Do Not Go Gentle

For the last 20 years, I have been working with aging athletes and adventurers as a Medical Exercise Specialist and personal trainer, as an owner of gyms for people over 50, and as a designer of fitness equipment. I work with people who have undertaken athletic challenges for the first time in their forties, fifties, and sixties, and I work with people who are still athletes and adventurers in their eighties and even in their nineties. I’m also a world-class masters athlete myself, so I am concerned with maintaining my own ability to perform at the highest level. I am continually amazed at how rapidly our understanding is changing about what is humanly possible at any given age.

In the last few years, however, I’ve been working to help people understand something more fundamental—something that separates the still potential athlete and adventurer from someone sliding headlong down the slippery slope. The ultimate dividing line is often what we call “the fall,” that little slip that becomes catastrophic. But decades before that actual catastrophe takes place, an insidious process begins that might best be described as the “fear of falling.” That fear gradually saps our strength and confidence—ultimately becoming a self-fulfilling prophecy.

Preventing falls takes effort, but mostly it requires understanding how the fear is set in motion. Most of all, we need to recognize that the first tremors of fear of falling are a call to action: specifically a call to lift weights.

Anatomy of a fall

Falls are typically a disastrous cocktail made of three compromised ingredients: strength, confidence, and range of motion (ROM).

Loss of Strength due to age-related muscle atrophy, called sarcopenia, reduces confidence and ROM.

Loss of Confidence due to injury and/or age reduces strength through muscle inhibition and reduces ROM.

Loss of ROM due to injury, associated atrophy, neurologic incident (stroke, Parkinson’s, MS) reduces strength and confidence.

In other words, the source of the fall is not a sudden obstacle, a change in direction, or misjudging the height of the step. We deal successfully with that sort of situation throughout our lives. Instead, the source of the fall is weakness, fear, and limited ROM that eventually creates the accident. The good news is that improving any one of these three factors has been shown to have a positive impact on the other two. Increasing your confidence will measurably increase your strength and ROM. Increasing your ROM will increase your strength and confidence. Increasing your strength is most important of all—and will most dramatically improve your confidence and ROM.

Why the slope gets slippery

Before we take another step forward, I want to clear up some basic misconceptions about strength and aging that I encounter all the time. Muscle is muscle, fat is fat. Muscle does not turn into fat. Fat does not turn into muscle. Muscle is dense tissue, about 18 percent denser than fat. Muscle is also much more metabolically active than fat, so a fit body has a higher metabolism. As we age, we lose muscle—typically 4/10ths of one pound of muscle per year after 50. Less muscle means our metabolism slows, so we tend to gain weight. But even if our weight stays the same, our volume increases—which means we float better and our clothes no longer fit. What’s more significant is that we have a larger body to support even as we have less strength to support it. Making matters worse is that our muscles are a major part of what’s called our proprioceptive system, which tells us where we are in space. As we age, we tend to become larger and less dense even as we get weaker and less in touch with where we are. It’s the perfect setup for a fall.

“But I walk, I don’t need anything else” is something I hear a lot—especially from practical people who design their dream homes without stairs. To me, it’s almost as if they’re in a hurry to qualify for one of those “free” scooters advertised on TV. Walking is great for your heart and your mood, but it’s an inefficient form of exercise from a musculoskeletal perspective. I have many clients who can walk but who can’t get out of a chair or rake leaves or pick up their grandchildren. They are not only missing out on life. They are heading for a fall. People should build their dream houses with plenty of stairs!

People who attempt to control their weight by dieting also set themselves up for a fall. Dieting tends to reduce muscle mass, reducing one’s metabolic rate and making the situation worse. If your clothes no longer fit, increase your activity to burn fat and build muscle. Your weight may or may not drop, but you will look and feel better.

“So what is the best way to avoid a fall?” people finally ask. And that question gets to the primary goal of exercising the aging body from a musculoskeletal standpoint. What you want to do is to preserve functional strength, which is another way of saying you want to preserve muscle, confidence, and ROM. Assuming you are healthy and free from major medical deficits, you have a lot of fine and enjoyable choices to choose from, including Leki stick trail hiking, cross-country skiing, yoga, Pilates, martial arts, dance, rowing, horseback riding, swimming, and fencing. All of these types of exercise are great for ROM and confidence. Just keep in mind that the optimum health strategy includes one or more of these activities, plus a regular weight routine to specifically work on muscle.

What kind of resistance

The safest and most effective way to build muscle for older people is using machines that create compound (multi-joint), closed chain, non-concussive movements with optimal range of motion such that the muscles are supporting the skeleton and not the other way around. While all that sounds complicated, it’s not really.

A compound movement involves two or more joints working together with their associated musculature. Imagine a rowing movement with the upper body. In that movement both your elbows and shoulder joints are moving together, so you are sharing the load between the two sets of joints. To accomplish this move you are firing the muscles of the forearms, upper arms, posterior shoulders, upper back, and middle back. No need to name all of the muscles exactly, just know that there is a lot going on in a compound movement. Typically, compound movements are closed chain, which essentially means the hands or feet are in contact with either the ground or with a machine. That stability increases safety.

Aerobic examples of great compound movements are cycling (either recumbent or upright, depending on ability and/or need for spinal support), rowing, upper body ergometers, and recumbent steppers. Strength examples would be squats, leg presses, seated rows, dead lifts, stiff-legged dead lifts, and high pulls. With all these movements good form is critical. Consult with a qualified trainer so that you can properly ingrain the right forms into your neuromuscular memory. Once you have established the proper motion, the rest is comparatively easy!

Less effective and potentially more dangerous weight exercises are open chain, primary rotary movements, such as arm or leg curls. Adding weight to the end of our lever arm or leg puts a lot of more stress on our working parts than compound movements. While such movements can be very helpful in some circumstances (including injury rehabilitation), you don’t want to do them without a clear purpose and supervision.

Things like stomach crunches and hip abduction/adduction machines are what we loosely call vanity movements: inefficient, ineffective, and potentially injurious. Save your open chain movements for the therapeutic environment where joint stability and range of motion are the order of the day. Focus instead on big, functional, compound movements that will keep you strong, loose, and not afraid to do the things you love.

Yes, You Are An Athlete!

We are all athletes, and our field of play is the real world: So our training had better include strength training, because we do it every day. Don’t think so? Let’s take a look:

Getting out of bed, getting off the toilet, getting off of your chair, and getting in and out of your car are variations of the ubiquitous squat.

Lifting your kids or grandkids, hoisting a laundry basket, and lifting groceries out of your car are just three forms of dead lift.

Now let’s combine upper and lower extremity movements (which require tremendous core support). For example, you are sitting in a chair holding an infant under her armpits, facing each other. You stand up and press her overhead. She screams with delight. You have just performed a squat-press and are a functional rock star.

Later in the day, you lift a box of tax receipts and place it in an overhead cabinet. That is a clean and press and now you are an Olympic functional rock star.

If you cannot perform any of these movements without some form of assistance, including “cheating” with momentum, you are losing functional strength and should be taking measures to combat that loss.

Progress Faster By Pedaling Backward

Sure, you know how to pedal a bike smoothly and evenly and fluidly; you learned as a kid and have reinforced that neuromuscular pattern through millions of revolutions. But try pedaling backward under a similar load with those same dynamic qualities and, at least initially, you will look and feel like a klutz; the movement will be jerky and the pressure uneven, just like brushing your teeth with your opposite hand. Why? Because these new movements are foreign to your dominant neuromuscular hardwiring. Introducing new and varied neuromuscular patterning improves kinesthesia, proprioception, and motor skills for fall prevention, and that’s just the short list. The field of neuroplasticity and neurogenesis is burgeoning and the evidence in support of safe and effective exercise is irrefutable. In other words, Just do it . . .differently!