chapter
16
Exercise and
Older Adults
Getting Older in America
From U.S. Department of Health and Human Services, 2003, A profile of older Americans: 2003
(Washington, DC).
General Changes Caused by Aging
Most physiological structures decrease in
function as we age, but the rate of change is
different for each structure. Affected
structures include
– the cardiovascular system,
– the nervous system, and
– muscle mass.
Individual Differences
• Each of us ages differently.
– Genetic factors
– Environmental factors (education, health care,
nutrition, exercise)
• A person can be intellectually young but
physically old.
What Happens As People Age?
• People become older and wiser.
• Strength and cardiovascular fitness
decrease; body weight increases.
• Changes are linked to increased risk of
heart disease, diabetes, osteoporosis, and
falls.
• Seniors need to stay fit to enjoy life and
retirement.
Health Concerns With Aging
• Health
– In 2003, 75% of older White Americans rated their
health as excellent or very good.
– Only 58% of African Americans and 61% of
Hispanics did the same.
• Physical disabilities
– Most older (≥65 yr) adults have one disability.
– Of older adults, 38% have a severe disability.
– Disabilities interfere with the ability to do ADLs.
Chronic Conditions
in Older Individuals
Most have a chronic health condition; many
have multiple chronic health problems. The
following are the most common chronic
conditions:
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Hypertension (49%)
Arthritis (36%)
Heart disease (31%)
Any cancer (20%)
Diabetes (15%)
Age and Cardiorespiratory
Fitness
.
(VO2max)
Adapted from J. Romijn, E.F. Coyle, L.S. Siddosis, A. Gastaldelli, J.F. Horowitz, E. Endert, and R.R.
Wolfe, 1993, “Regulation of endogenous fat and carbohydrate metabolism in relation to exercise
intensity and duration,” Am J Physiol Endocrinol Metab. 265: E380-391. Used with permission.
Age and Muscle Mass
Adapted, by permission, from M.A. Rigers and W.J. Evans, 1993, “Changes in skeletal muscle with
aging: Effects of exercise training,” Exercise and Sport Sciences Reviews 21: 65-102.
Age and Strength
• After age 50, strength decreases 15% per
decade.
• After age 70, strength decreases 30% per
decade.
Age and Body Composition
• Body fatness increases from 25 to 75 yr of
age:
– In men, 16% to 25%
– In women, 28% to 41%
• There is about a 10 kg (22 lb) increase in fat
for each group.
Age and Flexibility
Joint motion decreases with age. It is related
to the condition of
– muscle,
– connective tissue, and
– cartilage.
Are Age-Related Changes Inevitable?
• Yes! Part is due to a real aging effect:
– The number of muscle fibers decreases with age.
– Maximal HR decreases with age.
• No! Part is due to a less active lifestyle: Without
question, training programs increase both
muscular strength and cardiovascular endurance.
• Chronological age may not equal physiological
age: Performance ability greatly varies among
individuals the same age (e.g., Senior Games).
Good News: Exercise Helps!
• Older individuals respond to training like
younger adults, though rate of change may
be different.
• Endurance exercise lowers blood pressure
and improves insulin sensitivity.
First Things First
• Have a comprehensive physical exam.
• Determine risk factors, risk stratification.
• Establish contraindications to exercise,
orthopedic limitations.
Exercise Testing Equipment
• Choose the work instrument carefully.
• A cycle ergometer is a good choice, but
cadence may be an issue. The ergometer is
a good choice for clients with orthopedic
concerns.
• When using the treadmill, focus on slower
speeds.
Exercise Testing Progression
Follow a rate of increase similar to that for
extremely deconditioned individuals.
Functional Testing: Rikli and Jones
Senior Fitness Test
The Senior Fitness Test includes functional
tests that address various fitness
components:
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Chair stand, 8 ft up and go
Arm curl
6 min walk, 2 in. step
Chair sit and reach, back scratch
Height and weight
Benefits of Exercise
• Endurance exercises
– Improved cardiovascular function
– Muscles more sensitive to insulin
• Strength exercises
– Needed for optimal function in daily tasks
– Reduced risk of falls
• Flexibility exercises
– Maintenance of joint function, range of motion
– Reduced chance of injury or fall
Guidelines
for Cardiorespiratory Fitness
• Based on increasing moderate, everyday
activity
• Standard structure
– Warm-up structure
– Warm-up, stretch
– Cool-down, stretch
• Strong focus on individuals in group
– Individuals vary greatly
– Athletic old versus old old
Exercise Prescription
for Cardiorespiratory Fitness
Intensity
Duration
Base target HR on measured maximal
HR
Initially emphasize low end of the
continuum
Use RPE
5 to 10 min segments
Frequency
3 days a week
.
Training and CR Fitness (VO2max)
.
• Endurance training increases VO2max 10%
to 30%.
• In men, increase is due to increases in both
cardiac output and oxygen extraction.
• In women, increase is due primarily to
increase in oxygen extraction.
Exercise the Major Muscle Groups
• Begin with minimal resistance for first 8 wk.
• Do 8 to 10 exercises involving major muscle
groups.
• Do 1 set of 10 to 15 lifts.
• Exercise 2 days each week (48 hr between
workouts).
• Stay within pain-free ROM.
• Do not exercise if joint is painful or
inflamed.
Resistance Training
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Helps maintain strength
Easier ADL
Reduced risk of falls
Maintains fat-free mass
Higher metabolism
Good for weight control
Improved self-esteem
Body Composition and Age
• Weight gain
– Due more to a decrease in energy expenditure than
an increase in caloric intake
– Attenuated by regular lifelong exercise
• Exercise intervention
– Decreases fat in abdominal area
– Lowers risks of cardiovascular and metabolic
diseases
Balance and Falls
Decrease in balance is a complex problem
involving such factors as these:
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Lack of strength
Vision problems
Proprioception problems
Medications
Illnesses
Reduced flexibility
Environmental hazards
(continued)
Balance and Falls (continued)
Fall resistance can be improved with
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balance training,
resistance exercises,
walking, or
weight transfer exercises.
Bone Density
• Bone density decreases with age at a rate
similar to that of the decrease in fat-free
mass.
• The decrease is related to an increased risk
of bone fractures.
(continued)
Bone Density (continued)
• Exercise and calcium are important but
cannot substitute for loss of estrogen.
• Programs should focus on variety, using
– fast rather than slow movements and
– relatively vigorous activity (>70% of capacity).
Flexibility Exercises
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Maintain muscle length
Stretch muscles and connective tissues
Maintain range of joint motion
Maintain health of joint tissues
May decrease risk of falls
Improve reaching for objects
Flexibility Programs
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Stretch major muscle groups.
Stretch through full range of motion of joint.
Stretch before and after workout.
Hold static stretches to point of mild
tension (not pain).
• Dynamic stretches are done slowly.
• Consider classes like tai chi or yoga.
• Videotapes can also be effective.