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.

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Happy Anniversary! Five Years of Yoga for Healthy Aging

by Nina

It was our five-year anniversary yesterday! Celebrate with us this year by enjoying a virtual cake and ice cream by my daughter Rosie Gibson and by listening again to "Float," one of my favorite songs by Flogging Molly (I love the video, too). I still think that the chorus for this song, “Ah but don't, don't sink the boat/That you built, you built to keep afloat,” works perfectly as a theme for this blog. That, and the ending to the song:

A ripe old age,
A ripe old age,
A ripe old age,
Just doing the best I can! 



We’ve had a very productive fifth year! We now have 1,2689 posts on the blog, covering a wide range of topics, including aging theories, asana practice and individual poses, pranayama and meditation, stress management, brain health, cardiovascular health,  medical conditions, ayurveda, yoga philosophy, and mindfulness. If you are interested in reading earlier posts, you should know there are three different ways you can search the blog for particular topics (or authors). See How to Search for details on how to do so in our new format.

We had changes in our staff, too. We added a new regular contributor, Beth Gibbs (see Beth Gibbs Joints Yoga for Healthy Aging for information about Beth). Love you, Beth! By the way, our blog strictly non-profit, so this means that Beth as well as our ongoing staff (Baxter, Ram, Shari, Jill, Bridget, and me, your Editor-in-Chief) are doing this work out of love. I’m so grateful to be working with such an extraordinary group of people! 

We started our Yoga for Healthy Aging Teacher Certification program in 2015 (see Yoga for Healthy Aging 2017 Winter Intensive for information about our next intensive/teacher training). And we now have certified YFHA teachers throughout the USA and Canada (see Certified Teachers). 

Finally, Baxter and I found a publisher for our book on Yoga for Healthy Aging: Shambhala Press. The book will be released in the fall of 2017. Many thanks to Senior Editor Dave O’Neal for "discovering" us when he attended our first intensive!

I'll end by saying that as always we're grateful for and appreciate all our readers, and we love hearing from you. 

“Tomorrow smells of less decay
The flowers quick just bloom and fray
Be thankful, that's all you can” —Flogging Molly

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Best Advice When Looking For Exceptional Anti Aging Doctors

By Kenneth Kelly

Becoming an anti-aging expert is the best career decision one could make today. The number of people demanding such services has skyrocketed, more so in the developed nations. Their most essential services include the slowing down of the signs, symptoms, and manifestations of old-age. They are willing to go to any measures to reduce the onset of complications that come with advanced age. This article is filled with fantastic tips and insights on how to land a competent anti aging doctors.

The web never disappoints when it comes to finding out any news and information about any given topic. Go online and perform research. The most elaborate database has to be the anti-aging physician guide. Alternatively, one could visit the official websites of the leading aging clinics and facilities and gather all the relevant information and insights needed to make an informed decision.

There is nothing as powerful as personal referrals. When it comes to learning all about the leading practitioners around, always begin by talking to family and friends. Get their input and advice on how to find the best doctors around. The best thing about this avenue is that it is free of charge, and most importantly, you end up getting referred to a person who is trustworthy and capable of delivering superb services.

The best way to assess the credibility and the overall professionalism of a consultant is by meeting up with them. Sit them down at taking them to task on a few questions. For instance, get them to fill you in on the risks versus the rewards associated with the particular procedure they are performing for you. A quality expert will enlighten and illuminate you on the best health and wellness practices to adopt, moving forward. Methods like the ideal diets, exercise regimens, and even medications to help you.

Always strive to engage the most experienced doctors. These are the kinds of people who have the best reputation. They often boast of having the biggest fan base and following. They have such an impressive track record that their peers and competitors hold them in pure awe and reverence.

The best physicians in the field are keen to acquire and utilize the best technologies on behalf of their patients. Nothing is too expensive for them. With the help and aid of cutting edge equipment and medications that their patients stand a much better chance of staging a full recovery. Before you enter into a contract with any expert, insist on verifying the materials and procedures they use to ply their trade.

Before one is allowed to practice, they have to undergo many years of training. The process starts off at medical school. It then takes them to higher places of learning where they gain the relevant experience and expertise necessary for the practice. The aging-related world is always growing and evolving. It calls for the individual to keep on learning and refreshing their knowledge and understanding of what goes on to avoid becoming redundant.

Permits and licenses are a must have for any discerning establishment. Ask the doctors to provide you with a copy of their documents before you embark on any contract with them. Consult with other registered medical practitioners to verify and ascertain that they are indeed up to the task. The problem is that the market has become flooded with a vast number of unregistered facilities. The danger of working with such firms is that they could end up adversely affecting your health.

About the Author:

If you are searching for the facts about anti aging doctors, come to our web pages online today. More details are available at http://energeticfitness.com now.

Friday Q A Aging Muscles Bones and Joints

Adam and Eve by Lucas Cranach the Elder

Q: You all have been writing a lot about muscles and bones lately. I was wondering, how exactly does aging affect our musculo-skeletal system? And how can we influence the aging process with yoga and our lifestyle choices?

A: The process of aging affects our musculo-skeletal system in several particular ways. As I have written about previously, as muscles age, especially after about the age of 50, we start to lose muscle mass in a process called sarcopenia (see Strength and Aging). Sarcopenia is considered a normal part of the aging process, one that can lead to visibly smaller skeletal muscles—the ones that move our body and limbs around—which are then also going to be weaker. It is usually a slow, gradual process, but unchecked could lead to a point in a person’s life when the weakness could negatively impact his or her daily activities. According to an article Aging changes in the bones – muscles – joints from the National Institutes of Health: 

“Changes in the muscle tissue, combined with normal aging changes in the nervous system, cause muscles to have less tone and ability to contract. Muscles may become rigid with age and may lose tone, even with regular exercise.”

The body’s soft tissues tend to mostly made of water, and as we age, we also gradually experience a decrease in the amount of water in the muscles and the connective tissues (fascia and tensions) that surround the muscles and attach them to the bones, as well as the ligaments that connect bones to bones. As these changes occur, these structures become more brittle, less resilient and more likely to suffer injury, such as, strains and sprains. And because these structures don’t have a very good blood supply to start with, repair and recovery is typically slow, and slower as we get older. Other important soft tissue structures, such as the intervertebral discs between the vertebrae bones of the spine, and cushions, such as the meniscus in the knees and the labrum in the hip and shoulder joints, also suffer the same changes and the same potential for injury and degeneration. 

The skeleton, which is made up of over 200 bones, also undergoes changes as we age. Most commonly, the joint surfaces between the mobile joints can suffer wear and tear over a lifetime of use. The connective tissue barrier known as cartilage that coats the ends of each bone to make it slippery and cushioned can gradually thin out and leave the underlying bone exposed and sensitive to inflammation. This is commonly referred to as osteoarthritis (see Yoga for Osteoarthritis), an extremely common aging-related problem that can actually start at about any age, especially in those who use their bodies intensely for sports and work activities. 

Finally, the bones can begin to thin and lose density as we age, making them more vulnerable to fractures, which can then be slower to heal due to the abnormally thin bones. Thinning of the bones (osteoporosis) is extremely common in women over 65, with up to 50% developing it, and surprisingly common in men as well over 65, at 25% incidence. The bones of the thoracic spine (your mid spine) are at greatest risk for fracture, followed by the wrist bones and the femur bone (thigh bone) of the hip joint. Fractures from osteoporosis can lead to ongoing chronic pain, physical disability and, particularly with hip fractures, premature death. 

These factors and others, such the connection between the muscles and the neurologic system, can also lead to changes in posture and balance, which can also increase the chances of injury over time. An increase in general stiffness and pain can also arise with combinations of the above changes. 

On a brighter note, it has been noted in aging athletes, specifically long distance runners and cyclists, who maintain good cardio-vascular and respiratory function may see improved endurance in their sports compared to when they were younger! Here is a case where long term participation in physical activity pays off in improved function, not decline. This speaks directly to what we can do with regards to our lifestyle choices that can positively influence these changes of aging: stay active!  Regular exercise, modified to accommodate body changes such as arthritic joints or thinning bones, can help to slow, stall and even reverse many of these conditions. And for our purposes here, yoga can be an ideal standalone practice for some conditions, such as sarcopenia, and great in combination with other health practices for others, such as with osteoporosis or arthritis (which might also require medications and mineral supplements, for example). Eating a healthy diet and drinking adequate amounts of water to fuel and hydrate the body, and by extension these parts of the musculo-skeletal system, is another wise choice. 

For further information, check out these posts from our archives:

• Yoga for Strength: An Overview 
• Yoga and Flexibility: An Overview
• Healthy Bones for Men and Women Alike
• What is Osteopenia? How Can Yoga Help?
• Yoga for Osteoarthritis

—Baxter

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Friday Q A Why Focus on Yoga for Healthy Aging

Young & Old Irises by Melina Meza

Q: Dear Baxter, you're not that old yet—or at least you don't look it! So I was wondering why you decided to make yoga for healthy aging your area of specialty.

A: It is always hard for me to tell if I choose my specialty or the specialty chooses me! When I was in medical school, I thought I was going to choose to do a surgical specialty, as I was good with my hands and there was a kind of mystic healing that took place in the surgical suite. Yet, as I was exposed to all the different specialties of medicine in my training, I felt a new calling from family medicine. I realized I could affect so many more people, and of all ages. I enjoyed working with infants, children, teenagers, young adults, and older adults, so family practice kind of choose me.

With yoga for healthy aging, there was a similar draw. As I finished my yoga training, I was again thinking of how my new passion, yoga, and its health promoting and healing potential could reach the largest audience possible. And as I worked with yoga for the first 16 years of my practice, age itself may have been choosing this path.

And isn’t the concept of aging intriguing? At face value, from the day of conception, each of us is aging each and every day. The first 18 years or so of our lives are mostly about growth towards our adult bodies and brains, so aging is exciting, as we get closer to becoming mature adults—often considered a desirable threshold. Then, as we enter our young adult years, finding our place in society, and our first careers and important relationships, age seems have a neutral reputation for a while. And somewhere in mid-life, we realize we have been around a while and even begin to contemplate if and when this life might be over, and age’s reputation starts to tarnish. But all the while, we are getting one day older with each spin of the planet. And sometimes we are in good health, and sometimes we are faced with the myriad of physical, mental and emotional challenges humans fall prey to. Life.

I added yoga into the formula of my life around age 34, and have been reaping the rewards ever since, the ones we write about each week—flexibility, strength, balance, and agility, as well as the stress managing benefits and the sense of equanimity in the face of ever changing circumstances. But I have also seen these same benefits in the very young, the teenager, the young adult, and the much older adult who take up the yoga practice and make it a regular part of their lives. It’s quite powerful! So I want to inspire and teach as many people out there as possible about the wonderful potential yoga has for us as we travel our lifetimes. So, that is at least part of the reason why I have chosen to “specialize” in yoga for healthy aging. Thanks for asking and prompting me to sit and reflect in this immensely gratifying journey I am on with yoga.

—Baxter

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Science Aging and Yoga

by Brad

Paris in the Rain by Brad Gibson 

So I promised I would get back to the question of how one would use science to study the effects of yoga on aging. As a starting point, let’s look at one highly publicized study that appeared a few years ago in Lancet Oncology (see here).

This work was collaboration between Elizabeth Blackburn, a prominent and highly respected biochemist at UCSF and recent Nobel Prize winner in Medicine, and Dean Ornish, a clinician at UCSF and well-known author of books and articles linking better nutrition to health and disease prevention, especially for coronary heart disease. The basic premise of their 2009 Lancet study was to examine whether relatively short-term lifestyle changes consisting of a low-fat diet, moderate exercise and yoga-based stress management could effect telomerase activity in circulating blood peripheral blood mononuclear cells (PBMCs) that are largely cells involved in immunity. 

The authors enrolled 30 men with a pre-diagnosed low-risk for prostate cancer for a three-month regimen. They measured telomerase activity, an enzyme present in certain class of replicating cells that maintains the length of telomeres. Telomeres are repetitive stretches of DNA at the ends of chromosomes that protect the integrity of chromosomes, and with each cell division gets shorter. Telomere shortening has been shown to negatively affect a cells capacity to replicate and general maintenance. Telomere shortening has been suggested as a biomarker of aging, acting as a type of clock for cellular aging. This so-called “telomere theory of aging” has gone out a favor among some scientists in recent few years, and its role in aging is controversial. Nonetheless, the basic premise underlying this study is that higher telomerase activity will lead to longer telomere lengths, which will set back the aging clock a bit in some way, or at least lead to healthier immune cells.

The author’s conclusions were as follows: “Comprehensive lifestyle changes significantly increase telomerase activity and consequently telomere maintenance capacity in human immune-system cells. Given this finding and the pilot nature of this study, we report these increases in telomerase activity as a significant association rather than inferring causation. Larger randomized controlled trials are warranted to confirm the findings of this study.”

What they mean here is that the number of patients in the study was low (N=30 is very small for a study of this type, and only 24 of these could actually be followed up the multiple times needed over this three-month period for technical reasons), the patients were pre-selected as having a clinical diagnosis of possible “low-risk prostate cancer” (that is, not a random group and probably motivated for a positive outcome), and that the results can at best be interpreted as an association and not necessarily a cause of the three-month lifestyle change (that is, just because thus group showed an increase in their telomerase activity, it doesn’t mean it resulted from the lifestyle intervention, but it could be the result of any one of a number of variables that were unaccounted for during this period, sometimes referred to as “confounders”).

But larger randomized properly controlled trials are expensive to run, and without a serious backer—the government or a drug company—don’t expect to see a follow-up any time soon. Just think about the large-scale trails of vitamin E that after many years and millions of dollars not only failed to establish a link but also showed a possible negative association. This is part in parcel of the tough love and art of large-scale clinical trials that are required if you want to prove something using rigorous scientific methods. 

So what did this study actually show? At minimum they showed what was needed for carrying out a larger study (power calculation) to actually determine a causal relationship. No mechanism was defined for why telomerase activity increased, although several were suggested (reduction in oxidative stress and inflammation, for example). Otherwise one shouldn’t draw too many conclusions from this study, especially since three independent variables were introduced (diet, exercise and yoga) and the study group was so small and biased. And one has to also keep in mind that the telomere length was not directly measured, as the authors themselves pointed out that telomere length changes would likely to be too small to measure in such a short time (three months). So I guess there’s another message to take home: some things take time.

Reports like these remind me of one of the reasons I have sympathy for the “N of 1” studies, that is, experimenting on yourself. Not real science, but you’ve got to try something. Take up yoga, improve your diet, have a walk everyday, and see what happens. 

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Yoga for Healthy Aging Our Philosophy and Our Tools

by Nina

Philosopher in Meditation by Rembrandt

I always tell everyone, including Brad, that my husband is my worst employee. I mean, how long has it been since Brad has even written a single post for this blog? I don’t even want to know. But the reason I don’t just fire Brad—besides the fact that writing for our blog isn’t really a job and no one gets paid for their work anyway—is that when he does write a post, it is always really outstanding.

I’m bringing this up today because I just went and reread Brad’s very first post for the blog Full Disclosure because I’ve been thinking about how to express our basic intentions for teaching yoga for healthy aging. Just last week, Baxter and I discussed what we meant by “yoga for healthy aging”, and we agreed that “yoga for healthy aging” was both a set of yogic tools and a basic attitude or philosophy. You know, we said, that thing Brad wrote about the first week of our blog about acceptance and active engagement. 

And lo and behold! When I went back to see what he wrote, I found he expressed our basic philosophy so well, there was no reason even to rewrite it in any way.

So as a scientist who studies the biology of aging and the many diseases 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 59th 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.

At the time, I felt what Brad had said was very important, so I went ahead and expanded on the yoga philosophy he alluded to in his phrase “part of the underlying philosophy of yoga.” In my post Acceptance, Active Engagement, and the Bhagavad Gita, I explained that the main message of the Bhagavad Gita—one of the most important of the yoga scriptures—was about the benefits of acceptance along with the need for action. This is what is meant by when Krishna tells Arjuna to work “not for a reward” or, as in another translation, without being “attached to the fruits of your actions.”

Set thy heart upon thy work, but never on its reward.

Work not for a reward; but never cease to do thy work.

Do thy work in the peace of Yoga and, free from selfish desires, be not moved in success or failure.

Yoga is evenness of mind—a peace that is ever the same. — trans. by Juan Mascaro

Krishna explains to Arjuna that work is a necessary part of human existence, so the only way to attain equanimity is to do your work without any thoughts of results, remaining open to success or failure. And that this approach—this letting of all results, whether good or bad, and focusing on the action alone—is the essence of yoga. 

But how does this yogic attitude relate to healthy aging? Although we recommend that you practice yoga regularly with the goal of attaining a longer health span and maintaining your independence (see What is Healthy Aging, Anyway?, Yoga for Healthy Aging is Not Science Fiction, and A Declaration of Independence), we also believe it is important to keep in mind results are never guaranteed. As Brad said, the basic processes underlying human aging are largely inescapable, at least as we currently understand them. So we feel that at the same time that you work toward staying healthy by using the tools in your yoga toolbox you should try to let go of all thoughts of success or failure and simply focus on your practice. Then no matter what happens, you’ll be prepared to handle it. (See Acceptance, Active Engagement, and the Bhagavad Gita for background information about the Bhagavad Gita and its basic message.)

In my post Opening Your Yoga Toolbox I provided an overview of the basic tools in our yoga toolbox, saying we had divided them into three groups.

1. Physical health tools for body and brain
2. Stress management tools
3. Equanimity tools

All of these tools—including asana, pranayama, meditation, and yoga philosophy—are exactly what you will use to do to do your daily work, which is your yoga practice. And this set of yogic tools plus a basic attitude of acceptance combined with active engagement is what yoga for healthy aging is all about.

In this wisdom, a man goes beyond what is well done and what is not well done.

Go thou therefore to wisdom:

Yoga is wisdom in work. —trans. by Juan Mascaro

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