On Parents’ Day in Korea, people tend to purchase “parents' health.” Koreans, grappling with limited free time, replace traditional filial piety with supplements. Regrettably, this often proves to be an inadequate expression of love. If we seize Parents’ Day as an occasion to reassess the well-being of our elders, what essential aspect have we overlooked?

Let's begin with the “mild frailty” stage. This marks the tipping point where older adults start to experience a decline in health. This concept was created by Kenneth Rockwood, a professor of geriatrics at Dalhousie University in Canada. In Korea, older adults typically enter the “very mild frailty” stage around the age of 73. I refer to this phase as the life transition period into older adulthood because you can visibly observe signs of frailty. Skipping breakfast becomes easier, meat cravings diminish, and walking slows down, making movement more challenging. Even minor illnesses result in a weight loss of over 5 kilograms, while a glance in the mirror reveals thinning thighs and hips. This signifies the inevitable changes associated with aging.

In my previous column, I discussed the necessity of adjusting eating habits to align with your changing body. The same principle applies to exercise, although it's difficult to practice it in reality. When I inquire about patients' regular exercise routines in the doctor's office, the response is almost the same: “30 minutes of daily walking.” While walking is indeed beneficial, it falls short of meeting overall exercise needs.

The main focus of health management should be mobility, as it allows us to diagnose physical conditions, predict aging trajectories, and anticipate care needs, including life expectancy, future falls, nursing home placement, and care requirements. As people age, they gradually lose muscle strength and physical function. This impacts their mobility significantly. The challenge lies in the gradual nature of this decline, making it difficult to detect, and once noticed, reversing it proves challenging. It begins with struggles to lift and carry heavy objects and progresses to difficulty navigating stairs. While we may dismiss it as an inevitable part of aging, the situation worsens. Simply traversing from the bus stop to the hospital entrance becomes arduous, and eventually, going out alone becomes challenging. With each hurdle, daily routines start to falter, from maintaining personal hygiene to simple tasks like getting out of bed or using the bathroom.

Before designing an exercise strategy for your 70s and 80s, you need to think about the ultimate goal of mobility management. The first goal of mobility management is to build a body that can walk to age 100. Longevity extension and disease prevention are secondary goals. To build that body, you need to create an exercise portfolio, just like you would make a portfolio of assets. An exercise portfolio consists of four components: aerobic and strength training, stretching, and balance and coordination exercises. If your ratio of moderate to vigorous (sweaty and out of breath) cardio to strength training was 7:3, in your “very mild frailty” stage, it should be 3:7. Stretching is necessary to keep joints from stiffening, and balance and coordination exercises are necessary to use the body's muscles and joints in a coordinated manner.

Walking is categorized as a “mobility activity” in exercise guidelines, and I view it as a “maintenance activity” for people in their 70s and 80s. This means that it maintains the status quo, as without walking you could quickly become bedridden, and it also means that walking alone won't build a body that can walk to age 100. You can indeed get a stretching aerobic and strength training workout by extending your stride and walking fast or running up and down stairs, but it's rare to see people do that. This is because walking is perceived as a mild form of exercise.

The effectiveness of exercise portfolios has been proven in several studies. According to Professor Jang Il-young of Asan Medical Center, people in their 70s who follow an exercise portfolio for six months can significantly improve their physical functioning. It also reduces the likelihood of entering a nursing home or convalescent hospital or dying. Dr. Kim Hun-kyung, former head of research at Tokyo Metropolitan Institute of Gerontology, found that even 10 minutes of home-based muscle exercises every day can increase muscle strength by 20 percent after a year, reduce falling incidents, increase social engagement, and prevent depression.

Koreans' exercise habits are still insufficient to prepare for the centenarian era. According to the Korea Health Promotion Institute, as of 2018, 40.2 percent of adults practiced walking, 28.1 percent of older adults practiced aerobic physical activity, and 18.3 percent of older adults practiced strength training. The importance of an age-appropriate exercise portfolio is also evident when compared to Japan. According to Jung Song-ee, a researcher at the National Center for Geriatrics and Gerontology in Japan, when comparing older adults in both countries with an average age of 73.9 years, Koreans were estimated to be 3.7 years older than Japanese in terms of physiological age. Although Koreans were more physically active, the problem was their lack of an exercise portfolio. While Korean older adults were more likely to walk, hike, and bike, Japanese counterparts were engaging in a variety of age-appropriate exercises, including strength training, ball sports, and water sports.

Another problem for the people in the “very mild frailty” state is the lack of social services. They are neither “for treatment” nor “for care,” so they are not given attention from health or welfare officials. Rather, people who are beyond this stage and are very frail receive help from the care sector.

How we respond to this stage can determine whether an individual ends their life in bed or becomes well again. Here's a fundamental way to address the looming care crisis. Building exercise classes across the country and getting the entire population to do strength training, as Japan has been doing for the past 15 years, could dramatically reduce the demand for care. But few people are interested in this radical solution.

On Parents’ Day, rather than purchasing supplements for them, consider crafting an exercise portfolio for your parents. While it may seem like we're relying on individuals to fulfill what should be the state's responsibility, we can't afford to wait for systemic changes. Additionally, there are cost-free options available. Public health centers can coordinate or link you to local exercise classes. Another avenue is utilizing the Korea Sports Promotion Foundation's National Fitness 100 Service Program. Additionally, welfare centers, dementia care facilities, senior centers, and gyms offer programs. What may seem like a slow and frustrating process can be a fundamental solution to the problem.

Jung Hee-won, a geriatric physician at Asan Medical Center, graduated from Seoul National University College of Medicine and trained at Seoul National University Hospital. During his med-school days, while practicing the horn, he realized the importance of muscle maintenance and became interested in sarcopenia. His main research interests include frailty, sarcopenia and establishing age-friendly health systems for acute hospitals. This column was originally published in Chosun Ilbo in Korean on May 8, 2024. -- Ed.