Library : Year 2 | Session 5: Wellness Through Understanding - Overweight, Diabetes, Hypertension
I am a 65-year-old male who had two MI’s seven years ago. I have mild hypertension, COPD and have three lower-back fusions (spinal stenosis, arrested). I am fit and do a complete upper-body workout three times a week at the “Y”, lifting as much weight as I can safely manage (240 bench, 150 lat machine, 140 butterfly, curl 70, etc; three sets, 8-10 reps). I then do 30 minutes on a stationary bike, 20 or more minutes of which is at a heart rate of 120-130 bpm. This whole process takes about 2.5 hours and leaves me spent. I suspect I’m overdoing things, but I have no guidance.
Our local physiatrist group is of no help (interested primarily in rehab medicine), the “Y” trainers have no experience with people like me, and my internist doesn’t have any suggestion except to continue what I’m doing ‘cause I’m in great shape.
Where can I turn for direction in working out an exercise plan that is geared to be my age, physical problems and will stretch me but not beyond the elastic breaking point?--Jim
Dear Jim,
You really know how to embarrass a guy don’t you? Your questions are so important, so simple, and so earnest that slick answers should come easily, but they don’t.
How much is enough? How much is too much? How often? What kinds? are all basic and powerful questions, but the honest answer to all of them is that we really don’t have enough science under our belts to answer you as well as we’d like (just another reason to support the Mission of Fifty-Plus, which is to help generate these answers).
Your workout program makes me tired merely to read it, and here I am getting ready to run the Boston Marathon. You are in the top fraction of one percent of fitness effort, so doing enough is not an issue, but doing too much may be. But as soon as I say this, I identify the huge extra capacity of the human body for work. I marvel constantly at what we are capable of. Friend Dick Laine, age 70, told me last week that he was planning to run four 100-mile mountain trail runs this summer. Is that too much? It certainly is enough, but too much? Who knows?
If you and he, when you are 100, would please report back to us about your state of vigor, then we will all be better off. In the meanwhile, I suggest you continue to pursue your bliss while listening to the wisdom of your body, which in final analysis is usually your best advisor.
I am 53 and not making any gains with the weights. I lift regularly and have a 4-day a week cardio program. I am considering Andro and 19 Nor Andro Products. Will they help a 50+ age person? Thanks. ---Bill
Dear Bill,
My sincere advice to you is to seek a trainer and not a pill. The pills are just too dangerous. And don’t forget, as we age not losing strength is a gain.
I read the Health Notes in the Fifty-Plus Bulletin. I am a member and I have just one or two questions for you. In the August ’99 Bulletin, you answered Earl Beyer’s question on his hip pain.
I have pain often in my right hip after walking for about 2-3 hours. My doctor, Wayne Pietz, diagnosed it to be bursitis. I do not respond well to over-the-counter pain pills like Aleve, ibuprofen, Tylenol or aspirin. In other words, the pain persists. What medication did you think of when you say that bursitis of the trochanter can be pretty easily managed medically?
I also have quite some pain in my left hip, which is a THR, six years ago, after walking for 2-3 hours. The x-ray does not show any trouble in the artificial joint but the pain is there. Would a sports-minded orthopedist be able to help me? I am with Palo Alto Medical Foundation. Who would you recommend? I am a hiker and I hate to have to give it up.--Greetings from Annemarie 65 yrs old and grew up in Switzerland
Dear Annemarie,
Having failed anti-inflammatory drugs for hip bursitis, I would strongly suggest a trial of a cortisone shot, which is in my experience has been very effective.
With pain in both hips, not just one, I wonder whether your gait may be out of whack, and that a physiatrist (a physical medicine doctor) might be a wise suggestion. This expert could analyze your biomechanics, and see whether your movement may be throwing undue pressure on parts of your skeleton. I know the Palo Alto Medical Clinic has three excellent physical medicine physicians on their staff by the names of Yu, Lu, and Wu.
I am 60 years old and somewhat of a runner. That is, I still run at least once per week, sometimes 3 times per week. I belong to a health club so my running is on a treadmill. My schedule for working out is aerobic exercise three times per week and weight training twice per week. I have been running over 20 years. I really do enjoy it. I went from running marathons 20 years ago to a 30 minute run currently. I look forward to my run days and feel good afterward.
Recently, I purchased a heart rate monitor (a lot of club machines now have the heart monitor capability). When I joined this club in 1992, I was given a physical fitness test. The report I got back indicated my target hear rate should be between 114 and 132 beats per minute. Well, I never checked my heart rate all these years but the first day I wore my HRM was a run day and I set the treadmill heart rate monitor to a maximum of 132 and set my speed to 6.5 MPH (my normal warm up speed). In a few minutes I boosted the speed to 6.7 and started watching the HRM readout. It had jumped up to 135 and my speed falls to 6.5 (to keep me at my target heart). I stayed at this speed sometimes slower but I did not enjoy it. I felt I should be doing more. I talked to one of the fitness attendants. He said the target heart rate was not exactly scientific and thought I could run above the 132 mark but still below the 160 (220-age) mark.
Certain events in recent years have gotten me wondering and concerned. Maybe I have been overdoing it.
In early 1990s I had several echocardiograms because of leakage in my tricuspid. This was caught on my annual physical. One year I noticed I didn’t receive the echocardiogram so my next physical I asked and was told, “It disappeared”.
I like to warm up on my aerobic exercise day with ten minutes on the rowing machine. In order to track my progress, I watch my “calories used” on the machine counter. My average was 130. One day I felt good so I went for a new record and hit 137 calories but in the final minute or so the right side of my head felt like it was traumatized with a blow to the head. Needless to say, I made an appointment to se my doctor. He scheduled me for a brain scan with and wi/0 injection. It showed nothing and nothing more was said. I continue to row but now stay below 120 calories. Above that, the headache returns. This was in 1997. I do not have this headache while running.
In November of 1999, I bent over to pick up something. I might have stayed a few seconds. When I stood up I felt like someone hit the right side of my head with a baseball bat. I didn’t get sick but I did not feel like eating that evening. The headache reappears when I strain, like picking up too much heavy weights, and late at night just laying in bed. But it is not nearly as bad as when I stood up for the first time.
Are any of these events related? Am I blowing a head gasket? Or am I over doing my exercising? I see my doctor in two weeks for my annual physical.--Kenpatt
Dear Kenpatt,
Thanks for inquiring about your interesting clinical situation. By the time you read this, you will have already had your annual physical exam, so I am hopeful that your question will have been answered before.
The part of your story that grabs me is your recurrent headaches, which happen predictably with heavy exertion. Your negative scan exam is reassuring, but unfortunately doesn’t provide relief for your headaches. Maybe they have a muscular origin, or a vascular cause, or maybe something entirely different, but whenever a symptom doesn’t self-correct, I think that it is worth a more in-depth look. I would consider a consultation with a neurologist as a logical step.
I am a 71-year-old avid hiker who loves nothing more than a brisk 5-mile walk in the hills above my home. In the last two years, I have been bothered by frequent head colds with all the associated miseries, which accompany them. My question is this, is this just the luck of the draw, or as we age are we all subject to increased risk of infection?--Dolly, Evansville, IN
Dear Dolly,
In the January issue of Medicine and Science in Sports and Exercise, there was an article written by scientists in Lyon, France. In the two-year study of 61 persons 66-84 years of age, the authors concluded that the number of days which are burdened by cold symptoms is inversely related to the amount of daily energy expended in exercise. This finding is similar to others, which note that immune function, in general, is improved by a conditioning program. An additional point must be made, however, and that is that very hard exercise, such as marathon competition, tends to lower the resistance to infection immediately following the event. The Greeks knew a long while ago the “everything in moderation” was sound advice.
The millennium has come and gone without any substantial disruption, but I am disturbed to read that the Surgeon General finds that our nation’s health is not improving, and in many respects seems to be getting worse. Any comment?--Bill, Fort Worth, TX
Dear Bill,
Certainly, we are not as bad off as Russia, whose mortality rates are rising precipitously, but it is disheartening to hear that despite all the money spent on our health, and the amount of new science information that is available, America’s health profile is still too fat and too lazy. The Healthy People 2000 objectives were not met, and in some categories, kids’ obesity, exercise, and smoking habits, we look pretty bad. New guidelines (Healthy People 2010) are available. 467 objectives and 26 specific focus areas are in these guidelines. They are pretty modest, but I fear that unless our self-satisfied nation heeds a wake-up call, we will be in for another disappointment 10 years from now.
HHS Secretary, Donna Shalala, calls pursuing these objectives “a moral imperative” and states, “We want 100 years for every child born in this century”. We’d better get going.
I know you have previously called attention to the growing epidemic of Type II (adult onset) diabetes in our country and to the importance of physical inactivity in this disease. Are there any clues as to the specific site for this protective effective exercise. I am a Type II myself, and used to need drugs, but since I have adopted a running lifestyle my blood sugar level is almost all normal, and with no drugs either. Thank you.-- Ben, Kalamazoo MI
Dear Ben,
Last month I attended a major meeting of our Department of Medicine at Stanford featuring an expert from Yale lecturing about Type II. For nearly an hour he went on, illustrating in great detail the specific steps involved in insulin promotion of sugar metabolism in the cell. Each step suggested to him a different new drug potential, which could be effective.
I politely said, “Why not exercise, instead of drugs?” Indeed, in the January 4 issue of the prestigious Proceedings of the National Academy of Science workers from the Karolinska Institute in Stockholm reported that exercised rats demonstrates precisely the beneficial actions of exercise on the insulin steps which the Yale expert had consigned to potential drugs.
The problem, it turns out again, is that there is no money in exercise and prevention, but there is lots of money in drugs.
Surprise? Think of all the money you are cheating the drug companies of simply because you started to run.
I recall having read in the past your observations that exercise has been shown to increase intelligence. I find this proposal so important that I wonder if there is any new information that bears upon it. -- J. L, San Diego CA
Dear Jay,
I am sure what you remember is my excitement at reading the report of Bob Dustman of Salt Lake City several years ago. His research indicated improved IQ scored in subjects after having immersed themselves in an exercise protocol. Several other research scientists have pursued this line of inquiry.
You may have seen a small note in the New York Times several weeks ago, which abstracted an article that appeared in the November 9, 1999 issue of the prestigious Proceedings of the National Academy of Sciences (PNAS). This prompted me to seek out the original article by Fred Gage and colleagues at the Salk and Howard Hughes Institutes in La Jolla. The article was entitled "Running Enhances Neurogenesis, Learning, and long-term Potentiation in Mice".
The authors reviewed the familiar work, which demonstrates increased brain cell branching in environmentally stimulated mice as well as the new info that formation of new nerve cells is actually stimulated by running.
Gage's experiments involved allowing 17 mice (the runners) free access to a running wheel. They ran an average distance of 4.8 kilometers per day (WOW!). They continued this activity for two to four months, at which time they were tested for their maze solving ability, which was markedly better than the non-running rats. Further, exams into the brains of the two groups revealed that the exercisers had twice as many new brain cells. The conclusion was that running not only improves learning, but it also increases new brain cell formation. These changes could result from elevated levels of brain growth factors, increased formation of new blood vessels, or higher levels of the central neurotransmitter serotonin - all proven outcomes of an exercise program.
So your question about new information about the effect of running on the brain is hot. There is an awful lot of good work going on, and all of it seems merely to add to the ever-lengthening list of important benefits conferred by an active lifestyle. But all of us Fifty-Plus members already know that. Don't we?
I am actually embarrassed to be writing you about this vanity concern, but several visits to my doctor, including tests and x-rays, have failed to give any explanation for my problem which is this. I am a healthy 71-year-old woman who has always had a nice figure and have been proud of it, as is my hubby. But in the last two years my abdomen has begun to bulge, particularly the lower part. My clothes don't fit very well, and I look, frankly, pudgy. I haven't gained any weight, and I know I don't have a tumor or hernia because my doctor has checked me for these, but the fact remains that my girlish figure isn't so girlish any more. Any ideas? -- Amy, Columbus OH
Dear Amy,
Your story sounds extremely familiar. I cared for a lovely older woman for a number of years who was virtually driven to distraction by the very situation, which you relate. I am sure we went through the same type of inquiry, which you have been through, and with the same negative results. Finally, we concluded that her prominent tummy was due to the fact that she had simply shrunk as a result of marked osteoporosis of her spine. Her original height of nearly 5' 7" had diminished to 5"2" - she had lost five inches of height and as a direct result, the contents of her abdomen, which had not shrunk, were crowded into a smaller cavity which resulted in a new, and to her totally unacceptable, profile. This is like an accordion when it is compressed. Belly exercises or a girdle didn't help because the problem was not susceptible to these efforts. Reassurance was all I could offer her, and you, but she wasn't happy about this answer, as I suspect you won't be either. But at least you should have the confidence that nothing serious is going on inside your tummy, and I am sure your husband still loves you regardless of your new shape.
Walter Bortz, M.D., is a Clinical Associate Professor at Stanford University Medical School, a member of the Palo Alto Medical Foundation, and former president of the American Geriatrics Society. He has written several books on health lifestyles and aging.
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