Ageing and orthopaedics



Excess mass. Many of the degenerative changes of ageing are associated with excess body mass. It is a common perception that as one ages body-mass should increase. At times I am told by my affronted patients “I have always weighed this much, since I was a youth. How can you expect me to weigh less now?”


Get older, thinner. The reality is that an “ideal” body weight, which is probably acquired at the end of growth should, with ageing, decreased progressively. The reasons are that there is a loss of both the weight of bone and the mass of muscle. Therefore if the bodyweight remains the same it must be because there is more fat.


The lungs and stomach. The vertebral column shortens was ageing, and therefore the volumes in both the abdomen and thorax decrease . If the same amount of fat (or progressively more fat) is compressed into the abdomen then the diaphragm will be lifted and the space in the thorax compressed. This may be one of the reasons why reflux oesophagitis increases with ageing, as does the hiatus hernia. Add to that decreases in respiratory capacity, often in lungs which are functioning sub-optimally, and one has extremely good reasons for reducing mass. Oesophageal reflux can cause further deterioration in the lungs, coughing at night and so the cycle continues.


Weaker body more load. Therefore we have the unsatisfactory situation with weaker muscles and more frail bones being expected to carry a far larger body-mass, comprising a primarily of fat.


Metabolic effects. Excessive fat is not innocuous, as it has a huge influence on the hormonal balance of the individual, including the factors that go to create a diabetes, and creating excess female hormone.


Weaker structural tissues. Structural tissues, such as ligaments and tendons  lose their mechanical strength with ageing. This is partly because the blood supply to those structures diminishes and partly because the reparative processes following minor injury are slower.


Exercise plays many roles in musculoskeletal health (as it does in the health of the entire biology).


Hormonal benefits of exercise. There are general effects of exercise, which stimulate the production of natural anti-inflammatory medication substances, natural antidepressants and natural analgesics. For those with aches and pains, as well as the sense of depression that inevitably accompanies the degenerative processes of ageing, these are exceedingly important.


Strengthening benefits of exercise. In more specific terms exercise will retain, or perhaps increase muscular bulk and strength, which is so vital in protecting the joints. The calorie burn will be the most effective way of reversing the ratio of fat to muscle.There is nothing better than low impact exercise (such as cycling and swimming) to stave off arthritic degeneration in the knee

Osteoporosis. Exercise is the most specific counter to osteoporosis.


What type of exercise? In the ageing body by far the most effective form of exercise is swimming. However, if an exercise program is to succeed, and for that matter if any exercise patterns are to succeed, it must be firmly scheduled, so that the exercise is consistent. Three times a week is probably ideal, with a necessary day of “recuperation” between each session.


Particular care with swimming. Those who have problems with the joints, particularly with the vertebral column, but also the large joints of the body, need to exercise particular care in swimming. A painful back or a dowager’s hump, and many forms of scoliosis can make it exceedingly hazardous to enter the water unassisted. It is recommended that swimmers with these problems should always be accompanied whilst in the water, at least in the beginning.


Swimming and Gym coaching. It is also recommended that a swimming coach be employed initially. Many elderly people will regard this advice with scorn, saying “that is for children and toddlers. I know how to swim”.
However this is not an appropriate answer. Anyone who wants to brush up their foreign language or musical instrument playing needs help as an adult. Perhaps even more important is the fine tuning of swimming skills, which will allow the swimmer a more effortless period of exercise, and  consequently a longer period of exercise. Ideally the aim is to churn through the water without significant tension or stress for forty or more minutes during the session.


Cycling is a realistic form of exercise, with great benefits, particularly, to the knee. This is because it develops the quadriceps and other muscles which control (and so protect) the knee joint. The loads on the lower limb during cycling are less than walking and running, whilst the range of movement is often more than walking. If there are disabilities in the knees which prevent adequate movement then the use of shorter pedals shanks can overcome the problem. Ideally, adjustable shanks could be used and as the range of movement in the knee increases, so the length of the shank can be increased.


Cycling has the advantage that one can listen to music, dialogue or watch television. Reading a book is not realistic because of the jolting and sweating.


Making exercise fun. This is an important aspect of exercise as a therapy. Exercise must be attractive, appealing and fun. If exercise is a drudge then enthusiasm will be lost rapidly and ultimately the endeavour will fail, leaving only a large burden of guilt.

It is therefore suggested that careful attention be given to the “fun” aspects of exercise. The iPod has created a new dimension of music and literary content, and it might be that the iPod should be bought before the exercise bicycle.

Real cycling is an option which can give much additional interest to exercise, as well as a social and even the travel aspects. Many people combine an exercise bicycle with the “real” bicycle, and so are able to enjoy summer but continue to exercise during winter.


The importance of the logbook. Another ploy which is useful in maintaining stimulus and interest is to keep a detailed exercise logbook. This logbook should include details of the period of the exercise, and if it’s possible to measure  (as  is possible on many types of exercise bicycles) the total calorie burn. The logbook should also include a daily resting pulse (before getting out of bed) and the pulse rates before and after exercise as well as weight daily.
There is a tendency to forget how one improves was exercise and therefore the recording of this will not only stimulate the aim to keep improving, but demonstrate the efficacy of past exercise.


What can you expect if you  lose weight by reducing calories?


A number of chronic illnesses can be reversed, sometimes completely, simply by calorie reduced loss of weight. These include:

Diabetes of maturity

High blood pressure


Lower limb arthritis

Reflux oesophagitis

Respiratory incapacity and breathlessness

Prevention of hernias, or recurrence of hernias


Possible improvements include:

 A longer life. People (and animals) live longer on restricted calorie diets.

Reduced sleep disturbance from oesophagitis, reflux pharyngitis or apnoea

Urinary incontinence

Cardiac failure

Chronic bronchitis

Chronic sinusitis

Shoulder pain (when this is caused by lifting the body weight out of chairs).

Low back pain and sciatica.

Painful feet


All these illnesses are frequently treated by long-term medication. It seems so simple to be able to effect an improvement with less or no medication, at less cost, more energy, and a better quality of life by weight loss and exercise. Surely you owe it to yourself to try?