Run for Your Life

by Mark Cucuzzella

  Our aerobic strength declines as we age. But not necessarily by much. In what’s familiarly called the Dallas Bedrest and Training Study, five healthy twenty-year-old male college students were subjected to three weeks of strict bed rest. Before and after their confinement to leisure, researchers measured their VO2 max—the standard metric for exercise capacity, and a good indicator of one’s “physical” age. At the end of the three-week period, the students’ average VO2 max declined by 27 percent. (Afterward, they engaged in an eight-week exercise program that restored their original fitness, and then some.)

  The surprise came when the same subjects were studied thirty years later. Over the intervening three decades of living reasonably healthy and active lives, their average VO2 max declined less (from the first pretest baseline) than it had during their three weeks of bed rest. I’ve conducted many treadmill tests and measured VO2 max in patients and runners myself, and I see fit seventy-year-olds who score younger than out-of-shape twenty-year-olds. This doesn’t mean, of course, that the decline due to aging is fully preventable. It does mean that we can stay active, healthy, and strong until late in life.

  LIFE SPAN ≠ HEALTH SPAN

  Medical science counts our modern-day gain in life expectancy, and the statistical decline in age-adjusted death rates, as victories. Longevity—the quantity of our lives—has increased slightly in recent years, yet we haven’t seen a corresponding extension in the quality of our lives. Nowadays, a higher percentage of us are reaching advanced ages—over eighty, for instance—but it isn’t clear whether, on average, our functional life spans are longer than they were decades ago.

  Natural selection does a pretty good—not perfect—job of weeding out the unhealthy. All of us are the descendants of winners in natural selection. Take a look at your family tree, back to your grandparents’ generation or earlier. Find a truly healthy ancestor—one who lived into their nineties. In all likelihood, they were active and healthy until reasonably close to their time of death. How did they live, and what did they eat?

  In my experience, most active people don’t exercise to increase their longevity anyway. They simply sense that they live better and fuller lives when they do.

  The graph on the top describes the slow decline typical of modern Americans as they age. But it’s entirely possible, with healthful living, to follow the path on the bottom. Dr. Ken Cooper (the author of Aerobics) coined the phrase “squaring off the curve.”

  In an article in Biogerontology called “Live Strong and Prosper,” researcher Michael McLeod and his team confirm that aging is accompanied by a slowing in the growth of skeletal muscle, and a decline in muscle mass (sarcopenia). These factors are directly associated with mortality in the elderly, largely because they place them at greater risk for falls.

  Physician and author Walter Bortz asked a pertinent question: What comes first, frailty or sarcopenia? When you confine an elderly person with a narrow margin of strength in bed, it’s very difficult for them to ever emerge and reclaim full health. The goal of the patient (hopefully supported by their care provider) should be to remain upright and mobile, as long as possible. By increasing muscle protein synthesis, through activity and exercise, a strong, healthy muscle mass can be maintained. This greatly improves functionality and independence, reducing the chance of injury from a fall.

  Orthopedist Dr. Vonda Wright has also demonstrated sarcopenia in the MRIs below, images from two people in their seventies. The one on the bottom (the more physically active one) shows double the amount of muscle as the one on the top, though their body weights are roughly equal.

  One study found that only two weeks of limitations on walking (in an otherwise free-living condition) resulted in decreases in insulin sensitivity, lean leg mass, and VO2 max. We need to be vigilant. The risk of becoming diabetic (if you aren’t already) increases as you age and suffer extended downtime.

  A GENUINE, SELF-GENERATED FOUNTAIN OF YOUTH

  When we age, we typically face a variety of degenerative diseases. Contrary to conventional wisdom, running can help alleviate these by promoting healthful stresses, which in turn trigger cellular regeneration and even neurogenesis. The body is constantly repairing and growing, turning over cells—almost completely replacing them every eighteen months. This turnover is like replacing a gigantic girder bridge one section at a time while keeping the bridge open. The destiny of machines is to “use it and lose it”—they wear out. But for biological organisms such as our bodies, it is “use it or lose it.” We have a choice.

  We want the functional use to continue, of course, and hopefully we can even enhance it. It’s easy: if we apply good food, love, enjoyment, and movement, then positive growth and repair will occur naturally, even when we are older.

  GOING OVER A HUNDRED, PEDAL TO THE TRACTOR METAL

  Frank Buckles was the last surviving World War I veteran in the United States. (He also spent four years in an internment camp in Italy during World War II.) After an enjoyable evening with his family, he died peacefully at the age of 110.

  Frank was a neighbor of mine. During the period that he lived in rural West Virginia until the day of his death, he scrupulously observed three rules of good health:

  You must stress the body.

  Never be in a hurry.

  Don’t worry.

  He did morning calisthenics into his nineties, including standing on his head. He slowed down only when a piece of farm equipment dented his skull, which made it difficult for him to maintain his balance. He drove his tractor until he was 103 (you can imagine his response when doctors suggested, years earlier, that he was too old to climb onto it), and he continued to work on the farm until he was 105. Occasionally, after prodding from friends and family, Frank would see a physician. But the physicians inevitably prescribed meds, and Frank dumped them in the trash almost every time. The one drug he did take for aches and arthritis (not surprising at 110 years) was an occasional ibuprofen.

  I believe that Frank developed an extremely efficient metabolic system during his time at a civilian internment camp in Italy, when he was given one cup a day of food. He had the self-control to divide the cup into thirds and eat portions throughout the day. Some studies have linked dietary restriction to a slowed aging process, though this is difficult to test and prove.

  Genetics plays a role in how you age, but how you live is a larger factor—and it’s within our control, after all. Considering our busy, high-stress culture, Don’t worry is perhaps Frank’s most overlooked piece of advice. Stress hormones routinely flood through our veins as a physiological response to the numerous psychological challenges that greet us nearly every day.

  The Mayo Clinic cautions that the stress response is activated so often in many of us that the body may not have adequate opportunities to return to normal, leading to a state of chronic stress (indicated by prolonged high bloodstream levels of cortisol, the “stress hormone”). Chronic stress impairs cognitive performance, suppresses thyroid function, and causes blood sugar imbalances (such as hyperglycemia), decreased bone density, decrease in muscle tissue, elevated blood pressure, lower immunity, slowed wound healing, and inflammatory responses throughout the body.

  That sounds a lot like what we see in aging.

  Persistent high levels of cortisol also boost the buildup of adipose tissue—belly fat—which is linked to even more serious health problems: heart attack, stroke, metabolic syndrome, and higher levels of the damaging, small-particle-sized low-density lipoprotein.

  To keep cortisol levels under control, the body’s relaxation (parasympathetic) response should be activated promptly following a fight-or-flight (sympathetic) response. Frank Buckles’s secret was that following incidents of stress, he could quickly reset his parasympathetic system at healthy levels and reclaim a relaxed, clear mind. This topic is covered in chapter 13, and is especially applicable as we grow olde
r.

  TRAVELING BY FRAIL ROAD

  These days, elderly patients are spending a shorter time living and a longer time dying.

  Among elderly patients, I see a lot of frailty. The first thing I do is have them stand up from a sitting position. If they have difficulty, I work with them on the mechanics of standing, by helping them find their center of gravity and adjusting their posture and form. I also observe their walking speed. Slow walking speed is associated with multiple poor health outcomes.

  Although a solid medical definition of frailty is elusive, it refers to the phase of life when we lose our independence and our health. Many assume that frailty is the inevitable result of wearing out our bodies and minds. In fact, it comes from lack of use. As soon as you stop using your body, the decay and decline timepiece starts ticking. As Walter Bortz put it, “The body is like a grandfather clock: every day you have to wind it up.”

  And not just wind up the body. Cranking up the mind and keeping it invested with tasks, direction, and meaning is a critical part of the package, too. Longevity, we’re coming to understand, isn’t just physical. It’s associated with a feeling of purpose and with a connection to community. Isolation is associated with accelerated aging.

  Most important, we should remain positive and not worry about things we used to be able to do without effort. Rather, focus on what we can do, enjoy doing it, and look to the future for all that is new. As Abraham Lincoln said, “I may walk slow, but I don’t walk backwards.”

  Every day, I try to pause for a moment and consider Frank Buckles’s three simple rules for health. He showed me that aging well is a true endurance sport.

  OH, YEAH—OA

  Osteoarthritis is the leading cause of disability among the elderly, and it affects as many as a quarter of us when we reach the age of fifty-five.

  Many people believe that running is injurious to joints. It’s true that running and other impact sports, when done improperly, can increase the risk of knee trauma and osteoarthritis in the knee. But Paul Williams and colleagues at the Lawrence Berkeley National Laboratory found that even for recreational runners who participate in multiple marathons annually, running does not appear to increase osteoarthritis and hip replacement risk. For one thing, running can help control body weight, which is a risk factor for osteoarthritis. But running may even offer protection from osteoarthritis, by promoting cartilage thickening and by enhancing its viscoelastic properties. Walking, and low-impact exercise such as biking, Williams found, offer no particular protective advantage.

  YOUNGER NEXT YEAR

  The medical literature on aging guides us to a simple conclusion: stay active and keep moving. Those whose lives are characterized by prolonged sitting tend to acquire disease, including dementia, and become frail at an earlier age than nonsitters and regular exercisers. Once you become sedentary, the decay process is set in motion, and it doesn’t matter if your blood pressure and other health lab indicators are “within normal limits.” Once you’re bedridden, frankly, it’s all downhill from there.

  The Journal of the American College of Cardiology compares physical activity to a miracle drug. “The list of diseases that exercise can prevent, delay, modify progression of, or improve outcomes for, is longer than we currently realize.” One research team found that running as little as five to ten minutes per day was associated with a 30 percent reduction in mortality from all causes, a 45 percent reduction in mortality from cardiovascular disease, and an addition of three years to life expectancy. The benefits of exercise for healthy aging can compensate for some of obesity’s negative impact on aging.

  For many of us, visits to a clinic or hospital comprise the rare moments when we are faced with (sometimes uncomfortable) medical reality. If we want to grow old, it’s best to start preparing now, before that clinic visit. Being sedentary and overweight alone doesn’t normally send us to the doctor, though as we age its implications for health, longevity, and vulnerability to disease are clear and serious.

  The Hippocratic Oath requires that doctors “first, do no harm.” In my view, this obliges us to discuss the health effects of obesity and physical inactivity. If doctors and the medical establishment don’t proactively raise these issues with patients—which usually entails addressing their lifestyles—we are doing a disservice to them and to our profession.

  Insurance reimbursements focus on treatment. Physicians have little financial incentive to recommend preventive exercise and lifestyle changes. Additionally, many of them may not even know what physical activity to prescribe, nor where to send their patients. I feel that they must summon the best sources of knowledge and experience that they can. By educating themselves, they will be positioned to motivate their patients and our society, and to abandon old habits, wishful thinking, and symptomatic treatment. We’ll all appreciate it when we’re older.

  DRILLS

  Aging readers can begin by “resetting” their bodies every day, by working on posture and balance, and by keeping the fascia supple. How to do this? Start by kicking off your shoes. Make yourself tall, and stretch out like a cat. Find your balance and your connection with the ground.

  It may sound rudimentary, but work on properly arising from a chair, especially when you are weak from bed rest or an ailment:

  Position yourself in a seat, not too high or too low, with thighs parallel to the floor.

  Scoot your butt forward and tuck your feet under your hips; maintain a wide stance (the width of your hips).

  Lean forward (as if being tugged from the sternum), pivoting from the hips, and stand up in a single, fluid motion.

  Stand up in this manner two or three times every half hour—then gradually increase the frequency.

  A lab test that aging readers might like to consider (be careful what you ask for!) is a telomere length test. Your telomeres are the dynamic, protective caps on the ends of your DNA strands. Healthy, long telomeres reflect healthy cell replication and remodeling, and they tend to shorten with age. I was relieved that my results showed me as a (gratefully) much younger man—thirty-five in “telo years”—despite my busy and stressful life.

  CHAPTER 18

  The Nature Cure

  In every walk with nature, one receives far more than he seeks.

  —JOHN MUIR

  In many modern societies, biophilia and the recognition of nature’s extensive values [lie] dormant. Our present day context of sprawling settlements, enslaving technology, compulsive consumption, and weak natural sciences educational curriculums account for much of this disconnection and apathy, and yet at significant socioeconomic and potentially irreversible environmental costs.

  —HELEN SANTIAGO FINK

  MYTH: Exercise promotes health, regardless of where you are.

  FACT: Evidence shows that physical activity in nature provides additional levels of mental and physical health and well-being.

  Nature is something we tend to forget, or take for granted, yet it ties much of this book together. The natural world is the source of the food we eat, the air we breathe, the water we drink, and the resources that go into the products we consume. Evidence strongly suggests that exposure to nature benefits physical and mental health in a variety of important ways, and can derail disease before it develops.

  Humans are a species—highly evolved, we believe—that is inextricably linked to the natural world. And by moving our bodies through the range of motion we were designed for, including running, we become an extension of nature. What could be more fulfilling than to express ourselves in the most complete and natural way we can? And what more appropriate place to use and care for our bodies than in the environment in which we evolved? Medical researchers understand much about what happens to us physiologically when we exercise. We know less about the more intangible qualitative benefits of moving and being in the outdoors.

  Sports, which are gen
erally done outside, are a proxy for managing the challenges of nature. It may be no coincidence that some of the most popular individual sports are those that place the human body in a natural setting with only minimal tools or mediation: mountaineering, rock climbing, skiing, surfing, and swimming. And running. These activities pivot around the same basic goal: to efficiently and gracefully negotiate the challenging terrain ahead, assisted by little more than the bodies and minds we were born with. (Or, from another perspective, to simply get through it without falling, crashing, or sinking.)

  AN EPIDEMIC OF E-DEVICES

  The average number of hours per day that people spend indoors on digital devices seems only to climb, while our time spent outdoors—and in nature, especially—declines. Children and “screenagers” are especially vulnerable to a physically nondemanding but attention-robbing indoor lifestyle, such that we are broadly witnessing what Richard Louv (author of Last Child in the Woods) has termed “nature deficit disorder.” The habit of remaining indoors continues even as we learn how interior, manufactured environments (along with the poor nutrition and lack of physical activity that tend to accompany them) contribute to obesity, high blood pressure, type 2 diabetes, heart disease, depression, and many other illnesses.