Better Health While Aging

Practical information for aging health & family caregivers

How to Promote Physical Health While Aging:
The Healthy Aging Checklist Part 2

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Old man shooting a basketball ball and looking to sky in the park

This is the second in a series of posts explaining my Healthy Aging Checklist.

Remember, for the healthiest aging, we need to do the things that optimize health — and health care — so that the brain and body work at their best for now, and for the future.

I’ve identified six broad actions to take:

The Healthy Aging Checklist:

In this post, we’ll cover proven ways to promote and maintain physical health as one ages.

6 Proven Ways to Promote Physical Health

Here are the six “healthy living” actions that I recommend, for promoting physical health in all older adults. They all have a solid track record (which cannot be said for everything I see recommended online). They are also good “bang-for-the-buck,” in part because they provide real benefits to just about everyone who adopts them. And they help whether or not an older person has already developed chronic illnesses.

Now, the truth is that many of these overlap with the recommended actions for brain health. But I’ve tried to provide more links and resources related to how these actions benefit aspects of physical health such as mobility, heart health, and immune function.

Get Your Free Physical Health Cheatsheet! The 6 actions to maintain physical health in a handy PDF checklist that you can print or save. Includes useful resources for each action item. Click here now.

1. Exercise regularly — and include strength training twice weekly.

Why: Exercise helps older adults maintain their strength and mobility, plus it improves just about every physical health outcome you can imagine, provided you don’t overdo it or get injured.

Walking daily is not enough! Research suggests that strength training (e.g. weight lifting or other exercises that strengthen muscles) is especially beneficial as we age.  Without strength training, muscles weaken as we age, which can lead to anything from falls to difficulties with daily activities.

A 2014 research study in JAMA  found that a structured exercise program — involving sedentary adults aged 70-89 —  reduced the risk of “major mobility disability.” Exercise also tends to improve mood, which has positive effects on the rest of the body.

Note: Research has shown that even less-than-recommended exercise brings health benefits. So remember: it’s better to do a little bit every day than nothing at all. In fact, the most important thing is to find something that you can keep doing. Walking is relatively easy for many. Otherwise, classes or structured courses often help older adults stick with an exercise program; look for a class led by someone with experience coaching older adults.

If you are already walking regularly, that’s great, but it’s not enough to build up your muscles! So the next step is to try to incorporate all four different types of exercise that benefit older adults: strength, endurance, balance, and flexibility. Again, strength training is especially important in aging.

For more information:

2. Don’t smoke.

Why: Smoking tobacco is bad for just about every aspect of physical health. It’s especially damaging to the lungs, but also increases the risk of heart attacks, strokes, and various forms of cancer. Many tobacco-related diseases, such as chronic obstructive pulmonary disease, can cause difficult symptoms for years.

Fortunately, even after an older adult has developed smoking-related health problems, quitting smoking will reduce symptoms and one’s chance of a premature death: one study found that quitting smoking between ages 55-64 added four years to one’s life expectancy.

Note: Quitting smoking is hard, since nicotine is physically and psychologically addictive. Only 3-6% of people who try to quit on their own succeed. Medications and counseling have been proven to help quit smoking; combining these correctly usually increases the chance of successfully quitting to 30%. Many people need to try quitting a few times, so don’t let a past failure to quit stop you from trying again.

E-cigarettes do help some people quit smoking. Although we don’t yet know what are the long-term effects of vaping and using e-cigarettes, preliminary research suggests that it’s better to use e-cigarettes than it is to smoke.

For more information:

3. Get enough sleep. 

Why: Studies have found that chronic sleep deprivation is linked to increased cardiovascular disease, increased levels of inflammatory blood markers, and decreased immune function. Being sleep-deprived also causes fatigue, which can make it hard to be physically active (and is bad for mood, too).

Note:  Aging does cause sleep to become lighter and more fragmented, and may cause people to need a little less sleep than when they were younger. That said, chronic sleep difficulties or often waking up feeling tired is not normal in aging. Older adults often suffer from true sleep problems that can be treated once they are properly evaluated.

For more information:

4. Avoid chronic stress.

Why: Feeling chronically stressed has been linked to physical health problems such as cardiovascular disease, insulin resistance, and decreased immune function. Research suggests that this may be because stress can accelerate “cellular aging,” and also may promote inflammatory markers in the body.

Note: Common causes of stress in older adults include financial stress, relationship stress, work-related stress, and caregiving stress. To reduce chronic stress, it’s best to combine general approaches (such as improving sleep, exercising, meditation, relaxation strategies, etc) with approaches that can help you cope with your specific source of stress.

For more information:

5. Maintain a healthy weight.

Why: The main reason is that obesity is a major risk factor for disability in late life. (Strange but true: as people get older, the link between obesity and premature death gets weaker, a phenomenon sometimes called the “obesity paradox in aging.”)

Obesity — usually defined as having a body mass index (BMI) of 30 or more — worsens arthritis. It’s also been linked to many health problems, such as cardiovascular disease, diabetes and glucose intolerance, certain types of cancer, and sleep-related breathing disorders.

Studies have found that when overweight or obese people lose even a modest amount of weight — such as 5-7% of one’s current weight — this can improve physical health and symptoms. 

Do keep in mind that unintentional weight loss is a major red flag when it comes to the health of older adults, and should always be brought to the attention of health professionals.

Note: Historically, a low-fat diet has been recommended for weight loss and health reasons. However, I believe there’s a lot to be said for the theory that high-carbohydrate foods (which are often low-fat) increase insulin levels, promote hunger, and make it harder for people to lose weight. If you need to lose weight, you may want to do some research into various approaches before discussing with your doctor and coming to your own conclusions as to which weight-loss strategy to try. Older adults need to be especially careful about not losing too much lean body mass during intentional weight loss.

For more information:

6. Eat a “healthy diet.”

Why: Diet undoubtedly affects certain aspects of physical health. A healthy diet is one that doesn’t provoke negative health effects, such as being prone to take on extra weight, developing insulin resistance, developing atherosclerosis, or having uncomfortable symptoms in the belly or bowels.

Frail older people often need extra calories and protein, since malnutrition becomes more common as people age. Research also suggests that eating enough protein is important if you are working on strength training, as the muscles can’t grow stronger without enough protein.

Note: Exactly what should or shouldn’t be eaten, as part of a healthy diet, is being constantly debated among experts and the general public. As the effect of diet on a person is very individual, it’s important to follow how one’s body seems to respond to a given diet. (Pay attention to how you feel, how your weight changes, and how your blood sugar and lipids change.)

In general, research suggests that a diet high in vegetables and fiber and low in ultra-processed foods and added sugars — such as the Mediterranean diet — is a good choice for many.

For more information:

An Optional Extra Way to Promote Physical Health

7. Tinker with your nutrition and your microbiome

Why: Recent research suggests that a person’s health can be significantly influenced by the bacterial community (the microbiome) we all carry within our guts and in our body. The microbiome itself seems to be influenced by one’s diet as well as by other factors.

On the other hand, it’s not clear that taking extra vitamins and supplements — including popular anti-oxidants — promote health. The US Preventive Services task force report on this topic concluded the evidence of benefit is weak. Furthermore, commercially available supplements have often been found to be of poor quality, and “anti-aging” vitamins have no evidence behind them. To promote physical health, I believe that supporting the microbiome with good nutritious food will prove to be much more important than tinkering with supplements.

Note: It is not yet clear how we should advise people to optimize their microbiome, other than to eat a lot of fiber and minimize antibiotics. For some people, eliminating certain foods seems to improve well-being or certain symptoms. Research into the benefits of fermented foods and probiotics is ongoing. There is also fascinating research being done on how the microbiome changes with aging, and might influence certain aspects of the body’s aging.

For more information:

What’s Your Plan for Promoting Physical Health While Aging?

So that’s my short list of activities that are most important to do, to promote physical health while aging.

Which of these are you already doing, and which of these will you try to work on in the next few months?

Also, if you think I’ve missed anything major in the list (it has to be something with good evidence and that works for virtually all older adults), please let me know.

Get Your Free Physical Health Cheatsheet! The 6 actions to maintain physical health in a handy PDF checklist that you can print or save. Includes useful resources for each action item. Click here now.

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Comments

  1. Thank you for the Healthy Aging Check List. I have a nonprofit Seniors4Wellness that includes (8) pillars that are shared with older adults for a healthy life span versus a life span only. My questions are as follows.
    Are there studies that indicate the value of intervening at the age of 50 or younger so we become more proactive versus reactive on the front end of life versus the back end.
    Do you have an opinion as to the importance of not only focusing on one or two pillars but several at the same time. For example, being active socially and not focusing on mental or physical components has consequences.
    Do you know of any wellness model plans that include your (6) healthy aging components for seniors 50+. There are all kinds of plans, but I cannot locate what i would consider a wellness plan.
    Thank you for sharing of information.

    • Wow! Those are great questions but would take me a long time to answer thoroughly!

      There is a lot of research about lifestyle changes in early and mid-life to stay disease and disability free longer. Most of the research that I’m aware of looks at the risk of a specific condition and how lifesrtyle can affect it. An example is the “Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (Livingston et.al. 2020)”, which you can look at here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext

      I agree that a broad focus on various aspects of healthy living is more likely to pay off, and may have synergistic effect. It can be difficult for people to do “everything all at once” so starting with one domain and building towards a fuller lifestyle transformation can often lead to more long term success.

      My understanding of a wellness plan is that it’s an action plan to support a person’s physical, mental, spiritual, and emotional health. I expect this would be very individualized, and may need to be developed over time. I don’t have a specific template that I recommend, but I think it’s a great tool for setting goals and moving towards them!

  2. You mention “all four different types of exercise that benefit older adults: strength, endurance, balance, and flexibility.” How do approaches such as yoga, Pilates, and Tai Chi fit that recommendation?

    I had a physical therapist for a while after a fall who worked with me on balance, flexibility, strength (esp. core strength) coupled with walking (endurance?). Now that I “graduated,” she encouraged me to keep working on these attributes but move forward from the exercises she had given me into one of these regimens to develop further while making it more interesting. She saw those three as having attributes she thought would help me and figured I needed to pick one that seemed enticing enough so I would continue to do it.

    I’m currently trying beginning yoga.

    • I’m so glad that you’re exercising regularly! All of the activities you mention can be great for strength, flexibility and balance.

      There’s evidence that tai chi can also reduce the risk of falls and may also help with osteoarthritis, Parkinson’s disease, and cognition. You can read about the scientific evidence here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844554/

      Whatever you choose to do, I think your point about keeping it interesting is well taken! The best exercise is the exercise that you stick with.

  3. I am a healthy 70 year old female who has been fit and active all my life including healthy diet, I am now dealing with moderate to severe arthritis in lower spine and right shoulder. I have been prescribed specific strengthening exercises which I am supposed to do daily. However, I’m finding my muscles don’t recover as quickly as they used to and I often feel achy and muscle pain. I am also on a statin long term, not sure if that has any bearing. If I don’t do any strength training for a few days, I feel better. Is it normal to for older folks to have longer lasting post workout muscle pain than when younger?

    • I’m glad you’re exercising regularly! Older muscle can fatigue more quickly and take longer to recover compared to that of younger people, but there shouldn’t be significant, persistent pain.

      I don’t the statin is an issue in your symptoms.

      If you’re getting advice from a physiotherapist or kinesiologist, I would check in with them to see if you need to adjust your posture or some other aspect of your strengthening moves.

  4. Looks like Dr K and all the rest of us are wrestling with new research related to ketones as brain food, MCT, and hunter-gatherer life-styles. Sure looks like some long-entrenched views of the heart and cancer societies are on life-support. For sure, hard to trust epidemiological research because the “good guys” are hard to separate from any single influence in their life (for example, the good guys do walk more but also eat more blueberries.) In fact, the bigger the sample, the less likely it is that researchers have access to information to separate the factors.

  5. I am 69 and live in Texas where the temperatures routinely hit 100 degrees.I’m 6 feet and weigh 195 pounds. I play competitive tennis twice a week as well as golf and make every effort to stay hydrated. I recently became dizzy and nauseous while playing and had to quit. Many years ago we used to take salt tablets but I now limit my salt intake and drink lots of water and Liquid IV for electrolytes. Should I be taking salt tablets ? How can I prevent this from happening. I have not had issues with cramping..Thanks

  6. Good thing I do good things for my body just like exercising daily and eat healthy foods.

  7. Physical activity can get more difficult as we age, but it’s important to adjust your levels of physical activity and make sure it’s still something you’re doing every day! Thanks for sharing!

  8. Thank you, thank you, for being open to the idea that new alternative ways of eating may be more beneficial than the low-fat agenda foisted on us by Dr. Ancel Keyes as a cure all–especially those lowering harmful high-glycemic carbs!! As a follower of cardiologist Dr. William Davis of Wheat Belly Total Health fame, I know firsthand the value of his wheat-, grain-, sugar-free way of eating, the addition of quality necessary supplements, and the promotion of good gut biome to health. My elderly 90-year-old mother was able to stop 4 different long-term medications (amlodipine, omeprazole, claritin and, most importantly, oxycodone-apap) just by compliance with that way of eating which naturally by diet reduced her blood pressure, removed all gastrointestinal issues, stopped all allergy symptoms and reduced her pain level so that she only needs Tylenol on occasion now. While I had no major medical issues myself, my easy loss of 30 excess pounds, my reduced cravings and general well being on this way of eating has opened my eyes to its benefits. Your open mindedness is much appreciated.

    • Thank you for this comment and for sharing your story. That’s great that your mother was able to experience such improvements after changing her diet!

      I do think diet is important. That said, it’s important to note that different people seem to respond differently to various diets, so although a wheat-free diet may be associated with huge improvements in some people, research studies have confirmed that this isn’t the case for everyone.

      I say this because restricting certain foods often imposes a short-term burden on an older person, so although it may be reasonable to try it, I wouldn’t insist on it unless it were pretty clear that symptoms or something else important to the older person (to them! not necessarily to us as their doctors or children) was improving as a result of a dietary restriction.

      Also, in general, dietary interventions seem more likely to have an effect on health outcomes when people are younger than 90…this is especially true for preventive interventions.

      But I agree with you: making dietary changes — and other lifestyle changes — can be extremely powerful, and is often underused by many conventional health providers.

  9. Hi Leslie, the article looks great and will be helpful for many. But regarding following health routines, I think seniors will find it difficult, even the youngsters fail to do it. Proper means of monitoring might be helpful. Nowadays, many healthcare organizations are digitalizing many of their functionalities including consultation, diagnosis, health monitoring etc. They are also encouraging their patients to use those technology based associated devices not only to simplify their caregiving procedures alone, but also to improve patient health too.

    Due to age related problems such as degenerated memory, health issues etc., seniors won’t be showing much enthusiasm in properly maintaining their health. Keeping track of their routine tasks is a tedious part for their caregivers and medical practitioners. In such cases, these kinds of systems can help a lot. This solution also updates doctors regarding real time health values of the elderly. So that he can immediately provide proper medical advice within no time if any variation occurs. I strongly recommend making digital healthcare tools much popular among our aging community. Senior population is one among the most important beneficiaries of modern healthcare technologies and it’s a great blessing for them.

    • I agree that it’s a challenge for any person to keep up with a recommended health routine. In principle, new technologies should be able to make this easier. In practice, it’s been hard to develop something that works well for older adults, especially if they have multiple chronic conditions. I used to follow aging health innovation quite quickly, and almost everything has fizzled out. I do think eventually something will work, but we’re probably not there yet. Larger health systems are testing these kinds of systems, once they confirm that an app or service is working well for their older population, I will consider sharing more info about it on this site.

      • Thanks for the response Leslie. Looking forward for your upcoming posts on elderly healthcare technologies !

    • Yes, people are studying omega-3 fatty acids for treatment/prevention of sarcopenia (which is the loss of muscle that we see in frail older adults). The research is interesting and promising. However a new Frontline documentary reports that many fish oil supplements may not contain what they claim to contain.

      The Mediterranean diet encourages eating fish, and oily fish should be a good source of omega-3 fatty acids.

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