Exercise Programming for the Elderly Population

Exercise Programming for the Elderly Population

A long-term exercising program, successfully performed, can dramatically slow down and partly reserve the debilitating results of age and certain age-related complications. Exercise has a couple of propitious results: it could relieve pain, produce an experience of well-being, save you from falls, growth independence, lessen clinical costs, reverse obesity, shield joints from additional breakdown, and enhance lung and coronary heart function.

Physiologic changes of aging that limit function and general quality of life, occur at a faster rate as we get older. Research has shown that this lack of physical activity has negative effects on cardio-metabolic health, muscle-tendon health, functional fitness, physical independence, body composition, and all-cause mortality (Nelson et al., 2007).

Exercise programs for older adults should include aerobic, resistance, flexibility and balance training. Each individual type of exercise may benefit different health-related factors, but combining them all is essential for an effective exercise program in older adults.

The Benefits of Physical Exercise

Age causes deterioration in most organs but is particularly noticeable in our musculoskeletal system-in our muscles, joints, limbs, ligaments, tendons, and cartilages

Age and inactivity go hand in hand, and a sedentary lifestyle lowers the rate at which oxygen is transferred from the air to the blood through the lungs. Between the ages of 30 and 80, the average human loses 60% of their capacity to metabolize oxygen. Regular aerobic exercise, such as walking, cycling, running, etc., can nearly fully prevent the majority of this reduction in oxygen uptake Calcium is lost from bone due to muscular atrophy and inactivity. Osteoporosis is a disorder in which bones deteriorate and often break. Contrarily, exercise turns these processes around. Exercise builds muscles, improves limb flexibility, boosts endurance, and replenishes calcium in osteoporotic bones, among other benefits. These effects support individual independence in carrying out everyday tasks and aid to prevent falls, which are a relatively prevalent risk for senior patients. Exercise triggers the brain to release chemicals that reduce pain and increase happiness. Depression may be lessened by these results, reduce fatigue, and correct insomnia.

Aerobic/Endurance

Aerobic capacity measured by maximum oxygen consumption (VO2 max) shows a steady decline with age, as much as 10% per decade after 25 years of age. (Seals et al., 2009).

Exercise Recommendations

Initially, the aerobic exercise program for an older adult should start with a low level of activity and ideally progress to moderate activity (50%–60% of pretraining VO2max). The average moderate activity level for most older adults is 2.5 to 5.5 METS, which is the same as walking at a 3.2 to 7.2 kmph) or cycling at 16 kmph or less. In order to achieve a safe and adequate level of effort, it is recommended for older adults start a supervised exercise program. Aerobic exercise should be performed for 3 days or more per week for a total of 30 minutes with warm-up and cooldown periods of 5 to 10 minutes of low-intensity activity. The benefits of aerobic endurance training are observed with programs lasting more than 4 months, and even greater benefits are observed with aerobic endurance training programs lasting more than 6 months It is recommended that cycling, elliptical walker, and aquatic aerobic exercises should be considered as an alternative for older adults with conditions that may limit weight-bearing activity. Stationary recumbent cycling may be considered an option for older adults with low-back pain or poor balance.

Resistance/strengthening

Sarcopenia leads to a loss of strength, later on to a decreased functional status, impaired mobility, a higher risk of falls, and eventually an increased risk of mortality. The progressive decline in muscle mass and strength accelerates after 65 years of age; by 80 years of age, up to 50% of peak skeletal muscle mass can be lost. This normal aging phenomenon has been related to a lack of physical activity, loss of muscle fibers, protein synthesis, and mitochondrial function. (Concannon et al., 2012).

Exercise Recommendations

Initially, the resistance training program for an older adult should start with a low intensity (40%–50% of 1RM, or exercising to the point of fatigue). If the person is in pain or has a considerable weakness when performing the exercise, isometric strengthening should be used. If the person has more exercise experience or when the pain and weakness improve, the program should progress to moderate (60%–70% of 1RM) and high-intensity (80% of 1RM). These exercises should be performed 2 to 3 times per week, 10 to 15 repetitions; the major muscle groups should be addressed, including the core and hip muscles, which are essential for the prevention of falls (Micheo et al., 2012). Aquatic resistance exercises should be considered as an alternative for older adults with poor balance and conditions that may limit weight-bearing activity.

Flexibility/stretching

Flexibility is the range of motion (ROM) in a joint or in a group of joints. It is influenced by muscles, tendons, and bones and is described as the degree to which muscle length permits movement over the joint in which it has influence. It has been postulated that by 70 years of age, flexibility and joint ROM declines are significant for the hip (20%–30%), spine (20%–30%), and ankle (30%–40%), especially in women(Chodzko-Zajko et al., 2009).

Exercise Recommendations

Exercises that increase or maintain a range of motion around a are referred to as flexibility exercises. Holding a stretch at the point of slight tightness or tension for 10 to 30 seconds longer seems to have little apparent benefit while discomfort increases joint ROM. With longer stretching sessions of 30–60 seconds, older people may see greater gains in range of motion. Performing each flexibility exercise two to four times for 3 to 12 weeks frequency of at least; yields the greatest benefit. For each flexibility exercise, the target is to stretch for a total of 60 seconds. between each stretch, take a 30- to 60-second break. Duration and repetition can be modified to each person’s requirements(Garber et al., 2011). In older patients, activities that maintain or increase flexibility using sustained stretches of moderate intensity for each major muscle group and static rather than ballistic movements are preferred.

Stability/Balance

The capacity to keep the body’s center of mass (COM) within certain bounds is known as balance. In the geriatric population, balance problems are frequently a multifactorial condition. Proprioception loss, altered muscle activation patterns, a lack of strength in the core stabilizing muscles, and an inability to maintain regular postural control can cause elderly people to lose their balance.

Exercise Recommendations

Exercise prescription guidelines recommend using activities that include the following: progressively difficult postures that gradually reduce the base of support (2-legged stand to 1-legged stand), dynamic movements that perturb the center of gravity (circle turns), stressing postural muscle groups (toe stands), or reducing sensory input (standing with eyes closed). Balance training activities, such as lower-body strengthening and walking over difficult terrain, have been shown to significantly improve balance in many studies (Chodzko-Zajko et al., 2009). Stability and balance programs in healthy adults should be performed 2 to 3 days per week, particularly for older adults who want to improve function and prevent falls At the very first stage, single muscles are isolated with the goal of combining several muscles in simple movements in stable positions and in a single cardinal plane, progression can be given with increasing speed, adding multidirectional movements, adding off-axis loads in all cardinal planes, and adding progressively unstable surfaces. Neuromotor and proprioceptive exercise training, incorporate motor skills, such as balance, coordination, gait, and agility, which help improve balance, agility, and muscle strength, and reduce the risk of falls (Micheo et al., 2012).

occupational therapy (OT) treatments for balance disorders and fall prevention include increasing postural stability and strength, upper-extremity strength and endurance, proprioceptive awareness, and safe functional mobility. Functional standing tasks, such as emptying the dishwasher, can promote dynamic standing strength and proprioceptive awareness, increasing strength and endurance in postural muscles.

References

  • Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., Macera, C. A., & Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise, 39(8), 1435–1445. https://doi.org/10.1249/mss.0b013e3180616aa2
  • Seals, D. R., Walker, A. E., Pierce, G. L., & Lesniewski, L. A. (2009). Habitual exercise and vascular ageing. Journal of Physiology, 587(23), 5541–5549. https://doi.org/10.1113/jphysiol.2009.178822
  • Concannon, L. G., Grierson, M. J., & Harrast, M. A. (2012a). Exercise in the older adult: From the sedentary elderly to the masters athlete. PM and R, 4(11), 833–839. https://doi.org/10.1016/j.pmrj.2012.08.007
  • Micheo, W., Baerga, L., & Miranda, G. (2012). Basic principles regarding strength, flexibility, and stability exercises. PM and R, 4(11), 805–811. https://doi.org/10.1016/j.pmrj.2012.09.583
  • Chodzko-Zajko, W. J., Proctor, D. N., Fiatarone Singh, M. A., Minson, C. T., Nigg, C. R., Salem, G. J., & Skinner, J. S. (2009). Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 41(7), 1510–1530. https://doi.org/10.1249/MSS.0b013e3181a0c95c
  • Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., Nieman, D. C., & Swain, D. P. (2011). Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Medicine and Science in Sports and Exercise, 43(7), 1334–1359. https://doi.org/10.1249/MSS.0b013e318213fefb
  • Micheo, W., Baerga, L., & Miranda, G. (2012). Basic principles regarding strength, flexibility, and stability exercises. PM and R, 4(11), 805–811. https://doi.org/10.1016/j.pmrj.2012.09.583