Chapter 2  |
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"Too old" and "too frail" are not, in and of themselves, reasons to
prohibit physical activity. In fact, there aren't very many health reasons
to keep older adults from becoming more active.
Most older people think they need their doctor's approval to start
exercising. That's a good idea for some people. Your doctor can talk to
you not only about whether it's all right for you to exercise but also
about what can be gained from exercise.
Chronic
Diseases: Not Necessarily a Barrier Traditionally, exercise has been discouraged in people with certain
chronic conditions. But researchers have found that exercise can actually
improve some chronic conditions in most older people, as long as it's
done when the condition is under control.
Congestive heart failure (CHF) is an example of a serious chronic
condition common in older adults. In people with CHF, the heart can't
empty its load of blood with each beat, resulting in a backup of fluid
throughout the body, including the lungs. Disturbances in heart rhythm
also are common in CHF. Older adults are hospitalized more often for this
disease than for any other.
No one is sure why, but muscles tend to waste away badly in people with
CHF, leaving them weak, sometimes to the point that they can't perform
everyday tasks. No medicine has a direct muscle-strengthening effect in
people with CHF, but muscle-building exercises (lifting weights, for
example) can help them improve muscle strength.
Having a chronic disease like CHF probably doesn't mean you can't
exercise. But it does mean that keeping in touch with your doctor is
important if you do exercise. For example, some studies suggest that
endurance exercises, like brisk walking, may improve how well the heart
and lungs work in people with CHF, but only in people who are in a
stable phase of the disease. People with CHF, like those with most
chronic diseases, have periods when their disease gets better, then worse,
then better again, off and on. The same endurance exercises that might
help people in a stable phase of CHF could be very harmful to people who
are in an unstable phase; that is, when they have fluid in their lungs or
an irregular heart rhythm.
If you have a chronic condition, you need to know how you can tell
whether your disease is stable; that is, when exercise would be OK for you
and when it wouldn't.
Chances are good that, if you have a chronic disease, you see a doctor
regularly (if you don't, you should, for many reasons). Talk with your
doctor about symptoms that mean trouble -- a flare-up, or what doctors
call an acute phase or exacerbation of your disease. If you have CHF, you
know by now that the acute phase of this disease should be taken very,
very seriously. You should not exercise when warning symptoms of
the acute phase of CHF, or any other chronic disease, appear. It could be
dangerous.
But you and your doctor also should discuss how you feel when you are
free of those symptoms -- in other words, stable; under control. This is
the time to exercise.
Diabetes is another chronic condition common among older people. Too
much sugar in the blood is a hallmark of diabetes. It can cause damage
throughout the body. Exercise can help your body "use up" some of the
damaging sugar.
The most common form of diabetes is linked to physical
inactivity. In other words, you are less likely to get it in the
first place, if you stay physically active.
If you do have diabetes and it has caused changes in your body --
cardiovascular disease, eye disease, or changes in your nervous system,
for example -- check with your doctor to find out what exercises will help
you and whether you should avoid certain activities. If you take insulin
or a pill that helps lower your blood sugar, your doctor might need to
adjust your dose so that your blood sugar doesn't get too low.
Your doctor might find that you don't have to modify your exercises at
all, if you are in the earlier stages of diabetes or if your condition is
stable.
If you are a man over 40 or a woman over 50, check with your doctor
first if you plan to start doing vigorous, as opposed to moderate,
physical activities. Vigorous activity could be a problem for people who
have "hidden" heart disease -- that is, people who have heart disease but
don't know it because they don't have any symptoms.
How can you tell if the activity you plan to do is vigorous? There are
a couple of ways. If the activity makes you breathe hard and sweat hard
(if you tend to sweat, that is), you can consider it vigorous. Charts in
Chapter 4 explain more about how to tell if your exercise is moderate or
vigorous.
If you have had a heart attack recently, your doctor or cardiac
rehabilitation therapist should have given you specific exercises to do.
Research has shown that exercises done as part of a cardiac rehabilitation
program can improve fitness and even reduce your risk of dying. If you
didn't get instructions, call your doctor to discuss exercise before you
begin increasing your physical activity.
For some conditions, vigorous exercise is dangerous and should not be
done, even in the absence of symptoms. Be sure to check with your
physician before beginning any kind of exercise program if you have:
Chronic diseases can't be cured, but
usually they can be controlled with medications and other treatments
throughout a person's life. They are common among older adults, and
include diabetes, cardiovascular disease (such as high blood pressure),
and arthritis, among many others.
Most older adults, regardless of age or condition, will
do just fine in increasing their physical activity. You might want to show
your doctor this book, to open the door to discussions about exercise.
Checkpoints
Chapter
Summary There are few reasons to keep older adults from increasing their physical
activity, and "too old" and "too frail" aren't among them.
If you plan to work your way up to a vigorous level, check with your
doctor first if you are a man over 40 or a woman over 50. Also check
with your doctor first if you have any of the conditions listed under
"Checkpoints."
Your doctor or cardiac rehabilitation specialist can give you guidelines
for physical activity if you have had a heart attack recently. Controlled
exercise usually is an important part of long-term heart-attack recovery.
People with conditions called "abdominal aortic aneurysm" or "critical
aortic stenosis" should not exercise unless their physicians tell them
they can.
Almost all older adults, regardless of age or condition, can safely
improve their health and independence through exercise and physical
activity.
You have already read about precautions you should take if you
have a chronic condition. Other circumstances require caution, too. You
shouldn't exercise until checking with a doctor if you have:
Contrary to traditional thinking, regular exercise helps, not hurts,
most older adults. Older people become sick or disabled more often from
not exercising than from exercising. Those who have chronic diseases,
or risk factors for them, may actually improve with regular exercise,
but should check with their doctor before increasing their physical activity.
Dr. Andrew Puckett is a busy man with an impressive list of titles after his name. The 60-year-old associate dean for medical education at Duke University, in Durham, North Carolina, has a Ph.D. in adult education and a minor in clinical psychology, and he has been a counselor for years. He also has Parkinson's disease, a chronic condition that causes muscles to tremble and become rigid. He was diagnosed with it a few years ago.
Has his chronic condition slowed down his activities? It doesn't appear that way. In addition to his regular activities, 2 years ago, Dr. Puckett volunteered to take part in a study of how stretching exercises affect people with Parkinson's disease. He enjoyed the feeling of stretching so much that he kept doing the exercises after the 10-week study ended, and now does them at least 3 days a week for 40 minutes at a time.
It's not yet clear whether or not stretching exercises have an effect on Parkinson's disease, specifically, but it's very clear to Dr. Puckett that they have helped him feel better overall.
"I literally feel so much better from doing the exercises," he told us.
"I'm more flexible than I've been in 20 years. Stretching has given me so
much ease of movement. It's a fluid feeling," he said. In addition, Dr.
Puckett finds that stretching exercises give him a sense of well-being. He
likens it to the "runner's high" that some joggers experience.
Dr. Puckett noted another positive aspect of his stretching exercises: the feeling that he is nurturing himself. He described it as a secure feeling; a feeling that he is doing something good for himself.
Another motivator for keeping up with his stretching exercises is "the fear of being stiff and rigid; bent over. I want to keep that from happening," he told us.
Besides working at the university, Dr. Puckett splits his own firewood, plays tennis, gardens, mows his lawn with a push mower, and walks a mile or more at least 3 days a week.
"But people shouldn't feel that physical activity has to be some super-human or highly disciplined effort," he said. "I don't want them to be scared off from the idea of exercising. I think once they experience how much better they feel, they'll want to keep on doing it. It has so many built-in benefits."