A 71-year-old patient came to me to address his chronic medical problems that include diabetes, obesity, high blood pressure and coronary artery disease.
Richard, which is not his real name, revealed that he spent many hours every day watching TV and did not exercise at all. I thought about what I should tell him about the risks of inactivity and the importance of exercise.
First, it’s important to clarify what is meant by “exercise.” According to the U.S. Department of Health and Human Services (HHS), “exercise is a form of physical activity that is planned, structured, repetitive, and performed with the goal of improving or maintaining health or fitness. All exercise is physical activity, but not all physical activity is exercise.”
The U.S. Centers for Disease Control and Prevention recommends 150 minutes per week of moderate-intensity exercise such as brisk walking, or 75 minutes per week of vigorous exercise such as jogging or hiking. In addition, you should incorporate at least two days a week of muscle-strengthening exercises that engage all the major muscle groups. For seniors, balance exercises are a must too, such as standing on one foot or heel-to-toe walking.
Richard was not alone in terms of his inactivity. According to the HHS, fewer than 15% of adults age 65 and older meet the exercise guidelines for both aerobic and muscle-strengthening activities.
The deleterious effects of inactivity have been well-documented. A meta-analysis in 2015 showed that prolonged sedentary behavior increases overall mortality and rates of diabetes, cancer and cardiovascular disease, which includes heart attacks and strokes.
The mortality risk appears to be greater in those who sit for uninterrupted periods compared with those who sit for shorter interrupted periods. The good news is that the excess mortality of sitting over eight hours per day can be attenuated by performing 60 to 75 minutes per day of moderate-intensity exercise. A prospective study involving 149,000 sedentary Australian adults found that even in those individuals who had the longest sitting times, their relative higher mortality risk was eliminated by engaging in at least 300 minutes per week of moderate to high intensity physical activity.
In addition to living longer, there are other health benefits of exercise.
• In a meta-analysis of adults 50 years and older, exercise improved cognitive function regardless of their baseline cognitive status.
• There is strong evidence that regular exercise is beneficial for the prevention of cancer of the breast, colon, uterus, kidney, bladder, esophagus and stomach, as well as moderate evidence for prevention of lung cancer.
• Psychologically, exercise reduces anxiety, helps improve sleep and lowers the risk of depression.
• In those with osteoporosis, weight-bearing exercise increases bone mass, while regular exercise decreases the risk of hip fracture.
• Long-term exercise lowers blood pressure, lowers the risk of stroke, decreases inflammation, helps prevent diabetes and reduces the decline in kidney function seen in normal aging.
• Aerobic exercise appears to lower the risk of death from influenza and pneumonia.
• Exercise, together with diet, results in greater decrease of body fat than diet alone.
• In men with erectile dysfunction, a study from 2023 showed that aerobic exercise restored sexual function more than testosterone replacement and almost as much as medicines like sildenafil, better known by its brand name, Viagra.
In general, the benefits of exercise far outweigh the risks. When I give exercise recommendations to my patients, I take into account their underlying health conditions.
For example, in patients with arthritis, I recommend exercise that doesn’t stress their joints, such as swimming or stationary cycling. In patients with osteoporosis, I emphasize weight-bearing, muscle-strengthening and fall-prevention exercises. If a patient is a breast cancer survivor, I will refer her to a unique program at the Peninsula Jewish Community Center in Foster City called “Pink Power.”
Getting back to Richard: I discussed with him the risks of inactivity and benefits of exercise. I advised him to go for short walks in his house during every television commercial. He had not been to a cardiac rehab program, and I suggested that a supervised exercise program would help his diabetes, hypertension and heart condition. He was thankful for the referral.
Before you finish this article, please think of at least two exercise goals and how you will safely implement them. There is nothing comparable to exercise for healthy aging.