Exercise
Protective Programs Designed Just for You
You don't want buns of steel. You want to steel your defenses against diseases that kill. And you would like to do it without stressing the bones, joints, and muscles that need more TLC with each passing year.
Yes, physical activity is good for you. But if you're like most people ages 60 and over, you bypass the exercise programs, books, and videos that shout "no pain, no gain." And you have made the smart choice. Research shows that moderate exercise gives you as much—maybe even more—protection from disease as the old grunt-and-groan-and-sweat type of workout.
"Moderate exercise can help you lower your risk of disease and carry on an active lifestyle beyond your eighties," says James M. Rippe, M.D., director of the Center for Clinical and Lifestyle Research at Tufts University School of Medicine in Boston and author of Fit over Forty.
Two-Phase Program for Protection
Experts today recommend a two-part exercise program: aerobic exercise (walking or bicycling, for example) to condition your heart and cardiovascular system, and strength-training exercises (calisthenics and high-intensity weight lifting) to build muscle and cut fat. And you need to exercise only two or three times a week.
You can ease into this routine gradually and safely. That's a big plus since "by age 60, just about everyone has some element of osteoarthritis, osteoporosis, joint irritation, or lack of flexibility," says Dr. Rippe. "Light exercise doesn't aggravate these conditions." In fact, exercise usually reduces them.
If you join exercise groups or walking clubs, you reap even more benefits—social activity and new friends. "We like to call this recreation, not exercise," says Gerald Fletcher, M.D., professor of medicine at the Mayo Clinic in Jacksonville, Florida.
Experts note that exercisers enjoy a better quality of life. "Exercisers are more active in the rest of their lives," says Dr. Rippe. "Many of the age-related declines that we see are tied to the expectation that people become more sedentary and uninterested in things around them as they age. It is true that if you're inactive, your metabolism slows, you gain weight, and you become even more inactive. But it doesn't have to be like that."
Stay Young at Heart
Researchers have found that exercise can give your body's systems the capacity to work as well as someone 20 years younger. So it is not surprising that physically active people—regardless of their biological ages—have lower rates of heart disease and are less vulnerable to strokes.
If you haven't exercised for years, don't be put off: "As soon as you start to exercise, your risk of cardiovascular problems drops by 25 percent," says Dr. Fletcher.
"Studies show that even if you start a regular exercise program in your sixties, you lower your risk of heart disease for the rest of your life," says Dr. Rippe. "If you're 60 years old, you may have another 25 years left, so the quality of life during those years is something to think about."
Don't let a heart attack hold you back. "Exercise has been proven to be a great therapy," says Kenneth H. Cooper, M.D., president and founder of the Cooper Clinic and the Cooper Institute for Aerobics in Dallas, who is also known as the father of aerobics. Studies show that people who become involved in an exercise program after their first heart attacks are 20 to 40 percent more likely to be alive seven years later than those who survived a heart attack and then remained totally sedentary.
Exercise is so important that cardiologists often prescribe (not just recommend or suggest) exercise for patients with heart disease, observes Alan Rozanski, M.D., director of nuclear cardiology and cardiac stress testing at St. Luke's Hospital in New York City.
In one study, researchers followed 68 patients who were on a waiting list for heart transplants and who also participated in an exercise program of graded walking. After three to six months, the hearts of 30 patients had improved to the point that they no longer needed new hearts. Two years later, their hearts were still going strong.
How does aerobic exercise perform these miracles? It makes your heart pump more vigorously to carry extra blood and oxygen to hardworking muscles. Over time, the demands of exercise make your heart physically fit—stronger and more efficient. "The heart becomes a bigger, stronger pump that pumps more blood with each beat," says Bryant Stamford, Ph.D., professor of exercise physiology and director of the Health Promotion Center at the University of Louisville in Kentucky.
You get practical payoffs: The well-exercised heart doesn't have to beat as fast when you do something demanding. Even though your body is stressed, your heart isn't. When nonexercisers shovel the sidewalk after a snowstorm, for instance, their likelihood of a heart attack jumps to 107 times their normal risk. Someone who exercises five times a week has a risk that rises to only 2.4 times.
Drive High Blood Pressure Down
Heart attacks and strokes don't come out of the blue. Much of the trouble that leads to these killers starts in the arteries, the tubes that carry the blood and allow it to flow to the body's organs. High blood pressure, a condition that becomes more common with advancing years, often sets the stage for all the other problems. Exercise can help get it down.
When you have high blood pressure, the blood circulates too vigorously under too much force. The pressure tears up the artery walls, which allows the harmful low-density lipoprotein (LDL) cholesterol to attach and form plaque. Over time, this turns arteries that used to be as smooth and efficient as the interstate into the equivalent of one-lane gravel roads. "High blood pressure wouldn't be such a serious problem if it didn't do so much damage to artery walls," says Dr. Stamford.
"We think exercise lowers blood pressure because it opens up the small vessels and capillaries and helps blood flow into the working muscles that need the extra nourishment," says Dr. Stamford. An added benefit for the muscles: They become better able to absorb oxygen and glucose (blood sugar). Exercisers with high blood pressure often find that exercise lowers it, which in turn allows their doctors to lower or eliminate their medications.
You reap the benefits of exercise long after your workout, even when you are lolling in a recliner with the newspaper. That is because exercise lowers the resting heart rate, which reduces pressure on the whole cardiovascular system, says Dr. Stamford.
If the blood flow gets blocked completely, which becomes more likely as the arteries narrow, you could have a heart attack (if an artery to the heart gets blocked) or stroke (if the blockage occurs in an artery leading to the brain). This happens when the platelets—the tiny disklike structures that help the blood coagulate—stick to each other and to the artery walls to create a clot. Exercise reduces your risk because it keeps the platelets from clustering excessively and damming the flow.
When you exercise, you also protect your artery walls. Studies in Europe suggest that a combination of diet and exercise decreases the soft plaque that gradually builds up and hardens, narrowing the artery.
The Honolulu Heart Program on Oahu, Hawaii, conducted a 22-year study of 5,362 Japanese-American men ages 55 to 68. The researchers found that nonexercisers were four times more likely to experience one type of stroke and three times more likely to experience another type of stroke when compared to more active men.
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When You Need the Doctor's Okay It is always a good idea to check with your doctor before you begin an exercise program. But it is a must if you have more than two risk factors for heart disease, says Gerald Fletcher, M.D., professor of medicine at the Mayo Clinic in Jacksonville, Florida. These risk factors are high cholesterol levels, high blood pressure, diabetes, a smoking habit, or a family history of heart disease. If you're at risk for heart problems, your doctor probably will want to do an exercise tolerance test to check for cardiovascular disease, custom-design an exercise program to ease you into the swing of things, and monitor your progress. |
Get a Grip with the Good Cholesterol
Any time you exercise, your body ends up with more of the high-density lipoproteins, or HDLs. That's the so-called good cholesterol that grabs the harmful LDL cholesterol and carries it out of the bloodstream before it can attach to artery walls. The biggest predictor of future heart disease is an HDL reading below 35, says Dr. Cooper. (That number is a measure of milligrams per deciliter or mg/dl.)
"We used to think that you had to exercise vigorously to raise HDL levels. But now we think that moderate amounts of low-key exercise such as walking can increase HDL levels by about 10 percent," says Dr. Rippe.
Researchers at Stanford University studied men and women ages 50 to 65 who exercised lightly. After two years, an HDL check showed that 52 percent of the exercisers had lowered their risk of heart disease by 10 percent. Another study showed that women who walked a slow 3 miles four or five times a week also upped their HDL levels. And a joint study of postmenopausal women showed that while good cholesterol levels rose with exercise, the amounts of artery-clogging LDL cholesterol dropped.
As you get older, your arteries gradually stiffen, which increases your risk of atherosclerosis, unless you take steps to flex them by exercising your body. Researchers at the Gerontology Research Center in Baltimore evaluated the arteries of 146 older men and women. The arteries of exercisers were up to one-third more flexible than those of couch potatoes.
Build Your Muscles to Block Disease
Strength-training exercises put one of the major risk factors in heart disease, cancer, and stroke into reverse—the otherwise inevitable increase of body fat. We're not talking about weight problems here, just the simple fact that as you age, you lose muscle, and it's replaced by fat.
Even if their weight remains unchanged, nonexercisers will probably greet their eightieth birthdays (assuming that they get there) with 30 percent less muscle than they had in their prime.
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Exercise: All-Purpose Protection Beyond combating heart disease, cancer, and stroke, exercise helps fight off or control a lot of other health problems. Here's what else. Betters your balance. As you age, your risk of falling increases. Studies show that weight lifting or balance training improves overall balance. In healthy community-dwelling elders, tai chi has been shown to decrease fall rates. Improves your sex life. Researchers have found that physical impotence often results from poor blood circulation to the penis. Since exercise improves circulation on a system-wide basis, doctors speculate that it will help reduce the problem. Increases mobility. When you work your heart, more blood goes to all parts of your body, including your brain. Those who exercise, studies show, perform better on mental tests and respond faster to stimuli. Makes more muscle. Strength training also produces larger, stronger muscles. The stress of exercise probably creates microscopic tears in the muscle fibers, according to William J. Evans, Ph.D., a physiology and nutrition researcher at Pennsylvania State University in University Park. In between exercise sessions, the muscles repair and strengthen the fibers and learn to synthesize and use proteins more efficiently. The brain gets into the act, too, putting more muscle cells to work to meet the extra demands. Improves your mood. "There is no question that exercise has been shown to improve mood and relieve anxiety and depression, although the reasons why are hard to prove in a laboratory setting," says Robert S. Brown, Sr., M.D., Ph.D., clinical professor of psychiatric medicine at the University of Virginia in Charlottesville and a longtime researcher on exercise and its effect on mental health. "I've never treated a physically fit person with a major depression." Exercise also produces physiological changes that may elevate mood. "My theory is that exercise—at least to the point of sweating—raises body temperature, which speeds up the metabolism," adds Dr. Brown. "That results in more oxygen going to the brain, optimizing essential chemical reactions." Exercise also releases endorphins, the so-called pleasure chemicals in the brain that can block pain and invoke feelings of well-being—or even euphoria like the much-ballyhooed runner's high experienced by long-distance runners and other athletes. Controls diabetes. Exercise helps your body produce the insulin that it needs to process glucose (blood sugar) and get it out of the blood and into the cells. "Millions of people are insulin-resistant," says Bryant Stamford, Ph.D., director of the Health Promotion Center at the University of Louisville. Glucose stays in the blood, which creates real problems because it crystallizes. A sugar crystal looks like a medieval mace, a weapon consisting of a ball with spikes on it. It tears up the lining in small blood vessels, which sets the stage for harmful cholesterol to attach to the artery walls and balloon into atherosclerosis, or hardening of the arteries. Exercise can help prevent that. Strengthens bone. Exercise strengthens bones weakened by osteoporosis because it increases blood flow and helps cells create new, healthier bone. A study at Tufts University in Boston followed 39 women ages 50 to 70 and found that bone mass, muscle mass, strength, and balance all improved with exercise. Eases joint pain. Because exercise develops the muscles that support your joints, says Dr. Evans, it usually eases the pain of arthritis and other joint ailments. |
This alarming ratio makes you older than you have to be. As your muscle decreases, stairs feel like a vertical mountain climb. Hefting that can of beans off the kitchen shelf gets harder and harder. And a common sack of groceries feels like an Olympic barbell in your hands. That's not good for your risk of cancer, heart disease, and stroke—and certainly not good if you want to continue to live independently.
One quick encounter with a tape measure will probably give you all the evidence you need that these changes are taking place. Researchers in England have determined that your body's fat level manifests itself in your girth, not just in your weight. You're at the threshold of increased health risk if your waist measures over 31 inches (for most women) or over 37 inches (for most men).
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Listen to Your Body Most exercise-related injuries happen because people try to do more than their bodies can handle. If you're overloading your system, your body will let you know. After exercising, you should be: Very energetic. Exercise should give you additional energy. "If you're exhausted when you finish exercising, you've overdone it," says fitness pioneer Jack LaLanne. "You should finish a session feeling exhilarated, yet relaxed. That way, you won't do too much and get hurt." If exercise leaves you languid, shorten your walk or lighten your strength-training weights. If you still haven't recuperated a half-hour after stopping exercise, check with your doctor, says Gerald Fletcher, M.D., professor of medicine at the Mayo Clinic in Jacksonville, Florida. Clearheaded. A feeling of nausea or faintness lets you know that your efforts are too intense for your body, although these symptoms can also mean that you're not spending enough time on your cooldown exercises. Review your routine. Add or lengthen the cooldown exercises. If that doesn't make a difference, shorten your walk and reduce your weights, says Dr. Fletcher. Pain-free. Exercise isn't supposed to hurt or leave you feeling stiff (although you may feel some soreness when you begin to exercise). Devote more time to warm-up and cooldown exercises, because they provide maximum protection against aches and pains, says Terri Merritt, a clinical exercise physiologist at the Preventive Medicine Research Institute in Sausalito, California. If problems persist, see your doctor or a fitness expert to rule out underlying problems and to make sure that you are doing exercises correctly. If you are overweight, your knees may not be strong enough to support you. If they hurt, shorten (or eliminate) your walks and concentrate on strength-training sessions to build up muscles and tendons to take some of the load off the joints, recommends William J. Evans, Ph.D., professor of applied physiology and nutrition and director of the Noll Physiological Research Center at Pennsylvania State University in University Park. You may experience lower back pain when you start to exercise. That's because, if you have spent a lot of time sitting, your hamstring muscles have shortened. When you walk or exercise, these muscles pull on the buttock muscles which, in turn, yank on the lower back muscles. If your abdominal muscles aren't strong enough to help support the lower back, you'll feel it. Include abdominal-strengthening exercises with your warm-up and cooldown stretches says Merritt. Remember that warm-up and cooldown exercises protect muscles and tendons as well as the cardiovascular system. Don't try to shorten your workout by omitting them. Breathing easily. While your breathing rate will increase when you exercise, you should still be able to carry on a conversation. If you can't talk and walk or talk and lift at the same time, your work pace is too intense. Slow down and lighten your weight load, recommends Dr. Fletcher. |
You can't head off the effects of time with diet alone. Researchers think that the changes in your body are connected to age-related alterations in your metabolism and your oxygen intake.
Exercise is your only defense, and it can go a long way toward reversing the loss that leaves you weak and at risk, observes William J. Evans, Ph.D., professor of applied physiology and nutrition and director of the Noll Physiological Research Center at Pennsylvania State University in University Park.
Just how potent are exercise's effects? Healthy men and women ages 56 to 80 participated in a 12-week strength-training program and on average lost 4 pounds of body fat. Their metabolisms increased by 7 percent, which contributed to their needing 15 percent more calories a day just to maintain their weight.
Regular exercise is associated with lower rates of colon cancer, probably because exercise speeds the passage of substances through the gut, according to Dr. Evans. Researchers at the European Institute of Oncology in Milan concluded that exercise might reduce the risk of colon cancer in men by up to one-third.
Laboratory research gives further support to the importance of exercise as a cancer fighter. In one study exercise was tied to increased killer-cell ability to attack tumors in mice. Some studies also suggest that regular exercisers are less likely to develop prostate and breast cancer.
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Exercise Danger Signals When you exercise or do anything strenuous, you put an added burden on your cardiovascular system. If you have any of these symptoms or medical conditions, see your doctor before you start or resume exercise, according to Gerald Fletcher, M.D., professor of medicine at the Mayo Clinic in Jacksonville, Florida. If you get a headache, cramps, or heart palpitations or if you feel dizzy, faint, or cool while exercising: If you're in the sun, get into the shade or someplace cool. If you feel any discomfort in your upper body, including your chest, arms, neck, or jaw: You might feel aching, burning, tightness, or a sensation of fullness. If you start to wheeze: You become very short of breath, or your breathing doesn't return to normal within 5 minutes. If walking gives you a cramp in one calf that flares up when you walk and simmers down when you rest: This could be a symptom of intermittent claudication, a condition caused by plaque buildup in the arteries of your leg. If that's the case, you may have similar deposits in your coronary arteries. If you have a substantial infection, such as bronchitis: Put off exercise until all is normal—your temperature, white blood cell count, and cultures. It's okay to exercise if you have a small skin irritation, as long as it is not irritated by exercise. If you have a cold or the flu: Wait until all symptoms (including fever) have been gone for two days before you exercise again. |
Jump-Start Your Immune System with Exercise
Moderate amounts of exercise not only strengthen you but may also muscle up your immune system, some researchers believe. In fact, when you exercise, your blood platelets and white-blood-cell count go up. During moderate exercise, the body manufactures more natural killer cells, which help keep immunity strong and fight free radicals caused by pollutants. With those two factors on your side, your risk of cancer drops.
Experts believe an immune system strengthened by exercise also may help fight some forms of cancer.
A stronger immune system makes life more pleasant on a day-to-day level, too. "We notice fewer colds, coughs, and bronchitis in people who exercise," says Dr. Fletcher.
Researchers aren't sure how exercise effects the immune system, but Dr. Stamford speculates that "when you exercise, you stress all of your body's systems. The immune system reacts like the body's fire department to take care of the stress."
The rest of the body responds to the stress of exercise by becoming stronger and better able to cope with the next round of demands. It's likely that the immune system muscles in on disease, too.
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Find the Right Time It is important to exercise when you can get the maximum benefit without risk. Here is advice from our experts for choosing the right time to work out. Easy does it, early bird. If you're a morning person, exercise after you have been up and about for at least 10 minutes. While you sleep, fluids sometimes pool throughout your body, even in such important places as the disks in the spinal column, in ligaments, and in muscles, says Richard Birrer, M.D., vice chairman of family medicine at the Catholic Medical Center in New York City. If you get up suddenly and begin to exercise, the accumulated fluids can cause major injuries, such as a herniated disk. Avoid internal conflicts. Exercising right after eating causes problems because both your intestinal tract and your muscles will need extra blood. The conflicting needs of each system may leave you with cramps or a feeling of nausea or faintness. Give your body 2 hours to complete its digestive chores. Choose your shots. If you have diabetes, avoid injecting insulin into a muscle that will soon be used for exercise. Working muscles process insulin differently than do nonworking muscles. |
Live Easy with Exercise
Okay, you have to make an effort to exercise, but there is a great trade-off. It can make other aspects of your life a lot easier. Here are some of the other things that exercise does to improve your life and battle disease.
Eases sleep. Without good sleep your body is more likely to catch diseases and less able to fight them off. "If you have a low activity level, it's normally hard to sleep," says Richard P. Allen, Ph.D., assistant professor in the Department of Neurology at the Johns Hopkins University Sleep Disorder Center in Baltimore.
A study conducted through Stanford University looked at 43 people ages 50 to 76. Those who exercised four times a week fell asleep faster, slept better and longer, and felt more rested than those who didn't.
Some studies show that exercise helps improve the quality of slow-wave sleep, the phase of rest that produces the strongest sleep experience.
Cuts the fat. Exercise helps the body get rid of triglycerides, a type of fat in the blood linked to an increased risk of heart attacks, generalized atherosclerosis (hardening of the arteries), and other medical problems. Researchers think that exercise enhances an enzyme in the blood and muscles that plucks triglycerides out of the bloodstream.
Trims the pounds. Extra body weight means extra risk for heart disease, cancer, and stroke. If you don't increase your calorie intake and burn at least 700 calories per week (the amount that you would use if you walked for 20 minutes, three times a week), you'll lose weight. Exercise also seems to help your body use the proteins that it takes in more efficiently.
Reduces stress. "It's not stress that kills, per se," says Dr. Cooper. "Rather, it's the way we handle it. And exercise has been shown to help people handle their stress better and thus should lower their incidence of heart disease and other health problems."
Research also suggests that exercise axes thromboxane, a chemical in the blood that promotes clotting and encourages platelets to stick together, which can trigger heart attacks. Nonexercisers with aggressive type A personalities show the highest levels of the chemical.
Lowers the dose. Because exercise helps the heart work better and may speed weight loss, people with heart disease, high blood pressure, or diabetes may show so much improvement that their doctors can lower the dose of their medicines or drop the pills altogether, notes Kaaren Douglas, M.D., director of the program in geriatric medicine at the University of California, Irvine.
Get Off to a Good Start
Here are the guidelines that you'll need to get your total exercise program of aerobic and strength-training exercise off the ground safely.
Get a physical. Exercise works because it stresses your body, which grows stronger as a result. It's important to make sure that your body's systems can handle the extra work, so you'll want to schedule a checkup with your doctor, says Dr. Stamford.
Warm up. Experts recommend 10 to 15 minutes of warm-up activity, which can include stretches, light calisthenics, or slow walking.
As you get older, your body needs to ease into exercise more gradually, according to Richard Birrer, M.D., vice chairman of family medicine at the Catholic Medical Center in New York City. That's because by ages 65 to 70 most physiological systems are down by about a third and take longer to warm up and cool down, notes Dr. Birrer. For example, the pulse rate goes down, he adds.
Break it up . . . or don't. Exercising more than 30 minutes at a time helps you lose weight, if you exercise three to five times a week and follow an appropriate diet, experts say. If you don't need to lose weight, three 10-minute exercise sessions per day will be just as beneficial for disease protection, advises Dr. Stamford.
Set goals. On your first walk or exercise session, you may decide to walk for 10 to 15 minutes and do three repetitions of each exercise.
That may turn out to be too much. Most people don't realize how out of shape they are. "It's not unusual for someone to get halfway around the block and feel winded. You have to start exercising gradually," says Terri Merritt, a clinical exercise physiologist at the Preventive Medicine Research Institute in Sausalito, California, who works closely with Dean Ornish, M.D., whose regimen for reversing heart disease is known the world over.
Don't be discouraged. Says fitness guru and author Jack LaLanne, "Any time you exercise, it's like putting money in the bank. If you can only start with a nickel, that's okay. Eventually, it'll add up. Any exercise is better than no exercise."
"If you haven't walked in 25,000 years, you're going to be winded after a block or two," says comedian Sid Caesar, who started exercising at age 57 to get his life moving toward good health. "But if you keep walking, in another week or two, you won't be."
When you can easily meet your goal, up your efforts. Lengthen your walks or vary the terrain to make the work harder. Increase the number of repetitions for each exercise or add weights to make the exercise more difficult. Don't get carried away, though. Even as you increase the workload, the effort should never be too taxing, according to Merritt.
Time it right. Experts say that you'll be able to stay with your program better if you exercise at the same time each day.
Play it safe. Find a place where you can do the walking phase of your program safely. "Your neighborhood isn't safe if you don't feel safe. If that's the case, look for other locations. Drive to another neighborhood or a public area where you feel comfortable," advises Dr. Douglas.
Mall-walking programs, often operated by hospitals or health centers, provide a haven where you can walk regardless of the weather. Call local malls to find out about programs, suggests Dr. Douglas. She recalls a trip to the Midwest, where "they opened up the mall at 7:00 a.m. just for walkers, and the place was mobbed with people doing laps. There were so many people, they practically knocked me over."
Dress for comfort. Your body has to get rid of the heat produced by exercise, so wear loose-fitting cotton or high-tech fabrics, such as Gore-Tex, that breathe. Use layers of clothing to stay warm and simultaneously dispel perspiration and heat. Use sweat suits only in cold weather when you need to stay warm. In hot weather and in direct sunlight, wear light-colored clothing and a cap to