50 is the new 40.

Medical research and back-up means that the average life expectancy is increasing. Australian men (79 years) and women (84 years) are ranked 4^th and 3^rd respectively internationally for life expectancy. Australian society is aging. Physically we hit our peak in our early to mid 20’s, thereafter physiologically we’re on the downhill spiral. How quickly we take this slide is largely dependent on the lifestyle choices we make. Choose poorly and not only will you shorten your life but also increase your vulnerability to a variety of lifestyle/degenerative diseases such as heart disease, Type II Diabetes, high blood pressure and certain forms of cancer (e.g. Bowel cancer). In essence you won’t live as long as you otherwise could and you’ll be more ill in the later stages of your shortened lifespan. Conversely, if you make the “right” choices not only will you live a longer life but you’ll also be able to condense down the amount of illness you experience to your later twilight years. In other words instead of struggling with illness for the last decade of your life you may only be ill for the last 18 months.

Choosing well gives you more quantity and quality of life.

The practicalities of the matter are that regardless of what you do, eventually you’re going to slow down – that is unavoidable, but what you can do is slow the slow down. As mentioned above during your early to mid 20’s your physiology peaks, plateaus and then starts its downward spiral – we know this as the aging process. Left to its own devices your “maximal oxygen uptake” or VO2max – the gold standard of cardiovascular fitness – will decrease by about 1% per year from your mid 20’s onwards.

In this regards it really is a matter of “use it or lose it”. Most top endurance athletes (of which VO2max is the critical determinant of performance) don’t peak until their early 30’s and if trained appropriately can maintain that peak through their mid to late 30’s – such is the power of exercise.  So, if you want to hold onto your cardiovascular fitness – which has a direct correlation to longevity – work it! At a minimum 3-4 times per week, ideally daily. It doesn’t have to “hurt” and you don’t have to be left doubled over in exhaustion at the end of a cardio session but you do need to have at least broken a sweat.

50 plusers respond in a similar fashion to cardiovascular exercise as their younger peers. Longer, easier cardiovascular exercise (e.g. A moderate paced 45-75 minute walk) will eat through your body fat levels and help optimize your body composition.  As we age and muscle fibre size shrinks and intramuscular fat stores (fat deposition between the muscle fibres) increase. Low intensity, longer duration aerobic exercise as described above taps into these fat stores and helps to keep the 50 year old plus leaner.

If all the exercise you do is of this type (longer duration, lower intensity), you’ll remain lean but your cardiovascular fitness will eventually decrease because it isn’t being “challenged”. To improve your cardiovascular fitness you have to “huff and puff” and become a little short of breath.

So, twice a week you need shorter (15-30 minute) more intensive type cardiovascular  sessions.  Such sessions will help maintain your VO2max or “cardiovascular fitness”.

“Fitness” per se has three main components to it:

1. Cardiovascular function – as discussed above.

2. Strength.

3. Flexibility.

Let’s look at the remaining two fitness components of the fitness equation and what happens to them as we age. Like cardiovascular function, strength also declines with age. This happens in direct relation to the amount of muscle mass. As we age our muscle fibres shrink or “atrophy” which is the technical term.  Now here’s the first big tip. If you’re looking for the fountain of youth get into strength training.  Strength training IS the fountain of youth.

By strength training three times per week, particularly if you haven’t done any strength training before, not only can you slow the aging process, you can actually reverse it! Simply spending 30-45 minutes in the gym, 3 times per week lifting relatively moderate to heavy weights (2-3 sets of 12-15 repetitions per set) builds local muscular strength and endurance.  As our muscle mass increases so too does our “resting metabolic rate” – in other words the amount of energy we chew through at rest whilst we’re doing nothing. In this manner building a greater muscle mass (hence more “active” tissue) our bodies expend more energy simply sustaining that extra muscle.

The result – you get leaner whilst resting!

The benefits of strength training are much more extensive than just the beneficial effects experienced in relation to body composition. The regular strength trainer can expect to:

• Improve body composition.
• Increase their resting metabolic rate – which means you can consume more food without putting on body fat!
• Improve balance and coordination.
• Lower the possibility of osteoporosis.
• Lower the possibility of orthopaedic problems (e.g. Lower back pain).
• Improve strength for everyday functioning (e.g. Lifting the shopping out of the car, working in the garden).

As we age we tend to get less flexible and stiffer. The old adage of “use it or lose it” couldn’t be any truer than when considered in relation to flexibility. Ideally for every minute spent engaged in cardiovascular exercise or strength training you should aim to spend 10% of your time stretching. How many times per week? For the best results – daily or at a minimum 5 days per week.

Stretching should be done slowly, progressively taking the muscle (or muscle group) to the point of stretch and holding it there for 20 seconds, three times on each side of the body. There’s another old saying around physical training circles “A long muscle is a strong muscle”. In other words, maintaining your flexibility will help in maintaining the strength and function of a muscle or muscle group.

The benefits of stretching include:

• Enhanced muscular function and range of motion.
• Lowered incidence of tears and injury.
• Improved coordination and “proprioception” (a knowledge of where one’s body is in space) – crucial in lowering the risk of falls as we age.

The Seven Golden Rules of Exercising when aging:

1. Get a Check-Up. If you’re a male over 35 or a female over 40 and you’ve been sedentary for the last few years your first port of call before starting any exercise program, making any dietary changes or embarking on any lifestyle modification program is to have a comprehensive check-up with a medical practitioner. This is even more important if you, any of your siblings and/or parents have any history of degenerative diseases like heart disease, stroke, etc. At a minimum you should ask your doctor to take a full medical history, check your blood pressure, conduct a stress ECG test and complete a full blood test. This will give both you and your doctor a good starting point as you embark on your new lifestyle. Most people will visit their dentist once a year for a check-up on their teeth, they’ll get their cars serviced every 10,000 kilometres, but when was the last time you had your cardiovascular system checked? As a rule of thumb everyone beyond 40 should be doing this annually.
2. Start easily and build slowly and progressively. I’d like a dollar for every person I’ve seen make the decision to “get fit”. This often happens at the start of the year as part of a new year’s resolution and it’s done with the best of intentions. In the space of two days they’ve spent a couple of thousand dollars on exercise equipment, quit smoking a packet a day, changed their dietary habits completely and launched into a training regimen that would make an Olympian wince. What do you think happens? Correct, within two weeks the exercise equipment is gathering dust in the corner, they’re back on the smokes and McDonalds is once again their choice of nutrition. When I say start slowly and progressively I apply that to every aspect of your lifestyle. The habits you’ve established over the last 40 plus years can’t be changed in a week. If you’ve smoked a packet of cigarettes for the last 20 years cut down by 2-5 for the first week, 8 in the second, 10 in the third and so forth. Do it progressively over time. Same with your exercise habits. Aim to get out and do something every second day to start with. Even 15 minutes worth of exercise is a great start. Once your body adapts to this lengthen the duration but keep the intensity low. Your body will adapt and strengthen – over time so don’t rush it. The less fit you were to start with the longer it will take to recondition yourself. Keep challenging your body by progressively overloading it with exercise –  5-10% more next week than what you’ve done this week. Within 3 months you’ll be doing things of a physical nature than 3 months earlier you wouldn’t have dreamt possible. If you know your dietary habits are poor make some subtle changes, 2-3 little changes each week. The first week you might start eating breakfast and changing from full fat milk to a low-fat version. Week two you may aim to increase your fruit and vegetable intake to meet the nationally recognized recommendation of 2 and 5 (two pieces of fruit and five servers of vegetables). Over time you build up your repertoire of changes so that in three to six months time they have become habitual and your new lifestyle won’t even resemble what you’re doing at the moment. However if you try and do it all overnight you’ll more than likely fail.
3. Do it with a friend. Find and exercise buddy. On those cold winter mornings when the temptation is to roll over and go back to sleep if you know you’re scheduled to meet someone for a walk or at the local gym you’re less likely to bail out. Exercising with a friend is a fantastic motivator. I’ve worked with countless people who’ve joined my training squads as a couple and trained towards various events. Setting a goal and objective such as a community fun run gives your exercise purpose and direction, training towards it with a friend increases your motivation by measuring your progress against your training partners – it’ll give you a lot of impetus.
4. In line with the previous point set some tangible short and long term goals. These are often referred to as S.M.A.R.T. goals. (i) S: Specific. Be as specific in your goal setting as possible. This will focus your attention and make you target your effort. An example, of a specific short term goal would be by October 4^th of this year I want to do the local 8km fun run in under 48 minutes. (ii) M: Measurable. Your goals need to be measurable in nature. In our previous example if we had have said, “By October 4^th I want to be able to run.” This isn’t really a measurable goal is it? Run how far? How quickly? Making your goals measurable gives you something tangible to achieve. (iii) A: Achievable. You need to ensure that your stated goals extend your current capabilities but not to the point where they are beyond your ultimate ability level. Chances are if you’re 52 years of age, have never run before and are taking up running for the first time, regardless of how much you improve you’ll never be likely represent Australia at the Olympic Games in the marathon. Setting such an unachievable goal sets you up for failure and disappointment. On the other hand targeting the World Masters Games in 18 months time to finish the marathon in under 3 hours and 30 minutes may well be an achievable goal. (iv) R: Realistic. This point follows on from the previous point of making something achievable but challenging. Be realistic in your exercise aspirations. Setting the bar way beyond your capability level sets you up for disillusionment and disappointment. It is far better to extend yourself towards a realistic goal, obtain it and experience those emotions of achievement that accompany such an experience. Nothing motivates like winning – set yourself up to feel like a winner. (v) T: Time. Your goals need to be time dependent. Without this time dependency your goals become open ended and wishy washy. “I’m going to run 10km in 50 minutes one day.” What does that mean? “When?” are you going to do it? Setting timelines against your goals gives them a sense of urgency and keeps you focussed and working with purpose rather than missing two days here and a week there. If your goal is time dependent and looming closer and closer it is more likely that you’ll stay focussed and on target.
5. “Try before you buy”. If you’re thinking about joining a gym or taking up cycling, whatever “try” it before committing yourself to the undertaking. Many a dollar has been wasted when the best intentions aren’t followed with consistent action. Take a 1 month membership out with a gym before making to a 12 month commitment. If after half a dozen visits you find you’re bored senseless and can’t stand “going to the gym” then you haven’t flushed $800 plus down the tubes. Same goes for any physical undertaking you embark on. If you don’t enjoy it you’re unlikely to stick with it so rather than investing heavily in it, shop around. You mightn’t enjoy the gym but you may find that you really enjoy netball and rock climbing so focus your attentions there. It really doesn’t matter what you do as long as you do something. To that end you’re more likely to persist with something that you enjoy rather than forcing yourself to do something your find laborious.
6. If you’re going to get yourself some “professional” guidance in your diet and exercise regimen insist on getting a true professional. At a minimum the health professional you’re dealing with should hold a university degree in Human Movement for the exercise component of your program and a degree in nutrition to counsel you on your diet. Unfortunately the health and fitness industry is one of the most poorly regulated industries in the country. The industry is rife with pseudo professionals. A “personal trainer” who has completed a part-time 6-12 week course is “qualified” to give you training guidance. In the general publics eye they are viewed in a similar light to an “exercise physiologist” who has, at a minimum, a 3 year full time university degree behind them. It is similar for dietitians – everyone eats so everyone is an expert when it comes to nutrition or at least it appears that way. To be called a “dietitian” (or more accurately an APD – accredited practicing dietitian) the health professional involved must have completed a minimum of a 3 year undergraduate degree. In contrast anyone can call themselves a “nutritionist”. Ask both perspective your exercise and dietary counsellors precisely what qualifications they hold. If they don’t, at a minimum possess an undergraduate tertiary degree look elsewhere. The nonsense and misinformation espoused by pseudo professionals in the health and fitness realm is not just concerning but downright dangerous. If you’re unsure about who you should be seeing in your local area visit the following websites. For an exercise physiologist go to: www.essa.org.au and for a dietitian see: www.daa.asn.au
7. Get the biggest bang for your buck. Given that most people are time poor these days and don’t want to spend inordinate amounts of time exercising do those activities that’ll give you the greatest return on time invested. Every exercise program should include five fundamental elements: (i) A warm up. This increases your body temperature, elevates your heart rate and respiration and prepares your body for the upcoming exercise bout. (ii) Aerobic/cardiovascular conditioning. Remember; (a) longer slower sessions will help with your body composition by burning fat and helping you become leaner while (b) shorter, more intense sessions will improve your heart and lung fitness by challenging your cardiovascular system. After basic fitness has been achieved a sound aerobic conditioning program should have elements of both to ensure the participant achieves both important physiological adaptations. (iii) Strength. A sound exercise regimen needs to strengthen all the body’s major muscle groups as well as the functional stabilizers. Strengthening the body’s major muscle groups is an excellent safeguard against osteoporosis for the aging individual as well a real metabolism kick-starter. Improving the functional stabilizing muscles helps to offset issues such as lower back pain and the risk of falling often experienced by the aging individual as coordination and balance falter. (iv) Flexibility. Improved flexibility provides a number of benefits to the beyond 50 demographic. Maintaining and improving flexibility lowers the chance of muscle tears and strains, helps to lower post-exercise muscle soreness and off-sets the incidence of various skeletal muscular related problems such as neck, shoulder and lower back pain. Many of the skeletal-muscular pains we experience in later life are the result of long term poor postural habits and muscular de-conditioning. Combining appropriate strength training with flexibility exercises can, in the vast majority of cases that don’t have some underlying medical causation, alleviate such pains. (v) Cool down. All exercise programs should have a cool down phase included in them. This allows the body to gently return to a resting state. During an exercise bout the body will be producing various exercise by-products (e.g. Lactic acid). By gently tapering off the exercise bout the body is able to dissipate such waste products. Abruptly terminating an exercise bout where you’ve been using the large muscles of your legs and/or back (e.g. Swimming, running or heavy strength training) increases your chance of fainting as the body is sending blood to these large muscle groups, the contractions of these muscles literally “squeeze” the blood back to the heart for recirculation. Stopping the exercise abruptly eliminates this “muscle pump” and increases the possibility of collapse as the blood “pools” in the previously exercising muscles critically lowering blood pressure, similar to getting up too quickly out of bed or standing up quickly from a chair and getting head spins.

From a nutritional perspective the needs of the aging and elderly are similar to the rest of the population and it is impossible to provide a “one size fits all recommendation” as many factors affect nutritional requirements. The following recommendations ensure (in the form of a balanced and varied diet) an adequate supply of energy, nutrition, and protective elements (e.g. Anti-oxidants and the like) and represent a healthy eating pattern. This is targeted at the healthy older "average person" with normal physical activity habits (i.e. Active without “training” ) - in other words a person with average energy and nutritional requirements. Exceptions must be made for sick older people or those with heavier exercise habits. As such the portion sizes will differ accordingly.

Note: words in italics and bolded are particularly important for people with a propensity for or existing obesity.

Fats and Oils

Daily consumption: 2 teaspoons (10 g) vegetable oil with a high proportion of monounsaturated, unheated fatty acids (e.g., canola oil, olive oil) in salad dressings for example.

Maximum daily consumption: 2 teaspoons (10 g) grease or oil (e.g., peanut oil or refined canola and olive oil) in food preparation.

Daily consumption: At most 2 teaspoons (10 g) spreadable fat (butter or margarine) on bread.

Daily maximum: One meal heavy in fat such as deep fried foods, breaded foods, cheese dishes, fried potato cakes, sausage or cold cuts, cream sauces, cake or pastry dough, chocolate, etc.

Pastries/Snacks
Enjoy them in moderation; at most 1 small portion daily (e.g., 1 scoop of ice cream, 1 bar of chocolate, 1 piece of cake, 1 handful of chips, a half handful of salted nuts).

Sweets, potato chips and other snacks are mostly heavy in fat, and therefore should be eaten as little as possible!

Meat, Fish, Eggs, Legumes
Weekly consumption:  2-4 meals of one portion of meat (1 portion = 80-120 g). More is unnecessary, less is no problem. Give preference to low-fat lean cuts of  meat!.

Weekly consumption: At most one meal of cured meats such as ham, sausage or bacon in place of meat.

Monthly consumption: At most one meal of offal such as liver, kidney, tripe, sweetbreads (1 portion = 80-120 g).

Weekly consumption: 2-3 portions of fish – preferably fatty fish such as sardines, mackerel, etc. (1 portion = 100-120 g).

Weekly consumption: 1-3 eggs, including processed eggs, e.g., in baked goods, soufflés, or cream sauces.

Weekly consumption: 2-3 portions of legumes and legume products such as lentils, chickpeas, Indian beans (1 portion = 40-60 g, dry weight), tofu (1 portion = 100-120 g).

Milk and Milk Products
Daily consumption: 2-3 portions of milk products (1 portion = 0.2 L milk or 1 cup of yogurt or
30 g hard cheese or 60 g soft cheese; 1 portion contains about 250 mg calcium). Wherever possible opt for low-fat options

Low-fat and reduced fat products are preferable.

Grain Products and Potatoes
Daily consumption: These should form the basis of the diet. Eat at least 3 portions of starchy foods such as bread, potatoes, rice, cereals or pastas, preferably whole-grain products. Portion sizes depend on the amount of physical activity.

Use low-fat preparation methods.

Fruits
Daily consumption: 2-3 portions of fruit, raw if possible (1 portion = 1 apple, 1 banana, 3 plums or a bowl of berries).

Vegetables
Daily consumption: 4-5 portions of vegetables, one of which should be raw, (e.g.  As a dip vegetable or a mixed salad). 1 portion = 100 g raw or 150-200 g cooked vegetables, 50 g leafy green or
100 g mixed salad.

Non-alcoholic Drinks
Drink at least 1.5-2 litres of liquid per day, preferably unsweetened and non-alcoholic drinks such as water. Alcoholic drinks should be limited to 2 standard drinks (male) and 1 standard drink (female) with at least 3 alcohol free days per week.

Attention: Make up for large losses of fluids (e.g., due to heavy sweating) by increasing your liquid intake accordingly.

Nutrition for the elderly - a checklist

1. Maintain a steady body weight (BMI 20-24.9), lose excessive weight (BMI > 30)
2. Drink a sufficient liquids to match daily fluid losses
3. Eat one protein-rich food daily
4. Eat plenty of fruits and vegetables and whole-grain products

Over 50’s are not unlike the rest of the community in their exercise needs and dietary requirements. They do however experience a number of subtle differences that must be addressed, particularly when embarking on a training program for the first time after an extended period of being sedentary. The long term benefits of appropriate lifestyle modification are significant and far reaching for the aging component of our community.