June 20, 2018
adults in cycling exercise class

Exercise: The Key to Active Aging

by Health After 50

Exercise can be a double-edged sword if you’re an active older adult. You know that it can help manage or prevent musculo­skeletal disorders like osteoarthritis and osteoporosis, but you wonder sometimes whether the aches and pains you sometimes feel when exercising—as well as a risk of sustaining an injury or exacerbating your condition—are worth the effort.

A study in 2017 in Arthritis Care & Research, which included 350 people with knee osteoarthritis, revealed that nearly 80 percent of the participants feared movement and physical activity. Most were afraid of worsening joint pain or an injury. Yet exercise is so good for you that its ben­efits almost always outweigh its risks. Studies repeatedly show that exercise helps adults maintain physical function and mobility well into their golden years.

Strength-training and weight-bearing activities are particularly beneficial for people who have conditions such as arthri­tis or low bone density because they can improve muscle strength and flexibility, minimize bone loss, improve balance, and reduce fall risk. Aerobic exercise improves heart health and mood and helps keep off excess weight, which can put enormous pressure on joints like the knees and hips.

Exercising precautions

Consult with your doctor or physical therapist before starting a new exercise program. If you have any of the follow­ing conditions, double check with your doctor or physical therapist to make sure your chosen activity is suitable.

Osteoarthritis. Try not to let fatigue and joint and muscle pain discourage you from working out. Inactivity can worsen joint pain and decrease function. The dis­comfort or pain you feel during activity won’t damage your joints (unless the pain is sudden and sharp—then stop your activ­ity immediately), although some people with significant osteoarthritis may have too much pain to exercise the affected joint. Exercise keeps joints healthy by increasing the flow of nutrient-rich blood to them. If you stick with regular activity, you should find that it can help relieve joint pain and stiffness, build stronger muscles that reduce joint stress, improve flexibility, and decrease disease activity.

Low-impact strengthening exercises, such as those that use your body weight, light dumbbells, or resistance bands, help stabilize joints by strengthening surround­ing muscles, which helps reduce injury risk. If you have lower-extremity arthritis, try strength training that targets the thigh muscles (quadriceps and hamstrings).

Range-of-motion exercises, such as stretching, yoga, or tai chi, relieve stiffness and restore flexibility. Aerobic or endur­ance exercise, such as walking, cycling (at low pedal resistance), and water exercise, helps with joint movement.

Protect Your Knees During Exercise

If you have a joint or bone condition and want to protect your knees when working out, avoid these seven missteps.

Fibromyalgia. Characterized by ten­der points around the back, hips, knees, and shoulders, fibromyalgia is best man­aged with exercise that involves endur­ance and gentle stretching. Resistance training with proper supervision has been shown to help relieve some tenderness.

Lupus. Symptoms of this autoim­mune disorder include joint discomfort and inflammation, fatigue, shortness of breath, and pain, which make it difficult to exercise. But if you persist with a rou­tine, you may find that regular workouts reduce fatigue. Stretching at bedtime may help lessen joint stiffness in the morning.

Low bone density. If you have osteo­porosis or osteopenia (a potential precursor to osteoporosis), you might worry that activity will increase your fracture risk, which can be true if you participate in high-impact activities, have advanced bone loss, or have a history of fractures. Other­wise, with your doctor’s approval, focus on resistance and balance training, especially exercises that target the back and help cor­rect posture, and weight-bearing activity like walking or low-impact aerobics. Such activities appear to slow bone loss, improve muscle strength, and lower the risk of falls.

Most clinical guidelines call for moder­ate-intensity, low-impact training to man­age osteoporosis. However, an Australian study in the Journal of Bone and Mineral Research in October 2017 found that intensify­ing resistance training and adding higher-impact moves appeared to measurably improve strength and increase bone mass and height without causing fractures in postmenopausal women with low to very low bone density. The women’s twice-weekly high-intensity training program consisted of weighted resistance training and a high-impact exercise. Notably, the participants were closely supervised as they performed the exercises; such a program should never be undertaken without the assistance of a physical therapist or an ath­letic trainer.

Low back pain. Short-term (acute or subacute) low back pain can become chronic if you fear that movement will cause or increase your pain. You’re more likely to avoid activities and be more sed­entary, which only makes things worse by weakening muscles. And if you suffer from chronic nonspecific low back pain, your doctor may suggest core stability exercises to strengthen the muscles that support your spine. You may also need stretching exercises to improve your hip flexibility, which will help decrease the demands on your back. A 2017 Cochrane review found that yoga resulted in small to moderate improvements in back-related function and pain after three to six months compared with no exercise.

Exercises to avoid

  • If you have joint problems: Avoid high-impact exercises like running, exercises that involve twisting and jerky motions, and extreme neck movements. If you have an autoimmune condition like rheumatoid arthritis, take a break from strength train­ing during flares and reduce the intensity and length of your endurance workouts.
  • If you have low bone density: Steer clear of exercises that involve bending or curving the spine forward (forward flex­ion), such as abdominal crunches or toe touches, which put too much pressure on the spine. Avoid activities like golf and tennis that involve rotating forcefully at the waist. High-impact activities like running or jumping rope can increase the risk of injuries, falls, and fractures.
  • If you have back pain: Avoid heavy weight lifting, sit-ups, and leg lifts; activities that require leaning forward for long periods, such as cycling; and exces­sive bending and twisting, all of which can put pressure on the spine.

More ways to head off injury

If you know that an injury or chronic con­dition isn’t causing the pain or discomfort associated with exercise, other factors may be to blame, including improper execution of an exercise, poor posture, an overuse injury, or muscle imbalance, tightness, or weakness. Consider working with a per­sonal trainer who can help you develop a personalized exercise program. He or she can help identify any muscle imbalances or weaknesses you may have and evaluate your form to ensure you’re performing your exercises correctly and safely.

Below are some do’s and don’ts to keep in mind when working out, especially if you have a musculoskeletal disorder:

  • Don’t skip the warm-up. Perform a low-intensity activity, such as walking, marching, or side-stepping in place for about five minutes. If you have arthritis, tack on an additional five minutes to reduce joint stiffness. Warming up helps direct blood flow to your limbs and may reduce your injury risk.
  • Do change things up. Overuse and repetitive stress injuries can affect the ten­dons, muscles, cartilage, bones, and nerves. Such injuries are often caused by wear and tear from a repetitive motion such as running, cycling, or hitting a ten­nis ball. Common overuse injuries include tendinitis and bursitis. Avoid injuries by varying workouts and giving your body time to recover between sessions.
  • Do watch your form. Incorrect tech­nique and poor posture when training can lead to injury. Poor posture is often a prob­lem for some people with arthritis who shift their body or alter their movements in an attempt to protect painful joints.
  • Don’t overdo it. Take caution when beginning an exercise program such as strength training. Improper technique or an overzealous approach can lead to injury. Start with easy weights and increase theamount of resistance gradually.
  • Don’t leave your muscles unbalanced. Work all major muscle groups. If one mus­cle group is much stronger than the oppos­ing group, it can disrupt the joint’s natural range of motion and lead to injury. For example, tight, overdeveloped chest mus­cles and neglected back muscles can nega­tively affect your posture, resulting in a rounding of your shoulders. Tight hip flex­ors inhibit the opposing buttock (gluteal) muscles, which can lead to a destabilization of the lower back. If your lower-back mus­cles are much weaker than your abdominal muscles, or vice versa, you’re likely to have bad posture and possibly back pain.
  • Do listen to your body. Stop exercis­ing right away if you feel sudden pain or develop local swelling. See your doctor if the pain persists.
  • Don’t ask your fitness instructor what may be causing your chronic pain. While he or she can point out poor exercise tech­nique that may be causing discomfort, your instructor isn’t qualified to diagnose pain.
  • Don’t forget to stretch. Stretching after exercise can increase your mobility.

This article first appeared in the May 2018 issue of UC Berkeley Health After 50.

Also see Get Fit Without Getting Hurt.