Stanford Medicine Newsletter Updates For the Local Community


Exercise may prevent ‘sedentary death’

Carol Winograd


Carol Hutner Winograd, MD, is a professor emerita of medicine and former clinical director of the Geriatric Research Education Clinical Center at Stanford. A specialist in geriatric medicine, she has co-authored a book, Treatments for the Alzheimer Patient: The Long Haul, and has written more than 40 scientific articles on functional impairment in hospitalized elders, mobility and geriatric assessment.

Is it inevitable that we will lose mobility and/or become frail as we age?

It is common, but it is not inevitable. The 20th century gave us 30 years more of life expectancy—from 47 years in 1900 to 77 years in 2007. It was added without any understanding of how to prepare and what physiology and metabolism and muscle strength were needed to thrive in those later 30 years. We’re now beginning to have the research data that confirms that it is not only possible but desirable for older adults—even adults in their 90s—to exercise doing cardiovascular work, strengthening, balance and flexibility.

Does being sedentary put us at greater risk of disease and death?

It’s very important for people to know that there is a phenomenon known as sedentary death syndrome—that inactivity may lead to premature death. Lack of activity can contribute to chronic diseases like type 2 diabetes and cardiovascular disease. Hypertension, falls, back pain, osteoporosis, arthritis—all may increase with inactivity. And mortality may increase with inactivity.

How is a sedentary lifestyle related to aging?

We all start adult life with a certain amount of muscle, though men start out with more than women because of testosterone.

So over time there is a gradual loss of muscle that begins in the 20s. Men and women lose muscle at the same rate, but women start at a lower level. Because women start with less muscle mass, they tend to arrive at the disability threshold—the point at which it becomes difficult to carry groceries or go up the stairs—much earlier than men. That is part of why so many women are frail.

There also is a certain amount of age-related decline. A 60-year-old super-elite trained athlete may be able to run as fast as a 20-year-old, but that crossover happens physiologically between 60 and 70. However, all of us can reverse the degree of decline through exercise. Cardiovascular, strength, balance and flexibility exercises also can help prevent falls.

What kind of exercise do you recommend for older patients?

Walking is a great way to start. Somebody who hasn’t exercised in a long time needs to start slowly. For someone who is able to walk, I suggest walking five minutes three times a day for a week or two. Then add one minute every week. That’s a very cheap, readily available way of doing it.

The scientific recommendations are three to four days a week of cardiovascular and two days a week of strengthening. It’s the strengthening that counteracts the decline in muscle. I recommend the website, which outlines an excellent program of exercise and physical activity.

At what point in life does your ability to do exercise training begin to decline?

Never. There was a study by Tufts University researchers who worked with eight men and women in their 90s whose function was basically bed-to-chair. They were put on high-intensity training for eight weeks, and at the end, they were able to increase muscle size by an average of 9 percent. The average strength gain was 174 percent on the right and 180 percent on the left. They were able to lift twice as much weight with both legs. What I think is most important and clinically meaningful is that some people no longer used canes to walk at the end of the study and were able to walk faster.

The study really revolutionized thinking because it was thought that once you lost muscle mass, you couldn’t gain it back. These findings now have been reproduced in numerous places.

What other studies reinforce the value  of exercise in older adults?

A group in Pittsburgh looked at the ability of people to walk a quarter of a mile. Over six years, they followed 2,700 people between the ages of 70 and 79 and measured the speed of their walking on a track. People who couldn’t do it at all had the highest mortality rate. The people who did it the fastest had the lowest mortality rate. The slower you were, the more likely you were to be in need of walking aids or to become wheelchair bound several years later. So your ability to walk a quarter of a mile predicted both your function down the line and your mortality.

When I first read this study, I was jumping up and down in the kitchen. My husband asked me,“What’s going on?” And I told him about the study. He said, “You’ve been saying that for years.” Yes, but now we have the data.


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