Pilates Plus

Old But Not Frail

2006-10-07T13:07:00.000-04:00

The New Age
Old but Not Frail: A Matter of Heart and Head

By GINA KOLATA
Published: October 5, 2006
Mary Wittenberg, the 44-year-old president of New York Road Runners, is a fast, strong and experienced runner. But she races best, she says, when she runs just behind Witold Bialokur. He can run 10 kilometers, or 6.2 miles, in less than 44 minutes and he is so smooth and controlled.

The New AgePursuing a Mystery
This is the third article in a series looking at the science of aging. Other articles will explore who ages well and why. The articles will remain online at nytimes.com/aging.
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Dorothy Bower, 78, has had to give up her walks around the grounds of her assisted living residence.
Researchers say cartoons that mock old age like this one may reinforce stereotypes among older people.
“He’s like a metronome with his pacing,” Ms. Wittenberg says. “I am often struggling to keep up with him and it’s a good day when I do.”
While Mr. Bialokur’s performance would be the envy of most young men, he is not young. Mr. Bialokur is 71.
It is one of the persistent mysteries of aging, researchers say. Why would one person, like Mr. Bialokur, remain so hale and hearty while another, who had seemed just as healthy, start to weaken and slow down, sometimes as early as his 70’s?
That, says Tamara Harris, who is chief of the geriatric epidemiology section at the National Institute on Aging, is a central issue that is only now being systematically addressed. The question is why some age well and others do not, often heading along a path that ends up in a medical condition known as frailty.
Frailty, Dr. Harris explains, involves exhaustion, weakness, weight loss and a loss of muscle mass and strength. It is, she says, a grim prognosis whose causes were little understood.
“It means that some people spend a long time in a period of their life where they have lost function,” Dr. Harris says. “People find that very distressing, and there is a tremendous health care cost.”
Now, though, scientists are surprised to find that, in many cases, a single factor — undetected cardiovascular disease — is often a major reason people become frail. They may not have classic symptoms like a heart attack or chest pains or a stroke. But cardiovascular disease may have partly blocked blood vessels in the brain, the legs, the kidneys or the heart. Those obstructions, in turn, can result in exhaustion or mental confusion or weakness or a slow walking pace.
Investigators say that there is a ray of hope in the finding — if cardiovascular disease is central to many of the symptoms of old age, it should be possible to slow or delay or even prevent many of these changes by treating the medical condition.
A second finding is just as surprising to skeptical scientists because it seemed to many like a wrongheaded cliché — you’re only as old as you think you are. Rigorous studies are now showing that seeing, or hearing, gloomy nostrums about what it is like to be old can make people walk more slowly, hear and remember less well, and even affect their cardiovascular systems. Positive images of aging have the opposite effects. The constant message that old people are expected to be slow and weak and forgetful is not a reason for the full-blown frailty syndrome. But it may help push people along that path.
Still, it is a view that can lead to blaming the victim, and some scientists at first resisted it. Now, though, more and more say they have been won over by an accumulating body of evidence.
“I am changing my initially skeptical view,” says Richard Suzman, who is director of the office of behavioral and social research programs at the National Institute on Aging. “There is growing evidence that these subjective experiences might be more important than we thought.”

The Walking Test
Eleanor Simonsick’s initiation into the unrecognized debilitations of aging came with a research study she helped set up. The question was whether older people who are relatively vigorous are also longer-lived. As an epidemiologist at the National Institute on Aging, she thought it was time to ask that in a rigorous way.
So she and her colleagues recruited 3,075 apparently healthy people in their 70’s who said they could walk a quarter of a mile with no trouble and climb a flight of stairs. Each was asked to walk up and down a corridor 10 times, for a distance of a quarter mile, maintaining their pace and not stopping to rest.
A quarter of them could not do it. And it was not just a matter of age. The average age of those who could do it was 73. So was the average age of those who could not. Dr. Harris explained: “I believe most people can amble. But we were asking them to walk as quickly as they could without stopping. That’s what people couldn’t do.”
Some walked so slowly, with tiny steps and labored cadences, that the researchers told them that they could stop because it was clear that they could never finish. Others Dr. Simonsick added, “just said: ‘I’m done. I’m sitting down.’ ”
“It’s very sad,” she added. “It’s not like we put them on a treadmill and cranked it up. You get the sense that they are simply deconditioned.”
The problem became worse. “In the first two years, a third of the group that could walk the quarter mile said they were beginning to have difficulty,” Dr. Harris said. “We thought, ‘Oh, this is impossible.’ ”
But it was real.
The researchers published their data in the May 3 issue of The Journal of the American Medical Association, finding that being unable to walk a quarter mile within five minutes portended troubles. For each minute beyond five, the risk of dying in the next four years increased by a third, the risk of having a heart attack increased by 20 percent, and the risk of having a disability increased by half.
Those who took more than six minutes for the quarter-mile walk had the same risk of dying or having a heart attack as those who could not walk the distance at all, and the effect was independent of age.
That led to the next question. Could teaching people to walk farther and faster prevent their growing so weak they could hardly walk?
Dr. Jack Guralnik, acting chief of the laboratory of epidemiology, demography and biometry at the National Institute on Aging, hopes it can. A new pilot study that he helped direct found that, with training, people could walk faster, improve their balance and more easily rise from a chair. Now he wants to expand that study to explore whether such training helps people retain their ability to walk and improves their health.
Richard J. Hodes, director of the National Institute on Aging is intrigued.
“It would be an extremely expensive study,” Dr. Hodes said, adding that its costs have not been added up. But, he said, if training could keep just 10 percent to 20 percent more people mobile, “I’m sure billions would be saved.”
Staving Off Frailty
Dorothy Bower, 78, used to take walks around the grounds of her assisted living residence in Wilkinsburg, Pa., near Pittsburgh. But no more. In the past six months, Ms. Bower says she has lost her energy. “I make it down the hall and to the dining room,” she says. “I have the feeling that if I worked at it I would get better, but it’s hard to get the motivation to try harder.”
“It is enough of an effort as far as I’m concerned to get to the door of our room,” Mrs. Bower says. “That takes me about five minutes.”
Mrs. Bower’s problem is frailty, doctors say. It is increasingly common as people age, and its symptoms — losing muscle mass and strength, feeling depleted, walking slowly, losing weight and doing less and less in a day — go together, says Dr. Linda Fried, a geriatrician and epidemiologist at Johns Hopkins who defined and characterized the syndrome. “They are all connected and form a vicious cycle,” she says.
Gerontologists say the full frailty syndrome is uncommon until people reach their 80’s, but its likelihood increases rapidly from then on.
For example, the Cardiovascular Health Study, a national study of more than 5,000 participants 65 and older, found that 9.5 percent of those 75 to 79 were frail. Among those 80 to 84, about 16 percent were frail, and nearly a quarter of those 85 to 89 had the frailty syndrome.
“I would say all 100-year-old people are frail,” said Dr. Anne Newman, a professor of epidemiology and medicine at the University of Pittsburgh. “Most 90-year-olds are frail. And some 80-year-olds are frail.”
Dr. Newman and her colleagues wondered what could be causing frailty in some but not others. They thought of undetected cardiovascular disease. The idea was that blood flow to the heart or muscle or brain could be impeded even if a person had had no overt signs of cardiovascular disease.
It was a new way to think about cardiovascular disease and a new way to think about aging, Dr. Newman said. “With frailty,” she said, “the slowing of gait, the loss of muscle strength, we had chalked up to being totally nonpreventable.”
When Dr. Newman and her colleagues examined participants in the Cardiovascular Health Study they saw evidence that their hunch seemed right. Participants with obvious disease who had congestive heart failure or a heart attack or stroke, for example — were likely to be frail. But those with no symptoms but partly blocked blood vessels seen on scans and other tests were nearly three times as likely to be frail as healthier people. And they became disabled — unable to care for themselves — about five years earlier than people without cardiovascular disease at the start of the study.
The researchers emphasize that cardiovascular disease is unlikely to be the sole cause of frailty. Severe arthritis or osteoporosis, for example, could make people slow down and set the cycle in motion. Strokes, heart attacks, cancer or any number of illnesses could bring on the frailty syndrome. But in explaining frailty among seemingly healthy people, the findings on cardiovascular disease made sense.
“With a lot of people, slow walking is due to poor blood flow in the legs,” Dr. Newman says. “Then their muscles atrophy.” And reduced blood flow to the brain, she says, can make people feel sluggish and depleted and unable to move quickly.
Cardiovascular disease may be why Mrs. Bower became frail. For 60 years, she says, she has had diabetes, a disease that damages blood vessels. So even though she has not had a heart attack or a stroke, blood flow to her muscles, heart and brain may be impeded, researchers say.
If they are right about frailty, Dr. Newman and others say, then the condition may be prevented or delayed by not smoking and keeping cholesterol and blood pressure levels low and by staying active.
But, the researchers add, their finding may be good news for today’s middle-age people who had the advantage of drugs to control their blood pressure and cholesterol levels before serious damage to blood vessels set in. And many are more active than their parents were when they were middle age.
Dr. Newman, for one, is optimistic.
“I think there will be less frailty and I think it will be delayed,” she says.
Overcoming Stereotypes
At 79, Dr. Robert Butler, still works 60 hours a week. He is president and chief executive of the International Longevity Center, a research and education foundation in New York and a professor of geriatrics at the Mount Sinai School of Medicine. He says he expects nothing less of himself, attributing his vigor in part to his luck in having excellent health and in part to something more subtle. He never bought into the pervasive stereotypes of old age.
Dr. Butler noticed the problem when he was a medical student. He recalls the private names doctors had for the elderly like crock and old biddy. In the decades since, he says, attitudes among doctors and the general public have not really changed. And, he adds, the stereotypes have an effect. “My experience with older people is that they certainly do get cowed by this,” he said.
But how much, and to what extent people get cowed surprised even researchers. It is hard to avoid seeing or hearing demeaning depictions of the elderly. There are greeting cards that make old people the butt of jokes. There are phrases like “senior moment” to describe a memory lapse. Then there are the ways older people are treated. For example, researchers find that people use “elderspeak,” speaking louder and using simpler words and sentences when talking to old people.
Still, when Becca Levy, a psychologist at Yale University, began her work on stereotypes’ effects on the elderly, she was not sure that she would find anything of note. She had examined the area with a study finding that older people in two cultures with a positive view of aging, China and the deaf Americans, fared better on memory tests than older people in the general American population.
Such studies are tricky, though, because there can be hundreds of differences between cultural groups, and something else could be responsible for the memory differences. So Dr. Levy and her colleagues decided try a method that was used to study the effects of stereotypes about race and gender. The idea is to flash provocative words too quickly for people to be aware they read them.
In her first study, Dr. Levy tested the memories of 90 healthy older people. Then she flashed positive words about aging like “guidance,” “wise,” “alert,” “sage” and “learned” and tested them again. Their memories were better and they even walked faster.
Next, she flashed negative words like “dementia,” “decline,” “senile,” “confused” and “decrepit.” This time, her subjects’ memories were worse, and their walking paces slowed.
Thomas Hess, a psychology professor at North Carolina State University, came to a similar conclusion about the effects of stereotypes of aging.
In his studies, older people did significantly worse on memory tests if they were first told something that would bring to mind aging stereotypes. It could be as simple as saying the study was on how aging affects learning and memory. They did better on memory tests if Dr. Hess first told them something positive, like saying that there was not much of a decline in memory with age.
But, Dr. Levy wondered, were there long-term effects of believing the stereotypes of aging? She found a study that could provide answers, the Ohio Longitudinal Study of Aging and Retirement. The two-decade-long study included 1,157 people, nearly every resident of Oxford, Ohio, who was 50 or older and was not suffering from dementia. And it had questions about beliefs about aging.
It turned out that people who had more positive views about aging were healthier over time. They lived an average of 7.6 years longer than those of a similar age who did not hold such views, and even had less hearing loss when their hearing was tested three years after the study began. The result persisted when the investigators took in account the participants’ health at the start of the study, as well as their age, gender, and socioeconomic status.
Some like Dr. Suzman were swayed, but Dr. Hodes urges caution. As provocative as the data may be, he notes, the studies cannot tell for sure what is cause and what is effect. It may be that people who had negative attitudes about aging somehow knew that they were not really well.
Dr. Hodes confesses that in this case indirect studies may be the best that can be done. To obtain direct evidence would require randomly assigning some participants to keep hearing negative comments about themselves as they age and others to hear positive things. “How ethical would that be?” he asks.
If it is true that perceptions of aging affect memory, behavior and health — and many researchers are betting that they do — that may bode well for today’s middle-age people, Dr. Levy says. They may not be quite so willing to declare themselves old when they reach their 60’s and beyond and they may be less likely to believe the stereotypes of old age.
Still, Dr. Levy and others say, it can be difficult to resist the pervasive stereotypes of aging. Many people may accept them without realizing it.
“Then they become a self-fulfilling prophecy,” Dr. Levy said.
But not for people like Dr. Butler or Mr. Bialokur, who managed to escape that trap. Others, too, say they have thrived simply by ignoring the stereotypes.
Anita Vazzano, who turned 75 on Aug. 9, says she just does not give old age much of a thought. A widow who lives alone, she still works, taking a bus each day from her home in Bensonhurst, Brooklyn, to her office in Manhattan. She knows many people become weak and frail when they grow old, but that is not her, she says. “It has to happen someday, but that day is so far off,” Mrs. Vazzano says.
She knows the stereotypes. She has seen the offensive greeting cards. And she hates them.
“If I was old,” she says, then catches herself and laughs. In her view, she adds, old age, “is not going to happen for a long time.”

2006-09-30T12:15:00.000-04:00

September 22, 2006
Footloose and Boot Free: Barefoot Hiking
By ETHAN TODRAS-WHITEHILL
FIVE minutes into the trail at Oxbow Park, west of Rochester, Minn., the dirt path became a narrow field of sharp rocks. Immediately ahead was a twisting wooden staircase with extruding nailheads. Nothing to be concerned about if you’re wearing shoes. But I wasn’t.
Jim Guttmann, my guide to the world of barefoot hiking, walked calmly ahead of me over the rocks, his face a portrait of serenity, and up the steps. Not once did he wince or alter his gait. “Your body adapts,” he had told me. But mine was not adapting fast enough.
The Barefoot Hikers of Minnesota were at Oxbow, an Olmsted County park with trails through wooded hills and along a river, for one of their regular get-togethers to challenge nature with feet au naturel. The six members who turned out this particular Saturday ranged in age from David Berg, 26, a tall, tan stay-at-home dad who hiked with thumbs consistently tucked under the straps of his small backpack, to Meg Palan, 67, a former nurse with oversize glasses and mostly white hair. Mr. Guttmann, one of the group’s original organizers, fell somewhere in the middle at 44.
None of the hikers seemed to think they were doing anything particularly odd — and from a wide perspective, maybe they weren’t. Going barefoot is still the norm in some cultures in warm climates. Although the half-dozen or so barefoot hiking clubs in the United States tend to attract turnouts in the single digits for hikes, Germany, Italy and other European countries have entire parks devoted to barefoot walking. Broader barefoot lifestyle organizations include the Society for Barefoot Living (www.barefooters.org) and Parents of Barefoot Children (www.unshod.org).
The hikers of the barefoot world tramp not only through mud and dust, but also over rocks, tree roots and the frosty ground of autumn (though they usually draw the line at snow). Yet although they may bring to mind tales of fakirs or extreme-sports enthusiasts, barefoot hikers are neither ascetics nor thrill seekers. Almost universally, they say they go shoeless for a sense of communion with the earth and for the sheer pleasure of feeling more of the world with their feet.
The Minnesota hikers compared the sensory experience of barefooting to wine tasting. Fresh fall leaves, Mr. Guttmann said, are “crunchy and cool,” and mud is “black dough that squishes up between your toes.” Dennis Slattengren, a 60-year-old nudist who owns a vending machine route and who was at least wearing shorts for this trek, savored the texture of silt that has run onto concrete and partially dried — “like warm velvet,” he said. On the hike at Oxbow, the pace was languid, and although the path was wide enough for two or three to walk abreast, the barefooters frequently walked single file to enjoy the spongy earth or a strip of moss underfoot. “So many people have very little or no connection with our beautiful earth and all of nature,” Ms. Palan later lamented.
AS a first-time barefoot hiker, I just wanted to make it through this four-mile hike with all 10 toes intact. Confronting the rocks and the nail-studded staircase, I gritted my teeth and stepped forward, but before I even reached the stones, my right foot came down on a bent stick that buried itself in the tender arch like a stake. I let out a muffled yelp.
Mr. Guttmann encouraged me to press on. “It’s like if you always wore a blindfold or earmuffs and then suddenly got exposed to lots of light or sound,” he said. “At first it’s overwhelming, but you get used to it.”
Our hike that day took us from a picnic area across a river and into tall maple forest, where we walked a circular route, popping out briefly into small fields and eventually returning to the river. We all waded in to enjoy Mr. Guttmann’s “black dough.”
Barefoot hikers take care of their neophytes. Mr. Guttmann showed me how to walk flat-footed on stones to distribute weight across the many sharp points and how to lead with the ball of the foot on the forest floor to roll off any stray twigs or rocks. Mr. Slattengren identified scourges like nettles, whose oil makes the feet itch, and thistles, which can take weeks to fully work themselves out of the foot. Every now and then I noticed a footstep that felt gooey and moist, although no water was to be seen. Mr. Guttmann waved it off. “It’s all in your mind,” he said, laughing. “Just don’t think about whatever it was, and it’ll wear off down the road.”
The only other hikers we met were a well-shod family of five who hurried past, glancing askance at our feet and barely returning our friendly greetings. Alan Seaver, who created the Barefoot Hikers of Minnesota with Mr. Guttmann, said that snubs were an exception and that people were generally pretty friendly on the trail.
“The funny thing is the number of people who will pass us wearing huge, expensive hiking boots and talk about how ‘they wish they could do that,’ ” Mr. Seaver said. “You can. Just take off your shoes.” He and Mr. Guttmann carry barefoot-hiking business cards to hand out on such occasions, but finding other barefoot enthusiasts is not easy, and the members of this club were happy to have one another.
Seasoned hikers, of course, have the advantage of seasoned feet. This group’s looked pretty normal from above, but on the underside were footpads more suited to bears than to humans. David Berg, who was in training for a barefoot marathon, had a particularly remarkable set: his feet resembled those of the Michelangelo statue with which he shares his first name: wide, bulging with muscle and solid as marble. Since a canoe trip in the fall of 2004 when he started “taking the shoes off,” he said, his feet had grown wider and stronger and no longer needed arch support.
“My dad thinks I’m crazy,” Mr. Berg said. “My father-in-law can’t imagine how I manage to walk all over his property without shoes or regard to the location of any paths, but my wife has become accustomed to it.” He’s pinning hopes on his children, 2 and 4, who still go barefoot.
Although a few barefoot marathoners come along every generation, like the Ethiopian Abebe Bikila, who set a world marathon record while running barefoot in 1960, barefoot trail hiking is pretty much the antithesis of a competitive sport. Still, it has its shining stars.
Among them are Susan and Lucy Letcher, sisters who barefooted most of the Appalachian Trail in 2001 — while carrying 45-pound packs. Their feet were tender at first, Susan Letcher, 27, said, but after five days of twigs and sharp pine cones they were ready for anything. At one campsite in New Hampshire, 300 miles into the hike, they realized that they had been walking around on broken glass and hadn’t felt a thing. “The bottoms of our feet were like boot leather,” she said.
Their favorite hiking surface is sun-baked rocks, which Susan says feels like “walking on the scales of a sleeping dragon” and which Lucy, 30, describes as “cat’s-tongue’s roughness combined with a lovely warmth.”
Barefooters’ abilities to handle trails are no surprise to Edward Tenner, a specialist in the history of technology (including shoes) who is a visiting scholar at Princeton and the University of Pennsylvania. In his book “Our Own Devices,” he cited research in the 1950’s in which the feet of barefoot Hong Kong fishermen were found to be structurally healthier and more dexterous than those of shoe wearers, despite lacerations and deformed toenails. Shoes reshape the feet, Dr. Tenner said, and “if you believe that evolution has optimized parts of the body, it’s presumably healthier for a part of the body to assume its normal shape.”
DR. DAVID E. SAMUEL, a podiatric surgeon in Philadelphia, notes that the skin is a very sensitive organ and says that constant barefooting will increase that sensitivity, which seems to explain barefoot hikers’ enjoyment. But he firmly favors shoes. Barefooters risk puncture wounds, nail trauma and the invasion of small foreign bodies or unfriendly organisms, he said, adding, “I’m sure a lot of Neanderthals died from foot infections.”
Nevertheless, as the hike at Oxbow Park wore on, I found myself focusing less on the patches of gravel and muck and more on the bushes of purple and white phlox and the shifting greens of the maple leaf canopy. Somehow the extra sensations I felt that afternoon from the ground heightened all the others: I paid more attention than usual to the play of sunlight dappling the ferns and the sounds of bluebirds chirping.
Near the end of the trail, we came across a stretch of ground that molded to my feet while still supporting them, like space-age memory foam. I bent down to examine the substance and found it was several packed inches of pulverized leaves — pure compost — and I realized I had a tasting note of my own to share with the group. Soft, spongy, cool but not wet, with just a hint of crackle.
WHERE TO GO

Soup

2006-09-14T13:49:00.000-04:00

I love soup. Soup is a really good food for anyone trying to watch their weight. We don't eat a lot of soup in the summer - too hot, but the rest of the year we eat soup for supper a couple of times or more a week. Fortunately, my husband also likes soup.
I like to get soup piping hot before I ladle it into our bowls. You can't gulp down really hot soup. You have to put some on your spoon and let it cool off before you can put it in your mouth. That lag time lets your brain and your stomach coordinate the feeling of fulness before you put too much into your stomach.
I stress to clients that we should all eat more vegetables. It is easy to get lots of veggies into soup. Lots of veggies taste really good in soup. Use up whatever you have in the vegetable crisper in the fridge. Onions, potatoes, tomatoes, spinach, carrots, artichokes, string beans, kale, beets are lovely in soups. Beans, lentils, brown rice, and barley are all really healthy complex carbohydrates that work well in soups also. You can add a little chicken or meat or go vegetarian.
Look at some of my favorite recipes for several really good soup recipes. You can be a busy person and still have time to make a pot of soup. It takes a few minutes to put everything into the pot but while the soup is simmering you can do all sorts of chores.
I like to make a pot of soup big enough for a couple of dinners and maybe a bowl or two for lunch during the week. I'd rather bring soup from home and have that for lunch at work than have to go out for some unhealthy fast food.