Jaye Waggoner, BAA

It is a rigorous and demanding schedule by anyone's standards, never mind the fact that Ms. Geisler is 76 years old. What is her secret to staying so active and participating fully in her life and the lives of others? Well, according to her the answer is in the question. "I am out everyday, seven days a week." She has a routine that she follows and by doing that and through helping others she is fueled to continue doing the same. "If I sat at home with nothing to look forward to I would get depressed," she said. She went on to say, with a smile, just how important it is to "get moving and keep moving" even if it is just a walk around the block.

The pattern is certainly working for her. In the past she has only had to deal with an ulcer, that has since healed and a hip operation, which has somewhat limited what she can do physically. At 76, she is happy to say, she takes no prescription medications. She believes that physicians should put their foot down and try to limit the drugs they prescribe to seniors and in turn seniors should find other ways to feel good. "Doctors should talk to seniors and listen. Everyone relies too heavily on prescription drugs, especially seniors," she said. "This is not to say that drugs are the enemy, obviously in some cases like heart medication they are very necessary. But some," she went on to list, "like sleeping pills, tranquilizers, and those used to treat depression, may not be."

Ms. Geisler takes a multi-vitamin, vitamins E, C, B complex, calcium and magnesium, and drinks a lot of water, as she does not always feel like shopping and cooking. She also recognizes the value of exercise. She believes you can get exercise in a variety of ways. It does not have to be structured classes. "The only exercise I get is walking, and I feel good," she said. Not only does she bus and walk everywhere, she encourages other seniors, even those with limited mobility, to get out.

Ms. Geisler believes that like herself, if other seniors stay active physically, keep their minds busy, eat reasonably healthy and find someone who will listen and understand them, they could significantly improve their overall long-term health. "They may not find themselves needing so many prescription drugs down the road," she said. The recipe for good health, she says, could be as simple as talking, listening and really living, not simply existing.

Barry Goldlist, MD, FRCPC, FACP

Ever since the landmark article by Fries in the 1980 New England Journal of Medicine, entitled 'Aging, natural death, and the compression of morbidity,' investigators, elderly people, and probably many younger people, have wondered whether the progressive frailty and dependency traditionally associated with aging are, in fact, inevitable. Preventive medicine, which originally meant preventing death early in life, is now being applied to preventing disability in the elderly. There is persuasive evidence presented by the MacArthur Foundation Study of Aging in America that the lifestyle choices we make are important factors in how we age. This information is clearly and effectively presented by Rowe and Kahn in the 1998 publication, 'Successful Aging.' They make a persuasive argument that while most of the chronic degenerative diseases of aging have a significant genetic basis, manipulating environmental factors can still be incredibly important.

Rowe and Kahn present their most persuasive argument in touting nutrition and physical exercise in preventing age-related frailty. My reading of the literature over the past few years is that although any exercise is better than no exercise, very vigorous exercise is better than moderate exercise. While early detection of specific diseases is important as well (e.g. cancer screening, diabetes detection, hypertension detection and treatment), I for one am firmly convinced that exercise and diet will provide the 'biggest bang for the buck.' Although lifelong commitment to preventive health care is the optimum, it seems like there is benefit in vigorous exercise and proper nutrition regardless of the age at which it is started.

The maintenance of normal cognitive function with aging is a much more difficult issue. We do know that higher levels of education are associated with less cognitive decline in old age, but it is unsure if there is any causal link. Certainly maintenance of good physical health will help maintain good mental health as well. There is really no evidence at the present time that 'mental gymnastics' such as crossword puzzles, or specific diets (e.g. rich in antioxidants), will help in maintaining cognitive function.

In the textbook 'Principles of Geriatric Medicine and Gerontology,' Professor Hazzard writes a chapter on preventive gerontology that emphasizes the lifelong health practices that promote successful aging. It seems that it is never too early to plan for a healthy old age. Fortunately, it is also never too late to start.

Olya Lechky

The Pro Program, an exercise program for seniors with osteoporosis (OP), is demonstrating that regular exercise, combined with medication and good nutrition, can improve bone mineral density (BMD) if participants stick with the program over a period of two to three years.

Participants are referred by their family physicians. Dr.

Kim Wilson, BSc, MSc

Regular exercise is associated with cardiovascular, respiratory, neuromuscular and metabolic benefits. It is also an important factor in improving the immune system and preventing diseases, such as osteoporosis and coronary artery disease, while reducing disability. Physical activity also gives an energy boost, lowers cholesterol, enhances mood, and increases general feelings of well being.^1,2,3

Research has shown that regular exercise decreases the mortality rate in middle-aged men and probably in middle-aged women, but whether this occurs in the elderly has not been studied extensively.⁴ Very little research has been done to determine how much exercise an elderly person needs to do to obtain health benefits.

The intensity of exercise required to promote cardiovascular health among older persons has remained controversial.⁵ Some studies suggest strenuous activity reduces coronary disease risk while other studies found that less intense activity reduces the risk of coronary disease.^4,5 Not surprisingly, physicians are confused about how to prescribe an exercise regimen to their older patients.

Research in the area of exercise and health has traditionally focused on younger individuals.