This article was sparked by the plight of a recent patient with extreme right hip pain. They related how they had always had strong legs, and how their job, for years, required continual strenuous daily leg exercise, but that within a reasonably short time after retirement left hip pain commenced, leading to replacement. Now, a couple of years later, debilitating right hip pain began suddenly, the patient had extreme difficulty walking requiring a walking stick. Orthopaedic examination revealed both significant leg muscle volume loss and right hip deterioration.

Now one might be tempted to conclude here, that the years of hard work had worn out the hips. From a different perspective, one could also conclude that the previous years of hard exercise had staved off joint deterioration, while ceasing work had led to, both loss of leg muscle volume and joint deterioration. I tend to lean towards the later view.

The patient admitted that their post retirement exercise pattern included walking regularly and lots of work around their acreage property. This leads one to ask what is good exercise to maintain strength and function?

A study by Lambert etal (2008) gives us a great example. Participants did 3 sessions a week of

1. endurance,
2. Progressive resistance training (PRT)

to improve physical function. Each 90 min session included:

1. 15 min of flexibility exercises,
2. 20–30 min of aerobic exercise,
3. 30–40 min of progressive resistance training (PRT),
4. 15 min of balance exercises.

Aerobic exercises included

walking on a treadmill,

step-ups & stair climbing,

stationary cycling,

Stairmaster exercise

starting at ∼75% of peak heart rate, progressed over weeks to 80-90%.

The PRT consisted of nine exercises (squats, leg press, knee extension, knee flexion, seated row, upright row, seated chest press, biceps curl, and triceps extensions). Weightlifting sessions initially included 1-2 sets at ∼65% of one-repetition maximum (1RM), allowing 8–12 repetitions per set. Exercise volume was gradually increased to 2-3 sets at ∼80% of 1RM, allowing completion of 6–8 repetitions per set. Participants performed make-up sessions if they missed one, so each participant performed the goal of 36 sessions in 12 weeks.

What I like about the exercise program above is that it incorporates endurance, strength, flexibility, balance, while working up to levels that continually test the participant’s ability to complete the exercise. This generates hormonal signals to drive their physiology to build strong yet flexible tissues and brains, staving off physical mental deterioration. Like my patient many of us walk around the block and work around the yard but this type exercise while pleasant and certainly of some benefit is probably much-less likely help keep excellent muscle volume and joint function nor be able to help us stay as fit, strong & physically young as we’d like to be!

References

Lambert CP etal, 2008, ‘Exercise but not diet-induced weight loss decreases skeletal muscle inflammatory gene expression in frail obese elderly persons’, J Appl Physiol vol 105, pp473-478, https://www.utoledo.edu/med/depts/medicine/endocrinology/pdfs/Exercise_but_not_diet_induced_.pdf