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a Nutrition, Metabolism, and Exercise Laboratory, Donald W. Reynolds Center on Aging, University of Arkansas for Medical Sciences, and Geriatric Rehabilitation, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock
William J. Evans, Director, Nutrition Metabolism, and Exercise Laboratory, Donald W. Reynolds Center on Aging, University of Arkansas for Medical Sciences, 4301 W. Markham, Slot 806, Little Rock, AR 72205 E-mail: evanswilliamj{at}uams.edu.
IN 1983, John Holloszy published a prescient article titled "Exercise, Health, and Aging: A Need for More Information" (1) in which he discussed the lack of definitive information on the effects of exercise on aging and the development of age-associated chronic diseases. He stated, "In actuality, the scientific evidence that exercise promotes long-term health benefits is surprisingly skimpy and unconvincing" (p. 4). He further stated that the evidence for "beneficial effects of exercise is too meager to justify recommendation of strenuous exercise for the large population of sedentary and older individuals in the United States" (p. 2). At the time, Bortz (2) reviewed the remarkable similarities between disuse and aging and speculated that many of the so-called biomarkers of age were simply a result of a sedentary life. These two articles laid out important unresolved questions related to exercise and aging and advanced the hypothesis that increased levels of physical activity could prevent or even reverse many of the physiological and metabolic changes that come with advancing age. It is well known that aging is associated with decreased functional capacity, fat-free mass, bone mass, maximal heart rate, and other factors that greatly increase the risk of chronic disease and reduced independence in late life (3). The extent to which these changes are a primary result of biological aging or environment and lifestyle is only now emerging (4). This unresolved issue is at the heart of research in geriatrics and aging.
The issues laid out by Holloszy (1) have, to a large extent, been resolved. Since 1983 there has been an explosion of information on the beneficial effects of exercise. The American College of Sports Medicine (5) has issued a position paper recommending both aerobic and resistive exercise for elderly people. In this issue of the Journal of Gerontology: Medical Sciences, the article by Singh (6) moves beyond a simple recommendation of exercise for elderly people. This important paper not only lays out the rationale for exercise in older people, but it clearly distinguishes the very different effect of the modality of exercise and specifically discusses the prescription for exercise for older people. Aerobic, strengthening, balance, and flexibility exercises have some overlapping, but often very different effects. A sound and evidence-based prescription for any change in lifestyle is critical. This article provides the strongest argument, to date, why exercise should be the standard of care for all elderly people. Too often, physicians not only do not recommend exercise for their older patients, but may discourage them from participation in the mistaken belief that it may be harmful or dangerous. Because of their increased prevalence and risk of chronic disease and their decreased functional capacity and fitness, there is no group of individuals who can benefit more from increased levels of physical activity than elderly people (although the ability to see long-term functional effects has been disputed (7), probably because of the failure of many persons to adhere to exercise regimens).
However remarkable the effects of increased physical activity, without a workable strategy to increase the levels of physical activity among elderly people, continued research into the positive effect of exercise in this population is academic. Most of the general public has been educated to believe that exercise is beneficial, but only a small proportion of the population gets sufficient exercise. Even individuals who obtain major beneficial responses to supervised exercise programs rarely continue to exercise on their own. Clearly, our most important future research needs are finding ways to motivate people to exercise regularly and figuring out how to engineer exercise back into our daily lives. The article by Singh (6) is a valuable tool and should be required reading for all health care professionals who deal with elderly people.
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