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11: Let's Stop Fragilifying Older People Already
364 Plays3 years ago
Welcome to Episode 11 of the Movement Logic Podcast! In this episode, Sarah debunks the commonly held beliefs around aging, strength loss, and frailty, where these beliefs come from, and what we should be doing for people 65+ instead (spoiler: once again, strength training FTW).
- What is the narrative around falling and why do people become so afraid of it
- How the fear of falling creates a self-fulfilling prophecy around age-related decline in physical performance
- When does muscle mass loss start as part of the aging process
- How strength training improves not just muscle mass but many other aspects of performance including balance
Reference Links:
Quantum Leap Community (Sarah’s mentorship group)
QLC: The Library (Sarah’s recorded classes)
Strength Training for Seniors (book)
Strength Training past 50 (book)
MRI comparison of active vs sedentary 74 year old
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Watch the video of this conversation at: www.movementlogictutorials.com/podcast
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Transcript
Introduction and Episode Overview
00:00:06
Speaker
Welcome to the Movement Logic podcast with yoga teacher and strength coach Laurel Beversdorf and physical therapist, Dr. Sarah Court. With over 30 years combined experience in the yoga, movement, and physical therapy worlds, we believe in strong opinions loosely held, which means we're not hyping outdated movement concepts. Instead, we're here with up-to-date and cutting-edge tools, evidence, and ideas to help you as a mover and a teacher.
Dr. Sarah Court's Work Ethic and Philosophy
00:00:39
Speaker
Welcome to episode 11 of the Movement Logic podcast. I'm Dr. Sarah Cork, physical therapist and movement aficionado. And today it's just me and you because the only person I know who spends as much time working as I do is our brilliant friend Laurel Beaversdorf. And before you think I am glamorizing over working, please note that we both love what we do. And I at least do spend a fair amount of time just lying down, not only while I'm sleeping.
Challenging Fragility Narratives in Aging
00:01:06
Speaker
So what I want to talk about today is how and why we fragilify older people. And I know that's fragilify is not a word, but I think you know what I mean. And what we should be doing instead. Before I get into it, I want you to know that when I talk about something, I try to use the PT evaluation process, which consists of three things, research,
00:01:28
Speaker
clinical experience and patient wants and needs, which means I consider the research on the subject, but I also consider what I see in the clinic with my patients, which often totally contradicts the research. And I also take into consideration how my patients' wants and needs factor into how we work together. So this week's question is, why do we fragilify older people?
00:01:53
Speaker
Since fragilify is not a word, what do I actually mean by this? Well, in true movement logic style, let's define our terms. Let's define the word fragile. So when I looked it up, it is defined as something easily broken or damaged, not strong or sturdy, delicate, and vulnerable.
00:02:16
Speaker
And if we're talking about older, quote unquote, older people, there's some terrible medical terminology where they categorize. And I don't know the exact cut off ages, but it's like old, older, oldest, and then like something like extra, extra old or some, some really terrible name. So.
00:02:40
Speaker
The general delineation that I'm going to be using for my terms of what I consider older is 65 plus, just so we have a sense of what category of people we're talking about. There is also a term used in the medical field called frailty, which has sort of some of the same connotations.
00:03:00
Speaker
Medical frailty is defined as clinically recognizable state of increased vulnerability, resulting from aging associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is compromised.
00:03:21
Speaker
So there are people in the older category who fit into this medical frailty definition, but I think what tends to happen is we dump everyone in the older category into
00:03:38
Speaker
a version of this medical frailty. It may not be that they are completely bed bound or need full assistance, full 24 hour care, but we tend to think that frailty of that level is either
00:03:56
Speaker
An inevitability, no matter what, if you're as soon as you get older, you're going to just be descending in your strength and your endurance in your independence, things like that. I think, especially for women, the sense of vulnerability.
00:04:13
Speaker
as we get older can increase if we buy into not just the narrative about how we become more fragile, our muscles waste away, our bones become brittle, we need to become scared of falling and breaking a hip.
00:04:28
Speaker
You know, so on and so on because there are age related changes to tissue like that's that's just true. But the lie is that the idea that these age related changes are inevitable and we can't do anything about it.
Strength Training as a Solution
00:04:44
Speaker
And then it becomes this self-fulfilling prophecy where it's, I'm afraid of falling because that's the narrative, because that's what I've heard. Friends might have fallen, things like that. Because I'm afraid of falling, I move less or I move in less varied ways.
00:05:00
Speaker
because I'm moving less or with less variation, I do lose muscle mass, motor control, bone mineral density, et cetera. And then that way I'm putting myself more at risk for the very thing that I'm afraid of happening, right? So it becomes this sort of catch 22 where I'm told that I should be concerned about all of these things because I'm concerned about
00:05:25
Speaker
falling, especially, or hurting myself in some big way, I don't take movement, quote unquote, risks. I stay very sort of safe and small. And then by doing that, I actually create a vulnerability that doesn't actually need to be there. The good news is
00:05:45
Speaker
Strength. I feel like strength training is, honestly, the more we study it and the more we understand what it does for people, it starts to feel like it's the answer to a lot, maybe not everything, but to a lot of movement needs. So strength can help with a lot of things that happen, these sort of age-related processes that happen. It's never too late to start. So if you're listening and you are 75 and you're thinking, well,
00:06:15
Speaker
That's all well and good for that, you know, spring chicken over there. P.S. I'm not as young as maybe I look. I don't know how young I look. I'm going to stop that pathway. But it's never too late to start. And it's never too late to get stronger than you currently are. Let's break down this narrative. Why why is this the story? So we're going to talk. I want to talk about a few age aging related musculoskeletal processes that happen.
00:06:44
Speaker
The first one is something called sarcopenia, sarco like sarcomere, like the unit of muscles, and penia is just sort of another phrase for loss or decrease. Sarcopenia is muscle mass loss. Depressingly, it starts in our 30s, and once you are over 50 years old, unless you're doing something about it,
00:07:06
Speaker
you tend to lose about 2% of your muscle mass per year. The other thing is, it's not only for older population. This is also something that happens, and it happens very quickly. If you are bed bound for a long period of time or hospitalized for a long period of time, the amount of inactivity just like within a couple of days, you start to lose that muscle mass.
00:07:35
Speaker
The issue is being sedentary, not moving as much. But we tell people who are older to sit down, rest, don't hurt yourself, I'll get it for you, all that kind of stuff. And so this is actually making it worse because we are encouraging people to move less.
00:07:57
Speaker
And so we really need to figure out how to change this attitude towards how we treat older people I think sometimes there's a sense that you know you as the older person you've done enough you've had a long life you're in your whatever age range at the moment and you know.
00:08:15
Speaker
Take a break. We're going to do it for you. This is our gift to you. You know, let me make dinner. Let me clean the house, you know, all those sorts of things. And I get that it is seen as a way to be kind maybe or thoughtful or generous or take care of someone. But in fact,
00:08:32
Speaker
it's actually the opposite what you're doing. So get in the habit of telling the older people in your life to go get you a sandwich. Why don't you vacuum? I'm just kidding. Don't do that. But we need to find some sort of middle ground where we're not so concerned. Like, for example, I went to get a table the other day and
00:08:54
Speaker
When I went to get it, the person I was getting it from said, you needed two people to carry it because it had a heavy glass top. I was like, all right, well, I'll bring my mom. My mom is in her 70s. We show up. The person that we were getting the table from was also an older woman. And she looked at me and she looked at my mom and she was like, you brought, I mean, she didn't say it like this, but she was basically kind of like, you brought this older lady to help you with this glass table?
00:09:17
Speaker
And I was like, yeah, because this is the only way she's going to stay strong is if we include her in activities that require strength. Turned out it wasn't actually that heavy. And I probably could have done it by myself, but it is good. It's good for my mom to have to awkwardly carry a piece of glass through a doorway and down some steps and get it into the back of my car. Right.
00:09:41
Speaker
that's giving her that movement variety that's making her use her muscles in different ways than she ordinarily would. So this is something that we need to change how we think about with people and have it less be about I'm helping you and I'm protecting you by not asking you to do these physically difficult things. And instead, obviously, within a scope that is appropriate for the person, include them in those activities. Take them on a hike.
00:10:07
Speaker
play Ultimate Frisbee. I personally wouldn't choose that because I don't like throwing or catching, but I think you understand what I'm saying. Let me get back to sarcopenia, which is where we were before I went off on this enormous tangent. When you have this muscle loss, what actually happens on a physiological level?
00:10:28
Speaker
So with sarcopenia, what happens is whenever there's a muscle tissue injury, it actually leads to more fibrotic scarring, meaning the injury doesn't turn back into new muscle tissue. It turns into like scar tissue, essentially.
00:10:46
Speaker
So that also then is going to affect how well the muscle itself functions. The muscle also gets infiltrated with adipose tissue, which is fatty tissue, right? So it becomes, this is a terrible, I'm sorry, I have a lot of examples that have to do with meat that we eat because
00:11:08
Speaker
that's often what pops into my head, but I think about when people value something like steak that's really marbled. If you imagine that kind of marbling of fat into your muscles, you could probably picture how, okay, that's probably not gonna be that useful either because that's not muscle that I can recruit.
00:11:25
Speaker
It becomes harder to create contractions and harder to metabolize the glucose that your muscles need to function. And all of this leads to strength limitations, obviously mobility limitations, and it puts you at an increased risk for falling.
Effects of Aging on Body Systems
00:11:43
Speaker
That's the muscle tissue itself. Then if we go into what neuromuscular changes are happening, the relationship between your brain and your muscles, you have decreased motor units. What that means is, for a muscle to contract, there are nerves that go into the muscles and recruit the muscles and make them contract.
00:12:11
Speaker
you would have, for example, let's say you used to have 100 nerves that were doing it. Now you have maybe 50. So each nerve is now responsible for a larger section of the muscle fibers, which makes you lose some of that fine motor control. Fine motor control is things that you do typically with your hands, but like writing with a pen or buttoning your shirt, things like that, tying a shoe that require
00:12:39
Speaker
more of that kind of dexterity because of these decreased receptors in your nervous system it leads to that obviously on in bigger picture not just fine motor but it leads to decreased force and power output it causes more general wobbliness and and fatigue.
00:12:59
Speaker
So these are things that can happen. So we have talked and we'll continue to talk in various episodes on this podcast about osteoporosis. Osteoporosis is essentially decreased bone structure strength. Your bones become less strong.
00:13:16
Speaker
As we get older, for women as we go through menopause, perimenopause in particular, there is a decrease in the estrogen and testosterone in your body which decreases your bone mineral density. Age-related changes, we've got sarcopenia, we've got our muscle mass loss, we've got neuromuscular changes, and we've got potentially osteoporosis, decreased bone strength.
00:13:43
Speaker
So this scenario of I'm going to fall and break my hip or break a bone, it's not unfounded because statistically, the worst case scenario, let's say you fall and instead of just having a bruise or something like that, you break a bone. And a lot of the time people break their hip or their pelvis
00:14:07
Speaker
The the pelvic bones are one of the areas they're most impacted by that bone mineral density loss, so you break your hip you go to the hospital you're lying in bed because you have a broken hip.
00:14:22
Speaker
And that lying in bed, as we discussed with the sarcopenia, it increases that muscle loss very, very quickly. So if you're in the hospital for three to five days, you're already losing muscle mass, which potentially you couldn't afford to lose. Hip fracture among older people has a 20% mortality rate.
00:14:46
Speaker
20%, one in five people who break their pelvis and go to the hospital don't come back. And I'm not trying to be scary, but that's just, that's the statistics. And it's not the breaking of the hip itself. It's all the sequelae. It's everything that happens afterwards, right? They are bedridden. They perhaps worked in great health to begin with. There may be numerous comorbidities, right? Other systemic illnesses or diseases going on. I got to say, I kind of get it.
00:15:16
Speaker
I kind of get it around the messaging about don't fall because it's going to kill you, right? And again, it's not the fall itself, but it is everything that happens afterwards once you are in the hospital for an extended period of time. So there are other systems as well that are impacted by age-related processes, not just musculoskeletal or neuromuscular, but things like your vision.
00:15:40
Speaker
you tend to lose depth perception as you get older. And if you've never experienced what poor depth perception is like, try closing one eye and walking around and you'll get a really good sense of like, whoa. So that and also something called contrast perception, like it's harder to see perhaps like the different shades of a step when you're stepping down. So hard to see where something is.
00:16:10
Speaker
So that's going to impact how well you move, right? If your perception of where things are in space, using your visual system, which we all rely on a great deal for navigating the world around us, is really impacted. The vestibular system is also impacted, and that is your inner ear and how it helps you with your balance.
00:16:31
Speaker
It's a long story, but essentially there are little crystals inside of your ear, and as they move around, they send messages to your brain about where you are in space. Those crystals start to get drier. As a result, we tend to have increased vertigo episodes and a slower response to positional change, meaning, let's say you did trip, for example,
00:16:59
Speaker
as your position and space is changing, you're not getting the message to your brain as quickly as far as like what to do about it. You know, as far as like, oh, hey, put your hand out and catch yourself on this handrail, things like that.
Movement Logic Sponsorship and Offerings
00:17:13
Speaker
There are also executive function changes within the brain itself that just decrease and are not as quick, right?
00:17:28
Speaker
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Speaker
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Speaker
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Speaker
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00:19:12
Speaker
So while it may seem like I've just painted a very bleak picture that contradicts everything that I started this episode with, you may be listening to all this and be like, oh my God,
Strength Training for All Ages
00:19:24
Speaker
you know what? Sit down, older people. You sounds terrible. And also like, is this going to happen to me?
00:19:32
Speaker
What the short answer is, is strength training. Strength training really works. It works for all ages, all populations. Yes, you may have to regress. You may have to use something that to you maybe doesn't look like a heavy weight, but for someone who is just starting out, you know, five pounds might be really significant.
00:19:53
Speaker
Does strength training for older population look different than strength training for a younger population? The short answer is no. The parameters are the same. From research, they'll say between two to three days a week, about 80 percent of that one rep max effort level. In some of our other episodes, we've gone into what a one rep max is.
00:20:21
Speaker
And if that's something that is difficult to figure out, which I think, I mean, personally, I think it's quite difficult to figure out. And I usually instead for myself or with my clients, I'll use the rate of perceived exertion, which is your sense of how hard you're working. And if 10 out of 10 is everything out of the tank and zero out of 10 is no work at all,
00:20:46
Speaker
You want to stay around the sort of seven, eight range where you're working really hard, but you're not straining. You're not doing anything that's going to injure yourself, but it is extremely effortful. So that's roughly around the same thing as a one rep max. And I just, I just find it to be an easier thing to, to figure out. And, you know, everybody's favorite three sets of 10.
00:21:08
Speaker
And I might do an episode later about what is three sets of 10? Why do we get stuck on three sets of 10 of everything? So two to three days a week, 80% rate of perceived exertion, three sets of 10.
Attitudes Towards Exercise in Older Adults
00:21:23
Speaker
But literally anything is good. So even if it's one time a week, and even if it's one set of 10, that's gonna be better than nothing. So is it simply that
00:21:37
Speaker
As people age, they become afraid of the falls risk that they fall into. They become afraid of tripping. It limits their movement variability, their strength output.
00:21:54
Speaker
Is that just, is that the only reason why people stop exercising? I'm not sure. I can only sort of speculate. I do think there is also a sense of, I made it this far, time for me to relax. I'm thinking specifically about my dad, who definitely has that attitude. And he goes on some walks for exercise and, you know, God bless him. But, you know, he's not, he's not,
00:22:24
Speaker
pushing himself particularly hard. It is ironic. And for those of you that are movement professionals, I don't know if you'll have the same experience, but
00:22:31
Speaker
as much as members of my family will ask me about things like a weird rash or why they're having this weird kind of feeling next to their eyeball, things that, by the way, I am not qualified to answer, but they certainly now look at me as like the medical professional, but any movement-related advice or exercises I might give them to do, strategies, things like that, it pretty much goes unheeded.
00:23:00
Speaker
So there is some of that, I think, story, at least for some people, at least for my dad. I can think of one older person who definitely believes it's time to relax. The other part of it, I think, is
00:23:11
Speaker
many people don't have this ingrained sense that exercise is good for you. There was a big exercise boom that happened in the 70s and in the 80s where aerobics came in. For those of us that were there, things like step class and strength training is now more popular, I believe, but just the idea that you would go out of your way to do some exercise that wasn't
00:23:38
Speaker
a sport right so you're not you know playing tennis with your friends or whatever and it's not related to exercise involved with taking care of your household and in particular I think for women but the idea that you would just go
00:23:55
Speaker
exercise as a woman. You weren't you weren't going to the gym per se in and doing like the weights that the men were doing that was like men's territory but for women in at that time it was really it was aerobics there were maybe some small hand weights and of course we all know that small hand weights are for women because they make them pink but it was at least this onset of
00:24:16
Speaker
a sense that exercising is good. For people who are in that generation, they have this habit of doing exercise for the sake of exercise. It's not such a stretch to then perhaps turn direction away from aerobic and turn it into more weights-related, strength-related. If that wasn't a period of time that was meaningful,
00:24:41
Speaker
to you as an older person, you just maybe never thought about exercising. It just wasn't a thing that you did. I talked about her in another episode, but I used to have a patient who's 102. And she certainly was not at any point part of that movement. Boom. Right. At that point, she was older. She was already an older
00:25:06
Speaker
Let me think about the math on this. It wasn't aimed at her, let's say. She wasn't in her 20s or 30s in the 70s and 80s. So she did not develop an idea that exercise was something that you did for recreation or to stay healthy. You got your exercise by taking care of the household.
00:25:27
Speaker
pushing my grandmother had one of these pushing a floor like a manual vacuum cleaner. No, no. I don't think even you can even call it a vacuum cleaner just a manual sort of push brush thing.
Reframing Exercise for Older Generations
00:25:39
Speaker
I hated that thing so much. But that was where you got your physical exercise from and so many of these things have become automated or mechanical or we've taken the effort away.
00:25:51
Speaker
So some of it is helping people reframe the idea of what exercise is, what it looks like and how important it is for them. You know, there's a there's a image on the internet that you can look up.
00:26:06
Speaker
And I'll link to it as well. That is an MRI of a horizontal slice through someone's thigh. And the top image is a 20 year old and the muscle takes up most of the leg.
00:26:21
Speaker
And then there's the bottom image is a sedentary, I don't like, you know, someone in their 70s, and most of the leg is
Strength Training Benefits and Research
00:26:28
Speaker
fatty tissue. There's a very little bit of muscle. You can also see the difference in the bone density quality between the two images. So that's, you know, that's a good scare tick tactic image. But there is also, and I will also link to this, an image of someone who is a 70 year old triathlete, same slice through the leg,
00:26:46
Speaker
much more similar to the image of the 20-year-old. The bottom line is you can make strength gains at any age. You can push people who are older. And I think sometimes there's a sense where even in the PT world, I see this, where I'm just going to give you the little hand weight. You have to be thoughtful about it. You have to practice progressive overloading the same way you would with anyone you are working with. And it may be that
00:27:14
Speaker
if you know that they have osteoporosis or they have bone marrow density loss, which is also called osteopenia, those two phrases are used interchangeably. Or if they have other comorbidities, other physical concerns that you are worried about, refer them to a physical therapist for something like that. But if not, if they're generally healthy and they just are deconditioned, you quite literally can do exactly what you do for any other client that you're working with.
00:27:45
Speaker
So what does the research say about strength training for an older population? Well, it improves a lot of things, not just strength. So it improves something called functional mobility, which is your ability to do day-to-day activities like getting up and down from the floor, getting in and out of bed, getting in and out of the car, things like that.
00:28:05
Speaker
It improves sarcopenia, and I don't know enough about the research to know if it reverses any of that fibrotic behavior, but it'll certainly increase some of that muscle mass and density. It improves gape speed. It improves how fast someone can walk.
00:28:24
Speaker
It improves both static and dynamic balance, which puts someone at less of a false risk and hopefully helps them have less fear of falling. And it also improves bone mineral density when done with appropriate load.
Resources and Community for Movement Teachers
00:28:40
Speaker
So there's tons and tons of reasons for anyone
00:28:43
Speaker
in this group of people let's say 65 and older to start or really work on increasing their strength training and all of them in some way lead back to reducing this falls risk that becomes such a concern for so many people so that's great news and if you're listening to this and you're like well okay i get it sarah saying that it's the same parameters as
00:29:11
Speaker
Working with younger people, but I still feel like I don't know enough. Maybe I'm not qualified. I want to tell you about two things that I Have as part of my continuing education programs for movement teachers and I'll link to both of these as well. One of them is called quantum leap community. It is an online mentorship group that meets once a month.
00:29:33
Speaker
And in addition, you have access to me to ask questions about clients that you're working with. Every month we cover a different topic of a different population that might be someone that you encounter. There's a huge library at this point of past meetings that you can access. And I do what I call office hours, but it's kind of like a Reddit ask me anything where you can literally just type a question into the group and
00:29:59
Speaker
I'll record a little video to answer it. Or if it's a big question, we'll make it a topic for one of the upcoming meetings. We also have special guests that come. I give people access to other courses that I'm teaching. They get free access to things like that. So it's a great group. I really enjoy it. It's small enough that you get personalized attention as you need it. And so if that's interesting to you, that link will be available in the show notes.
00:30:28
Speaker
The other option is what I call the quantum leap community library, where you get a la carte access to each of those recorded webinars and the recordings involve both lecture and a lot of movement we do a lot of.
00:30:43
Speaker
Examples of oh you're working with someone who has I don't know hip replacement. Let's look at examples of good movement ideas to do with that person. So you can go through and cherry pick topics that are interesting to you are relevant to Clients or students that you are currently working with. And I do have one that is about working with people who are
00:31:03
Speaker
getting older. So as well as other topics that often show up in older population, like a hip replacement or a knee replacement. So that's another resource that I can offer. And I, again, I'll link to that as well. So you can take a look at both of those. The bottom line is, yes, you can
00:31:23
Speaker
push yourself or your clients or students who are over the age of 65. Yes, you can do progressive overload in your training sessions the same way you would with someone who is younger. You just have to do it appropriately. And if that's something that you don't know how to do, like, how do I increase a parameter?
00:31:44
Speaker
definitely check out my resources because I talk about that and certainly I talk about it in the lecture that I did on working with a older population. Okay, well, I hope this has been helpful as far as understanding why people may be afraid of falling if they get older, why they may become more sedentary, how that becomes this sort of catch-22 scenario, and how you can help them get out of it.
00:32:13
Speaker
A note that you can check out the show notes for links to all the references I mentioned in this episode, and you can also visit the MovementLogic website where you can get on our mailing list to be in the know about sales on our tutorials, and that's movementlogictutorials.com.
Episode Conclusion and Call to Action
00:32:29
Speaker
You can also watch the video version of this episode, and this is a very special video version where I have just the craziest hair imaginable. If you want to see what my face looks like while I'm thinking out loud and my recording, quote unquote, studio, which is just the corner of a closet with some fake plants in it.
00:32:51
Speaker
Thank you so much for joining me for this week's episode of the Movement Logic Podcast. Finally, it helps us out if you like this episode to subscribe and rate and review on Apple Podcasts or wherever you're listening right now. We would be super appreciative if you did that. Join us again next week for more Movement Logic, more of our strong opinions loosely held.