Getting Doctor’s OK to Exercise a Stale Notion?

Older adults are usually warned to consult a doctor before starting an exercise program. But using age as a reason to require a physician’s approval is an outdated notion that keeps many seniors from pursuing activity that could boost their health, specialists say.

“Exercise is much safer than inactivity in terms of health and well-being,” said geriatrician Maria Fiatarone, chief of the physiology lab at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. “So rather than seeking permission to exercise, you should have to get permission to be sedentary.”

Requiring seniors to consult a doctor before starting to exercise “sends the wrong message,” said Fiatarone, whose extensive research on weight training with seniors shows that even frail elderly can increase their strength by more than 100%. “It implies that physical activity is inherently dangerous or ill-advised, and it reinforces the mistaken belief that it’s safer to be inactive.” But while “chronological age has nothing to do with it,” Fiatarone said a person’s health status may make it advisable to consult a doctor before exercising.

“You should see a doctor, regardless of your age, if you have undiagnosed symptoms--such as chest pain or fainting spells or red, swollen knees,” she noted. “And if you have a chronic condition that’s out of control, such as high blood pressure or diabetes, you should consult a physician before beginning to exercise.”

There’s a “short list” of grave medical conditions that might make exercise unsafe, such as severe aortic stenosis or a serious terminal or untreatable disease, Fiatarone noted. “But for most chronic conditions--like heart disease and arthritis--exercise is a well-recognized and effective therapy.”

Because chronic health problems are more prevalent among older people, some exercise programs require all seniors to consult their physician first, and in some cases, to get a stress test. But Fiatarone said that “for most totally asymptomatic people, there’s no reason to require a $600 stress test.”

The American Heart Assn., however, recommends stress tests for middle-aged and older people who have not been physically active and plan to begin a vigorous exercise program.

“To be on the safe side, we recommend that people over 40 and those with risk factors for cardiovascular disease [including cigarette smoking, diabetes, obesity and family history of cardiovascular disease] get at least one stress test if they want to do vigorous exercise,” said Dr. Gerald Fletcher, a cardiologist, an AHA spokesman and professor of medicine at the Mayo Clinic Medical School in Jacksonville, Fla.

But for nonvigorous activities--such as walking, pool aerobics and doubles tennis--a physician’s OK is unnecessary, Fletcher said. “People can start exercising at a low to moderate intensity on their own without medical screening.”

He defines nonvigorous exercise as “an activity you can do while carrying on a conversation.”

Formerly sedentary people who begin exercising should start slowly and progress gradually, regardless of age. “But remember that it’s never too late to start exercising,” Fletcher said.

“Even if you’ve been sedentary for 20 years, if you begin exercising regularly at age 50 to 60, you decrease your risk of heart disease by 25%.”

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Resources

* The National Institute on Aging’s “Age Page: Don’t Take It Easy--Exercise” is available by calling (800) 222-2225.

* The American Heart Assn. offers numerous free booklets on exercise. Call (800) 242-8721.

* The American Academy of Orthopaedic Surgeons’ brochure for seniors, “Keep Moving for Life,” is free by calling (800) 824-BONES.

* This column looks at the concerns of older Americans. Reader suggestions are welcome. Send to the Second Half, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053.