Older Bolder Life

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elder health

Health and Fitness Expectations after 40: Managing the Timeline Game

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Last week I introduced a series to come focusing on managing expectations, in particular expectations that those of us working to maximize our health and fitness after our 40th birthdays create for ourselves.

Given what we know about athletic performance, I’m thinking here of the old rule of thumb that your VO2max (think of VO2max as a measure of your body’s ability to utilize oxygen) declines by about 10% every decade post age 30, we probably should really be talking about expectations we create for ourselves post age thirty. (And this old study shows that the traditional 10% per decade decline doesn’t hold true for fit people actively exercising, even in their 7th decade).

And of course, the absolute crux of the timeline expectation game is damned simple – the time it’s going to take you to get from your starting point to your fitness, or weight, or metabolic health target depends on a host of factors unique to you, and critically where – relative to your targets – you’re starting from.

An Embarrassing Example from my Own Experience

When I first made the decision now just about three years ago to do what ever it might take to reclaim my health and fitness, I was a physical and metabolic disaster. In a full blow metabolic syndrome (I could have been a poster boy), I had just finished a round of treatment for renal cancer, had developed an idiopathic thrombocytopenia (low platelet count), weighed 412 pounds, and had so many aches and pains I could hardly walk through a store without the aid of a cart, and on the worst days, needed help tying my shoes.

A mentor helped me take the first steps in terms of revamping my diet and beginning at the most basic level in terms of rebuilding my fitness, and drilled into me the importance of setting attainable and rational short and intermediate term goals (incentives, and success, are huge helps). He also challenged me to set “reach for the stars”, seemingly at the time almost crazy goals as well; we can talk about structuring goals in detail sometime in detail – the psychology is fascinating – for sake of this story let’s just say I did set some seemingly unreachable long term goals (most of which I’ve now surpassed at the almost two year mark).

My mentor, wise friend that he is, hammered into me week after week that part of the process is indeed expecting life to get better (fitness to improve, weight to drop, etc), but he cautioned every single time that trying to pair my fitness and weight loss goals with a timeline I’d pulled out of thin air was a fool’s errand. He (correctly) harped on the principle that our expectations (especially when it comes to timelines) need to be tempered and tied to our reality unfolding day by day.

For Every Year a Couch Potato a Month in Recovery?

My mentor repetitively hounded me with another rule of thumb that he swears he learned from Dr. Phil Maffetone (I’ve yet to find it expressly stated on his site or any of his books), basically saying that after 40 (arguably 30 or 35 as well), for every year you’ve spent not exercising and overweight, you’ll spend at least a month of consistent fitness and healthy eating to reverse and overcome the damage and deconditioning done on your way back to a healthy baseline.

To be perfectly honest, I despise most rule of thumb discussions in health and fitness in general, as there’s simply too much variability in human physiology and experience to make them conform meaningfully to an individual’s reality.

That said, I’ve used this principle in advising clients and patients for years now – for every year a couch potato you’ll spend a month eating healthy and exercising consistently to restore a healthy baseline – and I’ll be damned if it doesn’t ring ring true more often than not. And note I’m talking about a healthy baseline here – becoming a masters cyclist or runner might take a little longer.

The Bottom Line: Play to Win the Long Game

In particular for those of us over 40, restoring optimal health and fitness after a period of…let’s say any time living with less than optimal nutrition and shunning exercise…is going to be a long game; accepting that reality will make the process immensely more rewarding, enjoyable, and sustainable.

Amazingly I still have people contact me for help in “easily dropping 50 pounds in three months”; most of the time we don’t mesh and work together – unrealistic expectations at the start are a huge hurdle to overcome. (Can somebody drop 50 pounds in three months? While possible, it’s sure as hell not probable, but it depends on where you’re starting from and how you want to get there; I dropped 50 pounds in four months myself at one point in my journey. )

By 40, most of us have accumulated at least a few dings and bruises, we don’t recover as quickly from aggressive workouts or injury, we often have very demanding work and family responsibilities, and we’ve often accumulated some damned harmful and deeply ingrained habits too. These things won’t prevent you from coming back, but they’ll impact your approach, and the timeline.

Have a long way to go to rebuild your health and fitness? It can be done; embrace the longer journey, savor the victories along the way, and build a lifestyle to take you into later years, remaining active, vital, and engaged.

Health and Fitness After 40: Managing the Expectation Game

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The Cambridge Dictionary defines the word expectation in several ways, and there’s a slight twist when comparing the US vs. the British definitions…

US: the feeling or belief that something will or should happen

UK: the feeling that good things are going to happen in the future; the feeling of expecting something to happen, what you believe or hope will happen in the future

At the risk of sounding a little too old school, I’d venture that – when it comes to personal health, wellness, and fitness – many of us have allowed the impatient, “I want it right now, dammit” tone dominating society now to impact how we view our own approach to, and our progress in, an effort to up our game and live healthier.

The longer I actively practiced medicine the more convinced I became that, for a variety of reasons we’ll talk about over the next several weeks, most of us have expectations regarding health, fitness, and function that are hugely divergent from our own personal realities, and if you’re not a thoughtful steward of expectations – lousy results often follow, many times leading to failure and disaster.

Here’s an example of what I’m talking about. During the last fifteen or so years in practice, I focused on the conservative management of spine disease and injury. Most of the patients I treated were older than thirty-five, overweight – some massively, poorly conditioned, sedentary or close to it, consumed some variation of the Standard American Diet, and many engaged in some other high risk health behavior, smoking and recreational drug use being the most common.

Most of the patients I treated stepped into my office with the expectation that, with some wave of the technological magic wand helped by some pharmacologic sorcery, their pain would somehow be resolved with minimal effort otherwise on their part.

Managing these expectations was in reality perhaps my biggest challenge in the medical game; it required patient, consistent, endless education, helping people understand what was wrong, why it happened, how recovery and restoration of function actually happens, and what the potentials were down the road for improvement and gains.

You can guess how the story unfolded; a minority really dug in, listened, learned, made life and activity changes, and genuinely improved. A bigger group went through the motions, did the minimum to quiet the problem at hand, and resumed their destructive lifestyle to return with another back pain crisis a few months down the road. Another minority refused to engage, and went off seeking the holy grail of a no-effort recovery, usually unhappy, bitter, and disparaging on the way out the door.

Health and Fitness After 40: Managing the Expectation Game

Over the next few weeks we’re going to tackle some of the expectations those of us over 40 (you could argue over 30 for most in America today) have regarding our own personal health, wellness, and fitness; of course we all want to be more fit, closer to our best weight, sharper, more engaged and energetic, and live as long as a highly functional – and happy – human as we possibly can.

Before your expectations derail your progress on your journey, let’s spend some time looking in more detail at some common areas where our expectations can quickly breed frustration. We’ll start with a fairly candid look at weight loss expectations next week, followed by a number of other topics in the weeks to come.

Medical Policy: A Slippery Slope if There Ever Was One – “Rational” Elder Assisted Suicide

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On a site dedicated to exploring health and wellness, it might at first glance seem a bit odd to find a link to a source talking about elder assisted suicide.

[As a quick aside, let me make my personal position crystal clear on the topic – I am against all forms and every practice of assisted suicide on moral grounds. Clearly adherents and supporters of the practice can put forth, at least on some level, cogent arguments, however, particularly in the context of the “elderly” as discussed in the links below, I find even the discussion abhorrent.]

That said, one of our goals here is to present occasional medical policy topics that have practical and current standing; given as to how media outlets such as the New Year Times have recently called attention to the issue, and physician friends have continued to report discussions along this line by entities ranging from local medical ethics committees to national professional association level, policy-articulating boards, I felt it reasonable to throw this out there.

Several months ago I was actually sent this link – Promoting ‘Rational’ Elder Suicide – by a physician friend; this friend (who shall remain nameless for obvious reasons) holds an appointment in a prominent American School of Medicine, heads his specialty department, and has served several stints on medical ethics boards for local centers as well as an ethics task force for his specialty nationally. He also happens to hold a JD in addition to his medical degree; of note, he never actually practiced law.

In his email he lamented that, for a variety of reasons, in his opinion we’re going to see a “significant push toward acceptance of assisted suicide for a an ever-enlarging spectrum of issues, including its routine use in the elderly who have outlived their resources, have diminished functional capacity and ability to meaningfully and consistently contribute to the greater society as a whole.”

Sober food for thought, and yet another reason to optimize one’s health and maximize one’s functional capacity for the long haul.

And back to more uplifting regular programming tomorrow…