Live Long and Well with Dr. Bobby

#56 Change exercise as you age?

• Dr. Bobby Dubois • Season 1 • Episode 56

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Exercise is the most powerful longevity tool we have, but after 50 the recovery curve, injury risk, and bone/muscle changes mean the smartest plan blends strength, power, impact, and slightly more recovery—so you can train hard without derailing progress.

What we cover

  • Why this matters now: record-setting older endurance athletes (and I’m racing at 69) show what’s possible—if we train wisely.
  • The “aging triad”: loss of muscle (especially fast-twitch/power), bone density shifts (sharpest around menopause), and rising osteoarthritis risk.
  • The injury paradox: the fitter you are, the more a single layoff can cost; preventing setbacks is a longevity strategy.
  • A practical framework: build strength, protect fast-twitch fibers, add tolerable impact for bone, and consider an extra rest day after hard sessions.

Evidence, in plain English (linked)

  • Muscle changes: We preferentially lose type-2 (power) fibers with age; quads are especially affected. Training can target this. Review
    .
  • Women & men both lose muscle mass percentage-wise; patterns differ but loss is universal. Same review
    .
  • Bone density: Women can lose ~2–3%/yr at the spine around menopause; men decline more gradually. CDC data brief
    .
  • Running & knees: Long-term cohorts show no higher knee OA in runners vs. non-runners (Stanford cohort
    ; systematic review, ~14k people
    ), and even runners with established OA didn’t worsen—and reported less pain. Prospective OA cohort
    .
  • Strength at any age: Even adults 85+ can add ~10% quad size and ~40% leg strength in 12 weeks; heavy strength work is safe when programmed well. Overview
    .
  • Power/fast-twitch support: Short (30–120 s) high-intensity efforts and plyometrics can improve type-2 fiber function and neuromuscular drive in older adults. Narrative review
    .
  • Bones respond to signal: In 80 trials (5,500 postmenopausal women), combined resistance + impact training improved spine and hip BMD regardless of menopause timing or baseline status. Meta-analysis
    .
  • Recovery with age: Some data show more soreness and temporarily lower strength 24–72h post-lifting in middle-aged vs. young adults—supporting a touch more recovery after hard days. Study
    .

Practical takeaways

  • Lift twice weekly
  • Add brief power: 20–30-second hard intervals or controlled mini-hops/step-downs; keep impact tolerable.
  • Build bones: pair resistance work with  impact (jog/jump rope as tolerated). If you have osteopenia/osteoporosis, get your plan cleared first.
  • Recover like it matters: if a session is truly hard, consider one extra easy/recovery day.
  • Audit risk: dial back higher-risk activities that would sideline you for weeks; prevention preserves gains.

If this episode helped, please rate the show and share it with a friend. To get my newsletter with practical, evidence-backed steps for living long and well, visit DrBobbyLiveLongandWell.com.


SPEAKER_00:

Here's a paradox. Exercise is the single most powerful intervention for healthy aging. Yet a single injury could undo your fitness gains. Where's the line between use it or lose it and unnecessary risk? How might we think about exercise as we get older? And when does older actually begin? I'll share evidence-based steps you can take. Hi, I'm Dr. Bobby Du Bois, and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and figure that you wish. Together we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey, and I hope that you feel empowered along the way. I'm a physician, Iron Man triathlete, and have published several hundred scientific studies. I'm honored to be your guide. Should your exercise change also? Many listeners have asked me about this question. As we get older, should we just continue what we're doing? Do more? Do less? Do it differently? What does the evidence tell us? Now, this episode is really important for my listeners who are 50 years or older, but it's also really important for people who are younger. Why? Because this is going to happen to you too, and you might as well try to get ahead of the problem as early as possible. And you probably have parents and older people in your life. This knowledge might help them, and you can help them as well. Well, why now? Well, one of the reasons, of course, is you asked for it. But in the recent Iron Man World Championships in Kona, Hawaii, they had the first 80-year-old ever finish the race. And this was a race that's two and a half mile swim, it's a hundred and twelve miles bike ride, and then a full marathon. So for an 80-year-old to do this, that's pretty incredible. The topics also came up with the New York City Marathon, which is a huge marathon that just happened. There were 4,000 people above the age of 60 and over 500 that were above the age of 70. So clearly, older people are doing exercise and doing endurance events. Topics also relevant for me. I'm 69 years old, and I'm competing and will hopefully just finish another Iron Man race this weekend. And by the time this episode comes out, I hopefully will have finished that race. This is a half Iron Man. I've done about four full Iron Man races and about 15 of the halves. Well, I'd like to explore this topic in four parts. Part one, a reminder, real brief reminder of why sports and exercise is really important in our life. Life enjoyment for our heart, for our muscles, for our brain, and our bones. Part two, what are we up against as we age? There are changes in our bodies, of course, in our muscles, our joints, and our bones, and how are we going to address that? Part three, what practical, tangible, evidence-based steps can you take to prevent some of these age-related losses? And four, something you might not have thought about. The risk of injury goes up as we age. Not only does it go up as we age, but when we get injured, the consequences as you get older of that injury and being off your exercise regimen for a period of time is extraordinarily consequential. And we need to think about that. Okay, before diving into the evidence on the topic, I want to thank you, listeners, for sharing with me how my work has influenced you. So some of my listeners talked about how they incorporated the end of one approaches for sleep and weight loss and various other things. Some people said that they've changed their sleep with lowering their bedroom temperature, which has really helped, or they've made exercise a priority in their life, or they're using a home blood pressure monitor, or they're working with various of the techniques I suggested to reduce calorie intake, like the 20-minute rule, or using smaller plates. And many of you are drinking less, less than six or seven alcoholic drinks per week. And one of you said, you're not convinced about ice baths. That's okay. You do all the other stuff. That would be wonderful. Others of you, can you share your thoughts? Uh, in part, this is important to me, but it's also important because I want to put together a survey to really understand how change is happening in folks' lives and how I can support that even more. And as always, tell your friends about the podcast. Hopefully they'll listen and enjoy it as well. All right, part one: the benefits of exercise. Well, you know, why do we do sports? Why do we do exercise? For a lot of reasons. One, sports are fun. Some people love golf or tennis or skiing or pickleball or soccer or basketball. They love to ride a bike or even a motorcycle. Of course, there's the longevity benefits. You'll live longer, multiple years longer, if you have a regular sports and exercise program. And that helps prevent key illnesses of your heart, your brain, cancer, diabetes, and the like. And really importantly, we hope the sports and exercise will prolong our good years and that we can continue to be functional decade after decade after decade. But how can we do this as we get older? Well, to figure out what to do, we first have to figure out in part two, what are we up against? So our bodies are changing in three key areas that we're going to need to focus on. First, muscle mass loss. We lose, probably after age 30, 1 to 2% per year of our muscle mass. Now that turns out to be about 10 to 20% of our muscle mass per decade. What I haven't talked before about is that our muscle mass may decline at a certain rate, but the strength we have actually declines much faster. So we may lose 5 or 10% of muscle mass, but that might lead to 10, 20, 30 percent loss of strength. So it's not a simple relationship, and keep in mind that strength is very important. A tiny bit of physiology. Our muscles are woven together two different fiber types. One, type one and type two. Type one is what we use for endurance, walking, hiking, um uh, and doing things like a slow bike ride. And then there are the type two fibers. Those are the fast twitch fibers that gives us bursts of power and speed and strong movements like jumping, which of course is critically important, having some of this powerful uh strength if we want to avoid falls or avoid lots of things and do things that are important to us. Here's the catch. As critical as those type two fibers are in terms of bursts of power and speed, we tend to lose more of those fibers than the endurance type one fibers as we get older. Yes, we lose both types, but we are gonna preferentially lose the type 2 ones, meaning our power, our strength. And that is so important to keep in mind as we begin to explore what we can do about this. Here's an interesting finding I wasn't aware of, but evidence suggests that yes, men lose muscle mass over time, women lose muscle mass over time. Turns out that the amount of muscle mass, not in terms of actual pounds, but percentage-wise, is the same between men and women. I would have thought maybe it would have been different because of testosterone levels, changing hormone levels in women as they age, but it turns out we all lose a certain amount of uh muscle percentage of our muscle year after year after year, men as well as women. Now, let's move on to bone loss. And here the sex differences are really profound and really important. So women uh and men build up their bone mass when you're young and in your teens and probably 20s. For women, during their 20s, 30s, 40s, up until menopause, they don't lose a lot of bone mass. However, there's a huge change in the five to 10 years around menopause, where women lose 2-3% of their muscle, excuse me, their bone mass in their spine a year, 1 to 2% in their hip or their lower forearm. That's like 10 to 30% of your bone mass in women lost per decade. Now, you do that two, three, four, five decades, and now you see why it's a huge issue. Now, after those five to ten years of uh profound loss, women do slow down the rate of loss as they get into their 60s, 70s, and beyond. They still lose bone mass, but not at quite the same rate. Okay, so losing bone mass is important because it gets you to a point of too little bone. If you have too little bone, first it's called osteopenia. And then if it worsens, worsens, worsens, at some point it becomes osteoporosis. And obviously the brittleness of your bones corresponds with how much bone loss there's been. So 50% of women in their 50s and beyond have osteopenia, a reduced amount of bone mass. And about 20% have osteoporosis. Now, for men, yes, we lose some bone mass, but two things. There's no cliff, there's no period of years where it's hugely greater. We just gradually tend to lose, and we tend to lose a lot less than women do. So in our 50s, we lose about a half a percent to a percent per year, or about a quarter of the loss that women experience. But men get osteopenia in their 50s and beyond. Maybe a third of men get that, but relatively few men, maybe 4% and older men, get osteoporosis. So problem for all, fractures are a problem for all, a bigger problem for women. All right, the third piece of the aging puzzle is joint damage and osteoarthritis. So the risk of osteoarthritis, which often happens in our knees and our hips, and it can be in your hands as well, does increase as we get older. It's only about a 3% risk in our 20s. It rises to about a 10 to 15% risk likelihood in our 60s, but by the time we're in our 80s, it's probably about half of us. And if you get osteoarthritis, it causes pain, pain in your joints, and it will be more difficult for many people to exercise. So, as a long-term runner, I have been a fan of studies that ask the question: does running worsen your knees and cause osteoarthritis? Because many people say, Dr. Bobby, do I need to give up running as I get older? And the answer from the research I'm about to show says no. So one is called the Stanford Study. They took a group of runners who were age 45. I'm not 45 runners who were in their 50s, and they compared with a similar number of people who weren't runners, and they followed them for 20 years, asked them about knee symptoms, asked them to get x-rays of their knees. And what did they learn? Well, both the runners and the non-runners, as they got older, they had a higher likelihood of osteoarthritis. But here's the critical piece of the puzzle the runners didn't get more osteoarthritis than the non-runners. So the running didn't seem to accelerate the problem. Okay, that was a relatively small study. There was an analysis of 17 studies. 7,000 runners, 7,000 non-runners, and they were about in their mid-50s, and they followed them for five years and they did X-rays as well. What did they find? There was no difference between the runners and the non-runners in the X-ray look at their knees. Perhaps there was a little more knee pain in the non-runners. There was also a study of patients that already had osteoarthritis, 1,200 people in their 60s. And they were overweight, BMI about 29. So they looked at runners and non-runners in people who already had osteoarthritis. Guess what happened? The people who were runners didn't have worse osteoarthritis than the non-runners. So what does this all mean? It probably means that running by itself doesn't cause arthritis. And if you're otherwise healthy and you enjoy running for all sorts of reasons, consider doing it some more and onwards as you get older. Now, here's a couple of caveats. Where arthritis becomes an issue is if you have injured the joint. So if you had a meniscal tear, if you had a ligament tear, the unsteadiness of that joint does increase your risk of osteoarthritis. So if this has happened for you, talk with your doctor about running and whether that would continue to be safe for you. Also, if you're quite overweight, running might put stress on your joints. So again, talk to your doctor about it. All right. We've had the depressing discussion of what happens as we get older. Now, part three, the optimistic part. What can we do about it? How can we maintain our muscles, bones, and joints? Now, if you're going to embark upon an exercise regimen and some of the things I'm talking about, and you haven't been doing it for a while or ever, talk to your doctor. Make sure all is well before you jump right in. Okay, so there's a series of steps, things you can do to help. Step one, build strength. Build strength, build strength. Why? Well, the more you have, meaning if you can build up more, the more you're able to lose. Because at some point when you get weak, it gets harder to get your life done and do the things you want to do. So if you can build up more, you have more to lose. And if you work at it, the inevitable losses in muscle mass and strength, you can diminish that loss, maybe even reverse it. Here's the problem. Only 27% of U.S. adults do resistance exercises. And this drops to just 10% of people over the age of 75. Now, the good news is whether you're 30, 40, 60, or 80, it is never too late to start. And there's a lot of studies in older people that show it's safe and it works. And one study that looked at 75-year-olds, and they were able to increase muscle strength and size through resistance training. Here's one example of a study. 12 weeks in people who were in their 60s, 65 to 75, and those who were above 85. So they compared them and asked the question: did the 85-year-olds gain muscle just like the 65 to 75-year-olds? And the answer is yes, they both gained about 10% increase in their quadriceps muscle size and a 38 to 46% increase in leg strength. Here's the wonderful thing. There were no differences in response by age groups. Yes, pound for pound, the older people gained less muscle, but proportionally they gained just as much. Also, heavy strength training is also safe and can be helpful. All right, so that's our first part of thinking about our muscles. But remember, above, we talked about the type 1 and type 2 fibers. So step two, help support your type 2 fibers. Remember, we preferentially lose the power and speed fibers as we get older. And our quads are critical for getting out of chairs and things like that. And, you know, hopping and jumping are some of the activities that emphasize these kinds of muscle fibers. But what has been shown is that high intensity, so 30 seconds to two minute bouts of speed or lots of jumping, burpees, there's a variety of ways that you can do this, increases not only the number of type 2 fibers so you can build back some of that loss, it also rewires some of our nerves. And the nerves trigger those muscles to do what they need to do, and that can also improve with this. I have a whole episode where I talk about protein intake. If you're trying to build muscle, make sure you have an adequate amount of protein intake. All right, step three. After worrying about our bone, our muscles, now we got to worry about our bones. So step three, support your bones. Here, there are two sets of activities you want to do. The resistance training we just talked about, but also impact exercises, the jumping, the running, those kinds of things. Look, if you already have a lot of bone loss before you do some of these new jumping kinds of things, do talk to your doctor. Well, there was a meta-analysis of 80 clinical trials in postmenopausal women. There were 5,500 women in this study. So it's a large number of trials and a large number of people. And what they did was to ask the question: did a mixture of strength training, going to the gym, lifting weights, and impact exercises, you know, jumping, running, did it make a difference? And what they found was there was real improvements in bone mass, bone um activity in both the spine and the hip, so that this worked. You don't just have to take the inevitability of losing your bone mass. Both a combination of strength training and impact training made a difference. Now, here is where the studies get really interesting. If you look at people who have osteopenia, a little bit of loss or osteoporosis, same benefit. So it isn't that, oh, I've lost bone already, I'll never regain it. It match people regardless. It also helped uh women, whether they were in early menopause or late menopause. So the key here is all women can benefit from this. Again, talk to your doctor if you already have significant loss. Okay, step four. As we get older, here's a question. Do we need to rest more? I don't mean rest in between sets or rest between each mile you run. I'm talking about days of rest. Do older people need more days of rest? Now, I wish there were lots of great studies to definitively answer this question. I'm older, I'm doing stuff. Do I need to take more days of rest during my week? Whereas I might have worked out five or six days a week, should I now work out more for like four or five days a week? Again, there's mixed data out there. But there was a study, a couple of studies. This small one asked the question: if you take people who are young and you take people who are middle-aged, and you give them a pretty significant squatting exercise regimen where you're really squatting a lot of weight, you know, not your maximum, about 60% of your maximum, uh, reps of 10. And they asked the question who got sorer, who found their muscles weren't working so well a day, uh, two days, three days later. So they looked at soreness, they looked at the strength of the muscles, and they looked at various blood markers. What did they find? Well, middle-aged people had more soreness on day one and day three than the younger people. And then when they tested the muscles to see, you know, had they fully recovered, the people who were middle-aged had lower strength. Of course, it came back, but it took more days to come back. So again, there aren't great studies on muscle and exercise as we get older. But let me give you an analogy where the data is pretty clear, and that is skin. If we wound our skin, get a cut, and you compare young people with older people, there is absolute data to show that in general, older people repair their skin more slowly. And that's pretty clear from the evidence, lots of studies. So I take this information about skin repair, add it to the more modest information about muscle repair, and conclude that it seems reasonable as we get older to take more days of rest. Now, does that mean you shouldn't walk seven days a week? Of course not. When I'm talking about rest days, it's rest days after more rigorous activities. So when you feel sore, you did a lot of exercise and you might want to take more time off than when you're younger. All right, now we're on to probably the most important part of this discussion, part four, the risk of injury and the risk of consequences of injury as we get older. Okay, we have a big dilemma you and I need to talk about. Exercise and sports are important. I've made that really clear in this episode and in many others. But getting injured is a problem. And the more you exercise, the more you do sports, the more likely you are to get injured. Look, injuries happen. Um and they happen at an even higher rate in old people than ever before, probably because we're playing more pickleball, doing more skiing. People are getting tendon problems, rotator cuff problems in their shoulders, Achilles tendons in their lower leg. In people above age 65, over the last decade, there was an increase of 20% in injuries, as has been shown. And of course, if you get injured, you have a much higher likelihood of having a fracture ending up in the hospital and everything else. Now, when you are 15 years old or 20 years old or 28 years old, and you hurt yourself, yeah, you might skip exercise for a day or two, and generally people bounce back pretty quickly. The problem is, as we get older, when injuries happen, we get into a catastrophic downward spiral. What do I mean by that? Well, if you get injured, you have less movement. If you have less movement, you have muscle loss. So a couple of studies to kind of bring this home. Now, these are admittedly in you know older, older people, but the concept is there. So they looked at people who um had uh immobilization, meaning they they really were pretty much at uh in the hospital or at bed rest. And after two weeks of that, just two weeks, there was 5% loss of their muscle thigh mass. And in another study, 10 days of bed rest in an older person, they lost a pound to a pound and a half of muscle. And as I said earlier, when you lose muscle, you lose a multiplier effect on your strength. So that loss of muscle probably represents an even greater loss of strength. Now, you can absolutely restart your exercise as soon as possible. But if you have a significant injury where you're out of commission for a month or two, say you really hurt your knee, you you know, you you um tore some ligaments, you um uh had a meniscal tear from skiing or you know, a bad uh pickleball uh injury, you're gonna lose muscle mass and you may never ever regain it. Now, you can try your best, you can try to regain as much as you can. If you started out with more muscle because you've been working at it for a long time, you do have more to lose. But this is something as we get older, we absolutely need to think about. So, what do you do with this information? I would say do an audit. What sports do you enjoy doing? Is it skiing? Is it cycling? Is it running? Is it mostly golf and hiking? And what's the risk-benefit trade-off? Meaning, how much do you love skiing a couple times of year versus the risk of you having a bad injury and having that downward spiral, which is a real problem? Are there modifications you can do? So, for example, if you love doing riding your bike outdoors, maybe you do more sessions indoors on an indoor trainer. Uh, if you're a skier, maybe you decide as you get older you're not going to do those aggressive runs, even though you want to show your kids that you're still able to do that. For many of us, we have the belief that it won't happen to me. But it can. I'm not saying it's going to, but it can. And you need to decide whether the risk is okay given what might happen if you get particularly injured and have that period of recuperation. Again. Again, you may never regain that strength and that muscle mass fully. What have I done? Well, I um I don't ride my bike outdoors as much, maybe once a week at this point. I do ride indoors, I do lots of other things, but I realize, you know, it's not that uncommon to have a bicycle accident. And it isn't just a uh a car that comes and gets too close to you. You know, you get a flat tire and you lose control, or there's a patch of wetness or gravel. And I'm not willing to take as much risk as before because I'm such an active person. If I were to have that and lose a lot, I'm not sure that I would be a happy person. All right, part five. Let's wrap up. Do continue to exercise or start doing exercise as you get older. Critical. And in general, there's no need to have major modifications. You're not going to hurt your body by doing these activities, the strength training or jogging or something like that. Strength is key as well as power. So keep in mind your type one, your type two fibers, and do take care of both sets. So do weightlifting, do jumping or impact exercises. Of course, obviously, do your regular aerobic exercise. Consider how often you rest because you might need more as you get older. And seriously consider the risks associated with what you do. Perhaps dial back some of those risky activities so that this doesn't happen to you. Well, my dear listeners, I hope you all live long and well. And with these tips, you may be able to continue doing all of that for many decades to come. Thanks so much for listening to Live Long and Well with Dr. Bobby. If you like this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at Dr. Bobby Livelongandwell.com. That's Doctor as in Dr. Bobby Livelongandwell.com.