Chapter 16

1. Chapter 16 Older Adult

2. Chapter Objectives • After completing this chapter, you should be able to • Define functional fitness. • State why functional fitness of older adults should be measured. • Describe the pretest/pre-activity screening process for older adults. • Measure the functional fitness of older adults. • Prescribe activities and exercise for the development of functional fitness for the older adult.

3. Functional Fitness Functional fitness is the physical capacity of the individual to perform ordinary daily activities safely and independently without undue fatigue. By year 2020, nearly 20% of the U.S. population will be 65 or older. Will have greater number of individuals age 85 and older. Can expect an increase in the number of individuals who are unable to function effectively.

4. Why Measure Functional Fitness? Sedentary lifestyle often directly related to chronic diseases associated with aging. Activity level of many individuals declines with age. Much of the age-related physical decline in older years may be prevented through an active lifestyle. Must encourage older population to be physically active. Important for older individuals to identify any physical limitations that could place them at risk before before they initiate active lifestyle.

5. Why Measure Functional Fitness? • In addition, proper measure and assessment can serve to: • identify physical weakness or deficiencies that will limit success with the initiation of an active lifestyle • identify physical abilities in which further decline may be prevented or reduced • provide a baseline for evaluating improvement in physical performance

6. Why Measure Functional Fitness? • In addition, proper measure and assessment can serve to: • provide feedback to individuals about their limitations and motivate them to initiate an active lifestyle • provide data for evaluation of program effectiveness

7. Testing Guidelines Pretest/pre-activity screening somewhat different than screening for younger adults. Should administer activity readiness questionnaire such as Physical Activity Readiness Questionnaire (PAR-Q)

8. Testing Guidelines • Cooper Institute (2004) recommends you ask older adult test participants to: • walk about 8 feet • stand and sit in a chair several times • reach upward, backward and across the body • flex and extend the knee • rotate the feet at the ankle joints • hold and work with small objects • stand while you observe their posture

9. Testing Guidelines • As test participants perform, ask them to comment on level of discomfort. • Index of Pain • Little or no joint discomfort • Mild joint discomfort • Moderate joint discomfort • Severe joint pain • Too painful to perform movement

10. Tests of Functional Fitness Many older individuals are capable of completing some of the physical performance tests items presented in other chapters. The ACSM Fitness Test, the Canadian Physical Activity Fitness & Lifestyle Appraisal, and the YMCA Physical Fitness Test include norms for adults sixty and over. Some individuals will be better served by attempting the items presented in this chapter.

11. Functional Fitness Assessment for Adults Over 60 Years Test Objective. To evaluate the ability of adults to carry on certain daily activities. Age level. Over sixty. Validity assumed for ponderal index, sit and reach, and agility course; coefficients reported for other items. Reliability coefficients reported. Table 16.1 reports average standard for ages sixty through ninety.

12. Functional Fitness Assessment for Adults Over 60 Years • Test Components • Ponderal index: Figure 16.1 is used to determine index. • Trunk/leg flexibility: Sit and reach. • Agility.dynamic balance: Figure 16.2 illustrates the course. Figure 16.2 Figure 16.1

13. Functional Fitness Assessment for Adults Over 60 Years • Test Components • Coordination: Soda can test. • Strength/endurance: A 4-pound weight is used for women, and an 8-pound weight is used for men.

14. Functional Fitness Assessment for Adults Over 60 Years • 6. Aerobic fitness: 880-yard walk. Individuals with the following conditions should consult their physician before attempting this item. • Significant orthopedic problems that may be aggravated by prolonged continuous walking • History of cardiac problems that can be negatively influenced by physical exertion • Lightheadedness while physically active or history of uncontrolled hypertension

15. Functional Fitness Test for Community-Residing Older Adults Test Objective. To assess the major underlying physical parameters associated with functional mobility in independent older adults. Age level. Sixty to ninety-plus. Validity coefficients reported for 30-second chair stand, arm-curl, 6-minute walk, and chair sit and reach. Face validity was accepted for the back scratch and 8-foot up-and-go. Reliability coefficients reported.

16. Functional Fitness Test for Community-Residing Older Adults Table 16.2 reports percentile norms for ages sixty through ninety-four. Test Components 1. Lower body strength: 30-second chair stand. 2. Upper body strength: Arm curl. A 5-pound dumbbell is used for women, and an 8-pound dumbbell is used for men. 3. Aerobic endurance: Two options – 6-minute walk and 2-minute step-in-place.

17. Functional Fitness Test for Community-Residing Older Adults • Test Components • Lower body flexibility (hamstrings): Chair sit and reach. • Upper body (shoulder) flexibility: Back scratch. • Agility/dynamic balance: 8-foot up-and-go. • Body composition: Body mass index.

18. Physical Fitness Assessment of Older Adults Cooper Institute uses this test to measure health-related fitness rather than functional fitness. With exception of one mile walk, components similar to two tests described previously. Test objective. Assess health-related components of fitness and establish baseline score. Age level. Forty to seventy-nine.

19. Physical Fitness Assessment of Older Adults Validity and reliability not reported but items similar to items for which validity and reliability have been reported. Table 16.3 reports average standards for sixty through seventy-nine.

20. Physical Fitness Assessment of Older Adults • Test Components • Aerobic capacity: One mile walk. • Muscular strength: Hand grip test. • Upper body muscular endurance: Arm curls. • Lower body muscular endurance: Lower leg extension. • Trunk and leg flexibility: Sit and reach test. • Shoulder flexibility: Back scratch. • Body composition: BMI and waist circumference.

21. Functional Assessments - Frail Battery of tests used to assess simple skills used in daily living. First trial serves as baseline score; subsequent tests show increases, decreases, or maintenance of the skill. Age level. For any adult who appears to have lost some mobility and functionality.

22. Functional Assessments - Frail • Test Components • Lower body strength: Chair stand. • Strength and endurance: Stair climb. • Functional mobility and habitual gait speed: 6 meter gait walk. • Balance and flexibility: Reaching up. • Position change: Bending. • Balance: Stance positions. • Upper body strength and endurance: Wheelchair mobility.

23. Physical Activity for the Older Adult For the older adult, physical activity includes all movements associated with everyday life (e.g., work , routine activities, exercise activities, and recreational activities. Older adult can experience the benefits of physical activity in much the same way as younger individuals.

24. Physical Activity for the Older Adult • With an active lifestyle, older adults: • have a better self image • sleep better • maintain appropriate body composition • have better muscle tone and strength

25. Physical Activity for the Older Adult • With an active lifestyle, older adults: • better manage stress • are more likely to have a positive attitude • experience fewer minor infectious ailments • have more frequent bowel movements (less constipation

26. Physical Activity for the Older Adult • Over the long term, the benefits of an active lifestyle include: • continuation of immediate benefits • increased cardiorespiratory endurance • increased muscle strength and endurance • increased flexibility

27. Physical Activity for the Older Adult • Over the long term, the benefits of an active lifestyle include: • prevention of bone loss, decreased risk of osteoporosis • prevention and/or postponement of declines in balance and coordination • postponement of decline in speed of movement and reaction time • improved mental health

28. Physical Activity for the Older Adult Regular physical activity can provide benefits for older adults regardless of their physical health. When preparing exercise guidelines for older adults, must consider individual differences in health status, physical fitness, and previous lifestyle. ACSM Fitness Book (2003) and PAR-Q & YOU in figure 11.1 provide a list of questions that will help individuals determine whether medical clearance should be obtained before they increase their physical activity.

29. Physical Activity for the Older Adult General exercise guidelines for aerobic activities: Activity Large-muscle, rhythmic activities provide cardiorespiratory benefits. Frequency The activities should be performed a minimum of two or three times a week. After a period of adjustment, most individuals are able to exercise 4 to 6 days a week.

30. Physical Activity for the Older Adult • General exercise guidelines for aerobic activities: • Duration • Typical exercise session would be: • warm-up and stretching: 10 to 20 minutes • aerobic activity: 25 to 30 minutes • cool down: 5 to 10 minutes • Intensity • Low to moderate and related to the functional capacity of individual

31. Physical Activity for the Older Adult Flexibility and muscular fitness exercises should be included. Should be related to functional capacity of individual. Best to avoid the use of rigid guidelines when prescribing exercise for older adult. Many sedentary individuals can experience health benefits through 10- to 15-minute segments of mild activity.