Physical Activity and the Elderly

1
Physical Activity and the Elderly

• Laurel Hadsell
• Sarah Glenn
• Whitney Kindell
• Candice Harper

2
Evidence Based Practice Question

• In the community dwelling elderly population,
  ages 60 years and older, does purposeful
  cardiovascular exercise at least two times a
  week, compared to no exercise at all, result in a
  constant or increase of mental and physical
  health?
•  

3
Why this is a problem

• Adults aged 65 and older compose the most rapidly
  growing component of the United States
  population, in fact, it is estimated that nearly
  one quarter of the American population will
  exceed 65 years of age by 2050!
• An inactive lifestyle is a major risk factor for
  acute and chronic illnesses and disabilities in
  the elderly.
• Physical inactivity has been related to
  functional decline and high disease incidence in
  the elderly (Yanowitz and LaMonte, 2002).
• An increasing prevalence of inactivity among the
  elderly may create a potential burden to the
  health-care system.

4

• Physical activity levels among most elderly
  adults are insufficient to confer health
  benefits.
• The majority of adults over 65 years reported no
  leisure or physical activity.
• Studies show with increasing age, there is a
  deterioration of physical function and neuromotor
  performance that is associated with an increase
  number of falls and disability in older adults.

5
Statistics

• A 5-year study of Medicare costs indicates that
  older adults who are healthy but sedentary,
  average 6,780 MORE in Medicare costs than those
  who engage in low-intensity exercise.
• Less active, less fit individuals, have a 30-50
  greater risk of developing hypertension.
• It is estimated that only 30 of individuals over
  the age of 65 exercise on a regular basis.
• Oklahoma ranks 46th in the nation for a lack of
  physical activity.

6
Statistics

• After age 30, the maximum aerobic dynamic
  performance capacity decreases by an average of
  8 per decade.
• Approximately 250,000 deaths per year in the
  U.S. are associated with physical inactivity.
• Almost 15,000 people, ages 65 and older, die from
  falls every year.

7
Statistics

• Healthy persons in their 7th and 8th decade of
  life have, on average, 20-40 less static and
  dynamic muscle strength than younger persons.
• After age 30, approximately 6 of the muscle
  fibers necrotize every decade.
• On average the maximum oxygen uptake capability
  falls by 8 every decade.

8
The aging process

• Decrease in maximum cardiac output
• Reduction in lung performance
• Loss in skeletal muscle mass
• Decrease in myoglobin in muscle cells
• Reduced insulin sensitivity

• Reduction of bone density and loss of minerals
• Decline in short term memory
• Changes in hormonal regulation
• Diminished capability in immune system

9
Review of Research

• Cross-sectional studies
• -assess physical fitness measures
• -examine the relationship between physical
  fitness measures
• and general health and social support
• -assess feasibility of measuring physical
  fitness in the primary
• care setting
• Integrative reviews of literature
• -examine the relationship between physical
  activity and its
• relationship to cardiovascular health and
  mortality among
• multiple research articles

10
Review of Research

• Physical activity testing
• -to determine the effects of exercise on the
  health related
• quality of life and functional status of
  the elderly population
• Memory and information processing scales
• -assess memory processing, including learning,
  retention and
• retrieval abilities
• Quality of life, Depression and Life satisfaction
  scales
• -assess functional and mental cognition related
  to quality of life
• and lifestyle
• Cognitive function testing
• -examine the relationship between level of
  cognitive
• functioning and variables such as age,
  education, depression, and
• functional status

11
Summery of Literature

• Carvalho-Bastone Filho, 2004
• -Benefits functional improvement
• -Decreases depressive symptoms
• -Prevents mental status decline
• Chan el at., 2005
• -Cardiovascular and/or Mind Body exercises
  enhanced
• memory function and learning ability
• Fahlman el at., 2007
• -Resistance and aerobic training increased
  strength and
• endurance
• -Reduced morbidity and mortality rates

12

• Fahlman el at., 2007
• -Moderate exercise 3x a week improves functional
  ability
• -Increased measures of strength and endurance
• Houde Melillo, 2002
• -Integrative review stating physical activity is
  considered an
• important factor in the quality of life of
  the elderly population,
• and is proven to reduce mortality rates.
  Although, there is a
• lack of clarity regarding OPTIMAL level of
  physical activity.
• Kalapotharakos el at., 2006
• -Aerobic exercise can maintain or reverse the
  decline of physical
• and neuromotor performance

13

• Lindwall el at., 2008
• -Active older adults performed better on
  cognitive
• function tests
• -Delay mental problems and mental crisis
• Muraki el at, 2001
• -Difference in functional performance
• Purath Kark, 2008
• -Physical activity increases upper and lower
  body strength
• -Increases aerobic endurance
• -Increase balance
• -Decreases chronic conditions

14

• Stiggelbout el at., 2004
• -Once weekly participation in exercise program
  is not
• sufficient
• -Twice weekly will produce benefits of increased
• functional status and health related quality
  of life
• Uffelen el at., 2008
• -Aerobic fitness contributes to improvement or
• maintenance of cognitive function
• -Exercise improves memory, information
  processing
• abilities, and executive function

15
Pros

• Allocating exercise into the patients schedule
• Promote quicker healing
• Reduce morbidity and mortality
• Individual physical activity program
• Functional independence
• Reduce co-morbid conditions
• Reduce healthcare costs
• Self-care
• Leisure time

16
Cons

• Lack of clarity
• Barriers to participation
• Individualized
• Physical fitness assessments
• More research
• Barriers in the primary care setting

17
Recommendations

• Physical exercise participation at least twice a
  week for
• aging individual.
• Moderate exercise for duration of greater than
  30
• minutes.
• Strength training, resistance training, and
  flexibility exercises, performed in conjunction
  with aerobic conditioning.
• -Capable of producing significant strength,
  endurance, and functioning increases in the
  elderly population.

18
Recommendations

• Warm up and cool down phases of 5-10 minutes in
  duration, including flexibility and aerobic
  exercises.
• - Important due to the risk of hypotension and
  musculoskeletal complications.
• Aerobic training should be initiated gradually,
  at light-intensity levels, with progression to a
  moderate intensity.
• - Assists in injury prevention by increasing
  the elasticity of the muscle and connective
  tissue.

19
Recommendations

• Participation in group physical activity to
  provide social support and frequency of
  participation.
• - Resulted in an increased probability of the
  patient engaging in physical activity.

20
Evaluating Effectiveness

• Certified Personnel to Assess
• Patients health status, including living
  conditions, support, depression or life
  satisfaction scales, mini Mental Examination
  Scale, Geriatric Depression scale, physical
  assessments, and physical fitness.
• Long-time measurements
• Include the overall effects of decreased national
  mortality rates, increased life expectancy rates,
  and prevalence of chronic diseases within the
  population defined .

21
Evaluating Effectiveness

• Staff satisfaction of new policy acquisition
• Can be measured by job satisfaction
  questionnaires, surveys, and by formal or
  informal communication of the staff to the charge
  nurse or unit manager.
• Informant interviews should reveal an increase
  satisfaction of tasks and beneficence to the
  served population by the implementation of new
  interventions.

22
Suggestions for Further Studies

• Studies need to be carried out over longer
  periods of time.
• More studies need to focus on a specific type of
  exercise and compare the differences in the
  amount of benefits.
• -What is the optimal intensity, duration, and
• frequency?
• Examine the benefits of combining different types
  of exercise.
• -Which types of exercises are better for
• cognition? Physical attributes?

23
References

• Carvalho-Bastone, A. Filho, W.J. (2004). Effect
  of an exercise program on functional performance
  of institutionalized elderly. Journal of
  Rehabilitation Research Development. 41(5)
  659-668.
• Chan, A.S., Yim-chi Ho, M., Cheung, M., Albert,
  M.S., Chiu, H., Lam, L. (2005). Association
  between mind-body and cardiovascular exercise and
  memory in older adults. Journal of the American
  Geriatrics Society. 53(10) 1754-1760.
• DeJong, A. Franklin, B.A. (2004). Prescribing
  Exercise for the elderly Current research and
  recommendations. Current Sports Medicine Reports.
  3 337-343.
• Fahlman, M.M., McNevin, N., Topp, R., Boardley,
  D. (2007). Combination training and resistance
  training as effective interventions to improve
  functioning in elders. Journal of Aging and
  Physical Activity. 15(2) 195-205.

24

• Fahlman, M.M., Topp, R., McNevin, N., Morgan,
  A.L., Boardley, D.J. (2007). Structured
  exercise in older adults with limited functional
  ability. Journal of Gerentological Nursing.
  33(6) 32-39.
• Houde, S.C. Melillo, K.D. (2002).
  Cardiovascular health and physical activity in
  older adults An integrative review of research
  mehtodology and results. Journal of Advanced
  Nursing. 38(3) 219-234.
• Kalapotharakos, V.I., Michalopoulos, M.,
  Strimpakos, N., Diamantopoulos, K., Tokmakidis,
  S.P. (2006). Functional and neuromotor
  performance in older adults Effect of 12 wks of
  aerobic exercise. American Journal of Physical
  Medicine Rehabilitation. 85(1) 61-67.
• Lindwall, M., Rennemark, M., Berggren, T.
  (2008). Movement in mind The relationship of
  exercise with cognitive status for older adults
  in the swedish national study on aging and care
  (SNAC). Aging and Mental Health. 12(2) 212-220.

25

• Muraki, T., Nagao, T., Ishikawa, Y. (2001). A
  preliminary investigation to explore the effects
  of daytome physcial activity patterns on
  health-related QOL in healthy community-dwelling
  elderly subjects. Physical Occupational Therapy
  in Geriatrics. 19(2) 51-62.
• Purath, J., Buckholz, S.W., Kark, D.L. (2008).
  Physical fitness assessment of older adults in
  the primary care setting. Journal of the American
  Academy of Nurse Practitioners. 21 101-107.
• Stiggelbout, M., Popkema, D.Y., Hopman-Rock, M.,
  DeGreef, M., Van Mechelen, W. (2004). Once a
  week is not enough Effects of a widely
  implemented group based exercise program for
  older adults a randomized control trial.
  Epidemail Community Health. 58 83-88.
• Uffelen, J.G., Chin, A.P., Marijke, J.M.,
  Hopman-Rock, M., Van Mechelen, W. (2008). The
  effects of exercise on cognition in older adults
  with and without cognitive decline A systematic
  review. Clinical Journal of Sport Medicine.
  18(6) 486-500.

26
Questions?