“Luck”, wrote John Milton in the seventeenth century, “is the residue of design”. Two hundred or so years later, Louis Pasteur posited that, “Fortune favors the prepared mind”. Sometime around 1960, a spectator watching PGA champion Jerry Barber practice, hitting bunker shot after bunker shot next to the hole, commented on his luck. Barber replied, “The more I practice, the luckier I get”.

Merriam-Webster defines happy-go-lucky as blithely unconcerned; carefree.

Falls are the leading cause of injury among adults sixty-five and older. Emergency rooms treat three million older adults each year. One in five falls result in injury. Ninety-five percent of these injuries are hip fractures. Because women fall more than men, three quarters of hip fractures belong to them.

Nearly fifty-nine million people have hypertension. Almost two-thirds of people over sixty have it, more women than men. Folks with hypertension pay roughly twenty-five hundred dollars more per year in healthcare costs. The annual healthcare costs associated with hypertension is one-hundred and thirty million dollars. By the year 2030, those costs are estimated to be around two-hundred million dollars.

Orthostatic hypotension, or postural hypotension, is a form of low blood pressure that occurs when stand from sitting or lying down. It can make you dizzy or lightheaded. It can make you faint. It can make you fall.

When you stand, gravity pools blood in your abdomen and legs. Your blood pressure lowers, because you have less blood circulating back to your heart. Special cells called baroreceptors, located near the heart and arteries, sense the lower blood pressure. They contact the brain. The brain contacts the heart, tells it to beat faster, and pump more blood. The heart responds, and blood pressure is increased.

The causes of acute hypotension are simple things, like dehydration, or low blood sugar from lack of food. Chronic orthostatic hypotension is usually the sign of a larger problem. Heart problems, like low heart rate, or heart valve problems. Endocrine problems, like thyroid conditions, adrenal insufficiency (Addison’s disease), low blood sugar (hypoglycemia). Diabetes.

As we age, the baroreceptors near our heart and neck arteries slow. An aging heart may struggle to speed up and increase blood flow. Certain medications can create orthostatic hypotension. Hypertension medications, like diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, can, ironically, create orthostatic hypotension. So can certain antidepressants and antipsychotics. Muscle relaxers. Erectile dysfunction meds. The medicine chest of a lot of kids my age.

Casting no aspersions on the medical profession, it’s easy to see how a typical person could be blithely unaware. A patient, over fifty, has hypertension, and her doctor prescribes one of several popular medications. Her blood pressure lowers, and she lives a carefree life. One day, she rises from her chair, feels dizzy, and quickly sits back down. After a minute or two, she recovers, stands, and carries on. Dehydration, perhaps.

A few days later, however, another episode of lightheadedness occurs, again while rising. It, too, passes. After a week without incident, she rises quickly, faints, and collapses on the floor. Fortunately, no broken bones.

She consults with her doctor, who is wise enough to consider whether the medication he prescribed for her hypertension may play a role in her episodes. He ponders changing her dosage, while also gently reminding her that at the time he placed her on that drug, he also suggested that she start an exercise program. Showing great sagacity, he this time strongly advocates that she start a strength program.

This lucky woman’s doctor knows that exercise can make the heart stronger, and a stronger heart can pump more blood with less effort. The force on the arteries increases, and blood pressure lowers.

He knows, too, that strength training improves balance, even without practicing the typical balance exercises. For instance, training the squat pattern, the movement his patient was performing during her fainting episodes, increases over-all strength, and not just bi-laterally. It increases uni-lateral leg strength, too, and thus, improves balance. The proverbial two birds, while not necessarily killed, are at least aggressively confronted.

This Paracelsus knows that, true also of other interventions, there is no definitive proof that exercise, directly influences aging. It does affect the quality of aging. Move more, move strong, move better, live better.

Our lucky patient is now better prepared. Perhaps she is not blithely unaware. Perhaps she is blithely aware. You know, happy-go-lucky.