With age comes physical limitations. But it’s important to stay active, says John Rinker, MD, an internal medicine physician who specializes in geriatrics at OSF HealthCare. When you keep moving, it helps reduce the risk of things like diabetes, high blood pressure, heart disease, obesity, cancer and neurocognitive diseases like Alzheimer's.

In other words, Dr. Rinker says, it’s not fun to live long if you’re not well. Your lifespan versus your health span, as he puts it.

“It really, really pays to maintain exercise and be in good physical shape as you age. It reaps huge dividends on how long you live,” Dr. Rinker stresses.

Guidelines

Each person should have a tailored plan as advised by a health care provider. But regardless of your age, the American Heart Association (AHA) generally recommends 150 minutes of moderate physical activity or 70 minutes of vigorous physical activity each week, spread out over several days. A brisk walk would qualify as moderate intensity (also called zone two training), while running, swimming or riding a bike would be vigorous. Vigorous exercise is associated with a term called VO2 max, referring to maximum use of oxygen. In layman’s terms, you’re breathing hard and conditioning the heart.

“Most of that type of [vigorous] training is at a higher interval. You’re going to get breathing really hard for three to five minutes while you sustain a pace that’s rather difficult. Then you’re going to rest and let that heart rate come back down. Then go back to the hard exercise,” Dr. Rinker explains. “That back and forth with the heart rate really helps to train how well your heart can pump blood to muscles. That’s a really good marker of how well conditioned you are.”

The AHA also recommends two days of strength training per week. That could be lifting weights, using resistance bands or calisthenics, where you use your body weight for resistance rather than equipment.

“I really like the strength training piece,” Dr. Rinker says.

“It doesn’t take a lot as you age to tension a muscle enough to maintain muscle mass. We really find that people who are able to maintain muscle more muscle mass as they age are going to do much better with those health span and lifespan issues,” he adds. “So, the goal isn’t to make everyone a huge bodybuilder. The goal is to decrease the rate of decline as we age.”

On the days you do strength training, aim for 30 minutes per day. Dr. Rinker says if you really want to lean into this area of fitness, consider getting a personal trainer.

Limitations

It’s important to work around your ability and not push through pain, Dr. Rinker says. If aging has brought back or leg pain, skip the treadmill and try swimming or a weightlifting session while seated.

“You want to make sure you’re not going to injure something further. That will create a bigger setback or other deficit that are not going to help you in the long run,” Dr. Rinker says.

The bottom line

From VO2 max to zone two to calisthenics, there are a lot of terms to keep straight. If you don’t want to overthink it, just remember to keep moving. Push yourself with some vigorous workouts if you can, but commit to some form of exercise regularly.

“Most of your day-to-day exercise [as an older adult] should be just basic activity,” Dr. Rinker says. “Think of a brisk walk. Walking at a pace for about 30 minutes where you could still hold a conversation with somebody, but it would be difficult to sing a song.

“If I can just get someone to walk every day, I think they’re going to be in good shape,” he adds.

Learn more

Read more about moving your body safely and aging well on the OSF HealthCare website.

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Exercising your heart

It’s no great surprise to read that men and women both benefit from working out.

But women may receive greater benefits from regular exercise than men, according to a study published in the Journal of the American College of Cardiology.

The study centered on the importance of exercise as a way to avoid dying prematurely. The researchers studied data from 400,000 people and found that women who exercised were 24% less likely to die early from any cause. Men who exercised, however, were 15% less likely to die early.

The study also revealed that the women who exercise had a 36% lower risk of dying from a cardiovascular event, compared to men at 14%. That’s important because women have twice the risk of dying from a heart attack than a man.

Mary O’Meara is a nurse practitioner with OSF HealthCare. She says society still views heart attacks more as a man’s disease. That’s simply not true.

“Usually, a male is feeling this really bad chest pressure, chest pain going in the left arm into the jaw, very pale. Women, very often, will just complain of fatigue, nausea or heartburn. ‘I feel wiped out. I just can't walk across the room. I need to sit down,’” explains O’Meara. “Unfortunately, that can be a sign of a heart attack in a female, and it gets missed quite often.”

While any movement is good, O’Meara stresses the importance of women incorporating strength and/or resistance training, such as lifting weights. Frequency and the amount of weight depend on the person and their situation.

“For a long time, women were encouraged to do more aerobics-calisthenics. We were always thought of as the weaker sex, I guess you can say, and we weren't really encouraged to do any weight bearing exercise,” says O’Meara. “A lot of research has come back that states that women should be focusing on weight bearing exercises for several different reasons.”

Strength training can also help women as menopause becomes an issue. According to O’Meara, hormones start changing between the ages of 40 and 50 – a time when women start losing muscle and see an increase in body fat. Strength training can help with that change, along with other health issues.

“We found that weight bearing exercise can reduce our risk of dementia and Alzheimer's, and also reduce our risk of osteoporosis, which is a big one,” says O’Meara.

O’Meara also has a nutrition tip for her patients. Protein, she says, is important for women to prevent muscle loss, especially during menopause. O’Meara recommends 30 grams of protein before and 15 grams after a workout, to help rebuild muscle that has been naturally broken-down during exercise.

Additionally, O'Meara is a proponent of healthy fats. She encourages patients to incorporate grape seed oils, olive oils, fish oils, flax seed oils, nuts and avocados into their diets.  Her philosophy is that good fats battle bad fats, and good fats protect our heart.

O’Meara stresses that it's never too late for women to start exercising. Even a short walk or work around the home, for instance, can go a long way to a healthier future.

“You read many testimonials from people who were couch potatoes and never exercised,” she says. “And then, they go into these exercises and do wonderful things that have really made a difference.”

For more information on women’s health, visit the OSF HealthCare website.

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Kren Harmon loves a good success story.

The licensed clinical social worker runs a neurological therapy group for older adults at OSF HealthCare in Alton, Illinois. Attendees might have short term memory loss due to a stroke, Parkinson’s disease or Alzheimer’s disease. Those challenges can also bring mental health concerns. But there is hope. Small group sessions like the ones Harmon runs have been proven to help not only with the seniors’ day-to-day life but also their sense of feeling alone.

“I had a new woman in group who said she had memory loss and was embarrassed. Another woman who’s a veteran of the group didn’t miss a beat. She reached over, touched the woman’s hand and said, ‘Honey we all have that’.” Harmon recalls. “The woman burst into tears and realized she’s not the only one dealing with this.

“That’s why I come to work every day,” Harmon says, beaming.

The fears, and how providers can help

Harmon has heard plenty of health concerns from older adults, and they’re all valid. The senior has moved out of their home and is worried about losing independence. They’re worried their health needs will be a burden on family. They might even be scared of dying.

Enter small group therapy. First, Harmon says, it’s a consistent thing on the senior’s schedule where they can look forward to getting out of the house and seeing people. Harmon says studies have shown more socialization for older adults means less confusion. But more importantly, the group connects attendees with others in their situation so they know they’re not alone. Harmon describes the concept in two terms: commonality of experience and installation of hope.

“We all have these same issues, but there’s hope,” Harmon says, restating what is said in a group session. “We can learn coping skills and accept what’s going on. We can support each other.

“Individual psychotherapy is great, but in group they get the benefit of having each other to lean on,” Harmon adds. “They say ‘This worked for me. You might want to try this at home.’”

A typical session might be a mix of camaraderie, memory tasks (medical term: cognitive stimulation therapy) and specialized topics like handling grief.

“We cover current events. What’s the date? What’s the weather?” Harmon outlines. “We do check-ins. Tell me something new in your life. People like that. They talk about their new great grandbaby.”

Harmon encourages her patients to expand on what they learn in group. The medical term for this is acceptance and commitment therapy. Find a way to exercise that works with your limitations. Explore a new hobby, such as puzzles or reading. Watching television all day won’t cut it, Harmon says.

“You’re never too old to learn a new skill,” she reminds.

Getting involved

If an older adult in your life could benefit from group therapy, Harmon says going through a physician might be the way to go. She’s found that seniors sometimes don’t listen to friends and family. But if their neurologist – someone they know and trust – recommends something, it might carry more weight.

“Having the doctor refer, I’ve found, makes a difference with that generation. When someone in a white coat says it, it’s the best idea ever,” Harmon chuckles.

You can also read more about healthy thoughts and behaviors on the OSF HealthCare website.

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John Rinker, DO, of OSF HealthCare, is in his mid-40s and in good health but he recently embarked on a journey that began with a quick swab inside his mouth to find out if he was at high risk of any of 10 major diseases.

The test that includes a simple cheek swab is polygenic testing. Polygenic testing focuses on the cumulative effect of many common genetic variations to determine a person’s risk for developing complex diseases, while genetic testing typically focuses on a single gene or a small number of genes to identify specific genetic conditions or mutation. Why did he get the test? Dr. Rinker believes knowledge is power.

“And potentially, how is it likely if I’m affected, I want to make sure that I’m aware for my children, right? And so personally, I chose to get the test done, because if there’s anything that I found, I would want to do everything in my power to make a change, if at all possible, so I can live a healthier life and a longer life.”

Dr. Mark Meeker, DO, is former vice president of Community Medicine at OSF HealthCare, now vice president and chief medical officer of OSF HealthCare St. Mary Medical Center and OSF HealthCare Holy Family Medical Center. Meeker explains polygenic testing creates Polygenic Risk Scores (PRS) that aggregate the effects of thousands of genetic variants to assess a predisposition to common diseases such as cardiovascular disease, diabetes and various cancers.

“(It’s not) looking for a specific change in a gene that puts you at risk of a specific disease. It’s risk categorization. So, do you have an elevated risk for something like Alzheimer’s or diabetes or colon cancer or breast cancer? Not ‘Do you have the BRCA (Breast Cancer Susceptibility) gene, the specific gene that puts you at risk for breast cancer?’ But ‘Do you have a compilation of genes that puts you in a higher risk category?’”

OSF HealthCare has been offering polygenic testing at five OSF Medical Group locations including Peoria, Galesburg, Kewanee, and Pontiac. The test carries an out-of-pocket cost of $275 because it is currently not covered by insurance. But, for some people it’s worth the cost to have the knowledge or peace of mind that comes with knowing if they’re at high risk for common cancers and diseases such as coronary artery, atrial fibrillation, and stroke.

Dr. Rinker has a family history of prostate cancer and fully expected he would turn up at high risk for that. However, his results showed Dr. Rinker at high risk for Alzheimer’s disease. There’s no cure but he says good diet, exercise and – importantly – getting enough sleep can help with prevention.

“That’s definitely something I’ve been trying to maximize or improve, not only from an Alzheimer’s perspective. But, you know, you’ll find a lot of these things in the human body all interact with something else, and you’re not just getting one improvement and one small outcome that you’re looking at. Well, that might be what the impetus for change is (but) it’s going to have a whole trickle-down effect on a whole host of other health issues or prevent a whole number of other health issues.”

Who is a good candidate?

The target group of individuals to get polygenic testing is between 20 and 65 because that’s when added screening and any lifestyle changes can have an impact. Dr. Rinker is excited about the potential to prevent disease among those who are at high risk.

“The more that we can find or identify a disease early the more we can either prevent the disease or get upstream of the illness occurring; always leads to better outcomes.”

Dr. Meeker explains that polygenic tests expand the analysis beyond family history and genetic testing to broader examination of the human genome.

“If you use a questionnaire, for example, a family history and stuff to screen for certain cancers, if you add polygenic risk scores to that, you can increase the pool of high-risk people by two- or three-fold, because it catches more people than these preliminary screening tools just don’t catch.”

The eight-month pilot continues. Leaders will consider whether to expand the testing across the OSF Ministry by considering the number of people taking advantage of it, along with feedback from providers and patients.

While PRSs can identify individuals at higher risk, they have limitations for complex conditions influenced by both genetic and environmental factors. But, Dr. Meeker believes in the future, polygenic risk scoring will influence individual screening recommendations.

“The hope is, as we learn more in this area and get this more highly refined, that we can really target our screening so we can screen fewer people to find the ones that are really at risk, without having to screen everybody and spending all that money and having all that exposure, you know, the potential false positives.”

Polygenic risk scores in the future could also help identify individuals who are most likely to benefit from specific treatments, improving the efficiency and effectiveness of clinical trials. And Dr. Meeker asserts, as research continues, more targeted, personalized approaches to care and prevention can improve overall health and wellness.

Currently polygenic testing is still in an early phase of the pilot, so it is available through five select OSF Medical Group providers in Peoria, Galesburg, Kewanee, Sheffield, and Pontiac. If you have questions, talk with your primary care provider or learn more at the National Human Genome Research Institute.

Top 10 health risks included in polygenic testing:

1.    Breast cancer

2.    Colon cancer

3.    Prostate cancer

4.    Ovarian cancer

5.    Coronary artery disease

6.    Atrial fibrillation

7.    Stroke

8.    Type 1 diabetes

9.    Type 2 diabetes

10.  Alzheimer’s disease

Dr. John Rinker

Dr. Mark Meeker

B-roll of polygenic testing

Tiffani Franada, DO, is a neurologist with OSF HealthCare who specializes in Multiple Sclerosis. Part of her passion is working with patients choosing brain-healthy diets and lifestyle, which prevents neurological diseases like Alzheimer’s, Parkinson’s and Multiple Sclerosis.

The MIND diet

"The MIND diet is a combination of the Mediterranean diet, which is healthy fats, olive oils, fish, fruits and vegetables. And the DASH diet, which is a low-sodium diet,” Dr. Franada says. “It's particularly helpful for patients who live with hypertension (high blood pressure). The two of those combined seem to be very effective at preventing the development of Alzheimer's."

Patients on the Mediterranean diet often have lower levels of inflammatory markers in their spinal fluid. Higher levels are suggestive of Alzheimer's. Patients also perform better on cognitive testing, Dr. Franada adds.

Fiber-rich foods

"In regard to carbs, whole grains are probably best, and they have really good fiber in them. As well as things like legumes and beans which have good fiber levels, which make you feel full for longer," Dr. Franada says. 

The National Cancer Institute (NCI) lists many high-fiber foods here. Lentils, vegetable soups, whole-wheat bread and pasta make the list. As well as fruits and vegetables like apples, apricots, broccoli and Brussels sprouts.

Berries and antioxidant production

"Blueberries are great, really berries of all kinds. They really help that antioxidant production," Dr. Franada says. "For vegetables, leafy greens are really helpful. They have a good amount of folic acid, which helps to reduce homocysteine (amino acid) in the brain. Homocysteine promotes inflammation and shrinkage in the brain, and we want to reduce that."

“Fats are not the enemy”

The word “fat” oftentimes has a negative connotation to it. Dr. Franada says there are healthy fats out there that offer benefits to brain health.

"Fats are not the enemy. Healthy fats are good for the brain. Your brain requires them, like fatty fish (salmon), which have good Omega-3s in them. If you don't eat fish, flax seed is a great alternative," Dr. Franada says. "Walnuts also have great, healthy fat in them. As well as olive oil, which has monounsaturated fatty acids which protects against inflammation in the brain." 

Lean meats, like chicken and turkey, can be good for brain health because there’s healthy amounts of protein and fiber in them, Dr. Franada says.

Don’t dismiss dark chocolate!

"Dark chocolate is great. Dark chocolate has good amounts of antioxidants. Of course, all things in moderation. But a dark chocolate square once a night, not a bad thing," Dr. Franada says. "Also, caffeine! Believe it or not, a cup of caffeine, like coffee or tea, can help with focus, attention and is helpful for the brain."

Dr. Franada recommends having your caffeinated drink of choice early in the morning, right when you wake up, instead of later in the day. Having it later in the day can give you a lot of energy, which leads to you not sleeping well at night. Sleep is also extremely important for brain health.

Foods to avoid

Ultra-processed foods have been trending lately, with health experts giving them more attention than usual because of their negative effects on people’s health. High sodium, added sugars and excessive amounts of bad fat headline are the reasons why we should avoid them, with these elements being linked to diabetes, obesity and cancer.

Obesity is typically part of a metabolic syndrome, where a person has elevated blood sugars, blood pressure and cholesterol. This puts patients at risk for stroke, sleep apnea, Alzheimer's and many other health issues. Those risk factors can put someone at risk for neurological disease. 

"Heavily processed foods are not great for the brain or the heart. Excess sugars, like added sugars, should be avoided as well. If you're going to have sugar, have something with natural sugar in it," Dr. Franada says. "Berries are much preferred to things with added sugars. Also, white bread and processed carbs should be avoided, too."

Effect on white brain matter

"There's some real-world data showing that the Mediterranean diet can prevent white matter changes on the brain, which are little white spots that develop on patients’ brains as they get older. It's also seen in patients with vascular risk factors," Dr. Franada says. "If you follow the Mediterranean diet pretty strictly, you can prevent getting those white spots. They also found people who adhere to that diet have better structural integrity. The left and right sides of the brain talk better to one another."

What about cheat days?

If you exercise five or six days a week and give yourself a “cheat day” where you splurge a bit, evaluate how the food feels in your body. Instead of packing on the calories and going bananas, Dr. Franada recommends reeling it in a bit and focusing on moderation.

"You'll probably start to recognize it doesn't feel so great," Dr. Franada says. "Maybe it's a chocolate dessert at night, or something smaller that you can do to still stay with your healthy diet, just in smaller quantities." 

Dr. Franada cautions against super rigid diets that make you "fall off the wagon" after a few weeks. "You have to find something that's sustainable for you," Dr. Franada adds. 

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Actor Chris Hemsworth recently made headlines when he announced that he’s taking time off from acting after undergoing testing that resulted in an alarming discovery: he has a greater risk of developing Alzheimer's disease at some point in his lifetime.

The 39-year-old Hemsworth made the discovery after undergoing tests as part of his documentary series Limitless, where Hemsworth tests his body and searches for ways to live longer.

While having a predisposition for Alzheimer’s is not a diagnosis, it can help someone take the appropriate preventative measures. Hemsworth has said he is going to spend time focusing on stress and sleep management, nutrition and fitness.

According to the Alzheimer’s Association, Alzheimer’s is the most common cause of dementia, making up 60-80% of dementia cases. Dementia is not a normal part of aging, and is caused by damage to brain cells that can lead to memory problems, confusion and communication issues.

“With dementia, it's a short term, memory-deficit, but usually long term is intact," said Andrea Shewalter, a nurse practitioner with OSF HealthCare Illinois Neurological Institute (INI). "People will forget what they ate for breakfast that day and they may forget having a specific conversation with a family member that morning or the day before, but they'll be able to tell you what they did 25 years ago and be able to reminisce with stories like that.”

Typically it’s a loved one who notices the initial troubling signs of dementia such as memory loss, problem-solving difficulties or issues with daily tasks such as paying bills, taking medication or preparing meals, so it’s the patients who are accompanied by family members to an appointment who are most likely exhibiting the greatest symptoms of dementia.

Shewalter adds that anyone is a candidate for testing. And if you have a loved one who has been diagnosed with dementia you do not need to wait to develop symptoms to look into testing options for yourself.

“When patients come in we refer them for a neuro psychological evaluation, where the psychologist reviews the 12 different domains of the brain through different systems and assessments," she says. "And they can come up with a potential diagnosis and are able to tell us what part of the brain is having a deficit or what deficit of the brain is occurring.”

But arriving at a dementia diagnosis isn’t always easy. Physicians have to recognize a pattern of loss of skills and function and determine what a person is still able to do. And it usually takes more than one test to come up with the diagnosis. Tests include cognitive and neuropsychological tests, neurological evaluation, brain scans, lab tests and sometimes psychiatric evaluation.

“I would refer anyone for neuropsychological testing, where they can help determine what areas of the brain are being affected," says Shewalter. "And then we usually send the patient for imaging to make sure that there's nothing from a pathological standpoint that's going on in the brain. Is there a brain tumor? Is there Lyme’s disease? Is there some sort of disease that is affecting this? We can also look at the structures of the brain to be able to tell if there a lot of shrinkage for their age. Is the brain compensating due to the atrophy or the shrinkage of the brain?”

In the early stages of dementia, Shewalter has several recommendations for patients to remain as independent as possible, including doing crossword puzzles, playing cards and crafting – anything that involves hand and eye coordination.

She also encourages socialization – getting out in the public and being around people as much as possible. While there is no conclusive evidence, there is still benefit to taking care of yourself as much as possible. That includes a healthy brain diet and a high intensity exercise program of 150 minutes each week. Finally, get your financial affairs and power of attorney in order, especially if memory loss progresses to the point where you can’t make decisions for yourself.

“We try to treat dementia as naturally as possible," adds Shewalter. "That's why we recommend the exercise, the increase in socialization, and the brain healthy diet, because it is what you make of it. If you just sit in a house and don't use your brain or challenge your brain and let the world go by, you often have generally worse outcomes than if you were to face this head on. Do the steps that we naturally recommend to decrease the rate at which your memory declines.”

In addition to taking preventative measures and staying active, having a support system in place early on is especially important for someone with any dementia diagnosis.

For more information about dementia testing, visit OSF HealthCare.

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