- Exercise & Fitness
Fit Over 50: Training For the "Third Quarter" of Life
I am in the process of writing a book on fitness, and I just finished the chapter on how to exercise when we are 50 years old on through the rest of our lives. I believe that the information is so valuable, I wanted to share it on a larger scale.
Exercise and the Older Population
As we get older, there are many things that we need to pay attention to in our exercise regimen. All of those old injuries come back to haunt us. They really never fully heal. For example, I have a degenerative disk in my lower back that happened when I did a stupid stunt. I was dared to jump off of the roof of a friend's house when I was seven years old. It did not bother me for most of my young adult life, but I am very aware of it now. I have permanent stiffness in my lower back, and if I sleep on the wrong mattress or sit in a poorly designed chair for a long time, I get a lot of pain in my lower back and sometimes even radiating down my leg. I have also developed tendinitis in my right elbow and knee, all from over training when I was younger. I know how to manage them, but they never went away. It is the same thing with all of my older clients. We all have some physical issues we deal with. The good news is that we all can still train with the intensity we need to make gains. Moreover, we all train in a way that will minimize future injuries. Here are some of the issues that I have encountered frequently from my older clients:
Rotator cuff tears
This is not a complete list, but it encompasses just about 90% of what I see. The following are remedies I implement to work on these problems when they arise.
This is by far the most common problem I deal with, and understandably so. Tendinitis simply an overuse injury. It happens from a repetitive movement of some kind done for years. Tennis elbow and golf elbow are the most common, but it also happens from movements you would not expect until it's too late. Data entry, for example, can lead to wrist tendinitis, or more popularly known as carpal tunnel syndrome. If you have tendinitis, the best thing you can do is rest the affected area...for a long time. A good rule to go by is that for as long as it took to get better, double the amount of time before you resume the activity that caused it in the first place. Do not “fight through it” by any means. Yes, you can do that for a while because the endorphins block the pain and damage you cause while working out, but it will feel worse when you are done. Moreover, it will continue to get worse, so much so that you may have to stop exercising permanently. That is not our goal.
Other methods you can use to speed up the healing process are to use ice and trigger point work. When my tendinitis gets bad, I will use my body back buddy (and curved stick with knobs on it) to dig into the tender spots and run it along the area. This really helps give me instant relief. As for using ice, it is best to apply it after your workout for about 10 minutes or. so. You can also do this two or three times a day to keep inflammation down.
As for the workout, you may want to use a shorter, pain free range of motion and slow down the repetition speed. Lower your weight to about 25% of what you would normally use. If your tendinitis still bothers you, stop exercising and give it more time.
A common tendinitis problem from strength training is from back exercises such as lat pull-downs, chins, or rows. The back muscles get so strong that the smaller forearm muscles over-strain to keep up. Tendinitis in the elbows set in if you are not careful. That is my big issue, and I still deal with to this day. I use wrist straps when I perform these movements now, and they take a lot of pressure off of my forearms. I can lift as heavy as I need to without my forearms bothering me. I highly recommend them after you have been training for about 6 months. Moreover, hand positioning is very important. Most trainers will recommend you take a wide over hand grip for your pull downs with the belief that you can more directly target your back muscles. This is not true. You put the biceps in a weak position, which will cause the biceps to fatigue sooner, thus limiting the stimulus to your upper back muscles. The underhand grip is better, but it still puts a lot of undue stress on the forearms. The best hand position I found was a parallel grip, where the palms face each other. The biceps are in a good, strong position, and you can train with heavy weights (coupled with the wraps), and never experience tendinitis.
Both Osteoarthritis and Rheumatoid arthritis are caused by inflammation of the joints. Osteoarthritis often times start with an acute injury, such as a football injury. This leads to the inflammation and eventually wearing down of the joint. Rheumatoid arthritis is more of an autoimmune disease. The synovial membrane that protects and lubricates the joints get inflamed, leading to pain, stiffness and eventual degeneration1.
Once the degeneration starts, there is not much you can do about that. Having said that, you can certainly slow down the process, and add more support from your muscles to give the joint more protection.
Just like the procedure for tendinitis, working with arthritic joints follow roughly the same protocol. Do a limited, pain free range of motion. Slow down the repetition speed to take the momentum out of the lift, and be conservative with your progression. I would recommend a rep range of between 15 to 20. Additionally, you must be attentive to the pain. On your workout days when you have more pain, lighten the weights. If you feel less pain and like you can push harder, do so.
It is very possible to get some relief from your arthritis pain after a conservative strength program for several months. This is largely due to gaining some muscle that will better support the joint.
Unless the pain one experiences from arthritis is unbearable, I would recommend staying away from Non steroidal anti-inflammatory drugs (NSAIDS). They are helpful in both reducing pain and inflammation, but there is a long term cost associated with using them. Chronic use can lead to bleeding and perforation to the stomach and intestines2. One time I trained a client who's husband was an avid runner when he was younger, and, of course, he had chronic joint pain. Out of iron will, he kept running and made the matter worse, but he took mega doses of ibuprofen to mask the pain. When I met him, he was on dialysis because his kidneys shut down from the self medication he did when he was younger. It was an in my face reminder of why it was so important to minimize the use of NSAIDS. Moderate use from time to time should not be a problem, but chronic use will be.
This, too, is a very common problem. An acute trauma on the disk when one is younger will show up later in life. Count on it. This does not meant that one cannot train hard, but one has to be judicious in his choice of exercises to prevent it from getting worse, and at the same time garnering more support from added muscle. Here are the exercises that someone with a degenerative should avoid (I am talking about the lower lumbar region...degeneration of a disk in the cervical spine is another matter):
Stiffed legged dead lifts.
Bent over rows.
Standing hyper extensions.
Exercises that can be done but with caution:
Low ab exercises such as laying face up raising and lowering both legs at the same time.
Most any other exercise can be done with no problem. You do, however, want to pay attention to how your back feels after a workout. If you did anything to aggravate the disk, you will most likely know the next day. Tightness, stiffness, and lower back pain are signs that you did something wrong. If you notice any of these symptoms, you can do some traction to take pressure off of the nerve, along with proper back stretches. Ice can be helpful too.
Active, athletic people run a higher risk of tearing the anterior cruciate ligament. The ACL is the ligament in the middle of the knee, and it attaches the femur to the tibia3. It is one of four different ligaments that attach both of the bones previously mentioned. However, because if it's location, it tends to be the most vulnerable to acute trauma.
The good news is that if one has acl reconstruction surgery, the knees can be just as stable as if the tear never happened. It is still good to use common sense and avoid putting unnecessary stress on the acl. A trainee can still do squats, leg presses, lunges, and other compound movements for the legs, and even though leg extensions are cleared by most physical therapists for someone with acl reconstruction, I would advise against it. Leg extensions put a shear force (a force coming from a 90 degree angle) on the knee, of which the acl is highly exposed to. There is no need to put the acl under that kind of stress, especially considering that leg presses and squats do a great job of strengthening the quadriceps muscles with a much lower risk potential. The trainee needs to be conservative in his progression...he just needs to go at a slower pace, but he should have no problem gaining full functionality and strength in his leg muscles. Moreover, the stronger he gets, the better support the acl will receive.
Hypertension is defined as a blood pressure reading of 140/90 for most of the time, and it is a leading cause of heart disease. Medical professionals strongly recommend getting those numbers lower, and a healthy blood pressure is 120/80.
There is a belief that high intensity strength training can be dangerous because strength training can cause a temporary rise in blood pressure4. However, research shows that strength training with a good diet can be very beneficial in lowering blood pressure over the long term.
I agree with this assessment, and I have taken precautions with my clients who have high blood pressure. Strength training is still very beneficial, and with most of my high blood pressure clients, their blood pressure numbers fell into the healthy range after a few months of exercise and proper diet. Once they were in the healthy range, I was able to push them just as hard as my other clients.
Here is what I recommend if you have hypertension:
Start with the weights that are light and you can do between 15 to 20 reps with little difficulty. The load should be light enough to prevent your blood pressure from spiking too high. Do increase the challenge of your workout every time you step into the gym, but be more conservative with your progression. Use a higher repetition protocol, so instead of doing 10 to 12 reps before you increase your weights, use a rep range of 15 to 20. Take a little longer in between your sets than I generally recommend. Let your heart rate drop closer to baseline before you do the next set. A good guideline would be to take about 2 minutes between sets. If you are still breathing pretty heavy after two minutes, take another minute before you start the next set.
Do not take any of your sets to momentary muscular failure. It is that point that will most likely spike your blood pressure, so you need to avoid it. After a couple of months of training, you should be far enough along in the progression that you will feel a good burning sensation in your working muscles. Do not be afraid of this.
Do keep monitoring your blood pressure on a weekly basis and adjust your workout accordingly. Most of the clients I trained were able to actually get off of their medication after a few months of exercise and diet intervention.
An inguinal hernia is the result of the soft tissue (usually the intestine of membrane lining of the abdominal wall) protruding through a weak point of the abdominal wall5. Some hernias have no known cause, but other times they can be caused by heavy lifting, increased pressure in the abdomen, and many times it is simply an abdominal wall weakness that happens at birth5,6. The older population (age 60 plus) seems more susceptible to developing a hernia. Once a hernia develops, there is nothing you can do to reverse it except surgery. If you do have a hernia, you must stop strength training outright and consult your doctor. It will only make the hernia worse.
You cannot prevent the predisposition to a hernia, but you can take some preventive measures that can be helpful. Both WebMD and the Mayo Clinic suggest:
Maintain a healthy weight through diet and exercise.
Do not smoke.
Use good body mechanics while lifting.
I would add to practice proper breathing while lifting heavy objects. This can keep the intra abdominal pressure lower, thus putting less strain on the abdominal wall. One other thing: Exercises such as the prone plank among the older population can be too strenuous. I am talking about people who are 60 years or older, so unless you have been physically active for many years, do these types of exercise with caution.
50 years old...The Third Quarter of Life
I really don't believe that 50 represents the third quarter of life, for I believe that with all of the advances with public health, medicine, and available knowledge about having a healthy lifestyle (much of it free and accessible on the internet), we can live to be a hundred years old with a high quality of life. Thus, 50 would represent "half time". The reason I titled this part is because 50 represents the third quarter of life if one does not exercise, eat right, and take good care of himself. Because of this, I strongly believe that around the age of 50 is a critical time to start consistent exercise program, specifically a good strength training program. As we age, we will lose muscle mass at roughly 3 to 5% a year from the age of thirty on up through the rest of our-lives. This is called sarcopenia, and it is, in my opinion, the major factor for a declining quality of life in our older years. Those who are physically active show a slower rate of muscle loss, but the process still happens7,8,9. There are many contributing factors to the cause of sarcopenia, many of which I feel is important to know about and I will discuss briefly, but the research is clear that the main cause is inactivity, especially in the form of resistance training7,8.
Other factors of sarcopenia:
Denervation of motor units. Aging causes the functioning motor units to decline. As the motor units decline, there is denervation to the muscles and they die7,8, thus leading to a loss of muscle mass. Research shows that by a large margin the fast twitch fibers die off in comparison to the slow twitch fibers. The slow twitch fibers decline about 1 to 25%, whereas the fast twitch show a loss of 20 to 50%7. As the motor neuron dies, the adjacent motor neuron will take over and re innervate to prevent atrophy8. The problem is that the motor neurons that pick up the slack are usually the slow twitch neurons which fire more slowly, produce less force, and are smaller in number and size7,8. Dr Kravitz believes that this may be the reason that the elder population struggle with balance and speed. The process is called Motor Unit Remodeling.
Hormonal Changes. Aging also causes a drop in many hormones that maintain strong muscles, and an increase in some that inhibit muscle growth7,8. Human growth hormone, insulin-like growth factor 1 (IGF-1), and testosterone all work in symbiosis to promote muscle strength and mass, and they all show a decrease in production as we age. On the flip side, aging increases the production of myostatin and cortisol. Myostatin is a contributing factor to preventing large muscles. It is part of a feedback mechanism to keep muscles from getting too big (bad news for bodybuilders). Apparently, aging also makes myostatin more prominent. Research is validating a hypothesis I've had for years: that the fast twitch fibers are the first to go with sarcopenia, and more importantly, once they are gone, they are gone. I have worked with people in their 50's and 60's who have done a strength training when they were younger, and those who have not. Those that did strength train when they were younger were able to regain most if not all of their strength and mass, whereas the ones who did not strength train when they were younger do not fare as well. This includes the clients that were active when they were younger with activities such as running and cycling.
Fifty years old seems to be a critical time to start a resistance exercise program. It is much more difficult to recruit the fast twitch fibers and keep them active by your 60's and 70's if you do not start when you are in your fifties. This does not mean it is too late to start if you are older, but it does mean it will be more of a challenge.
It is taken for granted that exercise is key for a healthy life. The problem, however, as we get older, is that all those injuries that we sustain from our activities when we were younger start to catch up with us when we are older. Improper exercise can make them worse. Moreover, we all will lose muscle mass as we age if we do not engage in intense strength training. Both of these issues tend to lead to sedentary behavior.
This does not have to be. By implementing the strategies I outlined above, one can exercise safely and intensely to maintain muscle, and by default, good mobility and reserve capacity into his golden years.
- Mayo Clinic: Osteoarthritis vs. arthritis. http://www.mayoclinic.org/diseases-conditions/arthritis/multimedia/osteoarthritis-vs-rheumatoid-arthritis/img-20008728
- Rx List: http://www.rxlist.com/ibuprofen-drug/patient-images-side-effects.htm
- MedlinePlus: Anterior Cruciate Ligament Injury. http://www.nlm.nih.gov/medlineplus/ency/article/001074.htm
- Mayo Clinic: Is weightlifting safe if I have high blood pressure? http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/weightlifting/faq-20058451
- Mayo Clinic: Inguinal Hernia: http://www.mayoclinic.org/diseases-conditions/inguinal-hernia/basics/definition/con-20021456
- WebMD: Inguinal Hernia-Topic Overview. http://www.webmd.com/digestive-disorders/tc/inguinal-hernia-topic-overview
- sarcopeniacure: About Sarcopenia. http://sarcopeniacure.com/about-sarcopenia/
- Chantall, Vella. Ms., Kravitz, Len. PhD. Sarcopenia: The Mystery of Muscle Loss.http://www.unm.edu/~lkravitz/Article%20folder/sarcopenia.html
Doherty, Timothy. Invited Review: Aging and Sarcopenia. Journal of Applied Physiology. http://jap.physiology.org/content/95/4/1717