Sports Medicine Book

Physical Exercise

  • Exercise in the Elderly

http://www.fpnotebook.com/

Exercise in the ElderlyAka: Active Older Adult, Activity in the Elderly

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  1. Efficacy
    1. Sedentary relative risk of Cardiovascular disease: 1.9
    2. Exercise reduces age related morbidity and mortality
      1. See Exercise for benefit summary
      2. Impacts functional independence
      3. Fitness Activity reduces mortality 19%
      4. Productive Activity reduces mortality 35%
        1. Employment
        2. Volunteer work
        3. Gardening
        4. Shopping
        5. Housework
      5. Social Activity reduces mortality 20%
        1. Movies
        2. Sporting or recreational activity
        3. Recreational travel
        4. Group participation
      6. References
        1. Glass (1999) BMJ 319:478
    3. Benefits realized even if Exercise started at late age
      1. Life expectancy increases even at age 75 years
        1. Paffenbarger (1986) N Engl J Med 314:605
      2. VO2 max decline reversed up to 30% at 6 months
        1. (1998) Med Sci Sports Exerc 30:992
  2. Physiology
    1. Muscle strength declines with aging
      1. Muscle strength declines 15% per decade after age 50
      2. Muscle strength declines 30% per decade after age 70
    2. Framingham Disability study
      1. Unable to lift 10 pounds: 45% of women over age 65
      2. Unable to lift 10 pounds: 65% of women over age 75
  3. Contraindications to Exercise
    1. Absolute
      1. Recent Electrocardiogram changes
      2. Recent Myocardial Infarction
      3. Unstable Angina
      4. Third degree Heart Block
      5. Acute Congestive Heart Failure
      6. Uncontrolled Hypertension
    2. Relative
      1. Cardiomyopathy
      2. Valvular heart disease
      3. Complex ventricular ectopy
    3. References
      1. (1998) Med Sci Sports Exerc 30:992
  4. Indications for Stress Testing before Exercise
    1. Exercise at >60% of VO2 Max
      1. Men over age 45 years
      2. Women over age 55 years
    2. Known Coronary Artery Disease
    3. History of cardiac, pulmonary, or metabolic symptoms
    4. Cardiac Risk Factors (two or more)
    5. Diabetes Mellitus
  5. Recommended Exercise program
    1. Stretch major muscle groups daily after Exercise
    2. Perform balance training twice weekly
      1. One legged stands
      2. Circle turns
      3. Heel stands
      4. Consider covering eyes while performing activities
    3. Cardiovascular fitness
      1. Moderate Aerobic Activity (2 to 5 METS)
      2. Activity totals 30 minutes or more on most days
    4. Strength Training
      1. Set of 10-15 repetitions each of 8 to 10 Exercises
      2. Perform Exercises 2-3 times per week
      3. Work all muscle groups, slowly and through full ROM
    5. Flexibility training
      1. Perform 2-3 times weekly
      2. Only mild discomfort should be felt
      3. Repeat 3-4 times per stretch with 30-60 second rest
      4. Perform both static and dynamic stretches
        1. Static stretch (hold position 10-30 sec then relax)
        2. Dynamic stretch (fluid motion such as Tai Chi)
  6. References
    1. (1998) Med Sci Sports Exerc 30:992
    2. Nied (2002) Am Fam Physician 65:419

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