Richard Keelor

The Role of Physical Fitness in Reducing Health and Long-Term Care of the Elderly

(Testimony to the joint hearing held by subcommittees on Health and Long-Term Care and Federal, State, and Community Relations of the Select Committee on Aging, Hon. Claude Pepper and Hon. Spark M. Matsunaga, chairmen.)

By Richard O. Keelor, Ph.D.
Director of Program Development
President's Council on Physical Fitness and Sports

Regular exercise has emerged as one of the key factors in reducing chronic physical degeneration associated with living in our highly sedentary society.

In testimony before the Senate Subcommittee on Aging one year ago, Frederick C. Swartz, M.D., Chairman of the American Medical Associations Committee on Aging, called the lack of physical fitness our nations greatest health problem. He went on to say that, “Here is the answer to the simplest and cheapest, and has the greatest application, and its reflection on the reduction of morbidity and mortality rates would be immediate and tremendous.” In reference to exercise for older Americans, this authority on aging for the AMA said, “We are convinced that participation in regular exercise programs increases the confidence and a feeling of well-being of the individual and helps him stay off dependency by preventing or softening the shaky hand  and tottering gait syndrome.”

While there are still a few misinformed individuals who view regular exercise is some kind of fad or passing fancy, and “fitness freak” can still be heard to describe a person who is intelligently managing his lifestyle with regular exercise, we believe that, by and large, Americans are slowly waking up to that physiological need of the human body for regular physical activity.

An even more dramatic demonstration of what we call the “physical fitness Renaissance” in America can be found in business and industry and in the government. Facing the growing human and financial cost of healthcare and the effects of chronic physical degeneration on employees, these groups are clearly moving toward a preventive strategy. Within this strategy, physical fitness has emerged as one of the cheapest and most immediate remedies in preventing the severe and unpredictable consequences of sedentary living.

Now, how does all this apply to our older population? We believe that many of the health problems and the disability, dependency and deterioration now associated with aging are “acquired changes” resulting from poor personal health practices rather than simply the result of the passage of time. A social attitude has evolved in this country which suggest because of a person's age he is expected to have these changes. Therefore, we should sit back and wait until they appear and then take the necessary steps as a humanitarian society to care for them when they develop.

We further believe that many of the problems noted in older people which we attribute to aging are the direct result of disuse, and are not just the normal ravages of time. There is clear evidence of loss of muscle cells if they are not used, just as there is evidence that the amount of muscle mass can be increased with appropriate exercise. Disuse of bodily systems not only affects skeletal muscles but also can affect the heart muscle, decreasing the heart's capacity. It can affect the lungs' capacity and almost every bodily system. Nature seems to follow a simple principle: “If you don't use it, you lose it.”

As an example of this, let us consider atherosclerosis. Atherosclerosis is the accumulation of fatty deposits in the arteries. This can occur anywhere in the body. If it affects the arteries to the heart muscle, it causes heart disease; to the brain, it causes strokes; to the legs, it interferes with walking; to the kidneys, it can alter their normal function. Because atherosclerosis leads to blockage of the arteries, it interferes with circulation. Cells will then be deficient in oxygen and nutrients and accumulate end products of metabolism like carbon dioxide. These adverse effects on the cells limit their capacity to regenerate and hinder their growth and response to use, thereby contributing to the disuse problem. In their extreme form, they can result in cell death.

Through causing heart attacks, strokes and kidney disease and its multiple problems, atherosclerosis accounts for approximately one half of the deaths in the United States. It occasions untold numbers of cases of senility because of brain damage and a host of other medical problems. The amount of fatty deposits in the arteries clearly increases with age, and it was therefore once assumed that our atherosclerosis was an aging phenomenon. This is obviously a false assumption since atherosclerosis also occurs in young people, particularly in the arteries to the heart, in men as young as 22 years of age and in sufficient amounts to cause heart attacks in these individuals. Nevertheless, because it increases with age, the changes it brings about are often considered as aging. They are, of course, acquired changes.

There is no argument about the application of this principle to muscle tissue. The commonly observed decrease in the size of muscles with increasing age is not all time related. The muscle mass can be influenced by the amount and type of physical activity. A person with relatively small muscles can develop large muscles with a properly carried out weight training program. Exercise that causes the muscles to have to contract firmly, or against force, will gradually increase the size of the muscles. Older individuals who have continued forms of physical activity that constantly work the muscles often have retained a larger muscle mass than much younger individuals who follow no physical fitness program. The range of possibility of development of muscle mass is so great that there is very obvious overlap between the physically active older person and the inactive younger person. Not that the very old person, by physical activity alone, can retain the maximum amount of muscular development that the human body is able to achieve. But physical activity is a major factor in maintaining muscle mass and its absence is a major factor in failure to develop, or maintain, muscle mass.

Because physical activity progressively declines in individuals with increasing years, or sometimes with material success, there is a tendency toward a gradual change in body composition so that a large portion of the muscle mass is replaced with fat tissue. This is a main reason for the change in body configuration attributed to aging. It is often said that as a person gets older, his chest falls. The largest dimension is no longer around the chest, but around the waist and buttocks.

The commonly observed loss of muscle mass in advancing years affects some muscle groups more than others. Muscle tissue is typically lost between the bones in the hand, leading to the development of the “bony hand” of older individuals. By appropriate hand exercises these muscles can be at least partially maintained. Similarly, the muscle fibers in the arms and legs tend to shrink, so that the size of the muscles in the extremities is decreased. The loss in size and strength of the abdominal muscle results in the relaxed abdomen, which is a major factor in the familiar “bay window.”

The muscles along the entire spine are likely to weaken, as are those between the shoulders. These and other changes are responsible for the posture and physical appearance of the bodies of older people. There is a constant battle against gravity to maintain upright posture. As the muscles weaken, the battle is lost and the body begins to sag. Just as an old tree gradually bends to the earth, the human body bends more and more; its muscles can no longer keep the skeleton in its optimal, upright position.

We commonly think of youth as being associated with supple bodies, with good muscles and strong bones capable of a wide range of physical activity and endurance. We think of age, by contrast, as being associated with loss of muscles, weak and brittle bones, and loss of body suppleness. Certainly within our framework of living patterns, these concepts are true. Yet in many parts of the world, older individuals continue to be physically vigorous with strong muscles, strong bones and supple bodies.

It is interesting to note that much of the deconditioning accepted as a normal byproduct of aging can be induced in young, well conditioned men by the simple expedient of enforced bed rest in as little as three weeks.

The Foundation for Optimal Health and Longevity in California has done International Research and exercise, diet and longevity to determine why some individuals and populations are able to maintain vigor of mind and body with advancing age, whereas the majority follow the course of progressive deterioration cited above. These studies were done in Ecuador, the Caucuses of southern USSR, Hunzaland in Kashmir and California over a five-year period.

The studies revealed that diet and prolonged physical activity as a part of an individual's lifestyle are a major factor in the maintenance of physical and mental vigor many years beyond the usual retirement age. Furthermore, regular endurance activity at appropriate levels of stress, improperly supervised programs, can allow older individuals to maintain physical and mental vigor, lower the incident rate of hypertension and cardiovascular disease, reduce blood cholesterol and triglyceride levels, and help them maintain slender, well muscled bodies. They concluded by observing that mental and physical deterioration so commonly seen in older individuals in the USA is not part of the normal process of aging, and therefore not inevitable. It is due to specific diseases, or is a consequence of many years of insufficient use of mental and physical faculties. Furthermore, they concluded that properly designed and supervised exercise programs based on an cure his activities appeared to be a practical substitute for the physical activities which are a part of the lifestyle of long-lived individuals in more physically active cultures than our own.

A variety of other research, too extensive to cite here, of the older individual has demonstrated a number of health benefits that accrue as the result of physical conditioning of the older individual, including improved muscle strength and increased joint flexibility, increased total blood volume, and a regression in EKG abnormalities.

A rather well-known study conducted in California by Dr. Herbert DeVries of the University of Southern California's School of Gerontology, which was supported by federal funds, clearly demonstrated the trainability of older persons with regard to physical fitness.

I can personally testify, having traveled throughout the country extensively as a clinician and lecturer on the subject of physical fitness, that the elderly are as responsive and interested in improving their overall physical capacities as any single group in our population. After all, they realize as well as anyone,  the frightful price their bodies have paid for years of sedentary living and, most of all, they desire to regain all the vigor and function possible in order to maintain their independence and enjoy their remaining years. I would invite anyone of you to join me in observing firsthand the several exercise programs for the elderly in the greater Maryland area, many of which have been a direct result of the demonstration project conducted by the National Association of Human Development in cooperation with the President's Council on Physical Fitness and Sports. Absorbed the movements of these vigorous, upright and enthusiastic people, many of whom have built themselves up to a point where they are into jogging and vigorous calisthenics.

It is a moot question whether they are active because of their enthusiasm, or enthusiastic and interested because of their activity. The two characteristics unquestionably go hand-in-hand. It may be significant that if one of these healthy older individuals is compelled to remain inactive for a prolonged period, by accident or illness, deterioration will set in and a steady downhill course will ensue unless the individual can be stimulated to return to the greatest degree of activity possible.

The major issue confronting individuals and agencies interested in reducing degeneration and dependence to improve levels of physical fitness of older Americans is: Where do we find the leadership to conduct programs and how can we afford to conduct? In the demonstration program we believe it was clearly shown that Lehman can be trained to conduct mild, low stress exercise programs in already existing social service centers. Furthermore, with very low comparative cost, volunteer leaders can be organized to assist and develop these programs throughout the country.

Central to any effort in improving the physical fitness of older people is a total approach of health education that recruits, educates and motivates a basic lifestyle from physical dependence to physical self-management.

In summary the President's Council on Physical Fitness and Sports is of the opinion that it would be both productive and economical in reducing the human and financial costs associated with the health and intensive care of the elderly to encourage the development of both immediate and long-range programs to assist older Americans to attain and maintain improved physical fitness. This opinion is based on the following beliefs:

1. Regular exercise at appropriate levels of stress can improve the function of the heart and circulatory system, increase flexibility and range of motion, and increase muscular strength in otherwise the conditioned older people. 

2. Appropriate levels of physical activity can reduce the effects of physical degeneration and dependency normally associated with older persons.

3. A state of improved physical fitness enhances the quality of life for the elderly by increasing independence. The ability to “go places and do things” without being dependent on others, provides a strong psychological lift which is conducive to good mental health.

4. The benefits of regular physical activity are not exclusive to already active older people. The frail, feeble and even bedridden individuals can profit to some degree from appropriate levels of exercise conducted by competent persons.

5. All levels of government and concerned individuals should encourage activities of health education leadership training to develop specialists capable of conducting and supervising fitness activities for the elderly.

6. It is only when adequate recognition is given to the important role of physical fitness in changing the destructive lifestyle of our people that we can fully expect to reduce the cost of health and intensive care of the elderly.

It would seem that we may have no alternatives. Aren't we already spending one of every eight dollars we make on healthcare? Isn't this cost continuing to go up at an astronomical rate? We can't accommodate ourselves to a situation like that. We have to prevent its development. That is the human course, it's the practical course, and it's probably the only course we can afford.

When adequate programs are developed and applied we believe that we will be able to document financial savings to the American people above the costs of such programs, not to speak of the psychological and physiological benefits that will be derived by individuals in society through having more healthy, happy and independent older Americans.

The American people spend billions on health care and the search for answers to medical riddles. Why not spend a million or so to put into effect the answers we have in a preventative approach?

I will be glad to answer any questions, and I thank you for the privilege of appearing before you.