We were on vacation in a town near a major summer music venue when we were somewhat startled by the number of tourists in their 70s, 80s, and older walking extremely slowly, often holding onto the arm of a companion (or their walkers) for support. Indeed, one large parking lot was reserved for cars with handicap stickers, and large golf carts took their occupants to the performance hall.

Was the slow, somewhat tentative movements of these concert goers and others strolling the streets of the nearby town an inevitable consequence of aging? Or was it the inevitable consequence of a sedentary, exercise-avoidant lifestyle?

The answer is both.

The decline in muscular strength, stamina, respiratory capacity, balance, and loss of muscle is a well-described consequence of aging. Forty-year-olds do not run as fast as 20-year-olds; hikers in their teens can run up a steep hill without panting (or at least not much); their parents and their grandparents will be huffing and puffing as they walk, not run, the same steep incline. A toddler can walk on a narrow board and may even skip a few steps. The grandparent may have to put his fingers on a wall to prevent losing his balance, and falling as he walks through a room.

However, these age-related deficits can be exacerbated by a sedentary lifestyle that may have begun 20 or 30 years earlier. Fortunately, these deficits can be slowed by regular exercise, even when the exercise is started in old age. According to the article by Mazzeo and colleagues, an older population does not have to accept a life limited by a loss of physical ability. With appropriate exercise and , it is possible to increase physical strength and stamina even among very old frail men and women, although of course, they will not be able to return to the level of fitness they once enjoyed as . The prescription for physical improvement includes flexibility and balance exercises, strength training and cardiovascular workouts, and can range from gym-based exercise to Tai Chi and dancing.

I have a friend who goes to the gym regularly; at age 74 she decided to get a senior citizen reduced fare bus pass. She told me she was scolded by a bus driver when she raced down the street to catch the bus preparing to leave the stop. “ Why are you using a senior bus pass?” he asked her. “Anyone who can run like you shouldn’t have one.”

The problem is that is it hard to motivate many unfit sedentary people of any age to, in a sense, leave their comfort zone on their couch, and engage in a routine of physical activity. How many people who were having difficulty walking to the concert would leap at the chance to join a gym, even at a trivial cost, or participate in yoga or water aerobics or weight lifting? Unless told to do so, i.e. because recovery from a medical disorder depended on consistent exercise, someone who has been relatively sedentary throughout adulthood is unlikely to start working out in his or her seventies and beyond.

Virtual trainers or computer programs that track and encourage physical activity are already being used to motivate the sedentary to engage in some physical activity. Praise for initiating and increasing the number of steps taken daily are delivered through messages on a smartphone or computer, to reinforce, and maybe even increase, the time and intensity of the exercise.

Video games are also being studied to see whether they may motivate people to exercise. Some programs, which allow a person on a treadmill or exercycle to manipulate activity on a screen, have been available for decades. A recent study attached a video game to a recumbent bike (as these bikes are easier to use by the elderly with knee problems than an upright exercycle.) The objective of the game was, ‘to create a village,’ and the exerciser could chop trees, dig ditches and build schools by pedaling on the bike and moving a device on the handlebars. The game elicited positive responses from the subjects, especially as each participant could be part of a small group working together to build a ‘virtual’ village community just by pedaling.

The use of a robot as a personal trainer has been studied to see if this too, may motivate elderly people to exercise. A robot wearing what must be robot workout clothes sits across from a study subject and shows the subject (in the article there is a picture of an elderly woman) what movements to make. The robot is programmed to praise, correct movements if they are being done incorrectly, to increase the difficulty and complexity in subsequent sessions, and at one point, ask the study subject to initiate movements which the robot will imitate. Communication from subject to robot occurs using a “Nintendo Wiimote Wireless Bluetooth button control interface” according to the article. The responses of the study subjects were positive, perhaps because the robots were programmed to be personable and pleasant.

More such studies are needed to see if robots could motivate the elderly to exercise, in particular those who do not have access to human-led exercise routines. It is easy to dismiss the use of robots or other gaming devices as the solution to motivating the unfit to become more fit. There are more reasons to do so (cost being a major consideration), than to accept the notion that this will cause people who never exercised to become gym jocks. However, all of us who scoff at this have to acknowledge that we may have laughed at the idea that a smartphone or a wristwatch-like device could monitor how well we sleep, how much we move, and how we are.

Although the research cited here was directed toward the elderly, the use of robots to increase physical activity will probably expand to include children as their comfort with video games and robots is so much greater. Exercise is vital to well-being. And perhaps robots are the solution; they can be programmed to ignore all our excuses.