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The term elderly doesn’t have a precise clinical definition, though it is often used in medical articles. Elderly has been used for older than 65 to older than 75, and some of us in the ST community are indeed getting older over time. Possibly coming into the definition of elderly at the age of 73, I do have an interest in exercises for older people. I also teach an ST class where the ages generally go from mid 60s to late 70s (though the oldest one has done yoga all her life and has enviable fitness and flexibility). Because it is a class of mixed fitness and abilities (some of whom are carrying injuries and after-effects of e.g. cancer) what we do is necessarily limited, though there is plenty of encouragement for those wanting to do more advanced versions. As well as flexibility, the focus is on core strength, balance and body awareness. One of the features of old age is muscle degeneration and loss of strength, known as sarcopenia. The extent to which this can be prevented or is reversible once it has occurred has been a matter for debate. The current consensus seems to be: 1. The best protection is to have a lot of muscle mass to start with, so you can lose more before becoming doddery. If you are not naturally endowed with a lot, the best thing is to build it up while young, when putting on muscle mass is relatively easy, and then exercise to keep it. 2. The next best thing is to start strength training at any age, even though it will not be as effective as when young. Positive effects have been reported even in the old-old (late 90s) (though that may be from a very low baseline). The strength training has to be for hypertrophy (80% 1 RM, or 5 reps to failure). It’s not appropriate to do this in my group class, and I’m starting a program on my own. Hating weights (I’m the skinny flexible type) I don’t want to go to the gym, and don’t have a spotter to learn styles like Olympic weightlifting, and want to use body-weight resistance exercises where possible. Given that the intention is that the weights will be beyond the maximum that I can handle, it needs to be very safe. At the moment I am doing: 1. Single-leg squats (I can make it more difficult by going lower). 2. Pull-ups – if I ever get good at these (like I was when young) I can try to move to a single arm version. 3. Push-ups (see no 2 comment). 4. I’ve tried shrugging up when in an elbow stand against the wall, but can do that too easily. I don’t want to do it with bending-to-straight arms (in a handstand) in case I collapse on my head. 5. Pull-ups holding a low barre with body almost horizontal (feet on floor), pulling the chest up to the barre (see no 2 comment). I don’t know if anyone has any further suggestions, and I would appreciate hearing if anyone does - remember that the muscles need to be maximally loaded and it needs to be very safe. I’d like to be able to exercise all major muscle groups just using body weight alone. Doing free exercises this way means that accessory muscles will be exercised as well, though I guess most wont be loaded heavily enough to combat sarcopenia. Should there be a special ST flavour for the elderly? The problem here is that there is such a range once people are in their 60s-70s-80s. The fittest will be able to do the same program as a younger person, while others may be limited to exercises like sitting in a chair and rotating their wrists 5x one way and 5x the other. Comments appreciated. Thanks, Jim.

The title is a bit off I know, but I am old myself. As well as classes for younger people (splits and deep backbends for aerialists, dancers etc) I have a regular ST class which is now populated by people in their 60s to late 70s (the oldest in fact has enviable flexibility, having done yoga all her life). But they include quite a range of people – some are like her, others are working round arthritis, the after-effects of cancer treatment, and more. My ST class as well as including standard ST exercises is intended to address some of the issues that people come with. I have found the following (some of which are probably primary, others secondary): 1. Lack of agility in simple movements. 2. Inefficient patterns of movement (in e.g. getting up off the floor). 3. Lack of confidence in simple movements. 4. General tightness –probably muscular as well as connective tissue including fascia. 5. Anterior dominance including weak and tight posterior muscles. 6. Poor core strength and core reflexivity. 7. Poor posture – excessive lumbar lordosis, thoracic kyphosis, head-forward posture. 8. Poor balance. 9. Poor body awareness. 10. Lack of strength. Some accept this because “this is what happens when you get old”. However I try to educate them that many things are possible as you get older, though you may have to try harder than a young person would. Because my classes include exercises for dealing with all of the above, the regular members now all have good function in these areas, unless held back by injury. My hope now is that they go home and educate their spouses (I also have a two-for-one offer to encourage spouses, though it is rarely taken up). The regular students obviously like it, having been coming to me for years. The rapid improvement shown by new members is heartening. I know one response could be “just do the standard ST program” and this is what I try to adhere to closely, but with a flavour to deal with the above issues as well. Some of the core exercises are drawn from Pilates, and the balances are various one-foot balances. I would like to introduce some more dynamic balances with e.g. wobble boards but do not think it would be safe with this group in the spaces I have, where there is nothing to grab onto if falling. To catch yourself when actually in the process of falling, I think you need rapid reflexes, and these need practice, though unfortunately they don’t get it in my class. I wonder if anyone else has experience with this age group, and whether they look out for other things too, and any comments on my program and approach. Jim.

A recent Swedish study has been in the news a lot, showing that increased milk consumption is associated not only with increased risk of bone fracture, but with increased death rates, cancer rates, heart disease, and general inflammation in the body. As someone who usually drinks a lot of milk (over 1 litre/day) I was concerned, so looked into it further. The original paper is freely available at http://www.bmj.com/c.../bmj.g6015.long. The common advice for people who have had bone fractures or are at risk of osteoporosis is to increase their milk intake, so a clinic interested in bone fractures in the elderly looked at the data to see if milk indeed helped. They used extant Swedish medical records (possible in Sweden because records are so complete, and also linked to a unique patient identification number), and related them to self-reported food intake. They found in women that those who had the maximum fresh milk intake (1.2 litres/day) had a 150% increase in all-cause death rate in any period (i.e. it went up to 250% of baseline rate), a 50% increase in rate of hip fractures, and a slightly higher (20% increase) in rate of other fractures. Overall cancer mortality went up by 50%, and CVD (cardiovascular disease) mortality by 200 %. The effects increased gradually with intake; i.e. there was no absolutely safe level. Bad news! The effects in men were much smaller, but men should not be complacent, because information was collected less adequately on the men, and they presented evidence that similar effects in men might have been lost in the noise in the data. In addition higher milk intake was associated with increased levels of inflammatory markers in the bloodstream, showing that milk puts the body under inflammatory stress. Long-term low-level inflammation is known to be associated with the development of CVD, oxidative damage, more rapid aging, loss of muscle strength in ageing (sarcopenia) and possibly Alzheimer’s disease. On the other hand, increased intake of fermented milk products (cheese, yoghurt) was associated either with none of these effects, or with increased protection. This points the finger at what is missing in fermented milk products, which generally (though not always- see below) contain lower levels of the milk sugar, lactose. The other components of milk stay in fermented products, so they are unlikely to be a factor. In the gut, lactose is broken down into glucose and galactose (unless people have lactose intolerance, in which case it stays in the gut and causes bloating and diarrhoea). Galactose is known to be toxic – injected into the bloodstream of animals it leads to early death, more rapid ageing, neurodegeneration, and inflammatory responses (similar things happen in human beings with a deficiency in the ability to metabolise galactose). It does this in quantities (in relation to body weight) comparable to what human beings would get from milk. So galactose in anything other than very small quantities (it is an essential ingredient of many of the body’s biochemicals) looks like bad news. I have therefore decided to cut my milk intake to about 0.5 litres or less/day. Could there be anything wrong with the study? Studies like these are notoriously difficult, because you are monitoring people over a long time, the population monitored may not stay consistent, and there may be many confounding factors which have not been compensated for properly. The biggest possible factor is what in medical terms is known as “reverse causation” – the people drinking more milk may have been told to do so because they are already known to be at higher risk of a fracture. But this does not explain (1) the reduced risk from eating fermented milk (which they are also told to do), and (2) the effects on all the other markers – CVD, cancer, inflammation, etc. Secondly, self-reported diet – especially reported for a short period a long time ago – is notoriously poor as a predictor. They gave evidence that it went some way to being correct but this remains as a factor. But it still does not explain why they got the effects (errors would tend to dilute out any effects, not enhance them – and this is what they think happened with the data on men). But the study was very good in many ways. It looked at the old and elderly over a long period. It had a very large number of participants, so was able to compensate for the many possible confounding factors (smoking, socio-economic status, other illnesses, etc). But there is always the possibility that the compensation was incorrect, as by its nature you are dealing with the unknown. It was certainly a good study by modern standard. So why have previous studies not found the same? Probably because they did not separate out liquid milk from fermented milk products, which have opposite effects. As for sugar in fermented milk products, the cheese in my fridge lists near-zero sugars (against about 5% in milk), but the yoghurt I normally get (labelled “no added sugar”) has the same sugar content as milk. It is quite possible that Swedish yoghurts are fermented out to a much greater extent than Australian ones – suggest caution is needed in choosing. My good news for the day! Jim.