Early one morning about eight years ago, my mom, then just shy of 90, stood at the door of my home office and said that her left arm hurt between her shoulder and elbow. Scared she was having heart problems, I called our family doctor, who sent Mom for a full day of cardiac testing. One test required her to walk on a treadmill. The staff hovered, worried that she’d lose her balance and tumble off. The attention was unwarranted. She easily kept up and even had enough breath to inform her attendants: “You know, I work out with a personal trainer every week.” She still does.
Mom has always valued exercise, and I’m convinced — along with her doctors, who are backed by a strong body of research — that her longtime fitness habit has slowed her decline and kept her in generally good health. (That pain in her arm turned out to be nothing.)
Exercise is “the best medicine no one wants to do,” says Ronan Factora, a gerontologist at the Cleveland Clinic. Even tiny bites of fitness bring big rewards. A 2011 study that aimed to figure out whether a low level of exercise could bring health benefits showed that even 15 minutes of walking a day can add three to five years of life.
“I tell my elderly patients that it doesn’t take very much exercise to benefit them,” Factora says. “We’re not talking about breaking a sweat. I’m not asking you to run a marathon. I’m just asking you to get up and move.”
People at any age benefit from exercise, he says, and the frailest residents in nursing homes benefit the most.
Exercise helps keeps aging bodies healthy by increasing blood flow to the brain, carrying extra oxygen and other nutrients. It also helps keep blood pressure and blood sugar at normal levels, lowering the risk for vascular dementia, Factora says.
Exercise can also lower risk for dementia by keeping the hippocampus — the place in the brain where we make and store memories — a healthy size, according to some research. As we age, the hippocampus shrinks, raising our risk for dementia. In a study published in 2010, researchers tested aerobic exercise on 120 healthy adults. After one year, the hippocampus increased in volume by 2 percent in the group participating in aerobic exercise — “effectively reversing age-related loss in volume” by one to two years, according to the researchers. The volume declined in control group members, who were not asked to do aerobic training.
Even frail people with dementia benefit from exercise. According to a new review by the Cochrane Collaboration, eight clinical trials found that people with dementia who exercised improved their performance on tests used to evaluate memory loss. The reviewers expressed cautious optimism about the results, noting that there were differences in results from individual trials and that there was not enough evidence to show that exercise improves symptoms of depression. “Nevertheless, these are encouraging results, as dementia is a debilitating disease that results in progressive decline in cognition and ability to perform” daily activities, the reviewers said.
Frailty itself should not keep those with cognitive impairment out of the gym. Researchers at the University of Heidelberg showed recently that people with dementia can be taught to use exercise machines and that the exercise done by people in this group can indeed be rigorous. And these workouts can help them both physically and mentally,
Everyone has limits, and it’s always best to start slowly, but “move from zero to something,” Factora says. He suggests having someone such as a physical therapist help monitor progress at first. Then move to a personal trainer and exercise on a regular schedule.
‘Get up and move’
For my mom, exercise hasn’t always meant the gym. When my sisters and I were young and playing in the yard, she’d always race us to the back door. She kept fit in part by cutting the grass in our large yard, a practice she continued throughout her 70s. “I’ve been doing this my whole life,” Mom says. “I used to be a secretary and I sat at a desk five days a week, so I always felt like I wanted to get up and move.”
After Mom was widowed 13 years ago, she moved in with my husband and me. To help with her social life and keep her osteoarthritis at bay, I signed her up for an aerobics class that we took together. She and the instructor hit it off so well that I signed Mom up for weekly private workouts with her.
From the start, the trainer put Mom, then 85, through a challenging, hourlong program that works every major muscle group. Today, Mom’s left knee is bone on bone — end-stage joint disease. She walks in pain every day, and some days are worse than others. But she goes to the gym anyway, climbing the stairs to the weight room even on really achy days.
Mom warms up on a recumbent exercise bike for about eight minutes. Then her trainer starts her on a circuit of resistance machines and free weights. Mom works her abs by sitting on a bench and doing crunches by lifting her knees to her chest. She stays on the same bench and works her legs by repeated standing and sitting. Then, she uses two-pound free weights for her biceps and shoulders. She’ll do some push-ups against the wall before moving to the equipment for more upper- and lower-body work.
She and her trainer finish up on the mat with a few more abs, and they end with some stretches. If Mom’s knee is really bad, they’ll skip the mat and finish with abs and stretches with Mom sitting on a bench. By then, her hour is up. Her doctor is amazed and delighted that she continues this routine, and tells her that he wishes all of his patients were that active.
Years ago, after Mom and her trainer had been working together for a few months, the trainer had Mom on a mat and said to me, “Hey, come here and your feel your mom’s abs.” They were rock-hard.
'She does 15'
Mom hasn’t always had it easy. She survived two bouts with breast cancer. When she was 74, she broke her first bone — her right wrist — when, as usual, she was moving too fast and slipped on the basement floor. At the time, I was working as a bone researcher at what used to be Jewish Hospital in St. Louis. Every Friday morning, we had a department-wide bone conference. Not long after Mom broke her wrist, Stanley Birge, a gerontologist at Washington University School of Medicine, spoke about exercise and falls in the elderly.
Afterward, I signed Mom up for one of his clinical trials on exercise and aging. During one of the office visits when Birge was taking Mom’s family history, she complained to him that I wouldn’t let her use the StairMaster in her basement unless I was there to supervise. Birge called me, and we had “the exercise talk.” He said that Mom’s spine was so riddled with osteoarthritis that it would “snap like a rusty hinge” if she didn’t keep those muscles strong. He also told me to let Mom use the StairMaster because “we can’t keep our parents in glass houses.”
After that, I let Mom use the StairMaster whenever she wanted, and I added some exercises to strengthen muscles in her upper back.
In 2007, Mom fell while running to answer the phone. Her left side hit the slate floor in our entryway, and she broke her left arm right below the shoulder. Once the break healed, Mom could barely raise that arm. The orthopedic surgeon sent her to physical therapy for eight visits, saying that she’d never regain her mobility. The therapist worked Mom’s shoulder in much the same way as her trainer, using weights and resistance training and a lot of stretching. After four visits, you’d never have known that shoulder was broken. The therapist called the doctor and canceled the rest of the visits, saying we’d be wasting our money if we continued with therapy.
As caregivers know, tending to aging parents takes its toll, even if the person you’re caring for is someone as wonderful as my mother. Three years ago, I began to think I really I couldn’t do it anymore and visited some residential care facilities.
The places were nice, and the residents looked clean and well-tended. But not one facility I visited had an exercise room. David Schless, president of the American Seniors Housing Association, assures me that the places I visited are the exception. “Starting about 10 to 15 years ago, it’s become much more common to include gyms in senior housing facilities,” he says.
Ultimately, I decided to keep Mom with us. She was 95 years old then, and I don’t think she would have lived to 98 had she moved into a residential facility.
Here’s what the years of working out with Mom have taught me: We greatly underestimate the sheer physical strength we’re capable of achieving at any age. A few weeks ago at the gym, I filmed my mom doing her second set of leg curls. I counted along, and at 10 reps, thinking she was done, I said, “That’s 10, Mom!” Her trainer corrected me: “She does 15.”