To Avoid 'Boomeritis,' Exercise, Exercise, Exercise

An apology to all baby boomers and beyond: I'm afraid that in our efforts to get everyone to become physically active, we've sold you a bill of goods. A 30-minute walk on most days is just not enough. There is much more to becoming - and staying - physically fit as you age than engaging in regular aerobic activity. (Of course, the same applies to those younger than 60.)

In addition to activities like walking, jogging, cycling and swimming that promote endurance, cardiovascular health and weight control, there is a dire need for exercises that improve posture and increase strength, flexibility and balance. These exercises can greatly reduce the risk of injuries from sports and endurance activities, the demands of daily life, falls and other accidents.

Musculoskeletal injuries are now the No. 1 one reason for seeking medical care in the United States. And falls, the Centers for Disease Control and Prevention reported last month, have become the leading cause of injury deaths for men and women 65 and older.

Unless you do something to slow the deterioration in muscle, bone strength and agility that naturally accompanies aging, you will become a prime candidate for what Dr. Nicholas A. DiNubile, an orthopedic surgeon at the Hospital of the University of Pennsylvania, calls "boomeritis."

"By their 40th birthday, people often have vulnerabilities - weak links - and as the first generation that is trying to stay active in droves, baby boomers are pushing their frames to the breakpoint," Dr. DiNubile said in introducing a November press event in New York sponsored by the American Academy of Orthopedic Surgeons and the National Athletic Trainers' Association.

"Baby boomers are falling apart - developing tendinitis, bursitis, arthritis and 'fix-me-itis,' the idea that modern medicine can fix anything," he said. "It's much better to prevent things than to have to try to fix them."

Dr. DiNubile pointed out that evolution had not kept up with the doubling of the human life span in the last 100 years. To counter the inevitable declines with age, we have to provide our bodies with an extended warranty.

Assess Your Fitness

In their recently published book, "Age-Defying Fitness" (Peachtree Publishers), two prominent physical therapists, Marilyn Moffat of New York University and Carole B. Lewis of Washington, D.C., provide the ingredients to help you make the most of your body for the rest of your life: a quick quiz and a five-part test to assess the status of your posture, strength, balance, flexibility and endurance, followed by five chapters with step-by-step instructions on how to safely improve the areas in which you are lacking.

The therapists describe what happens to these "five domains of fitness" as you age. Posture begins changing as early as the teenage years, the result of activities like prolonged sitting, carrying a heavy purse or briefcase, or working at a computer.

Strength declines as muscle fibers decrease in size and number and as the supply of nerve stimulation and energy to the muscles diminishes. Balance deteriorates as muscles tighten and weaken and joints lose their full range of motion.

Flexibility declines because connective tissue throughout the body becomes less elastic. And endurance falls off because of reduced flexibility, weakened muscles, and stiffer lungs and blood vessels.

Still not convinced you need to work on your fitness? See how you do on the therapists' quiz:

*Are you not standing as straight and tall as you once did?

*Is walking up a flight of stairs a strain at times?

*Are you getting up from a chair more slowly than you used to?

*Is it getting harder to look to the left and right while backing up?

*Do you get stiff sitting through a long movie?

*Is standing on one leg to put on your shoe difficult or impossible?

*Do you trip or lose your balance more easily?

*Does walking or jogging a distance take longer than it used to?

As a daily exerciser I consider myself a physically fit 65-year-old, and I did well on the quick quiz, but I flunked the tests for balance and flexibility. So I've added exercises to my weekly regime to improve these two domains of fitness.

"The antidote to aging is activity," the therapists wrote. "Inactivity magnifies age-related changes, but action maintains and increases your abilities in all five domains."

No Time to Waste,

Dr. Vonda J. Wright, a sports medicine specialist at the University of Pittsburgh Medical Center, said at the New York meeting that "boomers are 59, and we must intervene now to head off what happens to those who age in a sedentary way."

Injury and arthritis are the main reasons people stop exercising, she said. She urged those in need of a joint replacement not to postpone the surgery, which she likened to repairing a pothole.

Marjorie J. Albohm, a certified athletic trainer affiliated with OrthoIndy and the Indiana Orthopedic Hospital in Indianapolis, cautioned against "cookbook recipes" for exercise. "The key to a good workout is customization," based on a professional assessment of flexibility, cardiovascular endurance, strength and balance, she said. "The goal is to minimize symptoms and prevent new injuries," Ms. Albohm said, and she urged people to listen to their bodies to avoid making things worse.

Ms. Albohm emphasized flexibility, saying it is "not optional" as you age. "To prevent stiffness and maintain joint mobility you should stretch daily for 15 to 20 minutes," she said "using slow, controlled movements, before or after your exercise program."

For cardiovascular endurance, she recommended alternating between weight-bearing (walking, jogging) and non-weight-bearing (swimming, cycling) aerobic activities three days a week for 30 to 45 minutes each time.

Muscle strength, Ms. Albohm noted, can be increased at any age, even in one's 90s, to protect against falls, maintain mobility, prevent new injuries and empower individuals. Especially important is strengthening the muscles in the front and sides of the thighs, which help support the knees, and strengthening core muscles of the trunk (back, buttocks and abdomen) to protect the spine and support the entire body.

Finally, we need to worry about our bones. At least 1.5 million "fragility fractures" occur annually in the United States. These are breaks that result when someone falls from a standing height or less, trips over the cat or lifts something heavy, and they affect men as well as women, Dr. Laura Tosi, an orthopedic surgeon at Children's National Medical Center in Washington, D.C., said at the New York event.

"A history of a fragility fracture is far more predictive of future fractures than a bone density test," Dr. Tosi said, adding that a major cause is a shortage of vitamin D, which lets calcium into bones.

"The current standard for vitamin D is not adequate," she said, and predicted it would soon be raised to perhaps 1,000 International Units a day. Vitamin supplements are crucial, because adequate amounts of vitamin D cannot be absorbed through diet and sunshine alone.