Think of physical changes associated with getting old. For example, you may find that becoming less agile and more doddery are prominent and that negative changes like these come to mind most easily. Moreover, the fact that many of these changes can be slowed or reversed by physical exercise is not exactly welcome to many of us. Accordingly, we begin this chapter with some general principles which attempt to counter this dislike.
Muscles, bones, feet etc.
Muscles
Muscles tend to weaken after 30 years old and especially after 70. Moving in any way helps counteract this deterioration, but there are also some exercises which are particularly effective. We outline these and hope you will try one or more of them.
The idea here, consistent with the general principles at the start of this chapter, is to start with an exercise and a level you can do comfortably. Check with your GP or another appropriately qualified health professional that youâre not being too enthusiastic in your choice. Ideally, a further safety precaution is for somebody else to be present who is trained in manual handling, and who is fit, alert and strong enough to break your fall if needed. Alternatively, have a sturdy table or worktop in easy grasping distance.
Press-ups: five levels of ease/difficulty
Next we describe several variations of the press-up, ranging from one for beginners to the excruciatingly hard for almost anyone. We donât see the aim as being able to do the excruciatingly difficult variations! (Cf. general principles 2, 3 and 4).
Level 1 press-up
Stand facing a wall, raise your arms and press your palms against the wall and then move your chest towards the wall and back. Do as many press-ups as you can comfortably do and then stop.
Level 2 press-up
Stand next to a sturdy table or worktop, palms on the surface, and bend your knees, pressing down with your hands. Continue until your arm muscles are tired, counting the number of times you can bend and straighten.
Level 3 press-up
Kneeling on the floor, lower your chest towards the floor. Do this once and see how comfortable it feels. If itâs not comfortable, go back to level 2.
Level 4: the standard press-up
NB: This level is quite enough for most people.
Lie straight on the floor face down, supported only by your palms (which are placed beneath your shoulders) and by your toes.
Lower your body, breathing out and keeping your body straight and your buttocks squeezed together (imagine clenching a sheet of paper between them).
Lower your chest as close to the floor as is comfortable, breathing out as you do so.
Raise your body using your arms and knees, breathing in as you do it.
Thatâs one standard press-up. Aim to increase the number you do when and if youâre ready, bearing the general principles firmly in mind.
Advanced press-ups
There are lots of variations, e.g. holding one leg in the air, clapping hands between press ups, or resting both feet on a bench with your hands on the floor or ground.
Squats: two levels of ease/difficulty
Like press-ups, squats are a weight-bearing exercise, widely used and effective. They are more practical for some of us than press-ups.
Level 1: beginnersâ squat
Sit on the edge of a firm chair, hands clasped in front of your chest, and stand. Keep your weight on your heels.
Sit on the edge of the chair and repeat when and if your body feels ready.
As before, count the number you feel comfortable with and aim to increase it and/or your speed.
Level 2: the standard squat
Start standing, with your hands in front, feet shoulder width apart and squat as if to sit on a chair.
Other exercises for the main muscles include walking and running (discussed later in this chapter), weight-lifting and going up steps or stairs.
Also, we suggest eating some protein and carbohydrates in the hour or so after exercise and remembering to rest and recover.
Bones
Bones tend to become less dense and therefore weaker in old age. The main causes of this are not enough calcium and vitamin D, so eating dairy foods and protein, and getting plenty of sunshine, can be helpful. Even standing helps maintain calcium levels a little. However, bone is living tissue and needs stimulating through feedback and, in particular, impacts of the kind produced by jumping, running and dancing â but not cycling and swimming, because although good for cardiovascular health, they are not weight-bearing.
Feet
The health of young feet is often taken for granted. In contrast, old feet are prone to several problems, for example dry skin forming corns, thickening toenails (to the extent that they canât be cut in the usual way) and fungus infections (which if left untreated become very unsightly). Such changes can limit mobility, the first making movement painful, the other two through feeling embarrassed.
Having corns removed by a competent chiropodist is painless and the results are a pleasure. As a friend said after his first visit (in his mid-70s): âItâs like having two new feetâ.
Thick toenails are easily trimmed by a chiropodist. Fungus infections take much longer because toenails grow slowly and the many remedies prominent in chemists are, in the experience of one of us and his chiropodist, not very effective (they may well recommend a liquid medicine). Treatment with a laser is potentially much quicker but much more expensive, and the evidence for its effectiveness is unclear so far. Washing socks at 60 degrees and spraying anti-fungal spray inside shoes are also part of the treatment.
There are some basic exercises for increasing foot core stability â they focus on a set of muscles that affect many other aspects and parts of our bodies including backs and posture, but tend to be neglected. You may like to try the following daily:
Sitting on a firm chair, place your bare feet flat on a towel. Wriggle your toes, then seize the towel with them and scrunch it towards you. Try for a minute or two twice a day.
Sitting on the floor or a chair, âwriteâ the alphabet with your toes one foot at a time.
Knees and hips
Pain in knees and hips can be caused in several ways and may be diagnosed wrongly as just âpart of getting oldâ or as needing surgery when they donât. The causes include obesity and muscle imbalance and overuse, and the treatment options, apart from an operation, are medication, losing weight and structured exercises supervised by a physiotherapist. Generally, and obviously, it is best to try simpler procedures first.
If you do decide to have an operation to replace a joint, we suggest asking your GP which surgeons they and other GPs would go to for that operation themselves.
Ways of keeping joints healthy are regular exercise (with recovery and rest days), avoiding too much twisting, kneeling or lifting, and only occasional or no sugary food or drink (because they may cause inflammation).
Lower backs
For lower back pain, continue with normal activities as far as possible and vary the position of your body. It is a myth that the best treatment is bed rest or lying on the floor, although this was for many years the standard treatment, sometimes for several months, when the result of just a couple of days in bed is weaker muscles and bones and a slightly increased risk of dying from a blood clot.
The following exercises are worth considering for lower back pain:
- squats (see earlier in this chapter)
- brisk walking, arms swinging, head up (if it hurts, go more slowly for a while or stop)
- deep breathing in a relaxed way and using your diaphragm (rest your hands on your stomach and make it swell with your breath)
- mindfulness (deep breathing may be the active ingredient)
- whole body exercises, like running, dancing and swimming
- yoga, Pilates and the gym suit some people and not others â too much twisting and bending for them
Back pain is thus not inevitable with ageing, and we can do several things to help prevent it: being active (as discussed later in this chapter), maintaining a healthy weight (see the section on Diet in Chapter 2), eating and drinking well (both discussed in Chapter 2) and choosing a bed that suits you.
There is no such thing as an orthopaedic bed or mattress. Appealing as the idea may be, it is just a marketing term. A bed needs to be comfortable for you â e.g. you should not feel that the mattress is swallowing you, nor should it feel like a board â and it is probably worth changing a mattress after a few years. We also recommend the back stretcher developed by Neil Summers, especially after a warm bath, for a few minutes at a time.
Overall, drugs (including pain killers), surgery and injections are much more risky ways of treating back pain and are often useless. The simplest and (as it happens) the cheapest options are the most generally effective and safe, and most back pain heals itself. For the latest guidance, see nice.org.uk.
Necks
Neck pain is common and not usually a sign of serious illness, though it is of course painful and awkward. Possible exercises to try, very gently, are 1) stretch your neck, stopping if it hurts, by pointing your nose at the ceiling and moving it from side to side, 2) move your head from side to side, looking over each shoulder and using your hands to stretch a little further, and 3) put your chin on your chest. If these exercises donât work, see a physiotherapist.
Falls and balance
Falls are both more likely and more dangerous for older people. Broken bones can mean months of pain and anxiety, and loss of mobility and independence.
The risk of falling increases at around 65 years old. This is because we have far fewer of the nerve cells which specialise in balance and coordination by then. Moreover, this loss is true for athletes as well as the general population: general fitness doesnât prevent it, but particular exercises like those outlined next do.
Injuries from falls can be reduced and prevented by doing some of the following:
- press-ups (see earlier in this chapter) to strengthen wrists and arms, thus absorbing much of the impact of most falls and making your head less likely to hit the ground
- squats (see earlier in this chapter) to strengthen legs and prevent or reduce falling in the first place
Be especially careful with the following exercises: start them holding onto, or next to, something sturdy to steady yourself if you lose your balance â a wall or a table, but not a person.
- Stand on one leg when doing everyday things such as watching TV. How many seconds can you stand without wobbling? A much more difficult variation is to close your eyes before you lift one of your feet, and keep your eyes closed. As before, the aim is to do this comfortably and without wobbling.
Generally we think it better to compete with yourself, for example in how long you can stand on one leg, but you may prefer to compete with the average score of others or with a judgement on what i...