1: Sophie was “a vibrant, athletic woman who had seemed ageless,” Dr. Peter Attia writes in his book Outlive: The Science and Art of Longevity.
One afternoon, when she was in her early seventies, she slipped while working in her garden and tore a muscle in her shoulder.
That began a steep physical decline. Her “back and neck pain was so severe,” Peter writes, “that she could no longer work in the garden or play golf at all, her two primary passions in retirement.”
She had surgery but never fully recovered. “Her activity level dropped off almost to zero,” he notes. She “mostly sat around the house, feeling depressed. Her cognitive decline fairly quickly ensued.”
What is the #1 leading cause of accidental deaths in those ages sixty-five and older?
Falls.
“And this is without even counting the people who die three or six or twelve months after their nonfatal but still serious fall,” he notes.
The CDC reports that more than eight hundred thousand older people are hospitalized for falls each year.
The challenge we all face is that it takes dramatically less time “to lose muscle mass and strength than to gain it,” Peter explains. “Even if someone has been training diligently, a short period of inactivity can erase many of those gains.”
One study of twelve healthy people, with an average age of sixty-seven, showed that after just ten days of bed rest, the participants lost an average of 3.3 pounds of muscle.
“That’s substantial,” Peter notes. If inactivity lasts longer than a few days, the result can be a long and painful decline from which we may not fully recover. Which is what happened with Sophie.
2: This is where stability comes in.
Peter considers stability “to be just as important as aerobic fitness and strength. It’s a bit hard to define, but I think of stability as the solid foundation that enables us to do everything else we do, without getting injured. Stability makes us bulletproof.”
While Sophie was relatively fit for her age, she lacked stability. This put her at risk of injury.
“A typical seventy-year-old will do less than half as much ‘moderate to vigorous’ physical activity as he or she did at age forty,” he notes. “And after age seventy the decline accelerates. The fit people in their seventies and eighties are the exception, not the rule.”
Why is it this? Peter has a theory: “Older people tend to exercise less, or not at all, because they simply can’t. They have hurt themselves in some way, at some point in their lives, and they just never got back on the horse. So they continued to decline.”
Injuries can start at any age. When Peter was in medical school in his twenties, he lifted weights almost every day. One day, he experienced a mysterious back injury “that required two separate surgeries (one of which was botched), followed by a long and very difficult recovery,” he recalls.
“For several months I was almost unable to function, surviving on large amounts of painkillers. I couldn’t even brush my teeth without excruciating back pain, and I spent most of the day just lying on the floor. It got so bad that my mom had to fly out to Palo Alto and take care of me.”
The CDC reports that more than one in four Americans forty-five and older suffer from chronic pain. More than 10 percent say their pain limits their lives “most days or every day” during the previous six months.
The single biggest culprit is back pain, the leading cause of disability worldwide. In the U.S., total medical costs and lost productivity are estimated to be over $600 billion.
“As I learned,” he reflects, “all the aerobic fitness or strength in the world won’t help you if you get hurt and have to stop exercising for several months—or forever. . . This is why our approach to exercise must increase not only our conventional measures of fitness, such as our VO2 max and our muscular strength, but above all our resistance to injury.”
What is Peter’s first commandment of fitness? “First, do thyself no harm.”
We do this by focusing on stability. He writes: “Stability is often conflated with ‘core,’ but there is much more to it than having strong abdominal muscles. . . In my view, stability is essential to any kind of movement, particularly if our goal is to be able to keep doing that movement for years or decades. It is the foundation on which our twin pillars of cardiovascular fitness and strength must rest. . .
“Stability is what enables a seventy-five-year-old woman to continue playing tennis injury-free,” he notes. “Stability is what keeps an eighty-year-old grandmother from falling when she steps off a curb that is unexpectedly high. Stability gives a ninety-five-year-old man the confidence to go walk his beloved dog in the park. It lets us keep doing what we love to do.
“When we don’t have stability, bad things will inevitably happen—as they did to me, and to Sophie, and to millions of other formerly fit people.”
Our goal is to anticipate and avoid potential injuries. We train for stability as well as strength. We protect where we are vulnerable: our backs and knees.
3: Peter has two additional recommendations.
First, to investigate DNS or Dynamic Neuromuscular Stabilization. “The theory behind DNS is that the sequence of movements that young children undergo on their way to learning how to walk is not random or accidental but part of a program of neuromuscular development that is essential to our ability to move correctly. As we go through this sequence of motions, our brain learns how to control our body and develop ideal patterns of movement.
“DNS originated with a group of Czech neurologists who were working with young children with cerebral palsy in a hospital in Prague in the 1960s. They noticed that because of their illness, these kids did not go through the normal infant stages of rolling, crawling, and so forth. Thus, they had movement problems throughout their lives.
“But when the children with cerebral palsy were put through a “training” program consisting of a certain sequence of movements, replicating the usual stages of learning to crawl, sit up, and eventually stand, their symptoms improved and they were better able to control their motions as they matured. The researchers realized that as we grow up, most healthy people actually go through an opposite process—we lose these natural, healthy, almost ingrained movement patterns.”
Second: “We have to break out of the mentality that we must crush all our workouts every single time we go to the gym—doing the most reps, with the heaviest weights, day after day. As I learned, pushing oneself so hard all the time, without adequate stability, almost inevitably leads to injury.”
Peter doesn’t push strength training with his clients until they’ve internalized the importance of stability.
We focus on “doing things right, cultivating safe, ideal movement patterns that allow our bodies to work as designed and reduce our risk of injury,” he writes.
“Better to work smart than to work too hard,” Peter suggests, because our “goal is to be strong, fluid, flexible, and agile as we move through our world.”
More tomorrow!
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Reflection: How can I prioritize stability and injury prevention in my fitness routine to maintain my health and independence as I age? What small changes could I make to my daily activities to improve my overall stability and reduce the risk of falls?
Action: I will incorporate at least 10 minutes of stability-focused exercises into my daily routine, such as single-leg balance exercises or gentle yoga poses, to build a foundation for long-term fitness and injury prevention.
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