What Really Helps Foster Healthy Aging?

by Nina

Leaves Starting to Turn by Brad Gibson

As some of you may have noticed, the Sunday New York Times Magazine had an major article on aging with the rather overly dramatic title The Island Where People Forget to Die  about the island of Greek island Ikaria. A study at the University of Athens concluded that:

“people on Ikaria were, in fact, reaching the age of 90 at two and a half times the rate Americans do. (Ikarian men in particular are nearly four times as likely as their American counterparts to reach 90, often in better health.) But more than that, they were also living about 8 to 10 years longer before succumbing to cancers and cardiovascular disease, and they suffered less depression and about a quarter the rate of dementia. Almost half of Americans 85 and older show signs of Alzheimer’s. (The Alzheimer’s Association estimates that dementia cost Americans some $200 billion in 2012.) On Ikaria, however, people have been managing to stay sharp to the end.”

As usual with studies of long-lived communities, it was impossible to identify a single factor that was responsible for the long and healthy lives of the individuals within it. As the New York Times article says:

"If you pay careful attention to the way Ikarians have lived their lives, it appears that a dozen subtly powerful, mutually enhancing and pervasive factors are at work. It’s easy to get enough rest if no one else wakes up early and the village goes dead during afternoon naptime. It helps that the cheapest, most accessible foods are also the most healthful — and that your ancestors have spent centuries developing ways to make them taste good. It’s hard to get through the day in Ikaria without walking up 20 hills. You’re not likely to ever feel the existential pain of not belonging or even the simple stress of arriving late. Your community makes sure you’ll always have something to eat, but peer pressure will get you to contribute something too. You’re going to grow a garden, because that’s what your parents did, and that’s what your neighbors are doing. You’re less likely to be a victim of crime because everyone at once is a busybody and feels as if he’s being watched. At day’s end, you’ll share a cup of the seasonal herbal tea with your neighbor because that’s what he’s serving. Several glasses of wine may follow the tea, but you’ll drink them in the company of good friends. On Sunday, you’ll attend church, and you’ll fast before Orthodox feast days. Even if you’re antisocial, you’ll never be entirely alone. Your neighbors will cajole you out of your house for the village festival to eat your portion of goat meat."

In fact, if you leave out the rather sensationalist aspects of the story (the man who was cured of cancer just by returning to the island, a tale which may or may not be true), the main conclusion of the author had to do with community.

"The big aha for me, having studied populations of the long-lived for nearly a decade, is how the factors that encourage longevity reinforce one another over the long term. For people to adopt a healthful lifestyle, I have become convinced, they need to live in an ecosystem, so to speak, that makes it possible. As soon as you take culture, belonging, purpose or religion out of the picture, the foundation for long healthy lives collapses. The power of such an environment lies in the mutually reinforcing relationships among lots of small nudges and default choices. There’s no silver bullet to keep death and the diseases of old age at bay. If there’s anything close to a secret, it’s silver buckshot."

So, what, if anything, does this have to do with yoga? Well, did you know that all of us here at Yoga for Healthy Aging, even those of us who teach, take regular yoga classes? And we certainly do not attend these classes because we don’t know enough to practice on our own home. I think I can speak for all of us when I say that we do it for two other main reasons. The first reason is for the wisdom we continue to receive from our teachers, which helps keep our home practice inspired. But the second reason has more to do with the other people in the class than with the teacher: we want to stay connected to the yoga community. Being part of the yoga community is like belonging to a small “ecosystem” within our larger culture. Practicing with other people helps us stay steadfast in the healthy choices we have made, whether that is a having regular asana or meditation practice or even making career, family or other life decisions that we believe will be better for us.

So, thank you, thank you, thank you to all my fellow students in my regular class (you know who you are!). And, dear readers, I hope you, too, find the same sense of community in your yoga class. And if you don’t feel supported and encouraged in your current class, I urge you to get out there and look for one where you do.

What is Healthy Aging?

by Nina

Despite the horrifying vision of “exergames,” Brad’s post on Tuesday ("Successful Aging and the Thinking-Moving-Feeling Triad") got me interested in Dr. Dilip Jeste’s work. After all we’re all blogging away here about “healthy aging” without ever having really defined what it is. And that’s exactly what Dr. Jeste, Estelle and Edgar Levi Chair in Aging and Director of the Sam and Rose Stein Institute for Research on Aging at the University of California, San Diego, is currently trying to do. In an interview on Medscape (here), he said the following:

“Successful aging has not been consistently defined; that is one reason why this area is ideal for research. There have been some studies funded by the MacArthur Foundation beginning in the mid-1980s going on through the mid-1990s. But the [scientific] literature is limited, and there is no consensus on what is successful aging. Our research goals include developing a definition as well as criteria for successful aging.”

Jeste and his colleagues observed that while the components of successful aging typically include: longevity, life satisfaction, absence of physical disease, freedom from disability, mastery/growth, active engagement with life, high/independent living, and positive adaptation, sometimes only physical functioning and disability are considered. But most importantly, very few scientists include “self rating” in their assessments (that is, to put it bluntly, they don’t bother asking the subjects how they feel about their own experience of aging). So they decided to do a study in which “participants’ subjective ratings of successful aging were contrasted with sets of researcher-defined criteria, and correlates of subjectively rated successful aging were examined.” (See "Correlates of self-rated successful aging among community-dwelling older adults".)

One result of this study was this: “Nearly all the study participants rated themselves as aging successfully, but far fewer met researcher-defined criteria for absence of illness and physical disability.” (Note that only participants with higher levels of cognitive functioning were studied.)

Dr. Jeste concluded, as he said in the Medscape interview, “It is also important to say what is not an essential part of successful aging—absence of either physical diseases or physical disability is not necessarily a part of successful aging. I want to stress that people who have physical illnesses or physical disabilities can be aging successfully.” Instead he lists the components for successful aging as:

•    Higher level of cognitive functioning
•    Adaptation to changes associated with aging
•    Socialization—that is, some kind of social activity and/or social contacts
•    Life satisfaction

And in the very same interview, he gives two examples of people he considers to have aged successfully, and they are: Franklin Roosevelt and Frank White, a well-known Los Angeles yoga teacher. Hmmm. It appears we're not on different wavelengths after all. You may want to watch this video of Dr. Dilip, in which he speaks about wisdom and successful aging. Around the 12-minute mark, you can hear him speak about the Bhagavad Gita.

For some time now, I’ve been going around saying that yoga provides two out of the three of the requirements for healthy aging: exercise and stress reduction (the third is a healthy diet). As of today, I’m going to add a new one: wisdom.

STRESS TEST

by Nina

“You did great,” my oral surgeon said. “In fact, you were the most relaxed patient I’ve ever worked on. You even fell asleep there for a while.”

“Wasn’t asleep,” I mumbled through my numb and swollen lips. “Was doing yogic breathing.”

He looked at me with fascination, then quickly handed me a piece of paper and a pen. “Could you write down what you did for me?”

“Uh, email you later?”

Of course I didn’t become so good at yogic breathing just so I could stay, uh, relatively relaxed during gum surgery (though it was certainly an interesting test of my skills). As someone who once suffered from agitated depression, I’ve been using yogic breathing, along with many yoga techniques, for many years to manage my stress levels for my emotional wellbeing.

Under the Beach Umbrella by Joan Webster

Now it turns out that I’ve been practicing yoga for healthy aging while I was at it. Because I can tell you right now that along with exercise and diet, stress management is one of the most important keys to healthy aging. Chronic stress contributes to many common age-related diseases, such as high blood pressure and heart disease, and can cause a weakened immune system overall. It also affects the quality of your life. Possible effects of chronic stress include: chronic anxiety or depression, insomnia and/or fatigue, headaches, and digestive disorders.

And how does yoga help you manage your stress? Let me count the ways:

1. breath practices and meditation trigger the relaxation response 

2. inverted poses (and semi-inverted poses) physically reduce your stress levels

3. restorative yoga poses relax your body and quiet your nervous sytem 

4. active yoga poses (such as standing poses, twists, and backbends) release stress from your body and create a focus for your mind

5. yoga philosophy teaches you to cultivate equanimity in the face of difficulty

Over time, I’ll be providing detailed information and instructions for techniques in each of these different categories. And I hope very much that you’ll find one or more that’s useful.

And in case you’re wondering, yes, I did eventually email my oral surgeon. Next time you’re in a dentist chair (or are lying sleepless in bed, need a break after a stressful day, or just want to experiment), maybe you can try:

Breath awareness. Focus your attention on your natural breath, observing how your abdomen or chest rises with your inhalation and falls with your exhalation. When your mind wanders from your breath (to the dental procedure or any other topic), simply, and without judgment, return your attention to your breath. It is natural to be distracted from this practice, but it seems to work even if your attention wanders repeatedly.

Focusing on your breath will enable you to keep your mind of neutral topics rather than stressful ones, and after 10 or 20 minutes, the relaxation response (identified by Dr. Herbert Bensen of Harvard Medical School in the 1970s) will be triggered.

Extending the exhalation. The heart slows during the exhalation (and speeds up during the inhalation) so extending your exhalation is a relaxing breath practice (and also provides the benefits of breath awareness above). Take a deep soft inhalation followed by a deep soft exhalation. At the end of the exhalation, instead of inhaling again, retain your exhalation for one or two beats. Repeat through the procedure. Keep it easy. At no time should there be strain. If needed, return to your natural breath at any time.

During my procedure I did the second breath practice (extending the exhalation). But I’m very experienced with yogic breathing, and we generally recommend that beginners to start with simple breath awareness.

CLARIFICATION: AGING, YOGA, AND SCIENCE

by Brad

Today’s post is largely in response to the question: How would one go about investigating the effects of yoga on aging scientifically? Before tackling this question—which I will get to in the next week or two—I will first attempt to define or at least discuss a few key terms and assumptions. The reasons for this will hopefully become clear.

In the broadest the terms, “aging” applies to how systems or entities change with time. To inanimate objects, such as your new car or jacket, this begins right after it’s manufactured or, more relevantly, after you bought it.  This process of aging can be rapid or slow (weeks, months, or years), and depends a lot on what the object is and what it was designed for.  In biological systems (including us), we typically think of aging as starting after development, or post-puberty in our case.  We also tend to associate aging with a decline and/or loss of functions, both physical and mental.  However, aging can include more positive properties or phenotypes, such as increased knowledge and skill sets, and it isn’t all that hard to name a few that fit into this category. But in most biological scientific studies of aging, we refer to aging mostly in the former sense, i.e., an accumulation of mostly pathological properties, such memory loss, frailty, neurodegenerative diseases, bone loss, muscle loss, and so on. Surprisingly there are quite a few competing theories of basic aging, such as error accumulation, telomere shortening, antagonistic pleiotrophy, free-radical theory, and entropy, just to name a few. What all (or most) of these theories seek to address is the underlying molecular and physiological event that drives these largely negative processes. 

Winter Trees by Brad Gibson

The term “successful aging” is more recent, having come into wide use in the last few decades. If you want to read more about this concept, I found the first chapter in the book Successful Aging: Perspectives from the Behavioral Sciences by Paul and Margaret Baltes quite useful (for information see Cambridge ebooks). 

Even last week as I read the science section of the New York Times (see NY Times), I came across a short review of a just-published study on “Alcohol Consumption at Midlife and Successful Ageing in Women: A Prospective Cohort Analysis in the Nurses Health Study” (see PLOS).  In this prospective correlative study, researchers at Harvard demonstrated that a modest increase in successful aging for women who consumed small, but regular amount of alcohol at mid-life. (Maybe a glass of wine after yoga class isn’t such a bad idea after all?). Here they defined "successful aging" in a more precise manner: "as being free of 11 major chronic diseases and having no major cognitive impairment, physical impairment, or mental health limitations." Of course, this more operational definition to successful aging made it easier to make clear and objective distinctions among the woman in this group, typical of population based epidemiological studies. 

When we chose the term ‘healthy aging’ for this blog, the purpose was to provide information not on just how practicing yoga might help to avoid or reduce your chances of acquiring one or more of these age-related losses, but also to better manage and minimize their impact when they occur. Indeed, this is the position most of us are in, whether is through the vagaries of our genetic background, chance, past behavior, or whatever. (This reminds me of the joke: Q: What’s the best thing you can do to insure a long life? A: Choose your parents well.) So as I go back and reconsider the original question on how science can study the relationship of yoga and aging, I will reframe this question a bit: How can science study the effects of yoga on our overall physical and mental health as we age? I’ll tackle this question next time….  But as a preview, there are few good places to start, including the 2009 pilot study in Lancet on comprehensive lifestyle changes and telomere length (a biomarker of aging and cellular senescence) and several recently funded NIH studies examining yoga’s effects on depression, fatigue, and menopause. 

And please leave any questions for the Friday Q&A in the comments.

FULL DISCLOSURE

by Brad Gibson

Okay, so it took me ten years to finally listen to my wife Nina and take up yoga. I may be slow, but I’m not an idiot.  So what was the epiphany? There were actually several. 

The first was listening to my wife Nina and Rodney Yee at a book signing in Los Angeles talk about how restricted most of us are in using and exploring our bodies. As adults we typically sit, stand up, walk, and lie down.  That’s pretty much it. Compare this to our younger selves, where we rolled down hills on our bellies, spun ourselves so we were so dizzy we crumpled to the ground, and did handstands on the lawn.  And all that just for the fun of it.

The second was attending a seminar given by a well-regarded scientist from the University of California San Francisco.  Here I learned about the startling plasticity of the human brain, and its ability to rewire and reorganize itself based on various environmental and behavioral stimuli. One particular example struck me: that the regions in the brain that control movements to our fingers are spatially distinct and this spatial resolution and control can be lost if the hand is constrained in motion over long periods of time. These regions then shrink and become partially fused, resulting in the inability to use the hand in a way we are accustomed, and more like a paw. The good news was that this is largely reversible if the constraint is removed.  The brain—along with the slow recovery of the hand —can then restore these neural connections. The significance to our aging brain and body was clear, both in a negative and positive sense. We must actively fight against the restricted physical activity that we impose on ourselves, as well as the loss of dexterity that is the result of this behavior. Otherwise, this can become a vicious cycle as we react to our aging bodies by imposing further restrictions to our movements, and our brain’s ability to control and balance these movements becomes diminished as a result. 

The Light on the Water (from Muir Beach) by Brad Gibson

My third epiphany was a bit more vain, but important to me nonetheless. As I was attending a party in the Berkeley hills on a warm summer evening, I was struck by how many beautiful women were there. Now this party was not one of the faculty or science-type parties that I usually attend, but one made up of by yoga practitioners of many stripes and ages. But as I pondered this—admittedly over a few glasses of very good vodka and some really delicious food—I realized that these people held their bodies in a posture and poise that I was not generally accustomed to. They were not just physically fit, but healthy and vibrant. Okay, my wife did point out the next morning as I told this story that I not only didn’t have my glasses on, but was also pretty drunk by this point. Fair enough. But over the years—and under more sober conditions—I have found this observation to hold up pretty well. 

So as a scientist who studies the biology of aging and the many disease that are associated with aging, I have come to my own personal conclusions on the importance of practicing a mind/body discipline like yoga. And as I approach my 59^th birthday, the immediate realities of physical and mental loss become more apparent. And I am not one of those people who think I can avoid this. I do believe, however, that we have the capacity to regain some of theses age-related losses, and if not, at least slow down their progression. Regaining or maintaining a higher level of balance, physical dexterity, and cognitive function and resolution is therefore something that is attainable and has the capacity to make huge impacts on the quality of our lives. The aging component that works against all this and drives these declines, however, is scientifically and mechanistically poorly understood. This is what makes my scientific life and work so interesting. But as far as I can tell, the basic processes underlying human aging are largely inescapable, at least as we currently understand them. That doesn’t mean we can’t intervene or we have to give up, nor that some of the losses we associate with aging can’t be mitigated.  We probably need to practice both acceptance and active engagement as we confront our own aging—part of the underlying philosophy of yoga that I am still struggling with. In any case, it can’t hurt to strive to feel better and think more clearly. There are few things that I would consider more important.

My primary interest in participating in this ongoing discussion on “yoga for healthy aging” is to examine evidence on how practicing yoga might intervene and in some cases reverse some aspects of the mental and physical decline we think of as normal aging. In doing so I have to first acknowledge that there is a lot of crap out there, and as a scientist I would want to bring rigorous and critical thinking to the process of evaluating these claims. Most published studies or claims just don’t stand up to rigorous scientific and statistical scrutiny because of poor study design, small sample size or the lack of good controls. But I also I don’t want to fall into the trap of constantly seeking to debunk or ridicule studies that attempt to establish a connection between yoga (or other related disciplines) and possible beneficial effects on aging or limiting age-related diseases. Rather, I’m more interested in trying to extract whatever useful information I can from these aging studies and see if it can be applied to improving one’s yoga practice.

And lastly, a full disclosure: I’m a firm believer in science.  I am also a believer in western medicine, although with some qualifications.  My concern with western medicine is that it can overreach itself at times and rely on vastly incomplete scientific knowledge in coming to diagnosis or treatments.  Or worse yet, it can incorporate many cultural biases. That said, it’s by far the best and most successful form of medical practice that we have. I am also aware of limitations in the scientific method. Not so much as a philosophy or discipline, but rather from the standpoint of recognizing the difficulty of scientific inquiry in tackling highly complex phenomena or systems. And as complex biological systems go, humans are at the top. This makes it exceedingly difficult for scientists to predict, investigate or fully understand how we respond to various environmental, temporal and behavioral changes. And yes, yoga would fall under these latter categories, as would aging itself.

Despite all this, I believe there are important things that we can do that can impact and alter our aging status and overall health, and that yoga has the potential to be a key player in this process. Indeed, some reasonable information already exists on how yoga might lower blood pressure, or reduce muscle atrophy (sarcopenia), stress, or cognitive decline.  These and other such topics will be ones that my colleagues and I will try and tackle.

Do any of you have questions for our scientist?

TEACHING A MAN TO FISH

by Baxter Bell

Having started out in the healing profession as a medical doctor, I always remember back to the times when patients presented with physical affects of aging. In those days, when my prescription pad was my only option, I felt I didn’t have many good tools for helping them. For example, when a patient would present with complaints of lower back pain related to arthritis, I would typically prescribe anti-inflammatory medication, rest, ice and heat, and possibly a few visits to a physical therapist. These days I find it much more effective to start with modified yoga practices and lifestyle modifications before moving on to a typical western treatment.

Yoga is a treasure chest of options, techniques and tools, some of which have developed over thousands of years. And these days, when people in my classes and therapeutic sessions present with difficulties that are the direct result of aging (such as arthritis, auto immune diseases, and high blood pressure), I feel like I can truly offer something of benefit. By giving my patients new skills for self care, including yoga poses, breath work, and mediation techniques, I am, as the Chinese proverb says, teaching them to fish:

 “Give a man a fish and you feed him for a day. Teach a man to fish and you feed him for a lifetime.”

 Through this blog I’m hoping to be able to help you the same way. I’m also excited about the topics we’ll be taking on for the personal impact the information will have on my own life. I have been practicing yoga coming up on 20 years now, and as I look around at my contemporaries in age and background, I get the impression that my health is better than most of theirs. But I have big questions about why this is happening. For this reason the current scientific research on aging is very intriguing to me. And the process of getting new information and digesting it, and then figuring out its applicability and validity is one that I love. I start to look at it with a critical eye to determine how beneficial it is both to my patients and myself, and then present it in a more realistic and accessible way. The blog will allow me to the share this ongoing process with you.

We'll be answering questions this week in a Friday  Q&A post, so please ask any questions you have for me by leaving a comment. Tomorrow, Brad will hold forth.

IN THE KITCHEN

It came to us while the three of us were in the kitchen, preparing a meal together and talking about how these days, as we age, our yoga practices are designed to address our changing needs and concerns: wasn’t it about time the three of us finally collaborated on a project? “Yoga for healthy aging,” Nina said. “And a blog would be a perfect way to start.” Baxter was concerned that we might not have enough material for an ongoing project, but Brad said, “No way. We’ll never run out of topics!”

You see, between the three of us, we have a wealth of special information and techniques we'd love to share with you.

Baxter Bell is an MD, a medical acupuncturist, and a long-time yoga teacher. Besides teaching regular asana classes, he specializes in yoga for back care and anatomy for yogis. He'll be recommending yoga poses and other practices for you that address various physical aspects of healthy aging, including strength, balance, flexibility, circulation and agility.

Brad Gibson is a professor at the Buck Institute for Age Research, where aging and age-related diseases are the sole focus of the institute. As more is discovered about the aging process, our understanding about how to support healthy aging with yoga will increase. Brad will help you keep in touch with the latest scientific discoveries, and we'll explain their connection to specific yoga practices.

Nina Zolotow is a yoga writer as well as a certified yoga teacher and a long-time yoga practitioner, and her special area of expertise is yoga for emotional wellbeing (including yoga for stress, insomnia, depression, and anxiety). She’ll be recommending yoga practices for cultivating equanimity because as we age, reducing stress is more important than ever, both for our physical health and our peace of mind.

This week each of us will take a turn letting you know a little more about ourselves and why we decided to take on this project. After that, we hope to take requests! Below is a list of the general topics we are planning to take on. But please leave a comment if any you have any special questions or concerns you like us to address.

·      strength

·      balance

·      flexibility

·      agility

·      circulation

·      stress

·      cognitive functioning

·      equanimity

·      specific age-related diseases (such as arthritis, high blood pressure, Parkinson’s, diabetes, etc.)

·      what is known (and what is not known) about the aging process

Tune in tomorrow to hear from Baxter. In the meantime, here’s another photo of Mount Tamalpais, where the peak is above the fog line. Sometimes we can get there.