As a youth I was told to use my brain not my brawn. My uncles laid the foundation and built New York City as laborers and bricklayers. I remember my uncle Louie warning me, working just with your arms will give you a strong back but a weak mind. My Dad was one of the first of his generation of Italians to break that mold as a telegrapher and then as a writer for the United Press International (UPI). The concept of brain versus brawn either being smart or muscle bound was part of the scene of the 50s and 60s. The highly intelligent had big heads, small sinewy bodies as depicted in alien movies of the 1950 genre. My Italian immigrant ancestors gave me, a not so subtle mandate, build brains not brawn. Use your mind, not your muscles. What they didn’t realize is that there is no way a skinny Vinnie kid could survive in the testosterone driven Italian Benhurst seat of the mob Brooklyn, New York. Vince Lombardi’s motto “when the going gets tough, the tough get going”, was from his first hand experience in an Italian neighborhood. What Lombardi meant by “tough” was using one’s body, mind, and soul to one’s best ability and in balance.

THE BALANCE

From a scientific standpoint, the balance is in our genes, the hormone balance, our limbic- autonomic nervous system balance, and the cardiac-brain balance connection.
The Hormone Balance

Our bodies genetic heritage produces two types of hormones: anabolic and catabolic. Their effects counteract one another like a see-saw.

The anabolic hormone, growth hormone (HGH) testosterone, estrogen, progesterone, thyroid, and the catabolic hormones ACTH, cortisol, gluco- and minerocorticosteriods. The anabolic and catabolic hormones both have immediate and late effects. The anabolic hormones increase lean muscle mass, increase bone density, and decrease fat stores, with the result being an increase in rate of metabolism and weight loss, an increase in strength and endurance that results in increased attractiveness. Other effects are a decrease in insulin, stimulation of our immune system, and decreasing inflammation.

The catabolic hormones decrease muscle mass and bone density, and increase abdominal fat stores. The couch potato body. Other effects are stimulation of the sympathetic nervous system causing alarm, anxiety, and ultimate depression together with increasing insulin, inflammation, and decrease in actin causing muscle weakness. Further effects are the increase in salts, as sodium, resulting in increased blood pressure, increasing blood glucose and so provoking diabetes and hypertension. The final results are a decrease in strength, decrease in metabolism, and a decrease in attractiveness. An old Italian flick of Clint Eastwood’s “The Good the Bad and the Ugly” might be typified by these two hormones. The anabolic, the good, the catabolic, the bad, the ugly. In fact, the word “catabolic” comes from the Italian word “cativo” meaning bad. The catabolic hormones however are not all bad; we cannot live without them. They only earn their name “cativo” when they are out of balance.

The Limbic-Autonomic Nervous System Balance

Like the anabolic and catabolic systems, the sympathetic and parasympathetic nervous systems are controlled by the limbic part of the brain,the emotional brain. The sympathetic is the “alarm system”, triggered by adrenalin and noradrenaline to get the body ready for fight or flight. For example if the alarm system goes off in your house. Your heart races, your pupils dilate, your muscles tense into action, you breathe faster, you’re ready for action. Once the alarm is over, your body must return to it’s former state. It does so through the parasympathetic nervous system, or “relaxation system” makes one calm, decreases heart rate, and makes one feel relaxed. The catabolic hormones can stimulate the sympathetic nervous system excreting adrenaline and keep one in a continual alarm state. Exercise can turn off the sympathetic and catabolic hormone system and stimulate the parasympathetic nervous system, that is why we feel so relaxed after exercising.

The Heart- Brain Balance

What is good for the heart is good for the brain. As goes our body goes our mind. The heart pumps blood containing oxygen and glucose to the brain. The brain, though weighing only 3 pounds, uses up 25% of the glucose and oxygen in our body. A decrease in either causes a consequent decrease in function of the energy system of the brain, and causes initially dysfunction and finally damage to the brain itself. A decrease in oxygen, when one is on top of Mt. Everest, can cause hallucinations and confusion. If the oxygen deprivation is long-lived, it will cause permanent brain damage typified by imbalance, permanent memory and intellectual loss. The same is true for low glucose. A Diabetic person who takes too much insulin (which lowers blood sugar) will experience, at first confusion, and then seizures and death. One can see why the brain must keep the hormones in balance. Cortisol raises insulin in the brain, and this must be extracted. The brain does so by use of an enzyme that has 2 functions: first, reducing insulin in the brain, second, reducing amyloid (the substance that destroys brain cells and brain circuitry). There is a limited amount of this enzyme, if it is all used to remove insulin, then amyloid builds up and Alzheimer’s is the final result. Exercising reassures the brain that it will have enough oxygen and glucose to sustain it even when under duress.

So What Happens With Aging?
It is not good. The bad gets worse, and the good gets bad.

• The anabolic-catabolic balance reverses
• The limbic-autonomic system becomes less responsive
• The cardiac-brain balance is often disturbed

The Baltimore Longitudinal Study of Aging together with several other reputable studies showed that lean muscle mass decreases by 10% from age 30 to 50, then from 50 to 70 by 25%, by 80 years of age it is down to 40% , and 85 down to 50%. While there is increased fat deposits and connective tissue in the muscles making them flabby and rigid. Second, the metabolic rate decreases steadily every 10 years after 45 years of age with a consequent increase in weight if we stay on the same diet.

Next, our speed of movement according to Larson, from age 50 to 70 decreases by 36% and our dynamic strength decreases 26%. Our Type II muscle strength and elastic muscle decreases by 50%. When this occurs in Important muscle groups such as the quadriceps in our legs, it makes us unsteady and more likely to fall. Our strength and endurance are devastatingly impaired as we go from 50 to 70 years old. Unfortunately, as goes our body goes our mind. If we can stop the body from deteriorating, so can we stop the mind.

If things weren’t bad enough with aging, we are our own worst enemy.
One, our activity level. Studies have shown that as we age our general activity level, that is our engagement in activities and physical activities, decreases with consequent deconditioning of our body.
Second, injuries to lower extremity joints and shoulders are 6 times the incidence from 50 to 70 years old despite the lower activity level.
Third, socialization and recreational activities used to decrease stress diminish by 50%.

The question is, is this deterioration genetically programmed, out of our control, predestined, our fate? Or, can something be done to reverse these trends? The answer is unequivocally ye It is in our control. Physical exercise is the best method. Building brawn is protecting the brain. Let that be your motto.

So Let’s Begin

First let’s understand the difference between strength and endurance. Strength is increasing the power to lift a weight, endurance is the ability to maintain an activity. That difference was brought to my attention through experience. As a college student I had been training for the 1964 Olympics as a weightlifter. Our wrestling coach called me as his 191# wrestler had been injured and he needed a replacement. He invited me down and I trained for 1 week. Just before going out onto the mat, he patted me on the back and said “You have to pin him in the first minute”. I couldn’t understand why? A college wrestling match is 9 minutes. In the first 30 seconds my opponent was putty in my hands, by the second minute, I was on my back, completely exhausted. I had no endurance, but I did have strength…at least for a minute.

Stretching, Steps, and Strengthening

1. Steps or aerobic exercise is excellent for the heart, increases the strength of the heart muscle and the elasticity of the blood vessels that supply oxygen, and glucose. It is essential for endurance for Type I muscles, the type found in long distance runners. Normally, we have 45% Type I muscles and 55% Type II muscles. In marathon runners, they may have 80% Type I musclethis endurance muscle can be increased by 100% in 2 months.
   
   
2. The strength exercise is primarily anaerobic, and is best for the brain. It increases muscle mass and therefore body metabolism, decreasing the need for insulin and helping the catabolic-anabolic balance. It directly stimulates the brain to produce more growth hormone, testosterone, estrogen, progesterone, and thyroid hormone protecting the brain. At the same time it decreases the likelihood of falls and injury. Fear of falling is a major reason for inactivity and falls in those 70 years of age and older. If one remembers the slower one rides a bicycle, the more unstable and more likely you are to fall, the same is true with one’s walking. The slower we walk the more unbalanced we are. Strong muscles and aerobic exercise through walking, bicycling improve both our strength, velocity, and our endurance. They are essential to the mind-body connection. Numerous studies have shown that those octogenarians can increase their strength through weight training by 50% in 6 weeks. Those 60-70 years of age who weight train regularly have an increase in lean muscle mass of 14%, the same that those of the same age group who are given growth hormone on a monthly basis. Through weight training, Type II strength muscle fiber, which decreased by 36% at age 70, could return to its normal proportions along with Type I, those normal proportions being 45% Type I and 55% Type II in 30 year olds. Not only do you look good, but in fact, you are good. Not only does the body have more endurance and agility, so does the brain.
   
   
3. Stretching. Through stretching we maintain the elasticity and protect the joints necessary to do aerobic and anaerobic exercises. It is essential to the 3 step exercise regimen.

So Let’s Get Started with the Exercise Program

Before beginning, we must assess where you are.

1. Before beginning any exercise program, one must have a medical examination to avoid injury.
2. Then perform a simple exercise test.
   
   This is best given by your physician. One such example is the VO2 MAX step test.
   
   • First, take your pulse by counting your pulse for ten seconds then multiplying the result by 6 (i.e. 12 beats in 10 seconds x 6 = 72 beats per minute).
   • Second, at a stairway with a safety bar, step first with the foot next to the safety bar, then the other foot.
   • Third, step down with the initial foot followed by the other.
   • Next, complete this combination in 5 seconds. Continue the movement for 3 minutes.
   • Then rest for 30 seconds and take your pulse again.
     
     • If your heartbeat is less than ten beats above your resting pulse (your initial pulse recording) you’re at a good fitness level.
       If your pulse is more than 10 beats above your resting rate, you’re in average condition. However, if your pulse rate is 15 beats or more above the initial rate, this indicates fair to poor fitness.
       
       
   • Those with good fitness level can begin the subsequent exercise regiments according to their age if okayed by their primary physician. Those in average shape should begin at the lowest range of working out and gradually increase to maximum levels. Finally, those with fair to poor fitness might be best to start initially with a program prescribed by their doctor or begin with only the stretching exercises followed by the aerobic, and finally adding the strengthening regimen.

OVERALL EXERCISE PLAN:

Monday: 3-5 minute warm up, steps: 20-30 minutes, stretching: 5 minutes
Tuesday: 3-5 minute warm up, strengthening: 20-40 minutes, stretching: 5 minutes
Wednesday: 3-5 minute warm up, steps: 20-30 minutes, stretching: 5 minutes
Thursday: 3-5 minute warm up, strengthening: 20-40 minutes, stretching: 5 minutes
Friday: 3-5 minute warm up, steps: 20-30 minutes, stretching: 5 minutes
Saturday: 3-5 minute warm up, strengthening: 20-40 minutes, stretching: 5 minutes
Sunday: Strengthen your mind and your Faith

Remember the above is the ideal, there are few of us who are still working who can maintain such a vigorous program, but if sufficient planning and ingenuity is used, we can exercise at our offices, at our desks, and even in our beds before we get out of them in the morning. It is a commitment not to only oneself, but also to those whom we love. One patient of mine told me he had not missed a work-out unless ill for over 3 years. He prescribed his success was due to the reality of assisting those in a nearby nursing home, every Sunday, thankful he was only there to help.

STRETCHING:

Warming up: If you have a treadmill or stationary bicycle, it is best to walk or cycle for approximately 3 minutes at a leisurely rate (2.0 on the treadmill, #1 setting on a bicycle), or simply walk around the room for 3 minutes.

1. Stretching legs
2. Stretching arms
3. Abdominal stretches
4. Back stretches
5. Twists

STEPS (Aerobic exercise):

The concept of steps began in Japan and quickly spread to North America. The concept was to wear a pedometer and attempt to reach 10,000 steps per day. 2,000 steps equals one mile, or approximately 200 calories burned. 3,500 calories burned equals 1 pound. You can see that 10,000 steps equals 1,000 calories per day. Normally one walks approximately 2,000 steps per day. One can see by this simple method the potential for weight loss. However, random steps is not felt to be as effective as conditioning aerobic exercises, that is 20-30 minutes of exercise that is at 60-80% of our maximal capacity according to our age (please see chart 1). 30 minutes of exercise via walking, running, or bicycling, or using an elliptical machine can have the same benefits. A study with 30 minutes of aerobic exercise 3 times per week showed a 35% increase in endurance in the senior population. Alternatives to adding a walk are 1)if one uses public transportation, to get off the bus or train one mile before your destination, 2)using the stairs when possible, especially going up the stairs, going down often is traumatic to the knee joint, 3)parking one’s car far from the entrance of a movie theater or mall, 4)finally, taking dancing lessons and spending a Friday and Saturday night waltzing, cha-cha, doing the samba is not only aerobic conditioning but a lot of fun! Joining an exercise club serves 2 functions: it adds competition and inspiration, but most important, it helps with socialization which has clearly been shown (see chapter 8) to increase brain vitality, immunological systems, and decreasing depression.

STRENGTH (anaerobic exercise):

Tai Chi and Yoga, as well as Pilates serve both stretching, aerobic, and anaerobic regimens of exercise.

The jury is in on aging and brain vitality and mental agility. As we age, the mind follows the body. Let your body go and so goes your mind. To understand this body/mind and/or brain/brawn connection, there are certain physiological facts to understand.

1. The hormonal balance. Anabolic versus catabolic.
2. The cardiac brain connection.
3. The stress glucose connection.

A good body is associated with increase in Type I and II muscle tissue. It increases lean body mass and there is a decrease in fat. There is a loss, therefore, of your body mass index. It becomes lower. With a good body there is also a decrease in blood pressure, decrease in cholesterol, and normalization of your glucose.

The hormonal/catabolic connection is the following:

The anabolic steroids or growth hormones, testosterone, progesterone, estrogen and thyroid. These increase lean body mass, decrease fat, and are overall healthy for the brain.

On the other side, the catabolic or those that break down protein and increased glucose and fat and stimulate insulin production is cortisol. The glucocorticosteroids and mineral corticosteroids. The glucocorticosteroids increases glucose and the mineral corticosteroids increases sodium and, therefore, increasing blood pressure.

It is this balance, one with the other, with aging the balance of anabolic to catabolic steroids changes traumatically. There is a decreased production of by some 60-80% from 20 to 65 years of age in HDH and testosterone, progesterone and estrogen. A similar decrease is also seen in thyroid. At the same time, cortisol, which comes from stimulation from the hypothalamus, ACTH, which stimulates the adrenals and causes cortisol production, there is an increase as we age. The action of the corticosteroids, of course, increase glucose production, increases the amount of insulin that is produces, and leads towards insulin-resistant diabetes and diabetes itself. It also causes hypertension and hypercholesterolemia. In the brain the direct effect of cortisol has been shown to interfere with neurotransmission. The second effect of cortisol in the brain is to increase insulin levels which must be removed by an enzyme that usually reduces the amount of amyloid in the brain.  Therefore cortisol is directly causing the formation of amyloid plague that destroys our memory and ability to function independently. 

So, we can see what occurs with aging. There is a decrease of lean muscle mass, there is increase in cortisol, and the formation of hypertension, hyperlipidemia, and decreased mental agility.

There are three things that occur as we age.

1. The normal hormonal genetic decrease that affects the hormones.
2. Activity level. As we get older, generally activity level goes down and, therefore causes a deconditioned body. A deconditioned body has a decrease in plasticity.
3. There is an increase in stress, which causes cortisol to be increased.
   The next major problem is that with aging. The cardiac/brain connection.

The cardiac brain/connection is extremely important in that it is what is good for the heart is good for the brain. A part of aging is decreased blood supply due to a pump, that is the heart, that is decreasing the amount of glucose being delivered and oxygen being delivered. The decrease in oxygen and glucose affects the mitochondria, which requires oxygen such as that it would be equivalent to gas and the mitochondria which more or less the engine that produces the energy. So, therefore, anything that will cause increased plasticity of the heart, helps the brain.

So what are the problems? First, aging, disuse, and, third stress. Aging causes a decrease in hormones, a decrease in anabolic steroids, and an increased in catabolic hormones. Disuse causes a decrease in Type I and Type II muscles. Stress causes an increase in catabolic hormones, cortisol, and an increase in insulin which is injurious to the brain.

So what is the treatment here? The treatment, of course, is aerobic and anaerobic exercises. Aerobic exercises are good for the heart. Why? They increase plasticity of the blood vessels and that is the blood vessels become more compliant and can stand an increased pressure of blood going through them. Second, it also increases the heart pump and, therefore, heart efficiency. The heart, as you know, cannot lift weights and, so, it depends completely on aerobic exercise.

Anaerobic exercises seem to be best for the brain. An anaerobic exercise, this is weightlifting exercises, that cause the stimulation of HDH, testosterone, progesterone, and estrogen and thyroid. It causes an increase in lean muscle mass and a decrease in insulin and a decrease in actually the cortisol production.

The three major issues are:

1. The anabolic/catabolic hormone axis.
2. The cardiac/brain connection.
3. The cortisol stress connection.

With the cortical stress reaction one notes that cortisol, of course, increases glucose, increases insulin, increases lipids in the blood, will lead to diabetes and hypertension, and, therefore, increase cardiac disease. It also has a reaction on the inflammatory action of the brain causing chronic inflammation which causes further damage both in the brain and in the heart and blood vessels.

1. Regarding stress. Exercise has been clearly shown to decrease cortisol levels and, therefore, decrease the likelihood of Alzheimer’s disease. Stress on the other hand increases the likelihood of Alzheimer’s disease.
2. Exercise increases lean muscle mass, therefore, decreasing our body mass index which has been clearly shown to decrease the likelihood of Alzheimer’s. An increase body mass greater than 30 clearly has shown with a 2:4 fold increase in Alzheimer’s disease.
3. Increase in anaerobic hormones is caused by weightlifting.
4. Increased strength, especially in aging, is associated with less falls, less joint disease, increased cardiac ability, decrease in lung disease and lung infections, and decrease in peripheral vascular disease.

For these reasons, exercise is extremely important in:

1. Increasing our anabolic steroids.
2. Increasing our general strength.
3. Decreasing our stress.

All of these lead to a healthy mind and decreased likelihood of Alzheimer’s.