Middle Age Exercise: The Last Chance for Brain Health

I recently came across fascinating insights about the importance of middle-age exercise through a lecture by Professor Jung Se-hee from Seoul National University's Department of Rehabilitation Medicine. Her discussion about exercise patterns in Parkinson's patients and how middle-age cardiovascular fitness affects brain health completely challenges our preconceptions about exercise.

The Mystery of Exercise Revealed Through Parkinson's Disease

Observing the exercise patterns of Parkinson's patients reveals truly remarkable phenomena. A patient who can usually only manage shuffling steps suddenly walks naturally when dribbling a basketball. Another patient who struggles to walk on flat ground can skillfully run up and down stairs or ride a bicycle.

This happens because the brain uses different neural pathways. Walking is an automated movement we perform almost unconsciously. Parkinson's disease specifically affects these automated movement pathways. In contrast, basketball dribbling, cycling, and stair climbing require conscious attention and use different neural circuits.

This is called a "gait compensation strategy," which is actually used in treatment. When patients are asked to count numbers, step on laser points, or walk sideways, these methods redirect conscious attention and often improve their gait.

The crucial point here is that using these compensation strategies requires basic fitness and muscle strength as a foundation. If someone has never exercised and lacks both muscle strength and cardiovascular fitness, they can't run up stairs or ride a bicycle. This means exercise can become an important therapeutic tool when disease strikes later in life.

Middle Age: The Watershed of Health

While South Korea ranks 3rd globally in life expectancy, we're only 51st in healthy life expectancy. This contrasts sharply with Japan, which ranks 1st in both categories. This means we live long but not healthily.

From 2012 to 2022, the period of illness increased while healthy life expectancy remained stagnant. In other words, we're simply spending more time in hospitals receiving treatment.

The statistics on lonely deaths among middle-aged men are particularly alarming. Among those who die alone, 50-year-olds account for 26% and 60-year-olds for 25%. Looking at their medical history in the year before death, we see lifestyle diseases dominating: hypertension (50%), diabetes (40%), and alcohol disorders (30%).

Middle age is a period when people appear fine on the surface and remain socially active, but it's also when health management is easily neglected. This becomes the watershed moment for health.

Dementia Prevention: Middle Age is Key

According to dementia prevention research published in The Lancet, dementia is not fate but a preventable condition. 45% of all dementia cases are preventable, with middle age (45-65 years) risk factors accounting for 30% of preventable cases.

Middle-age risk factors include high cholesterol, diabetes, hypertension, obesity, smoking, drinking, and depression – all the health management items we're familiar with. In contrast, only 10% can be prevented after dementia is already diagnosed.

This means by the time someone thinks, "I have dementia, what should I do now?" it's already too late. Preparation must begin in middle age.

The Relationship Between Cardiovascular Fitness and Brain Health

Multiple studies demonstrate how middle-age cardiovascular fitness affects brain health. When people averaged 45 years old underwent exercise stress tests and had brain MRIs five years later, those with better cardiovascular fitness showed reduced brain atrophy and healthier neural connections.

Another study found that people with low cardiovascular fitness at age 40 had more brain atrophy 20 years later. A cross-sectional study of people aged 22 to 81 showed that those with poor cardiovascular fitness experienced progressive brain shrinkage with age, while those with excellent fitness maintained brain volume even as they aged.

This isn't simply about "exercise being good" – it means middle-age cardiovascular fitness can predict brain health 20 years later.

Real Exercise vs. Fake Exercise

So what kind of exercise should we do? Here's an interesting case: a 60-year-old man who played early morning soccer for 40 years complained of memory decline. When tested, his maximum oxygen uptake was in the bottom 10%. Despite 40 years of "exercise," his cardiovascular fitness was terrible.

The issue was exercise intensity. In terms of metabolic equivalents (METs), early morning soccer is only about 4-5 METs, not even reaching moderate intensity. Even during an hour of soccer, the actual time spent moving is very short – most time is spent standing or moving lightly.

Golf (with cart) is 2.5 METs, badminton is 4.5 METs, and baseball is 5 METs. Running, however, ranges from 10-16 METs depending on speed.

To build cardiovascular fitness, you need to use many muscles simultaneously, engage large energy-consuming muscle groups, and move continuously for extended periods. Running best satisfies these conditions.

Misconceptions About Exercise

Many people believe "knees are consumable parts that should be conserved" or "too much exercise actually shortens life." These are complete misconceptions.

In human history, the current period of sedentary living and body protection represents only 0.4% of our existence. Our bodies were designed to move extensively. Current sedentary lifestyles are actually abnormal.

The same applies to knee health. The way to protect knees isn't to reduce activity but to strengthen surrounding muscles to protect joints. Most people who need artificial joint surgery aren't those who exercised too much, but those who never exercised and lack muscle mass.

Running may cause knee pain, but this is an inflammatory response, not joint damage. Through proper management, it's possible to exercise at a level that minimizes knee damage while strengthening muscles.

In Conclusion

Professor Jung Se-hee's lecture gave me new insights into the importance of middle-age exercise. The examples of Parkinson's patients particularly show that exercise isn't just for maintaining health – it can become a crucial therapeutic tool in future disease situations.

Middle age is both a problematic period and a period of possibility. It's not too late yet, but we must act before it becomes too late. Making resolutions in your 60s is too late. Your 50s might be the last chance.

We need to abandon wrong preconceptions about exercise and start real exercise that builds cardiovascular fitness. While activities like early morning soccer, golf, and badminton are good, they have limitations for building cardiovascular fitness. We need exercise like running that uses the whole body and continuously consumes energy.

Ultimately, exercise isn't a choice but a necessity. It's so important that we should add exercise duty to the four national obligations. For a healthy old age, we must start proper exercise from middle age. Now is exactly that time.