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Who Gets to Get Stronger? · The Long Run

• speaker-0: Welcome to the first episode of The Long Run. I am Andy Friedman, one of the co-hosts, joined by my colleague. speaker-1: Doctor Anna Anaka. Very excited to be kicking off episode one. speaker-0: Absolutely. And in today's episode, we wanted to start things off with a bang. We are joined today by Dr. Roger Fielding, and we'll give you all of this background, but we wanted to start with the topic of strength training. It's it's so important when you think about aging well. I am currently very much in the process of my own kind of strength training as I prepare for the first Half marathon I've run in about ten years. So getting back into it. And we're gonna cover all sorts of topics, everything from the latest innovations around GLP ones and creatine to what is the science of of strength and and and how does that originate. So excited to share with you the conversation with Roger as we get into it. speaker-1: So our guest today, Dr. Roger Fielding, is a senior scientist at the USDA Nutrition Research Center on Aging at Tufts, where he's also a professor of both nutrition and medicine and the associate director of Boston's Older Americans Independence Center. He spent 30 years measuring what happens to muscle as people age and what can be done about it. 300 odd papers, nearly all of them are circling the one question: What keeps somebody able to do things? Thirty years ago lifting weights was for athletes and now it's something doctor tells eighty year olds to do. He hasn't just studied that shift. He helped cause it. Doctor Fielding, Roger, thank you so much for being here. speaker-2: Thank you. It's a pleasure to be here today. speaker-1: So you're down at the Tufts campus in Boston. How long have you been there? speaker-2: So I have been here at the Human Nutrition Research Center on Aging for the last twenty two years. So a little while. speaker-1: Absolutely. And what's kept you there? I know there's a lot of ways to study how our bodies handle getting older, but what's what's your corner? speaker-2: Yeah, I mean, I think two things have been important. This is one of six human nutrition research centers in the country. And it's the one that's focused really on the interactions between nutrition and the aging process. And the ability that I've had here to do both clinical and basic studies, examining the impact that aging has on muscle and muscle function and how lifestyle interventions can affect muscle function has really really been an important part of my research and really a large part of my career for the past twenty something years. So so I've been fortunate and privileged to be here at the the HNRCA to do that work. speaker-1: So what made you go in that direction? speaker-2: Well, you know a little bit of luck involved. I I sort of became interested in physiology when I was in college, got introduced to exercise physiology and began to understand the plasticity and ad adaptability that skeletal muscle has. And so pursued more training in sort of exercise physiology and metabolic responses to exercise. At the time mostly focused on how these These factors influenced athletic performance. But then, because of working with some other mentors and colleagues that were really interested in what happens to muscle function and exercise capacity as people age, started getting really interested in this idea that there were age-related changes in physiological capacity, aerobic capacity, strength, muscle mass, muscle power, and started to understand that. Just like with young athletes and young individuals, the capacity for older individuals to improve their muscle function existed. And there were ways that you can enable older people to improve their strength, improve their muscle mass, improve their cardiorespiratory function. And in fact, it's probably more important in older people because we know that these physiologic attributes really have an impact. We now know that they have an impact on how older people function in their in their external world and how they live independent lives. So so so anyway, that's how I got started, I guess. speaker-1: So I want to actually start with something that just happened at my kitchen table a couple of weeks ago. So my mother-in-law was in town and she had just come back from her doctor's and she was really upset because her nurse told her that she was inactive because she didn't go to the gym, she and she didn't lift weights. And she kept saying, I walk everywhere, look at my arms, I'm toned. Why do I need to lift weights? And so I asked her whether anybody had ever explained why. why they were so concerned about her lifting weights and she said no. They just kept saying, You're an active, go to the gym. So let's start there. What is resistance training actually for? And what wasn't said? Well first speaker-2: The good news is that your your mother-in-law's provider actually had a conversation with her about exercise. Because while that happens a lot now, it doesn't always happen. Right. But what I would also say is any physical activity is better than no physical activity. So the fact that your mother-in-law is walking pretty regularly is a plus and really important for a lot of the long-term health benefits that walking, exercise, cardiovascular type aerobic exercise has for reducing risk of cardiovascular disease, reducing risk of certain types of cancers, reducing the risk of of obesity and type two diabetes. But What we know now is that it's also important to try to preserve muscle strength and muscle mass as people get older, because we know that with aging, as people chronologically age, everybody loses muscle mass and everybody loses strength. And we know that resistance exercise training is one of the best, most effective ways to either preserve that muscle mass and muscle strength or reverse any of some of the losses that you have achieved throughout your chronological aging. speaker-0: Right. Interesting. You you you touched on this, Roger, earlier when you talked about how so much of the strength conversation is really oriented towards kind of younger demographics, people in their twenties, thirties, and forties. And and I think recent studies show that about a third of Americans currently are doing some kind of strength training. I am curious, like if you're seeing that same kind of energy shifting towards people as they approach retirement, or is that still like a demographic that no one's talking about? speaker-2: So so I I do believe that there are segments of the older population that are embracing all forms of physical activity and specifically understand the importance of strengthening exercises in particular because of some of the things we talked about. But what I would say is that that does skew a lot across, you know, socioeconomic demographics in terms of income, education, ethnicity. And while while a lot of a lot of older people are engaging in physical activity, it's it's not widespread and it's not at the level I think we need it to be, because we know the benefits of of physical activity and we know the benefits specifically of strength training. So we certainly need to do more, but certainly it's it's it's more common than it was, I would say, twenty or thirty years ago. speaker-1: And so when we're thinking about strength training, it the messaging is fairly simple for somebody in their twenties, thirties, and forties. There's the aesthetic benefit, there's the health benefit, but it becomes more vital as we w as we age. And, you know, there's a word for what happens to muscle as we age that most people have never heard about that you know quite a lot about. What is sargopenia? Yes. speaker-2: So, so, you know, this term sarcopenia actually was sort of coined and developed at Tufts by one of my mentors, Irv Rosenberg, who who's actually a gastroenerologist, but was such a big thinker that he really understood that this observation that people lose muscle as they age and they lose strength as they age really needs a name and really needs to be characterized as a syndrome of aging so that people Become aware of it and start to study it and really try to think about ways to reverse it. So very smart thing to do is call something something. And so he came up with sarcopenia. And now what we as a group of scientists consider sarcopenia to be is the age-related loss in skeletal muscle mass and strength that leads to a reduction in physical functioning. So, sarcopenia is the loss in mass and strength. And the consequence of sarcopenia is this is some measured reduction in physical functioning. So, what do we mean by physical functioning? Well, how fast somebody walks, how fast somebody can climb up a set of stairs, how rapidly somebody can get up out of a chair. Those are examples of tools or tests that we use to assess how well a person functions. speaker-1: Now is this something that we all are fighting against? Is this a diagnostic code or a diagnosis we will all see? Or is this something that can be mitigated? speaker-2: So I would say no. But what what what what I will say is that all people as they age, even if they're very active, will lose some degree of muscle mass and muscle strength. The people that have what we call sarcopenia are the people that have an accelerated loss in mass and strength so that they fall below a a a critical threshold where that loss of muscle mass and muscle strength really has an impact on their their ability to function. So even though we will all lose muscle and we'll all lose strength as we age, not everybody will develop the syndrome of sarcopenia. And that becomes important when we think about how we're how we might want to target sarcopenia, certainly with lifestyle interventions. But then also there may be some people in whom the lifestyle interventions aren't effective. They've lost so much strength and muscle that they can't engage in some sort of physical activity intervention. And there might be other therapies or medicines that might be appropriate for those individuals. So we really want to have a objective cut point for sarcopenia so that we can think about what the treatment options may be for those those individuals. speaker-1: And what I'm hearing from you is muscle is really king here, so to speak. So if we take two people at sixty, same weight, same blood work, but very different muscle mass, how differently does their next twenty years look? speaker-2: Well, I think it could look very different because we know that even if even if those people have the same trajectory of loss in muscle mass because one person is starting lower than the other person, they are going to approach that critical threshold where the loss in muscle mass and muscle function or muscle strength is going to begin to impact their their ability to walk, their ability to climb stairs. Their ability to get up out of a chair and ultimately their abil their ability to live independently. So that may occur with the person that's starting lower, that may occur when that they are 70 or 75. For the person that's starting significantly higher, that might not occur until they're 85 or 90. And I think there's been a real transition in in thinking about aging, and and that's that's also. bled into research on aging, that maybe we're not so interested in increasing lifespan or thinking about interventions and therapies to increase lifespan, but we're trying to extend what we think about as health span. So the number of years that you can live independently or the number of years that you can live disease free, rather than how long you want to live. I don't know anybody that wants to live to be a hundred if the last 15 years of that hundred years are spent wheelchair bound or bed bound or in a nursing home. I think what people tell me when I talk to older people is that they they want to live active, independent lives and they want they want advice, recommendations, treatments and interventions that are going to help them do that. speaker-0: Absolutely. We spent a lot of time here, Roger, thinking about that gap, that lifespan, health span gap. And yep. And really there's been some recent research that shows that the US is is really failing in terms of how large that gap is when compared to most developed countries and nations. So in thinking about like how we can prevent or slow aging related declines in the specific kind of condition of scarp copenia, like what are some of the things that people can look for as an early detection, if you will, before Well before there might be a diagnosis, like what can the average person kind of notice in their own lives? speaker-2: So so I think one of the things we know is that the rate of loss in muscle performance, for example, muscle strength, is is larger per year than is the loss of muscle mass. So people may begin to notice that they have difficulty with with tasks that maybe three or four years ago were very easy for them to perform. Now they're having a little bit more difficulty doing the garden, taking out the the trash. Doing housework. These are sort of cues that maybe they're losing some muscle function. And and and and maybe they need to start thinking and paying attention to that. But I would say that a lot of people don't recognize those symptoms. You know, when you when you have chest pain, you you sort of think, maybe, well, maybe I'm having a heart attack, or, you know, at least that's sometimes the first p thing people think. If you have knee pain, you have some arthritis. There are other symptom-associated diseases that people are very commonly recognize. But I don't think people think about when they're having difficulty climbing the stairs that they have a problem with their muscle. So we need to do a better job of trying to educate people about this and making them more aware that their muscle function is a really important part of their health because sometimes it's not the person that notices the problem. It might be their their son or their grandson or granddaughter or their their their their home health aid, for example. So so we really need to increase people's awareness about muscle health and that it's an important dimension of healthy aging and in and maintaining health span, improving health span. speaker-0: That's that's great, great advice. And I think the the next question is is maybe making it a little bit more practical. So you you've kind of recognized that there's a need to kind of reinvest in your own kind of physical strength, but you're out of practice. You you haven't hit the weight room in in many years. And and so the question I have for you is is what kind of advice do you typically provide or do you have for people who are kind of getting back into is the is there really injury risk and and what does the research say about people who are kind of getting back after years of maybe Not thinking about utilising these types of muscles. speaker-2: Yeah. Great question. And and also for for for many older people, they've never done any resistance exercise training. They haven't, this is this is a very new thing to them. And and you know, if I'm talking to an older person and they're interested in sort of what I should do for resistance training, we sort of have a conversation that sort of goes like this, you know, there are community resources. You know, the the YMCAs are really good programs and they they have programs that are targeted in many places for older adults. Many, many senior centers in communities now have some level of structured exercise programs. Maybe not always the the highest intensity programs, but at least some activity that includes some strength and balance training. so those are all resources. And then the other thing is. You know, strength training and resistance training can be accomplished through many means. Therapeutic exercise bands can be very, very effective for strength training exercises. Some body weight exercises as well, like squats, push-ups, sit-ups, other calisthenic type forms of exercises can be done that don't require any equipment. Seated chair rises that are unloaded, for example. Things like ankle weights can be used. And then even some forms of of Tai Chi could be considered. strengthening exercises. So there are even some guide the National Institute on Aging produces a guide for for exercise for older adults that I think is still available free and is online that does have instructions about how to get started with strength training. So there are different programs available for for older adults and even for people that haven't done this before. speaker-0: Yeah, that's that's great. I think there's awareness is is really important and I think most people don't know what type of local resources might be available. I I tend to rely on YouTube for a lot of these things as well and speaker-2: of course, you know, you know, and and I think generally the the qu the the information is is generally correct. You know, just like with any physical activity and and any new lifestyle, people do need to to exercise at a level that is appropriate for their pre existing medical conditions and and chronic diseases. Of course. What we say is that you don't need your doctor's permission to start an exercise program. But it's probably a good idea to let your doctor know that you're starting an exercise program and have that conversation because because we we don't want that to be a barrier to people participating in exercise. And there there are frankly very few people in whom physical activity and strength training in particular is contraindicated. So by and large, it can be done safely and effectively. But people need to exercise within their own individual limits and You know, we always tell people to start slow and and build up gradually. speaker-0: Red advice. speaker-1: So what I'm hearing you say, Roger, is that no matter how old you are, if you have a goal of increasing your strength and really giving some love towards your muscles, there is a safe way to do it. speaker-2: Yeah, I mean studies that were done here back in the the nineties even showed that even in institutionalized older adults that were living in nursing homes, if you introduced a supervised program of strengthening exercises, their muscle strength and their physical functioning improves. That's probably the extreme example. And even if even in studies where that we've done in a bit more community-based setting, in community living older adults, Even when we look at people who by definition have the frailty syndrome, again, they have a low level of physical functioning, they have we you know pretty low muscle strength. Even in those people, a structured regular program of physical activity that includes strength training can improve their physical function and r reduce their risk of becoming disabled. So so I think the evidence is pretty clear that at any age, you know, exercise and in particular resistance training exercise. Can have positive effects. One of the results or effects of resistance training exercise is to increase muscle size or muscle hypertrophy. What we do know is that the degree to which the muscle grows or hypertrophies is pretty robust in at young ages. But as people get older, the The degree to which their muscles can hypertrophy is actually diminished. It doesn't go away completely, but the magnitude of the response is is lower. But despite that, the muscle will still get stronger and function will still improve. speaker-1: So speaking of hypertrophy or in more layman's terms, muscles getting larger or stronger, when we're talking about people lifting weights for the first time at 70, their gains and their functional benefits from that are going to be different than somebody in their 20s or 30s. But in your trials, how often, how heavy, how long were these individuals doing their strengthening or resistance training before anything showed up, any small benefits? speaker-2: So what I would say we've done several trials of resistance training exercise. The duration of the trials has varied from 12 weeks to 24 weeks. Typically, what we've done is had people the goal was to have them train three times per week. Usually five to six major large muscle groups of the upper and lower extremity. Sort the magic three sets of eight to ten repetitions because we want us, you know, that's we've seen that has worked in the past. And then the intensity is usually about 70% of their maximum muscle strength. And we we re we measure that. We do we assess that pretty regularly. And and what we see is that strength begins to improve in these individuals. And I would say the average age of the participants in many of our studies is probably about 75 years, a plus or minus five years. And strength starts to improve within three to four weeks. And and when we see hypertrophy in the muscle, we can see it as early as 12 weeks. And we clearly see it at 24 weeks or six months. And that's that's if you're training within those parameters that I just sort of described. If you're doing less, maybe twice a week or once a week, you know, the the the the responses are going to be. blunted a little bit. So you you would see less of an increase in strength, less of an increase in in hypertrophy, for example. speaker-1: So we're not talking individuals have to be in the gym five to seven days a week to see benefits. It's little as three times a week. They'll start to be feeling stronger in a month and seeing results. speaker-2: Yeah, and in fact, you know, the g you know there are there are now, you know, guidelines for physical activity for for all Americans and there are specific guidelines for older adults. And the guidelines talk about a a minimum of one time per week of strength training is enough to at least maintain strength and maintain mass. More is better, but you we're not talking about six, seven days a week. Now, again, there are adopters and people that wanna exercise a lot, and there's nothing nothing intuitively wrong with that as long as they're not getting injured or really, you know, overdoing it a little bit. But but you know, we do see really solid benefits with two, three times per week. That's certainly adequate. speaker-1: So in the past, I know you've measured in aerobic capacity and strength. Physiologically speaking, what does each one actually translate to in terms of what somebody can still do? speaker-2: Yeah, so so we haven't talked too much about aerobic capacity or sort of cardiorespiratory fitness, but we know that with advancing age, there is about a 1% decline in cardiorespiratory fitness per year as people age after about the age of 35. And the best measure we have of cardiorespiratory or aerobic fitness is this measure called the maximal oxygen uptake or or VO2 max or maximal aerobic capacity. So this is really more related to sort of endurance exercise capacity, you know, how how well you can, you know, walk a mile or run a mile or walk or run two miles, three miles, four miles. And then strength is really, really related to what the what the maximum capacity of your muscle is to generate force or over a period of time to generate power. So that's sort of like at the other end of the spectrum. We think of endurance activities are sort of low force. For a long period of time that you're generating the force, whereas strength is when you're doing explosive activities, you're generating a high level of force, but it's for a much shorter period of time. speaker-0: Very interesting. You you mentioned VO2 Max. So that was something I had no awareness of before I started wearing my my Whoop device earlier this year. And now it's something I monitor daily. In a spirit of trying to kind of talk about other hot topics, we'd love to get your help in thinking about what's real and what's just noise. So for first up, let's talk about creatine. So creatine, you can't turn on a TV station or walk into a Costco without seeing, you know, creatine in your face, and everyone seems to be touting its benefits. When we were Preparing for this episode, we actually saw that you did some research on creatine back in ninety eight. So it's it's not so new. Would love to kind of hear a little bit about what you found in that research and anything that might be applicable to older adults as we think about the benefits or lack of benefits of something like creatine. Yeah. speaker-2: So, you know, creatine is marketed and sold as a dietary supplement. It's a natural product. It's found in all sorts of all sorts of animal proteins, meat, chicken, fish. It's it's in the food supply that we eat. So from a performance enhancing standpoint, creatine has been shown in a number of studies to work to improve exercise performance, largely high intensity sort of sprinting exercise, weightlifting. Those types of performance. The other question that has been asked is: if I take creatine as a supplement on a regular basis, is it gonna augment my training? Am I gonna get stronger and are my muscles gonna get bigger if I take creatine along with my resistance training? So there have been a number of studies looking at this. And there's also been so many studies that have been done on this: is that that people have been able to do what are called Systematic reviews or meta-analyses where they actually look at all of the studies together. And what the best meta-analyses have shown is that creatine plus resistance training in young individuals will actually exert a benefit above the effects of just resistance training alone. So if you're a young individual and you're really serious about training, if you take creatine supplement regularly, you'll probably get a little bit stronger. Your muscles probably get a little bit bigger. Maybe it's because you're able to train at a little bit higher intensity. In the studies, in the meta-analyses that have looked at this response in older adults to date, the response has been much less clear in that creatine plus resistance training doesn't seem to improve strength and muscle hypertrophy any more than just doing resistance training alone. Now that said, there are probably more studies that have been done in young people than in older people. There's also a lot of talk now about creatine supplementation and its effects on cognitive function. There have been some positive studies, but far fewer than far fewer of them, and really not enough, I think, to make a strong recommendation about the effects of creatine supplementation for cognitive function. Probably has a little benefit for exercise performance. I'm not sure it's something that. All older adults need to consider when they're becoming more physically active. But again, if someone's an adopter and they're really serious about their training and they really want to get every possible advantage, there may be some benefit. And the one thing we do know about creatine as a dietary supplement, because it's been used for years and years now by lots of people and it's sold all over the world, it's it is relatively safe. So it has a very very strong safety profile. So there's no harm in taking creatine, at least at the doses that are recommended. What the benefit is, I think varies a little bit and probably is less so in older adults. speaker-0: Super helpful and and very topical. And I guess switching to a another topical innovation which which hasn't been around for for 30 years is GLP ones. So so I'd be curious to kind of get your take on the benefits and and how it relates to the conversation we're having about strength training and muscle and and what you're seeing when people are taking GLP ones or people thinking about it, what they should be thinking about. speaker-2: Right. So the the GLP1 agonists, these are drugs that mimic some of the the hormones that are secreted by the gut in response to meals, have really and and now are are being used to treat individuals that have type two diabetes, and also now being has have been approved to treat people with obesity. And they have been really transformational in in treating obesity. And type 2 diabetes. The best data we have on weight loss from lifestyle interventions are if if people comply with weight loss interventions, voluntary reductions in food intake and a little bit of exercise, they may lose 8% of their body weight. But adherence has always been challenging. If you have bariatric surgery, you know, when you have your have an operation to remove some of your stomach or to reduce the capacity in your stomach. which is very, you know, invasive and and and a very big step, you maybe can lose 30% of your body weight. The GLP ones for weight loss are somewhere in the middle, 15 to 20% weight loss, but certainly much greater than than you see with lifestyle interventions. So from that standpoint, they have been transformational for for obese patients and for people with type 2 diabetes. But just like when you go on a lifestyle intervention to lose weight and you reduce your food intake, because that's the mechanism by which GLP ones work as well, you lose about two-thirds of your body weight. The weight loss is fat mass. So you lose fat, which is what you want. But then the about the other third of your weight loss, 25% to 30% of your weight loss, is lean mass. And there's been a lot of sort of debate about whether that's that's sort of A normal adaptation to achieving a lower or more normal body weight, or it's an adverse effect of these GLP1s. And I don't think we really know yet whether this significant loss in lean mass is really, from a metabolic standpoint and from a functional standpoint, is really significant. The concern, I think, is that we know that. You know, 60% of people over the age of 65 are overweight or obese. And it's very likely and will be likely. I mean, Medicare just re re started a program to offer GOP1s for old you know, people that are on Medicare. So that's everybody in the United States over 65. So so we know that the the use of these therapies is gonna increase in older adults. And it probably is happening now. And the question is, are there groups of people maybe that already have low lean mass, have low muscle mass, have low strength? Is there going to be negative consequences of them going on GLP1 therapies? We don't know that. The data on body composition changes with GLP1 therapies and the large phase three trials, which have largely been done in, you know, middle-aged people, 45 to 50 year olds, very, very few older people have been included in those trials for approval. And so So, more is really, we really need to understand a little bit more about responsive older people on these therapies. I will not be surprised if there are subpopulations of older adults in which GLP1 therapies will cause a meaningful and clinically important loss in muscle mass. That will not surprise me, but we haven't seen that happen yet. And of course, ideally. These patients should be counseled with getting more physical activity, trying to do more resistance type exercise training, and probably need to focus a little bit more on increasing their dietary protein intake as well. But how often and whether that happens or not, I think in the real world, I think is is is is sort of up for grabs. I but I do think we need to know more about that. So good good medicines for obesity, what they do to muscle, I think we still don't really know, and and we need to learn more. speaker-1: So speaking of muscle, is there looking forward, is there anything in the research world right now where these drugs are being paired with strength based interventions to protect this muscle? speaker-2: Yeah, so I I'm aware of some randomized trials that now are s trying to look at the interactions between GLP ones and and exercise. I'm I'm not involved in those specifically, but I I do know that those those types of randomized trials are ongoing. speaker-1: So there's some research to be on the lookout for. speaker-2: Sure, for sure, for sure. speaker-1: So bringing all of this back to what is this actually for? Right? We want to protect our muscle, we want to ensure that we're able to do what we want to do every day, especially as we age. In your studies and your experience, when you ask people what they want to be able to do, what do they actually say? speaker-2: Well, I think I think most older people that I talk to, and probably can include myself in that group a little bit now, too, is that they wanna live independent, productive lives and they wanna they wanna do things that can help them maintain that ability. I think as the the whole soci our whole societies has changed in terms of, you know, there are more older people, there are more people living to age eighty five and ninety than ever before in the history of civilization, you know, the idea of people sort of retiring when they're 60 or 65 and sort of going off to sort of not do anything for the rest of their lives is sort of transformed, I think. And so I think people are thinking about their their later years as trying to be more productive, more engaged, more socially interactive years. And people want to know what they they can do to help sustain that. I I think it's I think that's that's what people talk to me about. speaker-1: So it's really shifting the conversation from fitness for aesthetic or health purposes and more of fitness to maintain what they want to do. speaker-2: I I think so. And I I you know, I wanna be able to s you know, I wanna be able to downhill ski with my kids. I wanna be able to downhill ski with my grandkids. I wanna be able to play golf with my family. I wanna be able to be physically active for a lot more years. And I think there are a lot of people that wanna do that. And I think that that's that's should be the goal. speaker-1: Absolutely. In terms of when you bring up fitness in your studies, before we move on, when you're talking about what it is for, so we you obviously have the research component of looking at the muscle and the underlying mechanisms of whatnot. But do you dig into the functional pieces of downhill skiing or being able to get the mail from the mailbox? speaker-2: Yeah. So so there's a couple of ways to think about that is, you know, we're interested in the biology and how exercise influences the biology and muscle and and other other organ systems. And and then that biology sort of translates into how someone performs, you know, what's their strength, what's their VO2 max, you know, what's their endurance capacity? And then there are tests that we can do that sort of capture. Or give us a window into how they function. Like we measure how how far someone can walk in six minutes. We measure how far someone can walk across a short, short corridor, for example. We measure in time how fast they can climb up a standard rise of stairs. So that that gives us sort of what their physical functioning is. And of course, that still doesn't that tells us still what their capacity is. It doesn't tell us. what they actually do when they go home and they're in their condominium or their house or their apartment. And now more recently we can actually, you know, put an accelerometer on their wrist or their hip and actually send them home with that. And we can, you know, with some pretty cool technology, we can measure, you know, how active they are. We don't have to ask them. They don't have to remember. They don't have to write it down and tell us. We can actually measure it directly and in many cases remotely. how active they are. So, so we we are interested in that that component, because that's the ultimate goal. What is it that you do in your own environment? And is whatever we're doing or telling you or giving you, is that benefiting that? Is there real meaningful benefit there? So, so yeah, we we do try to measure those things, capture them. speaker-0: It's fascinating. I'm I'm curious, like as you think about, you know, your research and and look out into the future, what has you most excited? What should we be all looking for that you're really bullish on in the next few years? speaker-2: So one of the the projects we have now that I'm interested in is that trying to understand a little bit more about why some people respond to exercise and some people don't respond to exercise. You know, if you if you give even if even if you look at people that get a prescribed, in this case, strength training program or resistance training program, if you at they actually do the exercise, you know, we know they show up and they attend all the visits. Some people will will have robust increases in their strength and muscle mass. Some people are sort of fall in the middle, and some people barely respond at all. I mean, they respond a little bit, but not not as much as as other people. And and we have a study going on now where we're trying to understand how some of the the the biological changes that occur with advancing age influence this. variability or heterogeneity in the response to exercise training. So so I think that's really an interesting question. And and ultimately maybe I'm not sure how this is going to translate, but but maybe this also will influence how you you might presc if we figure this out, then you know, does that help you sort of tailor the right exercise prescription for the right person? And and I think it may. You know, there's there's a lot of interest in sort of personalized approach to interventions and lifestyles. So we're trying to figure that out. So that's keeping me busy right now. You know, and I I also think, you know, how people embrace technology and use technology to influence sort of lifestyle interventions, I think that's going to be a very transformational thing that happens and is happening now. To think that there are, you know, companies that actually sell devices that people can wear that track their activity, track their energy expenditure. Can measure continuously their blood pressure, their blood glucose. You know, all this portable remote sensing, I think, will become really important for both prescribing lifestyle interventions, monitoring lifestyle interventions, providing feedback to people, and maybe help in helping even to motivate them to comply with these beneficial interventions. We know exercise is good. We know exercise is is great for people. The challenge we still have is getting people to do it. People, a lot of people, you know, a lot of people don't A don't like to exercise, don't want to exercise. You know, you know, there's a laundry list of excuses and and and barriers to exercise participation. So, you know, what can we can would there be other ways that technology could help provide behavioral motivation, cues or or encouragement to to get people up? and moving I think would be really, really important. speaker-0: Absolutely. We spend all day thinking about how do we how do we motivate the right behavior change. And and you touched on personalization. So we'll we'll close with a a personal question, one that we asked all of our guests, which is really what does the the long run look like for you, Roger? speaker-2: Yeah. So I'm I'm I've always been physically active. Did a lot of running all my life and sort of the last couple of years I've sort of just sort of through my wife, I got sort of hooked on going to sort of boot camp and I do boot camp about six days a week now. And so that's high intensity strength training and interval training on the treadmill. So I pay money to have a some twenty year old yell at me to sprint on the treadmill. speaker-0: Amazing. speaker-2: If you asked me if I would I would do that four years ago, I would tell you you're absolutely crazy. The thought of like doing group fitness and doing supervised fitness programs just was not something that I had ever really thought I'd be interested in. But I really enjoy it and it's been really good. So I'm stronger, probably fitter than I've been in twenty years. And I've always been reasonably fit, but now I'm at a I think I'm a little different level. So speaker-0: So bingo. Well maybe I'll see you at my next boot camps. I I tried it once, but I might have been one and done. Anna, are you are you a boot camp enthusiast? speaker-1: I don't know. I I've tried it once, got very scared. I now work with a personal trainer who is also a physical therapist and it's been fabulous. But again, paying somebody fifteen years younger than I am to yell at me to do strength exercises. speaker-2: sizes. And and and you know, this is also the point too, right? It's not one size fits all. Some people like the one on one experience. I I never thought I would like the group and I we like the group. And, you know, it just varies. Sometimes there's a little bit of accountability with the group classes. You're going see your friend the next day and you know your spouse goes with you or partner goes with you. So it's not one size fits all. And and again, any exercise, any increase in physical activity is better than than the person that just sits in the chair and and does no activity. So speaker-0: Amazing. Well, thank you, Roger. I feel like we've we've learned a lot today. I also feel inspired. so maybe you've inspired me to try boot camp again. we'll see. But thank you. Thank you for for kind of sharing all of your experience advice with us today. speaker-2: Really enjoyed the discussion. Thank you. speaker-0: Thank you for for listening to our first episode of The Long Run. We are committed to bringing kind of new thinking and ideas and research all tied to the idea of aging well. Whether that's tied to improving your health or improving your wealth as we think about the years ahead, we are excited to keep bringing these episodes. Roger was a great guest. I learned a ton today, Anna. I think a lot of this was not news to you, but a fascinating conversation. speaker-1: Absolutely. And it's always good to hear that even just twenty minutes of strength training can really make a big difference. So you don't have to be in the gym six days a week, but maybe we can all aspire to Dr. Fielding's six day a week boot camp training. It's amazing. speaker-0: God. I I tried that once and I was like on I couldn't leave my couch for a week. So the fact that he's doing it is something that I'm gonna I'm gonna sit with and and maybe I'll be back out there. speaker-1: And I think it's important to note too it's something new for him. So as we talked about throughout, it's something that can be started at any time in life and it you don't have to be twenty to do it. speaker-0: Absolutely. Well stay tuned. We'll we'll be back for more episodes. Hope you enjoyed it. Would love to hear any feedback. The views expressed by hosting guests on this podcast are strictly their own and do not represent the official position of Jerd Inc. Content is for general information purposes only.