How to Promote Physical Health While Aging: The Healthy Aging Checklist Part 2

This is the second in a series of posts explaining my Healthy Aging Checklist.

Remember, for the healthiest aging, we need to do the things that optimize health — and health care — so that the brain and body work at their best for now, and for the future.

I’ve identified six broad actions to take:

The Healthy Aging Checklist:

• Promote brain health and emotional well-being.
• Promote physical health.
• Check for and address common aging health problems (e.g. falls, pain, memory problems, depression, isolation, incontinence, polypharmacy, etc).
• Learn to optimize the management of any chronic conditions.
• Get recommended preventive health services for older adults.
• Address medical, legal, and financial advance care planning.

In this post, we’ll cover proven ways to promote and maintain physical health as one ages.

6 Proven Ways to Promote Physical Health

Here are the six “healthy living” actions that I recommend, for promoting physical health in all older adults. They all have a solid track record (which cannot be said for everything I see recommended online). They are also good “bang-for-the-buck,” in part because they provide real benefits to just about everyone who adopts them. And they help whether or not an older person has already developed chronic illnesses.

Now, the truth is that many of these overlap with the recommended actions for brain health. But I’ve tried to provide more links and resources related to how these actions benefit aspects of physical health such as mobility, heart health, and immune function.

1. Exercise regularly — and include strength training twice weekly.

Why: Exercise helps older adults maintain their strength and mobility, plus it improves just about every physical health outcome you can imagine, provided you don’t overdo it or get injured.

Walking daily is not enough! Research suggests that strength training (e.g. weight lifting or other exercises that strengthen muscles) is especially beneficial as we age.  Without strength training, muscles weaken as we age, which can lead to anything from falls to difficulties with daily activities. I go into more detail about this topic in my Youtube video regarding exercising and aging: 

A 2014 research study in JAMA  found that a structured exercise program — involving sedentary adults aged 70-89 —  reduced the risk of “major mobility disability.” Exercise also tends to improve mood, which has positive effects on the rest of the body.

Note: Research has shown that even less-than-recommended exercise brings health benefits. So remember: it’s better to do a little bit every day than nothing at all. In fact, the most important thing is to find something that you can keep doing. Walking is relatively easy for many. Otherwise, classes or structured courses often help older adults stick with an exercise program; look for a class led by someone with experience coaching older adults.

If you are already walking regularly, that’s great, but it’s not enough to build up your muscles! So the next step is to try to incorporate all four different types of exercise that benefit older adults: strength, endurance, balance, and flexibility. Again, strength training is especially important in aging.

For more information:

• 4 Types of Exercise in Later Life: How to maintain strength, balance, & independence in aging
• How Exercise Helps Aging Adults: Key points from a landmark study
• How much physical activity do older adults need? (CDC.gov)
• How can strength training build healthier bodies as we age?
• National Institute on Aging: Four Types of Exercise and Physical Activity

2. Don’t smoke.

Why: Smoking tobacco is bad for just about every aspect of physical health. It’s especially damaging to the lungs, but also increases the risk of heart attacks, strokes, and various forms of cancer. Many tobacco-related diseases, such as chronic obstructive pulmonary disease, can cause difficult symptoms for years.

Fortunately, even after an older adult has developed smoking-related health problems, quitting smoking will reduce symptoms and one’s chance of a premature death: one study found that quitting smoking between ages 55-64 added four years to one’s life expectancy.

Note: Quitting smoking is hard, since nicotine is physically and psychologically addictive. Only 3-6% of people who try to quit on their own succeed. Medications and counseling have been proven to help quit smoking; combining these correctly usually increases the chance of successfully quitting to 30%. Many people need to try quitting a few times, so don’t let a past failure to quit stop you from trying again.

E-cigarettes do help some people quit smoking. Although we don’t yet know what are the long-term effects of vaping and using e-cigarettes, preliminary research suggests that it’s better to use e-cigarettes than it is to smoke.

For more information:

• Quitting Smoking for Older Adults (National Institute on Aging)
• Never Too Late To Quit Smoking: CVD Mortality Reduced When Patients Quit After Age 60
• Get Free Help: Speak to an Expert (Smokefree.gov)

3. Get enough sleep. 

Why: Studies have found that chronic sleep deprivation is linked to increased cardiovascular disease, increased levels of inflammatory blood markers, and decreased immune function. Being sleep-deprived also causes fatigue, which can make it hard to be physically active (and is bad for mood, too).

Note:  Aging does cause sleep to become lighter and more fragmented, and may cause people to need a little less sleep than when they were younger. That said, chronic sleep difficulties or often waking up feeling tired is not normal in aging. Older adults often suffer from true sleep problems that can be treated once they are properly evaluated.

For more information:

• How Sleep Affects Health, & Changes With Aging
• 5 Top Causes of Sleep Problems in Seniors, & Proven Ways to Treat Insomnia
• How to Sleep Well as You Age

4. Avoid chronic stress.

Why: Feeling chronically stressed has been linked to physical health problems such as cardiovascular disease, insulin resistance, and decreased immune function. Research suggests that this may be because stress can accelerate “cellular aging,” and also may promote inflammatory markers in the body.

Note: Common causes of stress in older adults include financial stress, relationship stress, work-related stress, and caregiving stress. To reduce chronic stress, it’s best to combine general approaches (such as improving sleep, exercising, meditation, relaxation strategies, etc) with approaches that can help you cope with your specific source of stress.

For more information:

• How stress affects your health
• Stress Management: How to Reduce, Prevent, and Cope with Stress

5. Maintain a healthy weight.

Why: The main reason is that obesity is a major risk factor for disability in late life. (Strange but true: as people get older, the link between obesity and premature death gets weaker, a phenomenon sometimes called the “obesity paradox in aging.”)

Obesity — usually defined as having a body mass index (BMI) of 30 or more — worsens arthritis. It’s also been linked to many health problems, such as cardiovascular disease, diabetes and glucose intolerance, certain types of cancer, and sleep-related breathing disorders.

Studies have found that when overweight or obese people lose even a modest amount of weight — such as 5-7% of one’s current weight — this can improve physical health and symptoms. 

Do keep in mind that unintentional weight loss is a major red flag when it comes to the health of older adults, and should always be brought to the attention of health professionals.

Note: Historically, a low-fat diet has been recommended for weight loss and health reasons. However, I believe there’s a lot to be said for the theory that high-carbohydrate foods (which are often low-fat) increase insulin levels, promote hunger, and make it harder for people to lose weight. If you need to lose weight, you may want to do some research into various approaches before discussing with your doctor and coming to your own conclusions as to which weight-loss strategy to try. Older adults need to be especially careful about not losing too much lean body mass during intentional weight loss.

For more information:

• Obesity in the elderly: More complicated than you think
• Rethinking Weight Loss and the Reasons We’re “Always Hungry”
• Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults

6. Eat a “healthy diet.”

Why: Diet undoubtedly affects certain aspects of physical health. A healthy diet is one that doesn’t provoke negative health effects, such as being prone to take on extra weight, developing insulin resistance, developing atherosclerosis, or having uncomfortable symptoms in the belly or bowels.

Frail older people often need extra calories and protein, since malnutrition becomes more common as people age. Research also suggests that eating enough protein is important if you are working on strength training, as the muscles can’t grow stronger without enough protein. I talk on the importance of protein in my Youtube video here: 

Note: Exactly what should or shouldn’t be eaten, as part of a healthy diet, is being constantly debated among experts and the general public. As the effect of diet on a person is very individual, it’s important to follow how one’s body seems to respond to a given diet. (Pay attention to how you feel, how your weight changes, and how your blood sugar and lipids change.)

In general, research suggests that a diet high in vegetables and fiber and low in ultra-processed foods and added sugars — such as the Mediterranean diet — is a good choice for many.

For more information:

• How to Follow the Mediterranean Diet for Senior Health, & Related Research Findings
• Healthy Eating As We Age

An Optional Extra Way to Promote Physical Health

7. Tinker with your nutrition and your microbiome

Why: Recent research suggests that a person’s health can be significantly influenced by the bacterial community (the microbiome) we all carry within our guts and in our body. The microbiome itself seems to be influenced by one’s diet as well as by other factors.

On the other hand, it’s not clear that taking extra vitamins and supplements — including popular anti-oxidants — promote health. The US Preventive Services task force report on this topic concluded the evidence of benefit is weak. Furthermore, commercially available supplements have often been found to be of poor quality, and “anti-aging” vitamins have no evidence behind them. To promote physical health, I believe that supporting the microbiome with good nutritious food will prove to be much more important than tinkering with supplements.

Note: It is not yet clear how we should advise people to optimize their microbiome, other than to eat a lot of fiber and minimize antibiotics. For some people, eliminating certain foods seems to improve well-being or certain symptoms. Research into the benefits of fermented foods and probiotics is ongoing. There is also fascinating research being done on how the microbiome changes with aging, and might influence certain aspects of the body’s aging.

For more information:

• To be healthy, take care of your microbiome
• Vitamin D: The Healthy Aging Dose to Prevent Deficiency & FAQs
• Vitamins and Minerals in Aging

What’s Your Plan for Promoting Physical Health While Aging?

So that’s my short list of activities that are most important to do, to promote physical health while aging.

Which of these are you already doing, and which of these will you try to work on in the next few months?

Also, if you think I’ve missed anything major in the list (it has to be something with good evidence and that works for virtually all older adults), please let me know.