II. Epidemiology
- More than a third over age 65 years old in U.S. with no leisure-time Physical Activity
III. Efficacy
- Sedentary Relative Risk of Cardiovascular disease: 1.9
- Sedentary status is also associated with increased mortality
- Ensrud (2014) J Am Geriatr Soc 62(11): 2079-87 [PubMed]
-
Exercise reduces age related morbidity and mortality
- See Exercise for benefit summary (including chronic disease specific benefits)
- Fall Prevention and reduced Hip Fracture risk
- Improved sleep quality
- Impacts functional independence
- Fitness Activity reduces mortality 19%
- Protects against the development of Dementia
- Productive Activity reduces mortality 35%
- Employment
- Volunteer work
- Gardening
- Shopping
- Housework
- Social Activity reduces mortality 20%
- Movies
- Sporting or recreational activity
- Recreational travel
- Group participation
- References
- Benefits realized even if Exercise started at late age
- Life Expectancy increases even at age 75 years
- VO2 max decline reversed up to 30% at 6 months
IV. Physiology
-
Muscle Strength declines with aging
- Muscle Strength declines 15% per decade after age 50
- Muscle Strength declines 30% per decade after age 70
- Framingham Disability study
- Unable to lift 10 pounds: 45% of women over age 65
- Unable to lift 10 pounds: 65% of women over age 75
V. Contraindications
- Absolute
- Recent Electrocardiogram changes
- Recent Myocardial Infarction
- Unstable Angina
- Third degree Heart Block
- Acute Congestive Heart Failure
- Uncontrolled Hypertension
- Relative
- Cardiomyopathy
- Valvular heart disease
- Complex ventricular ectopy
- References
VI. Indications: Stress Testing before Exercise
-
Exercise at >60% of VO2 Max
- Men over age 45 years
- Women over age 55 years
- Known Coronary Artery Disease
- History of cardiac, pulmonary, or metabolic symptoms
- Cardiac Risk Factors (two or more)
- Diabetes Mellitus
VII. Management: Starting an Exercise program
- Start slowly and build
- Example: Start with brisk walking for a total of 50 minutes per week
- Any activity is better than no activity
- Find activities that fit a patient's health status and functional capacity
- Start with low intensity activity if deconditioned or limited functional capacity
- Strength and balance may be needed before aerobic fitness in frail elderly at risk for falls or injury
- Consider water-based aerobic activity for patients limited by Osteoarthritis
- Consider Activities of Daily Living (e.g. stair climbing, errands)
- Consider classes (e.g. community center, YMCA)
- Consider an experienced fitness trainer (with caution to prevent injury or overuse)
- Set goals
- Consider a pedometer, and increase steps by 10% every 2 weeks
- Consider increasing daily walk time by 10 min each day until target time is reached
VIII. Management: Recommended Exercise program
- Stretch major Muscle groups daily after Exercise
- Perform balance training 2-3 times weekly (esp. elderly at risk for falls)
- See Geriatric Balance Training
- One legged stands
- Circle turns
- Heel stands
- Consider covering eyes while performing activities
- Cardiovascular fitness
- Moderate Aerobic Activity (2 to 5 METS)
- Activity totals 30 minutes or more on most days (150 minutes or more per week)
- Examples
-
Strength Training
- See Geriatric Strength Training
- Set of 10-15 repetitions each of 8 to 10 Exercises
- Perform Exercises 2-3 times per week
- Work all major Muscle groups, slowly and through full ROM
- Examples
- Calisthenics
- Resistance Training (Exercise bands, weight machines, dumbells)
- Pilates
- Flexibility training (Stretching)
- Perform 2-3 times weekly (best benefit with daily flexibility Exercises)
- Greatest benefit when performed after aerobic or Strength Training
- Only mild discomfort should be felt
- Consult regarding restrictions with medical provider or physical therapist if recent injury or surgery
- Repeat 3-4 times per stretch with 30-60 second rest
- Perform both static and dynamic stretches
- Static stretch (hold position 10-30 sec then relax)
- Dynamic stretch (fluid motion such as Tai Chi)