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Dare to Be 100: Don't Turn Off, Old, Fat and Frail

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Someone wise observed "it ain't how old you are that matters so much as how you are old." I have been consistently and increasingly aware of the issue of frailty in the aged. I note it in myself. It is observed that ours is the first time in American history when our children will live less long than we ancestors. This is alarming and unacceptable. A big part of this shortfall streams from the increasing burden of frailty. Linda Fried of Columbia School of Public Health and I have been publishing on this topic, because it continues to lack rigor. It is not a disease, but then what is it?

(1) Various definitions include "tendency to fail", and "increased risk of death."

Certainly age has something to do with it, but it is a truth that even young people can be frail when they withdraw from the mainstream. There are a number of tendencies that increase our likelihood of becoming frail. A series of articles have appeared to detail how our labor saving devices are making us work less hard. This starts with the car (Why Walk?), but it permeates almost every corner of our daily existence. We sit more and walk much less than we used to.

An unfortunate consequence of this reduced movement is the burgeoning problem of obesity. Obesity of course has a long list of demerits and lack of movement is a major contributor. I recall well a study done by the famous nutritionist Jean Mayer who took movies of adolescent girls at Camp. He found that the overweight girls moved much less than the lean girls, and this of course would contribute to caloric imbalance. We as a culture are becoming increasingly inactive, and this inactivity is increasingly perilous as we age.

For us older people an additional complication is the incidence of arthritis as we age. Stiff, painful joints further increase the likelihood of frailty, and the lack of movement shows up as we age.

An important aspect of this of course is the brain. We now know of the compound entitled BDNF, brain derived neurotrophic factor. It has been likened by some to Miracle Grow for the brain. It is a stimulant and in laboratory experiments when incubated with BDNF the brain cells actually sprout new branches. Through the work of Carl Cottman at UC Irvine we know that exercise is the predominant stimulant for the production of BDNF. It is of course no coincidence that almost all neurologists now advise strongly for a person threatened with Alzheimer's Disease to remain physically active, thereby increasing their BDNF levels.

So for these reasons and others I plead for us all not to turn OFF, not to become old, fat, and frail. Instead we need to be FOR, Fit, old and renewing. As we age we must counter the entropic demands of OFF. The central strategy to doing this is remaining physically and mentally active. We need to keep all of our receptor sites fully engaged, and this means sustaining physical activity. I have often held that the most important organ in an older person's body is not their heart, lungs, or kidneys, but their legs. When the legs are sturdy beneath us that it is a wonderful antidote to all.
My mother was always 30 or 40 pounds too heavy after my birth, and she lived to 95, and was not frail because she kept her legs under her. She carried the groceries up several flights of stairs and did a marvelous job of not turning OFF, old, fat, and frail.

This is a message to be heeded.

Reference: Bortz, W. A Conceptual Framework of Frailty 2002, J. Geron. Med. Sci.57: M283-M288.