The Four Pillars Of Mobility

Remember what happened to your parents? And now you see the same thing happening to your friends. They move less and sit more until, pretty soon, they can hardly move at all. They give up on playing golf or tennis due to injuries, or fear thereof, and then they start to avoid climbing stairs. Eventually, even playing with the grandchildren becomes a liability.

We now know that to age gracefully and maintain quality of life—extending your health span and not just your life span—you can’t go gentle into that good night. You have to be vigilant about staying mobile and active, or the alternative could be a nursing home, a wheelchair, or even being confined to a bed

Now is that how you planned
to spend your “golden years”?

Believe it or not, you can elude aging to a large extent just by taking care of the systems that support movement. You do this by supporting what longevity experts call the four pillars of mobility

1. Joints
2. Bones
3. Muscles
4. Strength & Power

A little investment in the maintenance of each pillar now will determine what you’ll be able to do later.

How little of an investment?

Well, some changes you’ll need to make to your daily life are so mild that you’ll barely notice them, and they might even feel fun. Other habits may present more of a challenge to adopt, but remember, you get back from your body what you put into it, and no investment at all will leave you bankrupt

Let’s examine each of the four pillars and how to care for them.

JOINT HEALTH

The body is constantly remodeling its cells, and as we age, that process breaks down. The cartilage that covers the ends of the bones that meet at our joints doesn’t replace itself as efficiently, and that can lead to joint stiffness and pain, and, ultimately, osteoarthritis (OA), a degenerative joint disease.

“Joint pain can often be a cascading downward spiral,” says Jon Coons, PhD, an expert in knee osteoarthritis and Professor of Exercise Physiology at Middle Tennessee State University.

“The person becomes inactive because of pain, so they become more deconditioned, and that leads to more pain. But movement by itself helps with the cellular issues that cause joint pain, as well as the conditioning that helps prevent it.”

In fact, joint health experts now know that…

the primary factor in joint pain is lack of physical activity, not aging itself.

So when it comes to being active as you age, understand that you’re not “too old” to exercise—you’re too old NOT to!

What Activities Can I Do For Joint Pain?

Now if the word “exercise” makes you cringe, understand that it doesn’t have to be a phys-ed class or a military boot camp. If you’re not currently exercising, experts recommend a walking regimen that most anyone can handle.

Start by walking for 10 minutes, three to five days per week.

Go at your own pace—a rate that is comfortable and pain-free—and, every week there- after, add five minutes. So, in Week 2, you’ll walk 15 minutes, in Week 3, 20 minutes, and so on. (You don’t have to exceed 35 minutes, which you’ll build up to by Week 6.) Walking by itself has been shown to reduce pain and stiffness, specifically in people who have knee and hip arthritis. The reason is twofold.

The knees and hips are synovial joints, meaning that they’re lubricated and nourished by synovial fluid. Therefore, the movement of walking keeps the knees and hips limber and encourages nutrients to enter the joints and promote their repair.

At the same time, the muscles above and below the joints learn to fire at the right times, providing more stability. It’s a phenomenon called muscle guarding, and it reduces pain. Plus, walking in itself strengthens muscles.

Are There Exercises I Can Do For Joint Pain?

Since strengthening muscles helps the joints, it stands to reason that resistance training can provide big benefits. The quadriceps (thigh) muscles are typically much weaker in arthritis sufferers than in other people, and building strength often brings relief.

Half-squats done with bodyweight (that means go halfway down, until your knees are bent roughly 90 degrees) are a great exercise. If balance is an issue, you can do leg extensions instead, using either a weight machine or ankle weights (if you’re working out at home). However, if you have a ligament injury in either knee, do a donkey kick instead. Get on all fours and draw one knee up to your chest as far as you can, and then extend the leg straight back, as if kicking.

In the upper body, the hands are the most likely to experience pain and stiffness as we get older. You can get significant relief—and have a little fun in the process —by working out with sand. Buy some playground sand from a home improvement store and fill a bowl with it. Squeeze handfuls of sand and release it.

Aquatic exercise is another great joint-saver. Floating in water unloads the joints, so light swimming is a good idea. Provided it’s warm, water also improves circulation to the joints, and the weight of water itself applies pressure to the body that can reduce inflammation when you’re active in it.

A study published in the Journal of Strength and Conditioning Research compared land-based and aquatic exercise programs and their effects on people with knee osteoarthritis over the course of six weeks. Both therapies were found to be effective for reducing pain, promoting range of motion, and increasing thigh muscle size and endurance, but the aquatic group reported significantly less pain during exercise.

For any exercise you do for your joints, use three sets of 10–15 reps as a general guideline (so, do the move 10–15 times, rest, and repeat for three rounds), but doctors’ caution that pain and comfort should be your coach. Perform every movement slowly and stop if it starts to hurt. Do these exercises every day if you can.

Find a Warm Pool

Aquatic exercise is another great joint-saver. Floating in water unloads the joints, so light swimming is a good idea. Provided it’s warm, water also improves circulation to the joints, and the weight of water itself applies pressure to the body that can reduce inflammation when you’re active in it.

A study published in the Journal of Strength and Conditioning Research compared land-based and aquatic exercise programs and their effects on people with knee osteoarthritis over the course of six weeks. Both therapies were found to be effective for reducing pain, promoting range of motion, and increasing thigh muscle size and endurance, but the aquatic group reported significantly less pain during exercise.

If you have access to a community center, see if they offer an aqua aerobics program, in which an instructor will take you through a joint-friendly, pool-based workout. For de- tailed exercise ideas to support the shoulders, hands, hips, knees, and more, watch Dr. Keller Wortham’s House Call - Home Edition Video Series, where you can search for different routines by body part.

BONE HEALTH

Bones not only support the body and protect the organs, they also serve as banks for important nutrients like calcium. Unfortunately, as we age, our bones lose density and become more brittle, putting us at greater risk for serious injury and, consequent- ly, more limited mobility than any other factor! And as pervasive as the bone weakening disease osteoporosis is, 80% of American seniors who suffer bone breaks are not tested or treated for it.

The National Academy of Sports Medicine (NASM) further warns that you’re at greater risk for osteoporosis if you have a petite body frame, low body weight, consume a high amount of caffeine, smoke, or are of white or Asian ancestry. Deficiency in the key bone support minerals calcium, magnesium, zinc, and boron can set you up for bone loss as well.

What Activities Can I Do To Protect My Bones?

The key to maintaining bone strength as you age is light impact—providing enough resistance to the bone tissue that the body gets the message that it needs to hold on to it. Luckily, this is more fun than it sounds.

The National Institute of Health (NIH) states that walking, hiking, climbing stairs, playing tennis or pickleball, and dancing are all worthwhile, effective bone-stimulating activities as we age. However, while they do provide healthy exercise, bicycling and swimming are not ideal for bone maintenance, because they don’t put enough direct load on the bones.

Are There Exercises I Can Do That Can Strengthen My Bones?

Resistance training scores big again here. NASM recommends that post-menopausal women and older men perform strength exercises (at least) two to three days a week to keep up bone density (see more resistance training recommendations in the muscle mass and strength/power sections below).

Specific attention should be given to exercises that challenge balance to help prevent falls, as well as those that target the hips and lumbar spine, the areas at the greatest risk for bone loss. These exercises may include lunges performed in different directions, and the yoga plank.

Now if you have osteoporosis already, NASM recommends avoiding jumping activities and any exercises that deeply bend the trunk or spine, such as sit-ups, rowing, and toe touches. These may increase the risk of fracturing a vertebrae

Apart from strengthening your heart and lungs, most aerobic exercise will benefit the muscles and bones—when it’s done with extra weight and light impact. Walking and hiking with a weighted vest or rucksack are good examples.

Aerobic training can be done three to five days per week, but see your doctor for personalized recommendations before beginning an exercise program.

If aerobic activity or resistance training seems daunting, Dr. Coons says you can start off in water to lessen the impact and progress to exercise on land, just as you can with your joint-training regimen. “Then,” he says, “eventually, you can build up to resistance training with weights, which will do the most to protect the bones.”

What Are The Best Foods For Bones?

Bone health owes a lot to good nutrition, and NASM says the most important nutrients for bone are vitamin D, protein, and of course calcium. But we now know that other minerals are critical as well, such as magnesium, boron, and zinc. Getting enough of each of these can be quite difficult for seniors, so it’s best to supplement. The Linus Pauling Institute recommends females age 51–70+ take in 1,200mg of calcium daily, while men of the same age need at least 1,000mg. Men who are 70 or older should bump the dosage up; 1,200mg daily should be their goal. Dairy foods such as milk and yogurt can contribute to this total.

Vitamin D is available in fish and eggs and some other foods, but it is difficult to get enough from diet alone. New research shows the original targets of 600IUs daily if you’re 70 or younger, and 800IUs if you’re north of 70, are most likely not adequate. However, the research support for those pushing daily doses of 5,000 or 10,000IUs is just not conclusive either. Top researchers now believe that the safest bet for Vitamin D dosage is to stick with 1,600IUs a day (40 mcg).

Seniors Do Not Get Enough Protein!

Most seniors don’t get enough protein as it is, especially at breakfast where they are woefully deficient. And working out increases one’s requirements! The problem is compounded by the fact that older individuals do not assimilate protein nearly as well as when they were young, so they actually need more protein when they get older, not less.

Protein Requirements

In its updated position on protein and exercise, the International Society of Sports Nutrition (ISSN) states that most people need 1.4–2.0 grams of protein per kilogram of bodyweight, and seniors should err on the higher end of that spectrum.

Meat, fish, and other animal products are still the best sources of protein, but for most seniors, supplementing protein is going to be a must in order to hit their goals.

MUSCLE MASS

As the authors of a review in the journal Frontiers in Physiology succinctly put it, “Loss of muscle mass and strength with aging, also termed sarcopenia, results in a loss of mobility and independence”—i.e., lose your muscle, and you might end up bedridden, or require someone else to care for you.

Due to declining hormone levels as well as reduced activity, most adults shed muscle rapidly after the age of 60. Apart from making it more difficult to get around and perform the activities of everyday life, not to mention sports and other recreational hobbies, muscle loss is associated with risk for falls, bone loss, insulin resistance (which can lead to type-2 diabetes), and, according to a 2020 article in Redox Biology, an increased risk of all-cause mortality

What Can I Do to Prevent Muscle Loss?

Remaining active in general helps to slow the rate of muscle loss, but to hold on to as much of that precious tissue as you can, and potentially build more of it, you’ll have to lift weights.

Don’t make the mistake of thinking you’re too old or infirm when it comes to muscle: one famous trial showed that even frail, hospitalized people in their 90s were able to improve their strength—by 174%!—and added nine percent more muscle to their thighs in just eight weeks of resistance training. In other words, you’re never too old, too sick, too weak, etc. You just need to ease into it.

The National Strength and Conditioning Association (NSCA) recommends that older adults perform multi-joint exercises—that is, those that work more than one joint at a time, and therefore mimic activities in our daily lives. These can include squats, lat-pulldowns, overhead presses, cable rows, chest presses, and core exercises.

Dr. Coons suggests you start resistance training by performing just one set per exercise (covering all the major muscle groups). Progress to performing two to three sets per movement, resting as needed between all sets. Train the whole body each workout, performing two to three workouts on non-consecutive days per week.

Start with a Weight that Allows You 8 to 15 Reps

It should be a load you can control and lift with good exercise form. When your reps begin to slow down significantly, or your form breaks, stop the set.

“Build a foundation of muscle mass first,” says Dr. Coons, “and then work on strength and power,” which we’ll discuss next.

STRENGTH AND POWER

Resistance training for muscle mass will improve your strength levels automatically, but as you get more accustomed to lifting, you’ll want to target strength and power more specifically.

Strength is your ability to produce force, and power describes your capacity to produce force quickly.

These are separate qualities, and rely more on neuromuscular efficiency than the size of your muscles. In other words, to improve them, you have to train your nervous system’s ability to recruit the muscle mass you have. And that means lifting heavier, and lifting faster, respectively. Strength and power will do the most to help you get out of a chair and catch yourself if you stumble.

How Can I Get Stronger?

Once you’ve mastered the basic exercises discussed above for sets of eight to 15 reps, you can emphasize strength by simply going a little heavier and restricting your reps to six to 10. All the other guidelines still apply, just add weight (and maintain safe form).

How Will Building Power Help Me?

Imagine getting up from the toilet, out of a car, or darting across the kitchen to take something that’s burning off the stove. All of these movements require a speed component as well as muscle force, and that means power.

After you’re comfortable with your strength workouts, spend a few weeks using lighter weights—lighter than you did for muscle mass—and try to increase the speed that you lift with on the way up. For example, if you’re doing a shoulder press, press the weight up as fast as you can. Then control it on the way down. Think, “fast up, slow down” on each rep. Aim for one to three sets of three to six reps, or until you feel you’re slowing down or breaking form.

A 2022 review in the European Review of Aging and Physical Activity found that power training may even be more useful than traditional strength training for improving physical functioning, a fancy term for your ability to get around.

Just remember it’s never too early or too late to get started. Honor each of the four pillars of mobility and those golden years can be even more golden than you ever expected!

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