Robust-Aging Q & A

Click on the a link below for the answer to a given question:

• Q1. RE: Exercise and intelligence: I recall having read in the past your observations that exercise has been shown to increase intelligence. Is there is any new information that bears upon this theory?
• Q2. RE: Hypertenion and exercise: I am a 65-year-old male. Where can I turn for direction in working out an exercise plan that is geared to be my age and physical problems?
• Q3. RE: Falls and steps to improve balance: My 82-year old husband is slowing down progressively and has had several falls. I know that you recommend the flamingo stand as a way of training balance skills. Any ideas?
• Q4. RE: Sleep: How important is sleep to health?
• Q5. RE: Passive Smoking: My husband of 42 years continues to smoke. His smoking may not only be hurting him, but me too. Is there any information about passive smoking and its health risks?
• Q6. RE: Joining exercise club: I know that I should exercise. Do I have to join a club, or an organized group to pursue my exercise? Or can I do it on my own, on my own schedule?
• Q7. RE: Fitness in nursing homes: I spend one afternoon a week volunteering in a local nursing home. As I was helping with a meal the other day, I wondered if these people had any evaluation of how fit they were.
• Q8. RE: Are athletes genes special?: Athletes like Lance Armstrong and Tiger Woods have such beautiful skills that I wonder if they are specially created, or if they have a unique set of genes that sets them apart.
• Q9. RE: Sedentary Death Syndrome: I recently heard the terms SEDS. What does it mean?
• Q10. RE: Boomeritis: Is there really such a disease as "boomeritis?"

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Q1. RE: Exercise and intelligence.
I recall having read in the past your observations that exercise has been shown to increase intelligence. I find this proposal so important that I wonder if there is any new information that bears upon it?

A1. Bob Dustman's research indicates improved IQ scored in subjects after having immersed themselves in an exercise protocol. Several other research scientists have pursued this line of inquiry. Fred Gage and colleagues at the Salk and Howard Hughes Institutes in La Jolla wrote an article entitled "Running Enhances Neurogenesis, Learning, and long-term Potentiation in Mice". The authors reviewed the familiar work, which demonstrates increased brain cell branching in environmentally- stimulated mice as well as the new information that the formation of new nerve cells is actually stimulated by running. Gage's experiments involved allowing 17 mice (the runners) free access to a running wheel. They ran an average distance of 4.8 kilometers per day (WOW!). They continued this activity for two to four months, at which time they were tested for their maze solving ability, which was markedly better than the non-running rats. Further, exams into the brains of the two groups revealed that the exercisers had twice as many new brain cells. The conclusion was that running not only improves learning, but it also increases new brain cell formation. These changes could result from elevated levels of brain growth factors, increased formation of new blood vessels, or higher levels of the central neurotransmitter serotonin, all proven outcomes of an exercise program.

Q2. RE: Hypertenion and exercise.
I am a 65-year-old male. I have mild hypertension, and have three lower-back fusions (spinal stenosis, arrested). I am fit and do a complete upper-body workout three times a week at the Y, lifting as much weight as I can safely manage…then do 30 minutes on a stationary bike, 20 or more minutes of which is at a heart rate of 120-130 bpm. This whole process takes about 2.5 hours and leaves me spent. I overdoing things? I have no guidance. Where can I turn for direction in working out an exercise plan that is geared to be my age and physical problems? and will stretch me but not beyond the elastic breaking point

A2. You really know how to embarrass a guy don't you? Your questions are so important, so simple, and so earnest that slick answers should come easily, but they don't. How much is enough? How much is too much? How often? What kinds? Thes are all basic and powerful questions, but the honest answer to all of them is that we really don't have enough science under our belts to answer you as well as we'd like. Your workout program makes me tired merely to read it, and here I am getting ready to run the Bejing Marathon. You are in the top fraction of one percent of fitness effort, so doing enough is not an issue, but doing too much may be. But as soon as I say this, I identify the huge extra capacity of the human body for work. I marvel constantly at what we are capable of. Is that too much? It certainly is enough, but too much? Who knows? When you are 100, would please report back to me about your state of vigor, then we will all be better off. In the meanwhile, I suggest you continue to pursue your bliss while listening to the wisdom of your body, which in final analysis is usually your best advisor.

Q3. RE: Falls and steps to improve balance.
My 82-year old husband Tom has been very active all his life, hiking strenuously until five years ago. Now he is slowing down progressively and has had several falls. I know that you recommend the flamingo stand as a way of training balance skills, but he is either uninterested or otherwise unwilling to participate. Any suggestions?

A3: I resonate with your problem. Falls are dangerous and can actually become the cause of death in frail older persons. But, like other problems, they are very preventable. Again, like other problems, they cannot be prevented without the active participation of the person at risk. Balance problems are improvable, and the flamingo stand helps, but so apparently do simple back exercises designed to strengthen the torso muscles. Balance is a multi-compartment function, and keeping the sturdiness of the torso is a central and vital component. If your husband can't, or won't stand on one leg, maybe he will do some sit-ups or leg-ups to tighten up his laxity.

Q4. RE: Sleep.
How important is sleep to health?

A4. There are three components of good health, and rest is one of them. Sleep is as critical as food and oxygen. Generally, we need 8 hours a night. That is one of the most important determinants of how long people live. Lack of sleep often is the cause of major disasters, like the Exxon Valdez, and it is also a contributor to all sorts of other diseases including heart disorders. According to Dr. William Dement of the Stanford Sleep Center. Sleep provides for repair needs of the body and restores depleted chemicals. Sleep' quality and duration is impacted hugely by physical inactivity in older people. Lack of sleep may cause emotional and cognitive instability, lower achievement, create poorer health, more disability and depression.

Q5. RE: Passive Smoking.
The major unhappiness of my life is that my husband of 42 years, who is totally sane on all other counts, continues to smoke. No I hear that his smoking may not only be hurting him, but me too. Is there any information about passive smoking and its health risks, or is that just hot air?

A5. A report from doctors at Tulane University estimates that 37% of adults are regularly exposed to passive smoke. They surveyed eighteen different studies involving hundreds of thousands of subjects about this area. Although not all of the studies were statistically significant, they were all consistent in the same direction indicating a higher incidence of heart attacks in passive smokers. When all reports were combined, the authors calculated that 1.25 represents your relative risk of having a heart attack because of your husband's habit. If he won't respect his own health risk, which is certainly much higher thank it would be otherwise, he might respect. He may be killing you as well as himself.

Q6. RE: Joining exercise club.
I know that I should exercise. Do I have to join a club, or an organized group to pursue my exercise? Or can I do it on my own, on my own schedule?

A6: Steve Blair and his fine group in Dallas reported in The Journal of the American Medical Association reported on this topic. They divided 235 inactive men and women into two groups, half pursued a structured exercise program, and the other half were provided an individually-tailored lifestyle program. After two years the groups were analyzed and the results were very comparable with regards to fitness gains, blood pressure change, and body fat loss. The authors concluded that both approaches worked; the personally-maintained program was as effective a strategy as the group approach. For me, it is all a matter as to what works for the individual. I pursue my jogging and weight program in my own company, where as my wife insists on having a buddy. So whatever your decision is, alone or group, just do it.

Q7. RE: Fitness in nursing homes.
I spend one afternoon a week volunteering in a local nursing home. As I was helping with a meal the other day, I wondered if these people had any evaluation of how fit they were. The nurses are always checking their pulses, temperatures, and blood pressures, but what about their fitness? It seems to me that this is really A6. First off, thanks and congratulations for giving of yourself as you do. Your volunteering is a noble gesture. Of course, you are right that fitness is not generally included in any survey of old people regardless of their circumstance. Doctor Mary Tinetti at Yale wrote a paper in JAMA a few years ago in which she reported that leg strength, not diagnosis, not cholesterol level, not age, not medication use, not any of the usual measurements, but leg strength was the single most powerful predictor as to whether a person was going to have to enter a nursing home. Maybe, we ought to be measuring leg strength as a standard test. Beyond this, research workers at Cal State Fullerton have devised a simple, six-item physical performance test which sounds like it might be valuable. The six activities which are measured: 1) The number of times you can arise from a chair in 30 seconds. 2) Using five pounds weights for women and eight pounds for men, see how many arm curls you can do in 30 seconds. 3) March in place for 2 minutes so that your knee reached a point midway between knee and hip. Count how many steps you take. 4) While seated, extend one leg, see if you are able to touch your toe with your finger. 5) See how closely your hands approximate while reaching behind your back. 6) Time yourself from arising from a chair, walking 8 feet, and returning to the chair. These research workers have established numerical ranges derived from 7,000 healthy older persons up into their 90s. By using this, or a similar testing procedure, caregivers to older persons could develop a real sense about how their charges were doing that surely would have more significance than what they are now doing that bears little, if any, relationship to their quality of life.

Q8. RE: Are athletes genes special?
Some athletes like Lance Armstrong andTiger Woods create a sense of amazement. They are so beautiful in their skills that it makes me wonder if they are specially created, or if they have a unique set of genes that sets them off from the regular crowd.

A8. Lance, Tiger and the rest of our athletic heroes achieve the magnificent performance almost entirely as a result of perspiring more than the rest of us. Just like the old saying about genius being made and not born, athletic supremacy arises through hard work. There is no gene for dunking a basketball or making birdies. Genes work as networks, not as individual items. Experiments with mice in which one gene is selectively deleted are called "knockout mice." Usually these deletions result in no observable change whatsoever, because other genes simply compensate for the missing gene. I recently ran across a small paper published in the journal, Nature, in 1999. The authors from Heidelberg coined the term "Synexpression" to indicate the clustering of functional interacting genes that are tightly coordinated. Therefore, it seems likely that Tiger, Lance and our other heroes have up-regulated their particular gene networks - their synexpression genes - by training, training, training. This concept thereby places in doubt any suggestion that you could clone Michael Jordan. You can't get another copy of him simply by replicating his gene display, since these genes are an interactive assortment of networks that are constantly being shaped and reshaped by an environmental cueing - and by training and more training. Without training, Michael will quickly turn into Archie Bunker, with the same genes, but no chance of dunking.

Q9. RE: Sedentary Death Syndrome.
I recently heard the terms SEDS. What does it mean?

A9. SEDS is a term coined by Dr. Frank Booth, distinguished Professor of Exercise Physiology at the University of Kansas. SEDS stands for Sedentary Death Syndrome, which stands for just what you think it does. SEDS seeks to capture the wide variety of medical conditions that are directly attributable to the fact that we are so sedentary. SEDS is not the first term to address this relationship. The term "hypokinetic disease" was drafted by Kraus and Raab in 1961. Another term is Exercise Deficiency Disease or EDD. Over 20 years ago I wrote a paper in the Western Journal of Medicine titled "The Disuse Syndrome." The components of the Disuse Syndrome are cardiovascular vulnerability, musculoskeletal fragility, metabolic susceptibility, immunologicsensitivity, depression and precocious aging. These commonly grouped six conditions are precisely attributable to an inactive lifestyle. The specific bio-chemical agencies behind each of these frightful diseases are known in great detail. The terms SEDS, Hypokinetic Disease, Exercise Deficiency Disease, and the Disuse Syndrome are all the same thing, and I'll bet you know what causes all of them and how they can be cured.

Q10. RE: Boomeritis.
I overheard a joking conversation at my Rotary luncheon last week. One fellow asked if we had heard of the new disease "boomeritis?" I couldn't tell whether he was being serious or whether it was a joke. Is there really such a disease as "boomeritis?"

A10. Any time you see "itis", it implies inflammation. Appendicitis is an inflamed appendix. Otitis is an inflamed ear, tendonitis is a sore tendon, and so forth. So, by definition, boomeritis means an inflamed Boomer. A Boomer, in turn, is a member of the 65 million - give or take a few million - members of the post-World War II generation who in 2010 will start to turn 65. Boomeritis refers to the fact that this huge population bulge will enter their later years with a very different set of health expectations. They will be more activist, more informed and less tolerant of inefficiency and incompetence, but very concerned about their own personal well-being. They will be active customers for replacement parts, need new hips, knees, shoulders and lenses. Restored contours will be featured, and the plastic surgeons will thrive like never before. The element of boomeritis that I expect to appreciate most will be a new emphasis on function. There will be less interest in how old you are or what disease you have, than in what you can do. This emphasis on function is fundamentally what life is all about in the first place, so the boomers are welcomed to this major perspective. Their focus will be more on what you can do - what is right about you - rather than what is wrong about you. Health, not disease, should be celebrated. If this new "disease" is what boomeritis is basically about, I hope that many people will catch it.