Older Couple Won't Tone Down The Intensity Of Their Exercise
DEAR DR. ROACH: My parents are both retired medical professionals who are in their early 70s. My father has diabetes that he manages with medication, and he also has a history of recurrent prostate cancer. My mother has had osteopenia for years. They want to remain in good cardiac health and have been exercising regularly in recent years to stay fit.
But their exercise is so intense for their age that they are starting to injure themselves doing it. (My dad had a stress fracture that he almost didn't notice, and my mom broke her toe in dance class.) Is there a middle ground here between maintaining cardiovascular function and maintaining orthopedic health in an aging body? If so, how would a middle ground look in practice? Because I am not a medical professional, they dismiss my concerns. -- C.S.
ANSWER: People exercise for many reasons, but if their goal is to improve their overall health, then regular-moderate intensity exercise, while avoiding very intense exercise is probably best. I certainly have had young and middle-aged patients develop stress fractures (especially runners), while dancers and many other athletes can develop broken toes and other bones.
Unfortunately, the recovery time in a 70-year-old can be longer than the six weeks it is for younger people, so it is certainly wiser to choose lower-risk activities for exercise. I do want to emphasize that having them exercise is critical. Exercise will help your mom maintain bone strength.
Exercise of any kind is beneficial for heart health in both men and women. It actually improves survival in men with prostate cancer and is critical for people with diabetes. The best exercise for a person is one that they enjoy doing and will keep doing.
Since they may not be listening to you, a conversation with their doctors may be helpful. Recommending an exercise program that has a lower risk of injury -- and that they won't get bored with -- may take some creative thinking and a lot of back-and-forth.
Finally, it may be that despite the risk of injury, they may choose to take the risk in order to keep up the exercise program they have been doing for years.
DEAR DR. ROACH: Is there enough information regarding oral weight-loss medications versus injections and their effectiveness? What is your advice? -- D.R.
ANSWER: A 2023 trial by the manufacturer of Ozempic, Wegovy and Rybelsus found that a 50-mg daily oral dose was effective for weight loss. Several trials have concluded that oral semaglutide (Rybelsus) is as effective at improving endpoints as an injection of semaglutide (Ozempic). However, there has not been a direct head-to-head trial, so I can't answer your question with complete confidence.
Although the manufacturer states that 50 mg of semaglutide was well-tolerated, my patients' experience with the usual doses of oral semaglutide (3, 7 and 14 mg) shows that nausea can be a real problem. The 50-mg dose is not available, so I have no personal experience in prescribing it. But this high a dose makes me a bit nervous.
Most of the data on semaglutide for weight loss and reducing cardiovascular risk come from the injections. It is possible but unproven that higher-dose oral medications will be just as effective. Tirzepatide (Mounjaro and Zepbound) is not available as an oral agent, so I can't say anything about whether it might be effective this way. I am treating most of my patients who decide on this type of drug for weight loss with injections.
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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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