Such a scenario need not be a given of old age. While a certain amount of decline in muscle tone, bone mass and other functions of the human body are inevitable as one ages, staying active and doing the right kind of exercise on a regular basis goes a long way towards maintaining strength and either avoiding injury in the first place or allowing for a complete recovery.
“Strength is important for older people,” believes Dr. Michael W. Schweppe, medical director at the Northern Dutchess Bone and Joint Center and a physician at Orthopedic Associates of Dutchess County. “You have to exercise more as you age to maintain muscle tone. In order to move and ambulate on planet earth, we’re constantly fighting gravity, so it’s not just a matter of pure strength, but also directing that strength to appropriately maintain balance.”
Schweppe cites a recent study that linked an older person’s lower body strength with the incidence of recovery after a fall or similar type of injury. “The number-one predictor of an older person being able to leave the hospital or rehab and go home and live independently after a hip fracture was pre-injury lower-extremity strength,” he said. “People who were weak in their legs were much more likely to be in nursing-home care than those people who were active and fit. That’s the key predictor of people being able to live in the community. I tell my older patients they need to keep their strength up.”
When they don’t and “something happens to tip them over the edge, such as a broken hip, and they’re having to use their upper body more and don’t have any reserve, they cycle downward,” added Schweppe. “People who end up being institutionalized in a nursing home have a higher mortality than those at home with family.”
Dr. Frank Lombardo, an orthopedic surgeon at HealthAlliance who also practices at Orthopedic Associates of Dutchess County, has seen for himself the difference in the recovery rates between patients with knee or hip replacements who were fit before the surgery versus those who were in poor physical shape. One inspiring example was provided by a 94-year-old woman who had a knee replacement three weeks ago and is already back bowling. “She’s thin and very physically active,” noted Lombardo. “She’s back to where she was” before the operation.
Walk the walk
Unfortunately, the sedentary lifestyle of many Americans hastens deterioration of bones and muscles. “Our bodies are designed to walk, not sit in cars,” said Schweppe. “They’re designed to walk and run and reach for things. A lot of problems we see in terms of lower-back pain and tendonitis come from forcing our bodies to sit inside little boxes.”
Schweppe referred to two more “primitive” cultures renowned for having a high proportion of documented centenarians, as described in the book Healthy Aging, by Dr. Andrew Weil. The people of Okinawa, located in southern Japan, have an average lifespan of 81.2 years, the longest in the world. Their diet includes lots of tofu, lean pork, seaweed, turmeric tea, purple sweet potatoes, and a bitter melon called goga, which has been found to lower blood sugar. They live in a tropical environment with clean air and water and walk everywhere.
The second culture in Weil’s book is located in the mountainous interior of Sardinia. Here, also, people eat natural foods and routinely walk extended distances.
In both cultures, “people have to walk long distances,” said Schweppe. “They remain active to a very advanced age. In Sardinia, studies show they walk miles up and down hills to the market...The association with physical activity and healthy aging can’t be denied.”
Maintaining health into old age involves several kinds of fitness. One is cardiovascular conditioning, which keeps the heart muscle strong. “Just walking isn’t always enough to generate a heart rate that qualifies as exercise,” said Lombardo, who noted that the appropriate amount of exercise varies by individual (older people should consult their physician about what’s right for them). However, he cautions that certain high-impact aerobics, such as spinning, zumba dancing, and step aerobics, can put too much stress on the joints. “By doing lower-impact activities and keeping their joints moving freely in a range of motion, people won’t deteriorate their cartilage,” Lombardo said.
He recommended exercise on an elliptical machine and on a stationary or recumbent bicycle as excellent conditioning. He also encouraged swimming, water aerobics and brisk walking. (Weil writes that many high-impact sports can actually cause neurological damage, since “aerobic exercise is a powerful generator of free radicals,” which make people more susceptible to infectious disease. Weil counsels moderation: climbing stairs, walking up hills, swimming and cycling.)
In general, Schweppe recommends people exercise a moderate amount every day. “A small amount of exercise every day is better than two hours every Saturday and Sunday,” he said.
Strategies for bone protection
Strength training, which builds and maintains bone and muscle mass, is another activity that’s important for maintaining health in old age. “Our bones are unique in that they respond to stress,” said Lombardo. “The more you use them, the more likely your body is building more bone. As older people become sedentary, their bones become brittle. Muscle mass protects ourselves from damage when something does happen.”
Bone mass is built up early in life, so it’s important for young people to stay fit and eat well in order to maintain their health in old age. The way to build up bones and muscles is through resistance exercise — lifting, pulling and pushing weights. Pilates, which employs rubber straps for spring tension, is another effective way to work the muscles against resistance.
Ujjala Schwartz, a health educator and nutritionist who runs the Healthy Senior Wellness Club at Benedictine Hospital, in Kingston, teaches a class twice a week to cancer patients and seniors over age 50 which uses a device called SmartBells to create weight resistance. Resembling a rubber steering wheel, the device comes in weights from a pound and a half to 75 pounds (Schwartz uses the lightest weight in her classes and the six-pound weight for herself). She has developed a program in which older seniors do yoga in a chair using SmartBells, which combines weight training, from the Western tradition, with the fluid movements of the Eastern tradition, such as tai chi chuan. “The SmartBell helps them stabilize their moves, gives weight and helps with balance,” she said.
Schwartz believes that better health starts with a positive frame of mind. “It’s an attitude change. [The seniors I teach] have been given permission to do something. Even for the much older ones, it’s fun and they laugh.”
Yoga is an excellent conditioner for the third component of maintaining healthy bones and muscles: flexibility and balance training. As we grow older, “we lose our intrinsic sense of balance, which is tied in large part to hearing and sight,” said Schweppe. “The inner ear has a mechanism that tells you where you’re headed in space, which deteriorates with natural hearing loss. But that sense of intrinsic balance can be trained by doing yoga. The different postures force the practitioner to put the body in a position that’s awkward and to recover.”
An important clue to maintaining flexibility can be found on the playground, Schweppe said. “When children play, they tend to use all their joints naturally through a full range of motion. But in a western sedentary lifestyle, we’re not using our hips or lower back, and they tend to atrophy.”
A dedicated yoga practitioner himself, Schweppe trained at the Sadhana Center for Yoga in Hudson and became a certified instructor. For the past four years, he has practiced yoga every morning for between 45 minutes and an hour and a half. He considers his practice of yoga to be “a great complement” to his surgical practice.
The breathing and ethical principals of yoga also contribute to health, he said. At the same time, since yoga is done barefoot, the feet also get a needed workout.
Lombardo, too, recommends stretching exercises, such as those found in yoga and pilates, as excellent conditioning for “key core strengthening,” and “maintaining a range of motion.” Keeping down one’s weight is also essential.
“A fair number of people I see need joint replacements, but they’re too big to have a hip or knee replacement,” Lombardo said. “Overweight people struggle with activity, because they’re so exhausted from carrying around all that weight. It also makes recovery from surgery more difficult.”
The stress of carrying around too many pounds, as well as previous sports injury leading to a lot of wear and tear on joints, are two causes of arthritis. “The more weight you put on a joint, the more you wear it out over time,” Lombardo said. For example, the knee experiences seven times the body’s weight with every single step, he pointed out.
Keep the weight down, stay active, stretch, give yourself a workout; there’s no better prescription for maintaining health and mobility in one’s later years.++
For information about the classes taught by Ujjala Schwartz, call her office at 334-3187 or home at 331-3037. Under a state grant, the Ulster County Department of Health and Community Heart Health Coalition have purchased stress balls and stretch bands, and produced an accompanying DVD and a booklet for an exercise program for seniors. While the funding has stopped, several groups led by volunteer instructors continue to meet regularly in Stone Ridge, Ellenville, Kingston and Rochester. Contact 334-5527 for times and locations.