Even for 60-year-olds, researchers reaffirm that exercise is essential. But walking won’t be enough – break out the weights and do some strength training too.
Like many in her age bracket, Sylvia McGregor, a 97-year-old woman in Sydney, Australia, faces her share of illnesses – in her case, arthritis, osteoporosis, hearing loss, macular degeneration , lung disease, hypothyroidism, chronic kidney disease, heart disease and two total knee replacements. But andlike most nonagenarians, she does intensive weight training twice a week.
She credits the exercises, which she has been doing for 12 years, with enabling her to live independently. “I still live alone and take care of myself,” she says. “It wasn’t until I was in the hospital last year that they told me I had to have a walker to go home alone. So I said, ‘It’s OK for me.’
McGregor is in one of the fastest growing age groups – people aged 80 and over. By 2050, this “oldest” group is expected to triple in number to 447 million worldwide.
Their longevity reflects better chronic disease management that allows older people to live longer even if they have serious health problems. But physical function deteriorates as people age, and many older people become unable to care for themselves, eroding the quality of those extra years and decades. “Maintaining independence is so important to people,” says public health scientist Rebecca A. Seguin-Fowler, director of the Healthy Living Program at Texas A&M AgriLife Institute for Advancing Health Through Agriculture, and StrongPeople, which manages nutrition and community-based nutrition. physical activity programs. “Even though they live in a retirement community and then eventually an assisted living facility, they still want to be able to do things on their own as much as possible.”
Exercise is the best prescription for maintaining independence, researchers say. But what is the right dose — in terms of frequency, intensity and duration? What type of exercise is best? At what age should you start – and until when is it too late?
There are too few studies of exercise in older people to offer definitive guidelines for this age group, says Erin Howden, a researcher and exercise physiologist at the Baker Heart and Diabetes Institute and co-author of a look at exercise among octogenarians in 2022. Annual review of medicine. But the evidence for ‘older youth’ – people aged 60 to 75 – is enough to provide good basic advice for anyone who wants to continue working in their garden at 97.
Independent living requires the ability to perform the activities of daily living – taking a bath or shower, getting dressed, lying down or getting up from a bed or chair, walking, using the toilet and eating. Doing these things requires four physical attributes: cardiorespiratory fitness (the ability of the cardiovascular system and respiratory system to deliver oxygen during physical exertion); muscle strength and power; flexibility; and dynamic balance, ie the ability to remain stable while moving.
Biological aging has an impact on each of them. Cardiovascular fitness – the ability of the heart and blood vessels to distribute and use oxygen during exercise – declines throughout adulthood as our circulatory capacity decreases. This decline accelerates considerably later in life. Beyond age 70, cardiovascular fitness drops by more than 21% per decade – and that’s for healthy people. Prolonged inactivity and common chronic diseases such as heart failure, diabetes and obesity make the situation worse. It is common for octogenarians to have such poor cardiovascular function that it contributes to preventing them from performing basic activities like vacuuming and cooking.
Dynamic balance, essential for walking, climbing stairs and avoiding falls, also declines, thanks to the deterioration of the musculoskeletal system and neurological function. And muscle mass declines about 3-8% per decade after age 30, with an acceleration of decline after age 60. This often reduces both muscle strength – the ability of muscles to exert force, allowing us to lift objects – and muscle power, the ability to do work quickly, which we need to climb stairs. The more still you are, the faster this loss can occur. This muscle loss, known as sarcopenia, is why walking, one of the most popular forms of exercise, may not be enough for us to function independently. “People think, ‘Oh, I’m walking,’ but walking won’t help you build muscle,” says Seguin-Fowler.
People who exercise throughout their lives have the best chance of maintaining functional independence in old age. Over the years, they have developed greater physical capacity – strength, range of motion, endurance and balance – and improved organ function. But that’s not most Americans. In fact, in 2018, only about a quarter of Americans 18 and older met federal exercise guidelines for adults, according to the Centers for Disease Control and Prevention.
These recommendations: at least 150 minutes per week of moderate-intensity aerobic activity (or 75 minutes of vigorous activity), plus muscle-strengthening exercises such as lifting weights or working out with resistance bands – at least 8 to 12 repetitions for each exercise – at least two days a week. To that, adults 65 and older should add balance and flexibility training — think tai chi, Pilates, or yoga — about three days a week.
If that prescription sounds daunting, Howden offers this perspective: Any amount of physical activity is better than none, and it’s never too late to start. And older people should always push themselves to do more. “Whether you’re walking or biking or whatever you’re doing, keep extending your practice time — then one or two days a week, try doing something a little more intense,” she says.
There are many ways to tick the aerobic exercise box. An analysis of 41 clinical trials involving older people with an average age of 67 found that many diets work, including walking, running, dancing and other activities, at different intensity levels and durations. In general, the more frequently a person exercises, the greater the benefit.
Conclusion: A healthy but sedentary 67-year-old who engages in aerobic exercise three times a week for 30-35 minutes per session, working out at moderate intensity, for 16-20 weeks, can expect to improve his aerobic capacity about 16% compared to people who did nothing.
Aerobic training earlier in life is best for preventing – and even at a younger age, reversing – the normal age-related stiffening of the arteries that is a risk factor for hypertension and stroke. For example, a study of 10 healthy but sedentary people aged 65 and older who worked out, over the course of a year, up to 200 minutes weekly of vigorous aerobic exercise improved their cardiovascular fitness, but the training had no effect on their arterial stiffness. In contrast, a small study in adults aged 49 to 55 found that cardiovascular fitness improved and heart rate decreased with a combination of high, medium, and low intensity aerobic exercise for 150 to 180 minutes per week for two years.
Howden, who led the second study, sees this as a clear conclusion: “Midlife and late middle age is when we need to get serious about incorporating a structured exercise program into our daily life.”
And the muscles? Two decades of research has shown that resistance training can prevent and even reverse the loss of muscle mass, power and strength that people typically experience as they age. Here’s what works, according to an analysis of 25 studies of people aged 60 and over, with an average age of 70: “one-rep max” – the maximum load they could completely lift if they only did it once. Each session includes two to three sets of each exercise and seven to nine reps per set.
When it comes to fitness in older people, the first study in this group was a clinical trial of 100 elderly and frail nursing home residents in Boston. The average age was just over 87, and more than a third of participants were 90 or older. The vast majority – 83% – used a cane, walker or wheelchair; half suffered from arthritis; many suffered from lung disease, bone fractures, high blood pressure, cognitive impairment or depression.
Those assigned to the exercise group completed a high-intensity hip and knee muscle resistance training regimen three days a week for 10 weeks. For each of the muscle groups, the resistance machines were set at 80% of the one-repetition maximum. The training was progressive, that is, the load was increased with each training session if the individual could tolerate it. The sessions lasted 45 minutes, and in each session the exerciser performed three sets of eight lifts for each muscle group.
At the end of the trial, users had significantly increased muscle strength and mobility in the hips and knees compared to a group of non-users. Four participants no longer used a walker after the training, making do with a cane instead.
The principal investigator for this study was Maria A. Fiatarone Singh, now a geriatrician at the University of Sydney. For older people, she says, strength training, which helps with balance, is the priority exercise because it allows for other forms of activity. “Most people, including medical professionals, still have this idea that the most important thing is to help people move, but that’s only important if they can actually move,” she says. “You must first have strength and balance.”
Fiatarone Singh started the bodybuilding program in which McGregor and his older peers do weights twice a week, and no one gets off easily. “We actually increase the weight every time we see someone in the beginning,” Singh explains. “At some point, their gains are less pronounced, but they still gain muscle mass if you continue to gain weight.”
When she looks at a graph of McGregor’s muscle mass over time – “His is rock solid” – Fiatarone Singh sees inspiration. “When someone over ninety sees himself getting stronger,” she says, “he’ll tell you how good it is.”
This article originally appeared in Knowable magazine, an independent journalism venture of Annual Reviews. Register to receive the newsletter.
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