H E A H

T
Matters
'

The Next Frontier

A revolution is taking place in our definition of aging.
Riding on the outcome are American lives and dollars.

BARBARA PASH SPECIAL TO THE JEWISH NEWS

ou're 60 years old.
You've got heart prob-
lems. You're 40 pounds
overweight. You're a
couch potato. You've got the ex-
ercise capacity of —
A baby?
"Oh no, babies have a pretty
high exercise capacity," corrected
Dr. Andrew P. Goldberg, provid-
ing a more sobering example.
"How about the exercise capacity
of a person in a wheelchair?"
Dr. Goldberg recently conduct-
ed a pilot project on the effects of
exercise on senior adults with
heart disease.
A revolution is taking place, he
says, and it's happening at the
new Claude Pepper Center at the
University of Maryland Medical
Center. Researchers there are ex-
ploring the definition of old, ask-
ing questions like how much are
old people with health prob-
lems capable of and how can
they be kept functional and in-
dependent?
Riding on the answers is not
only the quality of life for mil-
lions of elderly Americans, but
billions of dollars in health care
costs.
Dr. Goldberg isn't a house-
hold name. His office, located
on the fourth floor of the Vet-
erans Administration Hospi-
tal, adjacent to Maryland
Medical Center in downtown
Baltimore, isn't luxurious. But
his research is changing the
way people view aging.
Dr. Goldberg, 49, wears sev-
eral hats. An outgoing, talka-
tive person who keeps himself
in shape with regular exercise
and knows exactly what his
body fat ratio is (a healthy 26
percent), he is a professor of
medicine and head of the
gerontology division at the
Maryland Medical Center.
And, he is director of the
Claude A. Pepper Older Amer-
icans Independence Center,
named after the late Florida
congressman. It was estab-
lished this past fall with a five-
year, $5.6 million grant from
the National Institutes on Ag-
ing.
Maryland's Pepper Center
is one of only eight in the coun-
try, and is the only one in the
mid-Atlantic region. All Pep-
per Centers share the same
goal: to improve the quality of
life for older Americans. How-

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ever, each center takes a different
path to that goal.
For instance, at Pepper Cen-
ters at Harvard, Yale and the Uni-
versity of Michigan, researchers
are studying such problems as
Alzheimer's disease and bone frac-
tures. Maryland's Pepper Center
is the only one studying the sick
elderly and lifestyle changes.
"We need to understand what
can be treated with drugs vs. what
can be treated with changes" in
exercise and nutrition, said Dr.
Goldberg, who plans to expand
significantly the research projects
he and his investigators in Mary-
land's gerontology division have
been conducting for the past few
years and which were the basis
for the prestigious NIH grant.
Dr. Goldberg has been study-
ing the effects of exercise and nu-
trition on aging for almost 20

years. "Primarily, the idea is that berg who, in the 1980s, came from
aging is not the problem. The Washington University's Barnes
problem is the associated lifestyle Hospital, in St. Louis, to conduct
habits that evolve as you get old- geriatric research at the Johns
er that cause disease," he ex- Hopkins Medical Institutions.
Dr. Goldberg and his Hopkins
plained.
Obesity and inactivity can lead team studied healthy men, age 50
to diabetes, which can lead to car- and up, for two "risk factors" —
diovascular disease. "It's a slip- diet and exercise —in developing
heart disease. Convincing partic-
pery slope," Dr. Goldberg said.
But Dr. Goldberg doesn't claim ipants to change their habits was
to have found the fountain of not easy. Among the elderly,
youth. Exercise won't stop aging, whatever their health status,
nor will it totally eliminate med- there is one main impediment to
ical problems. But it can improve change. It is, in a word, fear. Dr.
Goldberg said: "Fear of injury, fear
life.
"Your functional independence of the unknown, fear of not being
and quality of life is going to be able to do it," whatever it is.
In the medical community, Dr.
sustained through remaining
physically active, eating a proper Goldberg said, "the feeling was
diet and avoiding injury," he said. that older people have lifelong
As common-sensical as that habits and they're never going to
now sounds, not so long ago it was change. We showed that wasn't
cutting-edge stuff, said Dr. Gold- true."
PHOTO BY CRAIG TERKOWITZ
Indeed, once par-
k
ticipants overcame
what he calls "the
fear factor" with
counseling and edu-
cation, they went on
to achieve relative
improvements that
challenged the con-
ventional wisdom.
`That I could take
a 50-year-old and get
him to improve his
exercise capacity, his
glucose metabolism,
his lipids the same
relative amount as a
younger person was
revolutionary," Dr.
Goldberg said.
Although the Hop-
kins research did not
delineate among eth-
nic groups, many of
the study partici-
pants belonged to
the Jewish Commu-
nity Center. Dr.
Goldberg, his wife,
Gail, and two sons,
Ethan, 18, and
Justin, 14, both
Friends School stu-
dents, are members
of Baltimore Hebrew
Congregation. Mrs.

• ."`" .°,7

Dr. Andrew Goldberg
(right) and Dr. Andrew
Gardner monitor
Levoyus Gude on the
treadmill at the Claude
Pepper Center at the
University of Maryland
Medical Center.

Goldberg develops tests for the
state Department of Education
and is a BHC board member.
In 1990, Dr. Goldberg joined
Maryland's faculty, where he has
been pushing the envelope on ag-
ing research even further. Now he
is dealing with lifestyle changes
and two of the most common
chronic and costly illnesses that
afflict America's elderly. They are
congestive heart failure (CHF)
and peripheral arterial disease
(PAD).
CHF is a progressive weaken-
ing of the heart muscle. There are
about 3 million Americans over
the age of 55 with congestive heart
failure, Dr. Goldberg said, adding
that coronary artery disease, dia-
betes and hypertension are the
most common causes. CHF is the
leading cause of hospitalization
in the elderly, with an estimated
cost of $10 billion annually for hos-
pitalization, doctor visits and med-
ication. Of CHF patients over age
60, fewer than half survive beyond
five years.
PAD is a problem of restricted
blood flow in the legs that caus-
es pain when walking It is a ma-
jor cause of disability in adults,
affecting more than 8 million
Americans age 55 and up. Treat-
ment cost is pegged at $4 billion
annually.
For the present, the exercise fa-
cility at Maryland's Pepper Cen-
ter is located in a small,
unpretentious room in the VA
Hospital, two floors below Dr.
Goldberg's office. The center is
crammed with stairclimbers, sta-
tionary bikes, treadmills, rowing
machines and free weights. This
is the equipment used in the two
previous pilot projects.
The facility is due for enlarge-
ment. Dr. Goldberg whipped out
drawings for the future 5,000-
square-foot Pepper Center exer-
cise facility. It will still be located
in the VA Hospital, but it will be
nicer, with an indoor walkino-
track, showers and lockers. It also
will have more convenient park-
ing arrangements so that re-
searchers can attract the number
of participants needed for the ex-
panded studies.
The center hopes to recruit 160
people with PAD and 60 people
with CHF. It is aiming for an
equal number of men and women,
all over age 60. They will be di-
vided into two groups, according
to Eric Poehlman, Ph.D., associ-

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