Exercise Programs In The Elderly: Risks and Benefits

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Exercise Programs In The ElderlyRisks and
Benefits

• Constance Bayles, Ph.D. FACSM
• Program Director
• Center for Healthy Aging
• A Center for Disease Control Prevention Center
• Graduate School of Public Health
• University of Pittsburgh
• Pittsburgh, Pennsylvania

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Exercise Programs In The ElderlyPresentation
Outline

• Pathophysiology
• Benefits Physiological/Psychological
• Preliminary Program Guidelines
• Exercise Testing and Prescription
• Medications and Exercise
• Exercise Programming
• Position Stands CDC (HAN Group)/ACSM
• Summary/Conclusions/Questions and Answers

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Exercise Programs In The ElderlyPhysical Decline

• Normal Aging
• Disease
• Disuse

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Exercise Programs In The ElderlyPhysical Frailty

• A state of reduced physiological reserves
  associated with increased susceptibility to
  disability.

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Exercise Programs In The ElderlyFrailty

• Extreme Old Age
• Disability
• Multiple Chronic Disease/Geriatric Syndromes
• Multiple Medications

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Exercise Programs In The ElderlyFrailty

• Frail Older Adults
• Dependent
• Acute Illnesses
• Falls and Other Injuries
• Recover from Illness/Injuries Slowly
• Institutionalized or Hospitalized

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Exercise Programs In The ElderlyFrailty

• Increased Mortality/Morbidity
• Increased Physical Decline
• Functional Impairment

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Exercise Programs In The Elderly

• 12.6 million people have coronary heart disease
• 1.1 million people suffer from a heart attack in
  a given year
• 50 million people have high blood pressure

American Heart Association. 2002 heart and
stroke statistical update. Dallas, TX American
Heart Association, 2001.
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Exercise Programs In The Elderly

• 17 million people have diabetes
• 90 to 95 of cases are type 2 diabetes,
  associated with obesity and physical inactivity
• approximately 16 million people have pre
  diabetes

Centers for Disease Control and Prevention.
National diabetes fact sheet general
information and national estimates on diabetes in
the United States, 2000. Atlanta, GA U.S.
Department of Health and Human Services, CDC,
2002.
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Exercise Programs In The Elderly

• 107,000 people are newly diagnosed with colon
  cancer each year

American Cancer Society. Cancer facts figures
2002. Atlanta, GA American Cancer Society.
Inc. 2002 Vainio H, Bianchini F. Eds. Weight
control and physical activity. IARC Handbooks of
Cancer Prevention. IARC Press Vol 6, 2002
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Exercise Programs In The Elderly

• 300,000 people suffer from hip fractures each year

Popovic JR. 1999 National Hospital Discharge
Survey Annual summary with detailed diagnosis
and procedure data. National Center for Health
Statistics. Vital Health Statistics 13(151).2001
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Exercise Programs In The Elderly

• 50 million adults (age 20-74) are obese
• 61 of the adult population are either obese or
  overweight

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Exercise Programs In The Elderly

• Research has shown that all individuals,
  regardless of age can benefit from regular
  physical activity, vigorous or moderate
• Mobility and functioning in older adults,
  including the frail, can be improved through
  physical activity
• Regular physical activity reduces morbidity and
  mortality from chronic diseases

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Exercise Programs In The ElderlyPhysical
Inactivity for U.S.Men and Women
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Exercise Programs In The ElderlyPhysiological
Changes

• Cardiovascular
• Respiratory
• Nervous System
• Musculoskeletal
• Renal
• Metabolic Systems

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Exercise Programs In The ElderlyPhysiological
Benefits

• Increased Cardiovascular and Cardiorespiratory
  Function
• Increased Muscle Mass, Strength, Efficiency
• Increased Flexibility,Coordination, and Balance
• Decrease Cholesterol Levels
• Improve Weight Control and Nutrition
• Aides Digestion Reduces Constipation

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Exercise Programs In The ElderlyPsychological
Benefits

• Decreased Anxiety and Tension
• Increased Self-Esteem
• Increased Energy Level
• Better Sleeping Patterns
• Improved Socialization
• Improved Quality of Life

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Exercise Programs In The ElderlyPreliminary
Program Guidelines

• Medical History
• Medication History
• Social History
• Exercise History
• Participant Consent
• Physician Consent
• Physiological Assessment
• Psychological Assessment

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Exercise Programs In The ElderlyExercise
Tests/Physiological Assessments

• Walk
• Bicycle
• Strength
• Balance
• Flexibility
• Functional Performance Tests

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Exercise Programs In The ElderlyExercise
Tests/Psychological

• Cognitive Tests
• Depression
• Health Perception

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Exercise Programs In The ElderlyPurpose of
Exercise Testing

• To Establish A Degree of Risk Associated With
  Exercise
• To Establish Appropriate Intensities For Exercise
• To Review Individual Objectives

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Exercise Programs In The ElderlyFactors
Influencing Exercise

• Low Oxygen Capacity (VO2)
• Increased Fatigability
• Increased Need to Monitor
• Poor Balance
• Decreased Strength
• Less Ambulatory Ability
• Poor Coordination
• Decreased Cognitive Status

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Exercise Programs In The ElderlyMedications and
Exercise

• Polypharmacy/Self Medication
• Renal Excretion of Chemicals is Reduced
• IMPORTANT
• Know Medications and Side Effects

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Exercise Programs In The ElderlyExercise Program
Mechanics

• Start Low
• Go Slow
• Monitor Signs and Symptoms
• Decrease Workload If Needed
• Monitor Progress
• Provide Variety
• Motivate
• Make Exercise Fun

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Exercise Programs In The ElderlyExercise
Prescription

• Reflects Medical Needs
• Reflects Social Needs
• Primary Goal Increase Functional Capacity and
  
• Independence
• Program Individualized and Progressive
• Compliance Important Issue

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Exercise Programs In The ElderlyExercise
Prescription

• Mode
• Intensity
• Duration
• Frequency
• Rate of Progression

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Exercise Programs In The ElderlyParts of the
Exercise Program

• Warm-Up
• Stimulus
• Cool Down

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Exercise Programs In The ElderlyExercise
Monitoring

• Heart Rate
• Blood Pressure
• Weight
• Ratings of Perceived Exertion (RPE)

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Exercise Programs In The ElderlyRisks and
Contraindications To Exercise

• Abnormal Heart Action
• Pain/Pressure in the Chest
• Dizziness/Lightheadedness
• Poor Coordination
• Flare Up of an Arthritic Condition
• Nausea/Vomiting
• Extreme Breathlessness
• Muscular Pain
• Unusual Fatigue
• Mental Confusion

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Exercise Programs In The ElderlyEnvironmental
Concerns

• Room Temperature
• Water Intake
• Meal Time
• Clothing

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Exercise Programs In The ElderlyCDC Position
Stands

• The CDC states that regular physical activity
  offers substantial improvements in health and
  well-being for the majority of Americans.
  Moderate physical activity performed on most days
  of the week can substantially reduce the risk of
  dying from heart disease, the leading cause of
  death in the United States and can reduce the
  risk of developing colon cancer, diabetes and
  high blood pressure.

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Exercise Programs In The ElderlyCDC Position
Stands

• Provides scientific and technical support to the
  states, national organizations, and professional
  groups to promote physical activity
• National Physical Activity Initiative is the
  primary focus. Reflects CDC commitment to reduce
  major risk factors for chronic disease in the
  United States

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Exercise Programs In The ElderlyHAN (Healthy
Aging Network)

• University of California at Berkeley
• University of Colorado
• University of Illinois, Chicago
• University of North Carolina
• University of Pittsburgh
• University of South Carolina
• University of Washington Lead Center
• CDC Healthcare and Aging Studies Branch

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Exercise Programs In The ElderlyCDC HAN
(Healthy Aging Network) Mission Statement

• The mission of the Healthy Aging Research Network
  is to better understand the determinants of
  healthy aging in older adult populations to
  identify interventions that promote healthy
  aging and to assist in the translation of such
  research into sustainable community-based
  programs throughout the nation.
• Healthy aging is the development and maintenance
  of optimal physical, mental and social well-being
  and function in older adults. It is most easily
  achieved when physical environments and
  communities are safe and support the adoption and
  maintenance of attitudes and behaviors known to
  promote health and well-being and by the
  effective use of health services and community
  programs to prevent or minimize the impact of
  acute and chronic disease on function.

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Exercise Programs In The ElderlyACSM Position
Stand, 1998 Exercise and Physical Activity for
Older Adults

• Regular exercise reduces/prevents functional
  decline associated with aging
• Endurance training can maintain/improve
  cardiovascular function
• Strength training offsets loss of muscle mass
• Exercise can improve bone health, improve
  postural stability, increase flexibility and
  range of motion
• Reductions in risk factors improve health and
  affect life expectancy

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Exercise Programs In The Elderly

• Summary
• Conclusions
• Questions Answers
• Thank You!
• Have a Great Day!