Practice in later life: what actually helps

Classical Ayurveda describes later life as vata-predominant, characterised by drying, depletion and reduced tissue, and recommends warming, nourishing, grounding, moistening measures with gentler activity.

Contemporary evidence about ageing points at some of the same things and at one thing the classical framework does not emphasise.

What changes with age

Muscle mass and strength decline from midlife onward, a process termed sarcopenia, affecting fast-twitch fibres preferentially and accelerating in later decades.

Bone density declines, particularly rapidly after menopause in women.

Balance and reaction time deteriorate, which combined with reduced strength produces fall risk.

Skin becomes drier as sebum production falls. Digestion changes. Sleep architecture changes, with more fragmentation and earlier timing.

Thirst perception declines, making dehydration more likely.

Several of these correspond well to the classical vata description, arrived at by observation.

The intervention with the strongest evidence

Resistance training. Not gentle movement — actual progressive loading against resistance.

The evidence in older adults is substantial. Strength training increases muscle mass and strength in people well into their ninth decade, improves functional capacity, improves bone density, and reduces fall risk.

This is the area where the classical instruction toward gentleness is least well aligned with what the evidence supports. Older people generally need more loading, not less, and the widespread assumption that exercise should become gentler with age contributes directly to the decline it is meant to accommodate.

Combined with balance training, exercise programmes have good evidence for reducing falls, which is among the most consequential outcomes in older age given the mortality and disability associated with hip fracture.

Where gentler practice fits

Balance work, mobility and mind-body practice have their own supporting evidence and are complementary rather than alternative.

Balance training reduces falls, and this is well established. Standing on one leg, heel-to-toe walking, and practices involving controlled weight shift all contribute.

Tai chi has among the better evidence bases for fall prevention in older adults and appears in guidance in several countries.

Yoga has evidence for balance, flexibility and mood in older adults, with the caution that some postures require adaptation and that instructors experienced with older participants matter.

Walking, which is under-rated, accessible and associated with substantial health benefit.

Adaptations that matter

Avoid loaded spinal flexion where osteoporosis is present or suspected, since it carries vertebral fracture risk. This rules out deep forward folds and certain abdominal exercises.

Be careful with inversions given the higher prevalence of eye conditions, hypertension and cervical spine changes.

Use support for balance work — a chair, a wall — which allows the practice to be done safely and progressed by reducing support over time.

Allow longer warm-up and longer recovery between sessions.

Watch for dizziness on standing, which is common with age and with several medications, and which is a fall risk in itself.

The nutritional points

Protein requirements are higher in older adults than the general recommendation, because of anabolic resistance — a larger dose is needed to produce the same muscle protein synthesis response. Adequate protein at each meal, alongside resistance training, is the combination that preserves muscle.

This is arguably the most under-applied nutritional finding in older adults, where intake frequently falls rather than rises.

Vitamin D and calcium for bone health, with supplementation appropriate in many older adults.

Adequate energy intake. Unintentional weight loss in older adults is a warning sign requiring assessment, not a benign feature of ageing.

Hydration, given reduced thirst perception.

The classical emphasis on nourishing, warming, easily digested food in later life corresponds reasonably to this, with the qualification that the protein point needs adding.

Medication review

Not part of the classical framework and highly relevant.

Polypharmacy in older adults is a major contributor to falls, confusion and adverse effects. Regular medication review, deprescribing where appropriate, and awareness of drugs that cause dizziness or sedation are among the more effective interventions available.

Herbal supplements add to this and should be included in any review.

The summary

Lift things. Practise balance. Eat enough protein. Get vitamin D. Have your medications reviewed. Stay socially engaged, which has its own evidence.

Gentle practice has a place and it is not a substitute for loading, and treating older age as a time to do less is the assumption most worth challenging.

Discuss starting exercise with a doctor if you have cardiovascular disease, osteoporosis, or a history of falls. Unintentional weight loss, recurrent falls or new confusion require medical assessment.