I’ve finished the book. I gave it four stars. There’s a lot of research covered here, lots of ground covered, and most of it is well written. When findings are conflicting we are told so, and the reasons for discrepancies across studies are often investigated in some detail. Conclusions drawn are often of a tentative nature, and the uncertainties involved are often emphasized. Given the amount of material covered, detailed coverage of specific studies and their limitations is somewhat limited, but stuff like differences in study design across studies and consequences of these are occasionally emphasized; the lack of longitudinal studies in specific areas of research covered are for example a few times highlighted as a potential problem regarding which causal inferences to draw from the research. Sometimes the controls included in a specific study are mentioned, sometimes they’re not, and that bothered me a little a few times as it was for example unclear in some cases whether a specific study had controlled for initial health status or not; the inclusion of this variable might not deal completely with the endogeneity problem (exercise affects health status, but health status also affects exercise ability – or at the very least perceived exercise ability), but without including it in some specific cases you’re quite likely to get into trouble, and it seems very probably that some older studies have overlooked this problem. In the book the results of quite a few RCTs are covered, which is nice – but there are also a lot of cross-sectional studies, epidemiological studies of various kinds, survey-based stuff… Natural experiments are almost (? can’t remember now if the proper word is ‘completely’…) absent in this work, but then again I guess this book was written before IV estimation really took off, and besides such methods would be most useful in areas which although related to the areas covered in the book are still sufficiently different in scope for it to (arguably) make sense not to include that kind of stuff in the book.
In general the stuff’s not easy to read if you don’t know a lot of stuff about biology, physiology and related fields, and I felt more than a few times that I was in over my head (though some chapters were a lot easier than others; because of my knowledge of diabetes and the physiological consequences of adiposity chapter 10 was an easy read) – but stuff like study methodology should not cause you problems as most of the -designs applied are quite uncomplicated. The stuff included about health impacts of health interventions (e.g. exercise) deals mainly with ‘idealized’ high-compliance settings; they do talk a bit about the adherence-/compliance problems which are observed when doing intervention studies, but more focus on this aspect might have been a good idea – at least I think the book sells the idea that exercise is good for the individual much better than it does the idea that large-scale policy interventions undertaken in order to improve health that way might be a good idea. I believe quite a bit of work has been done in that area since then, so you can find out about that stuff elsewhere.
I haven’t ‘punished’ the authors for not defining all terms applied in the work and for including stuff I was supposed to know but didn’t – it’s not their fault I’m an ignorant fool. But you should have in mind when interpreting my rating that a person like me is borderline too ignorant about stuff like immunology, microbiology, and cardiology to read and understand all the stuff in the book, despite having, among other things, read textbooks dealing with all three areas before. I got a lot of stuff out of this book, but I’d have gotten more out of it if I’d have known more about some of the things they cover.
I have included some observations from the book below. I’ve mostly stayed clear of the technical stuff:
“It has been suggested that declines in functional capacity with age reflect age-related reductions in physical activity. Inactivity has been estimated to account for 50% of the age-related loss in function. […]
The ability to move with purpose and to remain independent with increasing age depends to a large degree on retaining an adequate functional capacity in the neuromuscular system. This system, which governs the generation and control of muscle force, typically undergoes a substantial decline in functional capacity with age […] Beginning at approximately 30 years of age, human muscular strength declines at a rate of 10 to 15% per decade1 […] Because the activities of daily living usually do not require maximal muscular efforts, the gradual loss of strength for most individuals does not become functionally significant until after 55 to 60 years of age. […]
Evidence is accumulating that progressive resistance exercise is an efficacious, nonpharmacological treatment for age-related losses in muscle mass, quality, and function. The benefits of regular physical activity throughout the life span have been a major focus of exercise physiologists for many decades. […] Taken together, these results suggest that, if sustained over a lifetime, regular physical activity has a significant protective effect on muscle strength, function, and oxidative capacity. Benefits appear to relate not only to function, but also to longevity.9,10 […]
Evidence from both animal and human models suggests that there are age-related differences in the susceptibility of skeletal muscle to exercise-induced damage and ability for post-damage repair. One such difference is in the amount of work required to induce muscle damage. […] Human studies have […] tended to demonstrate a greater degree of exercise-induced muscle damage in elderly than in younger adults. […] Most animal and human studies agree that recovery from acute exercise-induced muscle damage is impaired in older subjects. […]
evidence is mounting that estrogen may be a key hormone for maintaining muscle strength in women.96 […] although gender differences in tissue antioxidant potential, partially due to estrogen, may exist, their importance in influencing exercise-induced peroxidative muscle damage is still undefined. […] whether females are afforded greater protection from postexercise muscle inflammatory damage and/or are delayed in muscle healing rates as a consequence of their higher estrogen levels is not yet firmly established. […]
The elderly appear to be more susceptible to exercise-induced muscle damage than younger adults. In addition, following such damage, there seems to be a relative impairment in muscle repair and adaptation in the sedentary elderly. Nevertheless, evidence suggests that the ability of older muscle to adapt to a resistance training program remains robust, and the physiological mechanisms associated with muscle repair and hypertrophy are still able to function even in older adults. […] regular resistance exercise may be one of the best intrinsic methods of protecting muscles from exercise-induced muscle damage and helping to normalize the rate and quality of muscle repair processes and adaptation to muscular activity in older individuals. […]
Over half of the older population is afflicted by arthritis, and approximately one-third of postmenopausal women will experience an osteoporotic fracture in their lifetime.1 […] distinguishing between disease processes and disease consequences of arthritis and normal aging is complex. […] More than 80% of people over the age of 75 years have clinical osteoarthritis and more than 80% of people over the age of 50 have radiologic evidence of the condition. Before the age of 50 years, the prevalence of osteoarthritis in most joints is higher in men than in women. […] The prevalence of rheumatoid arthritis increases with age and is found in about 10% of adults older than 65 years of age. […] The association between obesity and osteoarthritis has been evident for many years, but whether obesity was a cause or a consequence of the disease was unclear. It now appears that obesity not only predates osteoarthritis, but also increases the rate of disease progression, especially in women and in those with osteoarthritis of the knee.26,27 […] Occupational or recreational activities associated with excessive, repetitive, or high-impact joint loads are risk factors for osteoarthritis. In contrast, moderate physical activity such as running decreases the risk for osteoarthritis, at least in men.28 […] General exercise and physical activities are not harmful to the arthritic process, as was once thought. […] Despite many interstudy differences of methodology, there is consistent support for the notion that exercise and physical activity can and should play a role in both prevention and rehabilitation. […]
The one fairly robust finding across studies of exercise adherence is past exercise behavior. […] The fact that current exercise behavior appears to be best predicted by past exercise behavior is not surprising, but it is disconcerting, given that those individuals who most need to exercise are also those who are least likely to exercise. […]
Based upon […] systematic reviews of randomized investigations, the effect of exercise on bone mass appears to be a gain of approximately 1% per year, regardless of menopausal status. Data comparing male and female subjects are limited […]
Aging, per se, appears to have only a small effect on glucose intolerance and insulin resistance. The majority of insulin resistance that develops in older women and men is explained by increased adiposity, particularly in the abdominal region. […] life style appears to be a much stronger determinant of insulin resistance than aging per se. […]
Overall, exercise training in later life reduces the magnitude of catecholamine and pituitary hormone responses to a given bout of exercise, and increases the resistance to physical stress. Given that stress hormones are in general immunosuppressive, appropriate exercise training may be beneficial for the aging immune system, raising the threshold level of immunosuppressive (i.e., strenuous and/or prolonged) physical exercise. […] Strenuous exercise increases concentrations of various proinflammatory and anti-inflammatory cytokines, naturally occurring cytokine inhibitors, and chemokines.43 Given that aging is associated with increased inflammatory activity, strenuous exercise may induce the cytokine cascade more markedly in aging adults than in young peers. […] The results seem to imply that older adults should adopt a more cautious approach to strenuous exercise. […]
Human immune function undergoes adverse changes with aging. The T cells, which have a central role in cellular immunity, show the largest age-related differences in distribution and function. The underlying causes include thymus involution and continuous attrition caused by chronic antigenic overload. Immune function is apparently sexually dimorphic; women have more vigorous immunologic activity than do men, thus reducing their risks of infection. However, the same mechanisms make women more susceptible to various autoimmune diseases. The sexual dimorphism in immune function may become less apparent with aging, although it persists into later life […]
In Canada, by the age of 65 years, 37% of women and 31% of men have noted some limitations in their physical activity.28 As early as 55 years of age, 2% of men and 10% of women are unable to carry their groceries, and in those over the age of 80 years, the prevalence of this particular handicap rises to 20% of men and 30% of women.81 […] When interpreting functional changes, it is often difficult to disentangle what is a consequence of normal aging from the effects of disuse and chronic disease. One U.S. study estimated that as much as half of age-related decline in functional capacity was self-imposed, due to an accumulation of body fat and a failure to take adequate physical activity.32 […] in Denmark, Avelund et al.5 noted a substantial inverse relationship between levels of habitual physical activity and the loss of functional capacity. […]
Although an age-related loss of function can in itself cause disability, chronic disease is the usual source of impairment. […] A major part of the age-related loss of functional capacity, with the associated social and economic costs of prolonged disability, is due to adoption of an inappropriate lifestyle. […] The apparent prevalence of various disease conditions varies according to the diagnostic criteria applied. For example, aging is inevitably associated with a progressive increase in blood pressure, but when a certain arbitrary level of pressure is surpassed, hypertension is diagnosed […] Similarly, when the age-related decrease in bone mineral content reaches an arbitrary figure, clinical osteoporosis is diagnosed. […]
Many elderly people have multiple disorders, and it is then difficult to assess the contribution of specific conditions to the reported level of disability. In young and middle old age, the main causes of disability are chronic disease and a restriction of mobility, but in the oldest old mental deterioration and a loss of the special senses become important sources of impairment.62 […]
the main social costs associated with aging are incurred in the final year of life, as heroic attempts are made to prolong the survival of sedentary and severely disabled individuals.9,17 Regular physical activity decreases the risk of chronic disease and thus the scope for heroic treatment; it increases healthy life expectancy.17 […] there is little evidence that regular physical activity prolongs survival into advanced old age. What it does is to avert premature death, at a time when an individual is contributing to society rather than drawing upon its resources. The survival curves for active and sedentary individuals converge around the age of 80 years […]
The muscle force and aerobic power required to undertake many of the tasks important to the independence of an elderly person (for example, rising from a chair or climbing a flight of stairs) are almost directly proportional to an individual’s body mass. Thus, a 10% reduction in body mass will effectively increase muscle strength and maximal aerobic power by some 10%, equivalent to a 10-year reversal of the effects of aging.”