SHAMELESS PLUG

USBHOF.ORG

1

Aging 101 For Cyclists

2

Bona Fides

• I’m old myself• I’m a cyclist myself• I’ve been the son of elderly parents• I’ve been the son in law of an elderly person• I’ve had a ton of elderly patients• I’ve actually been to speaking school!

3

Bike for Life

4

5

What is a Realistic Goal for Aging?

Century at 100 years of AGE????

Versus

Staying out of the Nursing Home during your last decade on this earth.

6

Healthy Aging: Best Case

• Assume no Diabetes, cancer, stroke, C.A.D., COPD, heart failure etc.

• No morbid obesity, compulsive eating

• Normal aging v. disease

• What are the minimum changes even the healthiest persons will have to deal with?

7

These will happen to healthy persons

• Osteoarthritis

• Body fat changes

• Visual impairments

• Bone density loss

• Dental changes

• Tendon & soft tissues changes

• Skin & hair changes

• Loss of aerobic capacity

• Hearing impairments

• Decline in balance

• Mortality (may be delayed)

• And much more

8

Why is Falling (i.e. from a bike) so Bad for the Elderly?

• Bones break more easily• Bones heal more slowly• Blood vessels break more easily• Old skin is not so tough• Hip fractures can be fatal (esp in 90’s)• Brain atrophy creates room for serious

mischief

9

CT Scan of Younger Brain

10

CT Scan of Older Brain

11

Putting off the Inevitable

My suggested goal:

Protect the quality and financial cost of your last decade by ACTIVELY maintaining your physical and emotional health.

(not for sissies…this takes effort and perseverance)

12

13

Basic ADLs (Activities of Daily living)

These needed to stay OUT of the Nursing Home• Personal hygiene and grooming• Dressing/undressing• Self feeding• Transfers: bed to W/c, on/off toilet• Bowel and bladder management• Ambulation (Walking w/o assistive devices)• Housework/Shopping (lift 25 lbs)

14

Resist the Nursing Home!

• Exercise all the time

• Eat carefully, with a plan (avoid dieting)

• Promote your emotional well being

• No place for passivity here: you’ve got work to do

15

Maintaining Physical Health

• Aerobic exercise (e.g. cycling/walking)• Alter cycling style to match your abilities• Walking/ weight bearing exercise• Resistance exercise (e.g. weight lifting)• Stretching • Control body composition, avoid “over fat”

16

The cyclist devolution Standard Bike

Recumbent Bike

Adult Tricycle

Wheel chair

17

When to consider a recumbent?

• Your neck/back are in pain with standard bike• Your pain is better with a more upright

position, but you are frustrated by poor aerodynamics

• Genital numbness/erectile dysfunction• You want less risk from falls (height matters!)

18

When is it time to get off the Bike?

• You give up the car keys• You are taking a serious anticoagulant• Major orthopedic problem (temporary?)• Major illness (temporary?)• Poor balance• You have started to fall a lot• Be thinking about this AHEAD of time

19

Reorienting our exercise thinking based on long term goals

• Culturally we are biased toward “training for events”. Some of this is still OK.

• Now we are training for the rest of our lives, and we are training older bodies.

• This makes a whopping difference in how we approach things.

20

No junk miles

• “junk miles” implies that exercise that does not build toward a short term goal is valueless.

• Any exercise (any miles) burns calories and stimulates muscles

• Junk miles beat No Miles every time.

21

Weight lifting/muscle building

Older person’s goals• Time frame: rest of life

• Muscular physique: nice but not critical

• Bone strength: critical• Activity protection: critical• Technique: low wt, hi reps

• Exercise endpoint: predetermined plan

• Joint protection: critical

Young person’s goals• Short term time frame• Muscular physique: this

may by the only goal• Bone strength secondary• Not a serious consideration• Technique: hi wts, low reps• Exercise endpoint: push

until failure• Joint protection: incidental

22

Weight lifting for older folks

• Low wt dumbbells (5, 8, 10, 12, 15, 20 lbs) • High reps: 20 to 50 (not 8 to 12 killers)• Never add more than two reps.• Stay with new routines for a LONG time• Alternate days with two routines • Maintenance is not a four letter word• THINK SHOULDER PROTECTION

23

Shoulder protection

• Cyclists should focus on upper body, torso and low back (legs will take care of themselves)

• All upper extremity exercises impact the shoulder.

• The shoulder is intrinsically fragile • AC joint, Gleno-humeral joint, rotator cuff,

long head biceps tendon, all at risk.

24

Anterior Shoulder Anatomy

25

Posterior Shoulder Anatomy

26

Mechanical Disadvantage

27

Shoulder protection

• Avoid sudden increases in work load: much time needed for soft tissue adaptation

• Avoid exercises with loads of mechanical disadvantage (flys with elbows extended)

• One exception• Avoid extremes of range of motion• Avoid the “impingement” position • Avoid “body weight” exercises unless you have

carefully built up to that level

28

Impingement

29

More Shoulder Protection

• Don’t isolate the vulnerable gleno-humeral joint (stressful on the rotator cuff)

• Do make use of the scapulo-thoracic joint

30

Watch the total shoulder stress

Reps x set x lbs lifted = Rep-lbs

30 reps x 4 sets x 15 lbs = 1800 rep-lbs

22.5 reps x 4 sets x 20 lbs = 1800 rep-lbs

16 reps x 4 sets x 20 lbs = 1280 rep-lbs

31

Maxine’s tips for Elderly Weight lifters

32

1. Start low and go slow2. Always practice safe sets

N Engl J Med 2011;364:2392-2404

• Foods most assoc with wt gain: sugared beverages, potato chips, potatoes, meats

• Foods inversely assoc with wt gain: yogurt, vegetables, whole grains, nuts

• Caloric Density and glycemic index make all the difference!

33

Focused Eating (for maintenance)

• Focus on what you need and like to eat• Focus on selections high in fiber and water• Minimize refined carbohydrates (white stuff)• Make sure you eat all the foods every day• This will crowd out cheeseburgers • Eat as much as your exercise will allow• Depravation will always boomerang

34

Calorie deficit day

Data for Man, age 65, wt 170lbs, ht 5’10”• Basal needs (sedentary) 1950 Cal/day• Walking 2hrs @ 4mph: 780 Cal• Cycling 3 hrs @ 15mph: 2340 Cal• Total calories spent: 5070 Cal• Less consumed in diet: 2000 Cal• Calorie Deficit: 3070 Cal

35

Stretching (Bob Anderson)

36

Emotional Hygiene

• NOT mental illness: major depression, bipolar, schizophrenia, OCD, substance abuse, food addiction

• Emotional Hygiene v. Mental Health• Common sense emotional work, doing the

things we know we ought to do.• We need to be Proactive about this, not

passive

37

Emotional Hygiene

Care and Feeding of your social network• Networks deteriorate /renew all the time• Many stop renewing, and squeeze remaining

network for all emotional needs….and get push back

• One needs to plan on this and be ready • Cultivate younger friends if possible• Often easier for women, the gregarious

38

Emotional hygiene • When one door closes, YOU open another• You might as well be interested/interesting• Seek an emotional life independent of spouse• Don’t rely on old habits. Cultivate new ones• Avoid isolation, especially if life partner dies • Make yourself suitable company (think about

what others need)• Exercise your sense of humor

39

My Humble Suggestions:

• Cycling specific considerations

• Suggested Routines

• Grooming of the social network

40

Cycling specific considerations

• Stretch lower exty muscle groups regularly • Strengthen low back and core musculature• Strengthen neck, arm, wrist extensors (upright

bikes especially)• No need to spend time on Lower exty strength

unless you want to.• Balance cycling with a wt bearing activity, esp

walking (with weighted day pack)

41

Suggested Routine for cyclists

• Resistance exercises: rout A on MWF, rout B on TTS, rest Sunday

• Walk three times/week: MWF• Bike three times/week TTS• Rest Sunday • Stretching: daily six sessions per week.

42

Maintaining the social network

• Work on this all the time

• Be especially attentive if you suffer an emotional / social loss

• You need to replace the loss ASAP

43

The Payoff beyond Cycling

44

Or This!!

45

OR This!

46

last 5 year eating plan

47

48

Don’t worry about being dead.

Do worry about how you get there.

A LAST WORD FROM MAXINE