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Exercise Is Key to the Prescription for Healthy Aging, No Matter How Old You Are.

Dixon Hemphill, number 25, left, and Jack McMahon, number 600 at the start of the Plaza America Family 5K race in Reston, Va. 

When nearly 1,000 runners lined up recently for the Plaza America 5K in Reston, the world-class runners from Kenya had company at the head of the pack. Ready to run across the starting line with them were six Washington-area men, also fit and toned, but with one key difference. They were all 75 years or older.

No, these weren't lifelong athletes obsessed by exercise. Nearly all discovered running in middle age or later, stumbling by happenstance onto a source of energy and well-being whose value is now being verified by a growing body of research.

Whether the impetus is an approaching 40th birthday or an upcoming century celebration, "it is never too late to start exercising," says Jerome Fleg, who studies the health benefits of exercise at the National Heart, Lung, and Blood Institute (NHLBI). "There is no age that we have found where you can no longer reap the benefits of physical activity."

In studies of nursing home octogenarians as well as in trials of overweight, middle-aged adults, exercise is proving to be a powerful therapy to reduce blood pressure, boost cardiovascular health, strengthen muscles, improve metabolism, elevate mood and maintain mental functioning. On Monday, a team of researchers reported in the Annals of Internal Medicine that regular aerobic exercise, even when it doesn't cause weight loss, drives down blood pressure, regardless of age or weight or initial blood pressure reading.

"It's not that you are too old to exercise, it is that you are too old not to exercise," says Walter Michael Bortz II, a professor of medicine at Stanford University in California and a 70-year-old marathoner. "Fitness becomes a survival issue."

Equally enlightening, given the growing number of overweight and sedentary Americans, is new research suggesting that most of the physical changes chalked up to growing old – insulin resistance, decreased lung function and elevated systolic blood pressures – are not due to aging at all, but to inactivity. A New England Journal of Medicine study of more than 6,000 older men published earlier this year showed that poor physical fitness was a better predictor of death than smoking, hypertension or heart disease.

"There is no drug in current or prospective use that holds as much as promise for a life of extended vitality as does physical exercise," Bortz says. "Why reward the stockholders of Merck and Johnson and Johnson when we know that exercise is better for you and infinitely cheaper?"

People who perform regular, vigorous workouts exhibit only minimal declines in aerobic capacity with advancing years and seem to "hold the line on aging," says Andrew Goldberg, director of the Geriatric Research, Education and Clinical Center at the Baltimore VA Medical Center.

Not so for their less active counterparts. "Typically, beginning at middle age, aerobic capacity and muscle mass go down about 10 percent per decade," says NHLBI's Fleg. Without regular exercise, physical decline doesn't just continue steadily, it accelerates beginning at about age 60, suggesting that "at older ages it becomes particularly important to offset that with activity," Fleg says.

That's not surprising to Ray Blue of Oxon Hill, one of those senior runners in the Plaza America 5K. Blue, who turns 78 today, took up running 10 years ago to shed some bulk. He trimmed 22 pounds in about a year, continues to maintain his weight and runs an average of 30 miles a week. His blood pressure is a healthy 105/58 and his doctor recently told him that physically he seems more like a 50-year-old than a person who is nearing 80.

"I feel so much better than I did before I started running, and I don't have any health problems," says Blue, who competes in 70 races a year.

New Age Thinking

All this represents a radical shift from the common view just a few decades ago that aging meant seeing life boundaries shrink as inevitably as waistlines expanded. Those lucky enough to grow old often figured that breathlessness climbing stairs and a diminished capacity to walk, run and move went with the territory, as did high blood pressure, cardiovascular disease and even diabetes.

Not everyone, however, was convinced that aging automatically equaled physical decline. In the early 1980s, a team of scientists led by John Holloszy at Washington University in St. Louis began studying older athletes – those rare folks who defied the odds by continuing to stay physically active well past their fifties and sixties.

From this research, a new picture of aging began to emerge. Participants in these studies – usually male long-distance runners or cyclists, but also a few post-menopausal women – appeared far different from their sedentary counterparts. In terms of heart rate, blood pressure, blood glucose levels and lung capacity, "they look like younger individuals," says Hagberg, who was part of Holloszy's team.

Not so, however, for top-flight athletes who stopped training. They showed sharp declines in aerobic capacity – the ability to use oxygen – that was nearly as steep as that seen in people who had been sedentary for years.

What intrigued scientists was how physical activity protected against some of the deleterious effects of aging. To explore that question, researchers convinced small groups of healthy, active, older athletes to stop training for a short time. In as little as seven to 10 days, they experienced significant declines in aerobic capacity, a measure of cardiovascular health. Cholesterol and triglyceride blood levels began to climb and, most surprisingly, about a third developed glucose tolerance numbers that signaled diabetes. "They didn't change their body composition, they didn't get any fatter, but they became diabetic or almost diabetic," Hagberg says.

When the participants were allowed to retrain, however, all the symptoms reversed, leading researchers to conclude that regular exercise enables older athletes to avoid the development of insulin resistance and deterioration of glucose tolerance that leads to diabetes and is commonly seen with aging.

Nearly two decades later, a landmark federally funded study showed similar results in a study of overweight, middle-aged adults. The Diabetes Prevention Program concluded last year that regular exercise – and changes in diet – helped prevent development of diabetes in a group of people poised to develop the condition.

How Much Is Enough?

There's no question that vigorous aerobic exercise packs an impressive list of health benefits. But studies also show that activity doesn't need to be intensive to provide significant improvements at any age.

The more out of shape "you are to begin with, the less intense the exercise has to be to show an improvement," says Fleg. Studies show that even modest activity – walking three to four times a week, for example – significantly lowers blood pressure "and can match the benefits of taking blood-pressure-lowering drugs," he says.

It only takes lifting weights a couple of times a week to increase muscle mass and improve glucose metabolism, says Fleg, because "the more muscle you have, the more glucose you burn." He also notes that weight loss and moderate exercise help lower low density lipoproteins (LDL), the most damaging form of cholesterol.

Boosting aerobic capacity by about 20 percent – something that researchers say is achievable for most aging people with brisk walking, swimming, cycling or other activities – can help push back the cardiovascular clock by as much as 20 years, according to Fleg. "You might not be able to do that for all systems in your body, but you can at least do it for your aerobic capacity," he says.

No need to convince Bill Osburn, 78, of Bethesda. At 55, Osburn, who ran track in high school, took up jogging at his son's urging. He didn't do it very religiously, however, until 12 years ago, when doctors warned him that areas of his heart were becoming ischemic, meaning that they had been damaged by not getting enough oxygen.

Since then, Osburn's 30 miles per week of training have enabled him to recoup heart function and avoid surgery. He ran in 98 races last year, has finished 12 marathons and placed third in the Plaza America 5K this month. As he says, "the vigorous exercise has helped rejuvenate my heart."

Even so, exercise physiologists stop short of prescribing vigorous exercise or a one-size-fits-all workout plan for everyone. "People always ask me, 'What's the best physical activity?' " Hagberg says. "My answer is: The one that you will do. If walking is the upper limit of what you like and will do, then walking it is. We are all individuals and you have to customize this."

Besides, research suggests that the body is a master at rebuilding itself with activity. "It seems that physical training improves whatever problem you have, which is fantastic," says the VA's Goldberg, who also heads gerontology at the University of Maryland in Baltimore.

Then there are the psychological benefits. "I had one guy who was about 65 years old come in on a Monday morning, proud as can be," says Hagberg. "He had taken the window air conditioning unit out of his family room all by himself. In the past, he'd had to hire two college students. By becoming more physically active, he was able to gain independence and confidence."

Bottom line, says Goldberg, is that "the ability to become highly physically conditioned is malleable and modifiable no matter what your age."

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