Better Outcomes-Less Time:

Active Aging Week by Marsha Fretwell, MD

September 27th through October 3 2015 is Active Aging Week throughout the United States, Canada and Australia. Led by the International Council on Active Aging, it is an annual attempt to get older folks moving, both physically and psychologically. Why? Because we have more than enough scientific evidence to demonstrate the overall health value of exercising our bodies and minds, but that has not been sufficient to motivate most of us to actually do the work.

In this article, I will present a new way of looking at exercise that I hope will motivate all of you to get up and start exercising every day! First, let me present my background. After 30 years in practice, I have just given up my primary care practice looking after older folks, mostly 75 years or beyond. About 30 years ago, as I was preparing slides for presentations about all the chronic conditions associated with aging, I made a very important observation: every one of these so-called inevitable accompaniments of aging (arthritis, depression, heart disease, diabetes, strokes, constipation, more fat than muscles, insomnia, falls, etc.,) had EXERCISE listed as an intervention that could reduce or reverse them. Every one of them!

At that moment, I changed my entire approach to medical care and began trying to see that every one of my patients included exercise in their own health care. I wish I could say I was successful, but all of us know the 500 different reasons why exercise on a given day is just not the thing we feel like doing. I did make some inroads by developing strategies that fit the personality of each patient. My most successful approach was to suggest that one just walk to the front door, look at your watch, gently walk 15 minutes away from your house and then return home. I became the queen of “anything is better than nothing”. For those individuals who lived in retirement communities, assisted living homes, and skilled nursing, I worked with administrative and nursing staffs to put seated exercise bikes in their budgets and make them very accessible. Again, we experienced partial success. Finally, I became the Medical Director of a community based day center, caring for frail adults who wanted to remain in their homes. This time, I actually did say, “I am the Queen and everyone will exercise” 30 minutes the 3 to 5 days a week they visited the center. To my amazement, within 1 year, 85% of these nursing home eligible folks were using seated bikes or a device call a TREDLR™, which mimics the Singer sewing machine treadle, for 40 minutes a day. Lesson learned: If an activity actually becomes part of the culture, most folks will go along.

The science underlying the value of exercise has grown tremendously over these last 30 years. Most importantly, we now know that 150 minutes of moderate exercise (brisk walk) a week achieves almost all of the positive effects on those dreaded “geriatric syndromes”, especially raising the good lipids, and lowering the inflammatory state that underlies, diabetes, heart disease and stroke. Arthritis improves with exercise by building muscle to support the joints and lowering the inflammatory proteins in our bodies. Depressive mood is also responsive to exercise. Most importantly, it has been demonstrated that 7½ hours of walking a week will significantly reduce the risk of developing dementia. But it is a study on rats (bred to develop Alzheimer’s disease) that provides us with the new way of looking at exercise that I believe may bring about the cultural shift we need. Alzheimer’s disease is a degenerative disease where breakdown products of brain energy production collect in the cells and tissues of the brain, inevitably causing the healthy cells to die. Exercising the rats on a treadmill led to a reduction in these inevitable breakdown products in their brains.

Based on this work, I began using a different approach to exercise. As we now know it, increased exercise leads to increased blood flow to all of our tissues and organs and thereby removes the “trash” of our essential metabolic activity. Once we begin to realize that exercise is just “taking out the trash”, I hope we can begin to visualize our 30 minutes a day, 5 days a week as our daily responsibility to ourselves, our families and community. Almost all our gains in health and longevity over the last 300 years have been related to the public health efforts of trash removal and pure water. Now we see that the same principles operate in our tissues and organs.

Here is Asheville, we have recently been struggling with some issues of effective trash removal. What would our city be like if we never took out the trash or even if our trash removal operated every 2-3 weeks in a neighborhood? What if you washed your dishes once a month? Now visualize the “trash” accumulating inside your cells and tissues because of your sedentary life style. Today, start including exercise in your everyday life to increase your blood flow and clean out your cells and tissues. A 30 minute walk every day is where you start because you don’t want that “trash” building up.

Marsh Fretwell, MD, ret.