Healthy Aging: Know the Facts

By John Sandgren, MD
John Sandgren is a recent Evolve grad and a member of the Vital Aging Network’s Wellness 50+ Design Team. We are pleased to have his contribution to our knowledge base about how to age well.

Dec 082014

This is the sixth of a series related to physical fitness entitled: Think of Exercise as a Pill that Promotes Long Life and a Whole Lot More.

Young instructor is helping to an elder man

Aerobic Exercise has been our focus thus far in this series and it certainly has the most data documenting its health benefits, but there are 3 other important areas of physical capacity to consider as you design your exercise program.

Strength Training is important for everyone, and for adults with osteoarthritis, it may be of primary importance. HHS makes the following recommendation in its 2008 Physical Activity Guidelines:1

“Adults should do muscle-strengthening activities that are moderate or high intensity and involve all the major muscle groups on 2 or more days a week… . Muscle strengthening activities provide additional benefits not found with aerobic activity. … One set of 8 to 12 repetitions of each exercise is effective, although two or three sets may be more effective.”

The term “major muscle groups” means arms, shoulders, torso (chest, abdomen, back), hips, and legs. For adults 65 and older, some experts offer a slightly different recommendation: 10 to 15 repetitions per set rather than 8 to 12.[2] More repetitions, of course, necessitates the use of slightly lighter weights, which harkens back to what was said in Part 5 of this series, namely that most older adults should focus on moderate rather than vigorous activity.

Muscle strengthening for the arms and shoulders can start with home-made equipment like soup cans or empty milk jugs filled with sand, but other muscle groups will require other equipment. Don’t start with weights that are uncomfortably heavy and don’t assume that every weight machine in a fitness club is safe to try. A wise person will not imitate the technique of just anyone in the weight room; most people use weight equipment incorrectly. Moreover, exercises that may be safe for the very young or the very strong may not be safe for you. Coaching for the beginner by an experienced fitness instructor or physical therapist can be invaluable, and such experts may teach you to strengthen important muscles you didn’t know you had.

Train regularly, train consistently, and be patient. Setting incremental goals and noting your progress may relieve some of the boredom that comes with weight training. Remember, you are preventing and/or treating disability.

Balance Training appears effective in reducing the risk of falling, but guidelines on balance training are not yet well-developed. The HHS Guidelines say:

“Older adults should do exercises that maintain or improve balance if they are at risk of falling. … Reduction in falls is seen for participants in programs that include balance and moderate-intensity muscle-strengthening activities… .”

Chapter 5 of the HHS Guidelines describes a few simple balance exercises and supports the contention made in Part 2 of this series that muscle strengthening enhances the benefits of balance training.

A medical provider, physical therapist, or fitness instructor can design balance exercises to suit you. Properly done, these exercises will test your nervous system so Steve Rukavina, former Evolve participant and tai chi instructor, suggests focusing and relaxing: “Start with calm as you begin balance work. Quietly exhale your breath. Exhaling is easy, like the falling of a feather, and when you exhale fully, you will naturally inhale more deeply. Use a chair for support if you’re unsteady. As you develop strength and stamina, move away from the chair. Gently push out of your comfort zone. Your balance program should progress and have incremental goals.”

Flexibility is the fourth and final capability. Medical science has yet to prove any health benefits from flexibility exercises, but most likely this just means they haven’t been looked for. Common sense would say good flexibility of the body helps minimize injury in situations like falls and car accidents, and flexibility is certainly helpful for dancing, playing with the grandkids, picking things up off the floor, and seeing who or what is behind you. Flexibility exercises involve stretching, bending, and twisting. Use good judgment at the outset and proceed incrementally. Some people can bend over and touch their toes without thinking about it while others are doing well to reach their knees; both are acceptable starting points. The HHS Guidelines say:

“Older adults should maintain the flexibility necessary for regular physical activity and activities of daily life. When done properly, stretching activities increase flexibility.”

Exercise experts do recommend that stretching, bending, and twisting be done for at least 10 minutes twice a week, but even better is doing this each day following aerobic or muscle-strengthening activity when the muscles are warm.[2] Muscles shorten when used and metabolic waste products like lactate build up. Stretching muscles after exercise restores them to resting length and facilitates removal of the waste products. Stretching and walking around also facilitates proper constriction of dilated peripheral arteries and gradual return of blood to the central circulation, and a fuller reduction in resting heart rate is achieved compared to ceasing exercise abruptly without cool-down.

How much time you spend cooling down after aerobic or muscle-strengthening activity depends on just how hard you exercised; 10 minutes is standard practice for many. But be careful; when you stretch, there should be no bouncing, no pulsing of the muscles, not into the stretch and not during the stretch. Go gradually and steadily, and hold each maximal stretch for 10-30 seconds before slowly letting up.

A 5 or 10-minute warm-up preceding moderate or vigorous exercise is also advisable. Go easy here because the muscles are cold. Gently shake your muscles as you move about; loosen your muscles and joints with slow, exaggerated motions; and stretch lightly, forcing nothing. Blood flow to the muscles will increase, as will heart rate and breathing rate, before the more strenuous exercises to come really bump them up.

Read other entries in this seriesDownload a pdf of the entire Exercise as a Pill series.

John SandgrenJohn Sandgren is a recent Evolve grad and a member of the Vital Aging Network’s Wellness 50+ Design Team. We are pleased to have his contribution to our knowledge base about how to age well.



[1] Department of Health and Human Services, 2008 Physical Activity Guidelines for Americans. Hyattsville, MD: U.S. Department of Health and Human Services 2008.

[2] Nelson M, Rejeski W, Blair S, et al. Physical Activity and Public Health in Older Adults, Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007: 116:1094.