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Opinion | Mar 7, 2019

Successful Aging, Part one: Exercise

SUCCESSFUL AGING
Successful Aging, Part one: Exercise

Beginning at age 35-40 years, we lose our Muscle Mass and replace it with Fatty mass. Example. Women after age 35 years, lose an average of a pound of muscles per year. This means they begin to accumulate more calories per day since muscles help burn calories, faster.

Even though our fitness levels drop markedly, after age 45, Regular exercise, Maintenance of healthy weights, and Not Smoking help to delay this decline.

Regular exercise (jogging, biking, fast-walks) through the Middle ages can Delay Biological Aging by up to 12 years. (British J Sports Med. April 10, 2008)

DEFINITIONS:
Sedentary lifestyle: waking behavior characterized by energy expenditure less than 1.5METs, while sitting, reclining or lying. Such behaviors include sitting to watch TV, driving cars, office work. Sedentary lifestyle increases the risk of Diabetes, Stroke, Heart attacks, Cancers of the Gut, Lung and Uterus.

Exercise: planned, structured and repetitive physical activity designed to improve physical fitness.

Physical activities are grouped into 4 Types:

  1. Aerobic activities: Muscle cells use oxygen to power this activity. Aerobic activities are characterized by increases in heart rates and breathing. Examples: walking fast, dancing, playing soccer. This activity builds Stamina.
  1. Anaerobic or High-intensity interval training (HIIT) activities: More intense activities of very short duration, 30 seconds to 3minutes. The muscle cells use other metabolic pathways to generate the extra energy required to develop the force and bursts of activity. Examples include sprinting, Jumping and Power lifting. This activity continues to burn calories even when the body is at rest.
  1. Muscle strengthening. Activities aimed at improving or maintaining muscle strength and power. The use of free weights, and exercise equipment is typical. Examples include: carrying heavy weights, lifting objects, and stair climbing.
  1. Bone strengthening. These activities make bones strong and resistant to fracture. Examples include jumping, hopping, skipping. Leg presses, Squats, triceps extension, biceps curl, push ups

PHYSICAL FITNESS.
Physical Fitness levels are based on current:
. Musculoskeletal fitness (Muscle Power/Strength)

. Cardio-respiratory fitness (a.k.a. Aerobic Power) or VO2 Max, which is expressed in milliliters of Oxygen per minute per Kg Body Weight.

Every effort must be made to include all four types of physical activities in our daily routines.

Whereas the Muscle strengthening exercises must be done 2-3 days apart and no more than 2-3 times a week, the Aerobic exercises must be done often, possibly spread throughout each of the 4-5 days in a week, if time permits.

Exercise Restrictions:
Exercise is not for everyone. Persons with the following conditions need medical check-up first.

. Those with uncontrolled, stage 2 Hypertension, with BP>200/100mmHg at rest.

. Persons with Electrolyte Imbalance like: low Potassium, low Magnesium or high serum Calcium

. Persons with Irregular/Abnormal heart beats.
The underlying problems must be fixed before starting the exercises.

Both the muscle strengthening and Aerobic exercise can be started at any age.

To age successfully, and not appear very old, we must incorporate activities that promote both Aerobic fitness and Muscular strength in our daily routine.

1.(A.) CARDIO-RESPIRATORY FITNESS: VO2 Max indicates the maximum amount of oxygen the body extracts from inspired air and uses during physical activities. Muscles (and all cells) require energy production to function. The more oxygen a person can use during exercise, the greater their performance levels.

VO2Max = maximum milliliters of Oxygen consumed in 1 minute/ body weight in kilograms.

Elite athletes may have VO2 Max of >80ml/kg/minute.

VO2Max Variations;
. The VO2Max declines with Age: Vo2Max starts to decline in the late 20s. Intense Exercises antagonize this decline.

. VO2Max depends on blood Hemoglobin levels: Men have higher levels of hemoglobin than women, so men function at higher levels than women. Hemoglobin is the oxygen carrier protein in the blood. Some professional athletes, fail their drug tests because they take Epogen which increases the hemoglobin level.

V O2 Max (the best method to determine aerobic fitness) is measured in special laboratories, by documenting the volumes and concentrations of oxygen in both the inhaled and exhaled air of persons performing maximal graded exercises. It is expensive and cumbersome. It is done for professional athletes and employees, as part of their physicals.

Lactic acid (product of anaerobic activities) starts to accumulate at 50-60% of VO2Max in the unconditioned person; 70-80% of VO2Max in the Well-trained athlete.

Not everyone can have their VO2Max determined at the special laboratories.

1.(B.) METABOLIC EQUIVALENTS (METs) are used to express the intensity of Physical Activities.

Physical activities can be measured in terms of Energy Expenditure.

The ratio of a person's working metabolic rate relative to their resting metabolic rate is the Metabolic equivalent MET.

One metabolic equivalent (MET) (the metabolic rate at rest) is defined as the amount of oxygen consumed when sitting and doing nothing, and it is equal to 210ml/kg/hour or 3.5ml/kg/minute. In terms of energy, one MET is equivalent to I kcal/kg/hour. A person who weighs 60 Kg would burn 60 calories an hour while sitting quietly. A 2METs is 2kcal/kg/hour, and so forth.

Sleeping requires 0.9 METs.
The greater the level of intensity, the higher the METs.

At rest, a person uses,1MET, or 3.5ml O2/kg/min for metabolism. A person exercising at 6 METs requires 6x 3.5ml O2/kg/minute to function at that level.

LIGHT-INTENSITY <3METs MODERATE-INTENSITY 3-6 METs VIGOROUS-INTENSITY >6METs
Minimal changes in breathing and heart rates Moderate effort associated with increases in heart rates Individual can converse comfortably. Requires great effort. Associated with deep and rapid breathing and greater increase in heart rates. Conversations are carried on with shorter sentences.
Walking slowly/strolling at 1mph (2METs). Walking 2-3mph(3METs) Playing most musical instruments Walking 3mph requires 3.3METs. Walking at almost 4mph (4METs). Raking lawn(4METs) Yoga Gymnastics Playing games and sports with children Walking while carrying a child weighing <50lbs 7 METs: climbing hill, no loads. Swimming. High impact Aerobics 8METs: Running 12 min/mile . Walking fast 12-13min/mile . Walking at 15min/miles on a slight incline /climbing briskly up a hill 9METS: Running: 11.5 min/mile 10METs: Most competitive sports: Soccer, Basketball Tennis, squash. Jogging 10 min/mile. 11METs: Running 9min.mile Performing jumping jacks Pushing a disabled car.
Standing light work (cooking, washing dishes) Mopping or vacuuming and other housework. General building tasks (roofing, painting, thatching) 12 METS: Rope skipping, Squash Running a mile in 8 minutes.
Watching TV Standing while scanning groceries at Cashier. Boxing-punching bag Dancing Jumping on trampoline Shoveling snow by hand >10lbs/minute. Digging ditches. Weeding Swinging an axe Felling trees Climbing and trimming trees
Carrying/moving moderate loads (<20kg) Carrying/moving heavy loads (>20kg)

To achieve most health benefits, it requires a minimum total of 20METs hours per week of activity

Example A person walking at almost 4mph, is performing at 4METS. The person needs to walk for a minimum total of 5 hours each week (4METs X 5hrs= 20METs hours), to obtain most health benefits.

(2.) MUSCULAR POWER
Retaining stronger Muscles decreases the incidence of Deaths from all causes, and Cancers (BMJ 2008;337:439

Studies done in Sweden found that Lower Muscular Strengths in the Adolescent was associated with Premature Mortality from any cause, independent of their body weights and Blood pressures. (BMJ, Nov 20, 2012)

Muscle strength is necessary for athletic prowess and our functional abilities

Muscles burn fuel throughout the day; the more muscles one has, the more the calories they burn.

Muscle tissues burn calories 5.5 times faster than fat tissues (7kcal per a pound of muscles/day vs 1.2kcal per pound of fat/day). So, if one could retain their muscle mass, they would burn more dietary calories to improve their weights. For every pound of muscles gained, 50 extra calories are burned Per day

COMBO: AEROBIC AND MUSCULAR POWER MANITENANCE
Actually, a combination of Aerobic and strength training exercise, provide a better quality of life and physiologic functioning than aerobic exercise alone.

Exercise is key in both the primary and secondary prevention of the following conditions:

. Diabetes
. High Cholesterol and atherosclerosis.
. Hypertension
. Heart Attacks and Heart Failures
. Strokes
. Some Cancers (Lung, Breast, Intestinal cancers, Uterus kidney, Bladder Prostate)

. Osteoporosis
. Dependency on others for daily activities
. Fall in cellular immunity.
. Erectile Dysfunction
. Physical functioning decline, Frailty, Falls
. Mood disorders: Depression and Anxiety
. Neurodegenerative diseases: multiple sclerosis, Parkinson's, Dementia and Alzheimer's

STRENGTH TRAINING EXERCISES.
One cannot rely on aerobic exercises alone, to achieve complete physical fitness; strength training is required.

BENEFITS OF RESITANCE TRAINING include
. Reducing pain in joints
. Burning more fats for fuel, to keep us trim.
Exercise equipment are often used for resistance training: Weight machines, Free Weights (Kettle Bells, Dumb bells) Elastic bands.

Resistance training, using exercise equipment, may be done 2-3 days apart, and no more than 2-3 days per each week.

Any exercise that works all the major muscle groups is beneficial.

A 5-10 minutes warm up Exercises required prior to lifting weights

FREE WEIGHTS:
When lifting free weights, a single set of 8-12 repetitions suffices; however, 2-3 sets provide additional benefits if one has the time. Older persons need to use lighter weights to do a set with 15-20 repetitions

Other strength training activities include
. Climbing stairs, Squats
. Jumping, Hopping, Skipping and Dancing (these activities strengthen the bones too)

DURATION OF AEROBIC EXERCISE ACTIVITIES
It is the weekly sum total of moderate-to-high, intensive activities that count.

CHILDREN:
. Everyday. At least 60 minutes of aerobic activity. Children must play actively, throughout the day.

. 3days per week: Muscle and Bone strengthening exercises: running, jump rope for all children.

ADULTS
. Every Day: Move more with more intensity and Sit Less

. Every Week: >150-300 minutes of moderate-intensity aerobic activity, spread throughout the week.

>75-150 minutes of vigorous-intensity aerobic activities.

Bouts as short as 10 minutes add benefits and must be included in the weekly total.

. 2-3days/Week: Muscle strengthening activities that use all muscle groups

OLDER ADULTS
Each Week: .Balance training activities
.Aerobics activities
.Muscle-strengthening activities too.
Greater amount of physical activity is associated with improved physical functions, including

. Fast gait speeds.
. Better balance
. Increased ability to get up from Seated position
. Greater ability to carry out regular activities like bathing/dressing/toileting/eating.

Greater mental health.
JUST DO IT.

Alex Sarkodie MD
Alex Sarkodie MD, © 2019

Alex Sarkodie,MBChB has over 30 years experience in the field of Medicine

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