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Strength Training in the Elderly

I stumbled across an article in a German medical journal that reviewed strength training in the elderly. Well, over half my patients probably fall in the category of “elderly,” so, I thought I’d summarize it briefly here. I addressed this in my book, and the conclusions reached in the article reaffirm my argument for resistance training as an important component of fitness across all age groups, and gender.

The review covered medical studies over the past five years that collectively totaled thousands of participants.

Without strength training, we begin losing muscle mass from our 30th year to our 50th year in a gradual fashion, but, from 50 years of age and on wards there is an acceleration of lean muscle mass of 15% per decade, which may approach 30% by the 8th decade. Currently, only about 10-15% of the elderly do resistance training, which is unfortunate.

A common misconception is that there are significant side effects to resistance training in the elderly, most commonly that of musculoskeletal injury; however, in the studies reviewed, the adverse effects of exercise didnt’ seem to be commonly reported.

The studies show that resistance training will reverse the age-related loss of muscle tissue, increase bone density, counteracting to some extent osteoporosis, and can even decrease the symptoms of fibromyalgia.

So, then, how much exercise?

Three times a week; 3-4 sets of 10 repetitions per muscle group at an 80% intensity of what you can lift with one repetition.

I would suggest working with a trainer, to get started, at the YMCA, or other local fitness center; especially if you’re a bit short in the weight-lifting experience department. I’ve read other literature that suggests that multiple sets are not necessary if the first set it performed to muscle failure, and that subsequent sets are of diminishing return.

Resistance training does not have to mean free weights, although three are convenient dumbbell stacks in which you can dial a specific weight. Other options would include a set of resistance bands of varying resistances, and of course a circuit weight machine (not free weights).

I think that a lot of elderly folks, especially women, discount the importance of resistance training, as a tool for improving the quality of life of those golden years.

Weight management, aerobic exercise,  and strength training are all components of a healthy lifestyle, longevity, and quality-of-life.

 

Chainsaw for sale

Last week we had strong winds, which actually sounds kind of cool and exotic, on top of the hill with tree-tops swaying and leaves rustling to and fro; but, there are consequences.

strong wind+tall, dead tree=big mess for me

 The tree missed the house by two feet, and that’s only because it wasn’t tall enough. Remember the philosophical argument that goes “if a tree falls in the forest, and no one hears if fall…” Well, I heard this one fall, so I guess it really did. It was early morning, and I was laying in bed, listing to the exotic wind-noise, thinking that I’d better get up and get to work when there was a sudden significant sound, kind of like a “ka-CHUNK.” I didn’t say anything to Sue, as I tend to minimize noises in the night, realizing that it was actually morning-time.

“Did you hear that?” She asked.

“Yeah, probably one of the rocking chairs blew over.”

“I don’t know, it sounded louder than that.”

“Yeah, well, I’ll check it out, I have to get up anyway,” I sighed, throwing my legs over the side of the bed, sore ankle and all.

In the bathroom, I looked out the window towards the pond and saw a flower-pot tipped on its side–sure enough, “it was a flower pot,” I yelled into the bedroom.

“Flower-pot…? I don’t think so.”

“Well…surprise, that’s all I see.” I stumbled woodenly over to the sink, revved up my Oral-B ultrasonic toothbrush and started doing the business. As is my habit, I looked out the side window, at the Lord Baltimore’s, in full bloom, and then I saw it. “Holy Shit!”

“What?”

“It’s a big-ass tree. It almost hit the house.”

She didn’t even say I told you so, even though I deserved it.

Today, being Sunday, and not raining, was my day to dispose of above tree. I hauled out my Husqvarna 55 Rancher, kevlar chaps and gloves, a helmet with ear covers and eye screen, a container of gas mixed with oil (like it’s supposed to be), and a jug of chain-bar oil. It took me half an hour and several F’in-heimers to start the dang thing; and then, it didn’t cut, the automatic break/stop thingy didn’t work, and it smelled like something was burning. It seemed so much more difficult than three or four years ago when I used it last, and it was new. According to my way of thinking; there were two obvious solutions: 1) buy a new chainsaw, or, 2) call an expert.

I chose option number 2.

“Sorry to bother you on a Sunday Andy–thought I’d just be leaving a message,” I explained when he answered.

“No problem. What can I do for you.”

“Well,  one of those dead, standing pines fell down in those winds last week. I know that doesn’t narrow it down much.” There are numerous tall, dead, standing pines around my house. “But, it’s pretty obvious because it’s angled out over my fire pit. I couldn’t get my chain-saw…”

“Uh…Doc; you shouldn’t be using a chain saw,” he interrupted, “you should leave that to me.”

“Yeah, I know, but it seemed like the manly thing to do. I actually got it started, but then things kind of went down hill. Half the time, I can’t start it; and the other half-the-time I do, I’m afraid I’ll cut off my left hand.”

“I’ll take care of it for you,” he said.

“That’d be great.”

Today, two hours ago, I pulled my last chainsaw pull-cord–the motion pretty much identical to the “elbows-out, lawnmower” P-90X, exercise that’s part of ‘Back and Biceps’. As a matter of fact, I would make an excellent ‘chain-saw, pull-cord puller’, but it stops there. Once it’s all vibrating and rattling with it’s jiggling, sharp iron teeth–I’m outa there.

Vanishing Flesh

This is my upcoming contribution to the NWTC newsletter for October:

Don’t you just hate it when someone tells you “I told you so,” knowing full well that you know that they know that they were right. Well, when I wrote The Relativity Diet over three years ago, I placed a great deal of emphasis on resistance training, as a component to weight-loss and a healthy lifestyle; and now that particular issue has become all the rage in the medical community. There is effort afoot to categorize the age-related loss of muscle as a disease. A disease to be known by the name of Sarcopenia, which is a word derived from the Greek words for “vanishing flesh.”

It will become the new Osteoporosis. Everybody knows what osteoporosis is. I can’t remember the last time I reviewed the medication record for an elderly woman and didn’t see some sort of a calcium supplementation, which is a good thing because osteoporosis is bad, and much attention is paid towards it. Most women should have a bone density test at some point; it’s almost as common as a mammogram now. So we agree, having a nice strong skeleton, with thick bones stronger than limbs of oak, is good; but, what good is that nice skeleton you have there if you don’t have good muscles to move it around? People don’t say, my, my… look at that nice skeleton as you collapse breathlessly in your reclining beach chair on a hot summer day at Murphy Park, after a hard mile swim in the bay, your muscles swollen from their effort-induced tumescence; no, they say something more like, wow, look at that six-pack…she must work out.

Vanishing flesh… sounds absolutely ghastly, an appropriate topic for the scary month of Halloween, and if you’re beyond thirty and don’t participate in resistance training, you are already vanishing, maybe not your fat mass, but at least your muscle is. Beyond thirty, the loss of muscle mass is 10% per decade; from 60-70 it accelerates to 15% per decade; and beyond that it’s approximately 30% per decade. Scared yet? Are there goose bumps on your arms? I hope so, because this is important. It has everything to do with countering the deleterious effects of aging and loss of functionality, and quality of life.

I have written that resistance training is not as intuitive as aerobic training. When most people think of exercise, the first thing that comes to mind is walking or jogging or bike riding; all of which are good—for cardiovascular health; but abysmal for maintaining muscle mass. Although sarcopenia is multi-factorial, having causes other than simply lack of resistance training, resistance training is the most important, and identifying and treating any of the other factors is useless without exercise.

So, what are the other factors? There are dietary considerations of course, the most important being an adequate protein intake, which might very well be deficient in older adults. Another factor is the age-related decline in certain hormones such as; Growth Hormone and testosterone. Did you know women need testosterone too? Although they need less, it is as essential to their health as it is for men. There may be a role for nutritional supplements such as; creatine, vit. D, whey protein, acetyl-L-carnitine, glutamine, and potassium bicarbonate.

Now, please don’t rush out and by bottles of all this stuff, you know how I feel about that, if you’ve read my book. The great majority of folks who eat a healthy, balanced diet, as I describe in The Relativity Diet, would be unlike to have any deficiencies, other than hormonal, perhaps. Your doctor can run the appropriate blood tests necessary to diagnose a hormonal deficiency, and if present, Hormonal Replacement Therapy (HRT) can be given consideration.

You and your doctor have been worrying about your skeleton for years, now it’s time to start worrying about your muscles. Although it is easier to prevent sarcopenia that it is to treat it, it is treatable, and it is never too late to start. So, it’s time to get off the couch, pick up a weight or resistance band, and get busy living…and don’t say I didn’t tell you so. 

Weight Maintenance II

Consider someone fifty pounds overweight. Using the quick and dirty formula for caloric need (11 calories/pound), that amounts to 550 calories per day to maintain that excess fifty pounds. Now, considering nothing else than the first laws of thermodynamics (calories in=calories out), that someone will have to go on a “diet” that is 550 calories less than what they are currently consuming.

At the end of the “diet,” what would be the most logical maintenance mechanism? Continuing on the diet, of course, forever. If you go back to doing what you were before, there is only one outcome–regaining the weight commensurate with your caloric consumption and daily activity.

A problem arises when the “diet” is not valid long-term, which I allude to in the previous post. If you don’t have ownership of your diet, if it is foreign and not your own, then the risk of recidivism is much higher. This is why I think that you need to have a direct knowledge of the caloric content, carbohydrate and protein content of the foods you eat as opposed to a “system” that gets between you and your energy consumption.

Don’t forget that there are many variables; Diet Induced Thermogenesis, daily exercise (aerobic and resistance training) to elevate your BMI, the timing of meals, and other strategies addressed in the book, all of which will facilitate both weight-loss and maintenance; because, for all my grousing about calories in and calories out, it is obviously more complex than that.

A strategy, implied in the above, that would be helpful for maintenance would be the addition of lean muscle tissue (weight-lifting) to a significant extent, which will increase your basal metabolic rate. I exercise five to six hours a week, about half resistance based, and I’ve found that I maintain my goal weight within a fairly tight range, without having to specifically count calories.

After your “diet,” and by that I also mean your daily energy expenditure habits, becomes ingrained (your new normal), you will be able to do the same.

Your diet is temporary only in the sense that it lasts as long as it takes for you to follow it naturally, without having to count and keep track on a daily basis; and if you vary by more than 5% (like the Holidays), then you start keeping track again.

Weight Maintenence

I would like to address a question, or concern posed by a reader in a comment under the “Getting Started” page/post. It is such an important concern that I didn’t want it languishing, relatively unseen, in a comment thread. The comment is copied below:

Your book and message made a difference in my approach. I did weight watchers and with the science, I took a different tact in my food choices (more protein, less bready carbs) and added in daily exercise. I’m now at BMI 24.5 and feeling great.  However, I’ve been here before. The challenge is keeping it off. WW maintenance has never worked for me in the long run, one of the weaknesses of the program.  Any advice that would make a difference? I need a different maintenance approach. Thanks.

First of all, congratulations, dear reader, for reaching your goal, which is an admirable achievement, and hard-earned I am sure. I too have reached a goal-weight in the past, only to let it slip away, sadly watching the numbers on the scale creep right back up to where I started at in the first place, and sometimes even higher.

First of all, dear reader, the thrust of my book, “The Relativity Diet,” is that the onus is on you, the reader, to utilize your newfound knowledge to choose the food types from the three groups of macro nutrients in a manner that you are comfortable with. Generally, this means managing your carbohydrates in regard to total volume (less than 120grams/day, and low-glycemic), concentrating on lower fat protein sources (poultry, fish), generally eating more protein at the expense of carbohydrate, and of course, managing your caloric intake (counting calories).

You see, all of the above isn’t a temporary “guide” to get to a special place.  Nay, all of the above needs to become your new “normal.” On the Relativity Diet, when you get to your goal weight, nothing changes; in this case, “more protein, less bready carbs,” and “added daily exercise.” Why would you want to cease something that is so obviously beneficial?

This is the problem, as I see it, with many diets, including Weight Watchers with the points system. I think it is difficult to follow a “plan” for the rest of your life. That is why I think if your diet is based upon the choices you make, which is based on the science you have learned, then you take ownership of your diet, and it becomes your “usual food and drink,” which is actually the definition of “diet.” It is impossible for someone else’s diet, whether it be Jenny Craig, Nutrisystem, the points-based Weight-Watchers, or any other “plan” not your own to become your usual food and drink; it will be forever artificial, and thereby temporary.

There is no doubt that you will stray from your “diet” at some point. The important thing is to know that you are straying, that you stray not too much, and for not too long. As long as you return to your new normal of healthy eating and daily exercise, all will be well.

Thank you so much for your comment, and again congratulations.

Question about cardiovascular adaptation to exercise

A question from a very intelligent and motivated reader:

“…we started using the advice in your book as far as meals and exercising.  The first 4 or 5 days I couldn’t do more than 2 mph on the treadmill (30 min. miles).  After the 6th day I could do 3mph (20 min. miles) without a problem.  Exactly what happens to the cardio-vascular system to cause this?  Granted, I’m not quite ready for the Door County Triathlon, but I’m heading in the right direction. Weight 10 days ago, [censored] {6 pound loss}; height is still the same.”

Source material for the below is Exercise Physiology, Sixth Edition; McArdle Katch, and Katch.

It is absolutely amazing, the capacities our bodies have to adapt. One of the quickest adaptations is in the metabolic machinery in the cell—within 5-10 days of training there is an increased mitochondrial capacity to generate ATP aerobically (ATP is the energy currency of our bodies–it is to the human body as gas is to a car). The enzyme changes result from increases in total mitochondria, which are those little things in the cellular cytoplasm that look like little ovals with a “maze” inside of them. With this change, a person has an increased aerobic capacity within a number of days of starting a training program.

Another fairly immediate change is in the plasma volume (the fluid that comprises the vascular volume within which are all the red blood cells, white blood cells, and lots of other stuff)—after 3-6 aerobic sessions there is a 12-20% increase in the plasma volume; in fact, there is a measurable change within 24 hours of the first exercise episode. This effect enhances the stroke volume and oxygen transport during exercise. Unfortunately, the expanded plasma volume returns to normal levels after one week of no exercise.

The most significant adaptation in cardiovascular function with aerobic training is an increase in the cardiac output, which is the amount of blood that the heart can pump throughout your body, measured in liters/minute (Max Cardiac Output for Sedentary Adult is 20.0 L/min: for Athlete it is 30.4 L/min). Aerobic training also increases the amount of oxygen that can be extracted from the circulating blood. This is because there is an improved cardiac output distribution to the active muscles, and those muscles becoming better at extracting and processing the available oxygen.

There are many other benefits, both immediate and long term. For instance, after two years there is nearly a 50% increase in the capillaries (tiny blood vessels) in the muscles, which allows for more oxygen delivery to the tissues (20% after 2 mo.). In my book I discuss at length the underappreciated benefits of exercise; increase in metabolic rate, anti-depressant effect, and anti-inflammatory effect.

You would think that if more people knew of this, there’d be a lot more exercising going on. The truth is, most of our health ills today are largely self inflicted; smoking, drinking excessively, and obesity. If folks would not smoke, drink in moderation, maintain an appropriate caloric intake and exercise regularly, there would be much less of a need for doctors.

Ssshhh…don’t tell anybody–I still have to put beer in my cooler.