Maria Fiatarone Singh, M.D., professor of Medicine at Sydney University School of Medicine, is one of my most precious friends and an integral part of my belief system. I first met Maria during her early training in Boston in Bill Evans' lab. Her 1990 paper in JAMA, "Strength Training in Nonagenarians," is a centerpiece of my scholarly meanderings. Maria took frail 90-year-old residents of the Hebrew Rehab Center in Boston and measured the muscle strength in their legs. Predictably they were frail, but was the frailty the outcome of being 90 years old or was it because they were confined to inactivity? She then did a CAT scan on their legs. In the center was the femur, around the edges was the skin. Around the bone was this little crescent of tissue which was the muscle of 90-year-old residents of the nursing home.
Maria then set up a strengthening protocol, and lo and behold in a short period the CAT scan showed remarkable change. The femur and the skin were the same, but the little muscle crescent had become robust. The residents stood and walked instead of tumbling and falling. Their frailty was due to disuse, not to 90 years. This central finding has become paramount in most of my age presentations. The differentiation between aging and disuse was vivid. Maria had put a large exclamation point on this issue. She created the plank in the platform that demonstrated the essential value of exercise even in 90-year-olds. To me this is no longer a question without an answer.
Old people, all people need to move. This issue was conclusively settled by Maria and others. We Must move!
Sometime in the '80s I gave the kickoff keynote address in Washington to the Robert Wood Johnson research protocol entitled Blueprint for Activity that was designed to further the science base of exercise in aging. I recall the focus of my talk. "Really we already know the essential value of exercise in old people, in all people. This has been targeted, and has been firmly, finally answered. It has a red ribbon on it. So if this truism is established there is no reason to continue doing studies showing this value. That's already been shown. What remains is the hard subsidiary question, 'How do you encourage every one to do it?'"
This is now the forefront of the issue that Maria is pursuing at her home in Australia. She is embarking on a large population-based study driving to the heart of the question, "How do you get people to move more?"
Her study is well-funded, but it is complex with many, many variables confronting it. Behavioral research is intrinsically untidy with confounding variables all over. The interface of any organism with its environment is vital, but is complex and uncertain.
So as Maria transited the San Francisco Bay on her way back to Down Under after speaking in Boston I wished her well in her new enterprise. When she finds out how to get our slothful, obese population to move we will all rejoice in a "WELL DONE" salute. Go for it, Maria.
Meanwhile I continue to run, slowly but certainly.
Exercise for the young is an option.
Exercise for the old is an imperative.