Medical News: Strokes
Music Has Powers to Ease the Stroke-Injured Brain
By Judith Groch, Senior Writer, MedPage Today
Published: February 19, 2008
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine. Earn CME/CE credit
for reading medical news
HELSINKI, Finland, Feb. 19 -- Listening to music enhanced cognitive recovery and improved mood after a middle cerebral artery stroke, researchers reported.
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Action Points
Explain to interested patients that listening to music right after a stroke appears to be an inexpensive and possibly valuable addition to other forms of rehabilitation.
Note that these findings for improved cognition and mood came from a single study at one hospital and that music therapy may not work for all patients.
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Recovery of verbal memory and focused attention was better in patients who listened to music of their choice soon after a stroke than in patients who did not listen to anything or in those who listened to audio books, Teppo Sarkamo, M.A., of the University of Helsinki, and colleagues reported online in Brain.
Patients who listened to music also had a more positive mood, the researchers said.
Research has shown that during the first weeks and months after a stroke, patients typically spend most of their time in non-therapeutic activities, mostly inactive in their rooms, even though this time window is ideal for rehabilitation, the researchers said.
It's also been shown, they noted, that "an enriched sound environment" can enhance various brain function, including learning and memory. But, they said, its effects on recovery from neural damage have not been systematically studied.
So the researchers recruited 60 patients, ages 75 or younger, in the acute recovery phase from a left or right hemisphere middle cerebral artery stroke.
Patients entered a single-blind, randomized, controlled trial from March 2004 to May 2006, with therapy starting as soon as possible after admission to the Helsinki University Central Hospital.
They were randomly assigned to a music group, a language group, or a control group receiving only standard care.
During the following two months, the music and language groups listened daily for at least an hour to self-selected music (pop, classical, jazz, or folk) or audio books. The control group received no special auditory stimulation.
All patients received standard medical care and rehabilitation.
At one week (baseline), three months, and six months after the stroke, they also underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality-of-life questionnaires.
Fifty-four patients completed the study.
Tests at three months showed that verbal memory was significantly better in the music group than in the control group (P=0.012) or in the language group (P=0.006).
Focused attention recovery was also significantly better in the music group than in the control group (P=0.049) and marginally better in the music group than in the language group (P=0.058).
At six months, the findings were similar, the researchers said.
In addition, the researchers found that the music group experienced less depression and confusion. At three months, there was a significant difference in depression (P=0.031) and confusion (P=0.045).
Post hoc tests found that the depression score was significantly lower in the music group then in the control group (P=0.024) but only marginally different between the music and the language group.
The confusion score was marginally lower in the music group than in the control group (P=0.061).
At six months, the differences between the music and control groups were still marginally different for depression and confusion.
It is possible, the researchers suggested, that music in itself may help patients cope with the emotional stress caused by a sudden severe neurological illness.
Some aphasic patients in the language group, the investigators suggested, had difficulty listening to the audio books and thus did not find the intervention as enjoyable as patients in the music group.
In reviewing the possible neural mechanisms involved in the music-stroke connection, the researchers suggested that enhanced alertness, attention, memory, emotion, and motivation may be mediated by the dopaminergic mesocorticolimbic system.
Also, music may stimulate the recovery of damaged areas of the brain, they said.
In addition to the effect on cognition and mood, the investigators hypothesized that music may also have general effects on brain plasticity after a stroke.
Listening to music, they said, may stimulate both the peri-infarct regions in the damaged hemisphere but also regions in the other healthy hemisphere, thereby speeding up recovery.
It is possible, they suggested, that listening to music, especially if it contains lyrics, which activate the brain bilaterally, would facilitate recovery from unilateral stroke more than listening to purely spoken material, which activates the left hemisphere primarily.
However, the researchers said, this suggestion is tentative, and further research is needed to explain the potential effects of a musically enriched recovery environment on brain plasticity after a stroke.
They concluded that listening to music every day during early stroke recovery "offers a valuable addition to the patient's care … by providing an individually targeted, easy-to-conduct, and inexpensive means to facilitate cognitive and emotional recovery."
The study was supported by the Academy of Finland, Jenny and Antti Wihuri Foundation (Helsinki, Finland), and the National Graduate School of Psychology and Neurology Foundation (Helsinki, Finland). Funding to pay the Open 100 Access publication charges for this article was provided by the Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Finland.
No financial conflicts were reported.
Primary source: Brain
Source reference:
Särkämö T, et al "Music listening enhances cognitive recovery and mood after middle cerebral artery stroke" Brain 2008: DOI: 10.1093/brain/awn013.
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Tuesday, February 19, 2008
Friday, February 15, 2008
Can You Nap Your Way to Health?
Siestas and Your Heart: Can You Nap Your Way to Health?
From Harvard Health Publications
Here in the United States, many people consider eight hours an ideal amount of sleep — and most of them expect those eight hours to come in one block at night. But in Latin America, Mediterranean countries, and other parts of the world, the ideal slumber follows quite a different pattern. In sunny climates, people like to retreat from the heat and stress of a busy day for an afternoon siesta, then make up the difference by staying up late at night.
Cultural norms evolve to suit the needs and preferences of particular societies. But human biology is much the same in Athens and Chicago. Perhaps, then, a study of siestas in Greece will help Americans understand their own choices for healthful sleep. The study also raises the interesting possibility that a daily siesta may help ward off heart disease.
The Greek Epic Study
To look for a link between siestas and the risk of heart disease, scientists from the University of Athens Medical School and the Harvard School of Public Health studied 23,681 Greek men and women. All the volunteers were free of diagnosed heart diseases, cancer, and stroke when they enrolled in the study between 1994 and 1999. They all reported on their napping habits; the researchers classified them as regular nappers, occasional nappers, or non-nappers. They also collected information on all the participants’ age, education, smoking status, employment, exercise level, diet, body mass index, and waist-to-hip ratio.
The subjects were tracked for an average of 6.3 years; in this period, 133 members of the group died from coronary artery disease. As expected, advancing age, smoking, and abdominal obesity were linked to an increased risk of cardiac death, while exercise, a good diet, increased education, and gainful employment appeared protective. Surprisingly, though, midday napping was also protective, especially for men.
Among the entire group, siestas of any duration or frequency were associated with a 34% lower risk of dying from heart disease, even after accounting for other risk factors. Occasional napping was linked to a 12% reduction in cardiac mortality, but regular napping appeared to reduce risk by 37%. The apparent protection was stronger for men than women; among working men, occasional nappers were 64% less likely to die from coronary artery disease than their non-napping peers, and regular nappers were 50% less likely to die from coronary artery disease than non-nappers.
Early to bed, early to rise?
Mediterraneans and Latins may be the masters of napping, but Americans may be more likely to observe Ben Franklin’s prescription that “early to bed and early to rise makes a man healthy, wealthy, and wise.” Was Franklin right? A team of Harvard researchers had the temerity to test his dictum. They evaluated 949 men who had been hospitalized with heart attacks. After tracking them for an average of 3.7 years, they found no relationship between early bedtimes (before 11 p.m.) or early awakening (before 6:30 a.m.) and death rates, income, or educational attainment.
It’s still possible, though, that time is money, or that a penny saved is a penny earned.
Wake-up calls
Two earlier studies from Greece support the possibility that midday napping may reduce the risk of heart disease, but a larger study from Costa Rica and two from Israel produced opposite conclusions. Is there something different about Greece, or is there something different about the studies? Without discounting the unique characteristics of the Aegean nation, differences in the research may explain the contradictory results. The new study differed from the others by enrolling only healthy people; it also accounted for the effects of exercise — but the other studies did not. People who are ill often sleep during the day because of exhaustion or fatigue. By including them in the analysis, any benefit of voluntary napping by healthy people could easily be obscured. In fact, the Greek Epic Study reported the greatest benefit among working men.
If siestas are beneficial, how do they work? Stress reduction is the most plausible explanation and would fit with the observation that voluntary midday naps were particularly helpful to working men.
The power(ful) nap
The possible cardiac benefits of napping will require more study. But there are other, well-documented benefits. Studies of shift workers, airline flight crews, medical interns, and highway drivers have all reported that naps as short as 20–30 minutes decrease fatigue and improve psychomotor performance, mood, and alertness. That’s a big benefit to the napper — and to his passengers or patients.
Napping niceties
If you nap, be sure it’s because you want to, not because you have to. Sleep deprivation — from sleep apnea, restless legs syndrome, depression, or any other cause — produces daytime somnolence that may make you need to nap. Sleep deprivation is harmful to your health. If you find yourself nodding off when you least want to, don’t just give in to a nap. Instead, find out what’s wrong with your nighttime sleep, then work to correct it.
A voluntary daytime siesta is a different matter. It can be pleasurable, refreshing, and even healthful. If you do take a nap, try to time it to fit your daily sleep-wake cycle; for most men, early afternoon is best. To preserve your good night’s sleep, don’t nap too long; for most people, 20 to 40 minutes work best. And expect to be a bit sluggish or groggy when you wake up, so give yourself at least 10 minutes to fully awaken before taking on any demanding tasks.
Dream on
The Greek Epic Study raises the possibility that daytime siestas may help reduce the risk of dying from heart disease. Since napping takes less discipline than a good diet and less effort than regular exercise, it’s a hopeful possibility. But confirming studies are needed, and even if the association holds up, observational studies can never prove cause and effect. In this case, for example, siestas might be a marker for an overall healthier lifestyle rather than a unique way to protect your heart.
Remember, too, that it’s easier to nap in Athens, Greece, than Athens, Georgia, particularly for working men. A siesta may reduce stress in Greece, but it may introduce stresses in the United States.
Don’t count on naps to protect your heart — but if you enjoy siestas as part of a healthful lifestyle, nap away. And even if you can’t fit in a nap at work, if you travel to Greece you may be able to do as the Greeks do.
From Harvard Health Publications
Here in the United States, many people consider eight hours an ideal amount of sleep — and most of them expect those eight hours to come in one block at night. But in Latin America, Mediterranean countries, and other parts of the world, the ideal slumber follows quite a different pattern. In sunny climates, people like to retreat from the heat and stress of a busy day for an afternoon siesta, then make up the difference by staying up late at night.
Cultural norms evolve to suit the needs and preferences of particular societies. But human biology is much the same in Athens and Chicago. Perhaps, then, a study of siestas in Greece will help Americans understand their own choices for healthful sleep. The study also raises the interesting possibility that a daily siesta may help ward off heart disease.
The Greek Epic Study
To look for a link between siestas and the risk of heart disease, scientists from the University of Athens Medical School and the Harvard School of Public Health studied 23,681 Greek men and women. All the volunteers were free of diagnosed heart diseases, cancer, and stroke when they enrolled in the study between 1994 and 1999. They all reported on their napping habits; the researchers classified them as regular nappers, occasional nappers, or non-nappers. They also collected information on all the participants’ age, education, smoking status, employment, exercise level, diet, body mass index, and waist-to-hip ratio.
The subjects were tracked for an average of 6.3 years; in this period, 133 members of the group died from coronary artery disease. As expected, advancing age, smoking, and abdominal obesity were linked to an increased risk of cardiac death, while exercise, a good diet, increased education, and gainful employment appeared protective. Surprisingly, though, midday napping was also protective, especially for men.
Among the entire group, siestas of any duration or frequency were associated with a 34% lower risk of dying from heart disease, even after accounting for other risk factors. Occasional napping was linked to a 12% reduction in cardiac mortality, but regular napping appeared to reduce risk by 37%. The apparent protection was stronger for men than women; among working men, occasional nappers were 64% less likely to die from coronary artery disease than their non-napping peers, and regular nappers were 50% less likely to die from coronary artery disease than non-nappers.
Early to bed, early to rise?
Mediterraneans and Latins may be the masters of napping, but Americans may be more likely to observe Ben Franklin’s prescription that “early to bed and early to rise makes a man healthy, wealthy, and wise.” Was Franklin right? A team of Harvard researchers had the temerity to test his dictum. They evaluated 949 men who had been hospitalized with heart attacks. After tracking them for an average of 3.7 years, they found no relationship between early bedtimes (before 11 p.m.) or early awakening (before 6:30 a.m.) and death rates, income, or educational attainment.
It’s still possible, though, that time is money, or that a penny saved is a penny earned.
Wake-up calls
Two earlier studies from Greece support the possibility that midday napping may reduce the risk of heart disease, but a larger study from Costa Rica and two from Israel produced opposite conclusions. Is there something different about Greece, or is there something different about the studies? Without discounting the unique characteristics of the Aegean nation, differences in the research may explain the contradictory results. The new study differed from the others by enrolling only healthy people; it also accounted for the effects of exercise — but the other studies did not. People who are ill often sleep during the day because of exhaustion or fatigue. By including them in the analysis, any benefit of voluntary napping by healthy people could easily be obscured. In fact, the Greek Epic Study reported the greatest benefit among working men.
If siestas are beneficial, how do they work? Stress reduction is the most plausible explanation and would fit with the observation that voluntary midday naps were particularly helpful to working men.
The power(ful) nap
The possible cardiac benefits of napping will require more study. But there are other, well-documented benefits. Studies of shift workers, airline flight crews, medical interns, and highway drivers have all reported that naps as short as 20–30 minutes decrease fatigue and improve psychomotor performance, mood, and alertness. That’s a big benefit to the napper — and to his passengers or patients.
Napping niceties
If you nap, be sure it’s because you want to, not because you have to. Sleep deprivation — from sleep apnea, restless legs syndrome, depression, or any other cause — produces daytime somnolence that may make you need to nap. Sleep deprivation is harmful to your health. If you find yourself nodding off when you least want to, don’t just give in to a nap. Instead, find out what’s wrong with your nighttime sleep, then work to correct it.
A voluntary daytime siesta is a different matter. It can be pleasurable, refreshing, and even healthful. If you do take a nap, try to time it to fit your daily sleep-wake cycle; for most men, early afternoon is best. To preserve your good night’s sleep, don’t nap too long; for most people, 20 to 40 minutes work best. And expect to be a bit sluggish or groggy when you wake up, so give yourself at least 10 minutes to fully awaken before taking on any demanding tasks.
Dream on
The Greek Epic Study raises the possibility that daytime siestas may help reduce the risk of dying from heart disease. Since napping takes less discipline than a good diet and less effort than regular exercise, it’s a hopeful possibility. But confirming studies are needed, and even if the association holds up, observational studies can never prove cause and effect. In this case, for example, siestas might be a marker for an overall healthier lifestyle rather than a unique way to protect your heart.
Remember, too, that it’s easier to nap in Athens, Greece, than Athens, Georgia, particularly for working men. A siesta may reduce stress in Greece, but it may introduce stresses in the United States.
Don’t count on naps to protect your heart — but if you enjoy siestas as part of a healthful lifestyle, nap away. And even if you can’t fit in a nap at work, if you travel to Greece you may be able to do as the Greeks do.
Preventing Diabetes in African-Americans
New Resource for Preventing Diabetes in African-Americans
Joint CDC and NIH Program Releases New Resource for Use by Faith and Community-based Groups
A new diabetes prevention resource designed to encourage and help faith–based and community organizations get actively involved in deterring preventable diabetes among African–Americans was released by the National Diabetes Education Program (NDEP), a joint venture of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health.
The new interactive educational kit, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention, provides hands–on instruction and guidance in making behavior changes that can help prevent diabetes.
“Too many African–Americans have, or will get, diabetes,” said Ann Albright, PhD., director of CDC’s Division of Diabetes Translation. “Fortunately, many people and families can take steps to prevent that from happening. It′s often difficult to change or adopt new behaviors, but this new resource gives many examples of things that most people can do that will help them avoid a very serious life–long disease. This program also helps faith–based and community organizations which are very important to many African–American families provide the support that can make a difference in helping people take on new nutrition and exercise habits.”
The Power to Prevent program includes 12 interactive group sessions that provide hands–on instruction in ways to prevent diabetes, and shows how families and individuals can change their daily habits so that they get more physical activity, make healthy food choices and better control their food serving sizes. The sessions are designed to be led by various members of the faith–based or community organization, such as a recreation director.
“We know that churches, faith–based organizations and community groups can be very effective in helping people learn about diabetes, and in helping take steps that can prevent diabetes for most people,” said Albright. “That’s why we created this new tool. We need faith and community–based organizations to be actively involved in diabetes prevention among their members, and with this easy–to–use program, they can do that effectively.”
Diabetes is the sixth leading cause of death in the United States; and the prevalence rate more than doubled among African–Americans from 1980 to 2005, from 3.3 to 6.8. Diabetes is a disease associated with high levels of blood glucose resulting from defects in insulin production that causes sugar to build up in the body. It can cause serious health complications including heart disease, blindness, kidney failure, and lower–extremity amputations; and can also lead to premature death. It is estimated that, among Americans aged 20 and older, more than 20 million have diabetes, of which more than 3 million are African–Americans. After taking into consideration the age differences in the various populations, non–Hispanics blacks are 1.8 times as likely to have diabetes as non–Hispanics whites.
The CDC Division of Diabetes Translation, through the NDEP (co–sponsored by the NIH), provides diabetes education to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of diabetes. While the design and appearance of Power to Prevent is specifically directed toward African–Americans because of the increasing prevalence in this group, the basic content can be useful and relevant to all populations.
To download or order a free single printed copy of Power to Prevent go to www.cdc.gov/diabetes/ndep/power_to_prevent.htm. For general information about diabetes, please visit www.cdc.gov/diabetes.
###
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Joint CDC and NIH Program Releases New Resource for Use by Faith and Community-based Groups
A new diabetes prevention resource designed to encourage and help faith–based and community organizations get actively involved in deterring preventable diabetes among African–Americans was released by the National Diabetes Education Program (NDEP), a joint venture of the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health.
The new interactive educational kit, Power to Prevent: A Family Lifestyle Approach to Diabetes Prevention, provides hands–on instruction and guidance in making behavior changes that can help prevent diabetes.
“Too many African–Americans have, or will get, diabetes,” said Ann Albright, PhD., director of CDC’s Division of Diabetes Translation. “Fortunately, many people and families can take steps to prevent that from happening. It′s often difficult to change or adopt new behaviors, but this new resource gives many examples of things that most people can do that will help them avoid a very serious life–long disease. This program also helps faith–based and community organizations which are very important to many African–American families provide the support that can make a difference in helping people take on new nutrition and exercise habits.”
The Power to Prevent program includes 12 interactive group sessions that provide hands–on instruction in ways to prevent diabetes, and shows how families and individuals can change their daily habits so that they get more physical activity, make healthy food choices and better control their food serving sizes. The sessions are designed to be led by various members of the faith–based or community organization, such as a recreation director.
“We know that churches, faith–based organizations and community groups can be very effective in helping people learn about diabetes, and in helping take steps that can prevent diabetes for most people,” said Albright. “That’s why we created this new tool. We need faith and community–based organizations to be actively involved in diabetes prevention among their members, and with this easy–to–use program, they can do that effectively.”
Diabetes is the sixth leading cause of death in the United States; and the prevalence rate more than doubled among African–Americans from 1980 to 2005, from 3.3 to 6.8. Diabetes is a disease associated with high levels of blood glucose resulting from defects in insulin production that causes sugar to build up in the body. It can cause serious health complications including heart disease, blindness, kidney failure, and lower–extremity amputations; and can also lead to premature death. It is estimated that, among Americans aged 20 and older, more than 20 million have diabetes, of which more than 3 million are African–Americans. After taking into consideration the age differences in the various populations, non–Hispanics blacks are 1.8 times as likely to have diabetes as non–Hispanics whites.
The CDC Division of Diabetes Translation, through the NDEP (co–sponsored by the NIH), provides diabetes education to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of diabetes. While the design and appearance of Power to Prevent is specifically directed toward African–Americans because of the increasing prevalence in this group, the basic content can be useful and relevant to all populations.
To download or order a free single printed copy of Power to Prevent go to www.cdc.gov/diabetes/ndep/power_to_prevent.htm. For general information about diabetes, please visit www.cdc.gov/diabetes.
###
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Friday, February 1, 2008
Staying a Step Ahead of Aging
Staying a Step Ahead of Aging
Filip Kwiatkowski for The New York Times
By: GINA KOLATA
Published: January 31, 2008
YOU know what is supposed to happen when you grow old. You will slow down, you will grow weak, your steps will become short and mincing, and you will lose your sense of balance. That’s what aging researchers consistently find, and it’s no surprise to most of us.
But it is worth remembering that the people in those studies were sedentary, said Dr. Vonda Wright, a professor of orthopedics at the University of Pittsburgh.
Dr. Wright, a 40-year-old runner, decided to study people who kept training as they got older or began competing in middle age. She wanted to know what happens to them and at what age does performance start to decline.
Their results are surprising, even to many of the researchers themselves. The investigators find that while you will slow down as you age, you may be able to stave off more of the deterioration than you thought. Researchers also report that people can start later in life — one man took up running at 62 and ran his first marathon, a year later, in 3 hours 25 minutes.
It’s a testament to how adaptable the human body is, researchers said, that people can start serious training at an older age and become highly competitive. It also is testament to their findings that some physiological factors needed for a good performance are not much affected by age.
Researchers say that you should be able to maintain your muscles as you age, including the muscle enzymes needed for good athletic performance, and you should be able to maintain your ability to exercise for long periods near your so-called lactic threshold, meaning you are near maximum effort.
But you have to know how to train, doing the right sort of exercise, and you must keep it up.
“Train hard and train often,” said Hirofumi Tanaka, a 41-year-old soccer player and exercise physiologist at the University of Texas.
Dr. Tanaka said he means doing things like regular interval training, repeatedly going all out, easing up, then going all out again. These workouts train your body to increase its oxygen consumption by allowing you to maintain an intense effort.
“One of the major determinants of endurance performance is oxygen consumption,” Dr. Tanaka said. “You have to make training as intense as you can.”
When you have to choose between hard and often, choose hard, said Steven Hawkins, an exercise physiologist at the University of Southern California.
“High performance is really determined more by intensity than volume,” he added. “Sometimes, when you’re older, something has to give. You can’t have both so you have to cut back on the volume. You need more rest days.”
Dr. Hawkins, who says he no longer runs competitively, adds that he tries to put his findings into practice. “I run a couple of times a week and I try to make it as fast as I can,” he said. “I’m not plodding along.”
He also has been amazed by some people who seem to defy the rules of aging, people he describes as “those rare birds who get faster.” Some subjects in Dr. Hawkins’s research study, which followed runners for nearly two decades, actually had better times when they were 60 than when they were 50.
“We really don’t know why,” Dr. Hawkins confessed. “Maybe they were training harder.”
Then there are people like the 62-year-old man who suddenly took up running and began running fast marathons. That man’s inspiration to become a runner, said James Hagberg, an exercise physiologist at the University of Maryland, was watching a lakefront marathon in Milwaukee. “He got all fired up,” Dr. Hagberg recalled.
And there are people like Imme Dyson, a 71-year-old runner who lives in Princeton, N.J. She took up running when she was 48 and loved it, she says, from the moment she put on a pair of running shoes. Her daughter, who had been a college triathlete, told her how to train.
“She said, ‘Mom, if your workout didn’t hurt, you didn’t work hard enough,’ ” Ms. Dyson said.
“Working consistently really is the recipe,” she said. And it has made a difference for her, allowing her to run races, from 5K to marathons, so fast that she is consistently among the best in the nation in her age group. She has run a 15K cross-country race in 1:19:08, a pace of 8:29 a mile. And she ran a 10K race in 51 minutes 50 seconds, a pace of 8:20 a mile.
Not every aging athlete does so well. But Dr. Hagberg found that studies of aging athletes sometimes were distorted because they included people who had cut back on or stopped training. That’s understandable; there is no reason, researchers say, to exhort everyone to maintain an intense effort decade after decade.
Athletes would tell Dr. Hagberg that they had just lost their motivation. “Some of them would say: ‘Competition just doesn’t motivate me as much at 75. I’ve been doing it for 50 years,’ ” he said. “Others would say, ‘I just can’t keep it up any more.’ ”
But for those who still have the drive, the news that muscle mass and lactic threshold can be maintained is encouraging.
The reason people become slower, though, is that oxygen consumption declines with age.
In large part that is because, as has long been known, the maximum heart rate steadily falls by about seven to eight beats per minute per decade. It happens with or without training, in sedentary and in active people, Dr. Tanaka said, and no one knows why. But as a result, the heart cannot pump as much blood at maximum effort.
Dr. Michael Joyner, a 49-year-old exercise researcher at the Mayo Clinic who also is a competitive swimmer and a runner, added another factor: the lungs of older athletes cannot take in quite as much air.
With a slower heart rate and less oxygen in the lungs, less oxygen-rich blood gets to the muscles. In one study, Dr. Joyner found that highly trained athletes age 55 to 68 had 10 to 20 percent less blood flow to their legs than athletes in their 20s.
The older athletes in his group, though, were edging toward an age that often is a transition time in athletic performances, researchers are finding. For example, Dr. Wright and her colleague Dr. Brett Perricelli found that the performances of track athletes declined almost imperceptibly from year to year until their mid-60s, when the rate of decline picked up. At age 75, though, the athletes’ times fell, on average, by 7 percent.
The study, the results of which will appear in the March issue of the American Journal of Sports Medicine, involved track and field athletes age 50 to 85 who were participants in the 2001 Senior Olympics and also examined the times for American record holders in track events.
But older athletes still can have spectacular performances, Dr. Tanaka notes.
For example, the world best marathon time for men 70 or older (2:54:05) was set by a 74-year-old. That is more than four minutes faster than the winning marathon time at the first modern Olympics, the 1896 Games in Athens.
Of course, such statistics are of little comfort to athletes who do not want to slow down at all. Dr. Hawkins said he and Robert A. Wiswell, the senior author on his nearly 20-year study of athletes, used to joke that they needed a sports psychologist rather than a sports physiologist on their study. The athletes, he explained, could not bear to think that they would stop setting personal records.
That’s an issue for Don Truex, a 70-year-old dentist in Santa Barbara, Calif, who can’t understand why he has slowed down in the last year. He just ran a 5K race in 23:45. It was an average pace of 7:38 a mile, 90 seconds slower than he wanted to run.
“I’ve consulted with my doctor and we think I may be overtraining,” Dr. Truex said. He’s going to continue running five days a week but cut back on his five days a week of cycling.
Slower times are even more of a concern for Dr. Truex’s friend Barry Erbsen, a 67-year-old dentist in Los Angeles.
Dr. Erbsen started running seriously around 40. His best time in a 10K race was 38 minutes, a pace of 6 minutes a mile. Next he started running marathons, going faster each time until he had completed several, including the Boston Marathon, in 3:07:00.
Then, Dr. Erbsen started to slow down. He ran a marathon a few years ago in 3:45:00. He completed his next one in 3:58:00.
That nearly four-hour marathon was his last, he said. Instead, Dr. Erbsen took up mountain biking. So far so good, he said. He’s having a lot of fun. And, he added, “I’m not getting too much slower.”
Filip Kwiatkowski for The New York Times
By: GINA KOLATA
Published: January 31, 2008
YOU know what is supposed to happen when you grow old. You will slow down, you will grow weak, your steps will become short and mincing, and you will lose your sense of balance. That’s what aging researchers consistently find, and it’s no surprise to most of us.
But it is worth remembering that the people in those studies were sedentary, said Dr. Vonda Wright, a professor of orthopedics at the University of Pittsburgh.
Dr. Wright, a 40-year-old runner, decided to study people who kept training as they got older or began competing in middle age. She wanted to know what happens to them and at what age does performance start to decline.
Their results are surprising, even to many of the researchers themselves. The investigators find that while you will slow down as you age, you may be able to stave off more of the deterioration than you thought. Researchers also report that people can start later in life — one man took up running at 62 and ran his first marathon, a year later, in 3 hours 25 minutes.
It’s a testament to how adaptable the human body is, researchers said, that people can start serious training at an older age and become highly competitive. It also is testament to their findings that some physiological factors needed for a good performance are not much affected by age.
Researchers say that you should be able to maintain your muscles as you age, including the muscle enzymes needed for good athletic performance, and you should be able to maintain your ability to exercise for long periods near your so-called lactic threshold, meaning you are near maximum effort.
But you have to know how to train, doing the right sort of exercise, and you must keep it up.
“Train hard and train often,” said Hirofumi Tanaka, a 41-year-old soccer player and exercise physiologist at the University of Texas.
Dr. Tanaka said he means doing things like regular interval training, repeatedly going all out, easing up, then going all out again. These workouts train your body to increase its oxygen consumption by allowing you to maintain an intense effort.
“One of the major determinants of endurance performance is oxygen consumption,” Dr. Tanaka said. “You have to make training as intense as you can.”
When you have to choose between hard and often, choose hard, said Steven Hawkins, an exercise physiologist at the University of Southern California.
“High performance is really determined more by intensity than volume,” he added. “Sometimes, when you’re older, something has to give. You can’t have both so you have to cut back on the volume. You need more rest days.”
Dr. Hawkins, who says he no longer runs competitively, adds that he tries to put his findings into practice. “I run a couple of times a week and I try to make it as fast as I can,” he said. “I’m not plodding along.”
He also has been amazed by some people who seem to defy the rules of aging, people he describes as “those rare birds who get faster.” Some subjects in Dr. Hawkins’s research study, which followed runners for nearly two decades, actually had better times when they were 60 than when they were 50.
“We really don’t know why,” Dr. Hawkins confessed. “Maybe they were training harder.”
Then there are people like the 62-year-old man who suddenly took up running and began running fast marathons. That man’s inspiration to become a runner, said James Hagberg, an exercise physiologist at the University of Maryland, was watching a lakefront marathon in Milwaukee. “He got all fired up,” Dr. Hagberg recalled.
And there are people like Imme Dyson, a 71-year-old runner who lives in Princeton, N.J. She took up running when she was 48 and loved it, she says, from the moment she put on a pair of running shoes. Her daughter, who had been a college triathlete, told her how to train.
“She said, ‘Mom, if your workout didn’t hurt, you didn’t work hard enough,’ ” Ms. Dyson said.
“Working consistently really is the recipe,” she said. And it has made a difference for her, allowing her to run races, from 5K to marathons, so fast that she is consistently among the best in the nation in her age group. She has run a 15K cross-country race in 1:19:08, a pace of 8:29 a mile. And she ran a 10K race in 51 minutes 50 seconds, a pace of 8:20 a mile.
Not every aging athlete does so well. But Dr. Hagberg found that studies of aging athletes sometimes were distorted because they included people who had cut back on or stopped training. That’s understandable; there is no reason, researchers say, to exhort everyone to maintain an intense effort decade after decade.
Athletes would tell Dr. Hagberg that they had just lost their motivation. “Some of them would say: ‘Competition just doesn’t motivate me as much at 75. I’ve been doing it for 50 years,’ ” he said. “Others would say, ‘I just can’t keep it up any more.’ ”
But for those who still have the drive, the news that muscle mass and lactic threshold can be maintained is encouraging.
The reason people become slower, though, is that oxygen consumption declines with age.
In large part that is because, as has long been known, the maximum heart rate steadily falls by about seven to eight beats per minute per decade. It happens with or without training, in sedentary and in active people, Dr. Tanaka said, and no one knows why. But as a result, the heart cannot pump as much blood at maximum effort.
Dr. Michael Joyner, a 49-year-old exercise researcher at the Mayo Clinic who also is a competitive swimmer and a runner, added another factor: the lungs of older athletes cannot take in quite as much air.
With a slower heart rate and less oxygen in the lungs, less oxygen-rich blood gets to the muscles. In one study, Dr. Joyner found that highly trained athletes age 55 to 68 had 10 to 20 percent less blood flow to their legs than athletes in their 20s.
The older athletes in his group, though, were edging toward an age that often is a transition time in athletic performances, researchers are finding. For example, Dr. Wright and her colleague Dr. Brett Perricelli found that the performances of track athletes declined almost imperceptibly from year to year until their mid-60s, when the rate of decline picked up. At age 75, though, the athletes’ times fell, on average, by 7 percent.
The study, the results of which will appear in the March issue of the American Journal of Sports Medicine, involved track and field athletes age 50 to 85 who were participants in the 2001 Senior Olympics and also examined the times for American record holders in track events.
But older athletes still can have spectacular performances, Dr. Tanaka notes.
For example, the world best marathon time for men 70 or older (2:54:05) was set by a 74-year-old. That is more than four minutes faster than the winning marathon time at the first modern Olympics, the 1896 Games in Athens.
Of course, such statistics are of little comfort to athletes who do not want to slow down at all. Dr. Hawkins said he and Robert A. Wiswell, the senior author on his nearly 20-year study of athletes, used to joke that they needed a sports psychologist rather than a sports physiologist on their study. The athletes, he explained, could not bear to think that they would stop setting personal records.
That’s an issue for Don Truex, a 70-year-old dentist in Santa Barbara, Calif, who can’t understand why he has slowed down in the last year. He just ran a 5K race in 23:45. It was an average pace of 7:38 a mile, 90 seconds slower than he wanted to run.
“I’ve consulted with my doctor and we think I may be overtraining,” Dr. Truex said. He’s going to continue running five days a week but cut back on his five days a week of cycling.
Slower times are even more of a concern for Dr. Truex’s friend Barry Erbsen, a 67-year-old dentist in Los Angeles.
Dr. Erbsen started running seriously around 40. His best time in a 10K race was 38 minutes, a pace of 6 minutes a mile. Next he started running marathons, going faster each time until he had completed several, including the Boston Marathon, in 3:07:00.
Then, Dr. Erbsen started to slow down. He ran a marathon a few years ago in 3:45:00. He completed his next one in 3:58:00.
That nearly four-hour marathon was his last, he said. Instead, Dr. Erbsen took up mountain biking. So far so good, he said. He’s having a lot of fun. And, he added, “I’m not getting too much slower.”
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