Recently I read Less Medicine, More Health by Dr. Gilbert Welch and Watch Your Back by Dr. Richard Deyo. My 18-year-old car reached 250k miles last week, and I worked out at my gym in mid-day instead of at prime time. These occurrences got me thinking about the wisdom of striving to attain perfection -- even without much hope of ever doing so.
Let's start with the gym. Over the years, I've belonged to many different gyms, and it has almost always been the case that mid-day provided a break from the prime-time workout crowds. Early afternoon was generally a time when the staff took it easy; the cardio-machines were almost all available, and the few dedicated souls who were working out appeared to be there because they worked swing-shift or they had the day off. This is not the case at the gym I joined recently. Not at all. Mid-day is workout time for the folks I lovingly call the "Gym-rats in Retirement". (I've always been a "gym-rat" and aspire always to be one, so despite how it sounds, this is, indeed, a term of respect and endearment.) At mid-day, my gym is hopping! Starting at around 11 am and continuing until 4 pm, there are weight-lifting and kettle bell workshops, and balance classes, TRX training, and exercise classes for chronic disease management and cancer recovery. Throughout the day, there are older folks working with personal trainers, or following their own written (or online) workout schedules. There are senior citizens on eliptical machines, treadmills, stationery bikes, and rowing machines, some taking dance or Zumba class, and there are lots of people swimming laps solo or in masters' swim programs. Classes in Tai Chi, QiGong, Yoga, Pilates, Core Strength and Balance are going on, and folks in their seventies, eighties, and even nineties are enjoying each others' company as they workout--many of them EVERY DAY!
There is a great deal of good data on the importance of moving throughout the life-span, and especially into older age. In fact, many of the symptoms associated with older age (weakness, stiffness, loss of balance, joint pain) are actually symptoms of inactivity and not of aging. Many elders are afraid to exercise for fear of increasing their joint pain when in fact studies show a significant decrease in osteo-arthritis pain with movement. In the ADAPT study, combining a healthy diet and weight loss with exercise brought about noteworthy improvements in walking velocity and reductions in pain. Modest weight loss combined with moderate exercise produced significant improvements in self-reported functioning and pain and greater measured mobility, allowing people to avoid medications and surgical interventions. Exercise and weight loss are now considered "cornerstones" for the treatment of Knee Osteoarthritis in overweight older adults. Exercise has many additional benefits including preventing bone loss, elevating mood, reducing the chances of falling by improving strength, balance, and coordination, and preventing or managing cardiovascular disease.
Only about 25% of those 65 to 74 get regular exercise, however. Even when people have the time in retirement, they assume they are too old or out-of-shape to do even the simplest and potentially most beneficial exercise such as taking regular walks. Some worry about the cost, but moving does not have to cost anything. Most senior centers have fitness classes and many TV channels offer exercise demonstrations. Those who want to improve their strength at home can use soup cans or milk jugs filled with sand, and even do exercises sitting in a chair if necessary. Many elders with chronic medical conditions are eligible for sessions with a physical or occupational therapist and many health insurers cover all or part of the cost of gym membership for those over 65. Working out at a gym can be intimidating to many older people, however, depending upon the atmosphere and the degree of respect shown to elders. Mine is a modest gym with a very broad age range, from young singles and families to folks using walkers and wheel-chairs, some in their 90's. Some members have been working out with each other for 30 years! It works well because it is an environment with strong social connections; it functions a lot like a community center, with organizing activities like March Madness, time together watching the game, barbecue dinners, fundraisers for local animal shelters, and arts and crafts shows. The trainers and staff are quick to offer help and advice for exercises and any modifications that might be needed; all are supportive and encouraging. Offering a fitness center with respect and social support for all is an excellent business decision--the U.S. population is aging, and the benefits of exercise are being recognized more and more by those who pay the medical bills, like insurance companies, medical plans, and patients themselves.
So how are my car and the books by Drs. Deyo and Welch relevant here? They offer the message that we can keep going in older age, even with limitations, even in the midst of chronic conditions, living lives that are meaningful and worthwhile to us. My old car has quirks (a passenger side door lock that only works manually, a driver's window that works only intermittently, and the need for a quart of oil every thousand miles) but with regular maintenance my car gets me where I want to go.
Basic regular maintenance (moving more, moving correctly with good posture (e.g., using the Gokhale method), sitting less, eating well) can buy us humans some quality time too. As Drs. Welch and Deyo note, it is not always the case that it's better to fix a problem, even one like back pain. [Dr. Jerome Groopman, Professor of Medicine at Harvard Medical School, offers his own analysis of this issue from personal experience.] Sometimes it is better to live with imperfections as one strives to maintain functioning. For example, despite having MRI reports that detail litanies of 'fixable problems', some people can function, exercise, and live happy, productive, creative lives as long as they just keep moving. Combined with managing one's emotions and motivation, movement as a daily "treatment" can have far better functional outcomes than back or knee surgeries that "fix" the problems.
Trying to make a body (or even a car) function perfectly, without limitations or quirks, can introduce greater risk than benefit. As Dr. Welch notes, Americans get far too much medical care (too many drugs, too much surgery), much of it not particularly beneficial and some of it downright dangerous, because many believe that every problem needs to, and can be, fixed. A new study identifies medical treatment errors as the third leading cause of death in the United States today. The costs of medical care are climbing for the entire population, even those with "good" insurance.
Living with “quirks” and limitations is part of getting older; modern medicine might be able to help with some of those limitations, but for many of the challenges of aging, it's the day to day habits, like moving, that matter. Perfection may not be possible, but striving to become incrementally stronger, happier, and more resilient may be-- and that might be just good enough.
Let's start with the gym. Over the years, I've belonged to many different gyms, and it has almost always been the case that mid-day provided a break from the prime-time workout crowds. Early afternoon was generally a time when the staff took it easy; the cardio-machines were almost all available, and the few dedicated souls who were working out appeared to be there because they worked swing-shift or they had the day off. This is not the case at the gym I joined recently. Not at all. Mid-day is workout time for the folks I lovingly call the "Gym-rats in Retirement". (I've always been a "gym-rat" and aspire always to be one, so despite how it sounds, this is, indeed, a term of respect and endearment.) At mid-day, my gym is hopping! Starting at around 11 am and continuing until 4 pm, there are weight-lifting and kettle bell workshops, and balance classes, TRX training, and exercise classes for chronic disease management and cancer recovery. Throughout the day, there are older folks working with personal trainers, or following their own written (or online) workout schedules. There are senior citizens on eliptical machines, treadmills, stationery bikes, and rowing machines, some taking dance or Zumba class, and there are lots of people swimming laps solo or in masters' swim programs. Classes in Tai Chi, QiGong, Yoga, Pilates, Core Strength and Balance are going on, and folks in their seventies, eighties, and even nineties are enjoying each others' company as they workout--many of them EVERY DAY!
There is a great deal of good data on the importance of moving throughout the life-span, and especially into older age. In fact, many of the symptoms associated with older age (weakness, stiffness, loss of balance, joint pain) are actually symptoms of inactivity and not of aging. Many elders are afraid to exercise for fear of increasing their joint pain when in fact studies show a significant decrease in osteo-arthritis pain with movement. In the ADAPT study, combining a healthy diet and weight loss with exercise brought about noteworthy improvements in walking velocity and reductions in pain. Modest weight loss combined with moderate exercise produced significant improvements in self-reported functioning and pain and greater measured mobility, allowing people to avoid medications and surgical interventions. Exercise and weight loss are now considered "cornerstones" for the treatment of Knee Osteoarthritis in overweight older adults. Exercise has many additional benefits including preventing bone loss, elevating mood, reducing the chances of falling by improving strength, balance, and coordination, and preventing or managing cardiovascular disease.
Only about 25% of those 65 to 74 get regular exercise, however. Even when people have the time in retirement, they assume they are too old or out-of-shape to do even the simplest and potentially most beneficial exercise such as taking regular walks. Some worry about the cost, but moving does not have to cost anything. Most senior centers have fitness classes and many TV channels offer exercise demonstrations. Those who want to improve their strength at home can use soup cans or milk jugs filled with sand, and even do exercises sitting in a chair if necessary. Many elders with chronic medical conditions are eligible for sessions with a physical or occupational therapist and many health insurers cover all or part of the cost of gym membership for those over 65. Working out at a gym can be intimidating to many older people, however, depending upon the atmosphere and the degree of respect shown to elders. Mine is a modest gym with a very broad age range, from young singles and families to folks using walkers and wheel-chairs, some in their 90's. Some members have been working out with each other for 30 years! It works well because it is an environment with strong social connections; it functions a lot like a community center, with organizing activities like March Madness, time together watching the game, barbecue dinners, fundraisers for local animal shelters, and arts and crafts shows. The trainers and staff are quick to offer help and advice for exercises and any modifications that might be needed; all are supportive and encouraging. Offering a fitness center with respect and social support for all is an excellent business decision--the U.S. population is aging, and the benefits of exercise are being recognized more and more by those who pay the medical bills, like insurance companies, medical plans, and patients themselves.
So how are my car and the books by Drs. Deyo and Welch relevant here? They offer the message that we can keep going in older age, even with limitations, even in the midst of chronic conditions, living lives that are meaningful and worthwhile to us. My old car has quirks (a passenger side door lock that only works manually, a driver's window that works only intermittently, and the need for a quart of oil every thousand miles) but with regular maintenance my car gets me where I want to go.
Basic regular maintenance (moving more, moving correctly with good posture (e.g., using the Gokhale method), sitting less, eating well) can buy us humans some quality time too. As Drs. Welch and Deyo note, it is not always the case that it's better to fix a problem, even one like back pain. [Dr. Jerome Groopman, Professor of Medicine at Harvard Medical School, offers his own analysis of this issue from personal experience.] Sometimes it is better to live with imperfections as one strives to maintain functioning. For example, despite having MRI reports that detail litanies of 'fixable problems', some people can function, exercise, and live happy, productive, creative lives as long as they just keep moving. Combined with managing one's emotions and motivation, movement as a daily "treatment" can have far better functional outcomes than back or knee surgeries that "fix" the problems.
Trying to make a body (or even a car) function perfectly, without limitations or quirks, can introduce greater risk than benefit. As Dr. Welch notes, Americans get far too much medical care (too many drugs, too much surgery), much of it not particularly beneficial and some of it downright dangerous, because many believe that every problem needs to, and can be, fixed. A new study identifies medical treatment errors as the third leading cause of death in the United States today. The costs of medical care are climbing for the entire population, even those with "good" insurance.
Living with “quirks” and limitations is part of getting older; modern medicine might be able to help with some of those limitations, but for many of the challenges of aging, it's the day to day habits, like moving, that matter. Perfection may not be possible, but striving to become incrementally stronger, happier, and more resilient may be-- and that might be just good enough.
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