geriatric aspects of resistance

[Bob S.]

To reply to Armandos question about my definition of health- I think it is important to be strong, fast and fit- vague terms I know but nonetheless they are all important and we can argue the relative importance of each component- from my perspective strength training is vitally important as we age successfully, being fast is a product of strength and training for it, fit can arguably be achieved several ways -HIiT, LSD

There reaches a time when weight begins to put more stress on the frame than it can handle. Of all the members of this forum, you and bone-fixer probably are the most knowledgeable about this whole business. What can be done with a knee that lacks cartilage? What can be done with a spine that resembles a question mark, such that any weight lifted tends to make it worse? What can be done with a spinal nerve channel that is stenotic to the point where it brings about continual pain? These are rhetoric questions. I am not asking you for free medical advice. I am just asking what your general thoughts are with regard to the effect of resistance work on an aging skeleton, not on my specific problems. I have seen a number of orthopedic surgeons over the years about a number of things that have cropped up and I have followed their advice, including a lot of physical therapy routines. The usual reaction that I get from the medical world in general is that I have the body of a somewhat younger man, or just keep doing whatever you are doing, or "I hope that I am doing that well when I reach your age," or some such comment. All very flattering, but it doesn't really tell me what I should be doing and certainly no one has said that I should be doing high resistance work. Just what are the geriatric aspects of weight work other than lack of it is a sure way to lose muscle. It also seems to me to create skeletal problems unless one gradually cuts back on the intensity. I am really curious to know what you think about th is subject.

Bob S.

[Balkan boy]

Thanks for brining this up, Bob.
It's a subject that I'm currently investigating.

I think that some medical people and trainers are reluctant to recommend a relatively intense routine to an older person out of fear that they'll do more harm then good.
I know quite a few decent orthopedes that are useless for anything that isn't clinical. They weren't trained to deal with non-injured people and they don't' have the time and interest do deal with prevention.

I'm a bit biased towards C2 ergs, but it keeps coming back to me as a good solution for someone who isn't athletic and have never lifted wights. One can use it as a tool for strength and aerobic exercise. It's hard to introduce weights to a 60 year old sedentary woman.

You're a case-study material, Bob. There are very few people who stay vigorous or even lucid at your age.

[skiffrace]

Interesting question.
I think we do know a few things for sure, and a few things somewhat confidently.
In the first category:
1. Genes are #1. If you have really good ones, you'll be fine despite abusive lifestyle. If you have really bad ones, not much will help you. Most people fall into the 'average' category, which means: keep on reading...
2. Keep moving, no matter what.
3. Adjust the type, duration and intensity of the exercise to your physical condition (not age!)
Ex. if you knee cartilage is worn out from the lifetime of running, switch to swimming as the primary sport.
4. Eat healthy diet. (Michael Pollan: eat food, mostly plants, not too much)

In the second:
1. Both diet and exercise are very important, but diet is more. See this link about people who get megadoses of exercise, and still have pathological changes to their hearts: http://nutritionstudies.org/masai-and-i ... oser-look/
2. We live degenerate lifestyles - think that 30 minutes of exercise will make up for the whole day spent sitting. IT DOES NOT!
3. Maintain good social relations with other people - your spouse, family and community. Ongoing Harvard generational study places it as #1 factor in longevity.
4. According to another Harvard study, if you do things right, you can live in a reasonably good health till your mid 80s. How much longer after that - your genes will determine.

As for the specific issue of maintaining your muscles into old age? Well, again, there are limits to what can be done.
However, I tend to think that maintaining intensity is very important - we should try to do same workouts even as we age, even if that gets harder and harder.
I believe that if faced with the tradeoff between the duration and intensity, the duration should be sacrificed.
"Better less, but better"!

[Shawn Baker]

Bob, it is I think fairly well agreed that "older" people can and should do strength training and its benefits are seen at almost any age including yours

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117172/

As I can't give specific medical advice in this format I'll just leave some general remarks

Certain orthopedic conditions can make certain exercises undoubtedly problematic- but generally there is a work around in most cases. Even arthritic joint benefit from strengthening the surrounding musculature.

I think a very important point was raised above- for a long time a generally held belief is that osteoarthritis (by far the most common type of arthritis) is a "non- inflammatory process" unlike rheumatoid arthritis and several others- it is now becoming increasingly clear that an inflammatory process underlies the development of osteoarthritis in most cases- we also see inflammation as a common denominator in a host of other chronic "Western" diseases as well (DM, heart disease, dementia, autoimmune dz, etc..) many factors likely contributed to inflammatory process- including exercise or lack of it, sleep quality, stress and diet- of these diet (in my view) probably plays the largest role- I won't go into it much more than that but I think my dietary philosophy was indicated in the thread about diabetes a while ago. Even at 90+ it make sense to optimize as much as you can IMO

[wsmith]

Bob, i rarely post but enjoy very much the info you and others disperse. Thank you for your time and efforts. As an ortho trauma surgeon who deals a lot with geriatric fracture patients i have a spent a lot of time researching how best to help our patients stay active, healthy and not break bones. Here in Colorado, a lot of our older folks are very fit and want to train at a high level. No question that fast twitch muscle training needs to be a component for everyone after 50. Does not have to be crossfit, power lifting etc, but something. Most of the research indicates that our fast twitch tends to decline steadily after 50 while the slow twitch does not decline too much. This may be one reason older athletes do well in the long stuff and less well differentially in more anaerobic activity. But, training fast twitch consistently prevents or at least slows the decline significantly. For the less active older person this means they are better able to catch themselves when they fall and less likely to fall. For the older athlete it means maintenance of muscle mass with improved resistance to physical and mental decline. The easiest way for most is a simple weight training program built around your personal abililties and needs. Most older athletes have some exercises that just don't work for them due to previous injury, arthritis etc. The key is to find strength training or at least fast twitch training that works for the individual. Two resources that have a lot info on this are the book Bending the Aging Curve by Dr. Joseph Signorile and the website of Clarence Bass ( a devoted weight lifter and sprint type rower who at 78 is pretty healthy and fit with a moderate, sensible approach). We give Dr. Signorine's book and Mr. Bass' book: Take Charge to many of our patients to assist them in rehab and to help prevent future fractures. I hope this is somewhat helpful.

[ChrisPBacon]

Dr. Jonathon Sullivan owns a gym named Grey Steel Strength and Conditioning in Farmington, Michigan dedicated to the older crowd. He is an ER doc by trade and has a book due out in a couple of months on strength training older folks that should be good.

He has some videos posted on youtube.

[jamesg]

I see references to isotonic (presumably concentric and eccentric) work as opposed to isometric. Is this the main discriminate for OAPs, when movement has become a problem?

For broken and torn tendons in a shoulder and resulting discomfort, a physio here suggested I do isometric work, and it seems very effective.

I've also seen it suggested that fast twitch fiber is best trained by isometric work.

[left coaster]

my 2 cents on this topic...

Bob, not only may you have the body of a younger man but your mind and communication skills seem consistent with this as well. I'm an aging researcher and in our labs we use the term 'bio-age' rather than 'chronological age'. Bio age refers to how healthy your body is and how much wear and tear you have accumulated across your lifetime. Genetics and lifestyle certainly play a role but so does socioeconomic status and accumulated lifetime exposure to stressful events.

The dominant discourse on aging comes from the medical profession and is well reflected in the previous comments. I have a particular interest in the cognitive aspects of aging (i.e. the cognitive neuroscience of aging) and how they interact with physical activity. We often use the term 'lifestyle cross training' when making recommendations for 'older' adult activities. For example, beyond weight training, challenging low impact physical activity that involves quick motion, balance and some endurance exercise is also helpful for falls prevention. This is enhanced when done in a context that also requires complex attention (switching and divided), long term memory encoding and active use of working memory (keeping track of multiple pieces of information at the same time -- like mental math). Attention and working memory are aspects of cognition that show modest enhancement with challenging use. In turn, they support the encoding of short and long term memory.

So, what is the lifestyle cross training activity? Well, it could be something like challenging latin dance or medium intensity martial arts like hard form Tai-Chi. Both of these activities require quick movement, good balance and moderate endurance capacity. The also require us to pay attention to others while comparing this to ourselves, to hold movements in working memory and to strive to remember them for the next session. In a rowing context it would look more like rowing as part of a team on a boat where we need to pay attention to everyone else, plan with the group for a pace strategy and stick with it etc. When doing these types tasks we are challenging both physical and cognitive domains as well as engaging in social activity through participation in groups.

I fully agree with the previous posts about the value of weights and resistance training. However, in our experience, sustained lifestyle change usually requires fun and socially engaging activities that are not too repetitive. Going to the gym can get boring fast, and being an older person in a gym full of young people can be uncomfortable for many. I've been chatting recently with a retired faculty member at our school who took up ball room dancing in his 70's. He reports enhanced vitality, improved posture (he's almost 80 and stands perfectly straight) and balance and to have found a social group that he really likes to go out and mingle with -- now that sounds sustainable!

[Bob S.]

Thanks, L.C. I appreciate your detailed and interesting response.

[Eric308]

my 2 cents on this topic...

Bob, not only may you have the body of a younger man but your mind and communication skills seem consistent with this as well. I'm an aging researcher and in our labs we use the term 'bio-age' rather than 'chronological age'. Bio age refers to how healthy your body is and how much wear and tear you have accumulated across your lifetime. Genetics and lifestyle certainly play a role but so does socioeconomic status and accumulated lifetime exposure to stressful events.

The dominant discourse on aging comes from the medical profession and is well reflected in the previous comments. I have a particular interest in the cognitive aspects of aging (i.e. the cognitive neuroscience of aging) and how they interact with physical activity. We often use the term 'lifestyle cross training' when making recommendations for 'older' adult activities. For example, beyond weight training, challenging low impact physical activity that involves quick motion, balance and some endurance exercise is also helpful for falls prevention. This is enhanced when done in a context that also requires complex attention (switching and divided), long term memory encoding and active use of working memory (keeping track of multiple pieces of information at the same time -- like mental math). Attention and working memory are aspects of cognition that show modest enhancement with challenging use. In turn, they support the encoding of short and long term memory.

So, what is the lifestyle cross training activity? Well, it could be something like challenging latin dance or medium intensity martial arts like hard form Tai-Chi. Both of these activities require quick movement, good balance and moderate endurance capacity. The also require us to pay attention to others while comparing this to ourselves, to hold movements in working memory and to strive to remember them for the next session. In a rowing context it would look more like rowing as part of a team on a boat where we need to pay attention to everyone else, plan with the group for a pace strategy and stick with it etc. When doing these types tasks we are challenging both physical and cognitive domains as well as engaging in social activity through participation in groups.

I fully agree with the previous posts about the value of weights and resistance training. However, in our experience, sustained lifestyle change usually requires fun and socially engaging activities that are not too repetitive. Going to the gym can get boring fast, and being an older person in a gym full of young people can be uncomfortable for many. I've been chatting recently with a retired faculty member at our school who took up ball room dancing in his 70's. He reports enhanced vitality, improved posture (he's almost 80 and stands perfectly straight) and balance and to have found a social group that he really likes to go out and mingle with -- now that sounds sustainable!

While I pretty much agree with most of the above, I must be an exception to your rule. I've been going to the same gym almost daily for over 20 years and I just turned 70 in January. I do a lot of upper body weight training (circuits and free weights), and only rowing for my cardio. I am somewhat limited in that aspect as I've had two knee replacements and have recovered from a horrible total rupture of the quad tendon. Hence, no impact cardio whatsoever....that's OK, I love the Concept2 anyway. I truly look forward to going to my health club daily, and at this point I think I'm beyond it getting "boring fast" and "uncomfortable". Thanks much for your valuable input!

[jackarabit]

Longevity is an existential double bind. Can't live with it etc.

[wsmith]

i agree with left coaster. Tai chi, low impact movements and other flow type activity are hallmarks of fall prevention and successful aging, with pretty proven data. Despite being conventional surgeons we recommend tai chi and gentle yoga forms to all our senior patients (and younger patients). However, the original query was in regards to the utility of strength training for healthy seniors who are already engaged in serious training. The utility is likely more about lifestyle, maintenance of fast twitch fibers as opposed to improving a few seconds on a 2k rowing time trial. Strength training however is a surrogate for fast twitch physical activity and not the the only way to go. The famous blue zone elderly who live healthily into their 90s and hundreds have no gyms or formal exercise, but do have daily physical labor. That being said, i suspect that most on this forum find it easier to incorporate some sensible weight lifting than to build a stone wall to keep their goats in. But, building such a wall would likely be pretty fun! Bottom line: strength and fast twitch fibers keep people healthy, vital and reduce injury risk during aging. As we age we have less and less demand on us to maintain strength. Therefore, the logical corollary is do some training for strength. It is definitely a use it or lose it scenario. Current scientific evidence says there are a lot of ways to train strength effectively: one set per exercise versus several does not make a difference, 6 reps to 20 does not make a difference, 1-3 x per week not much difference. So do what you like but do something is the best bet.

[left coaster]

wsmith, I interpreted the initial post as a query about what to do when when there are barriers to strength training such as scoliosis or nerve impingement.

Having recently reviewed more publications on aging than I care to count, 4 cornerstones emerged for me in the literature. Physical activity, cognitive activity, social engagement and nutrition. From a rehabilitation or lifestyle intervention perspective (how I pay my bills), this brings forward the question: what do we do when one of these cornerstones is impaired or their are barriers to participation? We need to focus more attention on the other 3 while doing what we are able to with the 4th.

For example, someone with nerve impingement and scoliosis may not be able to do 'optimal' exercise that includes strength training. When shifting the focus to other cornerstones we need to get creative. For example, learning different forms of dance is very challenging from a cognitive perspective, it is low impact but also requires fast and coordinated movement and involves engaging with a social group. It may not be perfect as resistance training is not involved, but it's good and I anticipate on a population level we may not be able to tell the difference between this group and one who did everything 'perfectly'.

As all of us in aging research know, the recent drive to prove that computerized cognitive training results in meaningful improvement of cognitive function has failed. Endurance excise continues to chug away, but with small to moderate effect sizes across most studies. Then came the exercise plus cognitive training, but of course researchers implement both of these activities separately in experimental designs that have people 'training' for many hours during the week. Working out on exercise equipment and then doing cognitive training at a computer, so boring, yawn, it's just not a sustainable lifestyle intervention.

I believe it will eventually emerge (I know, a radical hypothesis) that the outcome is greater than the sum of its parts in terms of blending physical, cognitive and social activity with good nutrition into meaningful and fun activities such as dance, martial arts, geocashing, forming a walking group that debates chosen topics during the brisk walk, or any other activity you can think of that blends these together. We are complex and socially integrated animals and the basic science approach of trying to isolate one or two individual components of the interactive factors that support longevity may turn out to be short sighted.

[jackarabit]

Acting, thinking, caring.

[wsmith]

Good points left coaster. Most people, even wonderful athletic types have some physical limitations as they age that may prevent one preferred strategy vs another. Your post reminded me of a morning in Victoria Park in Hong Kong. I walked by a huge area filled with elderly couples vigorously doing ballroom dancing at 7am in the morning! They looked happier and fitter than me. i went and joined some 80 year old Tai Chi types who were still going after i left exhausted 2 hours later! Rowing is a great activity but it is also a pretty static, fixed motion movement that can lead to overuse injuries, muscle imbalances if not balanced out by other activities such as HIT weights, flow type activities and and relaxation/stretching. This may not matter so much to the younger competitive athlete but at some point in life , if these other activities are not used, injury and boredom will set in. As you point out, the real money in terms of longevity and health is with a balanced physical, emotional and social lifestyle. You don't want to be the Parent choking down a Kale smoothie and yelling at your kids because you are late for Yoga class or the Masters Endurance athlete who doesn't have time for friends or family. But, you do want to be in good shape in terms of muscle mass, anaerobic and aerobic capacity, near your 21 year old bodyweight and eating a healthy diet. TX