A Cautionary Tale: Thoughts About Lifelong Health and Fitness. Part 1
There will be three take-home messages from this post; they are definitely geared toward people who are on the high side of sixty and they (the messages) have been distilled from my observations, personal experience and some research.
Message #1: As you get older, it’s imperative to keep fit but you should probably dial back the intensity and duration of your workouts at some point. It also helps to keep an eye on your hormone levels. (Flagging hormones and too much exercise don’t mix.)
I’ll be sixty-five years old in a couple of weeks and have spent the latter fifty-five or so of those years being pretty physically active. Like many of us, I played a variety of sports in high school and have managed to stay active with a wide variety of indoor workouts and an equally-wide variety of outdoor pursuits, since then.
I underwent back surgery in September 2020 to repair ancient, trauma-induced spinal fractures (spondylolistheses) and once the bone graft was solid I started religiously rehabbing from that surgery, alternating resistance training and cardio workouts, working out 5-6 times/week. I kept all that up, gaining muscle mass and strength, even after I tore my right rotator cuff backpacking (don’t ask how) in the Fall of 2022.
All that aside, here I am in June 2023, having mysteriously developed bilateral hip and shoulder girdle stiffness over the last two or three months. It’s pretty bothersome in the AM but eases off through the day and is accompanied by a significantly elevated inflammatory marker on blood testing. In layman’s terms, my immune system is now having a squabble with certain connective tissues (e.g. tendon insertions, joint capsules) in my aforementioned shoulders and hips.
Conventional Medicine scratches its head, calls this condition Polymyalgia Rheumatica (PMR), says it’s idiopathic (meaning we don’t know what the hell causes it) and treats it with an extended course of high-dose prednisone. Prednisone is basically high octane, synthetic cortisol and is about four times as potent as cortisol. It is a great anti-inflammatory but is also immunosuppressive and catabolic, meaning it tears your tissues apart.
Conventional Medicine takes no consideration of possible factors that might collectively lead to a PMR-like presentation. There’s basically some head-scratching followed by a prescription.
From an Integrative/Functional Medicine perspective, I see it as a case of: a) pushing too hard without sufficient recovery: b) too often pushing cardio workouts too far into the zone of inefficient fuel burning resulting in copious production of inflammatory free radicals: c) allowing too many processed snacks to creep into my diet (creating even more free radicals): d) jacking cortisol too high, too often and suppressing the production of the anabolic (repair) hormones such as testosterone. Speaking of, when I did the blood test for the inflammation marker, I also asked for a sighting on my total testosterone. It was low.
I also blame Bulgarian Split Squats and Forward Splits.
I casually performed these manoeuvers one day a few months ago. Maybe my hip flexors were already a bit stiff. I dunno. It’s all a bit of a blur as we were also learning to play Pickle Ball on the weekends before the Bulgarian squatting and the forward splitting episode. Although I didn’t feel any immediate effects, I contend that the BSS’s and FS’s were the proverbial straws that broke the camel’s back.
(Trust me, the angle I got to with the forward splits was nowhere near 180 degrees.)
So to reiterate, my muscles and connective tissues were being pushed too hard, were under-recovered and waiting for that last insult to blow oxygen on some smoldering inflammatory fires, causing them to spread from the mismanaged southern forest regions into the mismanaged northern forest regions aka my rotator cuffs, one of which was still bravely trying to recover from the backpacking episode.
Here’s a bit more on cortisol:
Cortisol is rightly thought of as an anti-inflammatory hormone, rising modestly in the face of modest physical/emotional/chemical stress levels and cooling things off but rising excessively in the face of excessive stressors and making things worse, not better. Repetitive, excessive bursts of cortisol can eat muscles, loosen the junctions between the cells that line your colon, thereby promoting inflammation in general, build site-specific inflammatory liver and visceral fat deposits (visceral fat is in the omentum that keeps your intestines in place), throw off your insulin-glucose balance and also shrink structures in your brain, which causes you to write run-on sentences. Too much cortisol basically wreaks havoc, tearing through your body like an unguided missile. Not a great recipe for a long, healthy life.
This is why I elected not to go on prednisone aka the unguided turbo-cortisol missile.
My Integrative/Functional Medicine approach to getting out of this pickle (no pun intended) is this:
I’ve kept working out but have gone to lighter weights, toned down the bodyweight exercises and have stayed in Zone II for cardio. (More on that in a bit.) I am obligated at this point to inform readers that my wife, Jeanette, has told me for several years that I’ve been working out too hard. Many of you might have Jeanette as your Integrative/Functional Medicine practitioner. Try being married to her! (Actually, she is sharp as a tack and is right far more often than she is wrong, when it comes to health advice: and many other things.)
I’m not eating any processed food/snacks. I’m eating a lot less cheese and keeping my fat intake below 30% of total calories consumed because muscle working in Zone II burns your fat if you don’t eat too much other fat. I’m eating more good carbs to support glycogen stores. I’m eating more veggies. I started on some testosterone supplementation as males of my vintage often complain of stiffness that is relieved when they add testosterone. And my serum total testosterone was low, as mentioned. I fired off urine samples to profile all my major steroid hormones. I have a hunch that I was spending too much cortisol working out and not making enough cortisol while I sleep and when I first wake up, hence the inflammation and stiffness.
In the interim, until I get my urine steroid results, I’m thinking about adding some pregnenolone at bedtime. Pregnenolone is much easier on the body than prednisone as it can convert into cortisol, progesterone, DHEA and testosterone, providing anti-inflammatory and anabolic effects at the same time. It was used more than 60 years ago to treat rheumatoid arthritis but I’ll be darned if I can find that paper.
It’s going to be a process. I’m not labeling myself with an “idiopathic” condition and submitting to the standard prednisone strategy. I’ll adjust things once I get my urine steroid results. Acupuncture might also be in the cards in order to reblance the immune system.
I remind you that what I’ve just related illustrates the Integrative/Functional Medicine approach to a situation that might seem opaque to a conventionally-trained practitioner.
Zone 2 Training
Now what about Cardiac Training Zones? They can be defined in terms of blood levels of lactic acid and other measurements, but in general terms:
Here’s another simpler chart:
Zone 2 has gotten a lot of attention on and off over the years and lately, it is getting more air time again. There are various formulae to calculate your Zone 2 heart rate but 180 minus your age is probably good enough for many people. In this zone you can breathe through your nose and also talk comfortably: you probably just can’t do both at the same time. It’s called Aerobic training because you are burning fat in oxygen. In Anaerobic, higher-intensity training, you are burning glucose very inefficiently, without oxygen and generating many more inflammatory free radicals.
Recall from high school biology that our cells contain structures called mitochondria that are the powerplants: they generate ATP which is the cellular energy “currency”. All macronutrients (fats, sugars, protein) ultimately convert to ATP. So, the more mitochondria you have, the more ATP energy you can generate in any given setting from watching TV to running for your life.
The thing about Zone 2 cardio is that it helps you make more mitochondria and helps you burn fat. You don’t burn fat in high-intensity workouts.
This is a pretty good site if you want more detail: https://www.vitalscend.com/zone-2-and-5-aerobic-training-for-longevity/. It outlines the many benefits of Zone 2 exercise.
Benefits of Aerobic Training
Aerobic training works the fundamentals of our energy-producing machinery. Mainly it works to increase our ability to take in, transport, and use oxygen efficiently to produce more energy. But it comes with numerous other benefits for the bones, muscles, brain, etc.
- Improves cardiovascular health by strengthening and increasing the efficiency of the heart, lowering blood pressure, and the risk of heart disease.
- Increases lung capacity, which improves oxygen intake and respiratory system efficiency.
- Improves immunity by increasing the production of antibodies and white blood cells, resulting in better immunity and a lower risk of infection.
- Effectively manages weight, burning calories and helping with weight loss or management
- Improves memory and overall mental health by increasing blood flow and neuroplasticity, which improves cognitive function and overall brain health.
- Reduces stress and anxiety by releasing endorphins, which improve mood and relieve stress.
- Increases energy, combats fatigue and boosts motivation.
- Increases overall restfulness and sleep quality by regulating sleep patterns.
- Lowers blood sugar levels effectively, assisting in regulation and lowering the risk of type 2 diabetes.
- Enhances overall fitness by increasing endurance, stamina, and physical fitness.
- Improves physical, mental, and emotional health to improve the overall quality of life.
The intensity at which we train dictates the benefits and adaptations of our bodies. Training at low intensity has more to do with metabolic health and the creation of energy at the level of mitochondria. High intensities work best to stimulate the heart and lungs, increasing their capacity, thus boosting aerobic performance.
Summary
First of all, messages #2 and #3 will have to wait for the next post, which will talk about what to eat. The essence of Message #1 is that if your Integrative/Functional Medicine practitioner tells you that you’re working out too hard, you should likely pay heed, especially of you happen to be married to them! Don’t push yourself so hard when your age starts with a number greater than or equal to six.
Less is more.
Author: George Gillson, MD, PHD, CCFP
EvolveWell Medical Director