No hitting the snooze button for Sandy and Bette Baldwin, a couple who love their active life in the St. Andrews Estate retirement community in Boca Raton, Fla.
They could choose to ease into morning after a lifetime of working hard and raising a family, but not these two. The Baldwins set an alarm, get out of bed by 6:30 and lace up running shoes — except on the two days of the week when they work on resistance training and balance.
"We want to do everything we can to stay healthy," says Sandy Baldwin, 64. "I'll run until I can't anymore, and then I'll walk or go bicycling."
Experts on aging, concerned about the 77 million Baby Boomers and the rapidly growing older population, say more people need to adopt the Baldwins' commitment to physical activity. More than 62% of adults do not meet the exercise guidelines set by the Centers for Disease Control and Prevention.
Research shows the Baldwins are more likely to avoid age-related diseases and remain independent longer than those who do not exercise. The Baldwins live in a continuous-care facility but hope they never need to move to the nursing-home level.
"Exercise is the closest thing we have to a fountain of youth," says Marie Bernard, deputy director of the National Institute of Aging. "With all the gains we've made over the years allowing people to live longer, it would be nice if more people would take advantage of exercise to improve the quality of a longer life."
A rash of new research is exploring how exercise late in life can be beneficial and help people age in place at home rather than be forced into care facilities. Barbara Resnick, incoming president of the American Geriatrics Society, is conducting research to find ways to get people off walkers and see them ultimately "walk all the way to heaven."
'It makes us feel better'
Maintaining the independence and mobility of older adults is emerging as a national health priority, Resnick says. The proportion of Americans ages 65 and older is projected to increase from 12% to 20% of the population by 2030.
Exercise is more important the older we get, she says.
The Baldwins, who have been running together for 25 years, take to heart findings that show exercise can be a buffer against many age-related problems, including dementia and the muscle and bone loss that ultimately leads to frailty and loss of independence. Exercise also reduces the risk of getting heart disease and type 2 diabetes and helps prevent depression.
"We want to stay active as long as we can," says Bette Baldwin, 64. "We know exercise is good for the brain, cardiovascular fitness and osteoporosis. We also know it makes us feel better."
They want to be active and avoid illnesses that have immobilized three sets of friends.
Being in shape helps recovery
The guidelines established for older adults by the U.S. Department of Health and Human Services require 150 minutes a week of moderate-intensity exercise and two or more days of weight training that involve all the major muscle groups.
In her new book, The Complete Guide to Fitness and Health, exercise physiologist Barbara Bushman of Missouri State University says every person needs his or her own fitness routine, but all must include resistance training for muscle and bone health. Over the course of adulthood, muscle decreases, and the amount of body fat increases. As muscles contract to lift, push or pull a heavy object, stress put on the bone increases its mass. This makes bones stronger over time. Weak muscles and bones can lead to falls and broken bones, and time spent doing rehabilitation in nursing homes.
Most people do not understand the effect of deconditioning, says Gregg Warshaw, chair of the division of geriatrics at the University of Cincinnati.
"We get more illnesses as we get older," he says. "If you're in good shape and you get bad illnesses, you're likely to recover faster. That's another reason why exercise is so important to people as they age."
It's never too late to get some benefit, he says, but at some point, the progression of frailty might be hard to stop.
Frailty, says Katalin Roth, a geriatrician and internist in Washington, D.C., can be a downward cascade that leads to hospitalization and death. It is a "constellation of symptoms shown to be markers of dependence and is highly prevalent in old age. Among the symptoms are poor exercise tolerance, weight loss, decreased strength and a slow walking gait."
Nationwide study has begun
A paper published 10 years ago in the journal Gerontologist gave physicians a guideline for identifying frailty, says Bernard, but little research establishes how to prevent it. "We could always say exercise is good for you, but we haven't been able to say yet it prevents disability," she says.
Marco Pahor, head of the aging institute at the University of Florida, is involved in a nationwide study that aims to change that.
Millions of older people are at risk for disability, Pahor says.
"There is an epidemic of sedentary lifestyle and obesity in this country," he says, "and a second epidemic of an aging nation. Studies show the chance of someone 65 or older ending up in a nursing home is about 50%."
Seven other universities are also taking part in the research, known as Lifestudy. It involves 1,600 participants in a study comparing a moderate-intensity physical-activity program with a healthy-aging education program to determine what might be effective in preventing frailty. It is based on a pilot program, Pahor says, that showed those who were guided by instructors on moderate physical-activity plans did better than those who got doctors' advice alone.
"But will (exercise) truly change a person's life?" Pahor asks. "Keep them out of a nursing home? Let them walk across a room? We hope this trial provides this evidence. We need to find ways to keep people independent and at home."
Pahor says researchers also are studying the effects of physical activity on cognitive, cardiovascular and sleep patterns, "all secondary outcomes of this study." And the study will examine the cost of the intervention. "How much money could be saved by keeping people healthy?"
Study participants are in their 70s and identified as being at high risk for disability, says Anne Newman, who is leading the research at the University of Pittsburgh. "I'm surprised how many people say they don't know if they can walk 400 meters," she says. Doing the research "is the only way we'll know if physical activity is the secret. We'll be able to find out if it ever gets too late for physical activity to help."
Pahor says the University of Florida is one of many campuses doing pharmaceutical research to find other ways to stop aging, "but so far, there's nothing more promising than physical activity."
The reality of aging?
Resnick is a professor of nursing at the University of Maryland, where most of her research has been done on how to motivate older adults to exercise. "They have fear about exercise, are afraid it will hurt, or they're lazy," she says. She's been treating patients at the Roland Park Place, a continuous-care facility in Baltimore, for nearly 30 years and has seen how the smallest amounts of exercise can help.
The average age of her patients is 90. She encourages people in independent living to exercise but also studies how exercise helps nursing-home residents get off walkers and walking again.
"I had one 100-year-old patient who couldn't see enough to open the door to the exercise room," Resnick says. "But she'd open her eyes in the morning, look at me and say, 'Can I go exercise now?' And we'd go to the exercise room."
The Baldwins are closely watching the "older people" at St. Andrews Estates.
"There are days we miss (exercise), but not many," Bette Baldwin says.
"We have a lot of good role models here who are in their 90s. They're on treadmills and stair-step machines. If more people would do that, they'd be happier, healthier and live longer."