Aging Without Frailty – A Series (Part 3)

Welcome to Part 3 of this series on avoiding extended late life frailty.

In Part 1, we looked at frailty with the intent of establishing that it isn’t synonymous with aging and that it is not a disease but rather a condition related to disuse. I also introduced a clinical term often associated with this condition – sarcopenia – which the dictionary defines as “loss of muscle tissue as a natural part of the aging process.”

In Part 2, I took the position that debilitating loss of muscle mass as we age is a major contributor to our loss of independence but is, for most, an insidiously debilitating lifestyle choice.  And that our medical community is doing little to raise our awareness of how we can reduce the effects of sarcopenia.

What I hope to accomplish with the series is to elevate awareness and motivate and persuade readers to take a new understanding of this self-inflicted malady and make changes that will enable them to dodge some bullets later in life.

In other words, avoid the “frail trail”.

Really our choices are to confront it or let it continue to take us slowly, gradually, to an extended and miserable, costly late life – “living too short and dying too long.”

There are few givens when it comes to what happens to us in this second half/third stage of life –loss of muscle mass is one of them.  We cannot predict with certainty what other maladies may befall us in these later stages – and it’s likely some will.

But this one we can predict and proactively make some allowances for.

And we must because it is the most prevalent condition that robs us of the vitality we deserve to live an active, fulfilling late life.

We don’t need more Nobel prizes

In the words of Dr. David Katz, a physician at the Yale School of Medicine, and founder of an organization called the Academy of Lifestyle Medicine:

“We already know all that we need to know to reduce, by 80%, the five major killers in our country.  We don’t need more fancy drugs or equipment or more Nobel Prizes.  We know all we need to know today.”

 The Center for Disease Control (CDC) reminds us that four risky behaviors – lack of physical activity, poor nutrition, smoking, and excess alcohol consumption – are responsible for much of the suffering and early death related to chronic diseases.  These chronic diseases are also among the most preventable and regular physical exercise is one of the most important remedies.

The CDC also informs us that, in 2012, only 7.9 percent of those 75 or older engaged in aerobic and strength-training that met the 2008 federal physical activity guidelines for that age group. Yikes!!

By allowing our musculoskeletal resources to decline, we practically guarantee the onset of any of a number of potential calamities.

 

 

 

Here are just a few from a long list of conditions that medical professionals have observed that result from sarcopenia:

  1. Decreased strength
  2. Mobility and balance problems
  3. Falls
  4. Weak bones and fractures
  5. Weight gain/obesity
  6. Diabetes
  7. Decreased visual acuity
  8. Declining sensory perception
  9. Slowed reflexes
  10. Inability to cope with stressful conditions

Stop the death spiral

All of these contribute to the mountain of demoralizing statistics about where this is taking us in terms of living conditions and health care costs.  There are some who predict that the care of the elderly, as the ranks swell, could bankrupt our economy.

We can each do our part to stop this death spiral and take advantage of the longevity bonus that most of us will experience.

So, let’s cut through it all and get to a solution.

I’ll stand by my claim in Part 2 that sarcopenia is reversible and that the solution is:

Simple

Lift weights.  If you haven’t lifted a weight since Apollo 13, consult with your physician, start small and build up.  Learn proper techniques early to avoid injury as you proceed.

Inexpensive

Join a local gym.  If you are over 65 and have a Medicare Advantage plan, you are probably eligible for the very popular Silver Sneakers program.  I frequent a 24-hour Fitness facility six days a week under this program and don’t spend a nickel.

Immediate

With a consistent, disciplined strength training routine, you will feel and see significant results as soon as two weeks.  You’ll feel better, have more energy, sleep better and may even look better almost immediately.  It’s not about weight loss but, depending on your starting point, that may be a serendipitous result.

Drug-free

Aside from an occasional Advil early on as your muscles respond and grow from the new stress, there are no drugs needed to reverse this condition.

It really is that simple.  So why do so few of us do it?  Why is it so difficult?

The answer to that is simple also.  Attitude and habits.

The biggest battle is mental, not physical. Attacking and reversing a condition like sarcopenia requires a commitment to hard physical work.  It requires a commitment to an activity that most in the middle-age group and beyond don’t care for, think about or relate to.

This simple plan requires an attitude that accepts and understands the downside of inaction and commits to doing something about it.  But it must go beyond willpower because willpower alone doesn’t work.  We have broken New Year’s resolutions as ongoing proof of that.  Without a total commitment to reversal, this effort too will fail.

Our lives are driven by habits.  Many of the habits we’ve adopted directly contribute to the decline of our musculoskeletal resources (need I mention TV, snow blowers, electric knives, elevators, etc.?) An effective battle against sarcopenia will mean replacing some deeply entrenched lifestyle habits with habits that are, for most, uncomfortable and unfamiliar in the short term.

Notice I said replace.  We really can’t effectively change habits.   We must replace them.

My own sarcopenia battle

I think I’ve mentioned in previous articles that I’ve been a gym rat for over 30 years.  When I cold-turkeyed off of cigarettes on June 6, 1979, I took up running.  Then, in 1987, I joined a new athletic club and began a 17-year run of pickup basketball five days a week. I also began taking advantage of the weight room at the same time and thus put in place an aerobic and strength-training habit that I haven’t broken since.

Although my knees don’t permit basketball, at age 77 I still do 45 minutes of aerobic (upright bike, elliptical or treadmill) six days a week with three of those days including 30-40 minutes of weight training.

Nothing gets in the way of my dedication of 3-4% of my week to this habit.  If I can’t stay with it because of calendar issues or illness, I’m difficult to be around.

A resource to get you started

Recently I stumbled across Fred Bartlit, 87-year old attorney, West Pointer/Army Ranger, strength trainer extraordinaire.  I’ve referred to Fred’s campaign against sarcopenia in Part 1 and 2 of this series.

Time, space and your attention span prevents me from laying out a detailed sarcopenia reversal plan in a single article.  So, I’m going to leave that to Fred and his co-writers and recommend an investment in his book: “Choosing the Strong Path: Reversing the Downward Spiral of Aging”.  (Note: I have no affiliate arrangement with Fred.  He doesn’t know I exist – yet.)

Fred’s book will do two things:

  1. Provide a clear understanding of sarcopenia and its impact, physically, emotionally and financially.
  2. Provide a safe, sensible roadmap for incorporating strength-training into your life at a pace and level appropriate for your situation.

You will also find excellent resources at his website www.strongpath.com including some really outstanding brief videos demonstrating proper techniques for starting exercises.

This book and website can get you started right with a new motivational understanding of why you should be doing it.  We don’t need to be a part of the depressing statistics of what is happening to our demographic.

When we take this seriously, we can, in fact, “die young, as late as possible.”

I hope this series has been helpful.  It’s a huge topic to which one can’t do justice in 3,000 words.  Fred’s resources can.

We’d love to hear your story about your journey in this area.  Leave a comment for us below.

Aging Without Frailty – A Series (Part 2)

Avoid the “frail trail”, get on the “strong path”.

I wish I had thought of those words.  They belong to 87-year old Fred Bartlit, the West Pointer/Army Ranger/Attorney/bowl skier/strength-training gonzo I referenced in last week’s blog.  Those words are his mantra and they describe his mission. 

Not being the most creative person around, and not above abject pilfery, I’m borrowing the words and jumping on Fred’s coattails.  And, believe me, they are worthy coattails to be on because he, more than anyone I’ve run across, is doing more to call attention to the biggest threat to living a healthy, meaningful second half of life.

Chances are you haven’t heard of it.  All of us have some degree of it if we are over 30.

And we didn’t “catch it”.  It’s not an air-borne or body-fluid-transmitted affliction.  We are self-inflicted.

It’s called sarcopenia.  The dictionary defines it as a “loss of muscle tissue as a natural part of the aging process.”

It started when we were thirty or so. We didn’t really notice it because it’s stealthily insidious, creeping up on us very slowly.  We reach 50 and the drives are shorter, the handicap higher, the waistline larger.  We hit 60 and find we can’t get up easily off the floor when trying to play with our four-year-old grandchild.  At 70, the back goes out, the pickle jar lid won’t budge. Or – well, you get the point.

After 75, the loss of lean tissue increases exponentially if not remedied.

Sounds like a death spiral, doesn’t it?  It can be just that, accelerating the journey to debilitating frailty.

Perhaps it’s no surprise if you’ve never heard the word from your primary care doc.  The name, sarcopenia, didn’t even exist until invented in 1989 by Irwin Rosenberg by combining the Greek word for “flesh” (sarx) with the Greek word for “loss” (penia) to describe the loss of skeletal muscle mass and size.  The meaning wasn’t even codified into the International Classification of Diseases code until 2016 despite being a condition that has existed as long as mankind.

In fact, Mr. Bartlit, in his efforts to get the word out about sarcopenia,  found that many – maybe even most – practicing physicians are stumped by the word.  Most medical professionals simply think of it as an inevitable part of the aging process.  Staying strong and vibrant into old age is a very dissonant thought for physicians only trained to prescribe or scalpel.  Considering that 85% of physicians never take a single class in geriatrics in medical school, this perhaps isn’t so surprising.

It’s no mystery then that few are providing a remedy for this looming health crisis.

It’s a lifestyle malady

Sad to say, we are weaker by the day and we are wasting our lives away unnecessarily.

With all our striving for convenience and comfort, we’re paying a price by way of extended frailty in late life.  Our bodies are not designed for today’s lifestyle.  We are built to move.  Escaping saber-tooths or bringing down mastodons has given way to binge watching Game of Thrones.  Chasing a gazelle or forging for tubers has given way to a table at Applebees.  The heaviest thing many of us lift in a day may be the TV remote or that plate loaded with lasagna. The only time we get our heart rate above normal is running to catch the last bus/subway home or trudging upstairs to bed.

My neighbor just bought a 700 horsepower snowblower that would clear Independence Pass above Aspen in a weekend to clear his driveway of the typical 3-inch snowfalls we get here in Denver.

Consider the ridiculous concept of the Rumba.   My wife regularly clocks half of her daily 10,000 Fitbit step goal when she vacuums our unnecessarily large suburban home. (I help occasionally, honest!)

I could go on and on.

I hope we’re waking up.

I mentioned last week that one of the biggest fears we have as we age is losing our independence.  Sarcopenia is THE major contributor to loss of independence.

Think about it.  What is the ultimate loss of independence? Would you agree it’s being warehoused in an under-staffed, urine-scented nursing home?  Where dementia, drool and Depends prevail.  Where you may be one of the fortunate few who can get to mealtime without help.

What is typically the key criteria for being pushed into that environment?  It’s the loss of ability to perform basic bodily functions, due, in large part, to physical weakness – loss of muscle power.  Showering, toileting, dressing, walking – all require muscle strength and balance.

Most of us just simply let it get away from us and accept it as inevitable.

Sarcopenia is treatable – in fact, reversible.   At any age.

Fact is, sarcopenia is a choice.  Muscle loss can be reversed starting today.  No, if you are 60, don’t expect to be or look like the tattooed and tank-topped or lululemon-clad 30-somethings at the gym that work 52×7 to improve their mirror-muscles.  But you also don’t need to look like the pencil-thin, stooped, slow-gaited “geezer” or “hag” that you swore 30 years ago you would never become.

Embrace the gift of longevity

We hear a lot about how we are all living longer.  About this “gift of longevity”. Our average lifespan has nearly doubled since 1910.  Most of it is due to the profound medical advances that we’ve experienced in the last several decades.

It’s not true, however, that quality of life has kept pace.

Technology is adding years to our life.  For most of us, it isn’t adding life to our years.  Today, medical science can do a marvelous job of keeping people alive in what writer Douglas Adams called “the long, dark teatime of the soul”.   The words used by 15th century English philosopher Thomas Hobbes to describe the life of man seem appropriate to describe the life many experience in our culture in their later years: “solitary, poor, nasty, brutish. And long”.

One simply needs to look at the exploding growth of assisted living facilities and the drugs advertised to treat chronic illnesses to understand that the quality of our later years isn’t what it could be.  And that we aren’t embracing this gift of longevity.

For years now, I have publicly and openly expressed my intent to live to 100 or beyond.  I’ve shared with you that, without fail, my proclamation is met with repulsion.  The sole reason for the repulsion is both honest and ignorant.  It’s based on the fear of frailty, on the effects of sarcopenia.  It’s expressed in a void of understanding the causes and that it needn’t be.

The solution

Reversing sarcopenia is:

  • Simple
  • Very inexpensive
  • Immediate
  • Drug-free

Reversing sarcopenia requires:

  • An attitude shift
  • Habit change
  • Patience

I hope, b y this point, we’ve established the “why” of overcoming sarcopenia.  I’ll conclude the series next week by touching on the “how”.

Let me wrap this week with this quote from Fred Bartlit’s book “Choosing the Strong Path: Reversing the Downward Spiral of Aging”

“The crucial takeaway here is that for almost all of us, the last 15 to 30 years of our lives bear no resemblance to what we expected.  And, by far, the major reason for this end-of-life disappointment is our loss of strength with age.”

Stay tuned.  And leave a comment if you are on a “strong path”, what your path looks like, and what effect it has had.

Aging Without Frailty – A Series

Fred Bartlit really lit me up!!

Fred’s story showed up in a recent Sunday issue of our local newspaper.  My wife found it, brought it to me and said: “This guy is singing your song!”.

She was absolutely right.  Fred is an 86-year old West Point grad, former Army Ranger, founder and practicing attorney in a hugely successful law firm, back-bowl skier, a golfer who shoots his age in summer, and a strength-trainer extraordinaire.

All that is impressive and inspiring in its own right, but what lit me up most is Fred’s vigorous campaign against one of the most damaging myths of aging that we allow to penetrate our psyche.

That myth?  That we are all destined to get frail as we get old. To that, Fred says “horsefeathers” – or a more pejorative version of the word.  He’s chosen to walk his talk.

He’s taking his message to the masses, not only by example but by speaking out publicly and co-authoring a book “Choosing the StrongPath: Reversing the Downward Spiral of Aging”.  He’s not shy about holding our healthcare industry responsible for perpetuating the myth through their inaction and not educating patients on the ways to avoid early and long-term frailty.

Our two greatest fears

Research has shown that the two greatest fears we face as we age are:

  1. Fear of outliving our money.
  2. Fear of losing our independence

Frailty is how we lose our independence.

But what is frailty?

Six years ago, I stumbled into a book entitled “Dare to Be 100”, one of seven books written by Dr. Walter Bortz, 88-year-old retired Stanford geriatric physician and one of my heroes in this battle against the mythical stigmas of aging.  Dr. Bortz put frailty into perspective for me and helped me make some needed changes in my lifestyle.

Dr. Bortz points out that frailty has lacked a conceptual framework.  He poses interesting questions like:

  • Is frailty a disease? Is so, where do we look for it in our medical classroom or textbooks?
  • Is it a legitimate entry on a death certificate? Cause of death: he/she was frail. Not gonna happen.
  • Can we admit someone to a hospital with the diagnosis of frailty and have a prayer of insurance covering anything?
  • Is frailty aging? One would tend to think so since it shows up mostly with older people.  But, at the same time, we can identify younger people who are frail due to any number of causes.  If I put my leg in a cast for six months, it becomes frail.

So his position is that frailty is NOT synonymous with aging.  Rather, “it is the reciprocal of vitality, robustness, and healthiness.  It is a predisposition to failure.  It is a disconnectedness, a weakness, an infirmity.”  So an 86-year old Fred Bartlit can be totally unfrail while your 57-year old neighbor can be near totally frail.

More explicitly, and more profoundly, Dr. Bortz goes on to say:

“—frailty is a downward drift of matter from a more highly organized state of order, structure, and function to a state of increased disorder, instability, and susceptibility.  The cause of this total decay is the loss of contact of the system from its environment, with its ordering capacity.”

Did I lose you there?  Sorry.  He finally drops the formal classroom jargon and says bluntly: “Frailty is not aging. Frailty results from disuse – even more than it does from aging.  It is not a disease.  It is a condition.”

And it’s reversible – NO MATTER THE AGE!

Dr. Bortz helped me understand that a body, or an organ within it, reaches clinical frailty when it reaches 70% loss of functionality.  Falling below that 30% threshold is almost certain death of the organ or the body.

We have a “health space” with 70% to work with.  Graphically, it would look like the graph below.  Our mission should be to stay as high in the 70% space for as long as we can.  We have much we can do to make that happen, far much more than we are showing the drive to do in our culture.

I’ve borrowed another one of Dr. Bortz’s graphs to illustrate further how frailty works if intervention doesn’t take place.  If we just let life take its sedentary, convenience and comfort-seeking way without the intervention of proper diet and exercise, we are going to decline at a rate of about 2% /year after age 30, which is when our bodily decline begins to accelerate.  By 65 or 70, at that rate, we are in trouble.

On the other hand, if we were to “intervene” with appropriate health-inducing activities and reduced that decline rate to, say, 1% or 0.5%, perhaps that 100 year threshold I profess would easily be in reach – at least theoretically, notwithstanding the possibility of some form of disease or event that changes that decline rate.

And that’s where Fred Bartlit comes into the picture. I haven’t spoken with Fred but I think he would agree with all this.  I’ve asked for the opportunity to interview him so I can feature him in a future personal-interest article, but I suspect he is too busy to bother with that right now.  Regardless, Fred and I are very much on the same wavelength – and mission – in terms of crusading for the avoidance and/or reversal of frailty.

I have witnessed too many friends, relatives, neighbors – as I’m sure you have – who are stooped, immobile and old before their time. Some may be disease related, but most of it is due to inactivity.

There is a rampant, but undiscussed, condition with a big, scary-sounding name associated with that.  It’s called “sarcopenia”.  Fred is on a campaign against sarcopenia – as I am.  Because it doesn’t have to develop – and it is reversible.

I’m going to dedicate next week’s article to fleshing out and flushing out sarcopenia.   Because somebody needs to – our medical community isn’t.

Stayed tuned – hang with me next week.