KIN 321

Chronic Health Issues and Physical Activity

Effects of Exercise on Physiologic Aging

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 Physical Activity Statistics for Older Individuals

◉ The benefits of regular physical activity and exercise on general health and overall quality of life in
older adults are well established

◉ These benefits are particularly salient among patients with chronic medical conditions such as
osteoarthritis or cardiovascular disease

◉ More than 33% of adults 65 years or older reported no leisure-time physical activities

◉ Only 16% of older adults met national guideline recommendations for physical activity

◉ 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic

activity and two or more days of muscle-strengthening activities per week

◉ Barriers to exercise include a lack of knowledge, lack of motivation, and poor health
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 The Disablement Paradigm

◉ Many elderly individuals fear dying less than they fear becoming physically
dependent on others

◉ Although many older persons maintain highly engaged and functionally independent
lives, the rate of disability increases with age

◉ Physiologic changes associated with aging can manifest as impairments, which lead
to functional limitations and result in disability

◉ The typical aging process is associated with physiologic reductions in

cardiovascular and skeletal muscle performance that contribute to impairments,
which ultimately lead to disability
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 Pre-Exercise Training Evaluations

◉ Many older individuals have a history of falling, are frail, and have limited ability to
perform activities of daily living

◉ Overall prevalence estimates were 15.3% frail, 45.5% prefrail, and 39.2% robust

◉ This does not necessarily preclude a person from exercise participation, but it does
direct the focus to a pre-exercise evaluation

◉ A pre-exercise evaluation can assess the risk of falling (balance, agility, and
coordination), functional independence (range of motion), mental issues
(depression), and intellectual impairment (dementias), factors that are related to
exercise adherence
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 Pre-Exercise Training Evaluations

Test Measurement Outcome

Stand from a chair (at standard height) without aids or Measuring ability and time (goal is to
Chair Stand
using arms take less than 2 seconds)

Measuring ability and time (goal is to

One-Leg Stand Stand on one leg
last longer than 2 seconds)

Measuring number of errors (goal is

Tandem Walk Walking along a 2m line, 5 cm wide
make less than 8)

Maximal distance a person can reach forward beyond

Functional Reach
arm’s length while maintain stance

Stand up from a chair, walk distance of 3m, turn, walk Measuring total time (goal is to take
Timed “Up and Go”
back to chair, and sit down again less than 10 seconds)

Range of Motion Use a goniometer to assess joint range of motion

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 Addressing Skill-Related Fitness

◉ Those components of fitness that determine success in various performance-related

activities

• Agility
• The ability to rapidly and accurately change the direction of the whole body in space
• Lateral jump, two jumps forward-one jump back, single-leg forward hop

• Balance
• The ability to maintain equilibrium while stationary or moving
• Foot taps, marching, single leg raises

• Coordination
• Using the senses and body parts in order to perform motor tasks smoothly and accuratel
• Ball toss, jump rope, juggling or dribbling
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 Something to Think About

◉ Nearly _______ % of older adults suffer from at least one chronic disease.

a) 35%
b) 50%
c) 60%
d) 75%
e) 85%

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 Something to Think About

◉ Nearly _______ % of older adults suffer from at least two chronic disease.

a) 35%
b) 50%
c) 60%
d) 75%
e) 85%

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 History and Physical Examinations

◉ The most common chronic diseases present in the elderly are coronary artery
disease, arthritis, hypertension, diabetes, and obesity

◉ Of these, hypertension is the most prevalent, coronary artery disease is the leading
cause of death

◉ For the elderly, emphasis should be placed on assessing specified areas of risk

◉ When identified as high-risk, a qualified physician should perform a thorough

medical history and physical examination before the individual begins an exercise
program
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 The Value of Exercise Testing

◉ Recent exercise testing guidelines recognized a gap in knowledge about the prognostic
value of treadmill exercise testing in elderly persons

◉ 514 elderly individuals underwent treadmill exercise testing; overall mortality and
number of cardiac events were tracked for the next 2 years

◉ Workload was the only treadmill exercise testing variable that was predictive of death
and cardiac events

◉ Each 1-metabolic equivalent increase in exercise capacity was associated with a 18%
reduction in cardiac events among elderly persons, respectively

◉ In elderly persons, treadmill exercise testing provided prognostic information that is

incremental to clinical data.
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 Objectives of Exercise Testing

◉ Depending on the health status and level of habitual activity, the goals of the elderly
can be quite different.

◉ Performance and appearance are more important for your younger people while
health, independence, and general well-being become more important with age

◉ An exercise test is often used to assess health and identify potential risks

◉ When doing testing with elderly individuals, the tests should also assess the level of
independence

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 Overview of Exercise Testing Methods

Assessment General Procedure

Treadmill or bicycle ergometer

Cardiorespiratory
Low intensity small increments in work rate
Fitness
Mornings may be better for testing

Muscular Strength and Modified repetition maximums (with machines)

Endurance Focus on muscles involved in activities for daily living

Using a goniometer to assess movements at different joints

Flexibility
Evaluation of mental and intellectual impairment may affect ability to test

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Exercise Prescription Guidelines

Aerobic Activities

More often: walking, cycling, pool activities, seated aerobics

Mode Less often: jogging, swimming laps, rowing, aerobic dance

General physical activity should be performed daily

Frequency Moderate-to-vigorous intensity exercise 3-5 times per week

Activities for daily living should be performed at a comfortable pace

Intensity Moderate-to-vigorous intensity exercise performed at 50-70% of HRR

Goal is up to 60 minutes of continuous activity

Time Intervals may be as short as 10 min or as long as 30 min to start

Start low and gradually increasing intensity

Progression Progress duration and frequency first, because this approach may increase compliance

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 Aerobic Exercise

◉ Healthy older adults adapt similarly to younger adults:

• Improvements in VO2max
• 10% to 15% improvements at 40-50% of HRmax
• Greater improvements of up to 30% with higher intensities

• Improved stroke volume and cardiac output

• Improved oxidative capacity of skeletal muscle

• Improvements in a-vO2 difference

• Reduced systemic vascular resistance

• Improvements in insulin sensitivity and glucose homeostasis
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 Aerobic Exercise for the Body and Mind

◉ One study had 59 adults (age 60 to 79) did 6 weeks of training, 3x a week for 1 hour
• Do nothing group (control)
• Stretching-and-toning group (calisthenics)
• Aerobic group (walking)

• The aerobic group showed a change in brain volume

• Gray matter increased most in the frontal lobes (attention and memory)
• White matter increased most in the corpus callosum (thinking)

◉ Older people with mild cognitive impairment showed improvements in brain blood flow
and memory after a yearlong aerobic exercise program

◉ This may help people with mild cognition and potentially combat rising cases of
Alzheimer’s disease and other forms of dementia
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 Safe Exercise Practices

◉ 4-15% of heart attacks occur soon after exercise

• Atherosclerotic plaques may become dislodged
• Rates are 5x higher after high intensity exercise
• Risks are greater for new exercisers

◉ Immune function decreases following intense exercise

• The lungs may be vulnerable to infection
• Exercise may provoke an asthma attack (which can be fatal)

◉ Encourage better exercise practices

• Be mindful of exercise intensity (especially in the beginning)
• Regular exercise and health assessments encouraged

◉ Mechanical loading encourage Ca2+ uptake in the bones

• There is no change in bone mineral density, but activity may minimize bone mineral loss
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Exercise Prescription Guidelines

Resistance Training

Frequency Two or more times per week

50-60% of predicted maximum (moderate) or 70-80% of predicted

Intensity
maximum (vigorous)

10-15 repetitions for strength gains (up to 20 repetitions to improve

Time
endurance), 20-30 minutes per sessions

More often: muscular fitness training using machines and elastic bands
Type
Less often: Training using free weights

Free weights may be difficult for a person to balance (assist)

Considerations
Focus on major muscle groups for activities of daily living

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 Resistance Training

◉ Healthy older adults can see similar changes to younger adults (if training intensity is high enough)

◉ Programs lasting 3 to 6 months can lead to increases in muscle strength of 40% to

150% and increases in submaximal performance of 100% to 300%

◉ Muscle strength gains have been greatest when training is at moderate to high
intensity (60-80% of RM) with progressions of 5% to 10% per week

◉ Increases in strength are the result of both muscle hypertrophy and neuromuscular
adaptation

◉ Strength training also increases bone mineral density and content, metabolic rate,
and improves insulin and plasma levels
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 Exercise Challenges for Elderly

◉ Activity can generate excessive muscular forces

• May promote painful flare ups for those with joint issues

◉ Individuals may be on medications that mask joint pain

• Medications may promote anemia

◉ Many individuals have trouble sleeping

• May have low energy levels

◉ Many individuals experience significant morning stiffness

• Exercise will be more challenging early in the day
• But…activity may improve circulation
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Exercise Prescription Guidelines

Flexibility Training

At least two times per week

Frequency
Ideally every day but especially following other types of training

Subject should feel a mild stretch without inducing pain

Intensity
Progress range of stretch based on lack of discomfort experienced

Time 5 to 30 min total, with two 30s bouts on each muscle group

Static stretching
Type
Balance training to reduce falling risk

Consider doing seated stretches

Considerations
Use of a towel or elastic bands to assist those with difficulties

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 Range of Motion Training

◉ Healthy older adults may improve but to what end:

• Several studies demonstrated that regular range of motion training improves flexibility at
various joints (e.g., spine, hips, ankles, knees, and shoulders)

• Other studies have shown no effect

• Improvements in flexibility can increase the effective range of strength gains and improve
ambulatory ability

• Sensory stimulation modifies pain perception, which improves muscle relaxation

• Increased muscular strength and activation leads to better balance and postural control

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 Things to Consider

◉ Avoid inactivity; some physical activity is better than none

◉ The intensity and duration of physical activity should be low at the outset for older adults who are
highly deconditioned, functionally limited, or have a chronic health conditions

◉ The progression of activities should be individualized and tailored to the individual's tolerance and
preferences

◉ Muscle strengthening activities and balance training may need to precede aerobic training activities
among very frail individuals

◉ Older adults should exceed the recommended minimum amounts of physical activity if they desire to
improve their fitness

◉ Older adults at risk of falling should do balance training for three or more days per week
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 Working Towards Better Health

◉ Goal is to maintain an independent lifestyle (active living)

• Engage in a year-round training program
• Take days off when sore
• Decrease intensity after taking time off

◉ Goal is to empower the individual

• Many seniors avoid exercise out of fear of injury
• “How is this helping me?”, “What is this going to do for me?”
• Provide information about “how” and “why” to exercise

◉ Take a holistic approach to health

• Adopting better behaviours (improve diet, socialize)
• Take preventative measures (regular checkups, take medications + vaccines)
• Safety first (progress with caution, importance of warm-ups and cool-downs)
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 Goal Setting

◉ The initial adoption of physical activity is best predicted by readiness to change

◉ Before writing an exercise prescription, educate the individual about the benefits of
physical activity and motivate him or her with relevant personal goals

◉ Begin with activities that the individual can actually perform

• A trainer can also help decrease the fear of injury from exercise
• Individuals with physical function limitations may benefit from physical therapy first

◉ Counselling to promote physical activity and a healthy diet is important

• Provide behavioral counselling to promote a healthful diet and physical activity for CVD
prevention (especially for those with CVD risk factors)
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 Setting FITNESS Goals for Elderly Individuals

◉ F Fun

◉ I Independent living

◉ T Terminate aging stereotypes

◉ N Neuromuscular control

◉ E Extend life to their years not only years to their life

◉ S Stop disease promoting behavior

◉ S Social support and interaction

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 To Summarize

Exercise to help minimize chronic disease health risks

Participation in a regular physical activity program has many physiological health benefits including
reducing the risk and lessening the effect of many chronic diseases

Activity for health, exercise for training

Physical activity of light-to-moderate intensity helps improve health, moderate-to-high intensity
physical activity with an emphasis on aerobic endurance improves cardiorespiratory function

Maintaining functional independence

Resistance training increases muscle mass and strength and improves gait, balance, overall
functional capacity, and bone health

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