Posted by: drwbortz | July 15, 2010

Healthy Aging and the Oboe’s “A”

I can’t remember exactly, but it must have seemed very strange.  I was 4 or 5 years old when my parents took me to my first symphony orchestra concert at the Academy of Music in Philadelphia.

Leopold Stokowski was the conductor. 10 or 15 minutes before the music was to start, a hundred or so fellows in tuxedos and a few women in gowns started irregularly to meander onto the stage carrying a fiddle or horn. Eventually, they found a seat, usually next to someone with a similar instrument, and behind a shared music stand.

The sound on stage swelled to a mix of toots and arpeggios, everyone seemingly intent on contributing to the chaos. Cacophony is the right word for what was happening.  After all were seated the concertmaster stood up in front of the violins and all of a sudden the sound hushed- silence.  Then a forlorn single note emerged from somewhere in the middle of the orchestra. Virtually instantaneously, everyone was sounding the same note.  Amazing.

Almost immediately Stokowski walked onto the stage, with no baton, as was his habit.  The audience clapped, and soon the wonderful concert was underway.  Everyone seemed to be on the same page, the sound was glorious.  Not at all like that clamor before the oboe played its “A”.

Since then, I have seen this sequence repeated hundreds of times.  My early immersion into classical music has brought me a lifetime of high notes and rich sounds more entertaining than the Super Bowls I have witnessed.

My parents also steered me into my lifetime as a physician, an internist like my dad, with a shared special interest in aging.  This career has been similarly rewarding with thousands of intimate encounters of every possible description. I was in the life and death business, helping my patients die as late and as healthy as possible.

In this effort, I recognized early that aging was not a disease and thereby it is not susceptible to the operations and pills of the standard practice of medicine.  Aging is a life process, which requires a different conceptual framework to understand its workings.

One of the most important of these features is the absolutely central axiom of “use it or lose it.”  Any serious student of aging and every geriatrician each day sees the evidence of this axiom. Someone observed, “It’s not how old you are that matters, but instead it is how you are old.”  The How of aging is absolutely dependent on fitness, physical and psychological. A fit bone, or muscle, or heart, or brain will carry a person confidently and capably to a hundred years of age, our health warranty.

My 50 years as a physician, with a special interest in the issues of healthy aging, have been perfused with an insistence that exercise is a central concept of healthy aging.  The older a person becomes, the more important is the issue.

My friend Steve Blair wrote the central paper, “Physical Fitness and All-Cause Mortality” in the AMA Journal.  His work, done when he was lead researcher at the Cooper Aerobics Clinic in Dallas, showed a direct relationship between how long you will live and how fit you are.  I have quoted this article, hundreds of times.

Similarly I wrote a paper called “The Disuse Syndrome” in the Western Journal of Medicine in which I stated that six common conditions  all trace a major part of their causation to lack of fitness.  These are cardiovascular vulnerability, musculoskeletal fragility, metabolic instability (diabetes), immunologic susceptibility, depression, and precocious aging (frailty).

I pondered long why this impressive set of varied conditions all show the property of having lack of physical fitness as a major causative feature.  I suggested that exercise acts like a suit of armor insulating and protecting our body, from the assorted slings and arrows which disease hurls our way.

Just recently, however, I conceived of another way of thinking of the universal value of exercise, and that is to consider it as the oboe’s “A”, to which with all the organs and functions of the body tune themselves. The heart, the brain, the thyroid all hear the tone which fitness sounds. All harmonize in health.

Each of our hundred-trillion cells contains 30,000 genes switches which act as rheostats, all tuning in to a common signal.

The scientific word for this tuning is symmorphosis, an ugly word that I learned from Jared Diamond when I invited him to lecture here at Stanford University a few years ago. Symmorphosis proposes that the body structures and functions all react in a linked fashion, much as boats in the harbor behave according to the tide chart.  A moment’s reflection identifies that such linkage is not at all random, but imperative. If part of the body were to be listening to its chosen tuning, and all the others to a different note chaos would result. The toning of the fitness of the body responds as a rheostat to its signal setting, which is exercise.  A leg in a cast withers, a bored brain shrinks, a fallow artery narrows, but a loaded femur grows strong.  Use it or lose it is affirmed, like the orchestra getting the right signal.

What if the notes are flat or sharp? Disharmony and disease result.  A few years ago at Harvard Medical School, I was expounding on the use it or lose it theme and an audience member offered that they had heard another version of it, which is:”If who you are is what you do, when you don’t, you aren’t.” Clever and important .

Today I add my own kindred aphorism: “It’s never too late to start, but it is always too soon to stop.”

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