- [Narrator] "Health Matters" is proudly supported by MultiCare.

(lighthearted music) - Fitness and nutrition are important factors in longer life, and have a big impact on our quality of life as we age.

How much do we need, and what works best?

That's coming up next on "Health Matters".

(lighthearted music continues) Welcome to "Health Matters".

I'm Aaron Luna.

The recipe for a longer, more rewarding life.

Can it be as simple as staying active and eating healthy?

How do we define "active", and what happens when we stop moving?

Big questions with hopefully simple answers.

Joining us tonight with insight into these issues, Amber Nelson, physical therapist, and director of Aquatic Therapy at U-District Physical Therapy.

Dr. Mohit Jain.

Cardiologist at MultiCare Health Systems.

And Brittany Thorpe.

Registered dietician for MultiCare Health Systems.

When we say fitness, what are we talking about?

My mind thinks of middle school gym classes, how fast we can run the mile, how many sit-ups and pushups we can do.

The sit and reach.

Let's start with Dr. Mohit Jain.

Dr. Jain, how do we measure our fitness levels, especially as we age?

- Yeah, great question.

I think there's multiple ways of measuring fitness levels.

In the medical literature, we talk about heart rate responses, we talk about heart rate recovery aspects.

When we're looking at patients that need advanced cardiac care, we're looking at something called the VO2 max.

These are all very esoteric numbers to most of our viewers.

But in general, for our viewers, I would recommend just doing 30 minutes of moderate intensity exercises.

That is the current recommendations by the American Heart Association.

And that's five days a week.

So whatever you can do, that's good fitness.

(Mohit chuckles) - So there's not, like you were saying, there's not a yardstick that we need to measure ourselves with per our age.

- Exactly, yeah.

I wouldn't recommend any particular yardstick.

As we age, our heart rates do decrease.

We kind of use a formula of 220 minus age as prediction of maximum heart rate.

And you know, as we do age, that number does come down.

So I wouldn't recommend any yardstick measurements, but as much as you can do, if you can get to 30 minutes, five days a week.

(Mohit chuckles) - Gotcha.

Great.

Amber, a lot of us think of a fitness routine as going on runs a few times a week, or hitting the gym regularly.

It just doesn't have to be that though.

- No, and it's interesting, 'cause the CDC, as you're talking about, recommends 150 minutes a week.

So you can break it down to 30 minutes every time.

And it's moderate activity.

So moderate activity is, your heart rate is up, you're feeling a little bit of a sweat, but you can still talk to somebody.

So if you can hit that max.

And that can be gardening, that can be taking your dog on a walk, that can be going out dancing.

Whatever it is, it's just gotta be active, and you've gotta get a little bit of a sweat.

The other thing that the CDC recommends is some type of weight training or balance training.

So two days a week, getting something that's gonna help build those muscles.

Because as we age, our muscle mass starts to decrease.

So anything that you can do to keep your strength, and keep your balance, is what's gonna keep you active and moving.

- So it's something that can be as simple as walking around the block with a neighbor.

- Walking around the block with your neighbor.

Sit to stands are one of my favorite ones, where you sit down into your chair without using your hands, and you stand up 10 times.

It can be anything that you enjoy.

And so I think that's the thing that people sometimes seems daunting is... Activities should be fun.

And so you've gotta find something you like, otherwise you're not gonna stick with it.

- Mhm.

And sticking with it seems- - And consistency is key, right?

Rest is rust.

Your body's gonna stop moving as well.

And consistency is key.

So you've gotta find something you like.

For me, friends are huge.

So you've gotta find a tribe that's gonna keep you going.

- [Aaron] Someone to keep you accountable.

- Somebody to keep you accountable, right?

You don't wanna get up, you don't wanna go, but that friend's gonna call you, and give you a little bit of grief if you don't get going.

That's how the consistency keeps them in check.

- Well, we're talking about consistency, we're talking about movement.

They're only half the equation here.

Brittany Thorpe, registered dietician with MultiCare.

Brittany, what goes into our bodies is just as important as how we use them.

- Oh, absolutely.

So, food is fuel.

So if you're not fueling your body appropriately or adequately, we can't be expecting our bodies to function as well as they could or they should be.

So, nutrition is pivotal, you know, at all ages, and really for almost every condition and organ in our body.

So, same with activity and aging.

We wanna make sure we're getting a well balanced, you know, kind of rounded diet, and there are some key nutrients that are a little bit more increased and important to focus on as we age.

But still, it's pivotal.

- Mhm.

When we talk about well-rounded, what do we mean there?

- Yeah, so, when we're thinking about a balanced diet, it doesn't mean we're completely restricting food groups.

So, we do wanna be incorporating all the color on our plates.

So we're getting our good protein sources, when we're choosing lean proteins like chicken, turkey, fish.

Those are more heart healthy.

So, less on like bacon, and you know, sausage to me may like- - [Aaron] It's disappointing to hear.

- I know!

I'm sorry to be the bearer of bad news.

But you know, also, high sodium foods do increase our blood pressure, so it's increasing risk of stroke and things like that.

But anyway, so we do get balance with lean protein, getting our fruits and our vegetables.

Which can be fresh, they can be frozen, or even canned low sodium.

And grains are not the enemy, but choosing whole grains where we're getting some fiber, which also helps our bowel movements, and trying to limit liquid calories.

And so staying hydrated can be a challenge, especially for older adults, because our thirst decreases.

But we do wanna be choosing things like water.

You know, maybe less reliance on juice or whole fat milk, even though calcium is important as well.

- You see a lot of people- - [Mohit] Sodas are a big one.

- Soda.

- Yeah, certainly.

- Sodas are big junk calories, in sodas.

- Empty.

- So you have one soda a day, and you're adding how many calories to your body?

Or how many... - Well, what soda are we talking about?

(all laughing) - I guess it all depends.

- You know, and how big?

So usually when I'm talking to patients, they'll tell me, "I have one cup of coffee a day."

I'm like... "One cup?

One cup?"

Right?

- [Aaron] Yeah, right.

But yeah, significantly, it makes a difference.

You know, as we age, our calorie needs decrease, but we need to be really focusing on nutrition and nutrient dense foods, or else we're not gonna be fueling right.

- So you're probably a proponent of carrying around a big water bottle that we see everywhere, with the straws.

Everyone loves those.

- Yep.

- Yes.

- And my wife tells me metal is better than plastic.

(Aaron laughs) - That's not my realm, but yeah.

(Brittany laughs) Probably.

- As long as we agree that the water needs to be there, and not the soda, I think that's where we're going.

- [Mohit] Right.

(Mohit laughs) - I don't think you'd be going out on a limb here to say many of us don't always stick to our fitness routine.

Amber, what's a good way to kickstart a fitness journey, especially after it's been a while?

- So I think as we age, we have different requirements with nutrition, and our heart health.

So I think one of the first things is, getting in touch with your doctor, right?

So we wanna make sure that medications are set.

You need to talk with your doctor every year, because as our body changes, those medication needs can change, so that needs to be something that is, you know, always watched out for.

The other thing is watching vision, 'cause our vision changes too.

And so sometimes that can... Make different exercises harder.

So if those two things are set, and then finding a group that works for you.

I think a lot of times people, they take on something, and they take on a really big chunk of it.

And they're like, "All right, I'm gonna go start out.

I'm working five days a week, I'm going to the gym."

And then we fall off that kind of bandwagon because it's too much, and we hurt, and that.

So starting small, having a friend, and starting with something that you enjoy, or you've enjoyed in the past, is usually how we're gonna keep that habit.

- For a little inspiration, and maybe a little bit of a butt kicking, I met up with a 74-year-old Spokane woman who shared how she went from stressed out and unhealthy to strong and vibrant, with the help from a very special community of women.

Three days a week, you can find 74-year-old Paula Nordgaarden at Farmgirlfit.

- I don't think I'd be alive if this place hadn't opened.

- [Aaron] Friday morning, I joined her for "The Grind".

The Grind is a high intensity interval training workout.

And the intensity started with the warmup.

- You just do what you can do.

- Go to your level.

- Yeah, go to your level.

There was a series of exercises, and you could start wherever you wanted.

Starting with 10 wall balls, 10 step ups, mountain climbers and pushups.

Chopsticks.

- [Aaron] 13 years ago, while working in the nonprofit world, Paula looked out the window and noticed a new gym across the street.

- I wasn't in very good shape.

The stress of raising a half a million dollars a year will kill ya.

- [Aaron] Paula wasn't always stressed out and sedentary.

In her younger years, she was a rhythmic aerobics instructor.

However, she really started to slow down in her 50s.

And then at 62 years old, she walked across the street and changed her life.

- I wanted to be strong again.

I wanted to be able to go huckleberry picking and gardening and not hurt.

I was faithful, three times a week.

Plus yoga on Thursday.

And within six months, I was off blood pressure meds, I was off the cholesterol meds, I was feeling great.

I helped build a cabin in Montana that summer.

- Each round.

You get to pick!

- [Aaron] Over the years, Paula learned to fine tune her workouts to better fit her needs.

- I watch my watch.

So I watch my heartbeat.

And if I start to elevate too much, I'll take a little bit of time to rest in between.

And I just kind of pay attention to my own body, and do what I need to do.

But I try to do all the exercises.

Maybe not as many as the other girls do, but I try to do all of them.

- [Aaron] At the end of the day, it's all about training for her big summer goals.

- I spend a week in Montana picking huckleberries every summer, and I wanna continue doing that into my 80s.

- [Aaron] She encourages others, no matter their age or fitness level, to get moving.

- I want older women to know, not to be afraid of doing weight training.

It's so important.

Come down, give it a try.

- All right, we did good.

- We did great!

(Paula and Aaron laughing) (lighthearted music fades) - And Dr. Jain, in Paula's case, that consistent workout really had an impact on her overall health.

Is that unique in that case?

Or is that a benefit most people can expect when they start moving more?

- I think it's a benefit that most people should expect, and will experience.

When we exercise, we dilate the arteries of our body that improves blood flow to not just the tissues, but also back to the heart and the brain.

There's ample clinical literature that it releases endorphins that makes you feel happy.

Once you start exercising, you actually want to do more exercise, because it makes you feel so good.

It's the best antidepressant that we come across.

So, I think most people will experience those kind of beneficial effects.

- You know, we talked about 30 minutes a day.

Do we see incremental increases in those benefits as we go longer?

Or is it just kind of what your body can handle for where you're at?

- Yeah, it's a bit of both.

So, if you look at the curves, the curves are U-shaped.

So if you go really truly beyond, and we're talking the folks that are doing kind of like Orangetheory and Beyond, then you start to see some drop off in the exercise benefit.

But the large majority of us, like, you know, 99% of us will stay within that curve.

And the more you do, the better your effects will be.

So, you know, like the American Heart Association recommends 30 minutes, five days a week.

But if you're going to do high intensity workouts, we recommend maybe three times a week, and then supplementing it with weight training, like my colleagues here mentioned.

So, no one size fits all, but you know, whatever you can do, and sustain it.

And that's really the key.

So, that's what I would recommend.

- And Brittany, not everyone's going to be able to do something like The Grind workout that Paula was doing.

Should we change the way we eat as we change the way we start to move, and the workout routine?

- That's a great question.

Yeah.

So, kind of tying into sports nutrition.

So really in general, we're talking about nutrient timing too.

So, carbohydrates are our body's primary source for quick movement and exercise.

So if you're wanting to feel good and not bonk on energy, then you know, it's important we're incorporating fruits, dairy products, which is great for our older adults, where we do need calcium and vitamin D if it's fortified.

So, keeping those consistent throughout the day.

Same with protein.

So just like Paula is doing, some strength training.

If we are not getting adequate protein consistently throughout the day, which is defined as 20 to 30 grams per meal, 10 to 15 grams at snacks, then not only are we not gonna control hunger well, but we're really not gonna get the recovery that someone is looking for when they are doing movement.

And just kind lastly to touch, I would say also, even though calorie needs decrease with age, yes, if we're active, they're gonna increase a bit.

But really, we wanna make sure we are not significantly under fueling our bodies.

And so not only will that impact that activity at that time, but long term if we're under fueling, it increases risks for injury, which then someone may be out for periods of time, and kind of puts them at a step back.

- As you're changing your movement style and your eating routine to kinda hit that consistency, are there pitfalls that we should be aware of?

Or something that you recommend to kind of make sure that we are getting those healthy proteins, and the right sort of grains?

- Yeah.

So I think in general it's just figuring out what makes sense for your budget, and your preference, and your lifestyle.

So, you know, just in general, nutrition is something we also wanna maintain long term.

So there's a variety of, let's say, fad diets, or you know, just like starting a new routine.

If the nutrition is something where you can't maintain it, then it's not gonna work for you.

So if I'm seeing someone who's an on-the-go mom, or maybe they do need more kind of quick convenience options where we're getting that protein and carbohydrates, they're keeping things in the car, or they've maybe got a protein shake for after, and it works for them.

Whereas, you know, we might see some other people who enjoy cooking, and have more flexibility in their schedule, and so they're making it their routine.

And so yeah, just finding what works for you.

- Oh, and you say the routine is something you can handle, something you'll stick to... And does that translate to two years, three years, one year before you start seeing some, maybe you start to slim down, then you kind of fall off the bandwagon.

Are we talking about this is the lifestyle you should maintain indefinitely?

- Yeah, I would think more of the latter.

You know, this is something that's called healthy lifestyle, or lifestyle modification, That's, you know, top of the line.

So any cardiac therapies are coupled with lifestyle modification, and so this is the way you live.

So that would be my recommendation is, you know, you change your behavior.

And once you are able to change that, and you enjoy like, you know, we've talked about those themes here, then it doesn't feel like a burden, or doesn't feel like a chore.

I get this question asked all the time.

"Doc, what's the best diet?"

And I tell them, "The one that you stick with."

Yeah, so.

Yeah.

- So getting over certain things like that soda, if you have a lot of soda, and you like that.

- Yeah.

- Any sort of tips to kind of break that habit?

- Um, yeah, I think that's another great question.

And I would say, in the same sense, yes, we want a balanced diet, but we also have to make it feel not too depriving, right?

So there is a continuum.

So, would it be ideal if someone didn't have any soda?

Sure.

Where some people are like, "You're never gonna pull that Diet Coke outta my hand, right?"

(people laughing) So maybe we're like, can we reduce that to a reasonable level where we're still able to have that balance, but we can still enjoy the things that are maybe less healthy and acknowledge that.

I mean, nutrition is, in a big sense, enjoyment.

And so as you guys alluded to- - [Amber] You have to live.

- Activity.

Right?

And so, we are looking for that long term.

If we're only seeing temporary changes in nutrition or activity, then those benefits are only gonna last temporarily.

- Right.

Well, there are things that stand in the way of being active.

Time, motivation, pain.

Those small but nagging injuries that we sometimes tend to ignore and hope they go away.

As a physical therapist, Amber, tell us what do people experience when they see that, and how do you kinda get through that?

- Right.

So I think one of the misconceptions that I hear a lot of is, "Well, I'm old, I'm just gonna hurt."

And that's not true, right?

So if we continue to strengthen, we continue to keep our body moving, a lot of that pain is not normal.

So again, talking with your doctor, having a physical therapist.

We wouldn't send our car out without oil changes and keeping maintenance, and yet we tend to ignore our bodies or our aches and pains, thinking this is a normal part of life.

And if that normal part of life is pain, it's not normal.

So, keeping active will bring a lot of those away.

And Paula made a couple good points of like, you may not be able to do everything you did at 18, but you can still do a lot more.

And if you're having pain, go get help and deal with it, so you can continue to move.

Because if you sit on that couch, you can get stuck on that couch.

And I think that's one of the things that people have to really watch for, is not putting it off of, "I'm just old."

- I think when we were talking about pain, as some people think of it just part of life, I think of some, you know, myself included, when you were in athletics when you were younger, and you kind of got the...

The ol' push on the shoulder, suck it up and get back out there... Are we seeing a shift in mentality now as we have more information about how to deal with this chronic pain, and how has that impacted what you do?

- So, we're seeing that throughout the whole board.

From the pediatric of the kids population, all the way through as we age, is pain is not necessarily something that we have to live with.

We should pay attention to it, and address the issues that are causing that pain.

There is a difference though between pain, and hard and tough.

So when we're working out, a lot of times it's hard, and it's maybe not super comfortable.

And those things are okay, and we shouldn't be afraid of 'em.

But that is very different than, "I rolled my ankle, and something really hurts."

Or, "I threw out my back, and now I'm getting those."

So, not being afraid of some discomfort and working out as we get older, and having that feeling of a little bit uncomfortable, but also for having pain, addressing that, talking to your doctor, finding somebody to help you fix what might be going on.

We've got a lot more resources than we had back in the day.

- [Aaron] Yes.

- Yeah.

- And Dr. Jain, think about maybe over the winter, if you're a runner, you don't run as much, then you start running in the spring, the weather's great outside, then your heart starts feeling like, "Whew, I put a lot of pressure on it."

Is that concerning?

What should you watch for?

- Yeah, that's a hard question to answer in generalization aspect, because it depends on what your underlying conditions are.

I always recommend that, you know, you gotta listen to your body.

So if you're having chest pains, you know, make sure that you get checked out.

Women respond very differently.

They don't experience the classic chest pain.

They might experience back pain or jaw pain.

So, I always wanna make sure that you're not having any underlying heart conditions.

But other than that, if you've been given a good bill of health for going on doing exercising, then you do as much as you can.

A practical tip that I often tell patients, this was before COVID when we didn't have a lot of malls.

A lot of my patients would, you know, like window shopping, and I tell them, you know, go walk those Costcos and those malls, you know.

It's not as onerous.

You feel fun, and you know, so that used to get them out, and get them walking.

So there's a lot of ways that you can keep active.

You just gotta figure out what works for you.

And whether it's winter or or summer, stay active.

- Are there foods that help us recover quicker?

And do you incorporate that in your consistent diet?

Or is there some that you can just kind of bring on as an added bonus?

- Yeah.

And I think too, it depends on the intensity of, you know, kind of movement too, and what that activity feels like.

And so from a sports nutrition side, like, we should after a workout, be replenishing with some carbohydrates, 'cause we use those for movement.

We're using our muscles, so we need to be getting some protein.

And then also, hydration is really key too.

And so especially as we age, our thirst mechanism is not as sensitive, and so dehydration is a little bit easier.

So those three things I think I would focus on after an exercise routine.

But just in general, we're having a consistent fuel source for our bodies.

- How about oranges at halftime?

- Yeah.

(all laughing) Our very younger days.

- Halftime?

Are we talking about like, soccer?

- Soccer, yeah.

- Or... - Yeah.

So we're getting some hydration and carbohydrates.

It's great during, you know.

Protein is not used as fuel during an exercise.

So yeah, that protein is really the afterpiece.

So I think during your soccer, oranges are great.

- Mhm.

(Amber chuckles) - And what about, does that vary with children as well?

I mean, we're talking about fitness as you age.

You're not gonna be doing something, and necessarily have the same sort of routine for your child either, I would imagine.

- It depends, right?

So as we talk about, it's not a one shoe fits all.

It depends on what your activity level is.

So if you've got kids, and going out and playing with them, or running and doing soccer, or going on walks and a nature hike and picking up leaves.

Those are great for little kids, and they're great for us big kids.

So, it's not age specific, it's what your body can handle specific.

And those injuries that we suffer in our youth, and you always hear that, "Oh, my old trick knee."

Those sometimes do come back to haunt us, but it means that we then have to work a little bit harder, to maybe we have to stretch before I go out on that nature hike with my grandson, or my son, or whatever it might be.

It doesn't mean that you can't do that activity, you just have to prep a little bit better.

- It's about preparing more- - It's about preparing more for your activity- - Once you start aging- - Than saying, "I no longer can do that activity."

And so, like we talk about hiking, one of the bigger things is balance as we age.

So our balance system does not respond as fast as it did when we're a kid.

And so you have to work at it.

When you're a kid, you watch a kid, they'll jump from lily pad to stepping stone to whatever, and I don't see very many adults doing that.

So we have to practice our balance in different ways, whether standing on one foot while we brush our teeth, or when you're doing the dishes, "Can I stand on one foot?

Can I do these different things that challenge my balance?"

Because inherently as we age, we don't challenge it as much as little kids.

- Gotcha.

I've never tried to do the dishes on one foot.

I'll have to incorporate that.

- Maybe don't do the glasses with that.

(all laughing) - Something a little more unbreakable, I'd say.

- [Amber] Yeah, forks.

- Forks would be good.

- Falls are a big problem, especially in our older population.

That's one of the top reasons for hospital admissions is falls.

And so I really would like, you know, the viewers to be cautious, you know.

And be aware.

- Mhm.

Let's touch back, you were saying earlier that having a workout routine, sticking to movement is a huge endorphin booster.

And it kind of goes along with what you're talking about, finding a tribe.

Talk to me a little bit more about how that works in the body.

Like, why is that happening?

- Yeah, I mean, once we exercise, so, you know, exercise causes movement, or you know, movement equals exercise.

And as we are exercising, we have to dilate the blood vessels to be able to circulate blood faster.

So, you know, we call it cardiac output.

So the formula for cardiac output is stroke volume, which is the amount of blood ejected from the heart in a single heartbeat, times the heart rate.

And that's your total circulation.

So, essentially, the heart muscle has limited capacity in terms of cavity size.

So once you start exercising, you're gonna match up your stroke volume, you can't increase your stroke volume anymore.

So in order to continue cardiac output increments, you have to increase your heart rate.

So when we exercise, your heart rate goes up.

And in order to get your heart rate up, we have to release all these nice hormones that, you know, help you feel better.

And so that's the endorphins.

And there's a whole host of anti-inflammatory markers that get released with exercise, that make you feel better, so.

- All of this together, fitness, nutrition, managing our injuries as they come, ultimately staying active, not only prolongs our lives, it improves our quality of life.

Any last words of encouragement for people who are kind of on the verge of starting a workout movement routine?

- Well, I mean, I would say there is never a last time to kind of be making changes in your life.

I think some people think, "Oh, I'm too old."

Or, "I'm too set in my habits".

And habits can be harder to change the older that we get, but certainly, it's never, you know, enough time to change.

- I think for me, when I'm working with people, it's finding your why.

Why do I wanna move more?

Why do I wanna be healthier?

And finding your people or your tribe that make that easier.

Because we all know that sticking to something is hard, whether it be nutrition, exercise.

And it's always easier when you have somebody to help you be accountable.

And as we age, unfortunately, our friend and our circle groups tend to narrow.

And so finding places that bring you joy, and friends that bring you joy and keep you accountable, is gonna make it much easier.

- I want to thank you to our panel members for sharing their time and expertise.

Dr. Jain, Amber, Brittany.

Join us next month on "Health Matters", while we explore the impact that grief has on our health, and the resources available to help us through those challenges.

- [Narrator] "Health Matters" is proudly supported by MultiCare.

(lighthearted music continues)