Essay: Fit for life—a geriatrician's perspective on ageing well

Abstract

When I was at medical school I wanted to run a geriatric sports medicine clinic. Almost 30 years on, this vision of merging ideas central to exercise physiology with those at the core of multidisciplinary care of the aged has produced a wealth of empirical evidence. The results of the research suggest that the way in which we age and the resiliency with which we ward off disease is linked to our physical activity patterns and our degree of fitness. Hereditary as well as lifestyle factors govern fitness and physiological reserve. However, at least partial escape from a genetic predisposition to type 2 diabetes, stroke, coronary artery disease, hypertension, obesity, and other major scourges of modern civilisation is possible with the adoption of realistic doses of physical activity. Much of the typical phenotype of the aged person—a thinning, curved spine, wasted muscles, bulging abdominal adipose tissue—is more closely related to time spent in a gym than to the passage of years. Furthermore, body composition is still susceptible to change by anabolic stimuli, particularly robust forms of resistance exercise, in the tenth decade of life, despite a lifetime of sedentary behaviour. The therapeutic potential of exercise, as isolated or adjunctive treatment for established chronic disease, is increasingly apparent across a broad range of pathophysiological abnormalities and clinical syndromes. Furthermore, in mouse models of Alzheimer’s disease, brain-derived neural growth factors implicated in the hippocampal atrophy and dysfunction associated with dementia and depression as well as amyloid load are modifiable with voluntary exercise. Such modification of the structure and function of the central nervous system could perhaps underlie the consistent protective effect of physical activity relative to dementia and depression noted in prospective cohort studies.