Exercise Programs In The Elderly:Risks and Benefits

Constance Bayles, Ph.D.; FACSMProgram Director

Center for Healthy Aging

“A Center for Disease Control Prevention Center”

Graduate School of Public Health

University of Pittsburgh

Pittsburgh, Pennsylvania

Exercise Programs In The ElderlyPresentation Outline

Pathophysiology

Benefits: Physiological/Psychological

Preliminary Program Guidelines

Exercise Testing and Prescription

Medications and Exercise

Exercise Programming

Position Stands: CDC (HAN Group)/ACSM

Summary/Conclusions/Questions and Answers

Exercise Programs In The ElderlyPhysical Decline

• Normal Aging

• Disease

• Disuse

Exercise Programs In The ElderlyPhysical Frailty

A state of reduced physiological reserves associated with increased susceptibility to disability.

Exercise Programs In The ElderlyFrailty

• Extreme Old Age

• Disability

• Multiple Chronic Disease/Geriatric Syndromes

• Multiple Medications

Exercise Programs In The ElderlyFrailty

Frail Older Adults:• Dependent

• Acute Illnesses

• Falls and Other Injuries

• Recover from Illness/Injuries Slowly

• Institutionalized or Hospitalized

Exercise Programs In The ElderlyFrailty

• Increased Mortality/Morbidity

• Increased Physical Decline

• Functional Impairment

Exercise Programs In The Elderly

• 12.6 million people have coronary heart disease

• 1.1 million people suffer from a heart attack in a given year

• 50 million people have high blood pressure

American Heart Association. 2002 heart and stroke statistical update. Dallas, TX: American Heart Association, 2001.

Exercise Programs In The Elderly

• 17 million people have diabetes

• 90% to 95% of cases are type 2 diabetes, associated with obesity and physical inactivity

• approximately 16 million people have “pre diabetes”

Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2000. Atlanta, GA: U.S. Department of Health and Human Services, CDC, 2002.

Exercise Programs In The Elderly

• 107,000 people are newly diagnosed with colon cancer each year

American Cancer Society. Cancer facts & figures 2002. Atlanta, GA: American Cancer Society. Inc. 2002

Vainio H, Bianchini F. Eds. Weight control and physical activity. IARC Handbooks of Cancer Prevention. IARC Press Vol 6, 2002

Exercise Programs In The Elderly

• 300,000 people suffer from hip fractures each year

Popovic JR. 1999 National Hospital Discharge Survey: Annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Statistics 13(151).2001

Exercise Programs In The Elderly

• 50 million adults (age 20-74) are obese

• 61% of the adult population are either obese or overweight

Exercise Programs In The Elderly

• Research has shown that all individuals, regardless of age can benefit from regular physical activity, vigorous or moderate

• Mobility and functioning in older adults, including the frail, can be improved through physical activity

• Regular physical activity reduces morbidity and mortality from chronic diseases

Exercise Programs In The ElderlyPhysical Inactivity for U.S.Men and Women

Exercise Programs In The ElderlyPhysiological Changes

• Cardiovascular

• Respiratory

• Nervous System

• Musculoskeletal

• Renal

• Metabolic Systems

Exercise Programs In The ElderlyPhysiological Benefits

• Increased Cardiovascular and Cardiorespiratory Function

• Increased Muscle Mass, Strength, & Efficiency• Increased Flexibility,Coordination, and

Balance• Decrease Cholesterol Levels

• Improve Weight Control and Nutrition• Aides Digestion & Reduces Constipation

Exercise Programs In The ElderlyPsychological Benefits

• Decreased Anxiety and Tension• Increased Self-Esteem

• Increased Energy Level• Better Sleeping Patterns• Improved Socialization

• Improved Quality of Life

Exercise Programs In The ElderlyPreliminary Program Guidelines

• Medical History• Medication History

• Social History• Exercise History

• Participant Consent• Physician Consent

• Physiological Assessment• Psychological Assessment

Exercise Programs In The ElderlyExercise Tests/Physiological Assessments

• Walk

• Bicycle

• Strength

• Balance

• Flexibility

• Functional Performance Tests

Exercise Programs In The ElderlyExercise Tests/Psychological

• Cognitive Tests

• Depression

• Health Perception

Exercise Programs In The ElderlyPurpose of Exercise Testing

• To Establish A Degree of Risk Associated With Exercise

• To Establish Appropriate Intensities For Exercise

• To Review Individual Objectives

Exercise Programs In The ElderlyFactors Influencing Exercise

• Low Oxygen Capacity (VO2)• Increased Fatigability

• Increased Need to Monitor• Poor Balance

• Decreased Strength• Less Ambulatory Ability

• Poor Coordination• Decreased Cognitive Status

Exercise Programs In The ElderlyMedications and Exercise

• Polypharmacy/Self Medication

• Renal Excretion of Chemicals is Reduced

IMPORTANT• Know Medications and Side Effects

Exercise Programs In The ElderlyExercise Program Mechanics

• Start Low

• Go Slow

• Monitor Signs and Symptoms

• Decrease Workload If Needed

• Monitor Progress

• Provide Variety

• Motivate

• Make Exercise Fun

Exercise Programs In The ElderlyExercise Prescription

• Reflects Medical Needs• Reflects Social Needs

Primary Goal: Increase Functional Capacity and Independence

Program: Individualized and Progressive

Compliance: Important Issue

Exercise Programs In The ElderlyExercise Prescription

• Mode

• Intensity

• Duration

• Frequency

• Rate of Progression

Exercise Programs In The ElderlyParts of the Exercise Program

• Warm-Up

• Stimulus

• Cool Down

Exercise Programs In The ElderlyExercise Monitoring

• Heart Rate

• Blood Pressure

• Weight

• Ratings of Perceived Exertion (RPE)

Exercise Programs In The ElderlyRisks and Contraindications To Exercise

• Abnormal Heart Action• Pain/Pressure in the Chest• Dizziness/Lightheadedness

• Poor Coordination• Flare Up of an Arthritic Condition

• Nausea/Vomiting• Extreme Breathlessness

• Muscular Pain• Unusual Fatigue

• Mental Confusion

Exercise Programs In The ElderlyEnvironmental Concerns

• Room Temperature

• Water Intake

• Meal Time

• Clothing

Exercise Programs In The ElderlyCDC Position Stands

“The CDC states that regular physical activity offers substantial improvements in health and well-being for the majority of Americans. Moderate physical activity performed on most days of the week can substantially reduce the risk of dying from heart disease, the leading cause of death in the United States and can reduce the risk of developing colon cancer, diabetes and high blood pressure.”

Exercise Programs In The ElderlyCDC Position Stands

• Provides scientific and technical support to the states, national organizations, and professional groups to promote physical activity

• National Physical Activity Initiative is the primary focus. Reflects CDC commitment to reduce major risk factors for chronic disease in the United States

Exercise Programs In The ElderlyHAN (Healthy Aging Network)

• University of California at Berkeley• University of Colorado• University of Illinois, Chicago• University of North Carolina• University of Pittsburgh• University of South Carolina• University of Washington – Lead Center• CDC Healthcare and Aging Studies Branch

Exercise Programs In The ElderlyCDC HAN (Healthy Aging Network)

Mission StatementThe mission of the Healthy Aging Research Network is to better

understand the determinants of healthy aging in older adult populations; to identify interventions that promote healthy aging; and to assist in the translation of such research into sustainable community-based programs throughout the nation.

Healthy aging is the development and maintenance of optimal

physical, mental and social well-being and function in older adults. It is most easily achieved when physical environments and communities are safe and support the adoption and maintenance of attitudes and behaviors known to promote health and well-being; and by the effective use of health services and community programs to prevent or minimize the impact of acute and chronic disease on function.

Exercise Programs In The ElderlyACSM Position Stand, 1998

Exercise and Physical Activity for Older Adults• Regular exercise reduces/prevents functional

decline associated with aging• Endurance training can maintain/improve

cardiovascular function• Strength training offsets loss of muscle mass• Exercise can improve bone health, improve

postural stability, increase flexibility and range of motion

• Reductions in risk factors improve health and affect life expectancy

Exercise Programs In The Elderly

• Summary• Conclusions• Questions & Answers

Thank You!

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