A man we know, healthy and in his late 60s, used to visit his small local health club about three times a week. The routine made him feel stronger and more limber, and had proven benefits for his heart rate and blood pressure. But then came the pandemic, and shortly after the lockdown began in early 2020, the neighborhood fitness club closed for good. For the past two years, this man has not reestablished the routine that was helping him stay younger and fitter.
That anecdote came to mind as we read reporter Paula Span’s recent New York Times article in which health experts studying a growing body of research are sounding the alarm. The COVID-19 pandemic, these scientists warn, has had a significant negative impact on the activity level of millions of American seniors, which in turn could trigger a host of hidden impairments to their overall health.
Weakness, Instability – Lack of Movement Takes its Toll
Span begins her article with the story of Cindy Meyers, a 64-year-old California executive, who self-describes as “not a big exerciser.” Even so, Meyers’ life was not completely inactive pre-COVID. She commuted from Petaluma to San Francisco daily, cultivated an active social life with friends, and enjoyed going to restaurants, theaters, and lectures with her spouse.
Once COVID hit, Meyers—like so many others—began working remotely. The contrast surprised her. “You’re not cognizant of all the moves you’re making,” Meyers told Span, speaking of her life before the pandemic. Span adds, “That shift, perhaps exacerbated by a bout of depression in 2020, has taken a physical toll. […] Her limbs feel weak, her balance rocky; she has fallen several times.”
While Meyers’ life pre-COVID wasn’t especially active, it kept her busy. But without those activities, Meyers laments, “Basic kinds of movement you take for granted, like walking from one end of the house to the other, are exhausting. I’m worried about it.”
“To date,” Span writes, “much of the attention paid to the pandemic’s effects on the older population has focused on its frightful mortality rate: Nearly three-quarters of Americans who have died have been 65 or older.” But the shift that Meyers experienced—from a moderately active life to an inactive one—is not unusual, and has become a growing concern among seniors and health experts alike.
Even Mild COVID Cases Affect Physical Ability
These concerns are exacerbated by the adverse effects of actually contracting COVID-19. Span says, “Recent research indicates that many of those who had mild to moderate infections, even some who have managed to avoid the virus altogether, may be suffering functional declines.” But she adds, “[…] unsurprisingly, older adults whose COVID symptoms became serious enough to require hospitalization often contended with persistent physical and mental health problems,” and these effects can last for months afterward.
The recent numbers are staggering. “Nearly half of those 65 and older who had contracted COVID reported less ability to engage in physical activity like walking and exercising than before the pandemic,” Span explains, “but so did about one-quarter of those who did not become infected.”
Even the uninfected have found that their ability to do normal, everyday tasks—like dishwashing and dusting—has declined considerably due to being housebound.
Immobility Creates “A Cascade” of Negative Effects
While it’s plausible that some of the decline in mobility is just the cumulative effects of normal aging, the most recent studies have specifically tracked these changes over time, and have revealed that the public health restrictions during the pandemic carry the most weight.
A recent survey buoys this up, and reveals that the immobility in senior adults due to the pandemic has what experts call “a cascade of effects”.
To explain the domino effect that occurs, Span quotes Geoffrey Hoffman, a health-services researcher at the University of Michigan where the survey was performed: “You start with changes in activity levels,” he says. “That results in worsened function. That in turn is associated with both falls and fear of falling.”
Many Possible Causes for Decreased Mobility
Illness is only one of the causes of decreased mobility. The restrictions that came as a package with the pandemic probably had an even greater effect. “Not only did gyms, yoga studios, pools, adult day programs, community and senior centers all close for extended periods,” Span says, “many older people also undertook fewer ordinary chores and errands and may have skipped recreational pastimes.”
Between less (or zero) travel, shopping, church gatherings, family celebrations, and in-person appointments, older adults found themselves suddenly activity-less when they may never have even thought about it before. Dr. Hoffman puts it this way: “Picture how much activity we do without even thinking about it. [When activity is reduced,] it adds up over six or nine months, then you have loss of balance or muscle strength, which leads to more trips and falls.”
Exacerbating these issues are disparities in income, accessibility, and overall health: those who identify as low-income, and those with multiple chronic conditions, see an even greater and more rapid deterioration in health. And a lack of services designed to transport older adults to and from appointments has made it harder for seniors to access rehabilitation and physical therapy.
Physical Function Allows Independence
“Physical function is key to living independently — the future that a great majority of older people envision for themselves,” Span writes, painting a stark picture of the coming years. “A loss of mobility and function across a considerable proportion of the senior population could mean increasing disability, a greater need for eventual long-term care, and higher Medicare and Medicaid costs.” However, she adds, that bleak future is not inevitable.
“You can reverse deconditioning,” Dr. Hoffman says. “You can recover mobility.”
While there are certain structural changes that Dr. Hoffman would like to see Medicare and general physicians take on in prevention of serious falls—something he calls “pre-habilitation”—he urges individuals to take on the task of fall prevention themselves in whatever ways they can.
Span advises: “[…] individuals can resume walking, enroll in yoga or tai chi classes (outdoors, online, or seated in chairs, as needed), join fall-prevention programs, even practice getting in and out of chairs and lifting small weights on their own.” But she warns, “People should consult a doctor or physical therapist first if they have become severely deconditioned, however.”
Just as she began her article, Span finishes with the words of Cindy Meyers, who is trying everything she can to bring back her stamina and strength, including setting up an exercise bike in front of her TV. “I need an intervention,” Meyers says, a haunting end to the article. “This isn’t the way I want to live.”
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(originally reported at www.nytimes.com)