Let’s Get Pumped! – Part 1

As I approach my 45th birthday (incidentally, also the new colonoscopy age…), I am trying very hard to embrace aging.

I know, I know. Aging is inevitable… Why fight it…

(…but if one of you reading this has found the fountain of youth, created a time machine, or anything, feel free to message me).

This is not to say that nothing good has come with age — I love my increased wisdom (at least, I think I am wiser), enhanced perspective, thoughtful introspection, and increased comfort in my skin. I love that if I fart and it stinks and someone makes a big deal out of it, I am 100% A.O.K. saying “whoops” and moving on. My teenage self, on the other hand, would have been mortified.

Regardless of whether you have embraced getting older or not, I think most of us want to age well. I doubt anyone has ever said, “I can’t wait to be old and stuck in a wheelchair.” I believe most of us hope that when we hit retirement age, we will still be able to enjoy our usual activities, take trips, and play with our grandkids (or grand fur babies). Improving our muscle mass is one thing we can work on to keep us upright and doing a jig well into our 80s, 90s, or 100s.

We steadily lose muscle mass with age. Starting around age 50, we begin to lose muscle fiber; by age 80, we have lost about 50% (1). Even master athletes who have maintained a high fitness level throughout their lifespan lose 50% of their peak performance by age 80. While the degree of loss is variable by individual (depending on your sex, genetics, and lifestyle), the loss is inevitable and will affect us all.

This loss of muscle mass, also termed sarcopenia, is associated with frailty and disability. This frailty impairs our ability to perform our activities of daily living and increases our risk for falls and fractures. One-third of people over 65 suffer from falls annually (2). Falls in this age group are more concerning. Instead of suffering from a bruised ego, you are more likely to suffer from a fracture, which can be catastrophic; approximately one in five older adults will die within the first year after a hip fracture (3,4).

In addition to supporting movement, our skeletal muscles are also:

1. The primary reservoir for protein. Protein is made from smaller components called amino acids. These amino acids are then used to create other essential things in our body — such as other proteins (like enzymes), hormones, and brain chemicals (such as serotonin and dopamine). In addition, amino acids serve as a fuel source.
2. Regulators of glucose and lipid balance. Our muscles utilize a large portion of the glucose in our body and help regulate our overall metabolism.

As a result, muscle mass loss will affect many body systems, including metabolism, cognition, and heart and lung function. The loss of muscle mass will ultimately impact our quality of life, and severe losses can increase the need for long-term care placement (5).

Eek that sounds quite bleak.

Even bleaker is that we don’t have to wait until 50 to lose muscle mass. It can occur when we are younger at an accelerated rate due to acute or chronic diseases, such as cancer, infections, obesity, diabetes, and immobilization (6,7). These disease states increase catabolism, which is a breakdown process that will lead to muscle loss.

Now for the good news! Although we cannot halt muscle loss, we can slow its progression — even if you are an older person who doesn’t move much!

How?

Let’s pump you up! (Said in an Austrian accent inspired by Hans and Franz. For those of you too young to recall this Saturday Night Live routine, I highly encourage you to Google it).

To build muscle, we want to focus on resistance and weight-loading activities. What’s impressive is that in the process of building muscle with exercise, you will also accrue a whole other host of benefits from exercise, including:

• Reducing the rate of falls by 23% (2)
• Preventing bone loss and osteoporosis (8)
• Stimulating our mitochondria (our energy factories!) (9)
• Improving brain function. Long-term exercise will improve our brain plasticity and function and prevent neurologic diseases. But even short bouts of exercise can transiently improve our mental function (10)!
• Decrease our risk of death (11)!

What an excellent list of bonuses!

If you are starting out or not sure how to begin an exercise routine:

• Schedule it! Just like you schedule meetings and appointments, schedule your workout. Literally. Write it down in your calendar. I know most of you are very busy people. However, these are the most important appointments you can ever have, and nothing will happen if the most important person — you- does not show up.
• Get an accountability partner. Just like your teacher in school, having someone to keep you accountable often helps. My husband and I work out together daily and motivate (nag, shame, harass..) each other to work out even when we don’t feel like it or are feeling lazy.
• Keep yourself safe. If you are new to exercising and have health conditions, getting a check-up with your healthcare provider before starting an exercise program is a good idea. Beginning with a physical therapist or trainer is also good if you have balance or other mobility issues. A bonus is that your health insurance may even cover your therapy sessions! Don’t forget to warm up and stretch after a workout to prevent injuries.
• Consider rucking. While walking is excellent for getting you outside and reducing stress, a better way to walk would be to ruck, which is walking with a weighted backpack (or weighted vest). Thanks to Michael Easter, I have become a big fan of rucking. Rucking increases physical fitness and loads your bones for bone building, the other thing we lose steadily with age. It is also an easy add-on if you are already walking. Even better still is to hike with your weighted pack. Always start light, 5–10% of your body weight, to prevent injuries.
• Need some inspiration to start?
• Join a gym! A gym is a great way to connect with others and have others inspire you. I’m not sure about you, but knowing the instructor is watching me in an exercise class keeps me going!
• Find an at-home workout program online. Working out at home has enormous conveniences — it saves time, and you don’t have to find a babysitter! There are a ton of online classes you can do. The important thing is to find one that sings to you! Here are some that I like:
• Foundation training. This is a great program to strengthen muscles for stability. As simple as these moves look, they build up a sweat!
• Peleton. You don’t need to own any Peleton equipment to get an excellent workout from this app, and the instructors are phenomenal!
• Pvolve. This one requires more upfront cost for the gear, but it’s an excellent functional workout that strengthens muscles you never knew you had.

*I do not have any financial association with these companies — although I really should because they are great!

For my older patients, you may be thinking, “I am too old to pump iron.” Building muscle can indeed be more challenging as we get older. However, it is not impossible! Check out the biceps on my mother-in-law! In the last year, she has been doing some serious iron pumping at the gym, which has taken her from frail to “armed”!

I encourage you all to start exercising, and I look forward to dancing with you all when we are 100! Stay tuned for part 2!

Love,

Dr. Eri Shimizu

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About the Author:

Dr. Eri Shimizu is a board certified in Internal Medicine Doctor and certified through the Institutes of Functional Medicine. She earned a Bachelor of Science in Environmental Bioengineering from the University of Hawaii at Manoa and graduated summa cum laude from Creighton University Medical School. She completed her Internal Medicine residency at UCLA and worked at a Los Angeles county hospital. In 2012, she returned to Hawaii and served as a Hospitalist at Maui Memorial Medical Center. Maui is now home with her husband, two children, and a fighting fish named Rainbow.

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