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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.