Infantilization of seniors

Perhaps because I’ve reached an age where I might be considered a senior my own self, I’m becoming increasingly annoyed by the way public health advisors infantilize seniors.

It’s most obvious with fall risk, where “don’t fall” not only is repeated constantly, it almost always comes with a particular sort of blame-the-victim advice—remove tripping hazards, wear supportive shoes, be careful on wet or icy surfaces, always use your assistive devices (canes, walkers, etc.)—the implication being that if you fall it’s your fault for not having made your environment sufficiently fall-proof.

This advice is not merely useless or insulting; it is actively harmful.

It’s harmful first of all because it conflates “senior” with “frail” in a way that will inevitably lead the public to harass seniors just like the public feels free to harass fat people, smokers, pregnant women (especially those with the temerity to drink alcohol), or anyone who isn’t conforming with whatever the current public health fashion is.

Inevitably too, it will have that effect in the minds of seniors who will start to think of themselves as frail simply because everybody says so.

More to the point, it’s is precisely backwards for what you want if your goal is (as I think it should be) to prevent frailty.

  • Wrong: Remove tripping hazards. Right: Use pillows, empty boxes, rocks, sticks, 2x4s, and whatever else you have handy to make a little obstacle course on which you can practice navigating tripping hazards.
  • Wrong: Wear supportive shoes. Right: Wear the least supportive shoes you can handle and do foot exercises to gradually strengthen your feet.
  • Wrong: Be careful on slippery surfaces. Right: Pay attention to the surfaces you’re walking on and exercise due care on all of them.
  • Wrong: Always use your assistive devices. Right: Work with a physical therapist if necessary, and then do exercises to make yourself strong enough to obviate the need for an assistive device.

This is perhaps not as harmful as the infantalization of children and youth, which works extra harm because adults have more power to impose their conditions on children, whereas seniors mostly have enough autonomy to ignore inappropriate advice. But it hurts seniors in exactly the same way it hurts children, reducing their ability to become or remain robust actors in the wide world.

Now, I don’t want to fall into reverse-blaming the victim. If you are frail, then taking steps to reduce the risk of injury just makes good sense. My go-to activities to prevent frailty might well put an already frail person at serious risk.

I use the weir across the little creek behind Winfield Village for balance practice, when it’s dry and clear of debris.

I try to resist the urge to suggest to seniors that they should do hazardous activities in the name of preventing frailty. But the advice I see from professionals (and random strangers) goes too far in the other direction. Following it is going to doom already frail people to becoming steadily more frail.

Exercise mimetics, fasting mimetics

I have spent a lot of time following the latest research on all sorts of interventions to increase lifespan and healthspan. I am now ready to say that virtually all this time has been wasted.

I guess it hasn’t technically been wasted, in that I’ve come to understand the latest research, and that’s of some value. But when it comes to choosing interventions that might help me, it turns out there’s nothing new beyond the obvious healthy lifestyle recommendations of 20 or even 30 years ago.

There are a bunch of chemical interventions that are interesting—they have definitely been shown to increase healthspan and lifespan in animal models, and have had some very promising results in humans as well. However, it is becoming clear that virtually all of them are either exercise mimetics or fasting mimetics—drugs that activate (some of) the metabolic pathways activated by exercise or fasting.

From a public health perspective, perhaps this is of some interest. Given a population of sedentary people with poor diets it’s easy to foresee a mix of these drugs delaying mortality and morbidity—people will live longer, and during their extended lifespan they’ll have less disability, less illness, and require less medical care.

From my perspective though, it’s completely uninteresting. I would much rather just exercise than take a drug that provides a subset of the benefits of exercise. Similarly, I’d much rather just eat good food than take a drug that simulates some of the effects of doing so.

Do you want to live a long, healthy life? Here’s an plan for you:

  1. Eat a whole-food diet that’s low in sugar and refined carbs. Try to include a couple servings of salmon (or other fatty fish) per week.
  2. Finish supper at least 3 hours before bedtime, and make sure there’s at least 12 (preferably 13 or 14) hours between the end of supper and the start of breakfast.
  3. Get at least 2 resistance workouts a week where you exercise your big muscles (glutes, quads, hamstrings, pecs, traps, lats) until they are briefly very tired.
  4. Get at least 2 endurance workouts a week where you spend an hour or so exercising at a pace that’s a little more intense than a brisk walk.
  5. Get 1 workout a week where you raise your heart rate to 80% of its maximum for 30 seconds, rest for 30 seconds, and then repeat for a total of 10 rounds.
  6. Spend some time outdoors at least several times a week.
  7. Sleep until you wake up naturally almost every night.

That’s it. Unless you are sick with a diagnosed condition for which there is treatment, I very much doubt there is anything modern medicine—or even bleeding-edge longevity research—can do for you that you won’t get from this plan.

I’m sure my brother is very amused that it has taken me this long to come to this conclusion.

Non-SAD

I am a little too prone to use black humor to distance myself from the depressing effects of the long, cold darkness of winter, which sometimes leaves people worrying about me unnecessarily. So I thought I’d mention that despite a bit of anxiety over the inevitable turn of the seasons, my mood is currently pretty great.

Beyond just feeling good right now, I’m hopeful. Over the past decade I’ve been handling winters better and better.

The biggest factor, I think, is that I no longer have a job to lose, so I no longer get into the spiral where seasonal depression makes me less productive, making me anxious about losing my job, making me more depressed, making me even less productivity. Sadly, advising others to take advantage of this strategy is not very useful (although I do and will continue to support and advocate for either a citizen wage or a guaranteed job).

Putting early retirement aside as impractical for most people, I thought I’d briefly summarize my other current practices—mostly ordinary coping strategies—both as a reference for myself any time I start to feel my brain chemicals coming on, and perhaps as a resource for other people. Here’s what’s working for me:

  • Taking delight in things. In particular, I take delight in the opportunity to wear seasonally appropriate woollies. I also like to spend time in the Conservatory, go to art galleries or museums, listen to live music, and generally go on artist’s dates.
  • Getting plenty of exercise. Last winter I managed to get out for a run almost every week. As fall approaches I’m getting back to my lifting. (Here’s a great resource on the current science on using exercise to treat and prevent depression.)
  • Spending time in nature. I do that all summer, and it may be part of the reason that my mood is generally great in the summer. But I can do it in the winter too. (I don’t seem to have a post on this topic. I’ll be sure to write one this winter. In the meantime you can find various mentions by clicking on the vitamin N tag over on the sidebar.)
  • Light therapy. I’ve used my HappyLight™ for years, and it does seem to help. Getting outdoors anytime in the first couple of hours after dawn is probably even better—another thing I find easy to do in the summer that would probably help just as much in the winter.
  • Taking Vitamin D through the winter. The evidence for any benefit is scant, but even if it only helps through the placebo effect, it is at least a safe, cheap placebo. (There’s good evidence that people with high levels of vitamin D are healthier, but very little evidence that supplementing vitamin D makes people healthier. It could easily be purely associational—maybe more time spent outdoors both boosts vitamin D levels and makes people healthier and happier.)
  • Anything that boosts neurogenesis. That’s most of the things listed above, but lots of other things too, such as engaging in creative work. Also on the list are calorie restriction and adequate consumption of omega-3 fatty acids.

I have a few new possibilities up my sleeve:

  • There’s recent evidence that sauna bathing is dramatically effective at treating depression, probably through many mechanisms including the activation of heat-shock proteins. (One thing on my to-do list is finding a local fitness center or spa with a sauna and investigating the cost of a three or four month membership.)
  • Related to heat exposure is cold exposure, which activates many of the same protective proteins that heat exposure does. Cold exposure, of course, is trivially easy to achieve in the winter—just wear a coat or jacket one notch less warm than would be most comfortable.
  • Obviously sleep is very important, and with my Oura ring I’m tracking my own sleep carefully. This has already been helpful, and I’m hoping to be able to do more to improve my sleep (and thereby my mood) in the winter as well.

That’s what I’ve got at the moment, but I’m always on the lookout for things to alleviate seasonal depression.

2019-08-13 10:52

Went for a longish run at a nice easy pace. Felt good all the way through—good enough that I was going to add another half mile or so (by running around Dohme Park), only to have my knees abruptly say, “Nope. You have run the correct amount.” So I just stopped right there and came home. As I have started doing lately, I did this run in a fasted state (mumble mumble autophagy, mitophagy).

Movement in 2018

This year’s review of my movement practice will be a bit less detail-oriented than last year’s, when I included a long list of exercises, and a long list of non-exercise movement that I’d engaged in over the year. This year I exercised a bit less and moved a bit more, and came to a balance that I’m pretty happy with—that I don’t feel much urge to analyze.

I continued the winter exercise regimen that I described a year ago for the rest of the winter, but then let most of it go in favor of less-structured movement. As I say, I’m pretty happy with what I ended up doing, although the result was a decline in some of the strength increases I’d made.

Summer included a lot of solo walking (mostly in natural areas very close to home) and a lot of walking with Jackie (in a wide range of environments, including natural areas somewhat further afield).

One major piece of our walking was our big trip to Utah, where we got in plenty of hikes in Bryce Canyon, Zion Canyon, and Arches. (See image at top.) The length of any particular hike was nothing to write home about (although we did write home a bit), but the ruggedness—and especially the steepness—made the hikes very different from anything we manage at home.

Basically, summer was great—lots of time spent in the sun, lots of walking, lots of time spent with my sweetie, lots of time spent alone.

As summer transitioned to fall, I had the same problems I usually do, perhaps slightly worse this year than average because the transition seemed more abrupt, with early fall being unusually cold. Happily, late fall was no worse than early fall, and what was unusually cold for early fall is actually rather mild for early winter.

One thing I have done this fall is get back to running. In the past I’ve always meant to establish a running habit that I can carry forward into the cold months, and I have nearly always failed. This year, so far, I’m doing okay, getting in a couple of runs a week, with long runs of 5 miles or more. With just a little luck (not too icy, not too much bitter cold) I’ll be able to carry a lot more aerobic fitness into the spring than I usually manage. That would make it possible to do a spring running event, if I want.

I’ve had very good luck this year on the injury front, managing to stay healthy though the whole year.

I still teach taiji, both the beginners class and a class for continuing students, and it remains rewarding it all the ways it has been—physically (I get my own taiji in), mentally/emotionally (I get my meditation in), socially (I gather with a group of friends several times a week), and financially (admittedly in a small way).

Looking ahead, I’m rather inclined to stick with a movement focus, spending more time doing stuff (moving) and less time preparing to do stuff (exercising).


Weird (horrifying) study of human movement

A couple of weeks ago the New York Times linked to a new study on age-related declines in human movement. It’s an odd study, but not because of the result (which shows that children start moving less at age 6), because that seems entirely predictable to me, despite the general understanding previously having been that the decline started in adolescence.

Rather, what makes the study seem odd to me is the weird blind spot the researchers seem to have about when and how organisms (including humans) choose to move.

In the study itself the researchers make clear that they had considered the obvious presumption—that kids start moving less when they start going to school: “The overt explanation for this earlier decline could be the increased sitting times due to school.”

The  blind spot I’m talking about is presented in the next sentence, where they immediately qualified that:

However, time-specific analysis of [physical activity] has revealed that in addition to the increased [sedentary behavior] during school hours, there was also a distinct decline on weekends, out-of-school days, and during lunchtime.

Schwarzfischer P, Gruszfeld D, Stolarczyk A, et al. Physical Activity and Sedentary Behavior From 6 to 11 Years.Pediatrics. 2019;143(1):e20180994

What’s weird and horrifying is that they make that statement seemingly without it occurring to them that forcing children to sit still for hours on 5/7ths of the days of the week might affect their behavior on the other 2/7ths of the days.

Right off the top of my head I can think of four obvious reasons that would be true:

  1. The required behavior in school normalizes the behavior of extended sitting.
  2. Even a few weeks of enforced extended sitting will result in the kids becoming deconditioned aerobically, making physical activity more difficult and less appealing.
  3. Extended periods spent in any static posture—especially the static posture of sitting—will begin the process of reducing their range of motion (they’ll pretty quickly lose the ability to squat, for example), again making physical activity more difficult and less appealing.
  4. The addition of “physical education” to the kids’ daily schedule sets the pattern of replacing movement with exercise—a time-bound, regimented activity which attempts to pack the health benefits of a week’s worth of movement into just a few hours. (I’ve written about this before.)

Just one instance of this blind spot is bad enough, but it shows up again in a key reference. The researchers say that it is accepted that physical activity declines with age: “A natural and biologically determined decline of total [physical activity] throughout the life span seems likely.” They support that assertion with a couple of references, one of which looks specifically at movement in non-human animals.

Unfortunately that study (Ingram, D. K. Age-related decline in physical activity: generalization to nonhumans. Med. Sci. Sports Exerc., Vol. 32, No. 9, pp. 1623-1629, 2000, which is sadly behind a pay-wall.) has exactly the same blind spot: All the animals studied were captive animals. That study looked at how animal movement varies when an animal is moved from its “home cage” to some other cage. I can’t say I’m the least bit surprised the behavior of those captive animals closely resembles the behavior of children moved from home to school and back again.

I would be very interested in studies that included some free-range animals. (Which isn’t something I can do, but which seems at least possible now that accelerometers  are cheap.)

Of course school isn’t the only factor that inhibits children from moving more. The restrictions on self-directed play so well documented by Lenore Skenazy of Let Grow no doubt feed in as well.

So it would be great if there were studies of movement in free-range kids as well.

The final weird and horrifying thing isn’t anything new, but is something I hadn’t really been aware of before: The assumption that an age-related reduction in movement is “natural and biologically determined,” has led directly to public policies that normalize it:

This decline is also represented in recommendations from the World Health Organization (WHO): preschool-aged children should accumulate a minimum of 180 minutes per day of total [physical activity], children and adolescents (4–17 years old) at least 60 minutes per day, and adults only a minimum of 30 minutes per day in moderate-to-vigorous physical activity (MVPA).

To which I say, “Argh!”

I probably wouldn’t be so struck by this if I weren’t already tracking my own movement. (Cheap accelerometers again.)

For some time now I’ve been working to a goal of 105 minutes of movement per day, and over the last few weeks I’ve come pretty close, averaging just over 102 minutes of movement per day, according to Google Fit. (This number, based primarily on steps, somewhat underestimates my movement. In particular it gives me almost no credit for the time I spend teaching taiji, because although there’s plenty of movement, there’s not much stepping.)

The WHO recommendations make me strongly motivated to upgrade my goal for movement to 180 minutes per day.

Why should kids under 6 get all the fun?

(The image at the top is topical only in that it is is a photo from our afternoon walk yesterday.)

Exercising in the heat

I have always enjoyed exercising in the heat. In this I seem to be different from most people.

I originally took note of this fondness back in the early 1980s when I was living in Ft. Lauderdale. A ritzy local tennis club—way too expensive for me—offered summer memberships for just $100. I just got access to the outdoor courts and not to the indoor amenities, but all I wanted was a place where I could reserve a court and know that it would be available when I met someone there. The only downside was that you were playing tennis outdoors, in the summer, in Ft. Lauderdale. And it turned out I was okay with that.

I’m pretty careful not to be stupid about it. (And successfully so, it seems—I’ve never gotten heat exhaustion or heat stroke.) If I start feeling tired, thirsty, or overheated, I slow down, move to the shade, and drink some cold water.

Over the years I’ve had a variety of theories about why I didn’t mind exercising in the heat when other people hate it so much. I like to imagine that I’m just better at tolerating the heat than the average person: Everyone slows down in the heat, but maybe I slow down slightly less; at some high temperature, maybe I’d become competitive! More likely, since I’m not competitive I’m not making unfavorable comparisons between my speed in the heat versus my speed in cool weather, so the fact that I slow down doesn’t make me unhappy.

Recent research has given me a new, much more likely reason why I like exercising in the heat. On Rhonda Patrick’s Found My Fitness podcast, I heard an interview with Dr. Charles Raison, in which he described the results of a study suggesting that Whole-Body Hyperthermia was an effective treatment for depression. The experiment used infrared lights to heat people up to a core body temperature of 38.5℃ (101.3℉), but Raison is convinced that there is nothing special about the device used, and that a sauna, hot spring, sweat lodge, hot yoga—or just exercising in the heat—would have the same antidepressant effect.

Dr. Raison is studying further to try to elucidate the mechanism by which hyperthermia boosts mood in depressed people. (It seems to reduce inflammation, perhaps by boosting IL-6 which activates IL-10.  Heat Shock Proteins might also be involved, since they do all sorts of things.)

I have always been inclined to blame a lack of daylight for the seasonal depression that I’m prone to suffer from during the winter—both too short of a photo-period (which I address with a HappyLight™) and too little vitamin D (which I address with vitamin D supplements), but it now occurs to me that a lack of opportunity to exercise in the heat (and thereby raise my core body temperature high enough to trigger whatever it is that reduces depression) may be an independent factor.

It seems very likely that, just like my desire to spend time outdoors in daylight is probably self-medicating to boost my vitamin D and regulate my circadian rhythm, my desire to exercise in the heat is probably self-medicating to boost my mood.

I hesitate to rejoin a fitness center just to get access to a sauna, but I’ll have to investigate options for access to winter whole-body hyperthermia.