Living Well, a Holistic Approach Part 5

Do What You Can with What You Have

We all have accumulated injuries over a lifetime. Some of these are mental; some more physical. The mental we addressed earlier. Let’s spend some time with the physical. Most exercise programs are described as though all participants are healthy. At this age, that certainly is not the case. Each of us will evaluate a program or an activity and then modify it to fit our situation. Each of us must do what he or she can with the physical resources available. Eliminate or supplement as needed. If you have difficulty walking, then biking or swimming may be alternatives. If it is necessary to modify an activity then do so, whatever exercise plan you put in place must be right for you and no one else. That is true for everything and is why this is written more generally than other books of this type which usually have specifics for exercises, things to eat, particular types of meditation or other mental activities. But nothing works for everyone and a successful program must fit the individual.

In the physical health section, we will incorporate all that has gone before and not treat the physical as something separate. If physical conditioning is not an integral part of your lifestyle, then it will not be right for you and you will stop doing it . The physical must support and reinforce the mental, and a balanced diet provides the correct fuel for both. Keeping the number of calories appropriate to age and activity maintains the body weight relatively stable and renders it a more efficient machine. Informational writing like this separates these into sections for organizational or discussion purposes, but the mind and body work with them holistically.

 Walking

 Let’s begin with the daily aerobic exercise of walking. This will help maintain your weight and keep the body fat down. It has the invisible benefits of improving cardiovascular fitness and strengthening bones and muscles while increasing muscle endurance. Other benefits include reducing stress and improving balance and coordination. A major attraction is that you can do it whenever you wish. No planning or equipment needed.

The walk should be brisk, and posture is important. Your head should be up and looking forward, with the neck, shoulders, and back relaxed but not bent over. If the head is up, you will stand straighter. The abdominal muscles should be tightened, and this will occur almost automatically if you keep your back straight and head up. Over time, your pace will increase naturally, and you will cover more distance in the same time. The point is not powerwalking, but a brisk pace that still allows you to talk with friends or people you meet.

Shoes are important. They should have appropriate arch support, a firm heel, and thick midsoles so that your feet are cushioned. There are many walking shoes that fit this description and they need not be expensive. You can spend hundreds of dollars on walking shoes and be the best shod person on the walking path or street but that is a social goal and does not count toward physical conditioning. Stretching before walking is not necessary. Begin slowly and increase the pace as your body indicates. It will tell you if you are moving too quickly.

If you can do about thirty minutes a day, that should be fine; if you wish to do more, that is fine as well. The physical conditioning goal is to carry out a regular aerobic cardiovascular exercise while engaging most of your lower extremity, hip, abdominal, and back muscles. There is a lot of concurrent strength training going on here as well. You also are teaching yourself to maintain balance, since you will be on only one foot most of the time.

There is a lot of physiology going on here too. Your heart is doing what it was built to do - provide a basal amount of blood flow and then increase that flow as needed. The lungs and intercostal muscles are doing the same, except they are busy moving air instead. Walking also sends electrical signals to activate the cells along the surfaces of the bones in the lower limbs. They respond by laying down calcium and phosphorous to strengthen the lattice of the structure and more protein to fill the bone matrix. This is an excellent exercise to prevent or reverse osteoporosis. Your good Mediterranean diet plays a role here because it is providing the protein, calcium, phosphorous, and vitamin D that the gastrointestinal tract brought in and the cardiovascular system is moving to the targeted sites in the leg bones. We have not mentioned the endocrine system that plays a significant role here as well. Nothing in the body works alone. Look how much is going on and all you are doing is walking with some friends.

If you have a smart phone, it will serve as a chatty, nosey, and intrusive companion on your walk. It probably has an app called Health, or something similar, and when queried will tell you how many steps you have done, the distance walked, time you spend on both feet – about 30%, surprised? - length of your step, walking speed, and asymmetry. The last, given as a percent number, tells you how well you are balancing. You get a lot of practice in balance by walking since about 70% of your time is spent on one foot.

Keep walking in your exercise regimen in addition to whatever else you choose to do.

I enjoy walking in the morning. It is a quiet time, and you can focus on the beauty of the day. It is a peaceful way to begin, your mind is clear from a long night of sleep, and cloud patterns and a morning sky will keep it that way. The quiet contemplation of nature is an informal meditation that is as good as the various meditation exercises. Your mind and entire body are integrated with the meditative experience and the motion of walking. It is a restorative that costs you nothing and pays enormous dividends. It also keeps you from watching the news.

Strength Training

 Let’s begin with a truism, strength is important. It prevents us from falling down or losing balance and allows us to open jars. The term physical fitness includes not only strength, but endurance, coordination, flexibility, and balance. It has positive effects on other aspects of fitness, mental, physical, and social.

About half the age-related decline in aerobic capacity is due to a loss of muscle mass (Charette, et al. J. Appl. Physiology, 70: 1912-16, 1991.) But the data are clear that muscle strength can be improved significantly even at a late age. Ninety-year-olds can benefit from strength training (Booth et al., Med Sci in Sports and Exercise. 26: 556-60, 1994.) There are many books on strength training, but a good resource on this subject is Strength Training for Seniors, by Michael Fekete, Hunter House, 2006). That book defines seniors as anyone over fifty years and provides training programs and muscle-building workouts. It is a good source for training ideas but temper it to your age if you use it. Vigorous strength training is not your focus.

What is the goal? It is to maintain or increase physical strength. Not in order to amaze everyone but to live a fulfilling life and move about as you wish. If you do it right, you will build muscle and that will enhance your balance, provide freedom of activity, and self-confidence. One of the worries of seniors in general and persons over seventy in particular is falling. Falls are the major cause of disability and debilitation in this age group. The sequalae of falls are broken hips, arms, and broken or dislocated vertebrae. All of these put people in bed for a prolonged time or relegate them to decreased activity. This worsens osteoporosis and the inactivity brings about more loss of muscle strength. This, in turn, worsens balance and ability to prevent another fall. The cycle continues downward. Good muscle strength will prevent much of this. The body wants to work; it does not like inactivity. Physical inactivity begets mental inactivity. Physical and mental well-being both are enhanced when muscles are tight and are being stressed regularly.

To achieve best results and something of a guarantee that you will continue to exercise, that exercise must match your normal style of living. A person who plays golf probably will not want to lift heavy weights but would use the golf course as a way of doing regular walking – forget the golf cart or let someone move your clubs in the cart as you walk the course. Then, add light weight routines that exercise the upper body and core. All this improves the golf game, the summation of these efforts exercises the entire body, and is in harmony with the person’s style of living and mental outlook.

Ideally, a strength training program should translate improvements in strength immediately into functional improvements in one’s life.

Your strength training should be oriented to your mental and physical condition. It must be safe; that is, designed to minimize the possibility of injury or of worsening some medical condition while challenging yourself sufficiently. Personalize it to your needs, health and fitness state, and physical capabilities, you know these better than anyone. Work toward progressive improvement, but at a low slope. You should not push this. Stay within your level of comfort. Do not overextend. That way lies muscle and tendon pulls which will slow your progress considerably. At this stage of life, the body still will respond beautifully to well-managed increments in exercise but is unforgiving of insult. Woo it, do not attack it.

There are many books and on-line exercise programs and you will have no difficulty finding exercises to suit you. Most are designed for younger people and will be too intense. Select exercises that are simple, easy to do, within your capabilities, and will exercise all muscle groups in the course of a week. Keep the intensity of the workout at low to moderate and rest whenever you feel the need. Do not force muscles or joints to the point of pain. The adage “no pain, no gain” in a macho myth.  It is something young men say to encourage one another as they damage their muscles and joints. It will come back to haunt them in the future and it will haunt you almost immediately. This is not a misery contest; it is a rising arpeggio.

We have been talking about a program. The program is something you design for yourself, reassess, and adjust as needed. The strength training program is designed to fit an individual’s needs rather than the individual trying to fit into a pre-designed program. Begin with the lighter weight exercises that are easy to find in any of the sources mentioned. Perusing these sources will give you a good idea of what kinds of exercises are best designed for older people and how they should be done. You need not follow standard regimens. Soup cans and resistance bands were mainstays of my exercise program during the long COVID winter, and I gained muscle size, strength, and definition. Pushing and pulling against your own body’s weight requires no machines or purchases. Adapt exercises to your own situation and preferences. I recently celebrated my 84th birthday by doing 84 consecutive pushups.

Begin with some upper body, lower body, and core exercises that do not stress you too much. When you have mastered those, increase the number of repetitions or add some new exercises. You do not need a large number of exercises. A smaller number that you can repeat easily in 30 minutes is fine. At the end of the routine you should feel that you have done some work but are not exhausted. You have many other things you want to do in your day. Exercise should allow you to enjoy the remainder of your day even more. Design your program by acquainting yourself with the basics of strength training and learn as much as you can about your own fitness in the process. The program will evolve by planning and by trial and error, but it will fit your needs and allow you to improve safely and effectively. It will be designed for you, and you will find the process rewarding as you take charge of your own health and fitness.

A personal note about equipment. I suggest that you not buy any weights or anything expensive. If you want to do strength training with weights, use the local gym. There you will find people knowledgeable about the use of weights and who are willing to talk with you. Use machines in the gym that allow you alter the weight by the turn of the knob rather than free weights. That way you are not carrying iron around to place on a bar at a weight bench. It is just as easy to strain your back carrying the weight to the weight bench as it is at the bench itself. In fact, you are more likely to do so because the weight bench gives you the support you need as you do the lifting. Weight machines will have moving parts that you can push or pull, or they will have cables which will give you more freedom of movement. I prefer the cables because you can move groups of muscles in ways more closely related to normal activities.

Alternatively, you could use resistance bands which cost about $10–20 on Amazon.com and can be used at home. They were introduced in the 1980s and have become increasingly popular. I discovered these during the long COVID exile from society and now prefer them to weights. They generally come in a package of four or five, each with a different color. The colors indicate the degree of resistance – yellow at the low end and black as the most difficult. The setup is relatively simple, you grab the band with hands set comfortably apart and pull. You also can tie a knot in the center of the band, open a door and push the knot through between the door and the frame and then close the door. This locks the band in place, and you can pull in various directions with both hands. There also are resistance band kits in which the bands are woven into a circle. These allow you to work opposing muscle groups concurrently. The colors and relative difficulty are of the same color sequence.

In several studies resistance bands have been shown to improve strength and endurance, functional capacity, and quality of life [SAGE Open Med.2019:7:2050203119831116 and op cit.] Studies also have demonstrated similar outcomes in training response in different populations using conventional resistance training (weights in the gym) and elastic resistance training. That is, no difference in results between conventional resistance training (weight lifting) and resistance bands studied in different populations and in diverse protocols. These now are used by professional athletes, sports teams, rehabilitation centers, and other people who simply want to maintain and increase strength.

Another reason I have come to like resistance bands is that it is almost impossible to hurt yourself. You are pulling or pushing against a resistance, which is exactly what you want to do, but you control the amount of resistance at all times. You can increase or decrease resistance by shortening or lengthening the band. The moment you stop your motion, the resistance goes to zero. This is unlike a weight machine where the weight is set and will come crashing back to the start position if you do not maintain enough resistance. That is also the reason I think free weights are not a good idea for older people. If you are lifting over your body, and begin to fail, the weight comes crashing back to the start position and that is you. If you use free weights, use less weight and do not work over your body – work alongside. Otherwise, stay with weight machines, particularly cable machines, or resistance bands.

In the beginning, resistance bands will seem ridiculous. They are pieces of stretchable material and that is it. It is only when you begin to use them that the deceptiveness of these things becomes evident. In a short while, you will find your muscles begin to hurt and you will put away the black band and go back down to yellow and begin again where you should. My experience during the COVID lockdowns was that they are excellent strength training devices, and I have stayed with them since. If I feel the need for some social interaction or just a change of venue, I go to the gym. One does not exclude the other. If you travel, you can put resistance bands in a carry-on bag, and no one will challenge you. Try that with free weights.

Other Forms of Exercise

We have talked about walking and the types of strength training that use weights or resistance. But there is much more. Some of the strongest people I know and with the best balance and flexibility, are swimmers, dancers, or people who do yoga or Pilates. All of these are low impact exercises that use the body’s own weight as the resistance and hold it in certain positions or move it through a distance.

For older people, who have suffered injuries of various sorts, particularly lower back injury, consider swimming. It is good because it eliminates gravity while you are working out. It also provides a cardiovascular workout without the risk of injury. You can get a full body workout by using various strokes. Correspondingly, you can work out particular muscle groups by using a given stroke. The front crawl stroke generates the most force and recruits the chest muscles, the latissimus dorsi, and other upper back muscles. The backstroke is less intensive and can be used for recovery or a more relaxing swim. It will improve your back muscles because the latissimus dorsi muscles pull your arms below the water and then back to the surface again. Because you are in a back-down position, the hamstrings are more involved than in other strokes. The breaststroke is one of the most popular swimming strokes and recruits your upper and lower body working together. It is a good stroke for beginners because it makes fewer demands on your body and breathing is easier. The butterfly stroke is difficult and demanding. Unless you are engaged in competitive swimming, I suggest that you not use it.

Yoga and Pilates add value to a strength training program and are unloaded exercises – done with only your body weight. They develop core strength and flexibility. These, in turn, allow you to support more weight with less risk of injury. Yoga improves strength, balance, and flexibility. An article in Johns Hopkins Medicine states that yoga is as good as basic stretching for easing pain and improving mobility in people with lower back pain. The American College of Physicians recommends yoga as a first-line treatment for chronic low back pain. Gentle yoga also has been shown to ease some of the discomfort of inflamed joints. Regular use of yoga may reduce stress and promote relaxation. According to the National Institutes of Health, there is evidence that yoga supports stress management, natural health, mindfulness, healthy eating, weight loss, and quality sleep.

Pilates, done as mat exercises, not machines, has many of the benefits of yoga. Studies that show Pilates improves quality of life, primarily by decreasing back pain. That was my experience as well. It is often used as cross-training workouts. The emphasis is on core strength which makes it a bit more restricted than yoga. It is a low impact exercise that focuses on the body alignment, ideal range of motions at the joint, and a balance of opposing muscles. Much of what is said about yoga applies to Pilates, but Pilates is more restricted since it focuses on core strength primarily. I have no experience with Pilates done with machines and other apparatus.

I have done swimming and Pilates (mat exercises) and recommend them, particularly for resolution of chronic back pain – which I have had for about 50 years. The strongest and most flexible people I know personally do yoga. The strongest, most graceful and flexible people I have seen are in the ballet. In fact, at this late stage of life if you have not been exercising with weights before, it may not be the best time to begin. You probably should not begin ballet either. Think seriously of swimming, yoga, or Pilates. These are low impact exercises, activate all muscle groups, will improve your flexibility, and it is almost impossible to hurt yourself. The last two also provide the benefit of social interaction and will improve balance – an important consideration for many people. Most community centers have these available.

A FINAL THOUGHT

 If exercise is a chore, then you will not do it. Make health and exercise a part of normal living and not an addition. This means that the time required can be easily captured during the day through standing, walking, using stairs as easily as working in an exercise facility.  A great deal of exercise can be done without stress by avoiding the easy way to do a thing. Walk up the stairs; stand up while doing various tasks (antigravity work uses a fair amount of effort, but painlessly); stop watching television, get up and move around instead; put on an iPod and walk outside while listening to music or books.  But, to make it count you must do it on a regular basis and, if you are to do it on a regular basis, it must be something you enjoy. Some can do it at home; some prefer to walk along the street; some walk around a mall; some go to an exercise facility. It does not matter. The important thing is to enjoy it. If you do, you will see progress and as you see progress, you will be stimulated to continue. Since it must be part of your daily (or weekly) routine, make it fun. Set some sort of goal: walk progressively farther, lift more weight, and swim one more lap. When you reach a reasonable goal, maintain that pace. Do not continue to raise the bar mindlessly – that only leads to frustration or injury. Just get active and stay that way. Start slowly and continue progressively. Be realistic! Too much weight too soon will tear muscle and tendons. Too much aerobic exercise too soon will leave you breathless and unwilling to continue. Modus omnibus in rebus!

There are many possibilities for physical improvement, a smorgasbord or a garden, choose your metaphor, but also choose one of these and begin.

A GRACEFUL EXIT

Well, have we made a bouillabaisse or a souffle? Understanding ourselves at any time of life is difficult, but as the stage lights dim, we add uncertainty to confusion. Nevertheless, we go forward with style. Style requires mental strength and perspective, a body that runs efficiently, and physical confidence. It folds your years of experience into a last act carried off with aplomb and a great deal of enjoyment with a dose of fun. You have the tools, put them to work. Confound your enemies and dazzle your friends. Have the self-confidence to feel smug about it. Do you feel lucky? Huh! Do you?