Exercise in the Elderly

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. Fall Prevention and reduced Hip Fracture risk
      3. Improved sleep quality
      4. Impacts functional independence
      5. Fitness Activity reduces mortality 19%
      6. Protects against the development of Dementia
      7. Productive Activity reduces mortality 35%
         1. Employment
         2. Volunteer work
         3. Gardening
         4. Shopping
         5. Housework
      8. Social Activity reduces mortality 20%
         1. Movies
         2. Sporting or recreational activity
         3. Recreational travel
         4. Group participation
      9. References
         1. Glass (1999) BMJ 319:478-83
   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 314:605-13
      2. VO2 max decline reversed up to 30% at 6 months
         1. (1998) Med Sci Sports Exerc 30:992-1008
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
   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 30:992-1008
4. Indications: 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. Management: 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 (150 minutes or more per week)
      3. Examples
         1. Aerobic Exercise class
         2. Bicycling
         3. Dancing
         4. Golf (walking course)
         5. Yard work or gardening
         6. Swimming or water aerobics
         7. Tennis or raquetball
         8. Brisk walking
         9. Cross-country skiing
         10. Snow shoeing
   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
      4. Examples
         1. Calisthenics
         2. Resistance Training (Exercise bands, weight machines, dumbells)
         3. Pilates
   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 30:992-1008
   2. Elsawy (2010) Am Fam Physician 81(1): 55-62
   3. Nied (2002) Am Fam Physician 65:419-28