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Exercise and the Elderly. Physiological Changes With Aging. Aging or decrease in activity? Quality years. Changes in maximal oxygen consumption Muscle mass – sarcopenia Muscular Strength and Endurance Fat deposition and body composition Bone mineral density Osteopenia Osteoporosis
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Physiological Changes With Aging • Aging or decrease in activity? • Quality years
Changes in maximal oxygen consumption • Muscle mass – sarcopenia • Muscular Strength and Endurance • Fat deposition and body composition • Bone mineral density • Osteopenia • Osteoporosis • Diagnosed using T-Score cmoparing to normal young adults
World Health Organization Criteria for Classifying BMD Classification T-Score Normal BMD -1.0 or greater Osteopenia -1.01 to -2.49 Osteoporosis -2.5 or less Severe Osteoporosis -2.5 or less + fragility fracture
Osteoporosis • Bone turnover • PTH and vitamin D3 hormone • Peak BMD • Trochanter and femoral neck in mid to late teens • Spine in mid 20s • Determinants of peak BMD • 70-80% genetics • 20-30% lifestyle
Bone loss • Age related 0.5 – 1%/year • Menopause 1-2%/year for a 5-10 year period • Loss of BMD will continue to pre-adolescent levels
Fragility fracture • Women - Forearm ↑ at age 45-50 leveling off at 65 • Men – no ↑ • Women - Vertebral ↑ age 55-60 rising linearly with age • Men – ↑ 60-70 yrs • Women – Hip ↑ at age 65 and rises exponentially thereafter • Men – ↑ 70-75 yrs
Distal forearm fractures • Excellent marker for future risk • Wedge fracture at L2 →
Exercise Testing • Functional tests • Potential effects of osteoarthritis • Impact of muscular endurance
Training the Elderly • Still adapt normally to exercise • ↑ fitness levels associated with reduced mortality and ↑ life expectancy • Differences between training frail versus healthy elderly • Functional capacity and balance • Simple functional tests
Training the Elderly • Flexibility training • Resistance Training • Important to ADLs and RMR • Careful evaluation of HTN elderly • Arthritics train through pain-free ROM • Reps 2-3s concentric, 4-6s eccentric, 8-12 reps to failure, 2d/wk, progress every 2-3 wks • Breathing
Reducing risks • Calcium intake • Vitamin D • Exercise • Posture