Chapter 3

1. Chapter 3 Resistance-Training Strategies for Older Adults

2. Advantages of Resistance Training • Helps modify aging patterns • Helps stabilize health profiles • Mitigates frailty • Helps preserve and (possibly) enhance functional capacity, vitality, and quality of life

3. Obstacles to Resistance Training • Multiple chronic medical conditions • Limited access to appropriate programs or qualified instruction • Fear of injury • Logistical obstacles • Economic barriers

4. Prevalence of Aging • More than 35 million Americans over age 65 • Approximately 12 percent of total population • By 2030, 70.3 million adults over age 65 • More than 20 percent of population • Older adults susceptible to frailty, disease, and dependency

5. Frail Older Adults Constitute • 50 percent of all hospital care • 80 percent of home care services • 90 percent of all nursing home beds • US spent approximately 66 percent of $585 billion on health care in 2000 on older adults

6. Physiology of Aging • Pervasive loss of fat-free mass • Skeletal muscle • Increases in body fat • Cardiovascular changes

7. Sarcopenia • Age-related loss of skeletal muscle mass and strength • Progressive atrophy of skeletal tissue • Rate of loss accelerates after age 50 • Results in functional limitations • Impaired activities of daily living

8. Risks of Increased Body Fat • Predisposition to metabolic-based morbidities • Predictor of disability, physical limitation, declining mobility/quality, and higher mortality • Combined with sarcopenia, increases overall morbidity and mortality

9. Cardiovascular Changes • Stiffening of large central arteries • Heart exerts more effort • Pushing blood downstream • Increased cardiac workload causes: • Exercise intolerance • Increased susceptibility to instability

10. Inflammation • Caused by many non-cardiac diseases • E.g., chronic obstructive pulmonary (COPD), infections, arthritis • Detriment to functional capacity in elderly • Visceral fat common source of systemic inflammatory peptides

11. Benefits of Resistance Training • Allays muscle weakening/atrophy • Can stimulate muscle growth • Reduces body fat, inflammation, and catabolism • Increases function

12. Benefits of Resistance Training • Diminishes frailty • Preserves and/or restores more youthful, generally healthier physical profile

13. Positive Impact on Aerobic Power • Facilitates increases in overall physical activity • Enables safe initiation of physical activity • Increases posture, joint stability, balance, flexibility, and bone strength • Improves capacity for activities of daily living

14. Positive Impact on Sarcopenia • Increases fiber size • Increases muscle mass and intrinsic strength • Mitigates oxidative stress • Increases protective heat shock proteins • Contributes to pattern of increased overall activity that reduces ambient inflammation

15. Positive Impact on Body Fat • Fat reduction • Increased muscle mass leads to higher levels of physical activity • Reduced visceral fat mitigates associated risks for insulin resistance and hypertension

16. Positive Impact on Body Fat • Enhanced insulin sensitivity in skeletal muscle decreases inflammation and helps weight loss

17. Other Positive Impacts of Resistance Training • Bone mineral density • Increased muscle strength stimulates bone homeostasis • Helps mitigate osteopenia • Vasculature • Beneficial to vascular health

18. Training Goals for Frail Adults • Slow progression of weakening/disability • Regain capacity for activities of daily living • Emphasize safety and behaviors conducive to long-term progression

19. Training Goals for Frail Adults • Begin with basic, simple movements • Warm-up and stretching • Instruction on balance and breathing • Low-intensity resistance using body weight • Short sets • One to two sessions per week

20. Training Goals for Frail Adults • Advanced • Add resistance tubing, ankle weights, and other weights over time • Increase repetition number before resistance

21. Training Goals for More Robust Adults • Include strategies to achieve maximum increases in muscle mass, muscle strength, and function • High-intensity regimens achieve beneficial muscle and metabolic changes • Benefits among men and women similar

22. Exercise Prescription Strategies for Older Adults • ACSM guidelines use Borg scale of perceived exertion • Intensity ranges from 12 to 19, two to three days per week, up to one hour • Older adults can maintain these goals with key refinements • Particularly when frail

23. Exercise Prescription Strategies for Older Adults • Robust older adults can begin at lower intensities of 12 to 13 and then advance to 15 to 16 • Frail adults may advance to intensities of 12 to 13

24. Exercise Prescription Strategies for Older Adults • Emphasize muscles in lower and upper extremities that facilitate standing, walking, lifting, and reaching

25. Exercise Choices • Exercise machines • Provide greater safety • Make it easier to control ROM

26. Exercise Choices • Free weights • Offer greater accessibility • Provide cost advantages • Require thorough teaching and monitoring • May be difficult for frail older adults

27. Factors Influencing Exercise Prescription • Time of day • Proper clothing and footwear • Appropriate warm-up and cooldown • Static stretching for each muscle group • Proper breathing • Avoiding/Minimizing Valsalva maneuver

28. Factors Influencing Exercise Prescription • Rhythmic movements performed at moderate-to-slow, controlled speed through full ROM • Supervised training of proper technique • Length of sessions • Begin with short sessions • Only advance as stamina/comfort increase

29. Factors Influencing Exercise Prescription • Use of unilateral movements to increase balance and decrease total amount of work • Allowance for rest, as needed • Use of Borg scale to gauge exercise intensity

30. Effects of Cardiovascular Diseases on Exercise Prescription • Program must include: • Clinical assessment • Coordinated care with primary physician • Monitoring • Does not preclude participation in program

31. Effects of Cardiovascular Diseases on Exercise Prescription • Typically safer than aerobic training due to slower heart rate • Contraindications • Signs/Symptoms of unstable cardiac conditions

32. Barriers to Resistance Training • Fear of precipitating cardiac event or causing injury • Embarrassment over incontinence or lack of skill • Apprehension caused by hearing/visual impairments, cognitive slowing, and economic constraints

33. Barriers to Resistance Training • Lack of transportation • Poor nutrition • Lack of sleep • Muscle soreness • Causing fear or apprehension

34. Overcoming Barriers • Requires stepwise, individual approach • Apprehension • Education to prevent injuries • Seated exercises to help prevent falls

35. Overcoming Barriers • Sensory impairment • Visual aids and signs with large fonts • Consistent room organization • Proper lighting • Loud and clear manner of speaking

36. Overcoming Barriers • Economic • Most challenging barrier to overcome • Classes offered in senior centers • Help with transportation issues • Low-cost transportation options often unavailable to older adults

37. Home-Based Exercise • Unsupervised • “Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging”

38. Home-Based Exercise • Barriers to success: • Frail adults require personal instruction • Periodic reassessment necessary • Lack of emergency care

39. Community-Based Exercise • Occurs in health or fitness center • Supervised • Social

40. Advantages of Community-Based Exercise • Incorporates components of assessment, monitoring, and safety • Social reinforcement means higher adherence to routine • Achieves significant increases in lean mass and muscle strength • Better suited for frail older adults

41. Successful Resistance Training • For older adults, requires: • Social support and positive reinforcement from friends, family, and physician • Comprehensive management strategy to maximize recruitment, increase teaching and safety, increase motivation, and minimize attrition • Review sample 24-Week Program