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The Elderly

Matt Fleekop. 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. Matt Fleekop 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. Exercise For Senior Adults • Benefits to Exercise: • Reduced risk of chronic disease • Reduced risk of injuries • Manage pre-existing conditions • Prevent excessive weight gain- obesity/diabetes • Improved functional capacity- ADL’s • Improved flexibility and balance • Improved mental health

  24. Recommendations for Exercise Testing • Initial workload = 2-3 mets with incremental increases not exceeding .5-1.0 mets • Use cycle ergometer if balance, coordination, or weakness are a problem • Only use a treadmill if there is handrail support • Be aware of exercise induced dysrhythmias, they are common because of medications

  25. Indications to TerminateExercise Testing • Absolute: • Drop in systolic blood pressure >10 • Moderately severe angina • Dizziness, incoordination, loss of conciousness • Signs of poor oxygen availibility • Ventricular tachycardia • Subject’s desire to stop If over 75 yrs, only exercise at low intensity <3 mets, and no symptoms of cardiovascular disease

  26. Exercise Prescription • Always warm up- at least 5 mins low impact, low intensity (walk, cycle, movements) • Always cool down- at least 5 mins, light stretch, return heart rate/blood flow to normal, mentally relax • Accumulate 30-60 mins moderate aerobic activity (RPE =5-6) at least 5 days/week. If high intensity only 20-mins, 3 days/week • Avoid activities with high risk of falling (weak bones) • Low impact over high impact (walk, swim, cycle vs run, jump, bounce) • Resistance training will help preserve muscle mass, strength, functional ability, and mobility. 1 set, 10-15 reps, for 8-10 diff exercises targeting major muscle groups. RPE 5-8 (mod-vig), increase reps before increasing resistance.

  27. Continued • Form- neutral spine, controlled speed, full ROM, breathing, multi-joint for balance • Machines and resistance bands over free weights (balance), they allow for more control, ROM, stabilize back • Avoid strenuous exercise during hot and humid weather, always monitor fluid intake • Never exercise when chronic conditions may be present • ROM- hip, back, shoulder, knee, upper trunk, neck. Static stretches 15-30 secs (RPE 5-6) w/ 2-4 reps/stretch. Enhances mobility, balance, agaility

  28. Types of ExercisesUpper Body • Traditional exercises, hit major muscle groups. Various positions (depends on client). Stability ball will enhance core strength/ balance. Always focus on form. Most clients prefer bands/tubing over free weights. Tai Chi, yoga, pilates will also improve strength, balance, and endurance. • 10-15 reps each • Chest Press w/Elastic Tubing • Lat Pull Downs w/ Elastic Tubing • Shoulder Press w/ Dumbbells (seated) • Bicep Curl (machine) • Trice Extension (machine)

  29. Types of ExerciseLower Body • Hit major muscle groups. Use machines, bands/tubing, dumbbells. Exercise the muscles that are used in ADL’s. Focus on form. • Step-Ups- small step, increase intensity by adding dumbbells • Squat- bodyweight or stability ball wall squat • Calf Raise- standing on platform increase intensity by adding dumbbells

  30. Exercise And The Frail Elderly • Frail Elderly- over 75 yrs w/ physical or mental impairments, struggle w/ ADL’s. Usually live in nursing homes/assisted living communities. • Exercises will be performed seated or lying in bed. • Want to develop strength, flexibility, and balance (functional ability). • Goal- restore ability to perform ADL’s and prevent further loss of functional ability .

  31. Exercises For the Frail Elderly • Should be done in two 15 minute segments each day • Warm Up- toe taps, seated marching, heeltaps, shoulder abduction/adduction (very basic movements while seated) • Strength Training- work upper/lower on separate days. Practicing everyday activities rather than typical exercises. No resistance, we apply resistance, or tubing. Always consider the capabilities/limitations of client.

  32. Lower Body Exercises • Sit to Stand- use arms and legs • Knee Extension- single leg, add resistance if wanted • Leg Curl-single leg, add resistance if wanted • Heel Raise- both legs • Toe Raise- both legs • All are seated, 10-15 reps

  33. Upper Body Exercises • Chest Flies- elastic tubing • Seated Row- elastic tubing • Lateral Shoulder Raise- we apply resistance • Bicep Curl- 1lb dumbbells • Triceps Dips- seated to standing • All are performed for 10 reps, standing when possible

  34. Nutrition is Important • Water- minimum of 6 glasses/day, more if they are active • Nutrient dense food, little room for added sugars, fats, alcohol. • Protein- vital for structure, hormonal reactions and antibodies, transport/regulate fluid, and provide energy. Can help slow the loss of muscle mass. Need .8grams/kg body weight. • Carbohydrates- provide energy and help prevent muscle loss. Minimum of 130grams/day, more if active. Increase fruits, veggies, whole grains • Fat- reduce total intake, reduce saturated fats with monounsaturated fats, <300 mg cholesterol/day, balance omega 3 and 6.

  35. Continued • Proper vitamin/mineral intake • Vitamin B12- maintains neurons, facilitates cell synthesis, and helps break down fatty acids/amino acids. Not enough = anemia, neurological impairments, poor cognitive abilities. Source- meat • Vitamin D- help absorb calcium (bone health). Source- milk/sun • Calcium- maintain bone tissue/integrity. Not enough= osteoporosis, fractures. Source- milk products, grains, veggies, nuts

  36. Continued • Antioxidants- reduce damage from free radicals (defense system). • Vitamins C, E, beta carotene, lycopene, and selenium. • Vitamin C- bone health/matrix. Not enough = fragile/unstable bones. 90 mgs for men, 75 mgs for women • Vitamin E- 15 mgs men and women

  37. Sources - Jonathan K. Ehrman, P. M. (2008). Clinical Exercise Physiology. Human Kinetics. • 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. • - Williamson, P. (2011). Exercise For Special Populations.Killeen: Lippincott Williams & Wilkings. Health.

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