Becoming and staying physically active may significantly improve both musculoskeletal and overall health, and help offset or delay the effects of aging. According a recently published review of literature on the effects of exercise and diet on aging, much of the physical decline in the musculoskeletal system over time may be due more to a sedentary lifestyle than the process of aging itself.

It’s a common and longstanding assumption that it is the actual aging process that causes an inevitable decline of the body’s ability to function. But increased rates of injuries such as sprains, strains and fractures; diseases, such as obesity and diabetes; and osteoarthritis and other bone and joint conditions, while more common among seniors, may not necessarily be because they are getting on in years. It may have more to do with their lifestyle on the way there.

Recent research on senior, elite athletes suggests that using comprehensive fitness and nutrition routines helps minimize bone and joint health decline and maintain overall physical health. But since not everyone is an “elite-athlete”, the broader appeal of the study may lie in the fact that it looked at those behaviors among non-elite middle-aged adults and older adults who continue to remain increasingly active throughout middle age and beyond. A growing body of research and clinical evidence shows how staying physically active can – for anyone – control some aspects of physical decline through physical training.

From a musculoskeletal perspective, some of the benefits of staying physically active throughout the lifespan include maintaining bone density, muscle mass, ligament and tendon function, and cartilage volume – all key components of overall physical function and health. In reviewing the literature on the subject to date, the researchers affirm and recommend what are widely regarded as fundamental principles of exercise: An activity regimen that includes resistance, endurance, flexibility and balance training “as safely allowable for a given person.” Some of those recommendations include:

Resistance training. Prolonged, intense resistance training can increase muscle strength, lean muscle and bone mass more consistently than aerobic exercise alone. Moderately intense resistance regimens also decrease fat mass. Sustained lower and upper body resistance training bolsters bone density and reduces the risk of strains, sprains and acute fractures.

Endurance training. Sustained and at least moderately intensive aerobic training promotes heart health, increases oxygen consumption, and has been linked to other musculoskeletal benefits, including less accumulation of fat mass, maintenance of muscle strength and cartilage volumes. A minimum of 150 to 300 minutes a week of endurance training, in 10 to 30 minute episodes, for elite senior athletes is recommended. Less vigorous and/or short-duration aerobic regimens may provide limited benefit.

Flexibility and balance. Flexibility exercises are strongly recommended for active older adults to maintain range of motion, optimize performance and limit injury. Two days a week or more of flexibility training – sustained stretches and static/non-ballistic (non-resistant) movements – are recommended for senior athletes. Progressively difficult postures (depending on tolerance and ability) are recommended for improving and maintaining balance.

The study also looked a dietary behaviors, and recommends what it terms “proper” nutrition for older, active adults in order to optimize performance. For senior athletes, recommendations include 1.0 to 1.5 g/kg of daily protein intake and 6 to 8 g/kg of carbohydrate consumption (with more than 8 g/kg in the days leading up to an endurance event).

The researchers also uphold the practice of tailoring each program to the individual. According to authors of the study, when safely allowable, patients should be encouraged to continue to exceed the minimum exercise recommendation in order to improve fitness levels and minimize bone and joint health decline.

“An updated understanding of how active adults defy age helps orthopaedic surgeons not only manage their patients’ performance but also improve their lives,” wrote the authors. “A large segment of sedentary older adults will benefit from counseling that encourages the pursuit of more active and healthier lifestyles.”


1. Vopat, Bryan G., et al. “The Effects of Fitness on the Aging Process.” Journal of the American Academy of Orthopaedic Surgeons 22.9 (2014): 576-585.

NFPT Staff Writer

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