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 in terms
of getting their doctor's approval to
start exercising. As you will see in this chapter, that's a good idea for some
people. But given what we now know about the importance of exercise for older adults and about the health risks
of not exercising, we feel that there should be another side to the discussion. Your doctor can talk to you not only about whether it's all right for you to exercise; he or she also can talk to you about how important exercise is for
older adults.
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 during periods 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 throughout the body tend to waste away badly in people with CHF, leaving them weak, sometimes to the point that a person can't perform everyday tasks. No medicine has been shown to have a direct muscle-strengthening effect in people with CHF, but muscle-building exercises (lifting weights, for example) have, indeed, been shown to improve muscle strength in these people.
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. CHF, like most chronic diseases, has periods when the 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 their lungs are experiencing a fluid build-up or their heart's rhythm has become irregular.
If you have a chronic condition, you are probably asking yourself how you can tell whether your disease is stable; that is, how to know when exercise wouldn't be bad for you and when it would.
Chances are good that, if you have a chronic disease, you are being seen regularly by a physician (if you aren't, you should be, for many reasons). Your doctor should have discussed with you 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 have discussed, by now, how you feel when you are free of those symptoms - in other words, stable; under control. This is the time to exercise.
If you have a chronic disease, your doctor should be keeping up to date on your condition. Before you start exercising, let your doctor know. He or she might agree that it's fine to start, as long as you are free of symptoms, or might ask you to come in for a visit.
By listening to your lungs, your doctor can hear signs of fluid build-up that could signal the unstable phase of CHF. He or she can see changes in heart rhythm that warn of an acute phase of CHF, or clues about the status of other chronic conditions. Your doctor also can put your mind at ease by letting you know when it's fine to exercise because your chronic condition is stable. He or she may refer you to a qualified professional who can start you on an exercise plan.
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 types of activity. 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 at high risk for any chronic disease - for example, if you have a family history of heart disease or diabetes, or if you smoke or are obese - you should check with your doctor before increasing your physical activity. You should also see your doctor first if you just suspect that you have some risk factors and you haven't had a checkup lately.
Chronic diseases are illnesses that can't be cured, but usually 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.
Checkpoints If you are a man over 40 or a woman over 50, you should 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.
For some people, running is a vigorous activity, but for others, walking could be considered just as vigorous. It depends on you - on the shape you are in and on your medical conditions.
If you have had a heart attack recently, your doctor or cardiac rehabilitation therapist should have given you specific exercises to do when you were discharged from the hospital or your cardiac rehabilitation program. 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 before leaving the hospital, 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. It's especially important to check with a physician before beginning any kind of exercise program if you have either of the following conditions:
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.
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:
Chapter Summary
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" in this chapter.
Your doctor or cardiac rehabilitation
specialist should have given you guidelines for physical activity if you have had a heart attack recently. If not, call and ask for guidelines. 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.
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 doctors before increasing their physical activity.
There are few reasons to keep older adults from increasing their physical activity, and "too old" and "too frail" aren't
among them.
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.