Tammy Petersen, Author at MedFitNetwork

Portrait of smiling women wearing pink for breast cancer in parkland

Training Cancer Survivors

Tammy Petersen/30 July 2018/ All MFN blog/

Once a virtual death sentence, cancer today is a curable disease for many and a chronic illness for most. With continued advances in strategies to detect cancer early and treat it effectively along with the aging of the population, the number of individuals living years beyond a cancer diagnosis can be expected to continue to increase.

Approximately 15.5 million Americans in the United States are cancer survivors. By 2026 that number is expected to reach 20 million. Anyone who has been diagnosed with cancer, from the time of diagnosis through the rest of his or her life is considered a cancer survivor. And while not all cancer survivors are older adults, many are simply because of the cumulative effect of years of lifestyle issues that are risk factors for their disease. Survivors less than or equal to 19 years old comprise 1% of the cancer survivor population, 6% of survivors are aged 20–39 years, 33% are aged 40–64 years and 60% (more than half) are aged greater than or equal to 65 years.

Breast cancer survivors are the largest constituent group within the overall population of cancer survivors (22%), followed by prostate cancer survivors (19%) and colorectal cancer survivors (11%) (3). Gynecological and other genitourinary cancers each account for 9% of cancer survivors, followed by hematological cancers and lymphoma (7%) and lung cancer (4%). Other cancer sites account for much smaller percentages and together are responsible for 19% of the total number of survivors. In terms of stratification by gender, more than two thirds (69%) of all female cancer survivors have a history of breast (41%), gynecological (17%) or colorectal (11%) cancer. For male survivors, two thirds (66%) have a history of prostate (39%), other genitourinary (such as testicular or renal) (14%) or colorectal (13%) cancer.

Not surprisingly, cancer survivors are often highly motivated to learn more about things like nutrition, supplements and herbal remedies, and exercise that might improve treatment outcomes and ultimately their survival and quality of life. For many of the most important nutrition and physical activity questions faced by cancer survivors, the scientific evidence comes only from observational and laboratory animal data, or unreliable reports from poorly designed clinical studies. Moreover, the findings from these studies are often contradictory. Very few controlled clinical trials have been done to test the impact of diet, nutritional supplements or nutritional complementary methods on cancer outcomes among cancer survivors.

In an effort to identify and evaluate the scientific evidence related to optimal nutrition and physical activity after the diagnosis of cancer, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity and cancer. The findings of this group guide healthcare providers, cancer survivors and their families through the mass of information and help them make informed choices related to diet and exercise. The Expert Committee reviewed all of the scientific evidence and best clinical practices for different types of cancer and “graded” both the quality and certainty of the scientific evidence for factors affecting the most common cancers. As was already mentioned, there are few clear answers to many questions, a wide range of sources and often conflicting information. But, these experts agree that even when the scientific evidence is incomplete, reasonable conclusions can be made that can help to guide choices in the areas of nutrition and physical activity.

Physical activity may help cancer patients build up their physical condition; decrease the number of comorbid conditions (like heart disease and diabetes); reduce drug interactions; help cancer patients cope with treatment; restore good health; improve quality of life during and after treatment; and help cancer patients and survivors maintain independence as long as possible

Physical rehabilitation programs similar to those for cardiac rehabilitation may be effective in managing, controlling or preventing adverse medical and psychosocial outcomes manifested during cancer survivorship. For example, exercise programs are being developed as interventions to improve the physical functioning of persons who have problems with mobility as a result of therapy and are also being shown to be efficacious for weight control after breast cancer treatment, lessen the effects of chronic fatigue, improve quality of life, prevent or control osteoporosis as a result of premature menopause and prevent or control future or concurrent comorbidities.

Diet, weight and physical activity interventions carry tremendous potential to affect length and quality of survival in a positive manner and prevent or control morbidity associated with cancer or its treatment.

General Physical Activity Guidelines for Cancer Survivors

In general, physical activity is likely to be beneficial for most cancer survivors. Recommendations on the type, frequency, duration and intensity of exercise should be individualized to the survivor’s age, previous fitness activities, type of cancer, stage of treatment, type of therapy, and comorbid conditions.

Particular issues for cancer survivors may affect or contraindicate their ability to exercise. Effects of their cancer treatment may also promote the risk for exercise-related injuries and other adverse effects.

The following specific precautions are from the American Cancer Society:

Survivors with severe anemia should delay exercise, other than activities of daily living, until the anemia is improved.
Survivors with compromised immune function should avoid public gyms and other public places until their white blood cell counts return to safe levels.
Survivors who have completed a bone marrow transplant are usually advised to avoid exposure to public places with risk for microbial contamination, such as gyms, for 1 year after transplantation.
Survivors suffering from severe fatigue from their therapy may not feel up to an exercise program, so they may be encouraged to do 10 minutes of stretching exercises daily.
Survivors undergoing radiation should avoid chlorine exposure to irradiated skin (e.g., swimming pools and whirlpools).
Survivors with indwelling catheters should avoid water or other microbial exposures that may result in infections, as well as resistance training of muscles in the area of the catheter to avoid dislodgment.
Survivors with significant peripheral neuropathies may have a reduced ability to perform exercises that use the affected limbs because of weakness or loss of balance. They may do better with a stationary reclining bicycle, for example, than walking outdoors.

For the general population, the ACS and other health organizations recommend at least 30 minutes of moderate physical activity at least 5 days per week to reduce the risk for cancer, cardiovascular disease and diabetes. These levels of activity have not been studied or tested specifically in cancer survivors, however. For the general population and for cancer survivors, any movement is likely beneficial. Therefore, although daily and regular activity may be preferred and may be a goal, any steps that are taken to move from a sedentary to an active lifestyle should be encouraged. For survivors wanting maximum benefit, the message should be that the health benefits of exercise are generally linear, with benefit related to higher intensity and duration, although extremely high levels of exercise might increase the risk for infections.

Tammy Petersen, MSE, is the Founder and Managing Partner for the American Academy of Health and Fitness (AAHF). She’s written a book on older adult fitness and designed corresponding training programs. SrFit Mature Adult Specialty Certification is used nationwide as the textbook for a college based course for personal trainers who wish to work with mature adults. SrFit is also the basis for a specialty certification home study course that qualifies for up to 22 hours of continuing education credit with the major personal trainer certification organizations.

Enough Protein?

Tammy Petersen/3 July 2018/ All MFN blog/

I am often reminded of when my son shared with me a discussion from his fifth-grade class. His teacher, who up until that point he had thought infallible, taught erroneous information about sources of protein. He knew the information was incorrect, but was afraid to offer his input for fear of being labeled a “nerd.” Now, many years later, I am still amazed at how many people do not have even a basic understanding of nutrition. I also think one of the most misunderstood aspects of nutrition is protein—especially protein needs of mature adults.

Proteins

Proteins are essential parts of organisms and are involved in virtually every process within cells. Many proteins are enzymes that catalyze biochemical reactions and are vital to metabolism. Proteins also have structural or mechanical functions, such as actin and myosin in muscle and the proteins in the cytoskeleton, which form a system of scaffolding that maintains cell shape. Other proteins are important in cell signaling, immune responses, cell adhesion, and the cell cycle. Proteins are also necessary in our diets, since we cannot synthesize all the amino acids needed and must obtain al the essential amino acids from foods. (Note: Amino acids are the building blocks from which proteins are made.) Through the process of digestion, ingested protein is broken down into free amino acids that are then used in metabolism.

Proteins contain 4 calories per gram. This is an average, as each protein is slightly different (range roughly 3.5-4.5). Of the 22 amino acids involved in human nutrition, 9 are termed “essential” because they cannot be made by the body and therefore must be supplied daily in the food we eat. The rest, which the body can synthesize, are called “non-essential.” The essential amino acids are leucine, isoleucine, valine, lysine, threonine, tryptophan, methionine, phenylalanine, and histidine. A complete protein is a source of protein that contains an adequate proportion of all of the essential amino acids for our dietary needs. This does not refer to the protein source only containing all the essential amino acids, but also containing them in adequate proportion for use by the human body. A source may contain all essential amino acids, but contain one in lower proportion to the others, making it an incomplete protein.

Most animal sources and certain vegetable sources have the complete complement of all the essential amino acids in adequate proportions. Generally, proteins derived from animal foods (meats, fish, poultry, cheese, eggs, yogurt, and milk) are complete. However, proteins derived from plant foods (legumes, grains, and vegetables) tend to be limited in essential amino acids. Thus, a variety of protein sources in the diet is one way of assuring that the body’s amino acid needs are met. All the essential amino acids can be obtained on their own from various everyday plant sources, which do not need to be combined in the same meal.

The Protein Digestibility Corrected Amino Acid Score (PDCAAS) is a method of evaluating protein quality based on both the amino acid requirements of humans and their ability to digest it. Complete protein foods that obtain the highest possible PDCAAS score of 1.0 are proteins from milk sources (caseinates), egg whites, and soy protein isolate. Other foods, such as amaranth, buckwheat, hempseed, meat, poultry, soybeans, quinoa, seafood, and spirulina also are complete protein foods, but do not obtain a PDCAAS score of 1.0.

Protein Consumption

When protein is metabolized, the nitrogen is released and flushed out by the kidneys. Comparing nitrogen IN (protein intake) with nitrogen OUT (in urine) is the standard method of determining whether a person is getting the right amount of protein. For adults, nitrogen-in should match nitrogen-out. If you are losing less nitrogen than you are consuming in food, you are retaining protein. Retaining protein is normal for kids who are growing or for someone who is building muscle through strength training. But, losing more nitrogen than you consume means protein-rich tissue (mostly muscle), is breaking down. There are many potential causes for this, such as illness, stress, or chronic inactivity.

The current recommendation for protein intake for healthy adults is 0.8 g protein per kilogram of body weight per day. This number was determined using studies on healthy young adults. But consider that body composition changes as people get older. Once adults pass the physical prime of their teens and 20’s, they lose an average of 10 ounces of lean body mass a year. This is mostly in the form of muscle tissue. Few people actually lose 10 ounces of weight a year. Instead, most gain about a pound a year, so the loss of lean tissue is masked. Another way to look at this is the average person gains about 1 pound and 10 ounces of body fat per year. This phenomenon, called sarcopenia, is derived from Greek words for “vanishing flesh.” This change in body composition contributesto impaired wound healing, loss of skin elasticity, and an inabilityto fight infection.

An article in the July –August 2006 Journal on Nutrition and Aging reported that data from published nitrogen balance studies indicate that, a higher protein intake of 1.0 – 1.3 g/kg/day is required to maintain nitrogen balance in the healthy elderly. The researchers proposed that contribution of muscle protein to whole body protein metabolism was significantly reduced with age and explained by reduced muscle mass and lower rates of myofibrillar protein turnover. Consequently, the contribution of nonmuscle protein, especially that of visceral tissue whose rates of protein turnover are known to be more rapid was proportionally greater with aging. This research suggests that higher protein consumption rates could compensate for the decrease in availability of muscle amino acids and spare the muscle mass. Higher protein intakes for the elderly, especially the frail population, than those presently recommended for younger adults may minimize sarcopenia and in so doing protect against some of the health risks of aging.

To meet the recommendation of 0.8 g/kg/day for a younger adult, a 150-pound person would need about 54 grams of protein per day. To meet the minimum recommendation of 1.0 gram/kilogram body weight for the older adult (> age 50) a 150-pound person would need about 68 grams of protein per day. An ounce of lean meat, chicken, or fish has about 7 grams, a cup of low fat milk 8 grams, an egg about 6 grams, and an ounce of cheese about 6 grams. If the person ate two 4-ounce servings of meat per day plus an egg or glass of milk, then his/her total protein would be about 68 grams.

The diet of an older adult that contains a large amount of bread, pasta, cooked vegetables, juices, and sweets could easily end up being low in protein. Diets of any age group that consist mainly of fast foods or processed foods are often lacking the adequate amount of protein. As a fitness professional, you are likely far more conscious of the amount of protein that you consume than are your clients. Don’t neglect educating your clients in this area using specific examples and information. Don’t assume that if you tell a client they need a specific number of grams of protein per day that they will manage to consume that amount. Give them some examples and educate them on protein sources!

Sources

Hoffman, Jay R.; Falvo, Michael J. (2004). “Protein – Which is Best”. Journal of Sports Science and Medicine 3 (3): 118–30. http://www.jssm.org/vol3/n3/2/v3n3-2pdf.pdf. Retrieved 2010-6-08
J.A. Morais. J Nutr Health Aging. 2006 Jul-Aug; 10(4):272-83.
“Protein in diet”. Medline Plus Medical Encyclopedia. U.S. National Library of Medicine and National Institute of Health. September 2, 2003. http://www.nlm.nih.gov/medlineplus/ency/article/002467.htm. Retrieved 2010-6-08.
“Quinoa: An emerging “new” crop with potential for CELSS (NASA Technical Paper 3422)” (PDF document). NASA. November 2003. http://ntrs.nasa.gov/archive/nasa/casi.ntrs.nasa.gov/19940015664_1994015664.pdf. Retrieved 2010-06-09.
Schaafsma G (2005). “The Protein Digestibility-Corrected Amino Acid Score (PDCAAS)–a concept for describing protein quality in foods and food ingredients: a critical review”. Journal of AOAC International 88 (3): 988–94. http://www.ncbi.nlm.nih.gov/pubmed/16001875. Retrieved 2010-6-08.
“Tips and Resources: Vegetarian Diets”. USDA. http://www.mypyramid.gov/tips_resources/vegetarian_diets.html. Retrieved 2010-06-09.

Personal trainer and her client with dumbbells

Metabolic Syndrome: A New Focus for Lifestyle Modification

Tammy Petersen/4 June 2018/ All MFN blog/

Personal trainers have the opportunity to do more than just help people they train become more active. We need to be prepared to also help our clients implement lifestyle behavior changes related to stress, family history of coronary heart disease, obesity, smoking, high blood pressure and high cholesterol.

A look at what is called metabolic syndrome will help you understand why, even though increasing physical activity levels is the overall best thing you can do for any client, there are additional ways to guide them to a healthier lifestyle. Sometimes you may be able to help them make the changes yourself; and, sometimes you will need to refer them to another health professional like a doctor or dietitian for guidance. Either way, knowing how to help them or when to direct them to someone who is more knowledgeable than you is important. So, first let’s become familiar with the syndrome and the clinical criteria that the doctor uses to diagnose it. Your goal is then to help your clients understand and make the necessary changes so that they don’t progress to cardiovascular disease and the almost certain heart attack heart that will be the end result.

Cardiovascular disease is still the number one cause of morbidity and mortality in the United States and much of this burden of disease can be linked to poor nutrition and a dramatic increase in sedentary lifestyles, leading to overweight and obesity. This increase in weight leads to an increase in the incidence of type 2 diabetes, and blood pressure and cholesterol problems, which are all well-established cardiovascular disease risk factors. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III has updated the recommendations for the evaluation and management of adults dealing with high cholesterol, renewing its emphasis on the importance of lifestyle modifications for improving cardiovascular risk. The NCEP has coined the term “therapeutic lifestyle changes” (TLC) to reinforce both dietary intake and physical activity as crucial components of weight control and cardiovascular risk management.

As well as focusing attention on the LDL cholesterol (also called bad cholesterol) levels, the NCEP also identified metabolic syndrome as a secondary target of therapy. Metabolic syndrome (also called insulin resistance syndrome and syndrome X) is characterized by decreased tissue sensitivity to the action of insulin (pre-diabetes), resulting in a compensatory increase in insulin secretion. This metabolic disorder predisposes individuals to a cluster of abnormalities that can lead to such problems as type 2 diabetes, coronary heart disease and stroke. The prevalence of the syndrome has increased 61% in the last decade. It is crucial for medical professionals to identify patients at risk and follow these patients closely and counsel them about making lifestyle changes to lower the risk of type 2 diabetes and cardiovascular disease.

GUIDELINE: According to the NCEP, the criteria for metabolic syndrome includes at least 3 of the following 5 clinical factors

Risk factor	Defining level
Abdominal obesity Men Women	Waist circumference >40 in (>102 cm) >35 in (>88 cm)
Fasting triglyceride level	>150 mg/dL
HDL cholesterol level Men Women	<40 mg/dL <50 mg/dL
BP	>130/>85 mm Hg or taking antihypertensive medication
Fasting glucose level	>100 mg/dL or diabetes

Source: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md: National Institutes of Health; 2001. NIH publication 01-3670.

Millions of Americans at risk for metabolic syndrome can sharply lower their chances of getting this disease by adopting a healthy lifestyle (stop smoking, low-fat diet, weight loss/maintenance and increased physical activity). Without diet and exercise modifications, most patients will eventually fail and progress to type 2 diabetes within a decade and experience a heart attack about 10 years later. Experts recommend a diet reduced in saturated fats (<7%), low in cholesterol (<200 mg/day), high in fiber (20-30gm/day) and reduced in simple sugars. Weight loss of only 5-7% (less than 15 pounds) can make a big difference in health markers like cholesterol and blood pressure. A program that includes daily exercise reaching 85% of heart rate for age is reported to be of benefit too. However, any exercise is better than none, and a target of 30 minutes every other day is a reasonable level for most people.

As a fitness professional reading this, hopefully you are not asking yourself “so what?” but are instead seeing an opportunity to educate and motivate your current clients and to use your knowledge to help attract future clients. The medical community is good at diagnosing this syndrome, but not necessarily equipped to provide patients with the tools to be successful with the lifestyle changes they recommend. There exists a wonderful opportunity to build a partnership with physicians in your area. Most physicians will gladly refer patients to you for help with the all-important exercise and nutrition portion of the treatment program. In many cases, you have more knowledge in this area than the physician who has been trained in tertiary, not preventative, (i.e. most MD’s know very little about diet and exercise since this is not a focus in medical school) medicine. Often times all that you will need to get a referral is for the doctor to be aware of your existence and to give them an easy way to get the patient to you. A short introduction letter outlining your qualifications and showing your desire to help people make lifestyle changes is a good start. A personal visit to your primary care doctor and others in your area is even better. But, be prepared to take up just a few minutes of their time to introduce yourself, your idea, and leave your letter and cards.

References

Centers for Disease Control and Prevention. Early release of selected estimates based on data from the January-June 2003 National Health Interview Survey. URL: cdc.gov/nchs/about/major/nhis/released200312.htm.
Summary Health Statistics Tables for the U.S. Population: National Health Interview Survey, 2016 https://www.cdc.gov/nchs/nhis/SHS/tables.htm 16 Apr. 2018.
Centers for Disease Control and Prevention. Prevalence of health care providers asking older adults about their physical activity levels—United States, 1998. Morbidity and Mortality Weekly Report. 51(19):412-4, 2002.
Huang, Paul L. “A Comprehensive Definition for Metabolic Syndrome.” Disease Models & Mechanisms5-6 (2009): 231–237. PMC. Web. 16 Apr. 2018.

Our Aging World

Tammy Petersen/7 May 2018/ All MFN blog/

We are aging—not just as individuals or communities but as a world. In 2006, almost 500 million people worldwide were 65 and older. By 2030, that total is projected to increase to 1 billion—1 in every 8 of the earth’s inhabitants. Significantly, the most rapid increases in the 65-and-older population are occurring in developing countries, which will see a jump of 140 percent by 2030.

People are living longer and, in some parts of the world, healthier lives. This represents one of the crowning achievements of the last century but also a significant challenge. Longer lives must be paid for. Societal aging may affect economic growth and many other issues, including the sustainability of families, the ability of states and communities to provide resources for older citizens, and international relations. The Global Burden of Disease, a study conducted by the World Health Organization and the World Bank, with partial support from the U.S. National Institute on Aging, predicts a very large increase in disability caused by increases in age-related chronic disease in all regions of the world. In a few decades, the loss of health and life worldwide will be greater from noncommunicable or chronic diseases (e.g., cardiovascular disease, dementia and Alzheimer’s disease, cancer, arthritis, and diabetes) than from infectious diseases, childhood diseases, and accidents.

Since the beginning of recorded human history, young children have outnumbered older people. Very soon this will change. For the first time in history, people age 65 and over will outnumber children under age 5. This trend is emerging around the globe. Today almost 500 million people are age 65 and over, accounting for 8 percent of the world’s population.

By 2030 the world is likely to have 1 billion older people, accounting for 13 percent of the total population. While today’s proportions of older people typically are highest in more developed countries, the most rapid increases in older populations are occurring in the less developed world. Between 2006 and 2030, the number of older people in less developed countries is projected to increase by 140 percent as compared to an increase of 51 percent in more developed countries.

Population aging is driven by declines in fertility and improvements in health and longevity. In more developed countries, declines in fertility that began in the early 1900s have resulted in current fertility levels below the population replacement rate of two live births per woman. Perhaps the most surprising demographic development of the past 20 years has been the pace of fertility decline in many less developed countries. In 2006, for example, the total fertility rate was at or below the replacement rate in 44 less developed countries.

Increasing Life Expectancy

Some nations experienced more than a doubling of average life expectancy during the 20th century. Life expectancy at birth in Japan now approaches 82 years, the highest level among the world’s more developed countries, and life expectancy is at least 79 years in several other more developed countries.

Less developed regions of the world have experienced a steady increase in life expectancy since World War II, with some exceptions in Latin America and more recently in Africa, the latter due to the impact of the HIV/AIDS epidemic. The most dramatic gains have occurred in East Asia, where life expectancy at birth increased from less than 45 years in 1950 to more than 72 years today.

Changes in life expectancy reflect a health transition occurring around the globe at different rates and along different paths. This transition is characterized by a broad set of changes that includes:

A shift from high to low fertility;
A steady increase in life expectancy at birth and at older ages; and
A shift from the predominance of infectious and parasitic diseases to the growing impact of noncommunicable diseases and chronic conditions.

The health transition shifts the human survival curve so that the chances of surviving another year are higher at every age. In early nonindustrial societies, the risk of death was high at every age, and only a small proportion of people reached old age. In modern survival curves for industrialized societies, most people live past middle age, and deaths are highly concentrated at older ages.

Increases in the probability of survival raise questions about limits to life expectancy and the potential for human lifespan. Despite assertions that life expectancy must be approaching a limit, data on female life expectancies from 1840 to 2000 show a steady increase of 3 months per year. The country with the highest average life expectancy has varied over time—in 1840 it was Sweden, and today it is Japan.

Recent research raises other questions about the future of life. Researchers have been able to experimentally increase lifespan in insects and animals through gene insertion, caloric restriction, and diet. It remains to be seen whether similar increases can be replicated in humans.

Rising Numbers of the Oldest Old

An important feature of population aging is the progressive aging of the older population itself. Over time, more older people survive to even more advanced ages. For research and policy purposes, it is useful to distinguish between the old and the oldest old, often defined as people age 85 and over. Because of chronic disease, the oldest old have the highest population levels of disability that require long-term care. They consume public resources disproportionately as well.

The growth of the oldest old has a number of implications:

Pensions and retirement income will need to cover a longer period of life.
Health care costs will rise even if disability rates decline somewhat.
Intergenerational relationships will take on an added dimension as the number of grandparents and great-grandparents increase.
The number of centenarians will grow significantly for the first time in history. This will likely yield clues about individual and societal aging that redefine the concept of oldest old.

The oldest old constitute 7 percent of the world’s 65-and-over population: 10 percent in more developed countries and 5 percent in less developed countries. More than half of the world’s oldest old live in six countries: China, the United States, India, Japan, Germany, and Russia. In many countries, the oldest old are now the fastest growing portion of the total population. On a global level, the 85-and-over population is projected to increase 151 percent between 2005 and 2030, compared to a 104-percent increase for the population age 65 and over and a 21-percent increase for the population under age 65. Past population projections often underestimated decreases in mortality rates among the oldest old; therefore, the number of tomorrow’s oldest old may be significantly higher than anticipated.

The percentage of oldest old will vary considerably from country to country. In the United States, for example, the oldest old accounted for 14 percent of all older people in 2005. By 2030, this percentage is unlikely to change because the aging baby boom generation will continue to enter the ranks of the 65-and-over population. In Europe, some countries will experience a sustained rise in their share of oldest old while others will see an increase during the next two decades and then a subsequent decline. The most striking increase will occur in Japan: By 2030, nearly 24 percent of all older Japanese are expected to be at least 85 years old. Most less developed countries should experience modest long-term increases in their 85-and-over population.

As life expectancy increases and the oldest old increase in number, four-generation families become more common. The aging of the baby boom generation, for example, is likely to produce a great-grandparent boom. As a result, some working adults will feel the financial and emotional pressures of supporting both their children and older parents and possibly grandparents simultaneously.

While people of extreme old age—that is, centenarians—constitute a small portion of the total population in most countries, their numbers are growing. The estimated number of people age 100 and over has doubled each decade since 1950 in more developed countries. In addition, the global number of centenarians is projected to more than quintuple between 2005 and 2030. Some researchers estimate that, over the course of human history, the odds of living from birth to age 100 may have risen from 1 in 20 million to 1 in 50 for females in low-mortality nations such as Japan and Sweden.

PROJECTED INCREASE IN GLOBAL POPULATION BETWEEN 2005 AND 2030, BY AGE
Age	Increase
0-64	21%
65+	104%
85+	151%
100+	400+%

Source: United Nations Department of Economic and Social Affairs, Population Division. World Population Prospects.

Growing Burden of Noncommunicable Diseases

In the near future, the loss of health and life in every region of the world, including Africa, will be greater from noncommunicable or chronic diseases, such as heart disease, cancer, and diabetes, than from infectious and parasitic diseases. This represents a shift in disease epidemiology that has become the focus of increasing attention in light of global aging.

There is extensive debate about the relationship between increased life expectancy and disability status. The central question is: Are we living healthier as well as longer lives, or are our additional years spent in poor health? Some researchers posit a “compression of morbidity”—a decrease in the prevalence of disability as life expectancy increases. Others contend an “expansion of morbidity”—an increase in the prevalence of disability as life expectancy increases. Yet others argue that, as advances in medicine slow the progression from chronic disease to disability, there is a decrease in the prevalence of severe disability but an increase in milder chronic diseases.

A Host of Challenges

While global aging represents a triumph of medical, social, and economic advances over disease, it also presents tremendous challenges. Population aging strains social insurance and pension systems and challenges existing models of social support. It affects economic growth, trade, migration, disease patterns and prevalence, and fundamental assumptions about growing older.

Using data from the United Nations, U.S. Census Bureau, and Statistical Office of the European Communities as well as regional surveys and scientific journals, the U.S. National Institute on Aging (NIA), with input from demographers, economists, and experts on aging, identified nine emerging trends in global aging. Together, these trends present a snapshot of challenges and opportunities that clearly show why population aging matters.

The overall population is aging. For the first time in history, and probably for the rest of human history, people age 65 and over will outnumber children under age 5.
Life expectancy is increasing. Most countries, including developing countries, show a steady increase in longevity over time, which raises the question of how much further life expectancy will increase.
The number of oldest old is rising. People age 85 and over are now the fastest growing portion of many national populations.
Noncommunicable diseases are becoming a growing burden. Chronic noncommunicable diseases are now the major cause of death among older people in both more developed and less developed countries.
Some populations will shrink in the next few decades. While world population is aging at an unprecedented rate, the total population in some countries is simultaneously declining.
Family structures are changing. As people live longer and have fewer children, family structures are transformed, leaving older people with fewer options for care.
Patterns of work and retirement are shifting. Shrinking ratios of workers to pensioners and people spending a larger portion of their lives in retirement increasingly strain existing health and pension systems.
Social insurance systems are evolving. As social insurance expenditures escalate, an increasing number of countries are evaluating the sustainability of these systems.
New economic challenges are emerging. Population aging will have dramatic effects on social entitlement programs, labor supply, trade, and savings around the globe and may demand new fiscal approaches to accommodate a changing world.

A Window of Opportunity

Global aging is a success story. People today are living longer and generally healthier lives. This represents the triumph of public health, medical advancement, and economic development over disease and injury, which have constrained human life expectancy for thousands of years. But sustained growth of the world’s older population also presents challenges. Population aging now affects economic growth, formal and informal social support systems, and the ability of states and communities to provide resources for older citizens. We can think about preparing for older age on both an individual and societal level. On an individual level, people need to focus on preventive health and financial preparedness.

Since the mid-19th century, the life span in the US has nearly doubled. Most of the increase in life expectancy is due to declines in death from infectious disease. Unfortunately, the number of deaths from infectious disease has been replaced by the number of deaths from degenerative or “lifestyle” diseases. Most people would agree that living a long life without health and independence is not desirable. So, when we consider that an increasing number of people are living longer, we must also consider the problems that are created when the quality of these extended years is poor.

Morbidity is defined as the absence of health. All too often it is a state in which many frail elderly live for a long time prior to death. The major chronic diseases that contribute greatly to morbidity are arteriosclerosis, cancer, osteoarthritis, diabetes, and emphysema. These diseases usually begin early in life, progress throughout the lifespan, and worsen each decade until finally becoming terminal. An example is diabetes. It could begin with obesity at age 20, progress to glucose intolerance at age 30, develop into elevated blood glucose at age 40, be indicated by sugar in the urine at age 50, require medication at age 60, and lead to blindness and amputation at age 70. This is not a pretty picture.

The social consequences of an unhealthy older population are huge. Sickly elderly individuals become more and more unproductive which makes them and the family members caring for them miserable. All of this imposes a huge financial burden on society overall.

It has been estimated that by the year 2040 the average life expectancy of older people could increase by 20 years. By the middle of the 21st century there could be 16 million people in the US over the age of 85. It is also estimated that the average 65-year-old will spend 7½ years of this remaining 17 years living with some functional disability. If the present rate at which people are being added to the category of those experiencing morbidity is projected to the future, a 600% increase in healthcare costs will occur. Still expecting Medicare to take care of us all? Social and medical programs are directly linked to the size and health status of the elderly population in a society. The quality of life of our elderly – and in fact for all of us – will be affected not only by the number of years our seniors live, but also by how comfortably they spend those remaining years.

The emphasis in gerontological research has begun to shift from lengthening life to increasing years of health. The new goal is to shorten the period of time that people live in an unhealthy, dependent state. If scientific advances allow us to live 15 or 20 years longer, and if these 15-20 years consist mainly of pain, suffering, and dependence on others, what have we accomplished?

Because chronic diseases begin early in life and develop gradually, a healthy lifestyle can greatly postpone or even prevent the start of some of these chronic diseases like diabetes, emphysema, and heart disease. The longer the diseases are prevented, the less time an individual will experience morbidity in later years. As a matter of fact, individuals who practice sound health habits and prevent the onset of chronic disease for many years might NEVER experience morbidity.

While it is important for health professionals to develop and enhance life-extending strategies, we also must provide strategies that enable people to live as well as they can. There needs to be a balance between quantity and quality.

As a fitness professional reading this, hopefully you are not asking yourself “so what?” but are instead seeing an opportunity to educate and motivate your current clients and to use your knowledge to help attract future clients. If you are interested in working with older adults, it is important to have the knowledge base to safely and effectively train them. A good overall program to consider is the SrFit Mature Fitness Program, which is recognized for continuing education by many certification organizations including ACSM, BOC, NASM, NSCA, YMCA and others. You can check it out by going to www.aahf.info.

The medical community is good at diagnosing chronic lifestyle diseases, but not necessarily equipped to provide patients with the tools to be successful with the lifestyle changes they recommend. There exists a wonderful opportunity to build a partnership with physicians in your area. Most physicians will gladly refer patients to you for help with the all-important exercise and nutrition portion of the treatment program. In many cases you will have more knowledge in this area than the physician who has been trained in tertiary, not preventative, medicine. Most MD’s know very little about diet and exercise since they are not taught this in medical school. Often all that you will need to get a referral is for the doctor to be aware of your existence and to give them an easy way to get the patient to you. A short introduction letter outlining your qualifications and showing your desire to help people make lifestyle changes is a good start. Be prepared to take up just a few minutes of their time to introduce yourself, your idea, and leave your letter and cards.

Originally published on American Academy of Health and Fitness. Reprinted with permission from Tammy Petersen.

Source

Much of the information provided here was taken from a report prepared by the U.S. State Department in collaboration with the National Institute on Aging.

NIH Pub ID: 07-6134

CIMS Pub ID: BK025

The National Institute on Aging (NIA), part of the National Institutes of Health, was established to improve the health and well-being of older people through research. As part of its mission, the NIA investigates ways to support healthy aging and prevent or delay the onset of diseases disproportionately affecting older adults. NIA’s research program covers a broad range of areas, from the study of basic cellular changes with age to the examination of the biomedical, social, and behavioral aspects of age-related conditions. Although the main purpose of this research is to increase “active life expectancy” — the number of years free of disability — it may also promote longevity.