FEATURE:

Keeping that healthy edge as you age

That’s the advice of Elizabeth Rhee, M.D., staff geriatrician at The Queen’s Medical Center and a faculty member in geriatrics at the John A. Burns School of Medicine.

To Dr. Rhee, fitness involves not only diet, exercise and absence of disease, but social activity, mental and spiritual health, and the peace of mind that comes from having your affairs in order before your inevitable passing. This includes having your will made out, and an advance health care directive appointing someone to make health care decisions for you if and when you can’t.

Fitness includes ways to cope with the loneliness of widowhood or widower hood, empty nest syndrome and general mental health. There are studies, she points out, that show that people who have more friends and activities are healthier. If you are older than 50 and have not embarked on a program of life fitness, it’s not too late to start.

Most everyone wants to live a healthy, happy life, independent and mentally acute, and pass away quickly and peacefully, without pain, suffering, or the humiliation of being helpless and on life support. It doesn’t happen that way for all of us, but health experts say we can work to increase our chances of a healthy old age and a peaceful death.

“Going to a nursing home is the end of the line,” says Dr. Rhee. “People dread it. You want to keep your dignity, autonomy and quality of life to the end, but you have to work at it.”

Dr. Terry Shintani, who developed what was first known in 1989 as the Waianae Diet Program, and later published “The Hawaii Diet” in book form, says, “Some men especially have a macho attitude. They won’t change their habits. They shrug and say, ‘when I die I die.’ I tell them, suppose you don’t die, but have a stroke and live helpless for years in a nursing home bankrupting your family?”
Fitness messages aren’t new. We’ve all been told many times to eat a healthy diet, exercise, limit fat, sugar, salt and alcohol, stop smoking, maintain a happy, positive outlook, develop spiritual serenity, lower blood pressure and learn to cope with stress. But we often need reminding.

Experts in various fields shared their wisdom on fitness for this article:

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General health and disease risks

According to statistics, older Americans die predominantly of heart disease, diabetes, hepatitis, stroke and various cancers. Dr. Shintani’s belief is that the major killers are all related to poor nutrition and lifestyle choices.

Shintani has devoted his career to this concept. A law school graduate before he went to medical school, Shintani says, “I think I approached medicine with a legal mind and a different set of lenses.” Because nutrition was not addressed in medical school, he spent a postgraduate year at Harvard studying that field.

“We have an epidemic of obesity,” he notes. “Most Americans eat too much fat, meat, sugar, white flour and junk food. We live in an era in which there is a premium on time and convenience. We eat processed food because it’s quick and convenient and has a longer shelf life than the fresh vegetables, fruits and grains our ancestors cultivated and depended on for thousands of years, which provide vitamins and antioxidants.”

Why are Hawaiians so susceptible to obesity and diabetes? Shintani maintains that in ancient times when Polynesians paddled canoes all over the Pacific, and lived by fishing, farming and physical labor, natural selection favored people who had what he calls “thrifty genes.” They could survive periods of famine because their bodies were programmed to use and store calories efficiently. On a diet of fish and vegetables and physical labor they didn’t get fat but their descendents pack on pounds with a typical American diet and a more sedentary lifestyle.

Dr. Rhee of Queen’s says that diabetes is common in Asian ethnic groups, although they are less likely than Caucasians and Hawaiians to become obese.

She recommends regular medical checkups, including a colonoscopy every 10 years, more often if you have a family history of colon cancer or your doctor recommends it. “Colon cancer starts with polyps,” she says. “If you catch them early, you can prevent cancer.” She knows people dread having to “drink that awful laxative” but it’s important to have this exam.

A lot of women dread mammograms too, she adds, but women older than 50 should have one and a Pap smear every year. Men should have their prostate tested for this common cancer every year.

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Diet

Vicky Chaffin, nutritionist with The Queen’s Medical Center, says older people need antioxidants, B vitamins, Vitamin D, calcium supplements and Omega 3 fatty acids, and in general, should take a good multivitamin every day. As we age, she says, hormonal changes mean we lose muscle and bone. Brittle bones are easily broken and less easily mended.

“People often ask how much calcium they need,” Rhee says. “A lot of people think osteoporosis (in which the bones thin out and break down) is a female disease. But men get osteoporosis, too. You build your bones in your teens and 20s. After 30, you are just trying not to lose bone. I recommend 1200 milligrams of calcium a day and the earlier you start this the better.”

Fast food places have become popular gathering places for cost-conscious seniors to socialize over an inexpensive meal. But Chaffin says you can eat at these outlets regularly if you choose your food wisely and eat well the rest of the time. Virtually all the fast food outlets now offer healthy choices, including salads.

If you order a salad with chicken, she says, order it broiled rather than fried, and don’t use the whole pack of dressing, just drizzle a little on the greens for taste. If you order a hamburger, forego bacon and cheese, tell them to hold the mayonnaise, and ask for extra lettuce and tomato. Skip the French fries, hash browns and sausage. A couple of napkins can squeeze some of the excess fat from the hamburger patty.

If you are eating breakfast, Chaffin says, “Egg McMuffin isn’t too bad on an English muffin, but if you order it on a croissant, it has more fat and doubles the calories.” Although it’s not on the posted menu, McDonald’s will sell you a scrambled egg a la carte if you ask. You can team it with an English muffin, a side salad or orange juice.”

Chaffin adds, “The more people ask for healthier options, the more the fast food outlets will change their menus to accommodate customer requests.”

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Exercise

Do we need to be told yet again to exercise? Exercise can be as easy as going for a walk, but contrary to what some seniors believe, walking isn’t all you need to do. According to exercise professionals, seniors need to work on strength, balance, flexibility, endurance and range of motion.
Weight lifting helps develop strength and restore bone density. Cardiovascular exercise helps the heart. Stretching helps improve flexibility and range of motion and can cut down on injuries. Balance is important because seniors become increasingly susceptible to falling and breaking bones.

Physical therapist Kevin Lockette of Ohana Pacific Rehab Services says, in a lecture he gives regularly, “An inactive lifestyle can cause seniors to lose ground. Maintaining strength should be the number one fitness concern of older adults. In a national study of 6,000 adults over 70 years of age, 26 percent could not climb even one set of stairs without stopping, and 31 percent had difficulty lifting a 10-pound bag of groceries. Strength and balance training can significantly reduce problems, including injuries from falls.”

With Hawaii’s year-round warm weather, there are many low-cost options for seniors indoors and out. The Honolulu Parks and Recreation Department has a variety of inexpensive classes at various parks, including tennis, Tai Chi and various kinds of dance (excellent for improving balance, experts say) and swimming. If you never learned to swim, it’s not too late.

Fitness experts say swimming is a great low impact exercise that uses and stretches all your muscles and makes you feel good.

Private gym memberships vary from low budget to luxury. The YMCA’s eight branches on Oahu (including one opening soon on University Avenue) have gym equipment, and all but two have swimming pools. The YWCA in downtown Honolulu has both gym equipment and a pool.

Some people like the convenience of having their own fitness center at home. Roseann Lewis, co-owner with her husband Richard of Total Fitness USA in Kalihi, sells treadmills, compact work stations, free weights, fitness balls and other equipment to both gyms and private individuals. Those who buy equipment for their home tend to be older than 50, she says, because they have more disposable income and more space to use it.

Pointing out that there is lot of equipment on the market, some sold on television, she wants people to educate themselves before they buy something that’s hyped as the latest miracle machine and ends up breaking down. There’s also a difference between equipment designed for home use and commercial use, Lewis adds.

“Sometimes condominium boards go out and buy equipment for their exercise room and it’s designed to take 500 hours of use a year in a private home, not 5,000 hours. On the other hand, we don’t want to sell people what they don’t need and won’t use. We want them to make educated decisions.”

There are also specialized fitness centers that cater to women and/or seniors.

Emily Borro, 80, not only works out at Curves for Women, but is an employee there. This youthful, lively octogenarian started working for the company in Niu Valley five years ago, at 75.

She managed the Niu outlet for two years and now works one day a week in Kaimuki and two days in Hawaii Kai helping members with their training. Curves has hydraulic equipment and encourages its members to do an efficient workout in as little as 30 minutes.

Kaimuki manager Cathy Cannon says about 60 percent of the membership is older than 50 and part of the philosophy behind Curves is that older women grew up at a time when females normally didn’t pump iron. Some are new to it and feel self-conscious in a male-dominated gym. Fees run $39 a month with a joining fee that varies with specials, most recently one to support breast cancer awareness.

Club 50, on South King Street near McKinley High School, is geared to seniors. Owner Marina Ferrar says the equipment is hydraulic and the emphasis is on low impact workouts.

“Our program isn’t designed for body builders and marathoners,” Ferrar explains. “We’re directed toward average men and women who just want to be healthy. We try to have a good social atmosphere. People become friends.”

Fit for Life in Kalihi is also geared to seniors but focuses more on personalized training for people with specific medical problems. Owner Eric Okamura says 90 percent of his clientele are older than 50 and his oldest client is 87. He holds small, closely supervised workout classes. Prices are per workout and depend on what people need.

“People come here wanting strength training and flexibility,” he says. “As they age they find they can’t lift a laundry basket or a 20-pound bag of rice. They have trouble pulling themselves out of the bathtub. They need to exercise their muscles on all different planes, and work on core strengths. We don’t focus on six-pack abs here.”

A program new to Hawaii this year is Silver Sneakers, a division of Healthways, an Arizona disease management company. The program is available free for members of SecureHorizons and Humana health care plans, and YMCA members. The company has contracts with YMCA and some private gyms, including The Oahu Club, and offers a low-impact exercise program designed for seniors with input from physicians.

The idea, says Patrick Hagedorn, manager for Hawaii operations, is that most health plans are now interested in promoting preventive care. “It’s more than exercise,” he notes. “At the Kalihi YMCA, for instance, people have formed a social group. They bring food and have a potluck after class. It’s a holistic approach, they make new friends, and they improve their health.”

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One last resource:

KHNR Radio (609 on the dial) has a two-hour Doctor Health program on Saturday mornings. Host David Snow interviews doctors, fitness and wellness experts and other professionals and takes questions from listeners.

The program airs Saturday from 8 to 10 a.m. through October and 9 to 11 a.m. November through March.

Kathy Titchen is a Honolulu freelance writer and a former reporter for the Honolulu Star-Bulletin.

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