Exploring Physical Function and Healthy Aging Frameworks

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, Modern Management of the Older Adult division leader Christina Prevett discusses masters athletes who challenge negative age paradigms and serve as role models for younger generations. 

According to the episode, the decline in physiological systems can be attributed to both aging and other factors such as inactivity, sedentary behavior, obesity, and chronic diseases. It can be challenging to distinguish between changes in physiological systems solely due to the natural aging process and those influenced by these other factors. However, Christina suggests that psychosocial factors also play a role in positive aging. Factors like loneliness, connectedness, sense of purpose, and the ability to make healthcare decisions not only for oneself but also for others contribute to positive aging. These psychosocial factors are independent of physical capacity and can help individuals maintain a positive aging experience.

Christina emphasizes the importance of building and maintaining relationships, connectedness, and the capacity to learn, grow, and contribute in the context of healthy aging. These aspects are relevant not only for older adults but also for all generations, including Gen X, Gen Z, millennials, boomers, and masters athletes.

Loneliness is a significant issue in society, affecting people of all age groups, as highlighted in the episode. Building and maintaining connections and relationships are crucial for sustaining healthy lifestyle factors and combating the loneliness epidemic. This is particularly relevant for older adults, who may struggle to maintain relationships as they age. Christina mentions the challenges of making new friends as an adult, as expressed by her grandmother.

The masters athletes discussed in the episode serve as examples of individuals who demonstrate the importance of these aspects in healthy aging. They not only prioritize their physical performance but also value psychosocial considerations. Masters athletes have the opportunity to build relationships with individuals across different age groups who share similar mindsets regarding health promotion. This allows for the exchange of knowledge and the adoption of healthy lifestyle factors.

Furthermore, masters athletes have the capacity to learn, grow, and make decisions. They challenge negative age paradigms and combat belief systems around aging through their athleticism. They set goals not only for their own performance but also for serving as role models to younger generations within their family and sport. Masters athletes also contribute positively to their sport by creating mentorship opportunities for younger athletes. They serve as examples of successful aging and contribute to the overall belief in the ideology of successful aging.

Overall, this episode emphasizes that building and maintaining relationships, connectedness, and the capacity to learn, grow, and contribute are essential aspects of healthy aging for all generations, including older adults and masters athletes. These aspects not only contribute to physical well-being but also to psychosocial well-being and the overall belief in successful aging.

Take a listen to learn how to better serve this population of patients & athletes.

If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

EPISODE TRANSCRIPTION

00:00 INTRO What's up, everybody? Welcome back to the PT on Ice Daily Show. Before we jump into today's episode, let's chat about Jane, our show sponsor. Jane makes the Daily Show possible and is the practice management software that so many folks here at ICE utilize. The team at Jane knows how important it is for your patients to get the care they need. And with this in mind, they've made it really easy and convenient for patients to book online. One tip that has worked well for a lot of practices is to make the booking button on your website prominent so patients can't miss it. Once clicked, they get redirected to a beautifully branded online booking site. And from there, the entire booking process only takes around two minutes. After booking an appointment, patients get access to a secure portal where they can conveniently manage their appointments and payment details, add themselves to a wait list, opt in to text and email reminders, and fill out their intake form. If you all are curious to learn more about online booking with Jane, head over to jane.app.physicaltherapy.com. Book their one-on-one demo with a member of their team. And if you're ready to get started, make sure to use the code IcePT1MO. When you sign up is that gives you a one month grace period that gets applied to your new account. Thanks everybody. Enjoy today's show.

01:43 CHRISTINA PREVETT Good morning, everybody, and welcome to the PT on Ice Daily Show. My name is Christina Prevett. I am one of the lead faculty within our modern management of the older adult division. We have three courses in our geriatric curriculum that encompass CERT MMOA. We have our eight week online essential foundations course with our next course starting October 11th. We have our eight week online advanced concepts course, which if you have taken our essential foundations, you are eligible for advanced concepts that starts October 12th. And then we have our two day live course that we still have quite a few courses for the remainder of 2023 if you were looking to get involved. So we are in Falls Church, Virginia, October 7th and 8th. I am in Fountain Valley, California on the 14th and 15th. And then we are in Mattawa, New Jersey on the 21st and 22nd. And if you did not see that we are currently in what I call revamp season, we just updated our live content for MMA Live. And if you are in advanced concepts coming up in October, you are going to be getting brand new material. And I am so, so excited about that. 00:00 THE MASTERS ATHLETE And what we are going to talk about today is some of that content relating to the master's athlete. When we think about our geriatric curriculum, let's be honest, we are not talking about master's athletes most of the time, right? We often will talk about this sickness, wellness, fitness continuum. And when we talk to our geriatric clinicians who are on our calls or taking our courses, and we say, you know, what percentage of individuals are in the sickness or the completely sedentary side of the spectrum, We're talking about the majority, right? We're talking about the majority. We're getting individuals who are saying 80, 90% of their caseload is completely sedentary or is struggling with the chronic disease burden from multimorbidity. And very few of our clinicians are working with the master's athlete. So why do we care about this group? Well, one, we want to cover the full spectrum of geriatrics. But secondly, there is this really neat kind of underpinning that we are gaining from a research perspective when we are evaluating the master's athlete. When we talk about aging physiology, it can be really tough to tease apart what is what we would call the natural history of getting older, what are things that we can expect to change across our physiological systems as a consequence of getting older, and what are the contributions of other things to that aging process. We talk about how we have accelerators and brakes to the aging process, and we can stack the deck in our favor, and then we're just talking about risks and statistics. And one of those things is that as we get older, we tend to move less. We tend to be more sedentary. Obesity rates can go up. And chronic disease, one of the biggest risk factors across all categories, is age. And so we have this hard time teasing apart what is from the aging process and what is from the inactivity, the compounding effect of sedentary behavior, kind of what are those influences? And so the masters athlete has, especially for our lifelong exercisers, those who are veterans, who have never really stepped away from the sport for very long, we're starting to get some ideas and tease apart, you know, what is an aging process and what is accelerated because of changes related to inactivity, obesity, chronic disease. And so I kind of want to tie this in. So we have this physiological change. 06:05 CARDIOVASCULAR FITNESS IN AGING And when we look at, for example, in the cardiovascular system, our masters endurance athletes maintain their VO2 max by about 57%. And our endurance athletes, when we compare our masters endurance athletes in their 70s, have a lower VO2 max than our endurance athletes in their 20s, but a similar VO2 max to our younger individuals in their 20s who are completely sedentary. And so that is showing that while yes, there is a change to our cardiovascular output, our max heart rate is going to go down, our stroke output, our stroke volume, our cardiac output is going to decrease. Our amount of deconditioning in our VO2 max as a marker of cardiovascular fitness is a slower blunting than maybe we had previously thought. And things like our ejection fraction and our resting heart rate actually do not change with age in a healthy, cardiovascularly conditioned older adult. And to me, that's fascinating. So we're looking at that from the endurance side. When we flip to the strength side, we see that our raw strength in our power lifters is relatively maintained and up until about the fifth decade of life. So an individual squat bench deadlift, as long as they stay injury free and training volume remains pretty consistent, we're going to maintain those numbers for quite some time. 08:50 TYPE 2 FIBER REDISTRIBUTION And then as we go into different age groups over the age of 40, we're going to start to see some blunting down of that strength effect as a consequence of age. We talk about in the musculoskeletal system though, that there is this change in this redistribution of our muscular fibers, where we see a shift from this composition that has a bias towards type two fibers in certain muscle groups. And we see this shift towards more of a type one slow twitch fiber archetype in many of our muscles. And we seem to see that this is true in our strength athletes as well. And the way we're starting to gain insight into this information is by comparing our power lifters and our weight lifters. So our power lifters are slow strength movements. We have the squat, the bench, the deadlift. For our weightlifters, we are working on speed strength. So we are going to get those type two fibers at high percentages of our one rep max, but we're also gonna try and preferentially activate them with some of these fast twitch movements, such as the clean and jerk and the snatch. And we start to see that the open records for weightlifting in age groups decline much steeper. That means that we are still seeing this switch of type 2 fibers. That does not mean that we don't train power and we're going to try and have this use it or lose it principle that holds true for everything. But we know that that type 2 fiber redistribution is part of this aging physiology that we can expect to see in many of our older adults. Taking a step back from that, it's super interesting to see that we are getting this heightened or slower rate of cardiovascular aging in our endurance athletes. And we're getting this relatively slower change in the musculoskeletal system in our strength athletes. And that specificity principle appears to hold true. And it's something that we see very consistently in our rehabilitation efforts, right? We are trying to train the person's body to not experience pain, dysfunction, or loss of physical function in the exercises, in the movements, in the day-to-day tasks that are important to our individuals. And so when I step back and think about myself as a person in my 30s who's going to try to hold on to my physical function for as long as possible, somebody who maybe isn't in the highest level of competition, but would still consider myself to be very much an athlete, this idea of training both systems I think is extremely important and extremely relevant in our messaging for maintaining physical function. We see oftentimes that we focus in strength training for very good reason. Oftentimes our older adults, unless there's a significant amount of cardiovascular compromise, are losing the strength to complete activities of daily living, like getting off the floor or being able to get up from a chair without using their hands before their cardiovascular system. In our kind of community dwelling older adults, not our individuals with pulmonary pathologies like congestive heart failure or COPD, that cardiovascular system isn't being the limiting factor as often. But what we want to be thinking about is how do we optimize the reserve in both of these systems and how do we slow down the slope of the line? In I'm MMOA, we talk about how we do not want to think that successful aging is just related to physical function. Physical function is a really important part of aging frameworks. and successful aging frameworks, but it is not the only thing. And so I kind of want to take this conversation and then take it a step further. So while yes, we see that our masters athletes are able to have a blunting of the changes in physical function that we see with aging, as a consequence of optimizing their physical reserve earlier in life and then maintaining that optimized physical function into later decades. Where we want to also bridge this is towards some of the frameworks that we're seeing with healthy aging. So the World Health Organization put out a healthy aging framework with the idea of having this decade-long initiative that internationally we are going to try to be encouraging healthy aging initiatives because our global population is aging and that is going to put a massive burden on our healthcare system. And there's a lot of things that we need to think about. And so their framework is really brilliant in that they talk about the ability to meet basic needs and the ability to maintain mobility, like their ability to be mobile around their community. And I think our Masters athletes are good examples of what this might look like in order to try and maintain this type of physical function. 14:58 BUILDING RELATIONSHIPS IN AGING But the other three things are important considerations as well and do not relate directly to physical function, but there are some kind of extensions or indirect relationships that we can make. And those are the ability to build and maintain relationships, so that connection, the ability to learn, grow, and make decisions, so autonomy in some ways and purpose, and the ability to contribute, which really kind of ties into that purpose conversation. And if you listen to the MMOA podcast, Ellen and I were just on that platform, if you want to take a look, talking about the blue zones. And this was a series that was done on Netflix that talked about these areas around the world that have a higher percentage of individuals living over 100 compared to global norms. And where they were talking about this was not only related to physical function, where physical function was something that we were considering, but they also talked about some of these biopsychosocial considerations like building and maintaining relationships and that contribution to that other aspect of a person's soul and a person's being. When we look at the Masters athletes and we look at qualitative systematic protocols or systematic studies that are looking at some of the other indirect indicators of what a Masters athlete values outside of their physical performance, they kind of touch on these other aspects of the healthy aging framework. where the ability to maintain relationships, one of the things that can be a big struggle for our older adults, and my grandmother who was in her 90s said this beautifully, she said, everybody I know is dying. And Having, building new friends as a grownup is extremely hard. And so one of the other things that our master's athlete literature is really demonstrating is some of these other bio, or these psychosocial considerations that are just so important when an individual is aging. So what they're showing is that our older adults who are master's athletes continuing to compete have this avenue to build relationships with individuals across different age cohorts that have similar mindsets related to health promotion. And that's so important, right? We see that we tend to take on a lot of the lifestyle factors of the individuals who are closest to us. Our literature shows that if we are around individuals who are in the overweight or obese categories, we are more likely to be overweight or obese. The business sentence is, if you are the smartest person in the room, you are in the wrong room. And that's around this building and maintaining of connections and relationships that also have this trickling effect of helping to sustain healthy lifestyle factors. And this loneliness epidemic is so relevant now for all generations, Gen X, Gen Z, millennials, boomers, and some of our older adults. Like all of this connectedness is such an important part of healthy aging. And we're seeing this in our masters athletes as well. And then finally, this capacity to learn, grow and make decisions and the ability to contribute. Our masters athletes are also demonstrating this because they talk about this capacity with athleticism to combat belief systems around aging, to start tackling some of these negative age paradigms, to be able to have goals related to not only what their performance is, but role modeling their athleticism to younger generations within their family and within their sport. and their capacity to be able to create this mentorship for some of their younger athletes that allows them to contribute very positively to their sport. And so not only are we seeing that physiologically within our systems, our masters athletes are blunting some of the slopes of the line across different organ systems, but we're also seeing some of these indirect psychosocial positive contributions of individuals in the Masters Athlete space that are contributing to this overall belief around Masters Athletes having an ideology around successful aging. 17:23 MASTERS ATHLETES & CHRONIC DISEASE Some of our masters athletes, we kind of consider them to be completely free of chronic disease. And while we do see a lower incidence of chronic disease, like cardiovascular disease and diabetes, for example, in our masters athletes who have continued being active throughout their life, that does not mean that they are immune, but it does mean that when they are diagnosed with things like chronic conditions, that they are better able to manage those disease processes because they have these healthy lifestyle factors that are going to slow down the disease process. So all of these things kind of coming full circle, where we are looking at the master's athlete that while yes, in many of our older adults that we are teaching for clinicians, they are not going to be primarily focused in the master's athlete category. They do give us a lot of insight into the rates of loss in physiological systems and what we can attribute truly to aging versus other confounding variables such as inactivity, sedentary behavior, obesity, chronic disease burden. And then we can also see how some of the influence of these other psychosocial factors, this loneliness epidemic that we are seeing, this connectedness that is needed, this sense of purpose and the capacity to take risk and be a contributing factor to not only their own healthcare decisions, but those of their family and the people around them that are trusting them with their wisdom and knowledge and experience is a way for us to see this positive aging cohort that is also independent of their physical capacity that they are able to maintain. All right, I ended up going a little bit long, but I think this is such an important conversation. And not just for our older adults who are already in these age cohorts, but anybody who is listening, who is thinking about themselves as an athlete. Because we see in the literature that the Masters athlete is defined as anybody who is kind of reasonably beyond the open retirement age, but is continuing to train and compete in sport for the purpose of physical fitness. But in MMA, we think about it as anyone who wants to intentionally move their body towards a goal. And that may be all of you that are listening to this. It's like, how can you put in that master's athlete mindset into your own life to connect with other people with like-minded goals, to be able to optimize your physical function if you are listening and you are 30 or 40 or 50? to maintain that when you are 80? And then how can we do this to help drive purpose in our lives, to allow for that feeling of fulfillment that is just so important to maintain as we get older? All right, if you are looking for more information about research coming out in the geriatric space, I encourage you to go to pti.nice.com slash resources and sign up for MMOA Digest. Otherwise, I hope you have an amazing week and we will talk to you soon.

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