Losing weight and increasing fitness in old age

Best way to improve health is a global exercise strategy, Christopher Labos says.

The other day I got an email from a reader who had a bone to pick with me regarding my article on intermittent fasting. He asked me why all my articles were aimed at “those youngsters in the 60+ crowd” and why I don’t focus on people like him, 87 years old and going strong, who want to lose a little weight and stay healthy.

The question is a good one, but hard to answer. Most clinical trials don’t enrol elderly patients. That’s because younger patients take fewer medications, have fewer underlying medical problems and have fewer side effects. But while that makes the trials run more smoothly, it’s hard to know if something that works for a 40-year-old will work for a 70-year-old.

Weight gain is, unfortunately, common as we age. There are many factors at work, though many people simply gain weight slowly throughout their lives and the cumulative effect only becomes noticeable after a few decades. Also, people tend to lose muscle mass as they age, which in turn slows down their metabolism and leads to more accumulation of fat.

While you may wistfully wish for the body you had in high school, the main problem with obesity is not esthetic. Excess weight can lead to a decline in physical functioning and cause frailty. Obesity is a major risk factor for developing arthritis of the knees, because every excess pound puts incrementally more stress on these two joints.

Also, people can de-condition quickly. If you start avoiding stairs, you may find them hard to conquer if you try to tackle them again. Poor muscle strength threatens independence and an unsteady gait puts people at risk for falls.

The point is, reversing weight gain and physical decline in the elderly is critically important, which makes the underrepresentation of the elderly in clinical trials all the more unfortunate.

Obesity is a major risk factor for developing arthritis of the knees, because every excess pound puts incrementally more stress on these two joints.

However, a recent study in the New England Journal of Medicine gives a fairly good guide on how to address the problem. The Lifestyle Intervention Trial in Obese Elderly looked at how to address weight gain and frailty in older patients. In 2011, the same authors published a study showing diet and exercise worked better than either did alone.

But what type of exercise is best for an older patient? That is the question the newer study sought to answer.

Researchers recruited 160 subjects who were overweight (their body mass index or BMI was over 30) and were sedentary (they did less than 1 hour of exercise per week). The average age of the participants was 70.

Researchers divided the participants into four groups: a control group, an aerobic exercise group, a resistance training group and a combination group that did both aerobic and resistance training. Aerobic training consisted of either treadmill walking or bicycling, while the resistance training involved exercises with light weights. Groups also got advice about healthy eating habits.

All three of the exercise groups did better than the sedentary control group. The aerobic exercise group, the resistance exercise group and the combination group all lost about 9 kg (roughly 20 pounds).

However, when they were given a physical performance test that involved various tasks like climbing a flight of stairs, walking 50 feet and standing up from a chair, the combination group of aerobic and strength training exercise did best.

In the end, the best way to improve your health is a global exercise strategy. In terms of weight loss, it doesn’t seem to matter much what you do, as long as you eat less and move more. But in terms of physical fitness, a program of cardio and light weights seems best for improving overall conditioning and health. That should hold true even for the youngsters in the 80+ crowd.