AWAY POINT:  The DASH Diet (high in fruits & vegetables, low in salt) + weight loss + exercise is the best combination to lower blood pressure and improve cardiovascular risk factors.
  • Exercise--the most effective prescription out there.  It's the best "drug" available to prevent dementia and insure successful aging.  "Evidence Regarding the Benefits of Physical Exercise,"  Drs. Jeff Williamson & Marco Pahor, Institute on Aging, University of Florida.  This editorial in the Archives of Internal Medicine highlights the benefits of exercise on successful healthy aging.

"It is now well established that higher quantities of physical activity have beneficial effects on numerous age-related conditions such as osteoarthritis, falls and hip fracture, cardiovascular disease, respiratory diseases, cancer, diabetes mellitus, osteoporosis, low fitness and obesity, and decreased functional capacity, all conditions that greatly increase the risk of reduced independence in late life. 

Two of these studies (in the Archives of Internal Medicine) evaluated the relationship between physical exercise and decline in cognitive function, a major contributor to loss of independence and related institutionalization in elderly individuals.

Optimism in this area is sorely needed owing to the failure of promising interventions aimed at preventing cognitive decline and dementia in the recent past.

Physical inactivity is one of the strongest predictors of unsuccessful aging for older adults and is perhaps the root cause of many unnecessary and premature admissions to long-term care."