Popular Science Monthly/Volume 39/October 1891/Exercise for Elderly People
By FERNAND LAGRANGE.
THE tissues and organs do not all mature at once in man. It results that when we reach mature age our capacity for some exercises has notably diminished, while for others it has preserved its complete integrity. At forty-five years the bones and muscles have lost none of their solidity and vigor. The aptitude for exercises of force and bottom continues. But we can not conclude from this that the man is as apt in all forms of exercise as he was at twenty-five. While the motor apparatus proper is not sensibly modified in the maturity of life, particularly if one has kept it up by regular practice, this is not the case with some other apparatus that begin to decline earlier — notably with that for the circulation of the blood. The heart and the arteries, in spite of the most rational exercises, lose with age a part of their serviceableness, because they lose some of their normal structure.
After thirty-five years of age we recognize, even in conditions of perfect health, a tendency to sclerosis, a defect in nutrition that lessens the suppleness of the vessels and causes them to lose a part of their elastic force. This change, which goes on with increasing age, has received the picturesque designation of the "rust of life." Rust in a machine is the result of a lack of work, while deterioration of the blood-vessels is connected with the working itself of the human machine; it is the result of the wearing out of its most essential wheel-work, and it is to be observed most prominently in men who have carried exercise or work to the point of abuse. All directions for exercise in mature age, all precautions to be taken in its application, are controlled by this great physiological fact of the lessened capacity of the vessels to support violent shocks. This imperfection of the arterial system is the cause of a considerable tendency to shortness of breath; and it is by this shortness of breath that the man's diminished capacity for resistance is shown.
The differences in the structure of the arteries, even though they may not be carried so far as to denote disease, make the man 772 THE POPULAR SCIENCE MONTHLY.
of fifty years much, more vulnerable than the young man ; and vulnerable in precisely the organ most essential to life. It is, in fact, the heart that suffers in case of forced exertion, the conse- quences of a deficient elasticity of the arteries. Every beating of the heart represents the piston-stroke of a force-pump, and the blood-vessels are the pipes through, which the liquid flows to carry life to the furthest molecules of our body. But these ves- sels are not inert conductors ; they are endowed, in a healthy con- dition, with an elasticity which permits them to react at each pulse of the heart, swelling under the pressure of the sanguine- ous wave, and then contracting and returning to the liquid the impulse which they have received from it. The liquid, strik- ing upon the wall of a fully elastic artery, does not suffer at once the arrest which it would suffer on meeting a rigid wall. A billiard-ball, driven against a very elastic cushion, rebounds with nearly as much force as it had when it started. An artery which has lost its elasticity is, as to the column of blood that comes against it, as an ivory ball to a cushion that does not spring. And as the billiard-player must strike more vigor- ously upon the ball to make it perform its run when the cush- ions do not spring, so the heart, when the artery has lost its elas- ticity, must exaggerate its effort at the systole to enable every molecule of blood to traverse the circle of the vessels and return to its point of departure. In short, the less elastic the arteries, the greater the effort the heart has to make to secure equal work. Each heart-beat, then, of a man whose arteries have become old, is the occasion for an excess of labor by the cardiac muscle. The increase in expenditure of force passes unnoticed if the beatings retain their normal slowness, but becomes very sensible when they are quickened. There are some exercises which cause the number of heart-beats to double in a few moments. The resultant fatigue of the organ, which has already been brought to the point of overwork by the continual excess of work it has had to do, is easy to conceive.
The most natural consequence of fatigue of the heart is a momentary diminution of its energy ; and when the organ is weakened, the impulse it gives to the blood is no longer sufficient to cause it to traverse as rapidly as it ought the vessels through which it circulates with most difficulty, either on account of their narrowness, or of the mass which is precipitated into them at once. Hence what are called passive congestions of the internal organs, and particularly of the lungs. Congestion of the lungs is a frequent consequence in elderly men of exercises which accel- erate to excess the rhythm of the pulse, and is shown by shortness of breath. This, which is more prompt in men habituated to physical exercises, is one of the first symptoms of arterial dete-
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rioration. It is a warning which it would "bo a grave imprudence not to heed.
The elderly man should therefore give up all exercises of speed like running, and all those in which energetic efforts are added to speed, like rowing in matches. We see men of exceptional powers of resistance continuing to practice exercises of speed till they are forty-five years old ; but it is well to know how indulgence in cham- pionship feats late in life usually ends. Many affections of the heart are consequences of exercises or labors that exaggerate the effort of that organ in men who have reached maturity. The cen- tral organ of the circulation can not be subjected without danger to excessive work, when its play is not seconded by the elastic force of an unimpaired arterial system ; when it is partly deprived of the re-enforcement which is lent it by these contractile channels, the office of which in the circulation of the blood has been hap- pily described by giving them as a whole the name of the " pe- ripheric heart."
All men who employ animals in work know how their speed falls off with increasing age. Race-horses are withdrawn from the track shortly after they have arrived at the full possession of their force ; they are still good for competitions in bottom, and are capable for many years yet of doing excellent trotting service, but they can not run in trials of speed. Man's capacity to run likewise decreases after he has passed thirty years ; and the pro- fessional couriers who are still seen in Tunis, running over large distances in an incredibly short time, are obliged to retire while still young. Those who continue to run after they are forty years old, all finally succumb, with grave heart affections.
There are some persons who preserve to a relatively advanced age the faculty of enduring violent exercises, and of contesting with young persons in quickness of muscular work. Not long ago two men, one forty-five and the other forty-eight years old, contested in the regattas on the Seine and Marne. Their craft was called the old men's. Few oarsmen continue to row in races after they are thirty-five years old. But those whom we are speaking of, though long past the usual age for retiring, have often gained the prizes which competitors twenty years old dis- puted for with them. These exceptions, however, do not depre- ciate the force of the principles we have just explained. They prove that one rnay be young in spite of his years, and that the chronological age does not always agree with the physiological age. While some persons are in full organic decadence at thirty- five years, some others may not yet, at fifty years, have undergone the modifications of nutrition which are the beginning of old age. The capacity of a man for violent exercises is determined by the more or less complete integrity of the arterial tissues. Men who
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preserve a degree of immunity for exhausting exercises longer than the average are those whose circulation has remained regu- lar, and whose arteries have not yet begun to undergo sclerotic degeneration. They are really younger than their age. Every man, according to the happy expression of Cazalis, is " of the age of his arteries/' and not of that which he deduces from his birth. Taking a mean, we may say that after forty years a man ought to abstain from exercises that induce shortness of breath. Instead of exercises of speed, he should adopt those requiring bottom, for which he will preserve a remarkable capacity. Race-horses which have become incapable of enduring labor that involves speed may for many years afterward perform excellent service at more mod- erate paces ; they may even easily endure the paces of the hunt, when they have to carry their rider for the whole day, but in which the fundamental gait is not the gallop but the trot. So man preserves to the extreme limits of mature age the faculty of enduring a considerable labor for many hours, provided it is car- ried on with moderation. Many of the best mountain guides are approaching their sixties, and can easily tire young tourists. But everybody has remarked that the most experienced guides that is, the oldest ones go up very slowly, and that under that con- dition they can walk for an indefinite time. They do this by avoiding, through the moderation of their pace, the quickening of their pulse and the imposition of an excess of work on their heart.
In 1870, when the dangers of the invasion called all French citizens to take part, each one according to his ability, in the de- fense of the country, national guards of the reserve were organ- ized everywhere, in which all those who for any reason had not been incorporated in the active service were enrolled. In the exercises of these improvised battalions, men of very unequal ages could be seen elbowing one another in the ranks. Many of them, who had passed their fortieth year, but felt themselves still "game," came to take part in the manoeuvres, and were never behind in the long drill-marches. Generally, indeed, the elderly men displayed a greater power of resistance than the younger ones. But their superiority vanished as soon as the manoeuvres took the form of quick movements. The " gymnastic step " was the terror of these well-intending veterans ; after one or two min- utes of the run they could be seen leaving the ranks out of breath, while the younger ones, whom they had left behind on the long marches, kept on for a considerable time without feeling any obstruction to their breathing. Serious accidents were sometimes produced in these movements, when they were commanded by too zealous officers who forced the men to keep up their speed not- withstanding the difficulty in their breathing ; and national
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guards were sometimes seen, from having run too long in the face of threatened suffocation, to fall in their places, struck with pulmonary congestion.
Exercises of force would also be as badly chosen for elderly men as exercises in speed, and for the same reason that they fatigue the blood-vessels and the heart. Every muscular act that requires a considerable display of force inevitably provokes the physiological act called effort. A porter in lifting a heavy burden is obliged to make an effort, as does also the gymnast who exe- cutes an athletic movement with his apparatus. These are com- mon facts of observation, and impressions which everybody has felt. If we put all possible energy into any movement, respiration stops at once, the muscles of the abdomen stretch, and the whole figure is stiffened, while the veins swell and mark salient sinuosi- ties on the neck and forehead. I have explained the mechanism of effort in my book on the Physiology of Effort. It is enough to recollect here that it increases in excessive proportions the tension of the blood-vessels. Effort is translated, in fact, by a consider- able pressure of the ribs on the lungs, and through this upon the heart and large vessels ; under the influence of this pressure there is a reflow of the mass of the blood toward the smaller vessels and distention of their walls. When these vessels are tending to lose their elasticity, in consequence of the modification of struct- ure observed in mature age, the violence to which the effort sub- jects them results in the aggravation of their inert state. In the same way the " fatigue of a steel spring which has had too much to bear is increased. again after every violent pressure to which it is subjected. Nothing wears out a man who has reached maturity like great physical efforts, because nothing can more than effort aggravate the effects of that defect of nutrition which is called sclerosis.
In some cases arterial sclerosis is nothing but the gradual and slow consequence of the advance of age, but assumes a rapid pace that makes it a fearful malady. In such cases we can see young persons presenting the same physiological reactions against fa- tigue as the elderly man. One of the first symptoms of that acute aging of the arteries which is called arterial sclerosis is the dyspnoea of effort.* All elderly men are, in different degrees, tainted with arterial degeneracy, and all ought to avoid excessive muscular effort if they would not wear out their arteries before the time that is, would not grow old prematurely ; for every man is " of the age of his arteries."
While the elderly man has less capacity for some forms of exercise than the younger adult, he has no less need than the
- See Euchard, Maladies du Cceur et des Vaisseaux, 1SS9.
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other of the general and local effects of exercise. It is in the earliest period of mature age that the most characteristic mani- festations of defects of nutrition obesity, gout, and diabetes, in which lack of exercise plays an important part are produced ; and the treatment of them demands imperiously a stirring up of the vital combustion. Placed between a conviction that exercise is necessary, and a fear of the dangers of exercise, the mature man ought, therefore, to proceed with the strictest method in the application of this powerful modifier of nutrition. It is impos- sible, however, to trace methodically a single rule for all men of the same age, for all do not offer the same degree of preservation. We might, perhaps, find a general formula for the age at which the muscles and bones have retained all their power of resistance, and at which the heart and vessels begin to lose some of their capacity to perform their functions. The mature man can safely brave all exercises that bring on muscular fatigue, but he must approach with great care those which provoke shortness of breath.
The formula is thus subjective in its application, in the sense that it looks rather to the feeling of the person than to the exer- cise itself ; and from this point of view it is exactly applicable to all. One person is taken with shortness of breath at the begin- ning of a fencing bout ; another one of the same age can fence without losing breath, while he tires his legs and arms. Most frequently the question of measure in the practice of exercise is more important than the choice of the kind. Some exercises are dangerous only on account of the temptation they offer to impet- uous temperaments to pass beyond reasonable bounds. Thus fencing, which prematurely wears out too enthusiastic swords- men, may remain a very hygienic exercise for the man of fifty years, provided he is enough master of himself to moderate his motions. There are exercises, however, which of themselves im- ply the necessity of a violent effort or a rapid succession of move- ments ; among these are some of the exercises with gymnastic ap- paratus, wrestling, and running. These should be absolutely pro- hibited to the elderly man. This rule can not be invalidated by the rare examples of men who have been addicted to such exer- cises till an advanced age. Such men have continued, in respect to their structure, younger than their age ; they have kept their elastic arteries as other persons keep their black hair. They are physiological exceptions, and general formulas do not regard exceptions.
The need which the elderly man feels of a stimulation of his organic combustion may be satisfied in other ways than by exer- cises of strength and agility. It is, in fact, the sum of work that regulates the quantity of heat expended by the human body, and
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that is proportioned to the quantity of tissues burned, to the amount of oxygen consumed in the acts of vital chemistry that constitute nutrition. It is possible to reach a considerable sum of daily work without at any moment making intense exertion or rapid movements. The muscular acts of exercises chosen have for that only to be continued long, without being very violent or very rapid. In other words, it is enough that the exercise repre- sents " bottom " work.
"Walking is the type of " bottom " exercise, and is the most hygienic of all kinds for the elderly man, provided it is prolonged enough to represent a sufficient amount of work. Nothing is so good for the man of fifty years as a gunning tramp, or long pedes- trian tours like those the Alpinists make. But it is necessary to regard the social exigencies, which refuse to give everybody the desired number of hours, and compel another choice. There are many other " bottom " exercises that exact a larger expenditure of force than walking, without going beyond the degree of effort and rapidity that the arteries of the elderly man can safely bear. Many of what are called open-air games, like tennis, lawn-tennis, and even rowing, when practiced not for racing but as a recre- ation that is, with a liveliness graduated to the respiratory ca- pacity of the rower provoke, for example, in one or two hours, an elimination of the products of disassimilation and an acqui- sition of oxygen equivalent to what one can get from eight or ten hours of walking. They permit the busy man to gain time, compensating for the shorter duration of the exercise by its inten- sity ; but that in such a way that he can get the general con- secutive effects of exercise while avoiding its general immediate effects, super-activity of the circulation of the blood and of res- piration.
We ought to look also to exercise for local effects ; in order, in the first place, to keep the joints supple and counterbalance the tendency to incrustation of the cartilages, which is one of the consequences of age ; and, in the second place, to keep the muscles as a whole in sufficient strength and volume. The muscle, as we have read, is " the furnace of vital combustion/' and in developing the muscular tissue we favor the activity of combustion and the destruction of the refuse of nutrition. For the satisfaction of these requisitions, such exercises are adopted as might be called analytical, inasmuch as they bring the whole muscular system into play, not by the work of the whole together, but by a series of successive movements that call the various muscular groups into action severally one after the other. It is important, in order to preserve the easy working and suppleness of all the ar- ticulations of the body, to subject them to movements extending to the extreme limit of possible displacement. We might also,
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�� � by localizing the work successively in limited muscular groups, effect very intense muscular efforts without any fear as to their reaction upon the organism or upon the circulation of the blood. The floor exercises of the Swedish gymnastics exactly fulfill the conditions needed to obtain suppleness of the joints; similar exercises, according to the French method, would be well fitted for the object of preserving or increasing the local muscular development. — Translated for the Popular Science Monthly from the Revue Scientifique.
- Author of the Physiology of Exercise.