For US retirees, fitness lessons from Japan

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She wore a dark hat even though the sun had gone down, as she swung alone on a swing-set in Tokyo. Unsupervised children aren't an uncommon sight on Japanese playgrounds, but it was dinnertime. And the hat looked more middle-aged gardener than little girl. Curiosity piqued, I approached the petite swinger. She turned out to be a septuagenarian.

I saw older exercisers everywhere on a recent trip to Japan: Stretching on jungle gyms, walking briskly in pairs, gathering in groups to do calisthenics broadcast over the radio. All this movement no doubt contributes to Japan's vaunted longevity. The Pacific nation not only leads the developed world in absolute longevity, with a life expectancy of 82.6 for men and women combined, but it is also first in what researchers call healthy life expectancy. That is the number of years that a person can expect to live in good health, and for Japan it is 73.0, versus 68.1 for the U.S., according to a study released last week in the Journal of the American Medical Association. (Our healthy life expectancy ranked 26th out of 34 advanced-economy countries in the study.)

The study, a collaboration of researchers at multiple institutions, found that while the U.S. made "substantial progress" in improving health from 1990 to 2010, we lag many other high-income countries on life expectancy and other measures despite spending more on health care than they do-both as a society, and out of our own pockets. When it comes to preventing disease and disability, many experts say physical activity trumps all other healthy behaviors. "Exercise for aging is truly the fountain of youth," said Paula Papanek, program director of the exercise science degree program at Marquette University in Milwaukee.

The benefits of exercise, of course, can also have significant financial repercussions, especially for people 50 and over. It is a simple fact that unhealthy people spend more on medical care than their more robust counterparts. In just one example, Medicare is likely to spend about $38,000 more over the lifetime of an obese 70-year-old than it would spend on a beneficiary of similar age and normal weight, according to research led by Dana Goldman of the Schaeffer Center for Health Policy and Economics at the University of Southern California. And that is just Uncle Sam's share: it follows that an obese person would incur more out-of-pocket costs than her thinner peers, as well.

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Regular exercise won't likely prolong your life dramatically, but it can improve the quality of your remaining years, said Dr. Edward Schneider, professor of gerontology and medicine at the University of Southern California. Ideally, exercise begun no later than middle age can help people avoid developing conditions like diabetes and heart disease. But physical exertion can also help people manage many chronic conditions after they develop. It can reduce chronic knee and back pain. Regular physical activity also improves sleep and helps prevent falls. And it isn't just the body that benefits: Research suggests exercise can also ease depression and, in older adults, boost brain function.

In fact, regular exercise can mean the difference between independent living and costly institutionalization for older people, experts say. Schneider saw evidence of this in his own family. At age 89, his very active grandmother was a nursing home volunteer; by the time she reached the same age, his more sedentary mother was a nursing-home resident. The median national rate for a private room in a nursing home is $83,950 annually, according to the 2013 Genworth Cost of Care Survey (although cost, of course, isn't the only reason most people would prefer to age in their own homes).

Even the frailest older people can benefit from moving to the extent they're able, said Michael R. Mantell, senior fitness consultant for behavioral sciences for the American Council on Exercise. His wife Paula, a certified personal trainer, has among her clients a couple in their 80s. The wife is wheelchair-bound and has Alzheimer's disease, but she delights in playing catch and other games with Paula, and she's improving her strength, balance and coordination by doing so, Mantell said.

Exercise benefits everyone, including the svelte. Being thin doesn't give you a free pass to couch surf. People who are healthy but sedentary lose 10% to 15% of their aerobic capacity and muscle strength per decade starting around age 35, said Dr. Michael Joyner, an exercise researcher at the Mayo Clinic in Rochester, Minn. People who maintain a healthy weight and exercise 150 minutes per week can delay the start of the loss by five to 10 years and reduce the rate of loss, he said. This advantage can translate into stronger bones and fewer falls down the line.

No serious sweat required

When we talk about exercise, we don't necessarily mean sweating it out at the gym. Brisk walking outside-or in a mall, if the weather's bad-works just fine. The key, Schneider said, is to keep it fun and interesting. Record your favorite show and watch it on the treadmill, or buy a dance DVD and boogie down in your living room. Find a buddy to attend exercise classes with you.

You don't need to break a serious sweat, either. Experts recommend "moderate" exercise, and on a scale of 1 to 10, with 1 sitting on the couch and watching TV, and 10 running so hard you can't talk, moderate exercise would be a 5 or a 6, Mantell said-the equivalent of walking when you're in a hurry. Older exercisers should combine aerobic exercise around five times a week with strength training at least two times a week and regular balance training, experts recommend. While balance training can take the form of tai chi or yoga, it could also simply mean standing on one foot while waiting in line at the store (as long as there is ready support nearby).

It is wise to consult your doctor before beginning any exercise program. While almost everyone can benefit from movement, physical activity can be dangerous for someone with undiagnosed heart disease, for example. Prospective exercisers can find a questionnaire online (http://www.recgov.org/fitness/PAR-Q.pdf) called PAR-Q, short for "physical activity readiness questionnaire," that can flag potential concerns to bring to a doctor. If heart disease is diagnosed, a patient might be assigned to supervised exercise until he's ready to exercise on his own, Papanek said. Diseases aside, many older Americans wind up in the emergency room with exercise-related injuries after taking on too much, too soon, Schneider said. Those starting out would benefit from a session with a personal trainer, he noted.

If this all sounds daunting, consider this: The biggest benefits of exercise accrue not to the regular runner who doubles her distance from five to 10 miles, but to the sedentary person who decides to get off the couch. Said Joyner, "You get a lot of the benefit with the first bit of effort." Even just the effort it takes to put in a few minutes on a swing set.