The Lucky Years: How to Thrive in the Brave New World of Health (30 page)

In 2006, Robert Wolfe, who is now director of the Center for Translational Research in Aging and Longevity at the University of Arkansas for Medical Sciences, wrote a paper for
The American Journal of Clinical Nutrition
titled “The Underappreciated Role of Muscle in Health and Disease,” in which he chronicled muscle’s role in the body.
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Over the past several decades Dr. Wolfe has performed pioneering research in human metabolism, especially as it relates to aging and specific medical problems. In this particular publication, in which muscle is described as the unsung hero, he emphasizes muscle’s contribution to the prevention of many common conditions and chronic diseases. His paper echoes what other scientists have found when they examine the biological benefits of muscle and muscular strength.

More muscular strength has been shown to be associated with the following:

• smaller waist circumference

• less weight and fat gain

• lower risk of developing hypertension

• less insulin resistance

• lower chronic inflammation

• lower risk of high blood pressure

• lower levels of triglyceride (blood fats)

• lower levels of bad (LDL) cholesterol

• better blood sugar balance

Contrary to what you might think, recovering from illness or trauma relies a lot on muscle mass, muscle strength, and muscle function. Multiple studies have demonstrated that muscle mass and strength factor into how long it takes to recuperate from illness or injury. The less muscle mass and strength before, the longer to return to a normal life, if that’s even possible. I see this frequently among cancer patients. The ones diagnosed with cancer who are physically strong live longer than those who enter a period of illness frail.

While it’s common knowledge now that chronic diseases related to poor lifestyle account for many deaths in the United States, it’s not widely understood that changes in muscle play an important role in the progression of most conditions. Take, for example, the damaging effects of advanced heart disease and cancer. Both of these illnesses are often associated with rapid loss of muscle mass and metabolic function, and survival can often depend on the extent of muscle loss.

Because aging involves a gradual muscle loss over time that speeds up as one gets older, there’s a relationship between the state of one’s muscle mass and length of life. The progressive loss of muscle mass and function that typically occurs with aging is called sarcopenia, and it can erode one’s quality of life over time. Imagine not being able to do basic activities like getting out of bed, walking, feeding yourself, or using and
moving your body to take care of yourself. A devastating loss of muscle mass can lead to such an outcome. Muscle mass and strength are key to survival, arguably as fundamental as oxygen and water, food and sleep. And losing them isn’t inevitable!

A 2011 study out of the University of Pittsburgh subjected a cross-section of 40 high-level recreational athletes, who were aged forty to eighty-one years and trained four to five times per week, to a battery of tests to demonstrate that muscle strength does not have to decline significantly with age.
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Their results contradicted the common belief that muscle mass and strength decline automatically as a function of aging. The researchers noted that such declines may signal the effect of chronic
disuse
rather than muscle aging. They wrote: “This maintenance of muscle mass and strength may decrease or eliminate the falls, functional decline, and loss of independence that are commonly seen in aging adults.”

A question that science has been trying to answer is what the perfect dose of exercise should be. So many things in health and medicine come with dosing instructions, but not exercise. And even though we’re told to spend at least 150 minutes engaged in moderate exercise per week, that guideline is so broad as to be meaningless to most people. Exercise has had a “Goldilocks problem,” with experts wrestling with finding the line between too much and too little.
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Although the sweet spot for any individual will be different, the data from two recent large-scale studies suggests that, generally speaking, the ideal amount of exercise for a long life is a little more than what many of us think, but we don’t have to run marathons. And if we do like to take exercise to extremes, the latest research also shows that intense or prolonged exercise is not likely to be harmful and could extend people’s lives by years.

These impressive studies were published in 2015 in
JAMA Internal Medicine
. One of them, conducted by researchers with the National Cancer Institute, Harvard University, and other institutions, collected
information about people’s exercise habits from six large, ongoing health surveys.
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They managed to gather data from more than 661,000 adults. Then, the researchers created categories for these people based on how much they exercised on a weekly basis. There were those who didn’t work out at all and some who exercised to extremes—working out for twenty-five hours per week or more, ten times the current recommendations. Comparing fourteen years’ worth of death records for these different groups, all of which were made up mostly of middle-aged folks, the researchers found that the people who didn’t exercise at all were at the highest risk of premature death. Not so surprising. But what was interesting is that those who did some form of exercise below the recommendations lowered their risk of an early death by 20 percent. That’s a huge benefit for a little bit of effort. The individuals who completed the recommended 150 minutes per week of moderate exercise of course showed greater longevity benefits. These folks enjoyed 31 percent less risk of dying during the fourteen-year period compared with the people who never exercised.

The optimal amount of time, however, to gain the most benefits was found to be 450 minutes per week, which is a little more than an hour a day. According to the data, the people who tripled the recommended level of exercise were 39 percent less likely to meet an early death than people who never exercised. And they weren’t spending this time running at full speed or maxing out their heart rate on a piece of gym equipment. They were working out moderately, mostly by walking. This was where the benefits hit their peak, though they didn’t necessarily take a total U-turn thereafter. The few people who took their exercise time to extremes, at least ten times the 150-minute recommendation, enjoyed roughly the same reduction in mortality risk as those who simply met the guidelines, but not as much as the 450-minute group. In other words, they didn’t increase their risk of a premature death, but they didn’t bank more health benefits for all those extra minutes breaking more sweat.

The second study, from Australia, shared a similar conclusion, though it was more focused on determining how intensity factors into the mortality equation.
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And it debunked the conventional wisdom that says
frequent, strenuous exercise might contribute to an early death. Much to the contrary, the study found that spending lots of time engaged in a strenuous activity increases longevity. As with the other study, the researchers first categorized the people in their sample, a batch of more than 200,000 middle-aged Australian adults followed for more than six years, based on how much time they spent exercising and at what intensity level. They wanted to see the difference between people who engaged in only moderate activity (e.g., social tennis, gentle swimming, or light household chores) and those who included at least some vigorous activity (e.g., competitive tennis, aerobics, jogging). Checking death statistics, the researchers confirmed what the other study concluded: meeting the exercise guidelines lowered the risk of premature death by a lot. This held true even for people whose exercise was simply walking.

What probably surprised the researchers is that adding intensity—but not necessarily more time sweating—conferred substantial benefits. The people who spent up to 30 percent of their weekly workouts in strenuous activities were 9 percent less likely to die sooner than expected as compared to those who exercised
for the same amount of time
with no vigorous activity. And those who engaged in strenuous activities for more than 30 percent of their exercise time earned an extra 13 percent reduction in early death, compared with the group who had no vigorous activity. For the small handful of folks who spent more than 30 percent of their workout doing intense exercise, no corresponding increase in mortality was noted.

The only big caveat to these studies’ conclusions is that the researchers had to rely on people’s memories about their exercise habits. In other words, these were observational studies and not randomized experiments. So they can’t definitely prove a causal relationship between any exercise dose and changes in mortality risk, but there was enough evidence to say that exercise and death risks are associated. And the associations are indeed strong and consistent enough to say that movement, and vigorous movement once in a while, does a body good.

Even though I asked you to track your movement during the two-week challenge, you might still be wondering how fit you are today. And you might also question whether you’re in the bottom 20 percent.
In general, if you can walk a couple of miles at a decent pace, covering a mile per fifteen minutes, or climb several flights of stairs without difficulty, then you are in average shape at any age, whether you’re a man or woman. But there’s usually room for improvement. In terms of muscle mass, you’ve probably got some decent muscle strength if you can complete your normal daily activities without much strain. But again, there’s always room for improvement.

I’ll also give you a quick fitness test to do right now: Using the least amount of support that you need and without worrying about how fast you’re moving, can you sit on the floor and then rise up to a standing position? Turns out that if you can get yourself up from the floor using just one hand—or even better, without the help of any hand—then you are not only in the top 25 percent of musculoskeletal fitness, but your survival prognosis is probably better than that of those unable to do so. In 2012, a study performed in Brazil at an exercise medicine clinic revealed that an inability to sit and rise from the floor shows an all-cause mortality risk (another way of saying that you’re more likely to die from any cause).
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Put simply, the better you can do this task without relying on your hands for stability and support, the longer you’ll live.

You don’t need to sign up for an athletic event or join a running group to attain an ideal level of fitness. In the empowering words of legendary University of Oregon track and field coach and Nike cofounder Bill Bowerman, “If you have a body, you are an athlete.” Although we all would do well to maintain a formal exercise program that builds and maintains fitness through a combination of cardio work, strength training, and stretching, a more fundamental and primary goal should be just moving more throughout the day. You should make it a goal to become at least 10 percent fitter than you are today.

You can engage in short bursts of exercise throughout the day, which can help minimize your time spent sitting. Or you can commit to a routine that blocks out an hour or so for your workouts. Just be sure that if you do dedicate a single period to your exercise regimen, you don’t allow yourself to be sedentary the rest of the day. Ideally, break up your sitting time by getting up and walking periodically (remember, how fast you
can walk is a signal of future health). Keep a pair of three- or five-pound free weights near your desk to perform some bicep curls on a break.

In the Lucky Years, technology will increasingly help us be less sedentary and stay fitter, and keep track of these metrics. If you completed the two-week challenge I outlined in chapter 5, you know you can monitor how much you move during the day and record levels of exertion. Whether you use the most complicated or the simplest technologies, monitoring your body’s movement over time is key to understanding it. Health and fitness apps can tell you more than you ever wanted to know about yourself, giving you truly objective data that can help you plan your workouts and maximize opportunities to move. Be careful not to overwhelm yourself with too many apps and gadgetry, however. You risk burning out on all that tracking and quickly losing interest as fast as you can with a fad diet. Start with basic apps that will track your mileage and minutes in a state of heightened heartbeats. Then add more apps and gadgets as you go along and find technologies that you know you will use. One site to bookmark is
Greatist.com
. It offers a catalog of the best health and fitness apps and will help you navigate all the latest and greatest tools. It covers all kinds of health-related apps, including those in the categories of food and nutrition, mind and brain, sleep, and productivity.

Before I end this chapter, I must throw in a little bit about popular strategies to look and feel younger. These include things like testosterone and human growth hormone pills and injections. You know I’m not going to endorse the use of the products that come with significant risk factors. Case in point: Contrary to what the multibillion-dollar testosterone-boosting drug industry claims, these drugs have not been shown to reverse common issues related to aging such as low libido, fatigue, and muscle loss. Yet they come with potentially serious long-term complications, chiefly cardiovascular problems.

Testosterone therapy was developed for people who had pituitary problems—people who made no testosterone at all. Over the last
decade, though, people started to use it for all the problems of aging, even though medical science does not support that. In fall 2014, the FDA moved to change the labeling on the drug, thereby drastically limiting its use to men who have abnormally low hormone levels due to disease or injury, instead of aging. This $2 billion industry was examined in a 2015
Journal of the American Medical Association
study on patients with low-testosterone (or Low-T). It found that the testosterone gel administration did not improve overall sexual function or health-related quality of life, the reason most of the men were taking the supplementation.