So you want to begin exercising.

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So you want to begin exercising.

• Section on Geriatrics
• American Physical Therapy Association

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Please choose one answer

• Do you exercise regularly to increase physical
  fitness 3 or more times/week for 20 or more
  minutes/session at a level that increases your
  breathing rate and causes you to break a sweat?
• No, and I do not intend to begin exercising
  regularly in the next 6 months
  
• No, but I intend to begin exercising regularly in
  the next 6 months
  
• No, but I intend to begin exercising regularly in
  the next 30 days
  
• Yes, I have been, but for less than 6 months
• Yes, I have been for more than 6 months

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Write down your reasons for starting to exercise

• Be specific.if you are doing it for health
  benefits state which ones

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Common Pros

• I would have more energy for my family and
  friends
  
• I would feel less stressed if I exercised
  regularly
  
• Exercising puts me in a better mood for the rest
  of the day
  
• I would feel more comfortable with my body if I
  exercised regularly
  
• Regular exercise would help me have a more
  positive look on life

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Benefits of exercise

• Reduces the risk of dying prematurely.
• Reduces the risk of dying from heart disease.
• Reduces the risk of developing diabetes.
• Reduces the risk of developing high blood
  pressure.

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Benefits of exercise

• Helps reduce blood pressure in people who already
  have high blood pressure.
  
• Reduces the risk of developing colon cancer.
• Reduces feelings of depression and anxiety.

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Benefits of Exercise

• Helps control weight.
• Just 30 minutes of day of exercise prevents gain
  and promotes loss while increasing muscle mass
  (Slenze, 2004)
  
• Helps build and maintain healthy bones, muscles,
  and joints.
  
• Helps older adults become stronger and better
  able to move about without falling.
  
• Promotes psychological well-being.

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Other Benefits

• Reduces the risk of having a second heart attack
  in people who have already had one heart attack
  
• Lowers both total blood cholesterol and
  triglycerides and increases high-density
  lipoproteins (HDL or the "good" cholesterol)
  
• Helps lower blood pressure in people who already
  have hypertension
  
• Helps improve balance and reduce falls

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• A physically inactive lifestyle is a primary
  cause of frailty in later years, especially for
  people living into their 80s and 90s
  
• Youve used all the reserve you had, unless you
  have continued to add to the bank of fitness
  
• Over 1/3 of nursing home admissions are primarily
  caused by mobility-related problems

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• Linear reduction in mortality occurs as fitness
  level increases
  
• For each 1 MET in exercise capacity achieved, a
  12 improvement in survival occurs. (Meyers et
  al, NEJM, 2002)
  
• A program of regular exercise can improve fitness
  by 15-30 within 3-6 months (ACSM, 1998)

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How Should I Begin?

• Should I seek my doctors permission?
• If you have chest pain, uncontrolled
  hypertension, or have had heart disease, then
  YES! Otherwise.
  
• Complete the Par-Q

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Am I ready to begin exercising?

• When in doubt, talk with your physical therapist
• But it is probably ok if you start slow with a
  simple activity like walking or basic
  strengthening and gradually increase the
  intensity without pain

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Precautions

• In view of the evidence for the benefits of
  exercise and the disability and mortality related
  to a lack of exercise, it may be more important
  to get permission NOT to exercise!

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How to start

• Consider the need to improve physical activity
• Technology induced inactivity
• Push-buttons to do nearly everything!
• Wheels to move most things
• Automated car wash
• Snow blowers

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A healthy start

• Increase physical activity 30 minutes or more per
  day
  
• Take the stairs instead of the elevator or walk
  up the escalator
  
• Park in the back of the parking lot
• Return cart to the store
• Stand up and sit down 10 times each commercial
  break
  
• Decrease sitting time!

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A healthy start

• Set goals
• Choose an exercise you enjoy
• Start with 10 minutes every day and slowly
  increase time until you are exercising 30 minutes
  3-5x/week
  
• Include some strengthening exercises
• Include some flexibility exercises

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Exercise Guidelines(these are GOALS!)

• Strengthening/resistance exercise 2-3x/week
• Endurance (aerobic) exercise 3-5x/week
• Recreational (physical activity) 7x/week
• Flexibility 2-3x/week

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Lets talk specifics

• Warm-up (5-10 minutes)
• Reduces susceptibility to injury
• Examples slow walking or stretching
• Should I stretch before I exercise?
• Not necessarily
• Muscles stretch better if they are warm, like
  after your workout

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Strengthening

• Strengthening
• Requires overload
• Can use bands, balls, weights, or machines
• 1 set of 8-12 reps at an intensity that you cant
  do more than 12 repetitions
  
• Examples chair sit to stand or squats, lunges,
  heel raises, modified push-ups

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Strengthening

• Strengthening should be the first place to start
• Why?
• It is less taxing on your heart
• Builds muscle mass to support joints
• Especially important if you have arthritis
• Reduces fat
• Especially important if you have diabetes

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Benefits of Strength Training

• Decreases the pain and stiffness of arthritis
• Increases muscle mass that improves function and
  fun
  
• Reduces the need for insulin in diabetes
• Increases bone mass in osteoporosis
• Reduces obesity
• Decreases back pain
• Improves depression and sleep habits

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Some Guidelines for Strengthening Intensity

• Good form comes first
• Spend 2 weeks getting the form correct
• Move to an intensity that you can do 8-10
  repetitions with good form
  
• 1 set is all that is necessary for beginners
• As soon as you can do 12 repetitions, increase
  the weight and drop back to 8

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Some Guidelines for Strengthening Intensity

• Always work within 8-12 repetitions (vigorous
  workout) or 12-15 (moderate workout)
  
• You get more benefits the harder the workout

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Endurance

• Types
• Uses large muscle groups like walking, swimming,
  or biking
  
• How long?
• 20-60 minutes
• The lower the intensity, the longer you need to
  do it!
  
• How often?
• 3-5x/week

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Recreational Activity

• Fun kinds of things
• Golf, gardening, tennis, hiking, dancing
• Physical activity throughout the day
• Parking in the back of the parking lot
• Taking the stairs instead of the elevator
• Getting rid of the remote etc
• How often? OFTEN!!!!!!!

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Cool-down

• How long?
• 5 minutes
• Stretches
• Hold stretch 30-60 seconds
• 30 seconds if younger than 50
• 60 seconds if over 50
• Examples hamstrings, calves, low back

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INTENSITY

• HOW MUCH IS GOOD ENOUGH?

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Borg Scale of Perceived Exertion (RPE)

• Perceived exertion is how hard you feel like your
  body is working.
  
• It is based on the physical sensations a person
  experiences during physical activity, including
  
• increased heart rate,
• increased respiration or breathing rate,
• increased sweating, and
• muscle fatigue or feelings of tiredness

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• BORG
• PERCEIVED
• SCALE OF
• EXERTION
• GOAL 30 minutes/day of 13-16

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Talk Test

• A person who is active at a light intensity level
  should be able to sing while doing the activity.
  
• One who is active at a moderate intensity level
  should be able to carry on a conversation
  comfortably while engaging in the activity.
  
• If a person becomes winded or too out of breath
  to carry on a conversation, the activity can be
  considered vigorous

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Walking and Biking Program

• Start low, go slow
• Start with 10 minutes, build to 30 minutes over 4
  weeks
  
• Once you have 30 minutes, start riding/walking
  faster
  
• Watch your perceived exertion scale (RPE)

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Intensity The Bottom Line

• Arguably the most important factor
• The more intense, the less time you need to
  spend
  
• Light-moderate activity and exercise does not
  build strength
  
• Remember the principle of overload?

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Activity by Intensity

• Light-Intensity Activities
• Walking slowly
• Golf, powered cart
• Swimming, slow treading
• Gardening or pruning
• Bicycling, very light effort
• Dusting or vacuuming
• Conditioning exercise, light stretching or warm
  up
  
• Moderate-Intensity Activities
• Walking briskly
• Golf, pulling or carrying clubs
• Swimming, recreational
• Mowing lawn, power motor

• Tennis, doubles
• Bicycling 5 to 9 mph, level terrain, or with a
  few hills
  
• Scrubbing floors or washing windows
• Weight lifting, Nautilus machines or free weights
  
  
• Vigorous-Intensity Activities
• Race walking, jogging or running
• Swimming laps
• Mowing lawn, hand mower
• Tennis, singles
• Bicycling more than 10 mph, or on steep uphill
  terrain
  
• Moving or pushing furniture
• Circuit training

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Duration how long?

• Anything is better than nothing!
• Start low, go slow!
• Begin with 10 minutes, goal is 30-60 minutes
• 2-3x week for strengthening
• 3x-7x/week for aerobic
• Daily for flexibility

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Lets make a plan!
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Safety Reminders

• Its about COMMON SENSE!
• Contact your health-professional if you
  experience chest pain or pressure, trouble
  breathing or shortness of breath,
  light-headedness or dizziness, or nausea.
• Dont perform activities that cause sharp pain or
  aggravate a medical condition
  
• Remember to breathe properly. Never hold your
  breath while straining, particularly if you have
  high blood pressure. Generally, exhale during
  muscle exertion, and inhale during relaxation.

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Lets be safe

• Soreness is to be expected in the muscles with
  any new exercise program. Use soreness as a guide
  for intensity. If you are very sore the day after
  exercising, exercise at a lower intensity next
  time. If the pain persists more than 2 days,
  contact your doctor.
• So how much soreness is ok? DOMS
• Joint pain should be avoided. The saying no
  pain, no gain is not true for older adults

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Avoiding Injury

• Discomfort vs. Pain
• When should I seek a medical opinion?
• My knees hurt, so I cant walk..
• My shoulder hurts, so I cant lift.
• My back hurts, so I cant do anything!....

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Exercise Essentials

• Good shoes
• Fun or appropriate music- books on tape
• Free weights
• A positive attitude
• Comfortable clothing
• Lots of water
• A supportive sports bra
• Safe, well-made equipment (e.g., cardio machines,
  heart-rate monitors
  
• Enough time
• A workout partner

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Sticking with it!

• Studies show that the more confident you are in
  sticking with your exercise program, the more
  likely you will!
  
• Make a commitment to someone that matters
• Dont get discouraged!
• If you miss a day its ok!

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Contact
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Examples of strengthening exercises

• Chair Squats
• Wall push ups progress to counter pushups, then
  floor pushups
  
• Toe stands start with both legs, then progress
  to one leg
  
• Step ups
• Hip kicks progress to using elastic bands

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Chair Squats
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Wall pushups
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Push ups
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Heel Raises
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Hip Kicks
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Rows
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Lunges
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Trunk Exercises
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