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For more information, go to www.arthritisresearchuk.org

Growing old gracefully - and healthily

Published on 24 July 2012
Source: Arthritis Today

Hands up if you want to stay healthy: taking part in the Age Well Day at Birmingham UniversityAgeing is a natural part of the cycle of life. But how can we age healthily, and why do some people age better and more healthily than others? As the UK population gets older, the new MRC-Arthritis Research UK Centre for Musculoskeletal Ageing Research hopes to provide some practical solutions to these important questions.

It’s easy enough to stay fit when we’re young and healthy, but as we get older, stiffer and often heavier our bodies tend to be more prone to musculoskeletal aches and pains and the onset of age-related conditions such as arthritis and osteoporosis.

While there’s nothing we can do to stop the ageing process, how can we reduce these risks, or at least, how can we ensure that we have a fighting chance of staying as healthy as we can as we get older?

Human ageing expert Professor Janet Lord puts it like this: “So many of our population are now living well into their 70s and 80s, and that should be a cause for celebration. But unless we can ensure that old age is spent in good health it will be a stage in life that is endured rather than enjoyed.”

As director of the new musculoskeletal ageing centre, Professor Lord is heading up a major programme of work at the Universities of Birmingham and Nottingham with the precise aim of making life for older people enjoyable rather than simply endurable.

An energetic 50-something, she’s a fantastic role model, only recently giving up running marathons (due to lack of time rather than lack of fitness) and is hugely enthusiastic about her mission.

The centre will focus on the role that diet and exercise play in preventing premature musculoskeletal ageing, with basic lab and field-based research translated into meaningful practical results that can be implemented into practice. And it aims to define the key factors, both biological and lifestyle-related, that drive age-related musculoskeletal frailty.

Professor Lord and her colleagues will use their expertise and facilities – in the new and impressively shiny Queen Elizabeth Hospital in Birmingham (the biggest hospital in Europe) where the centre is based – to develop and validate the most effective diet and exercise-based interventions that can be done by older adults whether they are in their own home, in care homes, or even in hospital or health care settings.

Director of the musculoskeletal ageing centre Professor Janet Lord

Motivation is key

Such lifestyle interventions are notoriously difficult to implement and Professor Lord acknowledges that motivation is the key to ensuring that older people maintain healthy lifestyles. This motivational aspect forms a key plank of the centre’s research programme.

“Crucially we’ll be working with health psychologists to make sure that older adults will take up and adhere to the lifestyle programmes that we develop – ensuring that our ideas work in real life as well as in the laboratory,” she says.

Professor Joan Duda, sport and exercise psychologist specialising in motivational processes (another 50-plus role model who enjoys hiking, competitive tennis and ballroom dancing!) is already working with people with rheumatoid arthritis to try and promote their engagement with physical activity, improve their cardiovascular health and enhance their well-being. She will be involved in the centre’s new dietary and exercises studies and is acutely aware that there is no point devising all kinds of new exercise and nutrition-related classes if the people they are aimed at aren’t sufficiently motivated to keep attending.

“It’s all about promoting positive behaviour change, and how to maintain it,” she says. “When people take ownership of their behaviour and make the decision to adopt healthier habits it’s the most effective. They are more likely to ‘stick with it’ and enjoy and feel better about themselves.

“Whether it’s about participation in physical activity, taking prescribed medicine, or eating better, we rarely observe adherence and improved well-being when individuals are told they have to do it.

“What’s most beneficial is that they have bought into why it is recommended that they should do something. We want to get away from the: ‘you have to do this or else’ type of approach to promoting healthy lifestyles. The carrot is better than the stick but it has to be a carrot that people select and that has personal value.”

Julie Robinson (centre) demonstrating how to Move It or Lose It

Move It or Lose It

Even very elderly people are not too old to benefit from physical activity, says Professor Duda. “Studies with the frail elderly show that you can still see strength improvements – not so that they can run a marathon, but having enough strength to lift themselves out of a chair independently, for example. And research has shown that physical activity leads to cognitive and neurological benefits for older adults.”

Former PE teacher and now exercise instructor Julie Robinson knows better than most about the benefits of exercise in the elderly, and the importance of motivation. Julie runs the Move It or Lose It exercise classes in community centres in Sutton Coldfield, and has worked with the team at Birmingham to produce three exercise DVDs using real-life subjects. (The exercise DVDs are already used in a study run by Professor Lord and Professor Duda to determine if video-based activities improve physical ability, whether people stick to them, and if they improve quality of life.)

The classes and the DVDs are aimed at elderly people, most of whom have arthritis, who know they need to exercise but don’t know how to or are frightened to.

Julie, who has clearly been taking the same enthusiasm pills as Professor Lord, has qualifications in chair-based exercises for the frail elderly, using resistance bands to improve muscle strength, and is also trained in instructing movement to music in the over 60s. “Plus,” she adds, “I have a desire to make things motivational. Anyone can say; ’lift your leg 20 times’ but you have to make it fun and engaging.”
Julie has produced the DVDs so that people in the classes can do the exercises at home, and for frail elderly people who can’t get out of the house. They are graded, from chair-based work, to more cardiovascular work and standing exercises. The DVDs and the classes have been a huge success with participants.

Seventy-five-year-old Brenda Turner, who has rheumatoid arthritis, is a real convert to the wonders of exercise, and featured in Julie’s first DVD.

Brenda’s condition, which started about eight years ago and affected her hands and knees in particular, was so severe she had trouble getting out or bed or getting up or down the stairs. She joined Julie’s class and a couple of walking groups three years ago and has never looked back.

“I started off with sitting down exercises, then gradually built up to standing up. It’s all about strengthening your muscles to help you balance and to get up from a chair without falling. It’s slow progress and you have to keep at it,” she says. Brenda also practises at home with a pedal bike, resistance bands and dumb bells, two or three times a week.

She no longer takes any drugs, doesn’t see her GP, and manages her condition through exercise.
Brenda adds: “It’s not a quick fix. You have to keep at it and it’s painful when you first start. You’ve got to force yourself to do it at the beginning. You can’t see the benefit straight away. One old chap said after a couple of times that he didn’t think it was doing him any good, and we haven’t seen him since! But I was determined to get on my feet and get out and get on with it. Julie makes the exercises interesting and we all have a laugh about it.”

Brenda worked in care homes for ten years before she retired and believes strongly that certain types of people get the most from exercise classes. “It depends very much on the personality of the person, whether they’re active or passive. Some of the people I worked with in the care helped tried to help themselves; others just wanted to be waited on. I’m a very active person, and I think that helps. Friends say it’s given me a new lease of life.”

The outcome of the study into DVD-based exercises should be of interest to those working in what Julie describes as the non-sexy side of the exercise industry. Anecdotal evidence is one thing, but there’s a need to provide evidence that this approach can work, so that it could be rolled out more widely.

Says Julie: “It’s all about bringing evidence and research into the real world for the benefit of older people – to connect science and life. It would be great if we could start a national movement – like Zumba for older people – for people who think: ‘I can’t do that…But they can.”

Move It or Lose It is just one of the current age-related activities that the centre will build on, and which will provide the springboard for future activities.

Testing high intensity exercise

Another study in progress is trying to determine if high intensity exercise (short 30 second bursts of high intensity exercise such as cycling on an exercise bike) will benefit older adults, and may therefore persuade those who don’t want to spend hours in a gym to increase their physical activity.

A practical session at the Age Well Day at Birmingham University1,000 Birmingham Elders

Another on-going project is the Birmingham 1,000 Elders, a group of fit people in their 70s and 80s whom university medics and scientists use as their control group in a number of studies. This group, all of whom live within an hour of Birmingham, will help the team to understand normal healthy ageing, and their bones, muscles, genes and lifestyles will all provide valuable material. They attend a yearly workshop called an Age Well Day at the university where Janet, Julie and others run research and exercise sessions.

Seventy-year-old Jenny Buchan is a typical Elder. Jenny has always been fit, doesn’t take any medication and these days is a member of Birmingham’s Be Active scheme run by the local council, which provides free gym sessions. Jenny is no slouch and has recently returned from a two-week holiday to India and does lots of travelling to far-flung destinations. “I do see people who are not as fit and active as me, and that spurs me on to try and keep going,” she says.

While luck and good genes probably plays part in Jenny’s continuing good health and well-being, her active lifestyle is bound to play a part – and to act as inspiration to currently less-active oldies.

Research in Nottingham looking at exercise and dietary supplements

The other partners in the new centre are researchers at Nottingham University, led by Professor Paul Greenhaff. Professor’s Greenhaff’s team are experts in trying to understand why we lose muscle as we age. Importantly, they discovered a few years ago that older adults do not respond to exercise in the same way as young people; specifically they do no build muscle as easily with exercise (something called anabolic blunting!). Professor Greenhaff’s team will test out different exercise regimes and dietary supplements to try and find the best ways to retain or even replace lost muscle in older adults.

The musculoskeletal ageing centre will launch in July. Arthritis Today will provide updates of progress, and also report on the work of the second musculoskeletal ageing centre based in Liverpool, Sheffield and Newcastle.

The MRC-ARUK Centre for Musculoskeletal Ageing Research at the Universities of Birmingham and Nottingham is funded by £2.5m over the next five years. The Medical Research Council is contributing £1.875m and Arthritis Research UK £625,000 with extra support by the two universities. Further funding will be sought to fund specific projects.

Bringing together scientists, clinicians and industrial partners, the main aims of the centre are:

• To understand the processes underlying the loss of muscle, bone and cartilage that occurs with age, and the role played by inflammation, metabolism, altered hormones and obesity. To find ways of addressing these processes and so delaying age-related changes in the musculoskeletal system.

• To develop intervention studies to assess the effectiveness of different diets and exercise regimes in older people, assessing different motivational approaches.

For more information, go to www.arthritisresearchuk.org/arthritis-information or call 0300 790 0400 to order the complete printed booklet.
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