Date: October 1st, 2001
The best medicine to combat the vagaries of old age is exercise. And it's never too late to start, says Dr. Maria Fiatarone Singh, professor of Medicine and Sports Science at the University of Sydney in Australia.
Dr. Fiatarone and colleagues at Tufts University developed and tested a strength training program using weights on frail men and women in their 80s and 90s who live at the Hebrew Rehabilitation Center for Aged in Boston. Nearly all have arthritis and heart disease and take multiple medications. Most use walkers and almost all experienced falls.
Within 10 weeks, researchers saw improvements across the board in their patients. Virtually all of the participants got stronger and were able to walk faster and climb stairs more easily. Those who were depressed became more sociable, and those who took nutritional supplements had improved appetites. The non-exercising control group lost muscle mass and received no benefits from nutritional supplements.
The evidence is clear, and so is the geriatrician's message to the medical community: doctors spend too much time prescribing pills and not enough on encouraging play for older patients.
Here, Dr. Fiatarone elaborates on her studies.
Q. We all know that physical exercise is good for our health and that most of us don't get enough of it, but what special benefits can exercise provide for the elderly?
A. There is a difference in the reasons for exercise for the elderly and exercise for younger people. An exercise program for the elderly is targeted more specifically for the prevention of disease and disability, while younger people exercise primarily to look better.
Q. What kind of exercise do the elderly need?
A. Not all exercise is good for all purposes. If you are using it like medicine, it's specific in terms of effect. You need to prescribe an exercise in relationship to what it is you are trying to promote. Somebody who has gait disorders - difficulty walking, falls a lot, has osteoarthritis and is susceptible to fractures - needs strength and balance training for the muscles. If the purpose of exercise is to prevent cardiovascular disease, you will need an aerobic exercise.
Q. Is strength training the best exercise for the elderly?
A. We looked at strength training for frailty and functional dependency. We looked at causes of frailty. Loss of muscle strength with aging is a cause of frailty. So the kind of exercise needed is strength training. Stretching and walking don't impact muscle size. If somebody is weak and the weakness is contributing to the health status or quality of life, strength training is the way to go. If core balance is the problem, it makes sense to give them balance training. Tai chi and yoga are examples of balancing exercises. Standing on one leg or walking on a balance beam are balancing exercises.
Q. Isn't it enough to walk regularly, or are the benefits of walking overrated?
A. All exercise training should challenge you to accomplish something not normally experienced and to conquer new challenges. When you walk, you normally don't get any better unless you challenge yourself in a more difficult way, like walking heel to toe. However, the epidemiologic literature shows that walking is associated with reduction in mortality and cardiovascular disease, diabetes and stroke. The more vigorously you walk, the better it is. But, you have to look at it like medicine. You can't use the same form, dose, and intensity, for all people.
A. Being a couch potato is lethal. We recommend seeing a doctor before starting any exercise program, but chronic, age-related medical conditions almost always indicate a need for exercise.Q. Isn't exercise dangerous for senior citizens, particularly those who are already frail and have fragile bones?
Q. Are there mental as well as physical benefits to exercise for the elderly?
A. Depression is well treated with exercise. Weight lifting and aerobic exercise work equally well. Exercise works 70 percent of the time for depression. It's better than anti-depressants because drugs are often less well-tolerated in older people. Nobody knows how or why exercise works. However, there are no good studies that show it can treat dementia. It helps with attention span, and there is some evidence that people who exercise are less likely to end up with dementia, but there is no way to tell if it is causal or not.
Q. How do you persuade seniors to get out of their rocking chairs and start pumping iron?
A. Independence and quality of life are the driving factors, not longevity. One thing people don't want is to become dependent on others. Strength training effects are evident in just a few weeks. They can see that they get out of chairs more easily and can move around better and that sustains people. Long-term adherence to strength training is quite high, whereas people are likely to drop out of exercising on a bicycle or walking.
Q. Is it ever too late in life to begin an exercise program and benefit from it?
A. It's never too late to start. Lots of people are starting in their 80s and 90s. It's good if you can come to old age with a bit of reserve, but even if you don't, exercise works.