Mikel Izquierdo (Pamplona, 55 years old) has been a teacher of the Master in High Performance Sports of the Spanish Olympic Committee for almost three decades, but he says that the most interesting competition is not losing tenths on a track, but preventing the bed from immobilizing an elderly person. Aging well, he says, is “retaining the strength to move, a clear mind to decide, and the ability to recover quickly when life stumbles.” And to achieve this, exercise is essential.
By applying the same principles he used in high performance – measure, individualize and progress – he saw how exercise can become a medicine to combat frailty, which manifests itself in slowed walking, the ability to get up and sit in a chair or hand grip strength. He saw that this fragility, which makes a person less in control of his own life, can be avoided through a well-designed exercise program, dosed and applied as if it were a drug. And consider that once you have this knowledge, it is unethical not to apply it to help you age better.
Izquierdo is professor of Physical Education and Sports at the Department of Health Sciences of the Public University of Navarra and head of the Physical Exercise, Health, Metabolism and Functional Capacity group at the Navarrabiomed Biomedical Research Center. He attended EL PAÍS via video call from Pamplona.
Ask. When you go to the doctor, they tell you to exercise, but this is usually a generic recommendation. What is wrong with this approach?
Answer. You need to treat exercise like a drug. In practice, this means abandoning the advice given for all these decades, moving, taking 10,000 steps, and moving to a concept in which it is prescribed in certain doses, with certain goals, and followed like any other treatment.
The patient would have to be assessed, the intervention adjusted, and what interactions the exercise had with other medications they were taking. In other words, it’s not about moving, but about the intensity, duration, type of exercise and how we combine it. The doses are not fixed, they must be modified, recoveries must be planned, safety, coordination, interaction with the disease, interaction with other medications that the person may be taking.
The message is clear: exercise will become the first-line treatment if it is prescribed rigorously.
Q. Do doctors generally have the knowledge to prescribe exercise?
A. This is knowledge that is taught to fitness professionals, but not in medical schools. Although later, doctors, when they go to conferences, it doesn’t matter whether it’s cancer or diabetes or whatever, find that they talk about exercise all the time. There is very strong evidence. We recently saw an article in the New England Journal of Medicine (one of the leading journals in which treatment-changing studies are published) demonstrating that exercise is medicine for cancer patients.
Of course, if you’re an oncologist and you’ve always managed pharmacological doses and surgical procedures, you suddenly think: what’s going on here? Doctors are aware of the need to understand how to prescribe exercise as an adjunct to other treatments.
Q. Why hasn’t exercise had as much importance in medical schools or in major scientific journals?
A. If lifestyles were managed, i.e. sleeping well, eating well, eliminating alcohol, having friends and exercising, the impact on public health would be brutal. But who is interested in this, who can make money from it? Also, if I tell you that I want to change your lifestyle, you will tell me to leave you alone. But if I see that you have an illness and I give you the pill because you are ill, you will almost always take it.
Q. Maybe it’s because when you’re old enough, if you’ve never exercised, it can be very difficult to start.
A. Well, it can also be difficult to get a tube inserted or opened during surgery, but when you’re sick, if you have to do it, you do it.
Q. How can the application of exercise as medicine facilitate the sustainability of the public health system?
A. Function should be systematically measured in addition to disease. Hand pressure, time required to get up from a chair five times… These functional elements are the best indicators of adverse effects. An oncologist knows that a person with poor functional indicators will not tolerate chemotherapy or surgery. The cardiologist knows that he cannot touch a poorly functioning patient, he cannot put a stent (cardiac intervention).
After measuring the function, to improve it, a physical exercise prescription must be prepared, which must be included in the patient’s medical history, along with other actions. And so that these do not remain good intentions, we need a system in which part of the funding granted to the centers depends on them. Because now, the financing is provided by the pharmaceutical company, which is the one that has the medical representatives to sell the products. And this is what has led to many current practices evolving.
In short: measure function, implement an exercise program, then provide incentives to centers that implement these actions. There is no need to create new structures, but existing ones are more effective.
Q. He talks about healthy aging, but many science and technology leaders now talk about treating aging as if it were a disease. What do you think?
A. This is one of the eternal struggles. From the search for the Holy Grail to the Dracula films. These are pacts with the devil. But if you are a fly, you will live a few hours; If you are a dog, a few years. And humans, over the past 70 years, have not changed the maximum life expectancy, which is between 115 and 118 years. We have an expiration date, like yogurt.
What happens is that more and more people die later, because the environment has been controlled. There are no more times of famine, there are no more wars, medicine is impressive. Now, sometimes it’s hard for someone to die because they can keep you alive in a bed with four tubes.
We need to live longer and better, but aging is not a disease, it is something natural. We age from the moment we are born. What we’re going to try to do is for us to have healthy longevity, for your intrinsic ability to be with you as long as possible, for you to die young as late as possible.
But the aging speed can be changed. There are people who have had a healthy lifestyle throughout their lives, who have done a lot of exercise, a lot of weight training, who can climb a mountain or do things that younger people cannot do.
But promises have been made to reverse aging with cocktails, supplements, over-the-counter medications that are unproven and ignore what is known to change the trajectory of aging: exercise and lifestyle.
The idea of anti-aging It is irresistible that you will live forever, but it has not been proven and it will not be proven. So what are they selling? Slogans. Aging is a disease that can be cured with a pill. And behind it all is a brutal industry that sells you resveratrol, spermidine, nicotinamide… all these molecules that slow down certain characteristics of aging. But it hasn’t been proven that they can make you live longer or that your function improves while taking them. There are no magic molecules, but these are fashionable packages of longevity, medicalizing life. Baseless promises.
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