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Week 9

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Reason 9

Exercise Aids Compression of Morbidity and Decreases Fraility

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In the last century, developed countries have seen life expectancy increase by over 30 years [1]. This increase in life expectancy is also seen in developing countries but at a slower pace. The challenge now is to ensure that this essentially new lease of life is not plagued by disability or illness. Unfortunately, the last part of life before death is often spent in frailty and disability. The goal is to shorten this period of frailty and disability. This is called “compression of morbidity”. Components of this frailty and disability include muscle weakness, slowed walking (gait), low physical activity, fatigue and exhaustion and unintentional weight loss.

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Exercise makes the muscles more youth-like

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Studies have shown that exercise and activity delay the onset of frailty [1]. On the contrary, seniors who are sedentary have longer periods of frailty or morbidity. They have illnesses and need care for longer periods.

Research has shown that the muscle tissue of seniors who are involved in regular exercise is similar to that of young adults. It seems muscle is the key organ that shortens or lengthens frailty in later life. If the muscles are strong and keep on working, then the period of disability and frailty prior to passing away is short. But if the muscles are weak and are not involved in regular exercise, then the period of disability and frailty prior to passing away is lengthened.

As exercise can maintain muscle tissue, it can therefore prevent seniors from becoming frail.

Another indicator associated with contributing to frailty is elevated glucose levels in the blood [1]. Generally, frail seniors have high glucose levels and non-frail seniors have lower glucose levels. This may be just because of exercise. Research shows that 150 minutes of physical activity per week works better than medications in reducing blood glucose [1]. In summary, exercise seems like the key component for decreasing frailty in seniors, and therefore aiding in the compression of morbidity.

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Running and compression of morbidity.

A study published in 2011 investigated the effects running can have on the compression of morbidity. The study was conducted over a 21-year period. Participants over the age of 50, including both runners and non-runners, were recruited in 1984. There were 538 runners with 423 healthy control subjects who did not run. At entry and every year thereafter, participants were asked to complete the Health Assessment Questionnaire Disability Index (HAQ-DI) to determine their physical ability. This questionnaire asked participants to report how difficult they found everyday tasks including dressing, walking, and eating. They were required to score each activity out of 3 (0 = no difficulty, 3 = unable to perform). Participants also reported their exercise habits once a year throughout the 21-year study period [2]. Every time data was collected, scores on the HAQ-ID were higher for non-runners than runners (i.e., disability was greater in non-runners than runners) [2]. This suggests that running helped maintain the physical ability of runners throughout the study.

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If you are over 50 and run regularly, the chance of you needing a hip or knee replacement is decreased.

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Furthermore, during the study the disability scores for both groups increased with age. However, this increase was slower in runners, who took longer to reach the same levels of disability than non-runners [2]. This indicates that running reduces the progression of disability, thereby aiding in the compression of morbidity. It is also worth noting that, at the 19-year point of the study, only 15% or runners had died, compared to a significant 34% of non-runners [2]. In addition, runners had a decreased need to have a knee or hip replacement. The worry and anxiety of every exercise enthusiast is that the increased exercise will cause the joints to wear out. This study, however, proved otherwise as runners had fewer knee and hip replacements.

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Metaphor 9 – Surgery – Is It Worth the Risk?

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What is the story?

Percy is invited to take part in two different challenges. Both the challenges involve jumping a distance of ten feet.

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In the first challenge, the jump is on ground level. In the second, the jump is between two high rise buildings. If he successfully completes the first challenge, he will win £5. If he successfully completes the second challenge between two high rise buildings, he will win £500. He decided to take up the second challenge. Unfortunately, he misses the target and falls from a great height, sustaining a serious injury.

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So, what went wrong?

Taking the risk of serious injury into account, Percy should not have accepted the second challenge. Jumping from the high rise building was extremely risky and not worth the proposed £500 reward.

How can we relate this story to our health?

Many of the surgeries performed in Orthopaedics are for wear and tear, which is a natural ageing process. The body part is not broken; it has only suffered some wear and tear. There are specific situations where surgical intervention for wear and tear will help, but surgery is not always effective. Some surgical interventions, like spinal surgery, have a high failure rate. Following spinal surgery, one in five patients go on to develop a condition called “Failed Back Surgery Syndrome”. This results in pain that is even more severe than what was experienced before, with no easy means of a cure. Patients who develop this condition sometimes state that they would not have had the surgery in the first place had they had known the potential consequences. Like Percy should have done, when considering the proposed challenge, patients who consent to undergo surgery should understand the risks and that the surgical procedure itself is irreversible. The risk of surgery is similar to the second challenge. Although the reward might seem to be a quick and easy outcome, the risks sometimes far outweigh the potential benefits.

Moral of the story

Be cautious if the risks are high.

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Exercise Notes For Week 1

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“Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.”

“At vero eos et accusamus et iusto odio dignissimos ducimus qui blanditiis praesentium voluptatum deleniti atque corrupti quos dolores et quas molestias excepturi sint occaecati cupiditate non provident, similique sunt in culpa qui officia deserunt mollitia animi, id est laborum et dolorum fuga. Et harum quidem rerum facilis est et expedita distinctio. Nam libero tempore, cum soluta nobis est eligendi optio cumque nihil impedit quo minus id quod maxime placeat facere possimus, omnis voluptas assumenda est, omnis dolor repellendus. Temporibus autem quibusdam et aut officiis debitis aut rerum necessitatibus saepe eveniet ut et voluptates repudiandae sint et molestiae non recusandae. Itaque earum rerum hic tenetur a sapiente delectus, ut aut reiciendis voluptatibus maiores alias consequatur aut perferendis doloribus asperiores repellat.”

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Remember the traffic light system should be used when you exercise.
Please do not go through the red light or break the pain barrier!

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Short intro of encouragement to compliment the notes above.

Please now go to the video page and begin you exercise plan for the week.

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Head and Neck

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Lower Back

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Otago

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References

Fried LP. Interventions for Human Frailty: Physical Activity as a Model. Cold Spring Harb Perspect Med. 2016;6(6).
Chakravarty EF, Hubert HB, Lingala VB, Fries JF. Reduced disability and mortality among aging runners: a 21-year longitudinal study [published correction appears in Arch Intern Med. 2008 Dec 8;168(22):2496]. Arch Intern Med. 2008;168(15):1638-1646.

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