Can Exercise Reverse Aging? How to Exercise to Age Well

Summary

Dr. Leslie Kernisan, a geriatrician, emphasizes the critical role of exercise in maintaining independence and quality of life for older adults in the Better Health While Aging video podcast. She explains that while walking is beneficial, it's insufficient for maintaining strength and balance. Dr. Kernisan recommends a combination of strength, aerobic, balance, and flexibility exercises, tailored to individual capabilities, to counteract age-related muscle loss and frailty. She also addresses considerations for those with cognitive impairments and the importance of adequate protein intake alongside exercise to build strength and prevent falls, advocating for a proactive approach to healthy aging.

Takeaways

• 😀 Exercise is crucial for maintaining health, independence, and quality of life in older age, not just for general health benefits.
• 🏋️‍♀️ Strength exercises, aerobic exercises, balance exercises, and flexibility exercises are the four key types of exercise beneficial for older adults.
• 🚶 Walking alone is often not enough for the physical demands of aging; a more comprehensive exercise routine is necessary.
• 💪 Strength training helps maintain and increase muscle strength, power, and mass, which is vital for daily activities and independence.
• 🔄 Aerobic exercises are essential for improving cardiovascular health and should be done in moderate to vigorous intensity.
• ⚖️ Balance exercises are critical for preventing falls and maintaining the ability to perform daily tasks safely.
• 🧘 Flexibility exercises help maintain a full range of motion in joints and muscles, aiding in everyday activities like tying shoes or picking things up.
• 📈 Even small amounts of consistent exercise can lead to significant health improvements and should be adapted to individual capabilities.
• 👨‍⚕️ It's important for older adults to consult with health providers before starting or increasing exercise routines, especially if they have pre-existing conditions.
• 🥚 Adequate protein intake combined with strength training can help counteract sarcopenia and maintain muscle mass in older age.
• 👵 Exercise programs designed for older adults can be more effective and safer, taking into account the specific needs and limitations of this demographic.

Q & A

Who is Dr. Leslie Kernisan and what is her area of expertise?

Dr. Leslie Kernisan is a board-certified geriatrician and the founder of the website Better Health While Aging dot net. She specializes in the health issues that affect people over the age of 60 and discusses ways to prevent and manage these problems.

What is the main focus of the Better Health While Aging video podcast?

The Better Health While Aging video podcast focuses on common health problems that affect people over age 60, discussing the best ways to prevent and manage those problems, as well as addressing concerns and dilemmas related to aging parents and older loved ones.

Why does Dr. Kernisan believe that exercise is crucial for older adults?

Dr. Kernisan believes that exercise is crucial for older adults because it's not only valuable for better health outcomes but also for practical reasons that significantly impact how people experience their later years, such as maintaining physical abilities, independence, and quality of life.

What does Dr. Kernisan say about the common misconception regarding walking as a form of exercise for older adults?

Dr. Kernisan points out that while walking is beneficial, many older adults may underestimate the value of other forms of exercise. Walking alone is not enough to maintain muscle strength, balance, and cardiopulmonary capacity, which are essential for maintaining independence and preventing falls.

How does exercise counteract the aging process at a cellular level?

Exercise counteracts the aging process at a cellular level by activating various cellular pathways that improve cellular and organ function. This counters the aging process where cells and organs become less able to repair and maintain themselves, and it can slow down or even reverse some aspects of aging.

What are the four types of exercises that Dr. Kernisan recommends for older adults?

Dr. Kernisan recommends four types of exercises for older adults: strength exercises (resistance exercises), aerobic exercises (endurance or cardio exercises), balance exercises, and flexibility exercises.

How often should older adults aim to perform each type of exercise according to Dr. Kernisan?

Dr. Kernisan suggests that older adults should aim to perform strength exercises, aerobic exercises, balance exercises, and flexibility exercises at least twice a week, with strength training ideally done three times a week.

What is the significance of protein intake in relation to exercise for older adults?

Protein intake is significant for older adults in relation to exercise because it helps in building and maintaining muscle strength. Combining adequate protein intake with strength training can help counteract frailty and sarcopenia, which are age-related losses of muscle and strength.

What advice does Dr. Kernisan give for those who want to encourage an older loved one to exercise?

Dr. Kernisan advises taking a step back and trying to understand the older adult's perspective, motivations, and fears. It's important to model the behavior oneself and possibly invite the older adult to join in exercises. However, it's also crucial to accept that each individual makes their own choices about their health and lifestyle.

What are some of the risks associated with exercise that Dr. Kernisan discusses and how can they be managed?

Dr. Kernisan discusses risks such as injury due to muscle or joint overuse, injury related to falling, and cardiopulmonary strain. These risks can be managed by consulting with health providers, starting with low-intensity exercises and gradually increasing them, giving the body rest days, listening to the body and stopping if pain is experienced, and considering treatment for osteoporosis if present.

How does Dr. Kernisan define frailty and what is its relationship with advanced age?

Dr. Kernisan defines frailty as a state of physiologic vulnerability to stressors, where the body and mind are working but are easily harmed or pushed out of normal function. Frailty often manifests with weight loss, decreased grip strength, exhaustion, slower walking, and decreased physical activity. While frailty correlates with physical age, even robust older adults are more physiologically vulnerable at 90 than they were at 70.

What is the importance of an exercise plan and how can it be beneficial for older adults?

An exercise plan is important as it provides a structured and organized approach to physical activity, ensuring that older adults engage in the right types of exercises on a consistent basis. It helps in maintaining motivation, avoiding injuries by gradually increasing exercise intensity, and ensuring that the exercise routine is tailored to the individual's needs and abilities.

Outlines

00:00

😀 Introduction to Better Health While Aging Podcast

Dr. Leslie Kernisan, a board-certified geriatrician, introduces her video podcast on the Better Health While Aging website. The podcast focuses on common health issues for those over 60, discussing prevention and management strategies. This episode is dedicated to the importance of exercise for maintaining independence and quality of life in older age. Dr. Kernisan emphasizes that while exercise is widely acknowledged as beneficial, many older adults may underestimate its value, especially for maintaining physical abilities like navigating stairs and carrying groceries. She also mentions that walking alone may not be sufficient for optimal health and hints at the need for a more comprehensive exercise regimen.

05:03

🏃‍♂️ The Importance of Exercise Beyond Walking

Dr. Kernisan delves into why walking, though beneficial, might not be enough for older adults. She explains that exercise is a structured form of physical activity intended to exert or challenge the body, usually for health promotion or personal enjoyment. The podcast discusses the cellular benefits of exercise, such as activating pathways that improve cellular and organ function, counteracting the aging process. Exercise can slow down or even reverse cellular senescence, improve glucose metabolism, reduce inflammation, and enhance mood, sleep, and anxiety. Dr. Kernisan stresses the role of exercise in maintaining functional abilities, such as performing daily tasks and recovering from injuries, which typically decline with age.

10:05

💪 The Impact of Inactivity on Aging

This paragraph highlights the consequences of not exercising, such as muscle mass loss and worsening balance due to weaker muscles and an aging neurological system. Dr. Kernisan explains that the rate of muscle loss accelerates after age 60 and that inactivity can exacerbate this decline. She also points out that individuals who have not exercised have less strength reserve, which can be problematic during hospitalizations or periods of immobility. The paragraph reinforces the necessity of intentional exercise to counteract age-related physical decline.

15:06

🏋️‍♀️ Strengthening and Balancing Exercise for Older Adults

Dr. Kernisan outlines the four types of exercises beneficial for older adults: strength (resistance), aerobic (endurance or cardio), balance, and flexibility exercises. She emphasizes that any exercise is better than none, and consistency is key to seeing benefits. The paragraph provides examples of each exercise type and stresses the importance of starting with an appropriate level of challenge and gradually increasing it. The goal is to build muscle strength, power, and mass, as well as improve cardiopulmonary capacity, balance, and flexibility.

20:07

🧘‍♀️ Enhancing Balance and Flexibility Through Exercise

This paragraph focuses on the importance of balance and flexibility exercises for maintaining mobility and preventing injuries. Dr. Kernisan suggests exercises like walking heel to toe and yoga to improve balance, while flexibility can be enhanced through stretching and activities like yoga that involve a wide range of motion. She advises against aggressive stretching before vigorous activity, recommending warming up first and holding stretches for at least 30 to 60 seconds to maintain flexibility safely.

25:09

🚶‍♂️ Exercise as a Tool for Fall Prevention

Dr. Kernisan discusses the role of exercise in fall prevention, noting that falls are a leading cause of injury for older adults. She recommends leg strength and balance exercises, which have been clinically proven to reduce falls, especially for those at high risk. The paragraph suggests consulting with a doctor for a comprehensive fall prevention evaluation and finding validated exercise programs, such as Otago or Healthy Steps in Motion, to aid in fall prevention.

30:11

📝 Creating an Exercise Plan for Regular Activity

The importance of having an exercise plan is emphasized in this paragraph, which should outline the types of exercises, frequency, and specifics on how to perform them. Dr. Kernisan suggests that a plan helps maintain consistency and motivation, and it can be adjusted over time as one's fitness level improves. She also recommends seeking professional help to create and update the plan, ensuring it is safe and effective.

35:13

👩‍⚕️ Consultation and Precautions for Starting an Exercise Routine

Dr. Kernisan advises consulting with a health provider before starting an exercise routine, especially for those with chronic health conditions. She discusses the importance of starting slowly and consistently, and the risks associated with overexertion, such as injury and cardiopulmonary strain. The paragraph also touches on the benefits of rehabilitation programs for those with heart or lung conditions and the importance of listening to one's body to avoid injury.

40:14

👴 Special Considerations for Frail and Elderly Individuals

This paragraph addresses exercise for those who are frail or of advanced age. Dr. Kernisan defines frailty and explains that even the frail can benefit from physical activity, though it's crucial to find a safe and tolerable level of exercise. She also discusses the importance of protein intake in combination with strength training to combat sarcopenia, the age-related loss of muscle mass. The key is to start with modest activity and increase it gradually.

45:16

🧠 Exercise and Cognitive Impairment in Older Adults

Dr. Kernisan explores the relationship between exercise and cognitive impairment, such as Alzheimer's disease. She notes the potential benefits of exercise for those with dementia, including improved mood and reduced irritability. However, she acknowledges the challenges in encouraging individuals with dementia to exercise, such as apathy, forgetfulness, and resistance. The paragraph suggests identifying obstacles and finding ways to make exercise more feasible and enjoyable for them.

50:17

👨‍👧‍ Encouraging Others to Exercise and the Role of Protein

The final paragraph discusses the delicate balance of encouraging older adults to exercise without being insistent. Dr. Kernisan suggests understanding the individual's perspective and motivations, and possibly modeling exercise behavior oneself. She also reiterates the importance of protein intake, especially in conjunction with strength training, to maintain muscle mass and prevent frailty. The paragraph concludes with a reminder that while exercise is beneficial, it may not solve all health-related concerns.

55:17

🏅 Conclusion and Call to Action

In conclusion, Dr. Kernisan emphasizes that it's never too late to start exercising and that even small, consistent efforts can significantly improve health, independence, mobility, and strength. She encourages viewers to consult with health providers before beginning an exercise regimen, start with low-intensity exercises, and combine strength training with adequate protein intake. The paragraph ends with a reminder to screen for osteoporosis and to consider treatment if necessary, and a final encouragement to engage in exercise to maintain an active lifestyle.

Keywords

💡Geriatrician

A geriatrician is a medical doctor who specializes in the health and well-being of older adults. In the context of the video, Dr. Leslie Kernisan is a board-certified geriatrician, emphasizing her expertise in addressing the health concerns of individuals over the age of 60. The term is used to establish the speaker's authority and relevance to the topic of health and aging.

💡Exercise

Exercise, as discussed in the video, is a structured form of physical activity done with the intention to exert or challenge oneself physically. It is central to the video's theme, emphasizing its importance for maintaining health and independence in older age. The script mentions various types of exercises, such as strength, aerobic, balance, and flexibility exercises, and how they contribute to better health outcomes and quality of life.

💡Aging

Aging is the natural process of growing older, which is the main focus of the video. It is discussed in relation to the physical, cognitive, and health changes that occur as people age, particularly after the age of 60. The video explores how exercise can counteract some negative effects of aging, such as muscle loss, frailty, and functional decline.

💡Independence

Independence in the context of the video refers to the ability of older adults to perform daily life activities without assistance. It is a key outcome that exercise can help maintain as people age. The script highlights how exercise contributes to practical abilities like navigating steps, carrying groceries, and maintaining strength and balance, which are essential for independent living.

💡Quality of Life

Quality of life is a broad term that encompasses an individual's overall well-being and satisfaction with life. In the video, it is closely tied to the discussion on exercise and aging, as regular physical activity is presented as a means to improve and maintain a good quality of life in one's later years. The script explains how exercise can help older adults participate fully in life and experience it positively.

💡Strength Training

Strength training, also known as resistance exercise, is a type of exercise that focuses on building muscle strength, power, and mass. The video emphasizes the importance of strength training for older adults to maintain physical abilities and prevent falls. It is one of the four types of exercises recommended in the script for maintaining independence and quality of life.

💡Balance Exercises

Balance exercises are designed to improve stability and prevent falls, which are a significant concern for older adults. The video discusses how balance exercises can challenge and enhance an individual's ability to manage movements that require coordination between the muscles, brain, and nerves. These exercises are recommended as part of a comprehensive exercise routine for older adults.

💡Aerobic Exercise

Aerobic exercise, also referred to as endurance or cardio exercise, is any activity that increases heart rate and improves the body's ability to use oxygen efficiently. The video script mentions aerobic exercise as a crucial component of an older adult's fitness routine, contributing to better cardiovascular health and overall well-being.

💡Flexibility Exercises

Flexibility exercises are those that allow joints and muscles to move through their full range of motion, helping to maintain or improve mobility. The video highlights the importance of flexibility for daily tasks and injury prevention, and it is one of the four types of exercises recommended for older adults to help preserve their ability to perform routine activities.

💡Frailty

Frailty, as discussed in the video, is a state of increased vulnerability to stressors due to reduced physiological function. It is often associated with advanced age and can manifest in various ways, such as weight loss, decreased grip strength, and reduced energy levels. The script addresses the safety and benefits of exercise for frail older adults, emphasizing the need to start with low-intensity activities and progress slowly.

💡Cognitive Impairment

Cognitive impairment refers to a decline in cognitive abilities, such as memory, attention, and problem-solving skills. The video mentions Alzheimer's disease and related forms of dementia as examples of cognitive impairment. It discusses the benefits of exercise for individuals with cognitive impairment, including improved mood and quality of life, as well as the challenges that caregivers and families may face in encouraging physical activity in this population.

💡Protein Intake

Protein intake is discussed in the video as an important nutritional aspect, especially for older adults engaged in strength training. The script suggests that consuming adequate protein, in conjunction with exercise, can help counteract sarcopenia and maintain muscle mass. It also touches on the recommended daily allowances and the importance of spreading protein intake throughout the day.

Highlights

Dr. Leslie Kernisan emphasizes the importance of exercise for older adults to maintain independence and quality of life.

Exercise is often underestimated by older adults for its value in maintaining physical abilities and independence.

Walking alone is not sufficient for the physical benefits needed in older age; a more comprehensive exercise routine is necessary.

Exercise can help prevent falls and maintain strength and balance, which are crucial for daily activities in later life.

Dr. Peter Attia's book 'Outlive' is mentioned as an inspiration, highlighting exercise as a potent longevity drug.

Exercise at a cellular level activates pathways that improve cellular and organ function, counteracting the aging process.

Aging leads to a decline in physical abilities, but regular exercise can slow down this process and improve glucose metabolism.

Strength exercises, aerobic exercises, balance exercises, and flexibility exercises are the four types of exercise recommended for older adults.

Strength exercises are essential for maintaining and increasing muscle strength, power, and mass.

Aerobic exercises are necessary for improving the body's ability to move and use oxygen efficiently.

Balance exercises are crucial for preventing falls and maintaining the ability to perform daily activities.

Flexibility exercises help maintain the full range of motion of joints and muscles, preventing constriction over time.

Exercise programs designed for fall prevention have been clinically proven to reduce falls in older adults, especially those at high risk.

Creating an exercise plan can help structure a routine and ensure all four types of exercises are included.

Consulting with a health provider before starting an exercise program is recommended, especially for those with chronic health conditions.

Starting with low-intensity exercises and gradually increasing them can reduce the risk of injury.

Rest days are important, especially for strength training, to allow muscles time to recover and grow stronger.

Listening to one's body and stopping if there is pain during exercise is crucial to prevent injuries.

Untreated osteoporosis can increase the risk of fractures due to falls, so screening and treatment are important for women over 65.

Exercise is safe and beneficial for even the most frail and advanced aged individuals, but it should be adapted to their capabilities.

People with Alzheimer's or cognitive impairment can still benefit from exercise, but it may require creative approaches and support.

Encouraging exercise in loved ones should be done with understanding and respect for their autonomy and choices.

Protein intake is crucial for older adults, especially when combined with strength training to combat sarcopenia and maintain muscle mass.

It's never too late to start exercising, and even small amounts of consistent exercise can significantly benefit health and independence.

Transcripts

Well, hello there everyone.

I'm Dr.

Leslie Kernisan,

board certified geriatrician and the founder of the website Better Health

While Aging dot net.

And this is the Better Health While Aging video podcast where

we discuss common health problems that affect people over age 60

and the best ways to prevent and manage those problems.

We also often address common concerns in dilemmas that come up

with aging parents and other older loved ones like what to

do if you're worried about falls or safety or memory or

even the quality of an older person's healthcare.

So in this episode,

I am going to talk about exercise and aging and what

they have to do with maintaining independence and quality of life

in later life.

Now, I think we all know that exercise is good for

your health.

We've all heard this over and over again.

So you might be wondering why is this geriatrician devoting an

episode to an obvious truth?

And the answer is that although I think older adults have

often heard that exercise is good for them,

I think that they often actually might be underestimating just how

valuable exercise can be because it's valuable not only for lots

of better health outcomes,

but for really practical reasons that end up making a huge

difference to how people experience their life in their later years.

So in particular,

I've recently been doing a deep dive into this.

I wrote an article for my website about it and it

was really striking to me the way doing the right kinds

of exercise can be so key towards maintaining physical abilities and

independence as you age.

And I mean really practical things like comfortably navigating steps and

stairs and carrying groceries and maintaining strength and balance,

I think is what is especially important for older adults,

not just for fall prevention,

but again for the ability to comfortably do those practical daily

life skills that allow us to participate in life.

Another thing I've noticed over the years is when I've asked

a lot of older adults about exercise,

they're kind of like,

well, I should exercise more,

but I walk,

I walk every day,

I walk a lot,

and walking is wonderful.

And I think many older adults think that walking is enough,

but the truth is walking is not enough.

And I'm going to talk more about why in today's video.

So by sharing what I've recently reviewed,

I hope to give you a better understanding of how exercise

can help you not only be healthier,

but really help you age better or make the most out

of your life right now and whatever years you have ahead

of you.

And I hope to make it feel possible and feasible for

you to exercise more or exercise differently in order to just

really reap those advantages that we can get from exercise in

aging. Now,

one of the things that inspired me recently was reading this

book Outlive by Dr.

Peter Attia.

So he is not a trained geriatrician,

I think he originally trained as a surgeon and researcher,

but he became interested in what he calls applied longevity.

He has a special clinic where they help,

I believe it's mostly people in midlife optimize their health for

longevity, but also for health span,

for the ability to feel healthy and be very functional for

as long as possible into life.

And so he recently published a book called Outlive that summarized

a lot of,

you know what he has concluded our best practices and,

and he covers lots of things that people often talk about

when it comes to,

you know,

being healthy and longevity,

nutrition and,

and some other things.

But, but I was struck by this paragraph,

which was exercise is by far the most potent longevity drug.

No other intervention does nearly as much to prolong our lifespan

and preserve our cognitive and physical function.

So, so given that,

you know,

what do we need to know about exercise?

Because it's not enough to just be like,

okay, I'm gonna exercise.

We really wanna be thoughtful about the way in which we

exercise. And some people can take this very,

very far,

get very,

very detailed in this video.

I'm gonna tell you what I think is most important for

people who are in their fifties,

sixties, seventies,

eighties, nineties and beyond,

if you are.

So, but before that,

really quickly,

what is exercise?

What does it mean to exercise?

We'll start there.

So exercise is essentially a form of structured physical activity.

So physical activity is anything that makes you move your body,

including getting up to,

you know,

go to the kitchen,

walking around,

running errands,

having fun,

socializing. But exercise itself is a form of structured physical activity

where the intention is to exert yourself or to physically challenge

yourself. And this is usually done either intentionally for health reasons

or health promotion reasons,

but it can also be for personal enjoyment.

So in particular,

many people enjoy some kind of,

you know,

we often call 'em sports,

right, for personal enjoyment or hiking might qualify as well.

So there are lots of activities that can qualify as exercise,

but I think what really distinguishes exercise is that it should

be more strenuous or challenging than your usual practical physical activities.

So you should have to exert yourself more than usual when

you are exercising.

Now in this video,

I'm not gonna go into like all the research and scholarly

literature about the ways that exercise improves health,

but I did wanna talk about it in one way that

I think is particularly relevant to aging.

So as you may know,

exercise in both observational studies and randomized studies generally improves lots

of aspects of health associated with reduced mortality,

better cardiovascular health,

you know,

better emotional health,

the list goes on.

But how does it do this?

And what's interesting is that when they study exercise at a

cellular level,

what they find is that exercising and different forms of exercise

activate, you know,

potentially different things at a cellular level.

But in general,

exercise tends to activate a variety of cellular pathways that improve

cellular function and organ function.

And this is important because this is essentially a counter to

Aging. Aging is fundamentally a process that affects our cells and

organs where over time cells and organs get less able to

repair themselves,

maintain themselves,

restore themselves.

They can either become,

not they can die cells,

but also they can become actually what's called senescent where they're

not functioning properly and they're actually emitting chemicals and factors that

negatively affect other cells in the body.

So, so that's what aging is at a cellular level.

So exercise in many ways kind of counters this and either

slows it or slightly,

you know,

can reverse it.

Exercise also broadly speaking generally will improve glucose metabolism and reduce

inflammation. This is important because dysregulated glucose and increased inflammation are

two of the mechanisms by which we see,

you know,

the body aging and further deteriorating itself as people get older.

Exercise also often does improve mood,

sleep and anxiety.

So it has these short term effects that are very important

for emotional wellbeing and physiology now.

So that's at the cellular level and the organ level and

a little bit,

you know,

the health level.

Now how does exercise improve aging from another lens?

And from this lens I wanna talk about aging not from

a cellular level,

but the way we actually experience it in our lives,

which is what in geriatrics we describe as a functional level,

which means how able are you to do the things that

you want to do easily,

comfortably so that you can participate in life to your fullest

extent? Because that is the way that we experience aging.

And generally as we age,

at some point we experience certain forms of what we in

geriatrics might describe as functional decline.

It gets harder to physically do things that we are are

used to doing.

And initially those might be particularly strenuous things,

you know,

like the hikes or certain forms of sports.

But it also often gets harder physically to do things that

are not particularly sporty.

So again,

you know,

lifting a child or your suitcase will get harder and eventually

lifting even the even lighter things could get harder.

Also, as we age,

it takes longer to recover from injuries and illnesses.

Many of us start to notice this by our forties and

it becomes often more pronounced as we get older and given

enough time.

If we are lucky enough to live to a very advanced

age, it can eventually become very hard or essentially impossible to

do certain physical actions without the assistance of another person.

So we can take a lot,

lot of this function and the ability to have our body

do what we want it to do for granted earlier in

life. And often at a certain point,

older adults are not taking it for granted because it can

get challenging.

So the really cool thing about exercise is that it counters

this, it slows this process or in some cases can even

counter it.

So it helps us maintain those physical activities and it essentially

slows the physical aging experience.

So when it comes to maintaining independence,

I think exercise is really,

really important as I'm going to explain in this episode,

it helps stave off muscle loss and frailty,

which are also two other common features that eventually tend to

catch up with people at some point in their later life,

some people earlier,

some people later.

And exercise is really important to maintain mobility to prevent falls.

So that helps with aging in place,

which is another often priority for older adults.

Now what happens if you don't exercise?

And some of you may be going through this because the

statistics show that the vast majority of Americans do not exercise

regularly. The vast majority of older Americans don't exercise regularly.

The thing to know is that you're not going to stay

the way you were at age 50.

And and I think we,

we know this,

but I think people don't actually appreciate from a practical concrete

level what that might look like.

So the normal aging process is not only that your cellular

function changes,

but that you will start to lose muscle mass due to

normal aging.

So this starts actually fairly early.

Experts believe that muscle mass in general decreases by three to

8% per decade after age 30,

but it really speeds up after age 60.

And initially I think the body can be a bit like

the brain initially we have more capacity than we need for

our daily life activities.

So whether you're particularly strong or not so strong,

you can still climb the stairs,

carry your groceries,

you know,

maybe lift up a child.

But eventually as you're losing that muscle mass that catches up

to you.

Another thing that happens if you don't exercise is that your

balance will worsen.

Now this is partly due to weaker muscles,

especially the stabilizing muscles in the core and it's also due

to the aging of the neurological system.

And all of this can be accelerated or worsened by certain

chronic conditions.

So again,

if you don't exercise,

you're going to have difficulty again with those practical activities like

the stairs and groceries earlier in life.

And it's especially true if you for some reason get hospitalized.

We also especially lose muscle mass when we are bed bound

and not moving.

That happens more quickly for older adults.

So people who have not exercised don't have extra strength and

reserve and when they get hospitalized and are kept bedbound for

a week,

they come out much,

much weaker than if they had not exercised.

So, so again,

I really feel that intentional exercise is necessary if we wanna

counter and slow the kind of normal process of things,

which is to experience this age related physical decline.

And, and again,

exercise doesn't mean that you entirely avoid it,

but you can slow it,

delay it,

and then depending on the form of exercise and the issue,

sometimes reverse some of these declines as well.

Now what about again,

walking for exercise?

So I already said it,

it's not enough,

but I'm gonna say it again here and I do wanna

say walking is wonderful.

I encourage every older adult to walk regularly.

It is a way of getting out and about in the

world to be out in nature or at least get some

fresh air,

some sunshine.

It's something that we can do with friends,

with family members,

with neighbors,

if you do it going uphills,

you know are really briskly,

it can even count as exercise.

But in most cases the walking that people are doing is

not strenuous enough to count as exercise,

meaning it doesn't build or maintain your muscle strength,

it doesn't challenge your balance enough and it doesn't challenge and

kind of build and maintain your heart lung capacity,

what we also refer to as cardiopulmonary capacity in medicine.

So if you want these benefits of exercise,

in most cases walking is not going to be enough.

So now let's talk about what is enough and how you

could be exercising again to optimize strength and balance and independence

in exercising.

So I'm gonna talk about the,

you know,

what I recommend and I just wanna say,

and lots of research has been done on this too.

Any exercise is better than no exercise.

So I will talk about a few different types of exercise

I recommend doing,

but if you're not exercising,

what's most important is to start doing any type of exercise

as long as you do it consistently.

By that I mean at least once a week,

twice a week would be better,

but at least once a week it can be small.

Small is often a safer way to to start.

But any exercise done consistently is better than no exercise.

And often people start seeing benefits within,

you know,

a few weeks to a few months.

But if you really want the benefit,

then you wanna think about how to make sure you fit

in these four types of exercise.

And that is strength exercise,

also known as resistance,

aerobic exercise,

also known as endurance or cardio balance exercises and flexibility exercises.

So let me now go through those four types in a

little bit more detail.

So first I'm gonna talk about strength exercises,

also known as resistance exercises.

This is something I was not particularly taught about in medical

school 20 years ago,

but I've come to realize is so important and does bring

some distinct benefits that are separate from cardio and aerobic type

exercises. So what are strength exercises?

These are exercises that challenge muscle strength to enable you to

maintain and even increase muscle strength,

muscle power,

muscle mass.

And so some examples they can be body weight exercises.

So that's things just where you use your body weight against

gravity to create the exercise of squats.

Pushups less,

you think pushups are too hard.

I can tell you there are several different types of pushups

that can build upper body strength.

One can start just against the wall,

then against the counter,

then on the knees,

then the full plank.

And then strength exercises can also be done with weights,

you know,

dumbbells, resistance bands,

weight machines at the gym.

These can all create resistance exercise.

Now the thing about resistance exercises is that they are supposed

to be at the right level of challenge and then they

are supposed to get more challenging over time because if you

keep doing an exercise with a certain weight and you're doing

it correctly,

then eventually you should get stronger and you should get easier

to do the exercise.

And once it's not challenging enough,

you really wanna increase the weight.

So how challenging should the exercise be?

So you're at the right weight if when you do the

exercise, so the squats or the pushup or the,

you know,

whatever it is with the weight,

if you can do it eight to 10 times or about

10 times with good form,

it is important to have good form.

That means you're using the muscles that the exercise is meant

to activate and you're less likely to injure yourself.

So if you're at the right weight,

you should be able to do it with good form about

I have been told about 10 times.

And another way to think of it is you could maybe

do it once or twice more before you completely poop out,

but not more than that.

So if you keep doing an exercise like that,

you will get stronger.

And so if you get to the point where you can

do 15 repetitions without pooping out,

then it's not challenging enough to continue to build the strength

of your muscles.

It's actually for the body becoming more of an endurance exercise

than a strength exercise.

So you know,

I know some people where their routine is to do 50

pushups, it's wonderful to be able to do 50 pushups,

it's an amazing,

you know,

achievement at the same time that's not further building the strength

in the the upper body,

although it certainly might be maintaining it.

And if you're doing 50 pushups,

you're probably in good shape and you may not need this

video, at least not this part of the video right now.

And then different exercises will work different parts of the body.

So you want a combination of exercise that allows you to

work the major parts of the body,

the core,

which is more than the abdomen,

it's also parts of the back,

the glutes,

you know,

the upper chest girdle,

the upper body,

the lower body.

And you wanna aim to do strength exercises at least twice

a week,

probably three times a week.

It's really good if you can manage.

Now how about aerobic exercises?

So these are exercises that give your heart and lungs a

workout. So usually you have to breathe harder,

you might find it hard to speak or be unable to

speak. And this is good because it improves the body's ability

to move and use oxygen.

So when you do strength exercises,

your heart is probably going to pick up at least a

little bit but it's not really getting a workout.

Whereas when you do aerobic exercises,

the heart and lungs are getting a workout.

So some examples might include swimming or water aerobics or cycling

or brisk walking.

And then of course there are machines indoors to do aerobic

exercises at all stationary,

bicycles, treadmills,

ellipticals and so forth.

So how much should you do?

The American Heart Association does have a recommendation.

They say that ideally you wanna be doing 150 minutes per

week of moderate intensity aerobic activity and moderate means that it

feels like a five to six out of 10 on the

scale of effort.

Or they say you can do 60 minutes per week of

vigorous activity.

So that would be an eight to nine out of 10

efforts. So 150 minutes per week for moderate activity is like

30 minutes,

you know,

five days a week.

Now people may feel like they don't have time to do

that much or that sounds like a lot and especially if

you're starting from nothing that that is a lot.

So the good news is that lower amounts have been studied

in research and have been shown to be linked to reduced

mortality. So yes,

that is the recommended amount that is great to work up

to, to aim for,

but if you're doing less,

that's okay,

that helps also.

So again,

even a little bit,

even a little bit of aerobic exercise done consistently every week

is going to help you out.

Let me now talk about balance exercises.

So what is a balance exercise or what is an exercise

that would qualify?

This is something that should challenge your balance more than your

daily life activities do.

Now we already use our balance for lots of daily life

activities standing up out of the chair,

leaning over to pick something up,

walking, right?

So a balance exercise should challenge you a little bit more

or a lot more depending on the exercise and your abilities

than usual.

So there are exercises that are specifically designed for balance.

So for instance,

just walking heel to toe where you walk with like one

foot and then you place the other one,

the heel right in front of the toe in a line

that is a balance exercise.

If it feels challenging to you,

you can do it with one hand,

you know,

against the wall at first.

There are other balance exercises.

I have a page on Better,

Health, While Aging of the Otago exercises and there's a whole

section on balance exercises there.

And then there are certain activities that just innately challenge balance

a fair bit.

Tai chi,

yoga dance.

I would include those as exercises that really challenge your balance.

So why balance exercise is important and relevant.

So when we balance two actually balance,

it requires the strength of stabilizing muscles in the core,

plus the participation of the brain to coordinate the movement and

also your nerves to send signals to the brain about like

here's the position of the body,

here's what's happening and nerves to send signals out from the

brain. Here's how to adjust,

here's what to do.

And what's wonderful is that even in people who are quite

old and frail,

research has shown that giving them balance exercises does strengthen the

body's ability to manage these skills.

It strengthens those stabilizing muscles and it strengthens the coordination as

well. Now how often should you do them?

I would say I think twice a week,

at least twice a week is also a,

a good level to aim for.

If you can do it three times a week,

that's great.

And then lastly,

there's flexibility exercises.

So flexibility exercises are the ones that help your joints and

your muscles move through a fuller range of motion to maintain

or even improve their range.

And this is important because if we don't do that the

joints and muscles tend to constrict over time.

And so really putting your body through like the full range

of motion helps maintain that mobility and flexibility.

And so generally,

you know,

the common example is to actually stretch and then there are

certain activities that I innately involve putting the body through lots

of range.

Again, you know,

yoga tends to to do that as well.

Now how to safely stretch?

So the research suggests that it's not such a good idea

to stretch a lot before a vigorous activity,

but that doing it afterwards is a good idea because first

of all we can stretch more effectively and safely when the

body is warm.

So I recommend first warming up the body.

You can do a little bit of aerobic exercise,

you know,

a few jumping jacks,

some squats,

or you can even do some strength exercises.

And then you wanna slowly stretch into a position and you

wanna hold and you wanna hold for at least 30 to

60 seconds.

A brief stretch doesn't give the body enough time to relax

and really try to take advantage of that,

that stretch.

It's also a good idea to breathe long exhales,

help the body relax because initially when we move into the

end of our range of motion,

our body is designed to tense up a little bit to

keep us from getting injured.

So moving into a position,

relaxing and then maybe stretching a little bit more can really

help with that stretch.

And you should not push yourself,

you should not,

should not be hurting.

We just wanna sort of like maintain that full range of

motion to maintain flexibility.

Another thing to also keep in mind is that you generally

wanna avoid bouncing into the stretch.

Young people can tolerate bouncing into a stretch,

but it's really just kind of like overly taxing the body,

it's alarming it and making it think I might be about

to get injured.

And I think there's really no reason to be doing it

if you're doing flexibility in later life and you wanna aim

to stretch all major muscle and tendon groups.

So those are four types of exercise that every older adult

should aim to be doing,

ideally weekly.

And you know,

how can you benefit from this?

Well let me just sort of illustrate again a few of

these practical skills and how they correspond to these types of

exercise. So to be able to comfortably go up the stairs,

that requires strength,

that requires balance,

and that requires at least some aerobic capacity.

What about to pick something up off the floor?

That requires balance,

that requires flexibility and that requires strength.

How about carrying your groceries?

That's going to require strength.

That's also gonna require balance because carrying things tends to put

us a little bit off balance or tends to challenge our

balance. And then what about picking yourself up off the floor?

Should you have a fall?

That also requires strength,

balance, and flexibility.

So I think flexibility,

especially people often kind of wave off and think it's a

luxury, but you know,

flexibility is needed to tie your shoes and to pick things

up off the floor.

So maintaining at least some flexibility is a good thing.

Let me now say a few words about exercise for fall

prevention. So in geriatrics for quite a while we've known that

certain types of exercises can be a very important part of

a fall prevention plan.

Now it's often not the only thing that we do for

fall prevention,

it really depends on why people fall.

If you wanna know more about what we would check after

somebody falls,

I have a video about that.

But why,

why is fall prevention important and why are the exercises an

important part of it?

So falls are actually the leading cause of fatal and non-fatal

injuries for older adults.

And the wonderful thing about exercise is that there have been

clinically proven regimens of leg strength and balance exercises that have

been shown to help reduce falls in older adults,

especially the ones who have had falls are frail and are

otherwise at high risk for falls.

So in those particular people doing exercises,

especially if they're done with physical therapy or other assistance to

give people support in doing them correctly and sticking with them,

they have helped reduce falls.

So if you're interested in exercise for fall prevention,

first of all I recommend talking to your doctor about falls

and making sure you've had a more comprehensive fall prevention evaluation.

But then yes,

in most cases we find that older adults who have been

falling would benefit from any an exercise program.

And so in that case I would encourage you to look

for a validated program that means a program that has actually

been designed by experts and studied and the results have been

published. And those include Otago Healthy Steps in Motion and others.

The National Council on Aging actually has a very nice webpage

where they list all the evidence-based fall prevention programs and you

can learn more over there.

Now let's talk a little bit more about how to make

this happen.

So one thing that really helps if you wanna exercise regularly

and make sure you get,

you know,

you hit those,

those four types of exercise is to use an exercise plan.

So what do I mean by this?

So an exercise plan,

you know,

basically means not winging it and just saying I'm gonna exercise

more and day thinking,

do I wanna exercise?

What do I wanna do?

So a plan means we organize ourselves a little bit more

and often they are sort of created on a kind of

weekly basis and they should include which exercises the person will

be doing on which days.

And then should also include some specifics on you know,

where they're going to do the exercise and how to do

the exercise.

So the idea is to have something really clear that is

easy to follow so that you're not there losing motivation,

trying to figure out what to do or how to do

it when it's laid out in a plan.

It's really nice and it's even better if you have somebody

who can help keep you accountable for that plan.

That could be you know,

your partner,

that could be a family member,

that could be a friend or it could be a trainer.

Another good thing to build into the plan,

this doesn't fit in so much weekly,

but maybe it could be a monthly thing,

is to kind of assess how it's going and whether it

might be time to increase the amount of exercise.

Because if you are doing the exercises consistently and correctly,

you should find that you're getting stronger.

So it is appropriate first of all for the muscles to

keep getting stronger.

You really should be increasing the weight and challenge and it

can be appropriate to also increase the aerobic exercise or some

other aspect of the exercise plan if it's accessible to you.

I think it can be really helpful to work with a

professional to create and update your plan.

So how can you get started,

especially if you have been sedentary or you fell off the

exercise wagon or otherwise are feeling inspired and wanna get going,

what do we need to know to get started?

So first of all,

I think for older adults it is often a good idea

to consult with your health provider,

your primary care provider,

or someone else who is knowledgeable and knows about your health.

This is especially important if you do have any chronic health

conditions, especially the ones that affect the heart and lungs or

your joints.

So let your health provider know that you are gonna,

you would like to start exercising or increase exercising or change

up, improve the way you're exercising and ask them for recommendations.

And especially ask them to talk with you about what kinds

of precautions you might want to take.

If you do have a history of heart or lung problems,

that doesn't mean you can't exercise,

however you may need to take precautions.

And what's wonderful is that there actually exist special rehabilitation programs

that are designed for people who have had significant heart conditions

or lung conditions to help them improve the capacity of those

organs to function.

So that might be something that you could discuss with your

health provider or be referred to.

Some people might also be referred to physical therapy.

And then otherwise it's really important when starting to feel that

it's okay to start low and go slow.

So that can mean several things.

Maybe that means that the first week or first few weeks

you don't attempt all four types of exercise.

You know,

you start off with two types and then add something in.

And for any type of exercise,

especially for aerobic exercise,

we don't wanna try to jump in and add like the

recommended amount right off the bat.

If you've been sedentary or not doing anything close to that

level, that can be a lot for the body.

It's very,

very easy to get injured that way.

So think of the recommended amounts you know of of exercise

overall in the week or at a time as kind of

goals to eventually get to and and it's important to just

be safe and you can start small as long as you're

consistent early on.

So small but consistent effort is the way to go because

initially what we wanna do is not necessarily reap all the

benefits from exercise,

but we,

we wanna build a habit and we wanna give the body

time to adapt and get stronger so that it can tolerate

the level of exercise that we eventually want to be at.

Too much too fast does lead to injuries.

And so speaking of injuries,

let me now talk about the risks of exercising.

So exercise is fantastic but there are some risks.

There are risks for everything in life,

especially, you know,

most things that are worthwhile.

So what are the risks?

I think of them as like three main risks.

So one is that there's a real risk of injury due

to muscle or joint overuse.

So this is when you get some inflammation or irritation or

sometimes it can even be an actual injury,

some kind of tear around a joint or muscle because you

started using it a lot.

And especially if the body is not strong enough or is

otherwise vulnerable,

you can get an injury from that.

Another risk is the risk of injury related to falling,

especially when it comes to,

you know,

more active sports.

I read recently that there's been a real increase in pickleball

injuries, you know,

in the emergency room because we have so many people taking

on pickleball and that doesn't mean we shouldn't play pickleball.

It's a great sport for people of all ages to play,

but can feel very accessible to older adults since it's less

taxing than tennis or some of the other racket sports.

But it's true that you know,

when people fall they can get,

you know,

scrapes and bruises but it's also unfortunately possible to fracture something

and it's especially women who have osteoporosis who are at risk

for fractures.

And then there's the risk of,

you know what I'm going to call cardiopulmonary strain,

which is basically like overdoing it,

especially for the heart.

Sometimes it can happen for the lungs,

but it's especially with the heart because if the heart is

overdoing it then people can get things like chest pain with

exertion. So especially for those people who have some preexisting heart

disease or heart conditions,

it is a risk that that can come up.

But the thing about the risks is that if there are

risks and even in people who have heart conditions,

lung conditions,

that doesn't mean that exercise is out of the question or

should be considered.

It's really a question of how can we manage those risks.

So how do we manage the risks?

Because I really don't want anyone to feel that they need

to avoid exercise because it's risky for them.

Instead what we want to do is to ask our health

providers for help managing and reducing the risks.

So how so first of all,

let them know,

you know again communication,

letting them know that you're interested in starting an exercise program

or leveling up your exercise program asking you know,

what kind of precautions considering physical therapy or other rehabilitation programs

before you do a lot of exercising on your own.

That can also be very valuable and your health provider should

be able to advise you as to whether that's a good

idea for you and they should be able to refer you

if they think it is a good idea.

Another way to lower risk is to work with a fitness

professional if that's something that is available to you.

And I personally think it's a good idea to work with

either a fitness professional who is about your age because a

lot of fitness professionals are relatively young and some have quite

a lot of experience with helping clients who are older who

are in their sixties or seventies or eighties and some do

not. So I think identifying somebody who has experience with people

your age group and often people who are about your age

group have gone through this for themselves,

for their friends and maybe more sort of attuned to the

adaptations and the necessity of,

you know,

sometimes going slower for older adults because again,

starting low and going slow is a great way to reduce

the risk of injuries.

A few other suggestions to reduce injuries,

another one is to give yourself rest days.

And this is especially important for strength training.

Research suggests that you know,

people can build strength better if they don't train on back-to-back

days, at least not the same muscle group,

right? So maybe on one day you might do your upper

body and the next day more the lower body.

But giving yourself rest days can help.

Another thing that's very important is to practice listening to your

body and to stop if something is hurting.

So I can't emphasize this enough,

it is normal for exercise to be uncomfortable.

Discomfort is normal but pain is not.

So if you're experiencing pain,

it's really important to not push through.

That's not even a good idea for younger people and I

think it becomes a less and less good idea as we

get older.

So if you're experiencing pain,

you wanna think about getting help from a professional to check

for injury or impending injury and to advise on how you

might want to modify your exercise plan.

And then last tip to reduce injuries is to avoid untreated

osteoporosis. So first of all,

the screening guidelines are that most women,

once they're 65 should get screened for osteoporosis.

So if you're in that age range and you have never

been screened for osteoporosis,

you should do so that usually involves a DEXA scan.

Some men screening can be recommended for some men as well

depending on their health conditions or whether they've been on certain

types of medications that are associated with more fragile bones.

And then if you're told you do have osteoporosis,

I highly recommend considering treatment with medication.

It's been researched a lot,

it does reduce fracture risk and is pretty safe.

People often worry about it,

but usually the risk of fracture is much higher than the

risk of a significant bad outcome from the medication.

And then my last tip is again to consider if you're

doing exercise classes,

consider the ones designed for people your age.

So now I wanna talk about a few exercise situations that

I have found come up quite a lot in geriatrics.

These are things that people ask me about a lot or

that I'm often advising families on or sometimes older adults on.

And so I have three.

So one is,

what about people who are of what we call advanced age

or very frail,

what about exercise when somebody has Alzheimer's or a related form

of dementia or some other form of cognitive impairment?

And then there's a situation of what if you want your

spouse or your aging parent or another older loved one to

exercise? So let me now talk about those.

So first of all,

advanced age or frailty.

I'm gonna start with frailty first.

What is frailty?

So you may know it when you see it,

some people as older people,

usually older,

although sometimes people look frail when they're younger,

if they're very,

very sick or have you know,

quite advanced cancer.

But we have seen some older people who look kind of

frail and what does this mean?

So frailty is often defined as a state of physiologic vulnerability

to stressors.

So physiology means the way your body and mind are working.

Vulnerable means it's easy for it to get harmed,

stop working correctly and to vulnerable to stressors.

The stressors can be,

they can be illness,

they can be being pushed off balance,

there are lots of things that can be stressors.

So frailty means that people's bodies have reached a point where

there really kind of barely holding onto their normal function and

it's very easy to be tipped over.

So it does correlate to physical age.

So most people,

if they live long enough and don't have a sudden accident

or injury,

a lot of people will go through a stage of being,

you know,

having some frailty before the end of their life,

especially if they get into,

we especially see it come up often in the last year

or two of of life.

And there's what we call a phenotype,

kind of a physical look to it that has been identified

and has been used sometimes in research studies to identify frail

individuals. So it often manifests with people losing weight,

especially muscle mass with having what's called decreased grip strength.

So if you ask them to squeeze something,

they can't squeeze as hard,

they feel often exhausted by their regular activities.

They get tired very,

very easily,

they walk more slowly than before and they may have decreased

physical activity so they're not doing as much as they used

to. And so some studies have sort of assessed for these

five characteristics in their subjects and if people had three or

more, they were identified as frail and frailty often goes with

a condition that is called sarcopenia.

So this is basically a condition of age-related loss of muscle

and strength that comes on from many older adults at some

point. And that's part of what makes frail people look frail

and behave in ways that are frail.

So that's how we define frailty.

And then there's advanced age,

which there's no exact definition for today.

I'm gonna go with 85 plus years.

So often when we talk about older adults and break them

up into age groups,

the, you know,

the oldest old used to be defined as 85 and older.

Now it's kind of often being switched to 90 because we

have, you know,

the boomer cohort,

lots of them who who are aging and we have more

just people in the older adult age group in general.

Now the opposite of being frail in medical terms is called

being robust.

So people who are robust,

you know,

it takes more to tip them into being sick,

being unwell and organ not working well,

they tend to look stronger,

healthier, more hail.

And so there are people who are in their nineties who

actually look quite robust.

But the thing is as we get older we are still

at some level becoming more physiologically vulnerable.

So even in people who are robust,

90 is more,

you'll be more vulnerable at 90 than you were at 70,

even though there are certainly some 90 year olds that I

have met who are less,

you know,

more robust looking than some 70 year olds that I have

met. And I'm sure you know people like this as well.

So what do we know about exercise for advanced age or

frailty? Is it safe and is it safe especially for the

frail older adults,

right? So because lots of people fall in both those categories,

they are frail and they are in their nineties,

is exercise safe?

And the answer is resoundingly,

yes, it's safe,

it's beneficial,

it is a good idea.

This has been studied in research studies and even the frails

older adults tend to benefit from physical activity and from exercise.

Now if you're very frail,

just normal physical activities,

practical activities might feel like exercise,

they might feel strenuous,

so they might qualify as exercise or we can give people

specific exercises.

The key for exercise when people are frail or very old

is to find a level that can be safely tolerated.

And in general this is gonna be way below the recommended

amounts, the optimal amounts.

Now even when people are very old or frail,

we ideally wanna aim for again those four types of exercises.

It's just that it may not take a lot to give

them a cardio workout and the strength exercises,

you know,

whatever requires strength and is something that they can do.

You know,

and we might start with fewer than eight repetitions,

right? We might start with like three to five things to

help them with their balance.

Range of motion also remains important as people get older.

So usually the key in this group is really scaling down

and starting,

you know,

very low and going very slow.

But the research does show that even modest activity and muscle

strengthening can slow down declines in activities of daily living.

Those daily life tasks that we often learn,

you know,

quite early in life as toddlers,

you know,

getting out of bed alone,

getting dressed,

getting to and from the bathroom,

it can help with those things.

And also as I said,

the right types of exercises can also help reduce falls.

Now there is an additional thing to consider when,

especially for doing exercise from muscle strength in older adults,

which is that the research does suggest that if we wanna

counter sarcopenia,

either prevent it or try to help somebody who has its

strengthen up.

We not only wanna do muscle strengthening exercises,

but people probably need to be eating enough protein as well.

And a lot of older adults are not eating all that

much protein.

And I'm gonna talk a little bit more about protein intake

and exercise in a moment.

So the key thing to remember for advanced age or frailty

is exercise is a good idea.

You just wanna start very low,

go very slow,

offer a lot of support.

Okay, next,

what about exercise when it comes to people who have Alzheimer's

and related?

So exercise has been studied a fair bit when it comes

to cognitive impairment and it's believed to have many benefits.

I mean how much it might slow or delay cognitive decline,

you know is being studied.

But it certainly tends to benefit people's quality of life,

their mood,

it helps people be less irritable,

it helps again maintain mobility and some of these daily life

activities. So it has a lot of benefits and for some

people it may actually like really help the brain maintain itself

for longer.

The challenge though,

when it comes to exercise,

and I know this 'cause I've had so many families make

this, you know,

approach me with this concern,

is that they often,

families often find that it's very hard to get a person

with dementia to exercise.

And so a common situation that I've encountered is that you

know, a beloved older person in a family has been diagnosed

with early Alzheimer's and as you know,

part of taking care of themselves,

their family,

their spouse may be,

or their adult child really thinks that they should exercise,

you know,

regularly and the person with dementia isn't doing it or doesn't

want to do it.

So what can we do in this case?

Well there are actually a lot of obstacles when it comes

to exercise in dementia.

So some people who have Alzheimer's or another form of dementia

are experiencing apathy or low motivation,

which may or may not be a feature of depression for

them. Some of them are just forgetting about doing the exercise,

some of them kind of want to but just are feeling

overwhelmed by whatever it is they need to organize in order

to actually do the exercise.

And then some of them are actively resisting.

They don't wanna be bothered and told by other people what

to do or they have some other reason for resisting the

exercise. So given that,

can we get around this and can we help people with

dementia exercise?

And the answer is,

you know,

potentially it is often possible to help them exercise.

And so what I recommend to families in this situation is

first of all to spend a little time kind of having

conversations with the person observing the situation and brainstorming to try

to identify all the obstacles that are present in your situation.

So in the situation that you are in,

is it more that they're forgetting or is it more that

there's active resistance or is it that there's apathy or is

it that they have pain,

you know,

in their knees and they they need help with that or

they need an exercise that doesn't activate that pain that much?

So we wanna identify those obstacles and then we can try

to see,

you know,

well what can we create to work around that that might

make it more feasible for the older person to exercise.

And that's gonna be different depending on each person.

But in general I would say that to exercise,

most people with dementia do need others to cue them and

encourage them.

It's often very hard for people with dementia to stick to

an exercise routine on their own unless they were exercisers before

and it's already kind of part of their,

their habits and motivations.

So it especially helps if there's a companion to kind of

be providing some guidance and queuing on what to do and

some encouragement.

But sometimes it can also work to just be in a

class, especially if it's a class,

A class that's designed for people with cognitive impairment where there's

a leader,

a guide,

and where you know,

the being surrounded by other people doing the exercise,

you know,

is is encouraging and provides some structure and guidance and can

feel satisfying as well.

The other thing that's really helpful when it comes to people

with dementia is to really look,

you know,

when we're trying to encourage exercises to look to activities that

they enjoy as as much as possible or to build in

some of those activities.

And then again,

I do think exercise class is designed for people who are

having some difficulty with their memory and thinking is a good

idea. So lastly,

what about when you want someone else to exercise?

So I get asked about this a lot.

People who really want their spouse to exercise or their parent

to exercise or sometimes their friend to exercise,

especially if you know they've been concerned about their friend's health

and wellbeing.

It's fine to encourage exercise,

but you wanna be very careful about insisting because often insisting

just doesn't work.

So what I would say if you're hoping someone else will

exercise more,

is to take a step back and start off by trying

to get yourself in a place of being curious and wanting

to better understand the person's perspective,

their motivations,

their fears,

their desires,

and then see if from that you might find,

first of all better understand what's getting in the way and

then maybe be able to suggest something that might help them

see the way some exercise might either become more feasible for

them or help them achieve a goal and it may or

may not work.

And if it's not working,

we have to accept that because the truth is that older

adults, all adults get to decide how to manage their life

and health and they get to make choices that maybe aren't

the best thing for their health.

And it can be very hard for those of us who

care about them to see that they're making a choice that

we think doesn't serve them well.

But sometimes that that is what we need to do when

we're in relationship is accepts that people are making a choice

we wish they would make.

So some other things you can do if you want somebody

to exercise,

consider whether you can model that exercise yourself and also consider

whether, you know,

as you've been modeling that exercise,

could you invite your older person to do some of these

exercises with you.

Lastly, I think exercise is great.

I really want,

you know,

I would love for every older adult to be doing some

exercise, but sometimes I see families getting very,

very hung up on it.

And I think it's partly because they're hoping that it is

going to solve the hard problems that they're hoping to avoid.

Like, you know,

mean that their mom never has to move out of the

home where she's lived a long time or that,

you know,

the cognitive impairment doesn't continue to get worse.

And exercise helps a lot.

I think it's really important,

but it doesn't,

doesn't necessarily change some of those big problems that we're hoping

it would solve.

So hopefully that can be a comfort if you're there wishing

somebody would exercise and it's not quite happening.

So before we wrap up,

just a few words about protein and building strength.

So I haven't talked a ton about nutrition so far.

Nutrition is important in,

in later life.

Exercise I think is more important than the specifics of how

you nourish yourself.

But there is one macronutrient that many experts believe is quite

relevant, especially when it comes to the building strength part.

And again,

building strength I think is really relevant to maintaining mobility and

independence in Aging.

And that is protein.

So research has shown that increasing protein intake combined with strength

exercises helps avoid frailty and sarcopenia.

And so there is a US RDA recommended daily allowance for

protein. It's not specific for older adults and many,

many experts believe that the US RDA is not enough for

older adults.

So the RDA is 0.8

grams per kilogram of body weight per day.

So in research studies they have often given older adults more

protein than that.

They get to different levels.

It might be 1.2

grams of protein per kilo per day,

or it might be 1.3

or sometimes I think they've gone up to 1.5,

1.6. And a certain amount of research suggests that you,

you can build muscle better when you combine the protein with

the strength training.

Now just protein by itself with no strength training doesn't have

nearly as much effect.

It's not clear to me whether it has an effect at

all. But adding protein to strength training seems to build muscles

more than just the strength training.

And some research also suggests that after you're at 1.6,

it's not clear that there's a lot of benefit with more

protein after that.

So I personally think it can be a good idea to

aim for 1.3

grams per kilo per day.

So that works out to 0.6

grams per pound per day.

So what you can do is you take your weight in

pounds and you multiply that by 0.6

and that's about how many.

So a little bit more than you know,

half your weight in pounds basically is how many grams of

protein per day.

Now many people don't wanna be fooling around worrying too much

about, you know,

how much protein are they eating,

but I think it can be instructive to at least first

of all,

find out what would be the daily protein goal for your

weights and then take a look at what you're eating right

now and your diet right now to find out how much

protein are you taking in because most older adults are not

getting this amount of protein per day.

And the other thing to keep in mind too,

a couple other things.

First of all,

if you have kidney disease,

it can potentially not be safe to eat a lot of

protein. So especially if you have more advanced kidney disease or

if you have any,

if you've ever been told there might be something with your

kidneys, check with your doctor and make sure it's not going

to be a problem to increase your protein intake.

And then the other thing to note is that the body

has a limit on how much protein it can take in

at a given meal.

I don't know exactly what it is.

I've seen estimates that are about like 25 grams,

you know,

maybe 30.

So you really wanna take that daily protein intake.

You can't just eat a giant steak at night and say

I did it because that's too much.

You're not gonna be able to take in all the protein

you need in a single sitting,

even if you actually were to ingest that much meat or

other food that contain that protein.

So you really wanna think about spreading it over three meals

or possibly even four.

So it could be three meals and a snack.

And so often in the studies they end up giving older

adults a supplement and,

and animal proteins are easier for the body to,

to absorb,

to digest,

to use in the muscles.

So people who are vegetarian or vegan can still supplement with

protein. There are pea proteins and other forms of vegetable protein,

but the,

the research suggests that animal proteins are more effective.

And so whey,

which does come from dairy if you tolerate dairy,

can be a good option.

So my key takeaways that,

you know,

I hope you'll,

you'll take from this are,

you know,

first of all that Aging just naturally the nature of Aging

is that we lose strength and muscle mass unless we are

actually intentional and proactive about maintaining it,

which usually requires intentional exercise to maintain strength.

And again,

walking is not going to be enough.

So I highly recommend that all older adults aim to do,

you know,

the four types of exercise to help retain physical abilities,

independence, strength to prevent falls.

And those are strength training at least twice a week.

Aerobic exercise,

balance exercises and flexibility exercises.

And it's probably a good idea to aim for each of

these to be doing at least twice a week.

You can reduce injuries by consulting with your health provider before

you start or significantly increase your exercise plan.

You can start low and go slow.

Avoid untreated osteoporosis to reduce your risk of fracture should you

have a fall.

So women in particular should get screened for osteoporosis.

If you have osteoporosis,

please consider treatment with medication unless there's a really good reason

to not do it.

That will reduce your fracture risk.

Look for exercise classes designed for people your age.

I think that can also help reduce injuries.

Work with a fitness professional,

again, preferably one who has experience with older adults,

if that's feasible and available to you.

And then combine strength training with adequate protein intake.

Again, I recommend 1.3

grams per kilogram per day to help counter or delay frailty

and sarcopenia that age-related muscle loss,

strength and balance exercises are especially good for fall prevention.

Look for a validated program and then remember that frail older

adults benefit from exercise too.

They just usually need to start lower and go slower.

So last thoughts,

remember it's never too late to start.

Every little bit of exercise helps,

especially if you do it consistently because even a small amount

consistently done will benefit your health,

your independence,

your mobility,

your strength,

and help you just be able to stay involved in life

the way you wanna be for as long as possible.

So with that,

thank you so much for watching.

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Aging video podcast.