Medical Fitness – Page 2

Physical therapist gesturing thumbs up besides senior woman on yoga ball

Medical Fitness – A Win for Professional and Patient

Douglas Feick, PT/21 September 2021/ All MFN blog/

Medical Fitness is a growing trend in health care. Medical Fitness helps extend basic healthcare from the classic and formal model of a person being a patient, receiving treatment and being discharged entirely, to after-care professional services. Medical Fitness is the integration of ongoing fitness, wellness and preventive care under the supervision of health professionals such as physical therapists, exercise physiologists, personal trainers, nutritionists, acupuncturists, chiropractors, massage therapists, mental health practitioners, health and wellness coaches, yoga professionals and more.

Medical Fitness is appropriate for many types of conditions such as arthritis, diabetes, orthopedic conditions, pre and post-natal, heart disease, fibromyalgia, stroke, cancer, mental disorders, and others. When properly implemented, Medical Fitness is a win-win for both patient and health professional.

Physical therapist gesturing thumbs up besides senior woman on yoga ball

Medical Fitness Advantages for the Patient

First, after discharge from the formal healthcare world, the patient can be referred to a variety of health professionals educated in the patient’s condition, providing both a continuum of care and a multi-discipline approach. For example, a person discharged from physical therapy after a total knee replacement might be referred to a certified personal trainer facility educated in post-rehabilitation of a total knee to continue to make further functional gains and improvements. If that person needed help with weight loss, perhaps a referral to a nutritionist would be included. If they also had issues with coping with their diminished function, a consult with a specialist in mental health might be provided as well.

Second, many times the medical facility in which care was provided will have a Medical Fitness component associated with it. Direct referral to this type of facility can provide the patient with security and confidence, being familiar with the facility and with the knowledge that the new health professional is familiar with their condition and diagnosis.

Medical Fitness Advantages for the Health Professional

First, by being part of a Medical Fitness community the health professional can refer a discharged patient for follow up care, secure in the knowledge that their patient will be cared for by an ancillary care professional who is trained and certified to provide a proper continuity of care plan along with the appropriate goals and treatments.

Second, by referring to a Medical Fitness multi-discipline team, the health professional receives security that if their patient has any other issues, those concerns will be addressed. For instance, with the example of the total knee replacement patient needing assistance with weight loss or nutrition consults, (treatments that don’t fall under the umbrella of physical therapy), the physical therapist is assured their patient will be helped to achieve a better transition back into their “non patient” status.

Third, when the health professional refers their patient into a Medical Fitness wellness and preventative care environment, the chance for overall improved outcomes is increased. Patients learn better self-confidence in caring for themselves, taking charge of their own health and lifestyle. If a patient’s condition begins to backslide, the wellness program professionals can help make sure the patient gets referred back to the health professional in a timely manner.

In conclusion, Medical Fitness benefits all involved. Quality of care is improved. Patients receive access to multi- discipline care and can learn to take charge of their life. Health professionals receive security of proper continuity of care and gain improved patient outcomes.

Douglas Feick, PT is a licensed physical therapist in Texas, with emphasis in orthopedics for over 15 years. He is President of BioEx Systems Inc, a software company providing software solutions for physical therapists, athletic trainers, chiropractors, dietitians and personal trainers. His hobbies include scuba diving, raising bees and he is an avid skydiver.

Healthcare Through Fitness

Dr. David Kruse/10 May 2021/ All MFN blog/

A discussion of medical fitness is rooted in an understanding of the health benefits of fitness and exercise. The documented benefits are endless and include management of chronic disease, management and prevention of osteoporosis, improved mood and sleep disorders, stress relief, management and prevention of obesity.

Health agencies across the spectrum of public health and disease-specific organizations recognize and promote exercise and fitness as an integral part of the management of chronic disease; diseases that include diabetes, cardiovascular disease, Parkinson’s, depression, multiple sclerosis, and arthritis, among others.

If fitness and exercise are well accepted as part of the management strategy for multiple diseases, why is it that access to organized exercise plans, and fitness professionals who can help implement those plans, are not a standard part of the medical treatment paradigm? Why is it not a standard benefit covered by common medical insurance policies?

The reasons are multifactorial and a reflection of the overall healthcare conundrum in our country today. Let’s focus, however, on how to make a change. We need to focus on how to integrate fitness professionals into the medical paradigm. A perfect model for this is an integrative medical fitness center.

What is a medical fitness center? It is a fitness facility with a multidisciplinary staffing approach and has the following characteristics:

Regular medical oversight by a medical director
Practitioners with nationally-recognized certifications and training in the care of chronic disease
Comprehensive health assessments and exercise prescription
Exercise classes geared toward specific medical conditions

These centers bring together credentialed staff in a collaborative way to provide exercise prescription plans specific to the needs of an individual with chronic disease.

The concept of the medical fitness center is not new; many currently exist in communities throughout the United States. However, an understanding of their importance in the context of the current healthcare environment has grown. The idea of creating “medical homes” that are collaborative across disciplines and provide a comprehensive healthcare approach is now being recognized to provide a high standard of care while simultaneously decreasing overall healthcare costs. This is true specifically for high-risk individuals who suffer from chronic disease.

Further integration of medical fitness centers, and broad access to exercise and fitness resources, will hopefully become standard of care and widely accessible to all individuals, especially those with chronic disease. This integration will inherently bring fitness professionals into the paradigm of healthcare and promote healthcare through fitness.

This article was featured in MedFit Professional Magazine.

Dr. David Kruse attended medical school at UC San Diego, after graduating from UC Berkeley. He holds board certifications in family and sports medicine. He practices sports medicine with the Orthopaedic Specialty Institute, in Orange, CA. Dr. Kruse is the Chief Medical Officer for the MedFit Network and on the Medical Advisory Board for the MedFit Education Foundation. He is currently a Team Physician for USA Gymnastics, Orange County Soccer Club, and Biola University. Visit his website, krusesportsmd.com

The Power of Collaboration in the Quest for Cure

Phil Kaplan/15 April 2021/ All MFN blog/

Let’s start with four statements I’m willing to call facts:
1. Chronic disease afflicts the majority of American adults over the age of 45.
2. People with chronic disease choose a visit with an allopathic physician (conventional medicine) as their first course of action.
3. A pharmaceutical prescription is the first course of action after linking symptoms and biomarkers to a commonly diagnosed disease (type 2 diabetes, hypothyroidism, hypertension, hypercholesterolemia, etc.).

Adaptive Health Paradigm: A Principle-Centered Perspective for Medical Fitness

Dr. Mark Kelly/4 February 2019/ All MFN blog/

I hope to give you some insights to both how the human body works as well as why medically-based fitness is not only valid, but absolutely necessary to reverse, assist, or prevent various chronic and acute disease conditions. Wow, that is a “mouthful” to say the least. I feel so strongly about this perspective that I hope to create the Adaptive Health Model as a major “brand” of fitness. My company (Principle-Centered Health) for the past couple of decades has always had a systems-based approach to health and fitness. This approach ties a lot of different facts into a common theme, usually called a theory in science. Even my dissertation looked at how people adapted to the physical, mental and social issues in their lives using exercise, self-efficacy, and social support, respectively, and levels of strain and burnout. How humans adapt to the stresses put on them is very specific and can go in good or bad directions.

What is the Adaptive Health Paradigm?

Like most theories, paradigms or what people consider “original thought”, this “adaptive” paradigm builds on the “regenerative medicine” framework, and some disease models; thus, is not original at all. What may be new, or unique about the adaptive perspective is taking the old phrase from physicist Isaac Newton and his third law of motion, “for every action there is an equal and opposite reaction.” The body will respond to stresses by reacting in a “defensive” manner. If we break something down, the body builds it up (opposite reaction). If we are too low or too high in some function, the body will try to correct this. This negative feedback loop controls most systems in our bodies. I have often described our bodies as fragile but resilient. It is our fragility that signals the resilience to kick into gear!

Luckily for us, fitness is based on this exact principle. If we do endurance training, we are going into a lower oxygen state and there are many mechanisms or functions that kick in (sympathetic nervous system) when we push or stress our bodies. The body is responding to what is known as an “acute insult” by increasing the ability to transport and use oxygen, so that this “insult” doesn’t hurt us next time. The same “specificity of training principle” occurs with resistance training. We breakdown muscle and the body builds it back stronger to tolerate that “insult” the next time. When multiple acute exercise stresses are added up, the body changes and we call this “training”.

If stresses are really high, either too intense, too long, or too often, the body gets injured due to this overload, or it needs a lot more time to heal back up. This is why overload needs to be done gradually and progressively. Even our brains use this idea as a guiding principle. We push our mental capacities to learn more, but if we stress it too much, it will repress memories or shut down (burnout).

This same principle applies when we give our body bad things, or a lack of good things, it adapts with a dysfunctional state or disease state. Chronic inflammatory diseases, diabetes, metabolic syndrome, coronary artery disease, emphysema and heart disease are just a few of the examples of how the “garbage in and garbage out”, or “use it or lose it” works. If we sit and work at the computer too much we develop dysfunctional postures and upper cross syndrome may develop. If we do not constantly stress some system, it reverses the training changes, and goes into the “default” state, which is untrained and unable to respond to daily stresses. We simply need to obey our bodily blueprints, we need to constantly use our bodies to maintain function, and overload it to improve function. We need to have the right nutrients in place to allow this to happen, and then basically – get out of the way!

Intelligence in the Body: Applications the Adaptive Health Paradigm

The perspective being proposed in this article shares much with the more holistic medical practices. The human body is really good at healing itself when is it given the right factors to do so, and when we “get out of the way” for it to do so. I know many people who strongly believe in using alkaline water to “cure their ills”. They believe that the body does not know how to regulate itself with its own pH. Most of these same people don’t know what pH even stands for! They don’t know that it is actually the inverse log of the hydrogen ion concentration relative to the hydroxide ions, and that the respiratory system and renal system will go into action as soon as blood pH goes 0.05 pH units high or low!

In other words, these people believe their own bodies are naïve or incapable of curing itself, and like a young child or baby, their body needs constant care and guidance. Most people are so stressed about “taking care” of their bodies that they are doing more harm than good via the stress hormones, especially cortisol being constantly secreted and their adrenal gland is getting fatigued. In reality, the body is really good at healing itself, when we keep it strong and in good operating condition (via exercise and movement) and when we give it the right components to do the healing (via nutrition), and we get out of the way of the immune system (by managing our daily stress levels).

The mind works very much like a muscle. It must be trained and kept strong and when injured it will react in dysfunctional ways, and fight to protect itself. I recently heard an expert in human behavior change speak on how to keep a resolution. He said, we can’t keep a resolution without changing the underlying behaviors which caused the bad habit or lack of a good habit in the first place. By changing the way we think, we change the way we act, and changing our actions will change the way we think!

“What Goes Around, Comes Around”

The quote often stated by Thomas Edison in 1903, which was to give rise to the HMO concept, “The doctor of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease.” Medical doctors (M.D.s) upon completing medical school and prior to practicing take the Hippocratic Oath, which is to do no harm. Even back in Ancient Rome, Hippocrates understood the importance of individualized medicine and the power to “get out of the way” (#5) and give the body what it needs to take care of itself. He had five rules that are still relevant in today’s medical practices.

Walking Is Man’s Best Medicine.
Know What Person the Disease Has Rather Than What Disease the Person Has.
Let Food Be Thy Medicine.
Everything in Moderation.
To Do Nothing Is Also a Good Remedy.

Integrative and Functional Medicine – Highly Inclusive and Holistic Perspectives

A philosophy of practice using these practices is integrative medicine. A brand of medicine created or at least popularized by Andrew Weil. The University of Arizona has this “brand” of medical school. Again, the academic requirements are similar to the M.D. and D.O. but expands its scope to other areas. From the website, Integrative Medicine (IM) is defined as a “healing-oriented medicine that takes account of the whole person, including all aspects of lifestyle. It emphasizes the therapeutic relationship between practitioner and patient, is informed by evidence, and makes use of all appropriate therapies. many different ways in the patient.

A new type of medicine is emerging from this functional perspective which is called personalized medicine. Again, the two are basically two sides of the same coin.

Figure 1: A diagram above showing the greater scope of each medical perspective- Integrative and Functional medicines are close in their holistic perspectives, with differing points of emphasis

What is going on within the individual to cause the disease or prolong its existence?

Sometimes disease hits simply because we were genetically predisposed to get it. However, very often if our system is strong and in good operating condition, we resist it from every occurring or overcome it quite quickly. Cancer is a prime example of this. We all have cancers in our bodies all the time. It is the strong immune system that fights it off. This is amongst the reasons that many, many chronic diseases hit us when we are old. The various system have lost their capacity to fight the dysfunction off, or recover from its destruction. Soon cell death (necrosis or apoptosis) or neoplastic (cancer) growth kicks in.

Harnessing the Power of Exercise and Diet to Fight Chronic Disease

Many, many chronic conditions that the MedFit Network and MedFit Classroom address are helped by exercise and diet because the ability of body to adapt and regenerate itself is enhanced. Most systems in our body fall under the “use it or lose it” scenario. High sugar, alcohol, smoking, and lack of movement are culprits in our health. Our body is not designed for an overload of these factors and across time, many different symptoms will develop because our body can no longer compensate or regenerate.

It is important for the medical fitness professional to understand the power of exercise and nutrition, and the proper application of these tools given the client’s or patient’s current condition. The field of physical therapy developed because many musculoskeletal conditions are helped by movement therapy or exercise. Many chiropractors believe that proper spinal alignment delivers proper neural signals throughout the body, which allows the body to optimize its regenerative capacity. Thus, an expert in medical uses of exercise to combat disease is critical to a healthcare team.

Dr. Mark Kelly Ph.D., CSCS, FAS, CPT has been actively involved in the fitness industry spanning 30 years as a teacher of exercise physiology at academic institutions such as California State University, Fullerton, Louisiana State University, Health Science Center, Tulane University and Biola. He was an exercise physiologist for the American Council on Exercise, a corporate wellness director, boot camp company owner and master fitness trainer.

References

Center for Integrative Medicine, Univ. of Arizona (n.d.). What is IM/IH? Retrieved from: https://integrativemedicine.arizona.edu/about/definition.html

Science Daily (n.d.). Personalized medicine. Retrieved from: https://www.sciencedaily.com/terms/personalized_medicine.htm

Good Reads (n.d.). Retreived from: https://www.goodreads.com/quotes/13639-the-doctor-of-the-future-will-give-no-medication-but

Kalish, N. (2018). Hippocrates’ Diet and Health Rules Everyone Should Follow. Reader’s Digest. Retrieved from: https://www.rd.com/health/wellness/hippocrates-diet/

Aligning with Medicine

Phil Kaplan/28 January 2019/ All MFN blog/

I’ve been to the mountain. Yes, I’ve been in the world of medicine. I’ve run my programs in hospitals, collaborated with physicians to address chronic disease, and spoken at medical conferences on topics ranging from “emotion and the patient” to “the healing powers of synergy.”

Between you and me, I’ve been to nicer mountains. While I have nothing but praise for doctors, when we lift up the medical curtain, the overall system, the collective mindset, and the impotence of the treatment of chronic disease provide an open door. For who? For fitness professionals, and I say that with qualification.

The challenge in great part is a naivete. Our “industry” is not well versed in the living dynamics between medical institutions, health insurance, and pharmaceuticals, so these lobbying giants are viewed by personal trainers as purely corrupt, as the evils that plague our population. Yet, when the mirror of honesty is confronted, the limitations of conventional exercise and eating are not by any means the panacea trainers profess them to be in the midst of a population struggling with health compromise.

YES, THERE’S AN OPPORTUNITY BUT . . .

. . . it requires a re-education, an enhanced skill set.

Physical therapists are not thrilled with the idea of personal trainers working to address muscular imbalances and injury recovery. Nutritionists approach trainers who coach their clients nutritionally with caution. The trainer is not deemed a player on the Allied Health Care Team.

We therefore hear assertions from “trainer island” with limited foundation.

“Insurance should pay for our client sessions, after all, it pays for medical treatments that don’t work.” Wow, is that a slippery slope, one I wouldn’t approach if it showed up in my backyard and I was equipped with anti-slip cleats.

“Doctors should refer clients to us.” That is best responded to with a simple, “why?”

“Doctors don’t care about their patients.” There’s a globalized bias that fails to account for a system that makes “exploration of the client condition” one of the greatest challenges in the field, regardless of the physician’s heart.

* * * * * * The opportunity lies in humility, in a willingness to step up and learn, and in providing a true complement to the system that is flawed. It isn’t an “us or them,” but it also shouldn’t be a one way street of elusive referrals. It’s a recognition that we have the per-session time to invest. We can gain the trust of clients. We can see clients regularly and facilitate programs that require joint responsibility.

The most important piece of creating an industry wide recognition of the trainer’s power is perhaps the dismissal of ego, the acknowledgement that trainers deemed competent in prescribing safe and effective exercise, have not learned to address metabolic imbalance, hormonal disruption, and inflammatory issues that underlie the most common conditions.

It’s in the spirit of betterment that I’ve committed to learn and teach, to isolate practices fully within the trainer scope of practice that address the sources and causes of the plagues that impact 65% of our adult population. It’s time, not to urge doctors to respect trainers, but for trainers to create a legitimate platform of respect, one where chronic dis-ease is treated as a self-induced condition with patient / client empowerment as the greatest vehicle for true opportunity, as the vehicle for collaborative respect, a vehicle for the trainer to serve as a bona fide health catalyst.

Phil Kaplan has been a fitness leader and Personal Trainer for over 30 years having traveled the world sharing strategies for human betterment. He has pioneered exercise and eating interventions documented as having consistent and massive impact in battling chronic disease. His dual passion combines helping those who desire betterment and helping health professionals discover their potential. Email him at phil@philkaplan.com

Pulmonary Hypertension and Mind/Body Medicine?

Robyn Kade/9 January 2019/ All MFN blog/

To understand how Pulmonary Hypertension reacts to Mind/Body Medicine, you must understand what is going on biologically. Mind/Body Medicine, such as meditation and exercise, can help to give these clients a better quality of life. As a fitness professional, it is important to know how, when and why you are using certain mind/body modalities.

Pulmonary Hypertension is a very rare disease of the lungs and right side of the heart. Sometimes there is no known cause except a change in the cells that line the pulmonary arteries. There is no cure, so managing the disease is the best most people can do. Some clients may be on multiple medications, which is normal. The changes in the pulmonary cells cause the artery walls to be thick and stiff. Extra tissue may form and the arteries may become tight. Young individuals usually become diagnosed by the age of 36 and women are diagnosed more often then men. Each year, 10 to 15 people per million are diagnosed in the United States. It is important to note that life expectancy is about 3 to 5 years if not diagnosed and treated.

Hypertension, as most people know, is a blood pressure which is 130–139 over 80–89. Individuals with hypertension can usually come off of medications with eating healthy and exercising. There are instances where the client will never stop taking medications, due to genetics. The client can eat healthy and exercise, but the blood pressure does not come down. A primary doctor may try to get the blood pressure under control, but can’t.

In this situation, the individual would be sent to a Cardiologist who specializes in Pulmonary Hypertension. There are four types of Pulmonary Hypertension and they each have their own symptoms and treatment. It is important to obtain a doctor’s clearance before working with this population.

Types of Pulmonary Hypertension

Group 1: Pulmonary Arterial Hypertension
This group is usually classified as having no known cause. It can be genetic or develop from someone having Lupus, Scleroderma or HIV. Symptoms for this classification can be chest pain, dizziness, fatigue, inability to exercise, low blood pressure, chronic cough, shortness of breath, swelling or swollen legs.

Exercise is very important for this group by strengthening the heart and lungs. Clients will initially go to cardiac rehab for four to twelve weeks. When rehab is over, remember to obtain a clearance prior to working with your client. Start your client out by doing their cardiac rehab program. The goal is to strengthen the heart and help the client to build cardiovascular endurance.

Group 2: Pulmonary Hypertension due to left lung disease
The heart does not pump blood or relax effectively. Medications are used for this group to help lung functioning. Blood pressure medicine and diuretics may also be prescribed. The physician may also ask their client to lose weight or use a CPAP if they have sleep apnea.

Group 3: Pulmonary Hypertension due to lung disease
This group of individuals may have COPD, Interstitial Lung Disease, Sleep Apnea, chronic high altitude exposure, and pulmonary fibrosis. Treatment consists of improving lung function, proper sleep breathing and staying away from high altitudes.

Group 4: Chronic Thromboembolic Pulmonary Hypertension
In group four, clients have blood clots in the lung. The blood clot restricts blood flow causing hypertension. It is important to work closely with the client’s physician for this type of hypertension.

Overall, exercise is thought to be good for individuals with Pulmonary Hypertension. There are, however, some guidelines to follow. Clients should never over exercise or become overheated. If you are working with someone who presents with symptoms, do not exercise upper and lower extremities at the same time. Exercise in extreme hot or cold environments should be avoided.

Stress management techniques will not help with bring blood pressure or heart rate down. For these clients, it is important to concentrate on the symptoms. Many individuals with Pulmonary Hypertension develop anxiety, depression and chronic stress. Clients may sit in a chair or lie on the floor for mind/body classes. It depends on what is comfortable for each client. It is important that the client knows to not get discouraged because they are not seeing a drop in blood pressure.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References:

http://www.tsmihfp.com
https://pulmonaryhypertensionnews.com/pulmonary-hypertension-who-classification/
https://phassociation.org/medicalprofessionals/consensusstatements/exercise/
http://pulmonaryhypertensionrn.com/types-of-pulmonary-hypertension/

The Space Between Fitness and Medicine: Where “the Good You Do For Others” Brings the Reward you Deserve | Part 3

Phil Kaplan/20 July 2018/ All MFN blog/

If you’ve been following this article/series since Part 1, here’s what you now realize:

There is a massive market of adults in “need” of exercise and nutritional interventions to rediscover the health they’ve moved away from.
Although the conventions of the medical field are poorly equipped to reverse chronic disease, and the conventions of the fitness field primarily offer protocols for training healthy individuals (even the “special pop” certifications address safety more than an aggressive approach toward dis-ease reversal), there is MASSIVE OPPORTUNITY for you to prosper in working with this “unwell” market.

The Biggest Population in US History

Dan Ritchie/16 July 2018/ All MFN blog/

Did you know the Baby Boomers were the biggest population in US history?
Well, that was until their kids, the millennials, came along. Baby boomers were born from 1946-1964 and were 79 million strong. We are now down to about 76 million boomers and 10,000 are turning 65 or 70 every day! The millennials only outpaced them by 81 million, but for some reason the entire fitness industry is competing for their business and their attention and completely ignoring the largest, wealthiest, longest living generation in US history!

The leading Boomers are 63-72 and they are becoming “seniors” in a completely new way. In fact programs like Silver Sneakers, and other “senior” fitness programs, they are not attending, because as they would put it, those are for “old people ”….maybe for my mom or dad, but not me! This entire generation is breaking the mold on aging and is looking for something new, something cutting edge, something to give them a competitive advantage on their next 20-30 years. They want to give the grand kids a run for their money and they are only just beginning to take on new adventures. So they need personal trainers, group fitness instructors and fitness programming to be the best it can be.

If you want to stand out and dominate this market, then you need expertise and credentials that set you apart, because they are not going to just train with anyone.

In 2014 we set out to change the fitness industry introducing the first ever Specialist program based on decades of research and over 2,000 clients. We knew the industry didn’t need just another “senior fitness ” lite exercise course, but rather, one grounded in the science of human function and longevity…..and one that believed people could be vibrant, healthy and fit at any age….up until their very last breath! We believe there will be hundreds more like Dr. Charles Eugster who decided to take up sprinting and wakeboarding in his 90s…..because it simply looked like a “hell of a lot of fun”!

If you want to be part of the functional aging movement I encourage you to check out the Functional Aging Specialist certification, and join the growing ranks. Save $100 on the certification with code 100OFFMFN. Click here for course details. 30% of proceeds from this FAI purchase is donated to the MedFit Education Foundation!

Dan Ritchie, PhD, has a broad background in the fitness industry including training and management in commercial and university/hospital-based fitness, for-profit, notfor-profit and educational facilities. His primary areas of expertise are in personal training for special populations: athletes, pregnancy, blind, stroke recovery, Parkinsons, multiple sclerosis, cerebral palsy, Fibromyalgia, Alzheimers, etc.

This article was reprinted with permission from the Functional Aging Institute.

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.

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.

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.