Which is more important as we age: stretching, balance work, or strength training?

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Combining strength training with weights and aerobic exercise is a great way for seniors to keep moving.

(CNN) People often complain of gray hair and wrinkled skin as some of the more unpleasant side effects of aging. It can be disheartening to see your youthful face slip away, but the state of your strength, balance and flexibility is far more concerning. Significant decreases in these areas can lead to pain, falls and fractures, and an overall loss of mobility and function. Think about the impossibility of playing with the grandchildren, climbing the stairs or carrying the groceries.

No matter how active we are, our muscle mass and strength decrease as we age. In fact, muscle mass and strength peak between the ages of 30 and 35. Thereafter, they slowly but steadily decrease. By age 65 for women and 70 for men, the pace of these declines increases, according to the National Institutes of Health. Similarly, everyone’s balance and flexibility decline with age due to changes in vision, sensory nerves, joints, ligaments, and more.

The joints in the spine, hips, knees and shoulders naturally become more arthritic as we age, and our ligaments and the interfaces between our tendons and muscles become stiffer, said Dr. George Eldayrie, a sports medicine physician at Orlando Health Jewett Orthopedic Institute in Winter Garden, Florida. It’s a very well known process.

Because these declines are well documented, the U.S. Centers for Disease Control and Prevention recommends that adults age 65 and older get moderate-intensity exercise at least 150 minutes a week. Additionally, they should perform strength training and balance exercises at least twice a week.

How to improve the quality and quantity of your life

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Aging can lead to inevitable declines in strength, balance and flexibility. The CDC recommends that adults ages 65 and older engage in moderate-intensity exercise at least 150 minutes per week.

Strength, balance, and flexibility are all important, but is increasing one more critical than another? Overall, if you’re looking to improve the quality and quantity of your life, getting aerobic exercise should be your primary concern, said Dr. John Higgins, a sports cardiologist at McGovern Medical School at the University of Texas Health Science Center at Houston. Resistance training is next in importance, with a mixture of balance and flexibility work coming in third.

On an individual level, though, it all depends on the patient, Eldayrie said. For an experienced athlete, strength and flexibility are most likely more important to help with performance and reduce injuries, she said. Someone who is 85 and wants to be functional, however, will focus on balance and strength to reduce the risk of falling.

There will also be differences based on a person’s health. Someone with arthritis should focus on joint flexibility first, Eldayrie said, while someone who has just had a knee replacement should focus on strength training. If you have osteoporosis, it’s important to work on your balance to avoid falls.

How to move

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Adults age 65 and older should do strength training and balance exercises at least twice a week.

Despite evidence supporting the importance of physical activity, 28 percent of Americans ages 50 and older are inactive, according to a 2016 CDC study. Additionally, inactivity increases with age, with more than 35 percent of those over 70 inactive. This is a problem. Physical activity can improve mental health and prevent dementia and cognitive decline. Pair that with the work benefits of strength, balance, and flexibility, and you stand a great chance of aging well.

Think of it as a pyramid, Higgins said. Aerobic exercise is the top of the pyramid, with the building blocks of it being strength, balance and flexibility. Without those foundations, the pyramid will collapse. You can’t get away with one of those things on your own.

If the thought of incorporating aerobic exercise, strength and balance training, and flexibility into your weekly routine seems overwhelming, keep in mind that you don’t necessarily need a gym membership or personal trainer. This important work can be woven into your life quite seamlessly.

For example, playing golf and gardening are fun ways to add some aerobic exercise to your life. So he’s walking the dog. Strap on a weighted backpack during your hike, and now you’re rucking, an exercise based on military training that combines aerobic exercise with strength training. Yoga is an easy activity on the body that helps flexibility, but also builds strength and activates your core. Standing on one foot in the grocery line or in front of the television is an easy way to add some balance training to your life.

Many people like to complicate things by having a plan and measuring their progress, but it doesn’t have to be that complicated, Eldayrie said. Just incorporate these things into your daily life and be consistent. The benefits will come over time.

Higgins agreed. If you don’t believe strength training, balance and flexibility work can really help, try it for a few months and see what a difference it makes, he said. You’ll likely find that you enjoy things more and are able to do regular aerobic work more easily and with fewer injuries, whether it’s playing with the grandkids or engaging in an exciting activity like zip lining.

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