By Wojtek Chodzko-Zajko
WebMD Live Events Transcript
May 31 is National Senior Health and Fitness Day. Join researcher Wojtek Chodzko-Zajko, PhD, for a discussion about remaining active in your golden years.
The opinions expressed by Dr. Chodzko-Zajko are his and his alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
Moderator: Hello and welcome to WebMD Live!
Dr. Chodzko-Zajko: Thank you.
Moderator: Your guest today is Wojtek Chodzko-Zajko, PhD. Dr. Chodzko-Zajko serves on the American College of Sports Medicine Strategic Health Initiative on Aging and Exercise, and is a professor of exercise science in the School of Exercise, Leisure, and Sport at Kent State University. Chodzko-Zajko is editor of the Journal of Aging and Physical Activity and president of the International Society on Aging and Physical Activity. He served on the scientific advisory committee of the World Health Organization, which recently issued its guidelines for physical activity in older adults, and as chairperson of the Fifth World Congress on Physical Activity, Aging, and Sports.
If you don't mind, I'd love it if you could begin with a little background about yourself and how you first got involved in this.
Dr. Chodzko-Zajko: I'm a professor of exercise science at Kent State, and my main area of interest is physical activity and aging research. I edit a journal called The Journal of Aging and Physical Activity, and I am president of an international society called the International Society of and Aging and Physical Activity. My main interest is to study the relationship between regular physical activity and aging. I'm very interested in comparing older people who are active both physically and intellectually, and socially, with older people who are less active in those dimensions.
Moderator: So, what's taken you out to Indianapolis this week?
Dr. Chodzko-Zajko: I'm at the annual meeting of the American College of Sports Medicine, ACSM, and it is the meeting of researchers and clinicians who are interested in physical activity and sports medicine. There are many people interested in aging and physical activity who attend this meeting.
Moderator: What kinds of topics are being discussed in that area?
Dr. Chodzko-Zajko: In the area of aging and activity, there are hundreds of different presentations at the ACSM meeting, ranging from results of exercise physiology experiments about exercise and aging, to studies on public health and activity, on the psychological benefits of physical activity. A very broad range of different papers are being presented.
Moderator: Was there any research that had you particularly excited?
Dr. Chodzko-Zajko: I've been very interested in following the developments of research from the Centers of Disease Control, and the World Health Organization (WHO) in assessing active living throughout the world. Sedentary lifestyles, or physical inactivity are a major public health challenge in all countries of the world, and the WHO and CDC (Centers for Disease Control) are very interested in developing methods for assessing how active the population is in different countries
Moderator: How do Americans compare to the rest of the world, exercise-wise?
Dr. Chodzko-Zajko: Good question. In 1996, the U.S. surgeon general issued a report on physical activity and health, and estimated that for the older population only about 17% of people over 65 are regularly active. In some other countries, the reported figures for activity participation are a little higher, for example Japan and Canada, but it's not always easy to make comparisons for cultural reasons. The bottom line is, I think that in all countries, there is a need to increase participation levels and physical activity for all age groups. How to do this is a major issue in research and public health planning.
Moderator: Where can one find the healthiest senior population on earth?
Dr. Chodzko-Zajko: The older adult population is tremendously varied. In all countries, you will find individuals who are aging and in very good health, but will also find a poorer quality of life. I don't think it is especially helpful to identify a single country as the best. The major characteristics of aging, there are differences across the population, and those are apparent in all countries.
Moderator: Is there any single way to measure this -- like length of life, body fat?
Dr. Chodzko-Zajko: In the early stages of research on aging, the major outcome variable was longevity or quantity of life, how long the person lives. In recent years, increasing attention has focused on the issue of quality of life. It's not enough to help people live a long life, if they spend the last ten to twelve years suffering from chronic disease, which adversely affects quality of life. There's tremendous interest now in assessing life quality in old age.
Moderator: Let's get to the specifics. How is our senior population doing?
Dr. Chodzko-Zajko: Our older adult population is living longer and longer, not just in the U.S. but throughout the world. For too many older people, old age is associated with physical decline, disability, loss of independence, and chronic disease. It is clear that lifestyle factors, such as regular physical activity, good nutrition, risk reduction, such as smoking and alcohol consumption, can all impact on quality of life for older adults. So some people are doing quite well, but others have significant problems with old age. The chronic diseases, cardiovascular, diabetes, depression, hypertension, and many others, including sarcopenia (that is the loss of muscle strength with advancing age), all of those impact on quality of life.
Moderator: Can those effects be prevented?
Dr. Chodzko-Zajko: That's the exciting part of working in this field. Most of those chronic diseases can be impacted by lifestyle factors that are quite effective, and affordable. The challenge is to find a way to convince people to change their lifestyle.
Moderator: And what's being done in that regard?
Dr. Chodzko-Zajko: There are a number of different organizations in the U.S. that are sponsoring the word about the importance of living sensible living patterns. The U.S. surgeon general report was issued by the surgeon general's office. The Centers for Disease Control, ACSM participate in the national coalition for the promotion of physical activity. All of these have spread the word about the importance of physical activity. Recently, NASA has become involved through its work with Senator John Glenn, and has produced a web site about physical activity and aging that thousands of seniors access every day.
Moderator: I've heard that there's an 'epidemic of obesity' in the United States. Is this true?
Dr. Chodzko-Zajko: Yes, and it's true for all ages, not just older adults, but for children and young and middle-aged persons. America is getting fatter, and more sedentary by the year. This is a public health emergency for our country. And part of the problem for older adults is that the cumulative effects of obesity and inactivity over a lifetime build up to diabetes, heart disease, and other chronic conditions in old age.
Moderator: How is it that we have done this to ourselves?
Dr. Chodzko-Zajko: I think that there are a number of reasons. Part has been an emphasis in culture throughout the world on making life easier, so we drive to work; instead of doing our laundry we have washing machines, dishwashers, many devices designed to prevent physical activity.
Moderator: So, we're victims of our own technological innovation, then?
Dr. Chodzko-Zajko: And also, more specific in the U.S., but in other cultures, too, we have de-emphasized the importance of physical education in our public schools. Many children are not required to participate in any physical activity in school. I think that this devalues the importance of being physically active throughout the culture, and enables people to adopt lifestyles that are routinely sedentary without thinking about it.
Moderator: How do you reconcile the truth about the American population with our projected image through advertising?
Dr. Chodzko-Zajko: I think advertising sends mixed messages. Often we see positive images of healthy and active persons through advertising, but also get advertising promoting different behaviors that are unhealthy such as drinking, smoking, or foods that would not be particularly helpful if abused. I think advertising alone is not going to be sufficient to change the behaviors of the American people. You have to educate and motivate. How do you motivate people to choose to become to more active in their own health and future?
Moderator: How much has our national diet changed in the recent years?
Dr. Chodzko-Zajko: My area of expertise is not in nutrition, but I would say that there's in general, with industrialization and development of more and more industrialized societies, the diet has tended to increase fat levels, and reduce the proportion of calories from carbohydrates, and that's a problem for obesity.
Moderator: How much of our physical condition when we age is based on genetics?
Dr. Chodzko-Zajko: When I started out in this field, people used to think that genetics was the major factor. Now, based on animal studies and research on twins, it is increasingly clear that lifestyle is probably more important in determining successful aging than genetics. Researchers estimate that genetics accounts for between 20% and 40% of the variation that occurs with aging. That's good news. Aging is not something that happens to us, it is something we participate in.
Moderator: What issues should one keep in mind when designing an exercise program for seniors?
Dr. Chodzko-Zajko: I think there are a number of issues. First of all, older adults are a very diverse group. And it is not possible to design a single exercise program that will work for older people. I think you have to recognize it should be a program that has multiple dimensions. If possible, exercise programs should involve an aerobic exercise component, or stamina component, a strength training component, as well as balance, flexibility, and agility. Of course, not all of those have to be done on the same day. The actual mode of exercise can vary. People can choose to walk, swim, bicycle, Tai Chi, many different things.
Moderator: Let's discuss strength training.
Dr. Chodzko-Zajko: Strength training is very interesting. Twenty years ago, we discouraged older adults from lifting weights. Now we encourage weight training for older adults because we know it's safe, and we know that loss of muscle strength is a major factor in loss of independence in older adults. Strength training can slow the loss of muscle strength very significantly. And more and more senior centers, retirement homes, and other aging facilities are introducing strength training programs. You can use weight machines, or more simple systems, such as elastic bands, which are often called Thera-Bands. And there's evidence that all sorts of different strength training programs are quite effective in older adults.
Moderator: How should one determine their weight limits?
Dr. Chodzko-Zajko: Weight limits apply mostly to machines where people are lifting stacks or doing free weights. Ideally, I would encourage older adults to try to get advice from an exercise professional who can help them set up an appropriate training schedule. If that is not possible, I would encourage people to life weights that they can lift comfortably for ten to 15 repetitions, and gradually build up. Part of the challenge with designing a weight training program, is to be sure to exercise the muscles of the body in a balanced way. For example, if you do an exercise that exercises the bicep in the arm, you also need to exercise the triceps, which is the antagonist muscle. If you don't have a balanced program, you can actually increase the risk of injury. For that reason, I encourage all older persons to get straightforward advice before they start to lift weights. That is not difficult to do, and almost all fitness centers or gyms have people who can advise older people how to lift weights sensibly. I know many people 80 or 90 years of age who enjoy lifting weights, and benefit greatly from doing so.
Moderator: Are there qualifications one should look for in a fitness professional?
Dr. Chodzko-Zajko: That's a very difficult question. There are many, many different kinds of professionals, ranging from people with PhDs in exercise physiology, to individuals who set themselves up as personal trainers with no formal education. There's a huge debate in our field whether or not we should demand licenses or certifications for fitness professionals. At present, there are no conclusions in this area, so I would warn people to ask the fitness professional you're working with to tell you about their training. Often on TV, you find people advertising different products, and not always are the claims made by these individuals appropriate and sensible. It's a kind of a buyer beware situation.
Moderator: Can strength training help to prevent osteoporosis?
Dr. Chodzko-Zajko: There's relatively little evidence that says that once you have it, which is loss of bone mass, that strength training alone can reverse osteoporosis. There's better evidence that physical activity is very important early in life. And there's some evidence that physical activity can help manage osteoporosis in old age, by strengthening muscle groups, reducing the likelihood of falls. I would encourage all older persons with osteoporosis to follow the advice of their physician, and to stay as active as possible so that they can minimize the consequences of osteoporosis, while staying healthy and improving their quality of life.
Moderator: Are there particular types of injuries that seniors should watch for when strength training?
Dr. Chodzko-Zajko: I think that in the area of strength training, if an activity is painful while you're doing it, that's a good sign to ease off. But in general, injuries for older people are similar to injuries in younger people. By far the major side effect of strength trainings is muscle soreness, and that usually goes away within a few days of strength training.
Moderator: Let's move on to aerobic exercise.
Dr. Chodzko-Zajko: Aerobics is exercise that stimulates the heart and cardiovascular system. Basically any form of physical activity that increases heart rate for a significant amount of time can be described as aerobic. This can be done many different ways, walking, riding a stationary bike, or actually bicycling, running, rowing, swimming, aerobics dance. No one form of aerobic exercise is best. What is important is that people should be aerobically active on most days, and the means that they choose should be the ones that they are most comfortable with. For older people, many, many people like to walk. Walking is an excellent form of aerobic exercise. When people have conditions that limit their ability to walk, for example, arthritis, very often aqua aerobics, or exercise done in a pool is a good substitute.
Moderator: What kind of target heart rate (THR) should one aim for?
Dr. Chodzko-Zajko: That's a good question. THR is one way to evaluate exercise intensity, and is common used by exercise physiologists. In the older adult population there are some difficulties with THR. Some seniors use medications which influence the heart rate. THR equations need to be adjusted for medication. Some studies have shown that tactile sensitivity decreases with age, so some older persons may have difficulty monitoring their own heart rate. Many seniors might want to use a much more simple method to monitor exercise intensity, and I call that the Talk Test. And that is simply to exercise with a partner, and carry out a conversation. Usually, if you are able to talk comfortably, you are not exercising too hard.
Moderator: Speaking of talking, what have you learned about the connection between social activity and health?
Dr. Chodzko-Zajko: In the older adult population, successful aging, or high quality of life, is dependent upon being able to play a meaningful role in society. As we age, many of the roles that are important to us, jobs, spouse, children, car, income, these roles get taken away from us as we get older. Finding ways to replace roles with new meaningful roles assists greatly in adjusting to old age. For example, many seniors participate in the university of the third age, or senior hostels at programs for older people to continue their education to become involved in social groups, and there's good evidence that this kind of social activity is associated with increased quality of life in old age. How does physical activity relate to this? If older people are too frail to participate in social, cultural, intellectual, and religious programs, very often they become isolated at home, they adopt a sedentary lifestyle, and are at risk for a cycle of decline in health, activity, increased depression. Recently, the World Health Organization has begun to focus on active aging as an initiative that goes beyond physical activity, but really looks at the whole spectrum of being active, rather than treating physical, educational, social activities as being independent from one another An example of this would be, a few years I consulted for a sporting goods company in Japan. They own a large number of commercial gyms and fitness centers throughout Japan. They were very interested in attracting older people into their facilities, and they developed special programs for seniors where seniors could participate in physical activity, social activity, educational programs, they could do calligraphy, read poetry, have tea together, so the idea was to attract people to come for perhaps two hours to a site, and get many forms of activity. On days when older persons were not feeling well, they did not have to exercise, but could still come to their activity center and do something else. I think this kind of broader perspective on activity is very promising, and is the way to go in the future.
Moderator: How much does Japan's attitude about fitness differ from that of America's, considering both countries are in a similar class technologically?
Dr. Chodzko-Zajko: In the journal that I edit, we just issued a special edition on successful aging and activity in Japan. I would say one of the major differences is in the reason, or purpose, for being physically active in the two cultures. In the West, I think many people choose to be active for specific extrinsic reasons, such as improve your health, lower your blood pressure, reduce cholesterol. I think many people in Asia exercise for more holistic reasons to do with harmony, or balance, or simply for a sense of Chi or wholeness. Having said that, there are many similarities between Japan and Western cultures, but there are also significant philosophical differences. If you go to China, Korea, and many other Asian countries, you can see thousands of older adults exercising very early in the morning, doing Tai Chi, or Asian martial arts types of exercises, and it is very inspiring to see. One of our challenges in the West is to learn what motivates older adults in these cultures, and to see if we can learn from the cultures in trying to motivate our own populations.
Moderator: What kind of difference has that exercise made for the Asian population?
Dr. Chodzko-Zajko: I think that you can't generalize to all Asian countries, but there are highly developed Asian countries, as well as developing countries. The population is aging throughout Asia in much the same way as in the rest of the world. The presence of chronic disease is just as much a public health concern in Asia as the West, and there's a significant interest in promoting healthful living just as much as in the U.S. So I know that, for example, the Japanese government recently issued guidelines for physical activity in their country. The Chinese government in the People's Republic of China is also very interested in national initiatives to promote physical activity and aging. Really there are similarities across all cultures across the world.
Moderator: How important is it to remain mentally active? Is it "use it or lose it" for the brain?
Dr. Chodzko-Zajko: It's very important to remain mentally active and stimulated. In much the same way as your physical body needs activity to prevent decline, your cognitive functioning can benefit from regular activity. And a number of researchers study the impact of cognitive training on cognitive functioning, and with clear evidence that older adults can continue to learn new skills, knowledge and strategies, as they grow older.
Moderator: What can you tell us about flexibility and balance exercises for seniors?
Dr. Chodzko-Zajko: There's a belief that flexibility and balance inevitably decrease as we grow older. There's some truth to that, that connective tissue, elasticity does decrease, and that sensory function responsible for balance also changes as we grow older. But there's now strong evidence that individuals who participate in stretching exercises, in balance activities, can significantly reduce that decline. In my exercise program at Kent State, we do many flexibility and balance exercises, and I have seen huge improvements in seniors clinically as a result of simply starting to do exercises they'd never done for the previous 20 to 30 years. Often, we do a lot of exercises with shoulder and head, rotation exercises, and many seniors tell me that after joining my program, they can reverse their car easier because they can turn their heads to see behind them when they're backing up. Those kinds of self-reported anecdotal observations are very common when older people join an exercise program. There've been recent studies looking at Tai Chi, which is an eastern form of martial art that utilizes balance as a major component. There's good evidence that people who do Tai Chi can significantly improve both static and dynamic balance. Static balance is your ability to balance in one place, and dynamic would be more being able to stay in control while moving, walking or some action, both of which are very important for everyday functioning. I think that a key goal of physical activity is not to be physically fit, or to be able to perform sports or activities, but rather to maintain what we call functional fitness, or the ability to function in everyday life. As we grow older, physical challenges threaten our independence, and our ability to perform activities of daily living. The goal of physical activity for older adults is not to become better athletes, or jocks, or other traditional PE (physical education) goals. Rather, the goal is just to maintain independence in everyday activities, to preserve function. That's why it's so important for the older adult population in particular.
Moderator: Well, it's certainly been a pleasure having you by today. Do you have any closing thoughts?
Dr. Chodzko-Zajko: I would close by saying for many years we have treated physical activity in the medical model, as if it were a bitter pill we have to swallow. You won't enjoy exercise, but you should do it because it's good for you. I think it's more appropriate to view physical activity as something fun and enjoyable. The challenge is for people to find activity they enjoy. It could be dancing, walking the dog, going for a swim, and stop thinking of exercise as something prescribed, but rather as a lifestyle choice that you will enjoy. Almost all older persons can find some form of physical activity which they can enjoy, which is realistic, and which will benefit them physically, psychologically and socially.
Moderator: Your guest today has been Wojtek Chodzko-Zajko,
PhD. Dr. Chodzko-Zajko serves on the American College of
Sports Medicine Strategic Health Initiative on Aging and Exercise, and is a
professor of exercise science in the School of Exercise, Leisure, and Sport at
Kent State University. Chodzko-Zajko is editor of the Journal of Aging and
Physical Activity and president of the International Society on Aging and
Physical Activity. He served on the scientific advisory committee of the World
Health Organization, which recently issued its guidelines for physical activity
in older adults, and as chairperson of the Fifth World Congress on Physical
Activity, Aging, and Sports.
The opinions expressed by Dr. Chodzko-Zajko are his and his alone. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.
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