These may be inevitable, Willcox said, but they do not need to necessarily turn into fatal illnesses.

MOVE IT OR LOSE IT

"What we thought were inevitable consequences of aging have changed as new research comes out," said Dr. Gary Johnson, chief of geriatric medicine at Straub Clinic & Hospital. "It's a challenge to know what normal aging is. It's a consequence of disease and lifestyle."

"Exercise is the best lifestyle medication one can take," Johnson said. Of course we know that exercise is good for muscles, bones and weight control, but it can have other benefits. "You can't just blame aging. There are things we can do. Cardiac reserve can be helped with exercise. We used to think there is a certain amount of brain cell atrophy that occurs inevitably, but a recent study was published that indicates a regular exercise program can keep brain cell atrophy from occurring."

The minimum exercise Johnson recommends to be effective is half an hour of moderate intensity five times a week. "With that, you're doing enough to effect changes in overall health," he said.

A study cited by Johnson reports that reducing daily caloric intake by 200 to 300 calories increases life expectancy.

"Exercising regularly and reducing caloric intake may buy you better years and better brain years," he said.

It's never too late to start an exercise program, Johnson emphasized.

Craig Ono of Kailua, age 94, is a prime example. For years, Ono was plagued with back problems. Then a friend recommended a book, "Dr. Thompson's New Way for You to Cure Your Aching Back" by Jess Stearn.

Ono spends at least half an hour every morning following exercises outlined in the "Rejuvenation" chapter of the book. The results have been dramatic. He is free of back pain, his flexibility is increased, and he now follows his morning workout with 100 push-ups.

"The only problem I have is with balance," Ono said. Since he quit driving at age 90 (he fell asleep at the wheel, and that was that) he has discovered that a hybrid tricycle is an ideal mode of transportation. He doesn't have to worry about balance issues, and it gets him to the store or the bus stop.

Ono said he feels better at 94 than he did in his 60s, 70s and 80s. He became aware of the importance of good nutrition, eating lots of fruits and vegetables, no red meat and only occasional fish and chicken.

Ono also makes an effort to keep his mind active. He turns CNN on while he exercises in the mornings. He does crossword puzzles daily. He loves to follow world news, especially of the 50 countries he visited when in his 70s and 80s — when he acted as a tour guide, taking local people to Europe, Asia, South America and even Africa.

He also learned to use a computer in his late 80s.

"I figured, hey, if I'm going to live a few more years, I'm going to get a computer," Ono said.

BALANCING ACT

Loss of balance is a frequent complaint among older people. It can often lead to falls and hospitalizations.

Falls, for example, cause almost about one in five deaths (21.6 percent) in those ages 65 to 74, two in five (41.2 percent) in those 85 and over.

Falls are often caused by loss of balance or weakness in muscles and bones. These can all be improved with weight-bearing exercise and workouts that focus on balance, such as Pilates, yoga, BOSU ball and stability ball exercises. Tai chi also assists with balance issues. Even practicing sitting and standing alone can help.

"With aging, there seems to be a deterioration in the centers of the brain responsible for balance, but we don't know whether it's an inevitable consequence or can be modified by exercise," Johnson explained. "We can modify this by making balance part of our fitness program. Tai chi is one way. You can intervene and improve balance through the right program."

Zunin, director of Manakai O Malama, notes that most people who are working out do cardio and strength training, but don't emphasize flexibility.

"What happens is we develop muscle mass and give our heart a workout, but our sinews become tight and brittle and we get carpal tunnel, tennis elbow, rotator cuff problems, achilles strains, miniscus tears, bursitis in the shoulder, and hip and back pain," he said. "These could all be managed by diligent stretching and flexibility training."

Zunin highly recommends yoga and Pilates for his patients. He also advocates dance, gymnastics and martial arts, all of which can contribute to increased flexibility.

MAINTAINING THE BRAIN

Nearly every healthy senior we interviewed plays mind games such as crossword puzzles, Sudoku, bridge or chess. Many also eschew television for reading.

"You have to get off your butt to maintain your brain." That's the mantra for Ing, 73, of Nu'uanu. Ing is seldom on his butt. When he's not practicing precise eye surgery, he's riding a wave or walking in the hills of Nu'uanu. "Exercise is your vitamin E," he quipped.

Ing is also strict with his nutrition. His weight is the same as it was his sophomore year of college. He avoids animal fat and eats a vegetarian diet. "The only animal protein I eat is fish oil, because it works as an anti-inflammatory. It helps with arthritis." He also avoids white sugar and white rice.

Straub's Johnson also emphasizes that exercise helps to preserve health. "We need to exercise the brain and the body. Mental activity is important. People who use their brain and do brain exercises do better with memory preservation than people who don't," he said.

REMEMBERING

Mary Lynne Godfrey, 86, of Kaimuki, says this about aging: "I just don't think about it. I just go on living day after day and just keep on going."

She added, "I think about dying, but I'm not morbid about it, just curious." She keeps her mind active with travel and intellectual pursuits.

Last year she visited the Holy Land, and while in Jerusalem, she decided to learn Arabic. She now has a computer program to help her learn the language. Yes, she is completely computer literate.

Other aging Islanders struggle more with memory and comprehension.

Zunin attributes this largely to the fact that we live in "an information age."

"Our brains are taxed more than anything," Zunin said. "We are so bombarded with information, e-mails, faxes, land lines, wi-fi, text messages. ... We've never had a chance to evolve and accommodate for all this. We are survivors of people who could run fast and think fast but didn't live past 35. Our brains and immune systems didn't change to allow for the lives we live. We are in uncharted territory for our evolution."

In late 2006, the Journal of the American Medical Association reported on a five-year study of 2,082 adults that shows brain exercises can ward off mental decline in middle-aged and elderly people.

In the book "Keep Your Brain Alive" (Workman Publishing), authors Lawrence C. Katz, professor of neurobiology at Duke University Medical Center, and Manning Rubin introduce "neurobics" (www.neurobics.com). Drawing on neurological research, they offer 83 neurobic exercises created to assist anyone who is experiencing memory loss. It's a regimen of mental cross-training that can be done anywhere, by anyone, at any time of day.

More next Sunday on how attitude can affect the aging process.