307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential

KEYPOINTS

• 01

  It's never too late to start, but waiting raises the cost

  Peter compares exercise to saving for retirement. Someone who puts savings into an index fund at 22 barely has to think about it. Starting later means saving more and taking more risk. Fitness works the same way. He sees 50 as one turning point and 65 as a bigger one, when strength loss becomes noticeable and changes in the inner-ear balance system start to raise fall risk.

• 02

  Muscle and activity both drop sharply around 75, and individual losses come in steps

  Fat-free mass rises until about 25, declines slowly until about 75, then falls steeply, especially in men. Physical activity follows the same pattern, and Peter thinks each drives the other. Luke van Loon pointed out that the smooth population curves hide what happens to individuals: a series of large, discrete drops, because after a certain age minor setbacks become permanent. A broken hip after 65 carries a 15–30% one-year death rate, and about half of survivors never regain their previous function.

• 03

  Aim to have VO2 max in the elite range for someone two decades younger

  The elite cutoff (top 2.3%) for women falls from over 53 mL/kg/min in the late teens to about 30 at age 80. Most people's late-life goals in the Centenarian Decathlon exercise need a VO2 max in the high 20s to about 30 in their final decade, and daily activities become limited in the high teens. A personal goal: keep VO2 max above your age for as long as possible.

• 04

  Fitness is a stronger mortality marker than most diseases

  In the large cohort Peter cites, smoking raised one-year all-cause mortality by 41%, type 2 diabetes by 40%, coronary disease by 29%, high blood pressure by 21% and end-stage kidney disease by 178%. Going from below-average to above-average VO2 max for your age also cuts risk by a hazard ratio of about 1.41, the same as smoking. Below-average to high is about a doubling, and even high to elite is about 29%.

• 05

  Older bodies still respond to training, but they also lose gains faster

  In a 6-week cycling study, people averaging 80 and 24 years old both improved VO2 max by about 13%, maximal workload by about 34% and endurance about 2.4-fold. Absolute values stayed far apart. In the 8-week detraining period that followed, the older group lost gains faster, so consistency matters more than intensity. His big goals for patients are two- to three-year projects.

• 06

  Variety and movement quality come before volume, load and intensity

  Even with a high 'training age' since 13, Peter, now over 50, prioritizes varied, multi-plane movement because he is more prone to injury. For beginners that means body-weight step-back lunges rather than only heavy leg presses. The most important outcome is that after 3 months the person sees it as positive, feels fitter and wants to do more.

• 07

  Build an aerobic base before adding VO2 max work

  Start with walking (as little as 5,000 steps a day on flat ground), incline walking, rucking with about 20 lb, or a recumbent bike. For beginners, a reasonable starting point is twice a week for 30 minutes. After 8–12 weeks, increase frequency first (3–4 sessions), then duration (at least 45 minutes). Peter defines zone 2 as the highest steady output with lactate under about 2 mmol. Use the talk test, or Phil Maffetone's 180 minus age, minus another 10 for beginners. Lactate isn't useful for deconditioned people, whose resting levels can be near 2.

• 08

  Introduce intensity gradually, then use 3–8-minute intervals

  A first step is ending a treadmill walk (for example 3 mph at 5% incline) with five 1-minute bursts at 10% incline. Later, do a weekly session of 3–8-minute intervals with 1:1 passive rest, building from 4 to about 8 rounds. Peter's favorite is 4 minutes: barely noticeable at minute 1, about 50% of maximum pain at three-quarters of the way through, brutal at the end. Choose activities where form won't break down under fatigue.

• 09

  Everyone should lift weights

  In a 6-week study, people in their late 70s and early 80s increased 3-rep-max leg extension by 78%, versus 83–84% in 20-somethings, even though their absolute strength was far lower (22 kg vs about 178 kg). Type II fiber atrophy is a hallmark of aging (Andy Galpin), and 13 weeks of training increased type II fiber cross-sectional area by 27% in men aged 60–73. Beginners should start with volume over load: 12–15 or more reps per set.

• 10

  Most falls come from weak feet, ankles and fast-twitch fibers

  About 25% of people over 65 (over 14 million in the US) report falling each year, and at least 50% of people in their 80s and 90s fall. US fall deaths rose about 30% from 2007 to 2016, and the projection is seven an hour by 2030. Contributors include lower-limb weakness, vision and inner-ear balance loss, poor footwear, clutter, and overtreated blood pressure causing dizziness on standing. Falls cause about 95% of hip fractures and are the leading cause of brain injury after 65. Recovering after stepping off an unexpected curb is a power movement that depends on type II fibers.