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The Elderly

Anthony DeLuca . The Elderly. Physical Activity and Life Cycle. Only 25% of elderly report being physically active 5 days/week for 30 mins/session. . How Aging Effects Nervous System.

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The Elderly

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  1. Anthony DeLuca The Elderly

  2. Physical Activity and Life Cycle • Only 25% of elderly report being physically active 5 days/week for 30 mins/session.

  3. How Aging Effects Nervous System • Skeletal Muscle- increased: risk of osteoporosis, arthritis. Decreased: mass, strength, speed, power, flexibility, type II fibers • Body Composition- increased: fat. Decreased: lean mass, bone mass. • Cardiovascular-increased: BP, risk for CVD. Decreased: cardiac output, VO2, dilatory capacity. • Metabolic-increased: glucose intolerance raising insulin levels leading to type 2 diabetes, risk of obesity.

  4. Continued.. • Respiratory-increased: chest wall/pulmonary artery stiffening, chest elastic recoil, lung pressure, dead space. Decreased: inspiratory/expiratory capacity, lung function, peak ventilation • Nervous- increased: risk of dementia, Alzheimer's. Decreased: blood distribution during exercise, cognition, memory, learning ability, reaction time, sleep, gait, balance, hearing, sight. • Energy Expenditure/Intake-increased: fat mass. Decreased: RMR, calorie expenditure, fat-free mass, calorie/protein intake. • Thermoregulation- decreased: ability to regulate body temp, amount of sweat per sweat gland, blood flow responses to exercise

  5. Physiological Changes due to Aging • Cardiovascular-rest: increased BP, decreased HR. Max ex: decreased HR, cardiac output, O2 consumption, responses to stimulation, atrial-venous oxygen difference; no change in stroke volume • Respiratory-max ex: increased breathing frequency, residual volume; decreased max ventilation, tidal volume, vital capacity • Musculoskeletal-decreased muscle mass, strength, balance, coordination, bone density, elasticity in connective tissue • Metabolic- decreased glucose tolerance, insulin action, metabolic rate • Thermoregulation- decreased thirst, skin blood flow, sweat production

  6. Chronic Medical Conditions in Elderly • Coronary Artery Disease- leading cause of death • Hypertension- most common • Arthritis • Diabetes • Obesity

  7. Pre-Exercise Training Evaluations • Chair Stand • Step Ups • Walking Speed • Tandem Walk • One-Leg Stand • Functional Reach • Timed Up and Go • Range of Motion

  8. Specific Exercise Testing • Cardiovascular- treadmill/ergometer, low intensity with small increases in work rate (peak VO2, HR, BP, ECG) • Strength- weight machines, modified 1RM focusing on muscles of ADL (load and reps) • ROM-gonimeter, measuring hip, ankle, knee, shoulder, low back, and hamstrings (degrees of motion)

  9. Cardiovascular Exercise Prescription • Mode-walk, cycle, pool, aerobics, ADL’s • Frequency-moderate 3x/week, vigorous 5x/week • Intensity-low- 40% HRR or <5 on RPE scale to 10. moderate- 50-70% HRR or 5-6 RPE. vigorous- >70% HRR or 7-8 RPE. • Duration-low/moderate- 30 min continuous, 60 mins total. vigorous- 20 mins, can be in intervals • Considerations-start with short bouts at a low/moderate intensity building up to 30 continuous minutes. Make initial progress to increase compliance with program. Think about arthritis, osteoporosis, and heart disease

  10. Strength Training Prescription • Mode-multistation machines, elastic bands, hand weights • Frequency->2x/week • Intensity- 5-6 RPE moderate, 7-8 RPE vigorous • Duration-10-15 reps for strength gains, up to 20 reps for endurance, 20-30 min/session • Considerations-free weights may be difficult so assistance/machines must be available. Focus mainly on large muscle groups used in ADL’s (legs, shoulders).

  11. ROM Training Prescription • Mode-static stretching and balance training • Frequency-minimally 2x/week, maximally everyday especially after an aerobic or resistance training • Intensity- mild stretch without pain, gradually increase range of stretch • Duration- 5-30 min total with two 30 sec bouts on each muscle group (all large muscle groups), yoga or tai chi for balance • Considerations-avoid ballistic stretching/ valsalva maneuver. Can be performed before and after exercise

  12. Skeletal Muscle Power: A Critical Determinant of Physical Functioning in Older Adults • What to Assess? • Lower Extremity Muscle Power • Vertical jump on a platform force • Unloaded leg extensor power , isokinetic dynamometry • Pneumatic resistance training equipment (provides high resistance without interia and dependency up gravity, no weight stack, just resistant force)

  13. Short Physical Performance Battery Test • Characterizes lower extremity function using timed measures of standing balance, gait speed, and strength. • Studies show that the majority of elderly who take this test are classified as “mobility limited.” • The elderly with low muscular power were at greater risk of being “mobility limited” as compared to those with low muscular strength.

  14. Muscle Contraction Velocity • Compared with muscle strength, contraction velocity of leg extensors has been shown to be a stronger predictor of lower intensity tasks such as habitual walking speed. • Higher leg press contraction velocity was associated with better performance on several measures of balance that are predictive of falling.

  15. Physiological Determinants of Muscle Power and Mobility Limitations • With increasing age, there is a reduction in the number and size of type II muscle fibers (which can generate 4 times the power output of type I fibers) • Muscle Power loss also influenced by: • Increases in muscle fat infiltration • Changes in neuromuscular function • Alterations in hormones

  16. Changes in Muscle Mass and Quality • An experimental assessment was attempted to examine differences in muscle power generation within a specific age range in order to capture key factors that contribute to muscle power deficits and mobility limitations

  17. Results • Lower extremity muscle • Elders : • 95% reductionin muscle power and a 25% reduction in muscle mass compared to healthy middle-aged participants. • 65% reduction in muscular power and a 13% reduction in muscle mass compared to healthy older participants. • Healthy older subjects : - Estimated 2% muscle mass decline per year after age 65 - Decline in muscle performance was 3 times higher than the loss of muscle mass, suggesting a decline in muscle quality.

  18. Restore Muscle Power • Resistance training that is designed to maximize muscle power output has shown that high velocity power training is: • Realiable • Well tolerated • Effectively can improve lower extremity muscle power in: • Healthy men/women • Older women with a self reported disability • Older adults with mobility limitations • Women older than 80 years

  19. High Velocity Resistance Program • After 12 weeks of high-velocity resistance training: • increase in leg power in older men/women (50%-141%) • increase in lower extremity muscle power in older adults with mobility limitations (25%) • increase in specific leg extensor muscle power in older adults with mobility limitations (46%) • Peak power output improved equally (14-15%) in all resistances of 20% 1RM, 50% 1RM and 80% 1RM in healthy older adults. - This suggests that power output can be increased with high velocity training at both low and high external resistances.

  20. Continued… • Demonstrates relationship between the respective training intensities and improvements in muscle strength (20%) and muscle endurance (185%) when using the highest loading intensity of 80% 1RM. • 12 weeks of explosive heavy resistance training with a loading intensity of 75%-80% 1-RM demonstrates: • Substantial improvements in muscle power (28%). • Gains in rapid muscle force-generating characteristics in healthy older women between the ages of 80-89.

  21. Power Training in Older Adults • Power training performed at a low intensity was associated with the greatest improvements in balance. • Exercises included weighted stair climbing. • Increased leg power (17%) • Increased stair climbing power (12%)

  22. Conclusion • Trials have determined that: • Muscle power > Muscle Strength – in predicting functional performance in older adults • High Contraction Velocity > Low Contraction Velocity – in improving muscle power • Exercise Programs targeted at improving leg muscle power are: • Safe • Well tolerated • Effective, even among frail older adults

  23. Sources - Kieran F. Reid and Roger A. Fielding. “Skeletal Muscle Power: A critical determinant of Physical Functioning in Older Adults.” Nutrition, Exercise Physiology Laboratory, USDA Human Nutrition Research Center of Aging, Boston, MA. Sept 19, 2011.

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