December 2, 2025 • 32 mins
Exercise is the most powerful longevity tool we have, but after 50 the recovery curve, injury risk, and bone/muscle changes mean the smartest plan blends strength, power, impact, and slightly more recovery—so you can train hard without derailing progress.
What we cover
- Why this matters now: record-setting older endurance athletes (and I’m racing at 69) show what’s possible—if we train wisely.
- The “aging triad”: loss of muscle (especially fast-twitch/power), bone density shifts (sharpest around menopause), and rising osteoarthritis risk.
- The injury paradox: the fitter you are, the more a single layoff can cost; preventing setbacks is a longevity strategy.
- A practical framework: build strength, protect fast-twitch fibers, add tolerable impact for bone, and consider an extra rest day after hard sessions.
Evidence, in plain English (linked)
- Muscle changes: We preferentially lose type-2 (power) fibers with age; quads are especially affected. Training can target this. Review
. - Women & men both lose muscle mass percentage-wise; patterns differ but loss is universal. Same review
. - Bone density: Women can lose ~2–3%/yr at the spine around menopause; men decline more gradually. CDC data brief
. - Running & knees: Long-term cohorts show no higher knee OA in runners vs. non-runners (Stanford cohort
; systematic review, ~14k people
), and even runners with established OA didn’t worsen—and reported less pain. Prospective OA cohort
. - Strength at any age: Even adults 85+ can add ~10% quad size and ~40% leg strength in 12 weeks; heavy strength work is safe when programmed well. Overview
. - Power/fast-twitch support: Short (30–120 s) high-intensity efforts and plyometrics can improve type-2 fiber function and neuromuscular drive in older adults. Narrative review
. - Bones respond to signal: In 80 trials (5,500 postmenopausal women), combined resistance + impact training improved spine and hip BMD regardless of menopause timing or baseline status. Meta-analysis
. - Recovery with age: Some data show more soreness and temporarily lower strength 24–72h post-lifting in middle-aged vs. young adults—supporting a touch more recovery after hard days. Study
.
Practical takeaways
- Lift twice weekly
- Add brief power: 20–30-second hard intervals or controlled mini-hops/step-downs; keep impact tolerable.
- Build bones: pair resistance work with impact (jog/jump rope as tolerated). If you have osteopenia/osteoporosis, get your plan cleared first.
- Recover like it matters: if a session is truly hard, consider one extra easy/recovery day.
- Audit risk: dial back higher-risk activities that would sideline you for weeks; prevention preserves gains.
If this episode helped, please rate the show and share it with a friend. To get my newsletter with practical, evidence-backed steps for living long and well, visit DrBobbyLiveLongandWell.com.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:01):
Here's a paradox.
Exercise is the single mostpowerful intervention for
healthy aging.
Yet a single injury could undoyour fitness gains.
Where's the line between use itor lose it and unnecessary risk?
(00:21):
How might we think aboutexercise as we get older?
And when does older actuallybegin?
I'll share evidence-based stepsyou can take.
Hi, I'm Dr.
Bobby Du Bois, and welcome toLive Long and Well, a podcast
(00:47):
where we will talk about whatyou can do to live as long as
possible and with as much energyand figure that you wish.
Together we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey, and I hope
(01:07):
that you feel empowered alongthe way.
I'm a physician, Iron Mantriathlete, and have published
several hundred scientificstudies.
I'm honored to be your guide.
(01:30):
Should your exercise changealso?
Many listeners have asked meabout this question.
As we get older, should we justcontinue what we're doing?
Do more?
Do less?
Do it differently?
What does the evidence tell us?
Now, this episode is reallyimportant for my listeners who
(01:51):
are 50 years or older, but it'salso really important for people
who are younger.
Why?
Because this is going to happento you too, and you might as
well try to get ahead of theproblem as early as possible.
And you probably have parentsand older people in your life.
This knowledge might help them,and you can help them as well.
(02:16):
Well, why now?
Well, one of the reasons, ofcourse, is you asked for it.
But in the recent Iron Man WorldChampionships in Kona, Hawaii,
they had the first 80-year-oldever finish the race.
And this was a race that's twoand a half mile swim, it's a
(02:39):
hundred and twelve miles bikeride, and then a full marathon.
So for an 80-year-old to dothis, that's pretty incredible.
The topics also came up with theNew York City Marathon, which is
a huge marathon that justhappened.
There were 4,000 people abovethe age of 60 and over 500 that
(03:02):
were above the age of 70.
So clearly, older people aredoing exercise and doing
endurance events.
Topics also relevant for me.
I'm 69 years old, and I'mcompeting and will hopefully
just finish another Iron Manrace this weekend.
And by the time this episodecomes out, I hopefully will have
(03:25):
finished that race.
This is a half Iron Man.
I've done about four full IronMan races and about 15 of the
halves.
Well, I'd like to explore thistopic in four parts.
Part one, a reminder, real briefreminder of why sports and
exercise is really important inour life.
(03:46):
Life enjoyment for our heart,for our muscles, for our brain,
and our bones.
Part two, what are we up againstas we age?
There are changes in our bodies,of course, in our muscles, our
joints, and our bones, and howare we going to address that?
Part three, what practical,tangible, evidence-based steps
(04:10):
can you take to prevent some ofthese age-related losses?
And four, something you mightnot have thought about.
The risk of injury goes up as weage.
Not only does it go up as weage, but when we get injured,
the consequences as you getolder of that injury and being
(04:33):
off your exercise regimen for aperiod of time is
extraordinarily consequential.
And we need to think about that.
Okay, before diving into theevidence on the topic, I want to
thank you, listeners, forsharing with me how my work has
influenced you.
So some of my listeners talkedabout how they incorporated the
(04:55):
end of one approaches for sleepand weight loss and various
other things.
Some people said that they'vechanged their sleep with
lowering their bedroomtemperature, which has really
helped, or they've made exercisea priority in their life, or
they're using a home bloodpressure monitor, or they're
working with various of thetechniques I suggested to reduce
(05:18):
calorie intake, like the20-minute rule, or using smaller
plates.
And many of you are drinkingless, less than six or seven
alcoholic drinks per week.
And one of you said, you're notconvinced about ice baths.
That's okay.
You do all the other stuff.
That would be wonderful.
Others of you, can you shareyour thoughts?
(05:40):
Uh, in part, this is importantto me, but it's also important
because I want to put together asurvey to really understand how
change is happening in folks'lives and how I can support that
even more.
And as always, tell your friendsabout the podcast.
Hopefully they'll listen andenjoy it as well.
All right, part one (05:59):
the benefits of exercise.
Well, you know, why do we dosports?
Why do we do exercise?
For a lot of reasons.
One, sports are fun.
Some people love golf or tennisor skiing or pickleball or
soccer or basketball.
They love to ride a bike or evena motorcycle.
Of course, there's the longevitybenefits.
(06:21):
You'll live longer, multipleyears longer, if you have a
regular sports and exerciseprogram.
And that helps prevent keyillnesses of your heart, your
brain, cancer, diabetes, and thelike.
And really importantly, we hopethe sports and exercise will
prolong our good years and thatwe can continue to be functional
(06:44):
decade after decade afterdecade.
But how can we do this as we getolder?
Well, to figure out what to do,we first have to figure out in
part two, what are we upagainst?
So our bodies are changing inthree key areas that we're going
to need to focus on.
(07:05):
First, muscle mass loss.
We lose, probably after age 30,1 to 2% per year of our muscle
mass.
Now that turns out to be about10 to 20% of our muscle mass per
decade.
What I haven't talked beforeabout is that our muscle mass
(07:26):
may decline at a certain rate,but the strength we have
actually declines much faster.
So we may lose 5 or 10% ofmuscle mass, but that might lead
to 10, 20, 30 percent loss ofstrength.
So it's not a simplerelationship, and keep in mind
(07:47):
that strength is very important.
A tiny bit of physiology.
Our muscles are woven togethertwo different fiber types.
One, type one and type two.
Type one is what we use forendurance, walking, hiking, um
(08:08):
uh, and doing things like a slowbike ride.
And then there are the type twofibers.
Those are the fast twitch fibersthat gives us bursts of power
and speed and strong movementslike jumping, which of course is
critically important, havingsome of this powerful uh
(08:30):
strength if we want to avoidfalls or avoid lots of things
and do things that are importantto us.
Here's the catch.
As critical as those type twofibers are in terms of bursts of
power and speed, we tend to losemore of those fibers than the
endurance type one fibers as weget older.
(08:52):
Yes, we lose both types, but weare gonna preferentially lose
the type 2 ones, meaning ourpower, our strength.
And that is so important to keepin mind as we begin to explore
what we can do about this.
Here's an interesting finding Iwasn't aware of, but evidence
(09:13):
suggests that yes, men losemuscle mass over time, women
lose muscle mass over time.
Turns out that the amount ofmuscle mass, not in terms of
actual pounds, butpercentage-wise, is the same
between men and women.
I would have thought maybe itwould have been different
because of testosterone levels,changing hormone levels in women
(09:34):
as they age, but it turns out weall lose a certain amount of uh
muscle percentage of our muscleyear after year after year, men
as well as women.
Now, let's move on to bone loss.
And here the sex differences arereally profound and really
important.
So women uh and men build uptheir bone mass when you're
(09:59):
young and in your teens andprobably 20s.
For women, during their 20s,30s, 40s, up until menopause,
they don't lose a lot of bonemass.
However, there's a huge changein the five to 10 years around
(10:19):
menopause, where women lose 2-3%of their muscle, excuse me,
their bone mass in their spine ayear, 1 to 2% in their hip or
their lower forearm.
That's like 10 to 30% of yourbone mass in women lost per
decade.
(10:40):
Now, you do that two, three,four, five decades, and now you
see why it's a huge issue.
Now, after those five to tenyears of uh profound loss, women
do slow down the rate of loss asthey get into their 60s, 70s,
and beyond.
They still lose bone mass, butnot at quite the same rate.
(11:03):
Okay, so losing bone mass isimportant because it gets you to
a point of too little bone.
If you have too little bone,first it's called osteopenia.
And then if it worsens, worsens,worsens, at some point it
becomes osteoporosis.
And obviously the brittleness ofyour bones corresponds with how
(11:27):
much bone loss there's been.
So 50% of women in their 50s andbeyond have osteopenia, a
reduced amount of bone mass.
And about 20% have osteoporosis.
Now, for men, yes, we lose somebone mass, but two things.
There's no cliff, there's noperiod of years where it's
(11:50):
hugely greater.
We just gradually tend to lose,and we tend to lose a lot less
than women do.
So in our 50s, we lose about ahalf a percent to a percent per
year, or about a quarter of theloss that women experience.
But men get osteopenia in their50s and beyond.
(12:14):
Maybe a third of men get that,but relatively few men, maybe 4%
and older men, get osteoporosis.
So problem for all, fracturesare a problem for all, a bigger
problem for women.
All right, the third piece ofthe aging puzzle is joint damage
(12:35):
and osteoarthritis.
So the risk of osteoarthritis,which often happens in our knees
and our hips, and it can be inyour hands as well, does
increase as we get older.
It's only about a 3% risk in our20s.
It rises to about a 10 to 15%risk likelihood in our 60s, but
(12:58):
by the time we're in our 80s,it's probably about half of us.
And if you get osteoarthritis,it causes pain, pain in your
joints, and it will be moredifficult for many people to
exercise.
So, as a long-term runner, Ihave been a fan of studies that
ask the question (13:18):
does running worsen your knees and cause
osteoarthritis?
Because many people say, Dr.
Bobby, do I need to give uprunning as I get older?
And the answer from the researchI'm about to show says no.
So one is called the StanfordStudy.
(13:39):
They took a group of runners whowere age 45.
I'm not 45 runners who were intheir 50s, and they compared
with a similar number of peoplewho weren't runners, and they
followed them for 20 years,asked them about knee symptoms,
asked them to get x-rays oftheir knees.
(14:01):
And what did they learn?
Well, both the runners and thenon-runners, as they got older,
they had a higher likelihood ofosteoarthritis.
But here's the critical piece ofthe puzzle the runners didn't
get more osteoarthritis than thenon-runners.
So the running didn't seem toaccelerate the problem.
(14:22):
Okay, that was a relativelysmall study.
There was an analysis of 17studies.
7,000 runners, 7,000non-runners, and they were about
in their mid-50s, and theyfollowed them for five years and
they did X-rays as well.
What did they find?
There was no difference betweenthe runners and the non-runners
(14:46):
in the X-ray look at theirknees.
Perhaps there was a little moreknee pain in the non-runners.
There was also a study ofpatients that already had
osteoarthritis, 1,200 people intheir 60s.
And they were overweight, BMIabout 29.
So they looked at runners andnon-runners in people who
(15:10):
already had osteoarthritis.
Guess what happened?
The people who were runnersdidn't have worse osteoarthritis
than the non-runners.
So what does this all mean?
It probably means that runningby itself doesn't cause
arthritis.
And if you're otherwise healthyand you enjoy running for all
(15:30):
sorts of reasons, consider doingit some more and onwards as you
get older.
Now, here's a couple of caveats.
Where arthritis becomes an issueis if you have injured the
joint.
So if you had a meniscal tear,if you had a ligament tear, the
unsteadiness of that joint doesincrease your risk of
(15:54):
osteoarthritis.
So if this has happened for you,talk with your doctor about
running and whether that wouldcontinue to be safe for you.
Also, if you're quiteoverweight, running might put
stress on your joints.
So again, talk to your doctorabout it.
All right.
We've had the depressingdiscussion of what happens as we
(16:15):
get older.
Now, part three, the optimisticpart.
What can we do about it?
How can we maintain our muscles,bones, and joints?
Now, if you're going to embarkupon an exercise regimen and
some of the things I'm talkingabout, and you haven't been
doing it for a while or ever,talk to your doctor.
(16:36):
Make sure all is well before youjump right in.
Okay, so there's a series ofsteps, things you can do to
help.
Step one, build strength.
Build strength, build strength.
Why?
Well, the more you have, meaningif you can build up more, the
more you're able to lose.
(16:57):
Because at some point when youget weak, it gets harder to get
your life done and do the thingsyou want to do.
So if you can build up more, youhave more to lose.
And if you work at it, theinevitable losses in muscle mass
and strength, you can diminishthat loss, maybe even reverse
(17:18):
it.
Here's the problem.
Only 27% of U.S.
adults do resistance exercises.
And this drops to just 10% ofpeople over the age of 75.
Now, the good news is whetheryou're 30, 40, 60, or 80, it is
(17:40):
never too late to start.
And there's a lot of studies inolder people that show it's safe
and it works.
And one study that looked at75-year-olds, and they were able
to increase muscle strength andsize through resistance
training.
Here's one example of a study.
12 weeks in people who were intheir 60s, 65 to 75, and those
(18:06):
who were above 85.
So they compared them and askedthe question: did the
85-year-olds gain muscle justlike the 65 to 75-year-olds?
And the answer is yes, they bothgained about 10% increase in
their quadriceps muscle size anda 38 to 46% increase in leg
(18:28):
strength.
Here's the wonderful thing.
There were no differences inresponse by age groups.
Yes, pound for pound, the olderpeople gained less muscle, but
proportionally they gained justas much.
Also, heavy strength training isalso safe and can be helpful.
(18:49):
All right, so that's our firstpart of thinking about our
muscles.
But remember, above, we talkedabout the type 1 and type 2
fibers.
So step two, help support yourtype 2 fibers.
Remember, we preferentially losethe power and speed fibers as we
(19:10):
get older.
And our quads are critical forgetting out of chairs and things
like that.
And, you know, hopping andjumping are some of the
activities that emphasize thesekinds of muscle fibers.
But what has been shown is thathigh intensity, so 30 seconds to
(19:33):
two minute bouts of speed orlots of jumping, burpees,
there's a variety of ways thatyou can do this, increases not
only the number of type 2 fibersso you can build back some of
that loss, it also rewires someof our nerves.
(19:53):
And the nerves trigger thosemuscles to do what they need to
do, and that can also improvewith this.
I have a whole episode where Italk about protein intake.
If you're trying to buildmuscle, make sure you have an
adequate amount of proteinintake.
All right, step three.
After worrying about our bone,our muscles, now we got to worry
(20:16):
about our bones.
So step three, support yourbones.
Here, there are two sets ofactivities you want to do.
The resistance training we justtalked about, but also impact
exercises, the jumping, therunning, those kinds of things.
Look, if you already have a lotof bone loss before you do some
(20:37):
of these new jumping kinds ofthings, do talk to your doctor.
Well, there was a meta-analysisof 80 clinical trials in
postmenopausal women.
There were 5,500 women in thisstudy.
So it's a large number of trialsand a large number of people.
(20:57):
And what they did was to ask thequestion: did a mixture of
strength training, going to thegym, lifting weights, and impact
exercises, you know, jumping,running, did it make a
difference?
And what they found was therewas real improvements in bone
(21:18):
mass, bone um activity in boththe spine and the hip, so that
this worked.
You don't just have to take theinevitability of losing your
bone mass.
Both a combination of strengthtraining and impact training
made a difference.
Now, here is where the studiesget really interesting.
(21:44):
If you look at people who haveosteopenia, a little bit of loss
or osteoporosis, same benefit.
So it isn't that, oh, I've lostbone already, I'll never regain
it.
It match people regardless.
It also helped uh women, whetherthey were in early menopause or
late menopause.
(22:05):
So the key here is all women canbenefit from this.
Again, talk to your doctor ifyou already have significant
loss.
Okay, step four.
As we get older, here's aquestion.
Do we need to rest more?
I don't mean rest in betweensets or rest between each mile
(22:27):
you run.
I'm talking about days of rest.
Do older people need more daysof rest?
Now, I wish there were lots ofgreat studies to definitively
answer this question.
I'm older, I'm doing stuff.
Do I need to take more days ofrest during my week?
Whereas I might have worked outfive or six days a week, should
(22:49):
I now work out more for likefour or five days a week?
Again, there's mixed data outthere.
But there was a study, a coupleof studies.
This small one asked thequestion: if you take people who
are young and you take peoplewho are middle-aged, and you
give them a pretty significantsquatting exercise regimen where
(23:11):
you're really squatting a lot ofweight, you know, not your
maximum, about 60% of yourmaximum, uh, reps of 10.
And they asked the question whogot sorer, who found their
muscles weren't working so wella day, uh, two days, three days
later.
(23:32):
So they looked at soreness, theylooked at the strength of the
muscles, and they looked atvarious blood markers.
What did they find?
Well, middle-aged people hadmore soreness on day one and day
three than the younger people.
And then when they tested themuscles to see, you know, had
they fully recovered, the peoplewho were middle-aged had lower
(23:55):
strength.
Of course, it came back, but ittook more days to come back.
So again, there aren't greatstudies on muscle and exercise
as we get older.
But let me give you an analogywhere the data is pretty clear,
and that is skin.
If we wound our skin, get a cut,and you compare young people
(24:18):
with older people, there isabsolute data to show that in
general, older people repairtheir skin more slowly.
And that's pretty clear from theevidence, lots of studies.
So I take this information aboutskin repair, add it to the more
modest information about musclerepair, and conclude that it
(24:41):
seems reasonable as we get olderto take more days of rest.
Now, does that mean youshouldn't walk seven days a
week?
Of course not.
When I'm talking about restdays, it's rest days after more
rigorous activities.
So when you feel sore, you did alot of exercise and you might
(25:02):
want to take more time off thanwhen you're younger.
All right, now we're on toprobably the most important part
of this discussion, part four,the risk of injury and the risk
of consequences of injury as weget older.
Okay, we have a big dilemma youand I need to talk about.
(25:27):
Exercise and sports areimportant.
I've made that really clear inthis episode and in many others.
But getting injured is aproblem.
And the more you exercise, themore you do sports, the more
likely you are to get injured.
Look, injuries happen.
(25:48):
Um and they happen at an evenhigher rate in old people than
ever before, probably becausewe're playing more pickleball,
doing more skiing.
People are getting tendonproblems, rotator cuff problems
in their shoulders, Achillestendons in their lower leg.
(26:09):
In people above age 65, over thelast decade, there was an
increase of 20% in injuries, ashas been shown.
And of course, if you getinjured, you have a much higher
likelihood of having a fractureending up in the hospital and
everything else.
Now, when you are 15 years oldor 20 years old or 28 years old,
(26:34):
and you hurt yourself, yeah, youmight skip exercise for a day or
two, and generally people bounceback pretty quickly.
The problem is, as we get older,when injuries happen, we get
into a catastrophic downwardspiral.
(26:56):
What do I mean by that?
Well, if you get injured, youhave less movement.
If you have less movement, youhave muscle loss.
So a couple of studies to kindof bring this home.
Now, these are admittedly in youknow older, older people, but
the concept is there.
So they looked at people who umhad uh immobilization, meaning
(27:18):
they they really were prettymuch at uh in the hospital or at
bed rest.
And after two weeks of that,just two weeks, there was 5%
loss of their muscle thigh mass.
And in another study, 10 days ofbed rest in an older person,
they lost a pound to a pound anda half of muscle.
(27:40):
And as I said earlier, when youlose muscle, you lose a
multiplier effect on yourstrength.
So that loss of muscle probablyrepresents an even greater loss
of strength.
Now, you can absolutely restartyour exercise as soon as
possible.
But if you have a significantinjury where you're out of
(28:03):
commission for a month or two,say you really hurt your knee,
you you know, you you um toresome ligaments, you um uh had a
meniscal tear from skiing or youknow, a bad uh pickleball uh
injury, you're gonna lose musclemass and you may never ever
(28:23):
regain it.
Now, you can try your best, youcan try to regain as much as you
can.
If you started out with moremuscle because you've been
working at it for a long time,you do have more to lose.
But this is something as we getolder, we absolutely need to
think about.
So, what do you do with thisinformation?
(28:44):
I would say do an audit.
What sports do you enjoy doing?
Is it skiing?
Is it cycling?
Is it running?
Is it mostly golf and hiking?
And what's the risk-benefittrade-off?
Meaning, how much do you loveskiing a couple times of year
versus the risk of you having abad injury and having that
(29:07):
downward spiral, which is a realproblem?
Are there modifications you cando?
So, for example, if you lovedoing riding your bike outdoors,
maybe you do more sessionsindoors on an indoor trainer.
Uh, if you're a skier, maybe youdecide as you get older you're
(29:28):
not going to do those aggressiveruns, even though you want to
show your kids that you're stillable to do that.
For many of us, we have thebelief that it won't happen to
me.
But it can.
I'm not saying it's going to,but it can.
And you need to decide whetherthe risk is okay given what
(29:52):
might happen if you getparticularly injured and have
that period of recuperation.
Again.
Again, you may never regain thatstrength and that muscle mass
fully.
What have I done?
Well, I um I don't ride my bikeoutdoors as much, maybe once a
(30:13):
week at this point.
I do ride indoors, I do lots ofother things, but I realize, you
know, it's not that uncommon tohave a bicycle accident.
And it isn't just a uh a carthat comes and gets too close to
you.
You know, you get a flat tireand you lose control, or there's
a patch of wetness or gravel.
(30:34):
And I'm not willing to take asmuch risk as before because I'm
such an active person.
If I were to have that and losea lot, I'm not sure that I would
be a happy person.
All right, part five.
Let's wrap up.
Do continue to exercise or startdoing exercise as you get older.
(30:58):
Critical.
And in general, there's no needto have major modifications.
You're not going to hurt yourbody by doing these activities,
the strength training or joggingor something like that.
Strength is key as well aspower.
So keep in mind your type one,your type two fibers, and do
(31:20):
take care of both sets.
So do weightlifting, do jumpingor impact exercises.
Of course, obviously, do yourregular aerobic exercise.
Consider how often you restbecause you might need more as
you get older.
And seriously consider the risksassociated with what you do.
(31:42):
Perhaps dial back some of thoserisky activities so that this
doesn't happen to you.
Well, my dear listeners, I hopeyou all live long and well.
And with these tips, you may beable to continue doing all of
that for many decades to come.
(32:04):
Thanks so much for listening toLive Long and Well with Dr.
Bobby.
If you like this episode, pleaseprovide a review on Apple or
Spotify or wherever you listen.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
(32:24):
health and longevity, pleasevisit me at Dr.
Bobby Livelongandwell.com.
That's Doctor as in Dr.
Bobby Livelongandwell.com.
Here's a paradox.
Exercise is the single mostpowerful intervention for
healthy aging.
Yet a single injury could undoyour fitness gains.
Where's the line between use itor lose it and unnecessary risk?
(00:21):
How might we think aboutexercise as we get older?
And when does older actuallybegin?
I'll share evidence-based stepsyou can take.
Hi, I'm Dr.
Bobby Du Bois, and welcome toLive Long and Well, a podcast
(00:47):
where we will talk about whatyou can do to live as long as
possible and with as much energyand figure that you wish.
Together we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey, and I hope
(01:07):
that you feel empowered alongthe way.
I'm a physician, Iron Mantriathlete, and have published
several hundred scientificstudies.
I'm honored to be your guide.
(01:30):
Should your exercise changealso?
Many listeners have asked meabout this question.
As we get older, should we justcontinue what we're doing?
Do more?
Do less?
Do it differently?
What does the evidence tell us?
Now, this episode is reallyimportant for my listeners who
(01:51):
are 50 years or older, but it'salso really important for people
who are younger.
Why?
Because this is going to happento you too, and you might as
well try to get ahead of theproblem as early as possible.
And you probably have parentsand older people in your life.
This knowledge might help them,and you can help them as well.
(02:16):
Well, why now?
Well, one of the reasons, ofcourse, is you asked for it.
But in the recent Iron Man WorldChampionships in Kona, Hawaii,
they had the first 80-year-oldever finish the race.
And this was a race that's twoand a half mile swim, it's a
(02:39):
hundred and twelve miles bikeride, and then a full marathon.
So for an 80-year-old to dothis, that's pretty incredible.
The topics also came up with theNew York City Marathon, which is
a huge marathon that justhappened.
There were 4,000 people abovethe age of 60 and over 500 that
(03:02):
were above the age of 70.
So clearly, older people aredoing exercise and doing
endurance events.
Topics also relevant for me.
I'm 69 years old, and I'mcompeting and will hopefully
just finish another Iron Manrace this weekend.
And by the time this episodecomes out, I hopefully will have
(03:25):
finished that race.
This is a half Iron Man.
I've done about four full IronMan races and about 15 of the
halves.
Well, I'd like to explore thistopic in four parts.
Part one, a reminder, real briefreminder of why sports and
exercise is really important inour life.
(03:46):
Life enjoyment for our heart,for our muscles, for our brain,
and our bones.
Part two, what are we up againstas we age?
There are changes in our bodies,of course, in our muscles, our
joints, and our bones, and howare we going to address that?
Part three, what practical,tangible, evidence-based steps
(04:10):
can you take to prevent some ofthese age-related losses?
And four, something you mightnot have thought about.
The risk of injury goes up as weage.
Not only does it go up as weage, but when we get injured,
the consequences as you getolder of that injury and being
(04:33):
off your exercise regimen for aperiod of time is
extraordinarily consequential.
And we need to think about that.
Okay, before diving into theevidence on the topic, I want to
thank you, listeners, forsharing with me how my work has
influenced you.
So some of my listeners talkedabout how they incorporated the
(04:55):
end of one approaches for sleepand weight loss and various
other things.
Some people said that they'vechanged their sleep with
lowering their bedroomtemperature, which has really
helped, or they've made exercisea priority in their life, or
they're using a home bloodpressure monitor, or they're
working with various of thetechniques I suggested to reduce
(05:18):
calorie intake, like the20-minute rule, or using smaller
plates.
And many of you are drinkingless, less than six or seven
alcoholic drinks per week.
And one of you said, you're notconvinced about ice baths.
That's okay.
You do all the other stuff.
That would be wonderful.
Others of you, can you shareyour thoughts?
(05:40):
Uh, in part, this is importantto me, but it's also important
because I want to put together asurvey to really understand how
change is happening in folks'lives and how I can support that
even more.
And as always, tell your friendsabout the podcast.
Hopefully they'll listen andenjoy it as well.
All right, part one (05:59):
the benefits of exercise.
Well, you know, why do we dosports?
Why do we do exercise?
For a lot of reasons.
One, sports are fun.
Some people love golf or tennisor skiing or pickleball or
soccer or basketball.
They love to ride a bike or evena motorcycle.
Of course, there's the longevitybenefits.
(06:21):
You'll live longer, multipleyears longer, if you have a
regular sports and exerciseprogram.
And that helps prevent keyillnesses of your heart, your
brain, cancer, diabetes, and thelike.
And really importantly, we hopethe sports and exercise will
prolong our good years and thatwe can continue to be functional
(06:44):
decade after decade afterdecade.
But how can we do this as we getolder?
Well, to figure out what to do,we first have to figure out in
part two, what are we upagainst?
So our bodies are changing inthree key areas that we're going
to need to focus on.
(07:05):
First, muscle mass loss.
We lose, probably after age 30,1 to 2% per year of our muscle
mass.
Now that turns out to be about10 to 20% of our muscle mass per
decade.
What I haven't talked beforeabout is that our muscle mass
(07:26):
may decline at a certain rate,but the strength we have
actually declines much faster.
So we may lose 5 or 10% ofmuscle mass, but that might lead
to 10, 20, 30 percent loss ofstrength.
So it's not a simplerelationship, and keep in mind
(07:47):
that strength is very important.
A tiny bit of physiology.
Our muscles are woven togethertwo different fiber types.
One, type one and type two.
Type one is what we use forendurance, walking, hiking, um
(08:08):
uh, and doing things like a slowbike ride.
And then there are the type twofibers.
Those are the fast twitch fibersthat gives us bursts of power
and speed and strong movementslike jumping, which of course is
critically important, havingsome of this powerful uh
(08:30):
strength if we want to avoidfalls or avoid lots of things
and do things that are importantto us.
Here's the catch.
As critical as those type twofibers are in terms of bursts of
power and speed, we tend to losemore of those fibers than the
endurance type one fibers as weget older.
(08:52):
Yes, we lose both types, but weare gonna preferentially lose
the type 2 ones, meaning ourpower, our strength.
And that is so important to keepin mind as we begin to explore
what we can do about this.
Here's an interesting finding Iwasn't aware of, but evidence
(09:13):
suggests that yes, men losemuscle mass over time, women
lose muscle mass over time.
Turns out that the amount ofmuscle mass, not in terms of
actual pounds, butpercentage-wise, is the same
between men and women.
I would have thought maybe itwould have been different
because of testosterone levels,changing hormone levels in women
(09:34):
as they age, but it turns out weall lose a certain amount of uh
muscle percentage of our muscleyear after year after year, men
as well as women.
Now, let's move on to bone loss.
And here the sex differences arereally profound and really
important.
So women uh and men build uptheir bone mass when you're
(09:59):
young and in your teens andprobably 20s.
For women, during their 20s,30s, 40s, up until menopause,
they don't lose a lot of bonemass.
However, there's a huge changein the five to 10 years around
(10:19):
menopause, where women lose 2-3%of their muscle, excuse me,
their bone mass in their spine ayear, 1 to 2% in their hip or
their lower forearm.
That's like 10 to 30% of yourbone mass in women lost per
decade.
(10:40):
Now, you do that two, three,four, five decades, and now you
see why it's a huge issue.
Now, after those five to tenyears of uh profound loss, women
do slow down the rate of loss asthey get into their 60s, 70s,
and beyond.
They still lose bone mass, butnot at quite the same rate.
(11:03):
Okay, so losing bone mass isimportant because it gets you to
a point of too little bone.
If you have too little bone,first it's called osteopenia.
And then if it worsens, worsens,worsens, at some point it
becomes osteoporosis.
And obviously the brittleness ofyour bones corresponds with how
(11:27):
much bone loss there's been.
So 50% of women in their 50s andbeyond have osteopenia, a
reduced amount of bone mass.
And about 20% have osteoporosis.
Now, for men, yes, we lose somebone mass, but two things.
There's no cliff, there's noperiod of years where it's
(11:50):
hugely greater.
We just gradually tend to lose,and we tend to lose a lot less
than women do.
So in our 50s, we lose about ahalf a percent to a percent per
year, or about a quarter of theloss that women experience.
But men get osteopenia in their50s and beyond.
(12:14):
Maybe a third of men get that,but relatively few men, maybe 4%
and older men, get osteoporosis.
So problem for all, fracturesare a problem for all, a bigger
problem for women.
All right, the third piece ofthe aging puzzle is joint damage
(12:35):
and osteoarthritis.
So the risk of osteoarthritis,which often happens in our knees
and our hips, and it can be inyour hands as well, does
increase as we get older.
It's only about a 3% risk in our20s.
It rises to about a 10 to 15%risk likelihood in our 60s, but
(12:58):
by the time we're in our 80s,it's probably about half of us.
And if you get osteoarthritis,it causes pain, pain in your
joints, and it will be moredifficult for many people to
exercise.
So, as a long-term runner, Ihave been a fan of studies that
ask the question (13:18):
does running worsen your knees and cause
osteoarthritis?
Because many people say, Dr.
Bobby, do I need to give uprunning as I get older?
And the answer from the researchI'm about to show says no.
So one is called the StanfordStudy.
(13:39):
They took a group of runners whowere age 45.
I'm not 45 runners who were intheir 50s, and they compared
with a similar number of peoplewho weren't runners, and they
followed them for 20 years,asked them about knee symptoms,
asked them to get x-rays oftheir knees.
(14:01):
And what did they learn?
Well, both the runners and thenon-runners, as they got older,
they had a higher likelihood ofosteoarthritis.
But here's the critical piece ofthe puzzle the runners didn't
get more osteoarthritis than thenon-runners.
So the running didn't seem toaccelerate the problem.
(14:22):
Okay, that was a relativelysmall study.
There was an analysis of 17studies.
7,000 runners, 7,000non-runners, and they were about
in their mid-50s, and theyfollowed them for five years and
they did X-rays as well.
What did they find?
There was no difference betweenthe runners and the non-runners
(14:46):
in the X-ray look at theirknees.
Perhaps there was a little moreknee pain in the non-runners.
There was also a study ofpatients that already had
osteoarthritis, 1,200 people intheir 60s.
And they were overweight, BMIabout 29.
So they looked at runners andnon-runners in people who
(15:10):
already had osteoarthritis.
Guess what happened?
The people who were runnersdidn't have worse osteoarthritis
than the non-runners.
So what does this all mean?
It probably means that runningby itself doesn't cause
arthritis.
And if you're otherwise healthyand you enjoy running for all
(15:30):
sorts of reasons, consider doingit some more and onwards as you
get older.
Now, here's a couple of caveats.
Where arthritis becomes an issueis if you have injured the
joint.
So if you had a meniscal tear,if you had a ligament tear, the
unsteadiness of that joint doesincrease your risk of
(15:54):
osteoarthritis.
So if this has happened for you,talk with your doctor about
running and whether that wouldcontinue to be safe for you.
Also, if you're quiteoverweight, running might put
stress on your joints.
So again, talk to your doctorabout it.
All right.
We've had the depressingdiscussion of what happens as we
(16:15):
get older.
Now, part three, the optimisticpart.
What can we do about it?
How can we maintain our muscles,bones, and joints?
Now, if you're going to embarkupon an exercise regimen and
some of the things I'm talkingabout, and you haven't been
doing it for a while or ever,talk to your doctor.
(16:36):
Make sure all is well before youjump right in.
Okay, so there's a series ofsteps, things you can do to
help.
Step one, build strength.
Build strength, build strength.
Why?
Well, the more you have, meaningif you can build up more, the
more you're able to lose.
(16:57):
Because at some point when youget weak, it gets harder to get
your life done and do the thingsyou want to do.
So if you can build up more, youhave more to lose.
And if you work at it, theinevitable losses in muscle mass
and strength, you can diminishthat loss, maybe even reverse
(17:18):
it.
Here's the problem.
Only 27% of U.S.
adults do resistance exercises.
And this drops to just 10% ofpeople over the age of 75.
Now, the good news is whetheryou're 30, 40, 60, or 80, it is
(17:40):
never too late to start.
And there's a lot of studies inolder people that show it's safe
and it works.
And one study that looked at75-year-olds, and they were able
to increase muscle strength andsize through resistance
training.
Here's one example of a study.
12 weeks in people who were intheir 60s, 65 to 75, and those
(18:06):
who were above 85.
So they compared them and askedthe question: did the
85-year-olds gain muscle justlike the 65 to 75-year-olds?
And the answer is yes, they bothgained about 10% increase in
their quadriceps muscle size anda 38 to 46% increase in leg
(18:28):
strength.
Here's the wonderful thing.
There were no differences inresponse by age groups.
Yes, pound for pound, the olderpeople gained less muscle, but
proportionally they gained justas much.
Also, heavy strength training isalso safe and can be helpful.
(18:49):
All right, so that's our firstpart of thinking about our
muscles.
But remember, above, we talkedabout the type 1 and type 2
fibers.
So step two, help support yourtype 2 fibers.
Remember, we preferentially losethe power and speed fibers as we
(19:10):
get older.
And our quads are critical forgetting out of chairs and things
like that.
And, you know, hopping andjumping are some of the
activities that emphasize thesekinds of muscle fibers.
But what has been shown is thathigh intensity, so 30 seconds to
(19:33):
two minute bouts of speed orlots of jumping, burpees,
there's a variety of ways thatyou can do this, increases not
only the number of type 2 fibersso you can build back some of
that loss, it also rewires someof our nerves.
(19:53):
And the nerves trigger thosemuscles to do what they need to
do, and that can also improvewith this.
I have a whole episode where Italk about protein intake.
If you're trying to buildmuscle, make sure you have an
adequate amount of proteinintake.
All right, step three.
After worrying about our bone,our muscles, now we got to worry
(20:16):
about our bones.
So step three, support yourbones.
Here, there are two sets ofactivities you want to do.
The resistance training we justtalked about, but also impact
exercises, the jumping, therunning, those kinds of things.
Look, if you already have a lotof bone loss before you do some
(20:37):
of these new jumping kinds ofthings, do talk to your doctor.
Well, there was a meta-analysisof 80 clinical trials in
postmenopausal women.
There were 5,500 women in thisstudy.
So it's a large number of trialsand a large number of people.
(20:57):
And what they did was to ask thequestion: did a mixture of
strength training, going to thegym, lifting weights, and impact
exercises, you know, jumping,running, did it make a
difference?
And what they found was therewas real improvements in bone
(21:18):
mass, bone um activity in boththe spine and the hip, so that
this worked.
You don't just have to take theinevitability of losing your
bone mass.
Both a combination of strengthtraining and impact training
made a difference.
Now, here is where the studiesget really interesting.
(21:44):
If you look at people who haveosteopenia, a little bit of loss
or osteoporosis, same benefit.
So it isn't that, oh, I've lostbone already, I'll never regain
it.
It match people regardless.
It also helped uh women, whetherthey were in early menopause or
late menopause.
(22:05):
So the key here is all women canbenefit from this.
Again, talk to your doctor ifyou already have significant
loss.
Okay, step four.
As we get older, here's aquestion.
Do we need to rest more?
I don't mean rest in betweensets or rest between each mile
(22:27):
you run.
I'm talking about days of rest.
Do older people need more daysof rest?
Now, I wish there were lots ofgreat studies to definitively
answer this question.
I'm older, I'm doing stuff.
Do I need to take more days ofrest during my week?
Whereas I might have worked outfive or six days a week, should
(22:49):
I now work out more for likefour or five days a week?
Again, there's mixed data outthere.
But there was a study, a coupleof studies.
This small one asked thequestion: if you take people who
are young and you take peoplewho are middle-aged, and you
give them a pretty significantsquatting exercise regimen where
(23:11):
you're really squatting a lot ofweight, you know, not your
maximum, about 60% of yourmaximum, uh, reps of 10.
And they asked the question whogot sorer, who found their
muscles weren't working so wella day, uh, two days, three days
later.
(23:32):
So they looked at soreness, theylooked at the strength of the
muscles, and they looked atvarious blood markers.
What did they find?
Well, middle-aged people hadmore soreness on day one and day
three than the younger people.
And then when they tested themuscles to see, you know, had
they fully recovered, the peoplewho were middle-aged had lower
(23:55):
strength.
Of course, it came back, but ittook more days to come back.
So again, there aren't greatstudies on muscle and exercise
as we get older.
But let me give you an analogywhere the data is pretty clear,
and that is skin.
If we wound our skin, get a cut,and you compare young people
(24:18):
with older people, there isabsolute data to show that in
general, older people repairtheir skin more slowly.
And that's pretty clear from theevidence, lots of studies.
So I take this information aboutskin repair, add it to the more
modest information about musclerepair, and conclude that it
(24:41):
seems reasonable as we get olderto take more days of rest.
Now, does that mean youshouldn't walk seven days a
week?
Of course not.
When I'm talking about restdays, it's rest days after more
rigorous activities.
So when you feel sore, you did alot of exercise and you might
(25:02):
want to take more time off thanwhen you're younger.
All right, now we're on toprobably the most important part
of this discussion, part four,the risk of injury and the risk
of consequences of injury as weget older.
Okay, we have a big dilemma youand I need to talk about.
(25:27):
Exercise and sports areimportant.
I've made that really clear inthis episode and in many others.
But getting injured is aproblem.
And the more you exercise, themore you do sports, the more
likely you are to get injured.
Look, injuries happen.
(25:48):
Um and they happen at an evenhigher rate in old people than
ever before, probably becausewe're playing more pickleball,
doing more skiing.
People are getting tendonproblems, rotator cuff problems
in their shoulders, Achillestendons in their lower leg.
(26:09):
In people above age 65, over thelast decade, there was an
increase of 20% in injuries, ashas been shown.
And of course, if you getinjured, you have a much higher
likelihood of having a fractureending up in the hospital and
everything else.
Now, when you are 15 years oldor 20 years old or 28 years old,
(26:34):
and you hurt yourself, yeah, youmight skip exercise for a day or
two, and generally people bounceback pretty quickly.
The problem is, as we get older,when injuries happen, we get
into a catastrophic downwardspiral.
(26:56):
What do I mean by that?
Well, if you get injured, youhave less movement.
If you have less movement, youhave muscle loss.
So a couple of studies to kindof bring this home.
Now, these are admittedly in youknow older, older people, but
the concept is there.
So they looked at people who umhad uh immobilization, meaning
(27:18):
they they really were prettymuch at uh in the hospital or at
bed rest.
And after two weeks of that,just two weeks, there was 5%
loss of their muscle thigh mass.
And in another study, 10 days ofbed rest in an older person,
they lost a pound to a pound anda half of muscle.
(27:40):
And as I said earlier, when youlose muscle, you lose a
multiplier effect on yourstrength.
So that loss of muscle probablyrepresents an even greater loss
of strength.
Now, you can absolutely restartyour exercise as soon as
possible.
But if you have a significantinjury where you're out of
(28:03):
commission for a month or two,say you really hurt your knee,
you you know, you you um toresome ligaments, you um uh had a
meniscal tear from skiing or youknow, a bad uh pickleball uh
injury, you're gonna lose musclemass and you may never ever
(28:23):
regain it.
Now, you can try your best, youcan try to regain as much as you
can.
If you started out with moremuscle because you've been
working at it for a long time,you do have more to lose.
But this is something as we getolder, we absolutely need to
think about.
So, what do you do with thisinformation?
(28:44):
I would say do an audit.
What sports do you enjoy doing?
Is it skiing?
Is it cycling?
Is it running?
Is it mostly golf and hiking?
And what's the risk-benefittrade-off?
Meaning, how much do you loveskiing a couple times of year
versus the risk of you having abad injury and having that
(29:07):
downward spiral, which is a realproblem?
Are there modifications you cando?
So, for example, if you lovedoing riding your bike outdoors,
maybe you do more sessionsindoors on an indoor trainer.
Uh, if you're a skier, maybe youdecide as you get older you're
(29:28):
not going to do those aggressiveruns, even though you want to
show your kids that you're stillable to do that.
For many of us, we have thebelief that it won't happen to
me.
But it can.
I'm not saying it's going to,but it can.
And you need to decide whetherthe risk is okay given what
(29:52):
might happen if you getparticularly injured and have
that period of recuperation.
Again.
Again, you may never regain thatstrength and that muscle mass
fully.
What have I done?
Well, I um I don't ride my bikeoutdoors as much, maybe once a
(30:13):
week at this point.
I do ride indoors, I do lots ofother things, but I realize, you
know, it's not that uncommon tohave a bicycle accident.
And it isn't just a uh a carthat comes and gets too close to
you.
You know, you get a flat tireand you lose control, or there's
a patch of wetness or gravel.
(30:34):
And I'm not willing to take asmuch risk as before because I'm
such an active person.
If I were to have that and losea lot, I'm not sure that I would
be a happy person.
All right, part five.
Let's wrap up.
Do continue to exercise or startdoing exercise as you get older.
(30:58):
Critical.
And in general, there's no needto have major modifications.
You're not going to hurt yourbody by doing these activities,
the strength training or joggingor something like that.
Strength is key as well aspower.
So keep in mind your type one,your type two fibers, and do
(31:20):
take care of both sets.
So do weightlifting, do jumpingor impact exercises.
Of course, obviously, do yourregular aerobic exercise.
Consider how often you restbecause you might need more as
you get older.
And seriously consider the risksassociated with what you do.
(31:42):
Perhaps dial back some of thoserisky activities so that this
doesn't happen to you.
Well, my dear listeners, I hopeyou all live long and well.
And with these tips, you may beable to continue doing all of
that for many decades to come.
(32:04):
Thanks so much for listening toLive Long and Well with Dr.
Bobby.
If you like this episode, pleaseprovide a review on Apple or
Spotify or wherever you listen.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
(32:24):
health and longevity, pleasevisit me at Dr.
Bobby Livelongandwell.com.
That's Doctor as in Dr.
Bobby Livelongandwell.com.
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