January 29, 1999

Helping the elderly stay active

A fitness routine need not include benchpresses

For Dr. Sandra O'Brien Cousins, one question drives her research more than any other: Why do so many elderly people have such a profound aversion to physical activity? What would prompt a woman in all seriousness to confess, as one did to Cousins last year, "I hope I don't have a stroke because then I'd have to exercise"?

In two recent books, Exercise, Aging and Health and Active Living Among the Elderly (both published by Brunner/Mazel, the latter co-authored with Dr. Tammy Horne of WellQuest Consulting), the professor of physical education explores the barriers to exercise among the elderly and the benefits of staying active. Reviewing more than 1,500 studies relating to the subject between 1990 and 1994, she says there's little doubt inactivity in old age is at least as harmful as smoking.

"If you're not very active, essentially you're aging twice as fast as nature intended," she says. A sedentary life poses a high risk of disability or early death, whereas exercising as much as 20 minutes most days of the week can be the "best medicine for many of the ills of old age."

Convincing older people to take a walk or step onto the treadmill, however, can be like pulling teeth, since the perceived dangers of doing so are often greatly exaggerated. "They conjure up all these outrageous ideas.especially the women come up with these very ingenious, creative beliefs about risk, like their heart will explode if they do a certain kind of curl or something."

Cousins says it's mainly elderly women who pay the price for a sedentary life, which can lead to osteoporosis and severe arthritis among other ailments. Despite the fact women live longer than men, about half end up in nursing homes, compared to about 20 per cent of men.

"And it's not because they've got Alzheimer's or dementia - they're weak, bent over like caged animals," she says. "Physical activity could help them enjoy a more resilient, robust, higher quality of life."

Cousins has seen enough success stories to know. She recalls one woman at a local nursing home who lacked the strength to do her hair or even raise her hands above her head. Her loss of self-esteem and subsequent slide into depression were heartbreaking to watch, says Cousins.

Within a few weeks of lifting very small, one-pound weights, however, the woman rapidly regained her strength. "She started doing her hair again and it changed her life. It was the best thing that happened to her in a long time."

Ironically it too often takes a traumatic event such as a stroke or heart attack, the very dangers exercise can prevent, to make a persuasive case for staying active.

Cousins has found the best way to encourage older people to exercise is to completely avoid references to sweating or breathing hard. And above all, don't even mention the heart, she says. It will only "feed into their internal dialogue," a vicious cycle of negativity that seizes upon any excuse, ending in defeat and resignation. It's always better to simply promote the pleasure principle, but even there, Cousins runs up against opposition.

"With that generation, there's a lot of historical baggage they're bringing from the depression. If you're going to be physically active [they believe], you might as well do something productive. They don't see having a whale of a good time at a square dance as being a productive way to spend your energy."

It's not just the aging who need an attitude check, however. Family members and even physicians have to be educated about encouraging the elderly to exercise. Sons and daughters, for example, who insist on carrying bags for their aging mothers and fathers may not be helping them out in the long run.

"Let her carry her groceries, if she's willing to do that," says Cousins. If she's not at risk, the load will only keep her strong. The benefits of even moderate, regular exercise "go on and on," she says. "There's no function of your body that doesn't benefit... even your skin."

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