A performance approach to extending your life (recommendations for adults)


If you are like me, you have worried at some point in your life about aging. Not only has it crossed my mind that I might not be functionally independant for my entire life due to what I thought was guaranteed declines in joint function and mobility with aging, but disease was also on my mind. As much as diseases such as Diabetes and Cardiovascular Disease are affected by lifestyle and environment, they, as well as other diseases such as Cancer, can be affected by genetics or environmental factors out of our control. Having a father that passed away in his thirties due to Cancer, the possibility of developing such a disease will never leave me, given my Family History.

What if there was something I could do to help prevent this imminent possibility, and give my loved ones some extra time on this planet?

The primary goal of recommendations for older adults is to maintain function and independence, with secondary objectives of extending life, decreasing the risk of chronic disease, and minimizing the period of disability1. Studies reveal that physical activity and fitness are associated with a decreased risk of morbidity (cardiovascular disease, diabetes, colon cancer) and all-cause mortality, and that inactivity is a major risk factor1–3. Older adults with one or more comorbidities or disabilities often function at or close to cutoffs of functional independence, but it appears that regular physical activity decreases ageing’s negative parallels1.

Although physical activity is an important determinant of physical fitness, it appears that not all intensities impact one’s health the same way; the type or dose of the physical activity is critical1. For example, there appears to be an inverse relationship between exercise and risk for coronary heart disease, cardiovascular disease risk for all-cause mortality, ischemic heart disease risk, cardiovascular disease risk and all-cause mortality1.

Highest energy expenditure groups in studies of all-cause mortality had the lowest relative risk of CHD and death. For example, it appears that there is a minimal threshold of moderate activity in the range 60-70% VO2max to prompt improvements in cardiorespiratory fitness.

Many studies have shown that more physical activity further reduces mortality rate and disease risk.

For example, Hakim et al.4 studied older men for 12 years and found that those who walked 1-2 miles per day compared to a control group who walked less that a mile a day had a 30% reduction in mortality. Furthermore, those who walked 2-8 miles had a further reduction in mortality rates, with half the risk. Similarly, other studies have proven this fact while measuring physical activity via total daily energy expenditure and found that moderately vigorous (>4.5 METs) activities were beneficial compared with activities of lesser intensity, and in the other 3 studies, only vigorous physical activity (>6 METs) was related to lower all-cause mortality1.

For some context, one MET is equal to 3.5ml/kg/min, and as physiologists, we like to use METs as a simple way to give us an idea of 1) How to prescribe daily activity in laymans terms, and 2) To be able to get an idea at someone's exercise capacity based on averages values for MET tables. Below is an example of METs required to do certain activities, and the associated energy expenditure related with those activities.

The decrements in fitness associated with aging puts older adults dangerously close to the theoretical aerobic cutoff of 15ml/kg/min for functional living1 (4.3 METS). Its hard to imagine a light/casual game of volleyball or golf being a person's maximal exercise tolerance. With this in mind, it has been suggested that the focus for older adults be shifted from a lifestyle approach ("be healthy") to a performance approach ("be fit and strong"). If such a method were to be adopted, it would be likely that the golden years would not only be extended in length but in quality as well.

What this means practically, is that while currently, it is not a societal norm to do large amounts of physical activity as we age, this perspective could be soon to change. Instead of making the common excuses of time, fear of injury, lack of knowledge, or preference of medications to fix common problems in our aging society, the evidence points us in the opposite direction - instead prompting high levels of fitness. These implications are ever-reaching, as they impact health care spending, taxes, longevity and flourishment of the pharmaceutical companies (negatively), and overall population health and wellbeing. The message is clear - get our grannies moving!

References

1. Paterson DH, Jones GR, Rice CL. Ageing and physical activity: evidence to develop exercise recommendations for older adultsThis article is part of a supplement entitled Advancing physical activity measurement and guidelines in Canada: a scientific review and evidence-based foundation fo. Appl. Physiol. Nutr. Metab. 2007;32(S2E):S69-S108. doi:10.1139/H07-111.

2. Murias JM. Cardiovascular Adaptations to Exercise Training in Older adults.

3. Stathokostas L, Jacob-Johnson S, Petrella RJ, Paterson DH. Longitudinal changes in aerobic power in older men and women. J. Appl. Physiol. 2004;97(2):781-9. doi:10.1152/japplphysiol.00447.2003.

4. Hakim, A. A., Petrovitch, H., Burchfiel, C. M., Webster, G., Rodriguez, B. L., White, L. R., Katshukiko Yano, M., Curb, D., Abbott R. Effects of walking on mortality among nonsmoking retired men. N. Engl. J. Med. 1998;338:94-99.

#Olderadults #Old #Adults #Mortality #Activity #Fitness #Riskofdeath #Comorbidities #Physicalactivity #exercisephysiologist #exercise #sarcopenia #function #independance #Disability #Cardiovasculardisease #Cardio #Healthcare #DoseResponse

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