The good news is that Australians are living longer than ever before. However, ageing comes with an increased potential for chronic disease. So, can these diseases be prevented or at least their progression slowed?
Two common diseases of older age are dementia and cardiac failure and both can significantly impair quality of life for many years. Prevalence rates for dementia in Australia are estimated at up to 10% in those 65 and over, rising to 30% in those 85 and over. For heart failure, the prevalence was reviewed in four studies – 1.5-2% of the population.
Increase incidental exercise, such as carrying heavy bags, walking to work, and climbing stairs
Issues associated with sedentary aging, such as losing one’s memory due to dementia or becoming increasingly short of breath on exertion as a result of heart failure, need to be addressed in advance. Primary prevention is important, and the earlier one adopts a healthier lifestyle the better: if modification is left until after middle age—around 50-65 years—the chance of success diminishes.
To rely on modern medicine to address these problems is unwise. Drugs used to treat the most commonly diagnosed type of dementia, namely Alzheimer’s disease, have had limited success despite millions of dollars of research over the last 50 years. The increasing stiffness of the heart caused by sedentary ageing can often result in irreversible heart failure, a condition that is also resistant to modern cardiac drugs.
There is considerable overlap in the risk factors for these diseases that come with aging. Common to both is leading a sedentary lifestyle, especially after middle life. Other reversible risk factors—such as smoking, type 2 diabetes, hypertension, high cholesterol, obesity, excessive alcohol consumption, and a poor diet—are also relevant. For dementia specifically, stroke, anxiety, depression and social isolation are associated risks.
A key recommended preventative measure is the adoption of a healthy, balanced diet. This can be achieved by following the Australian dietary guidelines or following a Mediterranean dietary pattern, both of which recommend a high intake of vegetables, moderate fruit, and low or no processed foods.
However, it is physical exercise that is most vital for these chronic issues, with multiple intervention trials suggesting a reduction in risk of dementia of 20-40% with increased activity. The question is then, how can sedentary people be encouraged to move more even if they are currently healthy, or with early developing chronic disease? And what sort of advice for increasing physical activity is helpful?
This cohort differs from those who exercise regularly, and so alternative and integrated methods of movement need to be encouraged. A good starting point is to increase incidental exercise, where becoming more active is gradually introduced into daily activities, such as household duties, carrying heavy bags, shopping, commuting to and from work, and climbing stairs. These activities avoid extra costs, address time constraints, are not dependent on special skills or equipment, and bypass gym aversion.
How can sedentary people be encouraged to move more even if they are currently healthy?
A recent article in The British Journal of Sports Medicine refers to this form of integrated exercise as the “best bang for buck for time unit” physical activity. Abandoning the notion that effective movement needs to occur over periods of 10 minutes or more, the contributors conclude that building a daily routine incorporating brief, sporadic bouts of high-relative-intensity incidental physical activity has numerous practical health benefits. It’s also especially attractive to those who are inactive, obese and in need of lifestyle intervention.
The authors perceive the next step is to measure the effect of this activity via wearable monitors, and promote incidental activity through environmental and clinical programs. Meanwhile, a simple iPhone or Fitbit could be used to measure daily steps and stair climbing. Such technological feedback has proven to be surprisingly motivating.
With respect to preventing heart stiffness or a lack of compliance leading to heart failure, a research team led by Dr Benjamin D. Levine, Professor of Internal Medicine at the University of Texas Southwestern Medical Center, concluded that two years of exercise training improved maximal oxygen uptake and decreased cardiac stiffness in previously sedentary, healthy, middle-aged adults. This training may provide protection against the risk of heart failure with preserved ejection fraction by preventing an increase in cardiac stiffness.
GPs are well placed to opportunistically advise their patients as to why they should take positive action to prevent major health issues later in life. With best results occurring from those who adopt healthy lifestyles before middle age, the path to long life begins with prevention, especially regular physical activity.