Sports Medicine Book

Physical Exercise

  • Exercise in the Elderly

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Exercise in the Elderly

Aka: Exercise in the Elderly, Active Older Adult, Activity in the Elderly
  1. See Also
    1. Exercise Prescription
    2. Pulmonary Rehabilitation
  2. Epidemiology
    1. More than a third over age 65 years old in U.S. with no leisure-time Physical Activity
  3. Efficacy
    1. Sedentary Relative Risk of Cardiovascular disease: 1.9
      1. Sedentary status is also associated with increased mortality
      2. Ensrud (2014) J Am Geriatr Soc 62(11): 2079-87 [PubMed]
    2. Exercise reduces age related morbidity and mortality
      1. See Exercise for benefit summary (including chronic disease specific benefits)
      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 [PubMed]
    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 [PubMed]
      2. VO2 max decline reversed up to 30% at 6 months
        1. (1998) Med Sci Sports Exerc 30:992-1008 [PubMed]
  4. 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
  5. 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 [PubMed]
  6. 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
  7. Management: Starting an Exercise program
    1. Start slowly and build
      1. Example: Start with brisk walking for a total of 50 minutes per week
      2. Any activity is better than no activity
    2. Find activities that fit a patient's health status and functional capacity
      1. Start with low intensity activity if deconditioned or limited functional capacity
      2. Strength and balance may be needed before aerobic fitness in frail elderly at risk for falls or injury
      3. Consider water-based aerobic activity for patients limited by Osteoarthritis
    3. Consider Activities of Daily Living (e.g. stair climbing, errands)
    4. Consider classes (e.g. community center, YMCA)
      1. Consider an experienced fitness trainer (with caution to prevent injury or overuse)
    5. Set goals
      1. Consider a pedometer, and increase steps by 10% every 2 weeks
      2. Consider increasing daily walk time by 10 min each day until target time is reached
  8. Management: Recommended Exercise program
    1. Stretch major muscle groups daily after Exercise
    2. Perform balance training 2-3 times weekly (esp. elderly at risk for falls)
      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)
        1. Alternatively, 75 min/week of vigorous activity (e.g. Jogging or Running)
      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 major muscle groups, slowly and through full ROM
      4. Examples
        1. Calisthenics
        2. Resistance Training (Exercise bands, weight machines, dumbells)
        3. Pilates
    5. Flexibility training (Stretching)
      1. Perform 2-3 times weekly (best benefit with daily flexibility Exercises)
      2. Greatest benefit when performed after aerobic or Strength Training
      3. Only mild discomfort should be felt
        1. Consult regarding restrictions with medical provider or physical therapist if recent injury or surgery
      4. Repeat 3-4 times per stretch with 30-60 second rest
      5. 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)
  9. Resources
    1. National Institute on Aging - General
      1. https://www.nia.nih.gov/health/publication/exercise-physical-activity/introduction
    2. National Institute on Aging - Go-4-Life
      1. https://go4life.nia.nih.gov/
    3. NIH Senior Health - Exercise
      1. https://nihseniorhealth.gov/exerciseandphysicalactivityhowtogetstarted/choosingyouractivities/01.html
    4. CDC Exercise Guidelines
      1. https://www.cdc.gov/physicalactivity/basics/older_adults/
  10. References
    1. (1998) Med Sci Sports Exerc 30:992-1008 [PubMed]
    2. Elsawy (2010) Am Fam Physician 81(1): 55-62 [PubMed]
    3. Guozhu (2017) Am Fam Physician 95(7): 425-32 [PubMed]
    4. Nied (2002) Am Fam Physician 65:419-28 [PubMed]

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