by: Anthony Campo
I believe this is an issue that has affected many older men, and if nothing is done will affect more and more individuals at increasingly younger ages.
I would first like to preface this by saying that I am not a medical doctor, but have experience working with individuals of all levels of the spectrum as both a Personal Trainer and Physical Therapist Assistant. This is an article meant to share my experience, and hopefully provide valuable information that can help others that are in a similar situation.
My Grandfather had just turned 84 years of age. Like most other men that age he was suffering from some complications due to an enlarged prostate. Other than that, he was in pretty good health other than some angina from time to time. All other measurable areas were within normal limits, and he was completely independent, even driving short distances safely. All of this was most likely due to a highly active lifestyle his whole life (even though he had never once stepped foot in a gym,) and a ” Health Kick” he had been on for the past 30 years ever since he had a little health scare with a TIA (Transient Ischemic Attack.) Both Angina and a TIA have no long term lasting effects, and can normally be treated.
So he went to the doctor to see what can be done about the enlarged prostate, as it was getting pretty uncomfortable for him to urinate (along with waking up multiple times during the night to urinate.) At this time the doctor had some concerns due to his PSA (Prostate Specific Antigen) number, and immediately wanted to take a biopsy of his prostate to check for cancer. At this point I would just like to point out that a high PSA is not necessarily indicative of having cancer, it is just a warning sign. No one has ever died from a high PSA number alone. My grandfather refused the biopsy as he was concerned with some side effects that could occur from getting the biopsy. My grandfather asked if there was anything else he could do. They started him on Flo-Max which it seems like 90% of men over the age of 60 are on these days. This seemed to help with the issues he was having urinating, and got him to a much more manageable level. Everything solved, right? Wrong. His PSA continued to creep up higher and higher, and even though he was suffering no symptoms, the doctor still pushed very hard for him to get the biopsy. It is important to note that one of the reasons a man’s prostate enlarges, and PSA numbers rise has to do with testosterone. As men get older, testosterone in the system can make a conversion into the chemical DHT. DHT is responsible for a number of male issues including loss of hair, the breakdown of muscle, and enlargement of the prostate which could lead to cancer. Testosterone itself, however, is a huge factor in good cardiovascular health (prevents heart disease,) helps to maintain vitality, neuro-muscular function, and sex drive. So my grandfather was suffering from a classic catch 22. Seeing that his testosterone was recently measured at 430 at the age of 86, it is highly likely that my grandfather had high levels of testosterone the majority of his life, which had led to his good health, and high level of function well into his 80s. On the flip side, this high testosterone was also most likely the culprit of his enlarged prostate and elevated PSA.
About 4 years had passed, and my grandfather had been regularly getting his PSA number checked. The doctor at this point was convinced that my grandfather had cancer, even though no test had showed it. The doctor recommended a new drug for my grandfather that would reduce his free testosterone. The body would recognize the drug as a synthetic form of testosterone, even though it does not act in the body as testosterone. The body would be fooled into thinking its levels of testosterone were sufficient, and shut down its natural production. Let me remind you that my grandfather was suffering from NO symptoms other than his high PSA number, and showed no signs of cancer that could spread to other areas of the body. A choice now had to be made. My grandfather decided to go with the doctor’s suggestion even though my recommendation was for him not to take the drug. What ensued was a course of events that I believe has resulted in an amazing breakthrough for the health and wellness of the geriatric population.
So the drug did exactly what it was supposed to. My grandfather’s testosterone levels sunk incredibly low in a relatively short amount of time (single digits low.) One of the first symptoms my grandfather really started to notice was a generalized weakness down into the legs. This weakness gradually became more severe, and then was accompanied by some neuropathy (numbness and tingling) down into the leg. At first it was more of a nuisance, but gradually began giving him trouble getting out of bed in the morning. Then, as what normally happens in these situations as an elderly individual begins to decline, he started having some falls. We were very lucky though, and he suffered no serious injury as a result from the falls. This was a huge deal, because in a fragile state if someone like my grandfather falls there is a high chance he could break something resulting in a huge loss of mobility and independence. Once this occurs it does not take long for your average elderly person to really start losing a great deal of their function. At any age the body adapts based on the demands placed on it. So when training, the goal is to place more demands on the body in order to cause a positive adaption of the body. The reverse is also true for aging individuals. If as you get older you place less and less demands on the body, a negative body adaption will ensue. For an individual that is still relatively high functioning this might simply result in symptoms like fatigue, muscle atrophy, or weakness. However, take someone like my grandfather and make them non-weight bearing for a period of time and this may result in the ability to no longer stand or walk. Once you can no longer stand or walk independently then this means that the individual will being doing even less, which could lead to more negative body adaptions for the long run. Research has shown that the ability to be able to get up and down is directly correlated to the duration and quality of life as we get older (http://fitness.mercola.com/sites/fitness/archive/2013/01/25/sitting-rising-test.aspx) .
Through my many interactions with people over the years in both personal training and physical therapy, people of all ages find it necessary say how old they are, and how they can’t do the things like they used to. The interesting thing is that you hear the “it’s tough getting old” comment from people anywhere from the age of 25 to 100 years old. Individuals 25 years old are already telling me how much they are already limited by their age. The truth is that age itself has very little to do with it. At some point people decide they are old, and start limiting what they can do, using age as an excuse. For the most part, your body only ages if you let it. According to Wolff’s Law, the body responds to the demands placed on it. Stop placing demands on your body and it will start withering away. Continue to put increasing demands on the body, and it will continue to grow and adapt. If you don’t believe it ask the 60 year old power lifter who hit a 700lb raw squat in competition. How about the 100 year old pole-vaulter that jumped over 7 feet? These people didn’t let time decide when they were going to stop trying to improve themselves. They continued to do what they always did, and their bodies stayed strong by adapting to the demands that they still place on them. This applies not only to the physical, but the mental aspect as well. The brain needs to be continually stimulated in order to keep it sharp. If the brain stops having new demands placed on it, it will engage in a process in which it will kill off unneeded brain cells. For these reasons age is not a major factor when it comes to health. It is simple, see what you can currently do, and anticipate what you can potentially do with an effective training plan. At no time does age by itself play a role as a limiting factor. So as all of us continue to age, let’s stop dwelling on what we think we “can’t” do and start focusing on what we can do. We can either choose to let our bodies decline, or we can choose to find new ways to make our bodies adapt, grow and become “ageless.”
It was clear that my grandfather’s now super low testosterone levels as a result of the medication had played a huge role in his pretty steep decline. Hormones in general are a primary driving force behind most bodily processes. Without an adequate level of the hormone testosterone in the body, my grandfather’s neuro-muscular pathways began to diminish, and weakness, atrophy, and neuropathy had set in. Also, because of his altered level of function his body mechanics began to change. Without proper mechanics he began to suffer from pain throughout the joints of the body that he had never suffered from before. Back, hip, and knee pain were just a few of the new issues he was now dealing with. Unfortunately in most cases the more pain you have, the less you do. This was the case for him, and one thing by one thing he began to do less and less. This continued the cycle of dysfunction, and between his 88th and 89th birthday he was now having trouble just standing up. His weight had dropped sufficiently from muscle wasting (from 150 to about 130lbs,) and his immune function was also compromised as he seemed to be getting infections regularly. One such urinary tract infection led him to a bed in the hospital where he had the wear a catheter for the first time in his life.
Enough was enough, and this seemed to be the tipping point for him. I had been pleading with him to start coming to the gym and training with me for what seemed like years. He now finally agreed. The following is the basic step by step protocol I designed for my grandfather that was able to return him to his previously high level of function and beyond.
To achieve any goal, there should be a hierarchy of things to focus on. This means the most important things, or areas that will yield the largest percentage success should be addressed first. As you get the most important areas under control, you can begin focusing on more specific areas. So for my grandfather, his long term goal was to stay healthy with a high quality of life for as long as possible.
So we first looked at this testosterone blocking medication. It became clear that he most likely did not have prostate cancer, and even if he did it probably would not kill him.
“Prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. In fact, more than 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today.” (www.cancer.org). There are more aggressive forms of prostate cancer, but due to the amount of time my grandfather was suffering from symptoms (about 4 years), and the fact that he was still relatively healthy meant that most likely he did NOT have the aggressive form that would kill him. He had been tested in other areas for cancer (in case he did have cancer and it spread,) and all tests came back negative. So at this point the testosterone blocking medication was doing much more harm than good, and it was much more likely that the course of events stemming from having NO testosterone COULD very well end up killing him. So taking all of this in consideration he decided to stop taking the medication.
Next we had to take a serious look at his nutrition. As a result of his body breaking down from the extremely low testosterone he had loss a significant amount of muscle mass. Also most likely due to the fact that his body was in a mode of self-destruction, his appetite was not like it used to be. So initially we had to address this situation in the simplest way possible. In my grandfather’s case, and in the hierarchy of nutrition, we had to try to put his body back into a building mode. The first thing we focused on was protein and calorie consumption. Protein is the main building block for the body, so we had to make sure he was getting enough to build build build! Also it was pivotal that he was taking in a surplus of calories in order for the protein to be used as building blocks and not energy. Because his appetite at this point was pretty poor I designed a protein shake for him to have. We have all heard of geriatric individuals drinking Boosts and Ensures, which are ok, however, I believe this custom shake is much better. I had him mix 2 scoops of your basic whey/casein blend protein with 3 tablespoons of olive oil, 3 tablespoons heavy cream, and water. This shake comes out to be about 800 calories and 50 grams of protein which is about 3 times more than your average Boost or Ensure. It also comes out to be only about 12 ounces of fluid so it is pretty easy to drink, and does not kill your appetite. Also the olive oil adds in a bunch of healthy omega-3 fats and antioxidants. For any male, getting about 20 percent of your nutrition from healthy fats is essential for proper levels of testosterone and hormone function in the system. In addition the healthy fats improve your HDL or “good” cholesterol, improves blood sugar (insulin sensitivity,) and fights heart disease. I set an initial goal for him of a minimum of 150 grams of protein per day with at least 1500 calories. At this point for him the more the better, but I believe he needed at least these amounts to begin making some serious progress in his muscle mass and overall weight. With this shake I was having him drink every day, it made these numbers very possible. In addition to the shakes I wanted him eating farm fresh eggs for breakfast every morning. The eggs contain all of the essential amino acids plus healthy fats and cholesterol that he needed to help restore some of his testosterone levels. He usually chose to have his eggs I recommended a minimum of 3 eggs per day) which pancakes. This was very good for him as it provided him with excess energy he needed so that his body could let protein better do the job of building. I had him add an extra egg and some protein in with the pancake batter so that it turned his breakfast into another 40-50 grams of protein. Every night for dinner he was to have some form of meat or fish with a green vegetable and a carb such as a rice or potato. This would give him another 30-40 protein and sufficient calories for the day. Also, to ensure he was getting enough protein and calories at some point of the day or night he was also to have a snack that consisted of either nuts, peanut butter, or a protein bar. I also recommended that he use either extra virgin olive oil, coconut oil, or grass fed butter to cook and season with as these are all excellent sources of healthy fats that will assist to boost his testosterone along with all the other health benefits mentioned earlier. This was quite an increase in eating for him, so it absolutely took some getting used to. The idea was that he would get used to this amount of food, and as his training began to kick in his body would begin desiring more food and nutrition, and his appetite would become stronger. The toughest part is the initial phase, because he was still not that hungry, and he really had to focus to get this proper amount of food in for his goals.
Once he began following this basic diet plan, it was time to begin him on a training program. The key thing to remember when training an individual of varying demographics or abilities is to identify at the individual a vast spectrum. The spectrum is a line chart that goes from terminally ill or bed ridden individuals all the way to an elite level athlete. Most people fall somewhere in-between these two ends of the spectrum. The idea is to assess just where they are on the spectrum, and get them to progress forward. Just how far forward the individual goes is dependent on their goals, and level of commitment. So for my grandfather, he fell on the spectrum as a declining, semi-independent individual. So based on this the first goal was to make sure he was no longer declining. So initially this meant that his training focused around making sure none of his symptoms got any worse, and that he maintained his current level of independence.
Fountain Of Youth
Everybody is trying to find the fountain of youth. The nasty reality is that without proper care, our bodies literally deteriorate as we get older. I’m telling you that you do not need to let this happen, and through a proper training program, you can reverse or slow down much of this aging process.
Many people are affected with osteoporosis as they get older. One of the main reasons this problem is such an epidemic is due to the lack of impact we place on our bones. As we get older, and participate in less demanding activities, the body responds by breaking down bone (because the body thinks it is not needed,) to ship calcium amongst other things out to be used in the rest of the body. By simply placing a bar on your back, or participating in training that places impact on the bones, you can prevent this from happening in the first place. Even if you are already suffering from some level of osteoporosis, training can help build new bone density no matter what your age is.
Hormones are a strong driving force in the body. Decreasing levels of testosterone, for example, as we get older can lead to a handful of problems, including difficulty losing weight and adding lean muscle. Choosing high intensity exercises such as back squats, and performing them correctly can actually help boost testosterone levels, along with other hormones such as natural human growth hormone production.
As we get older, without a correct training regimen, we build many muscle imbalances that inhibit our mobility, and can cause all kinds of pain and disablement. Most issues these days are covered up with pain pills, or even more immobility. The only way to truly fix these problems is to locate and train imbalances.
This was a very small and simple list, and I could go on for pages upon pages describing how proper training can help prevent or fix dysfunction throughout all the systems of the body. If you allow yourself to become more and more inactive as you get older, you will be speeding up the aging process. Through proper training you can address many of these issues to increase quality of life, and thus find the true fountain of youth.
So I started him on a home exercise program with exercises and activities he could perform everyday they would directly help him with his problem areas. He had been complaining about being very “weak-legged” and “numb” in the mornings. So before he was to get out of bed in the morning I gave him some warm-up/activation exercises that would get his muscles better prepared for the day. Every morning in bed he was to perform straight leg ankle pumps, glute-ham bridges, and straight leg lifts 10-20 reps each. His neuropathy was also getting worse so we wanted to prevent it from progressing. We got him a nerve-conduction velocity test to see specifically what neuro-muscular pathways were at a deficit. With this information I had him do some activities for his specific neuropathy. He began doing some self-massage and tapping down the leg into the foot. For more sensory and soft tissue work he was to roll his foot and lower leg on a baseball everyday which will also help with the “numbness.” After this I told him to get a towel and work at trying to pick it up with his feet which will improve some of his motor deficits. These soft tissue and sensory techniques would work alongside his training to help regenerate nerve function over the long run, and contribute to improving his all around function.
Next it was important to really begin assessing his movement patterns, and having him train compound functional movement patterns such as the squat. The importance of training the squat is widely known (you can find more in depth information on the squat at www.CampoTrained.com blog post Proper Squat Mechanics For The Beginner,) and we have spent and continue to spend a large portion of his training strengthening this movement. Initially with a movement such as the squat we want to “grease the groove.” So he learned the basic movement of the squat, and performed 30 reps of body weight squats everyday (we used a chair for him to squat to.) This was a very important movement because as was said earlier, the ability to get up and down is directly correlated to an individual’s quality of life as they get older. In addition the squat trains a number of extremely important muscles, which in addition to lower body strength has been shown to increase free testosterone and help build strength and muscle throughout the WHOLE body (http://www.t-nation.com/training/does-lifting-boost-testosterone). Also training the squat with this frequency and volume will help to build the baseline of strength that can then be progressed to more challenging movements with added loading. With this movement we also worked on his breathing patterns, and how to use breathing to improve balance, core stabilization, and motor-unit recruitment.
Another very important movement is the push-up. This is a great upper body movement to train that also helps integrate the core and trains intra-muscular coordination. At his level he was able to perform proper push-ups (more information at www.campotrained.com blogpost Proper Push-ups,) using his kitchen counter top. We also started off at 30 repetitions a day at this exercise.
The last compound strengthening exercise we started him off with on his everyday home exercise program was step-ups. This was easy because he was at a level where he was already able to perform stairs. Unilateral movements such as stairs and lunges are great strengthening assist exercise that help to build balance and symmetry (See more at www.campotrained.com blogpost Proper Lunges.) He was currently using 2 handrails to assist him going up and down the stairs for his daily living. In assessing his movement I was able to see he was safe using only one handrail. So when he was performing the stairs for exercise he was progressed to only using one handrail. He was to perform 3 rounds of stairs everyday focusing on form and proper muscular function.
For safety and efficiency reasons most of his at home training that he was to do on his own I kept at a level that he was able to train with more volume and frequency. Volume and frequency are two key aspects that should be focused on in order to facilitate positive body adaption. Training the body is all about modifying intensity. Two other EXTREMELY important intensities that need to be trained to create the greatest positive body adaption is maximal effort and dynamic effort training. These intensities require the greatest amount of coaching and supervisions so for that reason we would be doing maximal and dynamic effort training primarily in the gym.
Initially we aimed for 3 training days a week. This would allow for the proper level of all around training, at the proper intensity, and adequate amount of rest and recovery. The days would be separated into movement patterns, and accessory work to complement weaknesses.
Your Basic Roadmap To Training
If your goal is to make progress in the gym, then follow this basic outline for putting together a program…
Start with an all-inclusive warm-up consisting of soft tissue work, stretching, mobility work, and activation exercises. This will take different amounts of time depending on your limitations. Limitations can be anything from being sore and tight from your last session, or trying to rehab an injury. In warming up you should gain a better understanding of your body, and reach a level of preparedness that will allow you to get the best out of yourself each training session.
Your first lift should be a major compound lift such as any variation of squatting, deadlifting, or pressing. Depending on your level this can be anything from a modified pushup to a max effort deadlift. No matter the movement, the whole idea of doing this first is to get stronger at that exercise. This is an instance where you are training the movement, not the muscles. The sole purpose for this movement is to hit a record for yourself on the exercise (basically meaning doing something you never half done before.) Don’t worry about muscle fatigue, or trying to get a pump, just make sure you get stronger each week by lifting more weight, lifting a weight for more reps, or lifting a weight faster.
After you main lift you should pick accessory work that hits your weaknesses. Between your warm up and doing your main lift you should gain a pretty good understanding of where your weaknesses are. Choose exercises that will hit these weaknesses. Doing this will help your progress, and lower your risk of injury.
Once you have completed your warm-up, main lift, and accessory work, now you can get into your specializations. If your goal is weight loss, then do some conditioning and cardio. If you are trying to pack on muscle, do some bodybuilding and really finish the muscles off. If your goal is to be as healthy as possible, then make sure you stretch and do soft tissue work post workout as well. If your goal is all of these things, find out a way to combine them (such as complexes) that will fit your time schedule.
Follow this simple outline consistently, and you will be well on your way to success!