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Archive for March, 2015

A Sociological Look at Frailty and Aging

[A Three-Part Series]

Part II

Introduction

In Part II of this blog I am focusing on exercise and its impact on frailty and aging. Hopefully you are already in some program where you are exercising on a consistent basis. If not, then what follows in the way of research should give you all the motivation you need.

Background

To be sure, many older Americans continue to lead active and productive lives. However, the nation’s increasing longevity is bringing new challenges for health and social programs. Americans’ life span in 2009 was 78.5 years, according to the Centers for Disease Control and Prevention, about three decades more life than in 1900, when the average was only 47.3 years.

“We’ve added 30 years to the human life span, which is an unparalleled success story for public health, medicine and education,” Fried says. “As a result, it is critically important that we help these people who are living longer stay healthy.”

Of those living alone or with families, not in nursing homes or hospitals, about 4 percent of men and 7 percent of women older than 65 were frail, according to the parameters used by Fried and her colleagues in the 2001 study. The researchers, who studied more than 5,000 adults aged 65 and older, also found that the chances of frailty rose sharply after age 85, to about 25 percent. These numbers, the most recent data available, reflected conditions prior to 2001, and leaving “an important but unanswered question as to whether the frequency of frailty is the same, increasing or decreasing” today, Fried said.

Also, women are more likely than men to be frail, possibly because women typically outlive men and “start out with less muscle mass than men and, once they lose it, they may cross the frailty threshold more rapidly than men,” Fried says.

Stephanie Studenski, principal investigator at the Claude D. Pepper Older Americans Independence Center at the University of Pittsburgh, has been practicing in the geriatrics field for more than 30 years and sees “older people across the full spectrum, from frail 60-year-olds to vigorous 95-year-olds,” she says.

For the younger group, who usually are frail because of multiple chronic conditions, “sometimes medications can worsen frailty with their side effects, so adjustments can help,” she says. ” I tell these patients I can often make you better, give you more reserve and increase your resilience although not totally cure you. We can’t change from black to white, but often can push the black into gray.”

For those in their 80s or older, however, the causes of frailty are sometimes less obvious.

Barbara Resnick, a geriatric nurse-practitioner in Baltimore, remembers an 85-year-old woman, living at home, who “stopped going out to dinner with friends; she would say she was too tired and didn’t have the energy. She wasn’t walking out to get her mail anymore. She was eating less and losing weight rapidly.”

Her adult daughter became concerned and brought her mother to Resnick “and asked us to fix the problem,” recalls Resnick, who chairs the board of the American Geriatrics Society.

But there often is no quick fix. Clinicians checked the woman for underlying disease — they found none — and adjusted her medications. They also urged the woman to increase her physical activity, Resnick says. “That’s really the best way to manage frailty: Engage as much as you can; optimize what you can do. What’s important is resilience.”

Similarly, Kaufman recalls “a wonderful gentleman” in his 80s who had been doing quite well until his wife fell, broke her hip and had to enter a nursing home. The couple had been married 60 years. After she left, he began to slow down physically, and he stopped eating.

“He just gave up,” Kaufman says.” There was no one specific thing. But within a few months, he died. What do you put on a death certificate? If it was a pediatric case, we’d say ‘failure to thrive.’ He died of frailty.”

Researchers also are studying the impact of moderate physical exercise in preventing the most powerful indicator of frailty: slow walking speed. An ongoing study of 1600 people between the ages of 70 and 89 is comparing the effects of a moderate-intensity walking and weightlifting program to a program of health education only.

The exercise group walks for 30 minutes several times a week and uses ankle weights to improve lower-body strength. The education group receives information on diet, managing medications and other health-related matters, but not about physical exercise.

A smaller, earlier phase of the study suggested that physical activity was key, with a 26-percent reduction in walking problems among those who worked out regularly.

“You don’t have to go to an exercise program at the gym,” Kaufman says. “Clean your house. Walk to the mailbox to get your mail, or work in your garden. The greatest common denominator of frailty is muscle loss and slowing of gait, and it’s amazing what physical exercise can do.” Walston agrees. “Growing old may be inevitable, but growing frail is not,” he says.

Benefits of Exercise

One of the Healthiest Things You Can Do

Like most people you’ve probably heard that physical activity and exercise are good for you. In fact, being physically active on a regular basis is one of the healthiest things you can do for yourself. Studies have shown that exercise provides many health benefits and that older adults can gain a lot by staying physically active. Even moderate exercise and physical activity can improve the health of people who are frail or who have diseases that accompany aging.

Being physically active can also help you stay strong and fit enough to keep doing the things you like to do as you get older. Making exercise and physical activity a regular part of your life can improve your health and help you maintain your independence as you age.

Be as Active as Possible

Regular physical activity and exercise are important to the physical and mental health of almost everyone, including older adults. Staying physically active and exercising regularly can produce long-term health benefits and even improve health for some older people who already have diseases and disabilities. That’s why health experts say that older adults should aim to be as active as possible.

Being Inactive Can Be Risky

Although exercise and physical activity are among the healthiest things you can do for yourself, some older adults are reluctant to exercise. Some are afraid that exercise will be too hard or that physical activity will harm them. Others might think they have to join a gym or have special equipment. Yet, studies show that “taking it easy” is risky. For the most part, when older people lose their ability to do things on their own, it doesn’t happen just because they’ve aged. It’s usually because they’re not active. Lack of physical activity also can lead to more visits to the doctor, more hospitalizations, and more use of medicines for a variety of illnesses.

Prevent or Delay Disease

Scientists have found that staying physically active and exercising regularly can help prevent or delay many diseases and disabilities. In some cases, exercise is an effective treatment for many chronic conditions. For example, studies show that people with arthritis, heart disease, or diabetes benefit from regular exercise. Exercise also helps people with high blood pressure, balance problems, or difficulty walking.

To learn about exercise and diabetes, see “Exercise and Type 2 Diabetes.” from Go4Life®, the exercise and physical activity campaign from the National Institute on Aging.

Manage Stress, Improve Mood

Regular, moderate physical activity can help manage stress and improve your mood. And, being active on a regular basis may help reduce feelings of depression. Studies also suggest that exercise can improve or maintain some aspects of cognitive function, such as your ability to shift quickly between tasks, plan an activity, and ignore irrelevant information.

Some people may wonder what the difference is between physical activity and exercise. Physical activities are activities that get your body moving such as gardening, walking the dog and taking the stairs instead of the elevator. Exercise is a form of physical activity that is specifically planned, structured, and repetitive such as weight training, tai chi, or an aerobics class. Including both in your life will provide you with health benefits that can help you feel better and enjoy life more as you age.

Strength Training for a Healthy Heart

Regular exercise is a critical part of staying healthy. People who are active live longer and feel better. But what form of exercise is best? The standard teaching has been 30 minutes per day, five days a week of cardiovascular training, and three days a week of strength training. However, there has been a recent breakthrough in training approaches that focus on strength training for cardiovascular health.

The function of the cardiovascular system is to pump oxygen and nutrient-rich blood throughout the body and to remove waste products like carbon dioxide. The heart is a powerful muscle that contracts, expands, and hypertrophies, as other muscles do when worked. As the heart gets stronger, blood pressure and heart rate go down because the heart gets more efficient and can pump out more blood per beat.

Strength training, often called resistance training, refers to exercises that require muscles to exert a force against some form of resistance. The most common form of strength training is lifting weights, e.g., free weights, machines, elastic bands, body weight, or any other form of resistance. These types of exercises are known for developing and toning muscles, helping to develop and maintain the integrity of bones, increasing metabolism by increasing lean muscle mass, building stronger connective tissue and greater joint stability, and decreasing body fat. Strength training is beneficial for everyone. It is especially beneficial as we grow older because muscle mass naturally diminishes with age, and strength training will help prevent this muscle loss and rebuild what may have been lost.

Strength training as a component of a cardiac rehabilitation program is well-recognized by clinicians; however, it is now just coming to the forefront of preventive medicine for its profound effect in reducing the risks of cardiovascular disease. There have been several research studies on the effect of high-intensity, short rest weight training and its effect on cardiovascular health and fitness.

The findings are remarkable as strength training has not generally been thought to improve cardiovascular fitness. Aerobic activities that increase heart rate and make one breathe harder— walking, biking, and jogging—have typically been recommended for cardiovascular fitness. We are now learning that maximum increases in strength and cardiovascular fitness can be obtained from one type of exercise—strength training. Properly applied, strength training simultaneously engages both the muscular system and the cardiovascular system. Recommended intervals are three to five times per week for 20 to 30 minutes at a moderate intensity-level, or two to three times per week for 15 to 20 minutes at a high-intensity level.

The American Heart Association (AHA) says that for healthy adults, a regular program of weight training not only increases muscle strength and endurance, it also improves heart and lung function, enhances glucose metabolism, reduces coronary disease risk factors, and boosts well-being. When our muscles are stronger, there is less demand placed on the heart. This allows the lungs to process more oxygen with less effort, the heart to pump more blood with fewer beats, and the blood supply directed to your muscles to increase.

Strength training provides numerous health benefits. It can be very powerful in preventing and reducing the signs and symptoms of numerous diseases and chronic conditions such as obesity, diabetes, cardiovascular disease, osteoporosis, arthritis, and mild depression.

Additionally, it can help individuals recover from and prevent injury, improve endurance, flexibility, stamina, balance, and coordination. The idea is simple: strength is good. According to the AHA, strength increases “functional capacity,” which is the ability to perform daily activities. Being physically strong will decrease the strain that day-to-day tasks such as lifting, places on the heart.

Prior to beginning any form of exercise program, it’s important to see your physician for a complete physical examination to ensure you are healthy enough to begin an exercise regimen without risk. Share with your doctor your health goals and exercise plan, and seek his/her recommendations, especially those related to nutrition and smoking cessation.

Remember: regular strength training does more than just build better, stronger muscles—it builds a better, stronger, healthier body.

Strength Training for a Healthy Heart is an EHE International publication and is reprinted and distributed with its expressed written permission. EHE International, 10 Rockefeller Plaza, 4th Floor, New York, New York 10020; 212.332.3738; Information@EHEINTL.com.

Comments

Part II provided a general overview of the impact of exercise on frailty and aging. As everyone should recall the late Jack LaLanne was the ultimate guru of exercise and fitness. Jack was 96 years old when he came down with pneumonia and passed away. I can’t guarantee that you’ll live to be 96 years of age. But who knows!!! I’m not being facetious. Maybe with an excellent diet and exercise program, you’ll look back one day to a previous decade when you finally reached 100 years of age. Life is great! Even our “bad” days are “good” days. Why? Because we are alive, silly. Do everything you possibly can to live as long as you can. And while you’re doing that—live well and thrive. Enjoy the journey!

In Part III ahead I present data that summarizes major advancements in our knowledge of the impact of exercise on Frailty and Aging.

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