AARP's website still proclaims, "Older people often get sick or become disabled not from exercise, but from inactivity. Physical activity has even been shown to improve chronic diseases and conditions, such as arthritis and diabetes."

The American College of Sports Medicine continues to recommend regular flexibility training be part of a well-balanced exercise program in order to minimize the changes that occur with aging. Recently, a local sports medicine physician advised me, "The trick is to exercise enough but not to exercise too much." But how much is too much?

For the athletic senior, the major spoiler is the joint injury that requires surgery to relieve pain. Among all seniors, accidental falls are a major cause of injuries to backs, shoulders, knees and hips.

"One in every three persons over the age of 75," says David Severson, P.T., "suffers at least one major fall per year." A graduate of the University of North Dakota School of Medicine, Severson has been a practicing physical therapist since 1971, and the sole owner of the Milpitas Physical Therapy Clinic since 1980. He estimates that 60 percent to 70 percent of his clinic's patients are seniors. He and his numerous staff have designed exercise programs to return injured senior athletes to running, jogging, hiking and cycling. The therapist himself ran his first marathon at age 55.

The clinic's "Run Again" program includes exercises that increase flexibility, core and extremity strength, and balance. The latter is trained by stimulating proprioception--the ability to sense the spacial position of the body and limbs, independent of sight--a fine-tuning of the sense of balance that can aid not just the athlete, but also the frail elder who often trips and falls.

The "Midlife and Beyond" rehabilitation program includes pain control counseling, flexibility-strength-core stability-balance-endurance exercises, joint protection exercises, and transitioning to lifelong exercise habits that reward the patient with high levels of function. Many seniors arrive at the Milpitas Physical Therapy Clinic feeling that they are "falling apart" and with little expectation of their abilities to improve. Severson has achieved dramatically improved function with even frail elders.

Much of the prevention of injuries in the clinic's programs is due to the element of cross-training, a strategy highly recommended by researchers and other experts in sports medicine. The risk factors for joint injury and for arthritis are ironically similar: age, excess weight, heredity, inactivity and repetitive, high-impact stress for long periods of time--for example, arthritis and/or joint injuries to the hand are more frequent among boxers, elbow problems among tennis players and knee problems among runners.

According to Dr. Steven Fleck, sports physiologist for the U.S. Olympic Committee in Colorado Springs, the key to physical performance as we age is to be consistent in our exercise programs. Investigators at the University of Illinois have stated that there is no reason to expect significant decrease in flexibility over time in healthy adults. Their research suggests that until the age of 74, any substantial loss of joint mobility should be viewed as abnormal and not attributable to aging, and therefore should be treated much as it would be in a younger individual. These are encouraging results, but usually tempered with the caution that a balanced exercise program is key to continued mobility.

Although it's been reported that seniors don't stumble any more often than younger people, without continued exercise older seniors are not able to recover their balance quickly enough to prevent falls. Strength and balance training can increase the nervous system's ability to control fine movements, coordination and muscular responses. Proper flexibility training can improve mobility, Severson says, but "too much stretching, I believe, can create problems rather than solve them."

Aerobic exercise (such as running) is essential for cardiac training, but it does little for balance, the therapist affirms. Balance requires strength, and strength is needed for the core (trunk) and the extremities. Neglect of any piece of the exercise puzzle, and the patient can lose out on the most efficient, effective results. As we age, this balanced approach becomes more critical. Balanced exercise programs minimize the age barrier and maintain function at its maximum. Severson encourages patients to exercise longer and slower with each passing decade. For example, one hour of activity per day, six days per week, for the 50-something senior, changes to one hour and 10 minutes per day for the 60-something senior, and so on. The patient learns to focus on technique and joint protection rather than intensity.

El Camino Hospital