summarize: As a former athlete and lifelong exerciser, I already had a substantial fitness
base built up, even if I wasn’t necessarily moving or lifting correctly. Many of
my problems stemmed from lifting too much, cycling too much, or swimming
too much. The vast majority of people have the opposite problem: They’re not
doing enough. Or they haven’t done enough. Or they can’t do very much at
all. For most people, this is the real challenge. They need a jump start. The
good news is that these are the very people who can benefit the most. They
have the most to gain.
This is also where we see the true power of exercise—its ability to
transform people, to make them functionally younger. It’s quite incredible. I
mentioned earlier how taking up weight training in her sixties changed my
mom’s life. But there’s no better exemplar, I think, than the amazing,
inspiring Barry.
Barry was another client of Beth’s (but not a patient of mine), an
entrepreneur and executive who had spent his career building a successful
business, putting in long hours at work and spending virtually no time on
anything else, including his fitness. He took cycling trips occasionally, but that
was about it.
I see that a lot among my own patients: they trade health for wealth. Then
they reach a certain age and realize they are on a bad path. This was Barry:
After spending basically fifty years sitting in a chair, he retired and it dawned
on him that he was in terrible shape. Not only was his physical capacity very
limited, but he was in almost constant pain. He was then closing in on eighty
years old and looking at some painful years ahead—a bad Marginal Decade.
He began to wonder: Why had he worked so hard? In the state he was in,
retirement no longer seemed very appealing.
At some point, he had a revelation: instead of retiring, he would give
himself a new job. This “job,” as he saw it, was to rebuild his neglected body
so he could get more enjoyment out of life. He began working with Beth and
kept on going even as the pandemic made it impossible to train in person for
a while. He was highly motivated. Beth has to remind many of her clients to
stick with their workout schedule, but with Barry she had the opposite
problem: he wanted to spend too much time in the gym. She had to make him
take breaks and rest.
Barry’s goals are different from mine, obviously, but they went well
beyond vaguely wanting to “get healthier.” He wanted to be able to do a pullup—that was his stated fitness goal. What he really wanted was to feel strong,
and to be able to move in the world with confidence again, without fear of
falling, just as he had done as a younger man. But he was nowhere near that;
if Beth had put him on a pull-up bar, he likely would have hurt himself. He
could barely walk without pain. So he had to begin at a much more basic
level, learning how to do simple movement patterns safely.
Beth started him off with some of the same introductory exercises I’d
done: abdominal breathing, progressing into the slowed-down, segmental
Cat/Cow. To lessen his risk of falling she had him focus on balance-related
movements, beginning with his feet—learning to move and feel his toes
again, after decades of having been shoved into shoes. He then progressed
into one-leg walking and standing drills. Beth even had him dance, to help
him relearn how to move his feet and how to react to visual cues to keep his
balance.
They then progressed into building basic strength, beginning with walking
lunges to fortify his lower body. His abdominals were still weak from surgery
twenty years earlier—it’s not uncommon, I’ve observed, for these things to
affect people decades after the fact. So they worked on his abdominal
strength, beginning (as I did) with building intra-abdominal pressure. And
gradually, they worked toward building his upper and midbody strength—and
the scapular stability—he would need. Before long he could do better pushups than most twenty-something gym bros.
Beth put him through drills designed to improve his ability to react and
stay balanced. She had him use an agility ladder, similar to what NFL players
and other field-sport athletes use to develop balance, quickness, and footwork.
If you’re training to be an athlete of life, then you’re training to be an athlete,
period.
Last, she had Barry work on jumping drills, which is definitely out of the
comfort zone of most octogenarians. He was nervous, but eventually he got to
the point where he could hop off a pair of yoga blocks and land in a squat—
and stick it. The idea was to prepare him for the unexpected, so that if he did
find himself stepping off an unexpected stair or curb, he could catch himself
and not fall. Most people instinctively brace themselves, out of fear; they
don’t trust their “brakes,” their eccentric strength, and that almost always
makes their landing less safe. With stability, you have to be fluid and
prepared to react, almost like a dancer.
Another important move that they worked on was simply to get Barry to
be able to get up off the ground, using only one arm (or ideally, no arms).
This is one of those things that we who are younger take for granted. Of
course, we can get up off the ground—until, suddenly, we can’t. Children
learn to do it without a second thought. But somewhere along the way, adults
lose the ability to execute this basic move. Even if we have the requisite
physical strength, we might lack neuromuscular control; the message from our
brain just doesn’t reach our muscles. For someone who is eighty-one, like
Barry (at this writing), this is a big deal; it could make the difference between
continuing to live independently and having to think about going into a
nursing home. So Beth taught him a choreographed sequence of movements
that would allow him to stand up from a seated position, and he worked on
them until he had mastered it.
The “Barry Get-Up” has become a key part of the fitness assessment that
we do with all our patients, as well as one of the key events in the
Centenarian Decathlon (it should be in yours, too). It’s an important move,
whether you’re picking yourself up off the ground after a stumble or playing
with grandchildren on the floor. (For a video demonstration of the Barry GetUp, please visit www.peterattiamd.com/outlive/videos.) Everyone should be
able to do it.
But I think it’s also a metaphor for what’s possible with exercise training
(and, of course, stability). People like Barry help us to rewrite that narrative
of decline that trapped my friend’s mom, Sophie, and so many other people.
Exercise has the power to change us profoundly, even if we’re starting from
zero, as Barry was. It gives us the ability to pick ourselves up off the ground
—literally and figuratively—and become stronger and more capable. It’s not
about slowing the decline, it’s about getting better, and better, and better.
As Barry puts it, “If you’re not pushing ahead, you’re going backwards.”
