ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster.

KIM RIVERA HUSTON-WEBER:  I’m Kim Rivera Huston-Weber and I’m a copywriter here at Houston Methodist.

ZACH: And Kim, we’re both getting older.

KIM: Yeah.

ZACH: And we both exercise occasionally, at least speaking for myself.

KIM: Yes, I will admit that I think I started to get a little bit more serious about my exercise regimen when I -- after I turned 40.

ZACH: Okay. Congratulations.

KIM: Thank you so much.

ZACH: And how has life altered your exercise routine? Has it been -- have you been forced to change what you wanna do? Or have you just, you know, reading new studies? Like, how has that evolved for you?

KIM: I think I’m very much an elder millennial in that I kind of grew up with certain trends. Around the time I turned 30, like everybody was doing, like, the runs. So, it’s like, “Let’s do 5Ks, 10Ks, let’s run a marathon.” So, all of my exercise habits were kind of in these fits and starts. So, I would get really into whatever it is. I remember when-- do you remember when walking 10,000 steps a day became very trendy?

ZACH: Yeah, when pedometers seemed to be the trend of the day. Like if it’s around the time like people-- before smartphones, there were literal standalone pedometers.

KIM: Yeah.

ZACH: And some people had those, and those were -- man, I feel like I don’t wanna generalize here, but those were kind of obnoxious.

[Laughter]

Right?

KIM: Yeah. Yeah, I mean, it was weird and, you know, it became like this -- I remember like when Fitbits were like those little, tiny things that you like, would wear on your pocket.

ZACH: “Is that a pocket pager?” No, it’s a pedometer.

KIM: Yeah, no. So, I feel like I’ve always kind of fallen prey to these trends. So, I was never really super consistent about it, which we’ll learn with our expert today that it’s really key to aging the way you want to.

ZACH: Yeah, I mean, I’m still in my 30s, so I’m in that, that’s when you’re like-- you still think you’re young, but you are getting older. And sometimes I do feel like I’m still young. Sometimes I start to feel the creeping of the calendar there. So, I haven’t really adjusted anything per se. Maybe don’t like go as hard maybe as I would have in the in past, because you just -- I’m like, concerned about, well -- I can’t -- I’m getting older. I can’t recover as quickly as I could, right? That sorta thing. That’s the extent of the thought I put into it.  “Oh, I better adjust what I do, right, for X, Y, Z.” And fortunately, I don’t have any serious health issues or preexisting conditions, because that’s a whole ‘nother category. But what we’re talking about today is how to adjust your exercise and workouts as you age.

KIM: Yeah.

ZACH: And who did we talk to, Kim?

KIM: We spoke to Dr. Gillian Wooldridge. She’s a Primary Care Sports Medicine physician here at Houston Methodist.

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KIM: Thank you so much for being here with us today, Dr. Wooldridge.

DR. GILLIAN WOOLDRIDGE: Yes, thank you so much for asking me. I’m happy to be here.

KIM: I think when most people think about aging, especially when we’re younger, I think our minds go to some those superficial things about aging. So, getting the gray hair, pepper at your temples and, you know, getting those first wrinkles. But I think many of us might actually be a bit in the dark about the physiological changes that our bodies actually go through during the aging process, especially as we get more decades in the rearview mirror. So, our conversation today is about how we can adapt our fitness routines to hopefully age the way we want to. But how do our bodies actually change as we age, starting as young as age 30 or 40?

DR. GILLIAN: So, there are a number of ways that our bodies change as we age. So, the primary reason for maintenance for all of our bodies is basically to procreate, right? That’s how our species survived. And while we might-- may not think that as a society that’s still what our DNA thinks, right? So, much of our body’s processes are geared towards, “How can we make more humans?” So, our peak fertility typically is in our 20s, right? Teens and 20s. Then after 30, we’re no longer as able to carry to children safely and able to procreate. So, we do tend to see that there are fewer resources for our bodies to actually go through and maintain them. So, things that may happen for example are typically, our bone density peaks at age 30, and after that you’re in maintenance phase until we start to get estrogen levels dropping for women, and as we’re approaching perimenopause, we’ll actually start losing bone density. What can also happen as part of that over time is that we end up collecting these free radicals. We get some reactive oxygen species that act as these pro-oxidants that can cause damage to our DNA, damage to other structures. And unfortunately, with aging, we tend to lose some of those antioxidant properties. We’re able to make antioxidants, but we start to lose the ability to do so and so, you end up getting damaged cells, damaged DNA that may accumulate, and that can manifest and things like fatigue and loss of muscle, loss of bone. It can manifest in things like loss of skin elasticity, you can start to get heart disease, you can start to get slowed thinking processes and maybe some memory decline. So, there’s lots of things that are going on underneath the surface for sure that happen as we age.

KIM: I saw a quote that said, “Exercise is not the fountain of youth, but it is a long, good drink of vitality.” So, how does exercise affect some of those physiological effects we’ve been talking about?

DR. WOOLDRIDGE: There’s a number of ways that exercise can help. When we are engaging in regular exercise, especially long term, more moderate intensity exercise, it actually enhances our body’s ability to produce our own antioxidants so that we can counteract those reactive oxygen species that have a negative impact on our cells and our DNA. So, the more you engage in regular exercise, the more we’re able to do so. That being said, if you engage, as someone who’s like relatively sedentary, engages in very intense, exhaustive exercise without really having a background in exercise, you can actually produce too much of those reactive oxygen species, and that can have a negative impact. So, it’s really more about finding a long-term balance there. Additionally, we have known benefit of exercise on our brain plasticity, or our brain’s ability to adapt to challenges. And that, you know, a lot of this data comes from what we know about concussions and recovery from mild traumatic brain injury, but we know that exercise can have positive effects on risk of developing dementia and other issues like tha, that are associated with neurocognitive decline. So, really, exercise forces our body to be able to adapt to stresses, but we wanna make sure that we’re also not overly stressing.

KIM: This might be a bit of an assumption on my part, but I think, especially when we’re younger we might think of the more superficial aspects to exercise, like the outcome. So, we’re trying to exercise for an aesthetic. We want toned arms, we want toned abs, whatever the case may be. But when we think about developing fitness routines that are going to help us age well, what should we be focusing on?

DR. WOOLDRIDGE: Great question. So, of course, everyone wants the Instagram butt, right? That’s the goal. But I’m not even all that mad about that because at least it’s getting people in the gym and lifting weights and encouraging, especially females that it’s okay to lift weights, right? So, it’s okay to lift heavy also. And of course, another benefit of aging is that you gain more wisdom, ideally, and you kinda learn what other people think about you is none of your business. So certainly, I can understand, like anyone can, about wanting to achieve a certain aesthetic. But really, exercise is part of the way that we stay mobile and independent and healthy lifelong. So, ways of going about -- there’s a multitude of ways, right? So, one thing I alluded to earlier, of course, was engaging in regular, moderate intensity exercise. So, moderate intensity, think of it as, like, you could talk, but you wouldn’t be able to sing during that. So maybe on a scale of one to ten, if you think of an exertion scale, you’re kind of sitting in like the five, six range. Long term that has really tremendous benefits for us, induces our own body’s ability to create antioxidants to counteract pro-oxidant damage. And that can consist of things like aerobic training when we think about jogging, working in the garden actually is considered moderate intensity exercise. Those things are easy to, you know, incorporate into our lives, but also weight training counts as part of that too. So, you can do resistance training as well. We wanna make sure that we try to go through and really maintain our muscle mass or gain muscle. That’s what really has some long-term benefit for us. And then of course, there’s the cardiovascular endurance aspect. The easier your heart can adapt to different challenges, usually long term, the healthier you are. So, whenever you’re engaging in some sort of really strenuous activity, if you have a foundation to build that on, it’s not gonna be as difficult on your heart. Or God forbid, you become very ill and in the hospital, but you have a strong healthy heart, you’re more likely to be able recover from that without significant consequences. So, we wanna think about exercise really as a-- almost as a medicine in some ways for longevity, for-- and it’s not just about longevity, it’s also about quality of years. ‘Cause I think a lot of people would agree that they don’t necessarily want to live a really long time if that long time looks like them being immobile, inactive, dependent on others, not able to enjoy their lives. So, the way you stay mobile and active and independent is really by engaging in regular exercise, and those habits start in our childhood years, in our preteen years, and we wanna make sure that people are engaging in lifelong physical activity.

KIM: When we’re thinking about engaging in strength training, stability training, mobility, cardiorespiratory fitness and endurance, what are some of the recommendations for how much time we should be engaging in these different forms of training to make sure that we’re hopefully aging the way we want to?

DR. WOOLDRIDGE: When we think about general physical fitness, the American Heart Association recommends about 150 minutes per week of moderate intensity exercise, or 75 minutes per week of high intensity exercise. And that’s for general cardiovascular fitness and wellbeing, right? And of course that can again look like things like an aerobics class, it can look like a jog, it can look like a bike ride, it can also look like, you know, lifting weights, it can look like playing with your kids. There’s lots of ways that engaging in regular physical activity that don’t necessarily look like going to the gym. When we think about weight loss, a lot of people in general may have a goal of exercising for the purposes of losing weight. And really, in order to achieve significant weight loss, you really need to be engaging in about 240 minutes of exercise per week. So, roughly four hours per week of exercise. And a lot that sounds quite intense whenever you look at it in one big chunk. “Well, how do I find two and a half hours in a very busy week to engage in meaningful exercise for my health?” But it doesn’t have to be 150 minutes at once, right? That’s 30 minutes, 5 days a week. Not all those 30 minutes even have to happen together. If you can carve out three ten-minute sections throughout the day to jog in place, do some air squats, do some lunges, go up and down the stairs at work, all of that counts. There’s even some evidence to suggest that as little as 15 minutes per day of exercise has some degree of benefit on reducing heart attack and stroke risk. So, when I’m counseling patients about exercise and benefits and how to go through about doing that, I really try to make it very obvious that there’s ways that they can carve it out. Even, you know, the busiest of the busy have some time that they can carve out to do something meaningful. When it comes to strength training, typically the recommendation is gonna be two to three days per week of hitting all of your major muscle groups. Certainly, some people choose to divide that up by body region, they may think pushing versus pulling muscles. They may think upper body versus lower body. And that’s fine. Or you can work out major muscle groups as long as it’s not on consecutive days. So, spacing that out. So, I typically will tell patients about two to three days a week, and you actually get a very meaningful weightlifting session in about 20 to 30 minutes. There’s no need to spend an hour, two hours at the gym. If you’re doing it the right way, you can get a very meaningful workout in a relatively short period of time.

KIM: And to that point about what a meaningful strength program might look like, you had mentioned like it’s okay for women to lift heavy. And I know, I certainly grew up to be socialized that we shouldn’t be lifting a whole lot because we don’t wanna be bulky, right? I think a lot of young women got that message in the 90s and early 2000s. But when we’re thinking about strength, is it okay to use those 5, 10, 15-pound dumbbells? Or should we be lifting like very heavy weights? Or can we do body weight exercises? Like, does it matter?

DR. WOOLDRIDGE: So, I think the real answer to your question may come from where you’re starting off. I think for anybody who’s maybe new to an exercise program, starting off with more like body weight, calisthenic type stuff can be a great idea, just getting your body used to moving. And that looks like things like body weight squats, lounges, pushups, plank holds. Those are all ways of really learning to engage your muscles in an efficient manner so that they’re working together the way that they should. And then of course, if that becomes easier, adding some sort of weight or resistance becomes very helpful. Certainly, starting off with things like 5 or 10 pounds is fine, but really, in order to get the benefit from a weight training program, typically recommended to do more of a progressive weight training program. The American College of Sports Medicine typically recommends that the amount of weight someone should lift can be determined by how many times they can lift it. So, a good rule of thumb for safety purposes is you should be able to lift a weight about eight to twelve times for three sets. So, three sets of eight to twelve reps. And for patients who are maybe starting off with five pounds doing bicep curls, if they can, you know, barely get to three sets of eight reps, well then that’s probably a good one for them to work on for a while. But once they get to where they can do three reps of 12 pretty easily, it’s time to increase that weight. And obviously, we don’t wanna jump from 5 pounds to 15 pounds, but jumping from 5 pounds to 8 pounds may be very reasonable. And as the weight goes up, the reps may have to go down, and as you get stronger you continue to build up on the weight. There’s also the concept of doing something called drop sets. So, a drop set is where you lift a weight of any choosing and you lift it until you cannot lift that weight anymore, and then you go down to a slightly lower weight. You lift that until you cannot lift it anymore and then you down to yet another lower weight. And so, most people would do a drop set, you know, where they’re changing weights twice. And that’s a way of also effectively building strength and endurance and starting to fight off muscle fatigue. The idea is that you’re having good form though. Really good form to prevent injury is pretty essential. And making sure that it is a challenge. If you’re not breaking a sweat when you’re doing your weight training session, then you’re really not getting anything out of it.

KIM: That is something to keep in mind so -- ‘cause I feel for myself, like, I’ll keep going up in weight and then I’ll be like, “Well, am I really getting a benefit?” Which kind of goes to my next question, I guess this might sound kind of silly to ask, but is some exercise better than none at all?

DR. WOOLDRIDGE: Absolutely. So, it is absolutely true that some exercise is better than none at all. Anytime that you go through an engage-- are engaging in some sort of challenge for your muscles or challenge for your cardiovascular system, there is absolutely benefit. Because again, that exercise is going to trigger our body’s ability to create our own antioxidants, it’s going to strengthen up our muscles, which are essential for maintaining our bone density and our balance. It also does things like help fight off insulin resistance, ‘cause having excess sugar floating around is also terribly bad for aging and can accelerate aging as those excess sugar molecules get attached to things like nerves and other structures in the body. So, absolutely some exercise is better than none, and that’s what I really encourage patients to do. I think if you are-- of course, I mean you in the general sense, are looking to make a major lifestyle overhaul, thinking about, you know, all of a sudden carving out a significant portion of your day, going to the gym or exercising, just feels too intimidating, and it’s so hard to even get started. I often tell people, the way you eat an elephant is one bite at a time. So, going through and at least finding a sizable chunk or having a measurable goal is important, and that’s when there’s the purpose of FIT or FID with an exercise program. So, F is frequency, just making sure that we’re consistent in doing something on a daily or every other day basis. Then you think about the intensity, making sure that it’s challenging enough. And then you think about the time or duration, how many times are you lifting that particular weight or how long are you running? And as your time-- as you notice that you’re able to do something for a longer period of time, maybe we have to go back to that intensity. And so, you’re constantly going back and forth, flipping between intensity and time.

KIM: That’s so interesting. And in thinking about how our goals might have to change over time. In my early 30s I ran a Turkey Trot 10K that I didn’t a hundred percent finish the training program for. And so, I spent a good chunk of that Thanksgiving lying down, I was a little bit immobile, my legs were pretty sore, but then, you know, I kind of bounced back the next day and was feeling mostly fine. I feel like if I were to try that now, they would have to cart me off with a golf cart ‘cause I’m not-- I’m not making it. So, we change, right? And what we’re able to do changes along with that. So, how should we both mentally and physically adapt our movement goals as we age.

DR. WOOLDRIDGE: I think in that story you brought up a really good point and it was that you did a race that you hadn’t finished the training program for. So, a lot of people think that, “Well, once I hit a certain age, I can’t do X, Y, or Z activity,” and that’s really not true. You can pretty much do whatever you want as long as you’ve trained appropriately for it. So, for instance, I wanted-- I picked up skiing in mid-30s. I married into a family of skiers and so, I was trying to ski. And on my second time ever skiing I had the world’s least dramatic fall and tore my ACL, and now, I will no longer be skiing. I’ve made that decision, right? And it was just that it was something-- it was new, and I probably, maybe didn’t prepare for it as well as I should have. So, I think, really the possibilities are endless with appropriate training. I used to tell people, you know, the first 40 years, sure you can kinda roll out of bed and do whatever activity and you’ll be fine, after I hit 30, I realized that number is more like 30 years. And really, it’s kinda before age 30 you’re pretty invincible, after age 30, you need to start putting in a little bit of work to be pain free. You actually gotta-- you’ve gotta put some effort into it. So, as long as you’re adequately training for something, you can really do anything. I had a patient who was seeing me for knee pain, had pretty significant knee arthritis, and he was in his 70s. and I always like to ask patients, you know, what’s your goal, right? Like what are we trying to achieve here? What are you trying to get back to? And he was like, “Well, I really wanna do burpees.” And I asked, “Why?” He’s like, “Well, you know, I hadn’t been working out, and I just-- I really got into CrossFit as a way to get in shape.” And I said, “Oh, okay.” So, CrossFit’s maybe not a good way to get in shape. I think it’s a good thing for people to do who are already in shape to challenge themselves. But maybe the 70-year-old with the really bad bone on bone arthritis shouldn’t be picking up burpees as a way of getting in shape. So-- and again, it goes down to -- or it boils down to that intensity, right? So, we wanna make sure that we are engaging in something regularly that’s maybe a slow introduction. I feel like a lot of us have a tendency to really go hard or go home. And that’s one reason why gyms are absolutely full of people in January and then they all tend to burn out by mid-February, because they’re trying to make this radical change too quickly, and it’s all about that FIT principle. So, if someone’s been running marathons for forever and they turn 50, there’s no reason they have to stop running marathons. If someone has done aerial silks for 25 years, they don’t need to stop just ‘cause they hit a certain age. It’s all about what are we doing to prepare our body for that kind of exercise. And again, that’s a long-term investment in your own health, and making sure that you’re appropriately doing your research for “How can I prepare myself for this particular activity?”

KIM: That’s so interesting because in your anecdote about your patient, I think probably in his mind, he’s not 70, he’s 30 or 40 or, you know, because we all kind of want to maybe think of ourselves in that time when we’re at our peak. But we still might have to make modifications because while our minds might be one age, our physical body is another.

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KIM: Up after the break, more about how you can modify your routine as you age.

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KIM: Let’s talk about some of those modifications that we might have to make to our plans. You had mentioned at the top about menopause and perimenopause. That period usually begins like eight to ten years before the final period, and so, that’s when we’re having the hormonal fluctuations  and some of those classic perimenopausal symptoms. What should women be aware about during that timeframe and how may they need to adjust their training programs to kind of go through this time?

DR. WOOLDRIDGE: So, you know, I certainly think that any activity they’ve been engaging in, they should continue to do so. I think physiologically, one thing that’s happening is probably in about three to five years before the final period, we’re starting to lose bone density as women, so we lose, could be about half a percent per year or so. But then, once you hit the final period, which you don’t know until retrospect, for the first five years of menopause you’re losing more like 1 to 2% bone density per year. So, you get this really rapid drop. And then after about 5 years, it doesn’t level off, but the continued bone loss slows down considerably, the rate slows down. So, that’s gonna be a very vulnerable time for fractures, especially if someone’s engaging in really dynamic activities. So, I think the really common fracture that we see in that age group tends to be a wrist fracture, for example because they kinda trip and fall, but they fortunately have the reflexes to be able to catch themselves, right? Now, that changes a little bit as we are getting older when we typically see more like hip fractures or spine fractures because it’s more of a loss of balance and falling to the side or falling down on your bottom and you get a spine fracture. So, we just need to be aware that those possibilities exist. And maybe it goes from, “Well, all I ever do for exercise is running,” to, “Maybe I do running and some weight training and I also start to incorporate in some balance training. And I maybe I’m ensuring that I’m taking the rest days that I need to really recover and understanding that my body is not going to recover as rapidly as it did whenever I was younger.” So, I think we all need to accept that we are-- that we do get older, and there are certain things about that that can be a little bit uncomfortable, and an unpleasant reality. But it’s okay because for those of us who are in that period of our lives, that means we’re lucky enough to have gotten to the point where we’re aging and where we’re dealing with those changes. And there’s nothing wrong with having that introspection that we’re getting older and maybe things have to change a little bit. And change doesn’t always have to be a bad thing.

KIM: You bring up a good point about rest. So, I think rest is something that I struggle with. How should we be thinking about rest, no matter our age, in terms of how we’re approaching an exercise regimen?

DR. WOOLDRIDGE: Sure, so whenever I think about rest in somebody who is training, I think about two different types of rest. So first, I think about like having a day off to recover. In general, I think a good rule of thumb is thinking about having one day off every seven days. And that can be an active rest, that can mean going on a walk, it could mean doing yoga, it could mean doing something that’s a pretty, lower intensity. But you do want that day of rest that your body can recover, and that’s to avoid over training or overreaching, which can be associated with, you know, chronic overuse injuries. The other type of rest we really need to think about is sleep. Sleep is so important. If it weren’t important we wouldn’t spend a third of our lives doing it. So, sleep is really an essential part of how we are able to recover and how we’re able to repair damage. That’s whenever we typically get spikes in our growth hormones. That’s when a lot of our repair work happens, when we sleep. And so, when we starve our bodies of sleep, we’re starving our bodies of the opportunity to do that repair work, and we’re kind of in a state of over secretion of our flight or fight response, essentially to be able to stay awake. So, sleep is an essential part of good health. And everybody has different sleep needs. I probably really need about nine hours for my optimal being, meanwhile my husband is probably more like six to seven hours. So, it's all about finding how much sleep you need, and that’ll vary by individual. It also varies significantly with age. Our need for sleep actually typically decreases with age. And then also finding your own sleep cycle. I’m a nine to sixer. Some people maybe more like a midnight to seven. So, finding what works for you and being able to work around that, I think is really important.

KIM: You had talked about how bone density in women can decrease with age, but I think probably both men and women can start to collect conditions like osteoporosis or arthritis as we start aging. So, what can we do when we’re exercising to make sure we don’t sideline ourselves due to these conditions?

DR. WOOLDRIDGE: Sure, when it comes to things like osteoporosis for example, or thinning bone, there are some biological differences. Women will tend to have pretty significant bone loss by the age of 60. With men, that’s actually delayed, about 10 years, typically more like 70. And it’s because women have really a dramatic, or relatively dramatic drop in estrogen levels which preserve our bone, whereas men will often have a pretty slow decline of testosterone, which is what protects their bone. So, there’s little bit of sex difference that’s there that we wanna keep in mind. But when it comes to things like how can we exercise in a way that maybe prevents Osteoporosis from keeping us from doing what we wanna do, that’s where things like weight training come in handy. I often will have patients ask me about distant running, ‘cause they assume, oh, you know, it’s weight bearing exercise, it’s high impact, it must be good for my bones. And truthfully, it’s really not. If it were then the, you know, greatest percentage of my stress fracture patients wouldn’t be distance runners. What we typically see in endurance athletes like that is that they tend to have fairly low bone density at the spine and a slightly higher bone density at the hips, and that because when they are so lean and don’t have enough body fat, they often don’t have enough estrogen, and that’ll really impact their spine, their pelvis first, and it can actually make them more vulnerable to injury. So, when we think about exercising, doing something like running on a flat surface in a straight line is actually not a good thing for our bones. Humans are built to survive. Our species has survived for 20,000 years for a reason, and that reason is we’re really, really good at being efficient. We’re also very good at prioritizing our brain and our hearts over anything else. So, if you have a chronic repeated stimulus for example, like running in-- on a flat surface in a straight line, your body’s not gonna really start to repair that damage after a while, there’s damage that accumulates with exercise. And really, after about 20 loading cycles or 20 steps, if you wanna think about it, you really lose a lot of the sensitivity to that stress, you bone cells do, and so they no longer are going to really invest time in repairing any of the damage that accumulates from that because it’s not a new stimulus. However, if you’re engaging in activity like pickle ball where it’s a lot of start, stop, changing directions, that’s very interesting for your bone cells. They pay attention to that because it’s a new stimulus, it’s different amounts of force that are being applied and it’s different directions of force that are being applied. So, exercise like that is actually great for your bones. So, this kinda multi-directional, moderate to high impact exercise is fantastic. Additionally, again engaging in strength training, weight training, when you load the muscle, you also load the bone, you encourage the bone cells to essentially put down more bone as a means of adaption. So, really engaging in a progressive strengthening program as well as engaging in that kind of multidirectional, moderate to high impact activity earlier in life will actually serve you very well later on. And sometimes it has to be modified as time goes on, and, you know, as maybe other health conditions kinda start to accumulate. When it comes to arthritis, I would love to say there’s a bunch of stuff we could do to prevent arthritis, but the truth is, if you picked your parents wrong, you picked you picked your parents wrong. It is, especially arthritis is highly genetic, but there are certain things that we can do to influence that. For example, motion is lotion for the joints. The more you get up, and the more you move around, that synovial fluid that bathes our joints also gets to circulate, and it takes out old, damaged stuff and it brings in newer better stuff. So, moving is really important. Weight management is also important. And I am a firm believer in healthy at every size, I don’t think size dictates the state of health. However, we do know that probably beyond a certain size, there’s a lot of wear and tear that can start to accumulate much faster than it would at a slightly lighter body size. So, making sure that we’re eating healthily, making sure that we’re engaging in regular physical activity to keep our muscles strong, and to keep ourselves within a reasonable weight range is very important for preventing something like arthritis from becoming a huge problem.

KIM: And you know, I think it’s safe to say that with each passing year our energy levels probably change as well. So-- and they might not be what they used to be. So, what can we do if we find ourselves more fatigued or our motivation is waning as we age? How can we adapt?

DR. WOOLDRIDGE: You know, I think if there’s someone who’s really struggling with fatigue, first thing they should do is seek consultation with their primary care doctor. There are lots of potentially reversible causes of fatigue. You think about thyroid disorders, you think about anemia, you think about poor quality sleep from sleep apnea. There could be another nutrient disorder. So, I think anybody who’s dealing with fatigue should really make sure they speak with their primary care physician to ensure that there’s nothing metabolically wrong. The other thing to keep in mind is the less you do, the less you’re going to be able to do. So, a lot of times, I find that people may avoid exercise because they get tired with it, but then the less they exercise, the less they’re going to be able to do so because their body’s not gonna develop endurance and adapt. So again, it’s about finding maybe a lower intensity program that they’re doing on a frequent basis so that they can go through and start to retrain their body. Now, when it comes to fighting lack of motivation, I think that it’s such a significant problem for a lot of people. And I think sitting down and really having someone reflect on themselves about what is their motivation. Is their motivation that they want to be able to walk their daughter down the aisle at her wedding? Is the motivation that they want to be able to go up a flight of stairs without stopping in the middle? Is the motivation that they want to make sure that they can stay living in their own home and not have go to some sort of, you know, residential community? So, I think it’s really important that everyone reflects on what their own intrinsic motivation is and then they can basically design a program around that. One of my favorite movies is, “The Holiday”, with Kate Winslet and Cameron Diaz, and they have the producer who’s in there, the older gentleman. And you know, he, I think a great example of this is, you know, he’s-- there’s this award that people-- that the Academy wants to give him and, you know, because he’s on a walker he doesn’t want to-- he keeps throwing away the invitation because he doesn't wanna be in front of all of these people who were his colleagues on a walker. He finds that embarrassing. And so, Kate Winslet’s character basically says, “Okay, well let’s get you walking then.” And, you know, they start off relatively easy, they start off doing pool-based exercises, and they start doing things on land. And sure enough, he gets to the point where he’s able to climb the stairs unassisted and is able to accept his award. So, I think that’s a really great example of, “Okay, we have a certain goal in mind, what do we wanna achieve here and how do we gradually go about getting there in a safe manner?”

KIM: So, you bring up safety and I can think of some safety precautions, but, you know, what should we take when we’re approaching movement at different times in our lives? So, safety might look different at every age or is it the same?

DR. WOOLDRIDGE: That’s a very good point. So, because as we age certain things are going to change. And so, we may wanna take different precautions. You know, certainly, I think when we’re younger, one of the big focuses is making sure that you’re not engaging in too much too quickly. ‘Cause I think if you’re highly motivated to get better, you’re gonna wanna lift really heavy weights, or go for a really long run, or jump really high, whatever it may be. And so, I think it’s a little bit about ensuring that you have the foundation in place to go through and avoid injury, and gradually increasing the intensity and duration of the activity that you’re doing. But one thing that happens as we age that I often counsel patients about is our balance isn’t as quite as good as it used to be. I mean, that’s why one of the biggest things that we worry about or biggest thing that you know, more of our seniors worry about is falling. You know, there’s one reason why it’s you know, with the Medicare physicals, they always wanna ask about falls. ‘Cause we know that falls can result in fractures and brain bleeds and all sorts of things. So, you know, in somebody who’s a little bit older before they start engaging in an exercise program, they really wanna make sure that they’ve got some pretty decent balance. Exercise programs like tai chi have been shown to reduce the risk of falls. There’s even these like balance plates out there that you can get training with. I often send people to physical therapy for this. Or even something as simple as in your own home, standing with your feet together with a countertop, you know, by you to hold on to, just in case. And then maybe eventually progressing to where you eventually are standing on one foot, relatively unassisted. Or whatever it kind of looks like that. That being said, having some situational awareness is good. There’s no reason that you have to put your shoes on standing up. You can always just sit down, you can always just take your time to do what you need to do. It’s rare that there’s ever a true life and death emergency, or someone’s really having to run to get something done. So, I think having that awareness, and maybe having a little humility that we’re all human and that’s okay. It’s hard to make something better if we don’t really acknowledge where there’s an area where you may have some weakness that needs to be addressed.

KIM:  Is there any age where it becomes a now or never in terms of our fitness? So, you know, if you can’t run a 5K at 30, you’re never going to be able to run it at 40 or 50?

DR. WOOLDRIDGE:  No, not at all. But I think we should have more-- certainly reasonable goals in mind, right? There’s no reason, like a 50-year-old can’t run a 5K for example. But that being said, I don’t know that that’s gonna be a good goal for an 85-year-old who’s been sedentary. There’s no time at which it’s too late. I mean, there’s even evidence that in the oldest old, which we typically classify as patients over the age of 85, even they can benefit from something like a progressive strengthening program or an aerobic program. So, really, it’s never too late to start exercising. That can happen at any time. It just needs to be done in a way, certainly that’s safe as we’ve touched on earlier. And really in a way that doesn’t promote risk of significant injury. I mean, if somebody has a lot of cardiac risk factors, you know, they smoke cigarettes, they have diabetes, they have high blood pressure, they probably don’t wanna start getting into shape with a five-mile jog. They may wanna see, “Hey, can I walk around the block without getting winded first,” and gradually increase what they’re doing. This is a time though that I would love to emphasize that for any parents or grandparents out there, early adolescence, when we think about being between the ages really of about 10 to 13, exercise during that time actually really presents a once in a lifetime opportunity for bone health long term and for other love of exercise long term. So,  encouraging participation in a variety of sports, avoiding early sports specialization, and really encouraging physical activity. And it doesn’t mean that if you have a 12-year-old who loves to read that they can’t read, but we need to be engaging in physical activity. That is something that is really plaguing our society right now is more sedentary activity, a lack of physical activity. It will have negative outcomes on health. And especially in that age whenever you’re still in that bone-- that big bone building period, that is a truly once in a lifetime opportunity to set someone up for success 60 years down the road.

KIM: That’s so interesting because you don’t necessarily think that you’re setting yourself up for what your relationship with movement is going to be at such a young age, but if you think about it, when you were younger and-- I was a book lover, I’ll admit it. Surprise. But…

[Laughter]

So, I’ve had to teach myself to love the process of exercise. But it’s very worthwhile, and I’m glad to hear that it’s not a now or never situation.

DR. WOOLDRIDGE: Definitely not a now or never. And you know, there’s nothing wrong with having different interests. You know, it doesn’t mean that your, you know, late elementary, early middle schooler, you know, has to be an athlete and all the things. But I think finding some degree of physical activity they enjoy-- that’s the important thing is that you enjoy. It’s not a punishment, right? Exercise is not punishment. It’s more about, “Hey, how can we move our bodies in a way that’s meaningful?” And maybe if team sports aren’t for them, that’s okay. There’s all sorts of individual sports. So -- or there’s ways of just being active on their own without being engaged in like a formal type activity. So, I just encourage people to really look whenever it comes to their kids or grandkids trying to encourage exploring and trying a variety of activity to make sure that they find something that they enjoy, especially, in an ideal world, something that they could do long term, in addition to reading. There’s nothing wrong with being a bookworm. I was too.

[Laughter]

KIM: But I think that’s a very important message for ourselves too because I think you get into the mindset of, “Okay, well I need to run a 5K, or I just need to, like, grind out this workout on the elliptical for 30 minutes and then leave the gym.” But there’s a wide variety of activities that we could enjoy that are still exercise.

DR. WOOLDRIDGE: Oh yeah, absolutely. I tell people that all the time. You know, for my folks who do their own yard work, those are not my people, I don’t understand -- I don’t enjoy working in the out of doors. But for people who really enjoy, you know, working in the yard, I mean, yard work is considered moderate intensity activity and that absolutely counts. Or for, you know, unfortunately, doing like more household chores doesn’t really seem to have quite the pay off. But you can move your body in a meaningful way. So, thinking about going on a hike, if you live somewhere other than Houston. Going on a hike, it can, you know, it can just be fun, and you don’t necessarily think of it as exercise. Just kind of exploring the area. But something like that can. Or you know, playing catch with your kid or helping them, you know, with soccer. All of that physical activity counts, right? It doesn’t have to be this dedicated exercise time. I think whenever it comes to long term health, the important thing is not to engage in any extremes, one way or the other. I think that’s where a lot of people tend to get themselves into trouble, right? So, making sure that we are moderating our attitudes when it comes to things like physical activity or when it comes to things like even eating and what foods we consume. I often see, you know, the consequences of things, unfortunately, like eating disorders or even unintentional under fueling. And you know, what I try to tell people if there’s a little bit of an issue around eating, is you know, eating is not a sin and exercise is not punishment. That’s really one thing that I try to emphasize, going through and eating in a healthful manner to fuel your body is essential. Exercise is what keeps you moving, keeps you independent, even in the mornings when you don’t feel like dragging yourself to the gym. I get like that sometimes too, but I’ll tell you what, some good advice that was given to me is, “Okay, just go ahead and get to the gym, and if after five minutes you’re still not feeling it, go ahead and turn around back home, right?” And chances are you’re probably never gonna end up turning around and going back home. But we need to eat in a meaningful way that is going to fuel our bodies and give us what we need. We need those nutrients. You cannot build a house without bricks. You’ve gotta have the supplies there in order to be able to build a strong and healthy body. So, eating from your major food groups, eating in a healthful manner, having a cheat day here and there is totally fine. But really making sure that we are treating our bodies as-- not gonna say as a temple because I feel like that’s a little bit too cliché, but this is the only one we got, right? So, we wanna make sure that we’re fueling it in a way that’s important. We wanna make sure we’re moving it in a way that’s important because this is the one that’s gonna carry us until whenever our end may be.

KIM: Yeah. Dance with the one who brought you.

DR. WOOLDRIDGE: There you go.

[Laughter]

KIM: Well, thank you so much Dr. Wooldridge. This has been so enlightening, and I feel better about exploring a little bit more movement and going out there chopping it up and seeing what new things I can find.

DR. WOOLDRIDGE: And don’t feel like you have to run a 10K, start with a 5K. You know, right? Like make it easy. I don’t understand the running. If anybody ever sees me running, please call for help. That’s -- please call for help. I am being chased by something, so please call for help. Yeah, no, it’s a-- sometimes not as complicated as we wanna make it.

KIM: Awesome, thank you so much.

DR. WOOLDRIDGE: Yes, thank you for having me.

[Sound effect plays to signal end of the interview]

ZACH: So, Kim, I wanna get a poster that says, “Load the muscle, load the bone.” I think that’s a great takeaway. She had a lot of quotables, I think.

KIM: Yeah no, I really enjoyed this conversation because there is just so much about how you can approach exercise that I had never thought of before. Just because it’s rung true in my own life about how I’ve sort of diversified how I think about movement and exercise, ‘cause I used to be of the mindset that you have to go to a gym, you have to be on some kind of machine for no less than 30 minutes, then you have to lift some kind of weight, and then, poof, you’re done. But you know, you can go hiking, you can garden, and that’s all considered exercise, and I love that.

ZACH: Yeah, yeah.

KIM: Yeah. So, it makes me feel a little bit better when I have to get up super early to weed my garden.

ZACH: Well, I know you guys mentioned it. Is it better to exercise a little bit or none? Well, obviously a little bit, right? Because no matter what, get your body moving, right? That’s what it’s all about, you know. Speaking for myself, I have my ebbs and flows of my, you know, exercising. And, you know, when you start out, you’re like, “Ah, it isn’t really doing much, right?” But you don’t realize. But you turn arou -- you stick with it like a month, two months, three months, you turn around, “Oh look, it is doing much.” You gotta stick with it. And so, even if you’re doing just a little bit that adds up as opposed to well, “I’m just gonna sit here now  at my desk for three months and not do anything.”

 I mean, it’s common sense, but so many of us fall in that trap of ending up doing nothing, when we could just be doing something.

KIM: Yeah, I thought the acronym she used, FIT, about frequency, intensity, and time, and just kind of starting small with those goals, but just making sure that you’re being consistent with whatever it is you’re doing, and you’re going to see some kind of results. And another point that I thought was really good was she emphasized what your why is, or what your goal should be.

ZACH: A tangible.. yeah.

KIM: Yeah, like the tangible thing in terms of you wanna walk your daughter down the aisle when she gets married or you wanna hike on some like beautiful cliff somewhere in the world. You know, having these goals and doing the work to help sustain you to get there in small chunks works.

ZACH: No, absolutely because we all have those nebulous, “Yeah I wanna be healthy.” But what does it look like? If you don’t have set goals and start to have a set plan, like to get there. Like, “Okay, what’s the actionable steps you need to get between here and quote unquote healthy?” And having those actional like specific goals, I absolutely agree.

KIM: I’ve seen it in my own life where, you know, I think when I was younger -- and I grew up in the 90s and early 2000s and you were working out for an aesthetic. You were working out to be as thin as humanly possible. And that just doesn’t sustain you, really. But now, I think more about exercise and approaching movement with, you know what? I wanna be able to get in and out of my bathtub comfortably when I’m 80 or 90, right? Like I wanna have good years when I’m that old.

ZACH: Yeah, like she said, thinking about like the quality of life. I mean, you wanna live long, but you wanna have a quality of life as you live that long.

KIM: Exactly.

ZACH: And something that stuck out to me too was, you’re used to doing your reps, right and you’re like, “Oh good, I finally-- like, lifting these 35s, 12s, three rounds of it doesn’t kill me anymore. Great.” But then you gotta level up, right? ‘Cause she’s like, “Well, if you stop sweating-- like a workout without sweating doesn’t really do much for you. So, remember that too. ‘Cause you can get, you know, it’s good that you’re getting more comfortable, it means you’re getting stronger, but then, you’re not having that resistance as much so it’s doing less work. And so, at that point -- like you never wanna be comfortable in a workout.

KIM: Yeah, and it’s about, I think challenging yourself as well as making sure that you are doing different kinds of movement. You’re focusing on your balance, you’re focusing on your mobility, you’re focusing on your heart. And the exercises that you do can look widely different for all of those things. And I think that that can help you prevent injuries, which I think can sideline a lot of folks, especially as they add more decades to their life.

ZACH: Yeah, absolutely. Alright that’s gonna do it for this episode of On Health with Houston Methodist. We drop episodes Tuesday mornings, so please be sure to share, like, and subscribe wherever you get your podcasts. And until next time, stay tuned and stay healthy.