The Good Health Magazine : FITNESS : FITNESS PAST 40 : GROWING NUMBERS OF THE MIDDLE-AGED ARE STARTING TO TRAIN AND COMPETE IN THE HOPE OF : STAVING OFF THE EFFECTS OF AGE

“Nature takes care of you for about 40 or 50 years, which is the average reproductive span, but after that you are on borrowed time.” --Dr. Carl. W. Trygtad, geriatrician and head of the Division of Urgent and Emergency Care at Scripps Clinic in La Jolla

Betty Yoshioka, 49, is a Los Angeles businesswoman doing everything within her power to avoid growing old. Three years ago she took up running--marathon running. And this year, she volunteered for a series of comprehensive physiological evaluations, part of a 20-year study at USC, to determine the effects of exercise on the aging human body.

Yoshioka is typical of a growing number of middle-aged individuals who never before have been serious athletes but who are, late in life, starting to train and compete in the hope of staving off the effects of age.

Most latecomers to--as well as the regulars in--the world of athletics assume that vigorous exercise and a restricted diet will make them look better, feel healthier and live longer.

They may be right. Preliminary results of studies at USC and at several other universities suggest precisely what exercise aficionados had hoped to hear: Fatigue, weight gain, memory loss and other problems associated with aging may not be normal but instead the unfortunate and avoidable side effects of a sedentary life style.

This is not to say that we do not grow old and wear down. We do, of course, and the medical profession has organized two new subspecialties--geriatrics and geriapsychiatry--to help patients cope with the physical and psychological problems of aging. Scientists have also been busy trying to understand the fundamentals of the aging process. How, for example, do individual cells change as they get old? Do they have to change? What happens to sex in the later years of life? Does it have to deteriorate?

Much of the attention on aging, however, has been focused neither on understanding the process nor curing its effects, but on actually preventing it from happening in the first place--or at least delaying it as long as humanly possible.

Many organizations, including the American Heart Assn. and the President’s Council on Physical Fitness, advocate the virtues of exercise as a way to enhance well-being and prolong life. There are countless popular books on the subject of fitness and age: “Weight Training for the Over-35s,” “Exercises for Non-Athletes Over Fifty-One; It’s Never Too Late,” “The Senior Citizen’s 10-Minute-a-Day Fitness Plan.”

But scientists, physicians and other health experts say that modern science knows surprisingly little about the effects of physical activity on middle-aged people--and almost nothing about the impact of exercise on the elderly.

“It is true that some important advances have been made in recent years in understanding the causes of premature death,” says Dr. Ralph S. Paffenbarger Jr., a Stanford professor of medicine and one of the country’s experts on exercise and aging.

“Studies have shown clearly that people who stop smoking reduce their risk of cardiovascular disease and their risk of lung cancer.

“Some evidence from life insurance companies suggests that people who lose weight can expect to extend their lives a bit . . . Recent studies have shown that if there is a change in the lipoprotein profile (that is, if people reduce the amount of cholesterol and fat in their diet), there are benefits . . . If there is a change in the blood pressure level, either by pharmacological means or diet or exercise or some combination, there is also likely to be an increase in longevity.

“But,” Paffenbarger says, “there is no data at all on the effects of physical activity and age.

“What happens,” he asks, “when old or middle-aged people get out of the easy chair and become active? What is the optimal type of activity? . . . What’s the minimal amount of exercise? Are there hazardous levels of exercise? . . . These are questions for which we do not have answers--yet.”

The idea that exercise increases longevity is not a new one. In antiquity, there was speculation that sport was good for the human body. In more recent times, exercise has come to be viewed as beneficial for the psyche as well as the physique. It also has been observed that former athletes live longer than nonathletes.

Yet, there have never been studies to control bias in these observations; the theories associating exercise and health have never been proved, notes John O. Holloszy, a professor of preventive medicine at Washington University in St. Louis. It is quite possible, for example, that whatever genetic or biochemical characteristics cause people to become athletes also may be at work in allowing them to live long lives.

In a comprehensive review of the scientific and medical literature on exercise and aging published in 1983, Holloszy issued this warning:

The “good press that the health benefits of exercise have received in recent years is based largely on emotional reactions . . . and on wishful thinking. . . .”

The “evidence,” he says, is still “too meager to justify recommendation of strenuous exercise for the large population of sedentary and older individuals in the United States. . . .

“If it were necessary to obtain approval from the Food and Drug Administration for the use of strenuous exercise in health maintenance and if approval were based on the same criteria used by the FDA for a new drug, i.e., proof of efficacy and extensive evidence that it does not cause cancer or other harmful effects, it seems unlikely that approval for the use of exercise could be granted on the basis of currently available information,” Holloszy concluded.

Today, many scientists and physicians agree the knowledge base about exercise and age remains meager, in part because there has been so little attention focused on the elderly. Increasingly, however, the aging process is becoming the focus of serious research by first-rate scientists at major research universities--Harvard, Stanford, USC, Duke, Penn State, among them.

One of these researchers is Robert A. Wiswell, an associate professor in USC’s Department of Physical Education and Exercise Sciences, and director of the 20-year study in which Betty Yoshioka is participating.

Like many researchers in the field, Wiswell is essentially trying to describe what normal aging is and to determine what, if anything, can be done to alter the process. It is slow work.

Being able to make medically sound recommendations about exercise for the elderly was a dream of one of Wiswell’s predecessors nearly 20 years ago. In 1968, Herbert A. DeVries, then one of the country’s few experts in the field of exercise and aging, predicted “the time will come when it will be possible to prescribe exercise for an individual with the same scientific detail and exactness as that now employed in writing a prescription for medicines.”

“The problem is,” Wiswell said, working in his laboratory this past summer, “there is still so much we don’t know. And what we are discovering is that much of what we thought we knew simply is not true.” Wiswell and his colleagues expect, for example, that their research will disprove a widely held theory that human muscles invariably and rapidly deteriorate after the age of 35 or 40.

“Although the rate of deterioration we now see in most people after they hit middle age is about 1% a year,” Wiswell says, “it is our theory that the loss of muscle mass and strength is the result, not of the normal aging process, but of an ever-increasing sedentary life style.”

To test their theory, the USC researchers are comparing the physical changes that occur in nonathletes with those that are experienced by so-called Master Athletes, people over the age of 40 who continue, despite their age, to compete in sports. Among the 200 to 300 older athletes that Wiswell hopes to monitor over the next 20 years are women like Yoshioka, who took up long-distance running in middle age, a 75-year-old man who holds the world record in pole vaulting and an 87-year-old who runs at least 90 five- to 10-kilometer races a year.

Although it will be years before the final results of the USC study are known, there are already results from different studies trickling in from other universities.

Perhaps the most persuasive piece of scientific evidence supporting the notion that exercise lengthens life came three years ago from a project directed by Paffenbarger and his colleagues at the Stanford School of Medicine and the Harvard School of Public Health.

Published in the New England Journal of Medicine in 1986 and known as the Harvard Alumni Study, the project tracked the physical abilities and life styles of 16,936 Harvard graduates, ages 35 to 74, for 12 to 16 years.

All else being equal, the study showed, the more men exercised, the longer they lived. Men who remained physically active--that is, those who exercised or played sports or walked long distances on a regular basis--could expect to add one to two years to their lives by the time they reached age 80, the study said.

Further analyses and follow-up data will be forthcoming, perhaps before the end of the year. Already it is clear, however, that there are limitations to the study, Paffenbarger acknowledges.

The men who were part of the project--all graduates of Harvard--were hardly representative of the population as a whole, either in education, income or sex.

As with other longitudinal studies, the Harvard project made use of a mass of statistical data that can be misinterpreted, the researchers warned. For instance, the study revealed that men who gained less than 15 pounds of weight after college had a 33% greater risk of premature death than those who gained more. Does that mean it is healthier for men to be heavier? Surely not, the researchers reasoned. What the data probably indicate is that lack of weight gain, combined with a sedentary life style, is either connected with smoking or perhaps a sign of serious disease such as cancer.

In 1987, another study, this one conducted in Finland and involving a somewhat more representative population of men, basically corroborated the earlier Harvard findings.

In the Finnish study, published in the prestigious British medical journal Lancet, the activities and physical characteristics of 636 Finnish males, ages 45 to 64, were followed for up to 20 years. After adjustments were made for age, smoking, weight gain, blood pressure and serum cholesterol levels, it became clear, the researchers said, that vigorous and regular physical activity such as long-distance walking, bicycling and cross-country skiing could add at least two additional years to a man’s life.

“The problem with all of these studies,” said Paffenbarger in an interview this summer, “is that they are historical; they describe what people have done naturally on their own. They tell us nothing about when we intervene with exercise, what happens when people change their life styles early in life or late in life or somewhere in between.”

What’s worse, says Holloszy, while many projects have tried to assess the possible benefits of exercise, almost none is systematically trying to define the hazards of exercise.

Theories, never disproved, he says, suggest that exercise may bring about metabolic changes that hasten death rather than delay it. Much as a machine wears out more quickly the more it is used, so, too, may the human body be subjected to stresses which science does not yet fully understand.

“The studies also tell us virtually nothing about women,” laments Ruth Weg, professor of gerontology at USC.

One of the most famous studies on aging, known as the Baltimore Longitudinal Study, has been tracking the behavior and life styles of men since 1958. The first results of this study began appearing in the mid-1980s, including such intriguing suggestions as possible connections between regular exercise and the preservation of memory and other neurological functions in men.

Yet the study, so far, has had little, if anything, to say about women.

“Women weren’t even brought into the study until 1978 so we won’t even have basic data on what normal aging is in women for another 10 years,” Weg says.

Nonetheless, Weg is uncomfortable, as are many health experts, with the idea of waiting until all the data are in to start changing life styles and reforming eating habits.

“We may not have all the answers we need but we know enough now at least to start,” she insists. Her prescription is simple: exercise begun moderately and done regularly; a diet neither too high in calories nor too rich in cholesterol.

Weg is certainly not alone in her thinking. Even though they may not be able to say with certainty what kind of food is safe or how much exercise is best, many health-care professionals are clearly worried about the potential ill effects that fatty American diets and sedentary life styles may have on the rapidly aging population.

Because of improvements in sanitation and the advent of modern surgery and medicine, including drugs that can cure life-threatening infections, the average life expectancy of Americans has risen dramatically, from less than 50 years at the turn of the century to more than 75 years today. By the middle of the next century, according to some estimates, the average life expectancy could reach into the 90s. Even today, the fastest-growing segment of the population is people over the age of 85.

Yet, just because people are living longer does not mean they are living well.

Many older adults today live so precariously close to the threshold of disease and disability that one minor stress--a fall, a respiratory infection--could render them permanently dependent, according to a recent editorial in Lancet.

The situation has become so bad, the journal’s editors said, that only one healthy 79-year-old woman in three is able to walk fast enough across the street to be protected by the signals at pedestrian crossings.

In response to this situation, a new subspecialty of medicine has emerged.

Geriatrics is a relatively new field, and it has arisen, like its predecessor pediatrics, in part because of a growing awareness that the elderly, like newborns and children, have very different health problems than the rest of society, says Dr. Barbara Bernstein, a geriatrician at Sylvia Olshan Health Clinic, a community clinic located in Los Angeles’ Fairfax District and affiliated with UCLA.

Doctors are discovering the elderly cannot tolerate the same quantities of medication or even the same kinds of medication that young and middle-aged adults safely take for such common diseases as diabetes or heart disease.

Biochemical and physiological changes that take place as part of the aging process also mean that the elderly do not always exhibit the same symptoms of a disease as do younger adults.

“The symptoms of a heart attack in someone under the age of 65 or even 75 are quite predictable: chest pain radiating down the left arm,” says Dr. James W. Davis Jr., an assistant professor of geriatrics at UCLA, who spends part of his week at the Sylvia Olshan Clinic. “But these ‘classic’ symptoms are not ones we see in the elderly. They may be confusion, change in appetite, shortness of breath.”

The problem of diagnosing and treating elderly patients is further complicated by the number of physical ailments they may exhibit at one time.

“Often patients will have multiple medical problems which means that the physician has to juggle five or 10 medications,” Davis explains.

The result is, all too often, an unhappy combination. Even though the elderly account for only about 12% of the population, they account for so many of the hospitalizations from adverse drug reactions and so many of the fatal drug overdoses that the American Psychological Assn. recently labeled the situation Americans’ ” other drug problem.”

Because of these and other issues, the goals of a physician treating the elderly often have to be quite different from those of a physician treating a younger adult, says Dr. Robert T. Wang, medical director of a new Center for Geriatric Health at Century City Hospital.

When they are dealing with the elderly, doctors cannot always simply diagnose and treat an acute disease and then restore the patient to a “disease-free state,” Wang says. Often the goal of a geriatrician has to be to “identify functions that have been impaired” and “teach” the patient how to live with those impairments.

All told, however, there are a surprisingly small number of physicians who have any special knowledge of the problems of the elderly, according to a recent report written by researchers at UCLA and published in the Journal of the American Geriatrics Society.

One of the reasons is that few U.S. medical schools require even one course in geriatric medicine as part of the standard curriculum for physicians. Most teaching hospitals also have no formal programs in geriatrics. And, until recently, there has been almost no money for research in the field.

All that is now changing, albeit slowly.

“Despite the problems, progress is being made,” USC’s Weg insists. “Many of the old myths about aging are finally falling by the way.”

At the cellular level, scientists are making great strides in understanding just what aging is and how the process works. They now know, for example, that not all animals age. The shark, the sturgeon, the Galapagos tortoise are not immortal since they are subject to predators, accidents and disease, but their cells are not genetically programmed to die as human cells seem to be, explains Leonard Hayflick, a professor of anatomy at the University of California School of Medicine in San Francisco and one of the key researchers in this field.

Because it is clear that human cells are genetically programmed to have a finite capacity to divide, it also seems certain that there is an upper limit to the human life span, and that limit is probably what it has been for milleniums: the Biblical fourscore and 10--that is, 90 to 100 years or so, Hayflick says in 1980 and 1988 articles on the cell biology of human aging.

Scientists are still searching for an explanation why so many people are now living longer and moving ever closer to the upper limit of the human life span. Is it exercise? Better diet? Or is it simply Darwinian genetics at work--that is, nature somehow selecting those who will live longer so that humans will have a “reservoir” of years beyond the age of reproduction to make absolutely certain the species reproduces itself?

Reproduction and sex in the elderly also are issues about which scientists and doctors are beginning to revise their thinking.

In the Old Testament, Sara supposedly bore a child, Isaac, when she was in her 90s. a miscalculation on the modern calendar, sex, scientists are discovering, is also very much a part of growing old today, at least for some people.

“The issue of sexual activity in elderly people may be summarized as ‘some do, some don’t, and there is nothing wrong with either,’ ” writes Dr. Ole J. Thienhaus, associate professor of psychiatry at the University of Cincinnati College of Medicine, in the journal Geriatrics.

In recent years, however, scientists have discovered that there are changes in sexual functioning that do occur.

Erections in men, for example, often are less full; instead of pointing up at a 45-degree angle from the abdominal wall, they may never get much beyond a 90-degree angle. They are harder to achieve the older a man gets. And they disappear faster. After orgasm, it may take days to achieve another one, Thienhaus says.

In women, there is no loss of the ability to experience sexual climax at any age, but after menopause there is typically a 50% decline in involuntary contractions with orgasm. The production of less estrogen in the body means less vaginal lubrication and can cause tissue to atrophy.

Understanding these changes, as well as learning new positions and techniques, may need to be learned to enjoy sex in old age, but because sex is “largely tabooed by society” and because of the “gender disparity” that occurs with advancing age (two thirds of the elderly in America are women), many elderly people who would like to have sex, don’t find a way to do it, Thienhaus says.

Even more than losing their sexual identities, people worry about losing their minds when they get older. Indeed, most any lapse in memory--a failure to remember a name or a phone number, an inability to locate the car keys--is thought to be the result of advancing or premature senility.

In fact, that may not be so far from the truth.

Several decades of studies on the subject have shown that memory can begin to fade as early as age 35. By age 60, over half the population is afflicted by some degree of memory loss.

Some difficulties with memory, researchers have found, are the result of very serious and probably irreversible organic problems, such as Alzheimer’s disease. Little is known about the dementias. They are often extremely hard to diagnose; there are no cures and there aren’t even any antidotes to halt the progress or alleviate symptoms.

The good news, however, is that something can be done to compensate for many of the losses associated with normal, healthy aging, according to Drs. Jane F. Potter and Jerry O. Ciocon of the Geriatrics Section of the University of Nebraska Medical Center.

Studies have shown that the elderly remember information presented visually better than they do the same information presented auditorily. Thus, old people might be wise to read, rather than hear, what it is they want to remember.

Older people have difficulty learning because they have, in essence, forgotten how to learn. They don’t rehearse what it is they are trying to remember nor do they spontaneously make use of mnemonic devices, that is, formulas for organizing bits of information into comprehensible categories. Simply encouraging older people to use some of the tricks of memorization that they used as school children have brought impressive improvements in controlled studies.

The best prevention against loss of memory may be to keep busy and not to worry, Potter and Ciocon say in a 1988 review of research on age-related changes in human memory:

“Individuals who complain of memory problems are likely those who are more concerned about the aging process and who are more sensitive to normal changes . . . Furthermore, older people, especially those who are retired, may have fewer demands on their memories than they had during their working days. Their decline in recall may be due simply to inactivity.”

Perhaps no area of aging has been studied more and understood less than the psychology of growing old.

For decades, doctors have argued that there is more depression among the aged than in any other segment of the population.

“In fact, any of a number of recent studies show that this is probably not the case, but it is true that there are certain issues that must be faced in old age that are not always easy,” says Dr. David W. Trader, a geropsychiatrist at Century City Hospital’s Center for Geriatric Health.

“If I could say there is one theme of old age it is loss,” Trader says. “Loss of physical abilities, loss of health, loss of friends, loss of spouses, loss of job, loss of self-esteem, memory loss. People with good coping skills, people who have made changes, who have weathered transitions throughout their life, will do fine. Others will not.”

“But,” cautions Weg, in her professional experience as a gerontologist at USC and in her personal experience as a woman approaching the age of retirement, she has learned “there is one very important thing we must remember if we are to understand aging, and it is something we too often forget. Human beings are gregarious creatures. They need other people in order to survive.

“To live a full and active life until our bodies finally give out,” Weg says, “we have to assume an attitude about life, we can’t be isolated, we have to have feedback from society. Without these things, all the nutrition and fitness in the world won’t mean a thing.”