Keeping up the Pace

Advice for aging exercise enthusiasts

Julie Corliss
Harvard Health Publications

  Are you one of those people who not only meet but routinely exceed the recommended amount of exercise on most days? The federal guidelines call for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise every week for all adults, including those 65 and older. But some people spend far more time exercising, clocking daily hourlong runs or gym workouts, often coupled with lots of physical activity on the weekends — playing tennis, cycling, hiking or skiing, for example.

   In general, exercise related injuries to the joints, tendons and muscles become more common with age, mostly due to natural declines in muscle mass and flexibility. The prevalence of heart disease also rises with age. How does exercise — especially higher-than-average amounts — affect that risk?

   Without question, exercise is the best “medicine” for your heart.

   “Physical activity profoundly improves your cardiovascular health and longevity,” says Dr. Meagan Wasfy, a cardiologist at Harvard-affliated Massachusetts General Hospital. And, she notes, there are people who, by virtue of a combination of good lifestyle habits and good genes, can continue to exercise at high levels well into their 60s and beyond.

Is more always better?

   Still, don’t assume that the more exercise you do, the better, says Wasfy. The most impressive benefits occur when a person who has been inactive starts doing regular, moderate-intensity exercise. Doing more offers some added benefits, but only up to a point. One study tracked exercise and longevity in more than 660,000 people, with a follow-up that lasted an average of 14 years. Researchers found that even people who did less than the minimum amount of exercise recommended by the guidelines had a 20% lower risk of dying compared with inactive people. Those who did double the minimum amount lowered their risk by 31%, and those who did three to five times the minimum had a 39% lower risk. Beyond that, more exercise didn’t earn any additional survival benefits. However, there was no evidence of any downside, even at levels 10 times more than the minimum.

Benefits beyond heart health

   So if you’re accustomed to doing lots of exercise, staying the course as you age seems to be safe from a cardiovascular perspective.

   “As a person who’s highly active myself, I recognize that there are other reasons for exercising beyond improving heart health and longevity,” says Wasfy. Exercise helps people maintain a healthy weight and also helps to tame stress, especially when you work out with other people.

   But it’s fine if you decide to dial back your routine to a more moderate level. A less intensive regimen may protect you from overuse injuries but still benefit your cardiovascular health.

   Still, just because people are physically active doesn’t mean they are immune to heart problems. Here’s Wasfy’s advice:

• Get routine checkups, and keep tabs on your heart-related risk factors. “I sometimes worry that doctors may be biased to undertreat risk factors like high blood pressure or high cholesterol in people who appear very fit and healthy,” says Wasfy. Another issue she’s encountered: Avid exercisers are often reluctant to take medications because they feel they can control their risks with lifestyle changes alone. But you can’t outrun dangerously elevated levels of LDL cholesterol, which should be treated with medication.
• Don’t assume you can eat whatever you want. People who exercise a great deal can certainly consume more than their sedentary counterparts because their workouts burn so many calories. That doesn’t mean you can ignore the standard advice for a heart-healthy diet. You still need to limit foods that promote narrowing of the heart’s arteries (atherosclerosis), says Wasfy. Too much saturated fat and highly processed carbohydrates (like crackers, chips and cookies) and sugary treats in your diet can crowd out more healthful foods like fruits, vegetables and whole grains.
• Pay attention to heart-related symptoms. In general, highly active people tend to be good patients in this regard because they’re tuned in to their bodies, says Wasfy. “When people are used to running at a certain pace, they notice if they are suddenly going slower than normal,” she says. If there is no reasonable explanation — for example, they took time o or are recovering from an injury — that may be a reason to check in with a doctor, she says. Sometimes, the first symptom of atherosclerosis or a heart rhythm disturbance can be a subtle reduction in exercise capacity, Wasfy says.

Is it always best to limit your sodium?

Barbara Intermill

   A well-meaning friend encouraged me to add an electrolyte powder into my daily water bottle. “It’s got a lot of sodium,” she explained. “But you need extra sodium when you’re active and sweating.”

   This particular product contains potassium, magnesium and sodium — essential minerals that can be lost in sweat and urine. It was the sodium content — 1,000 milligrams — that caught my attention. That’s almost half the limit of 2,300 milligrams (the amount in about a teaspoon of salt) recommended for healthy adults by the 2020-2025 Dietary Guidelines for Americans.

   Health experts have done a pretty good job warning us that excess sodium intake is linked to high blood pressure — a risk for stroke and heart attack. Yet we do need an adequate amount of sodium for our bodies to function normally. Too little sodium — especially if we are drinking more water — can have serious health consequences, as well.

   Believe it or not, there is not enough evidence to establish one Recommended Dietary Allowance for sodium, according to the 2019 National Academies Consensus Study Report. And some experts are challenging the wisdom of requiring all Americans to consume less than 2,300 milligrams of sodium a day.

   That’s because intense exercise and sweating may increase your need for extra sodium. Also, many people with normal blood pressure and normal kidneys are able to deal with wide variations of sodium intake without raising their blood pressure, according to a 2021 review on this topic in the journal Nutrients.

   Sports-nutrition experts generally recommend we replace sodium and other electrolytes along with fluids after heavy exercise that lasts an hour or more (marathon runners, for example). Plain water will generally do the trick if our activity lasts less than an hour and we eat a normal diet.

   Remember, too, that sodium (along with other electrolytes) resides in most of the food we eat even if we never pick up a salt shaker. According to the Food and Drug Administration, 70% of the sodium in our diet comes from foods that are packaged or prepared in some way.

   Milk, for example, is recommended by some sports nutritionists as an exercise-recovery beverage. Why? It supplies fluid and the electrolytes potassium, magnesium, sodium, calcium and phosphorous. Milk also contains high-quality protein to repair working muscles and carbohydrates to replenish energy stores.

   So yes, we need sodium. And we may need more in some circumstances such as heavy water intake. But adding more sodium than we need may not be smart if we’re fighting high blood pressure.

   So here’s the challenge: Consider your personal health condition. Take a few days to add up the amount of sodium you typically consume. (It’s on the Nutrition Facts label of the foods you buy.) Then discuss what you find out with your health provider.

Southwest Montana Health Care Directory