05. exercise for elderly
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Geriatric Medicine Clinical Practice Module
Physical Exercise for the Elderly
R. Wishnu Hidayat
Sports Medicine Department FMUI
Jakarta 2010/2011
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Outline
Introduction
Exercise Benefit Preparticipation Examination
Fitness component
Summary
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Introduction
Learning objective:
Ability to give advice for older Elderly/senior
citizen healthy lifestyle based on knowledge of
fitness and exercise principles
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Elderly in Indonesia
Number?
Problems?
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etc.
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Body Changes in Aging
Structural changes
- anatomical
- Organ, tissue, cell
Functional changes
- sensoric- motoric
- cognitif
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Physiological Changes in AgingNieman, Fitness and your health, 2006
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Aerobic Capacity Change in Aging
Nieman, Fitness and your health, 2006
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Muscle Strength Change in AgingWillmore, Physiology of sports and exercise, 2008
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Effect of Cardiorespiratory Training
Nieman, Fitness and your health, 2006
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CNS
Increase skeletal muscle
work
/musculoskeletal system
Increase energy
need
Cardiovascular
system: increase
SV, BP
Respiratory system:increase ventilation
Increase O2
transport
(& glucose/FFA)
BODY MOVEMENT
Motoric
center Vasomotor, respiratory center,
sympathetic system
Neuroendocrinesystem
Fat tissue, pancreas,liver
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Exercise Benefit in Elderly
Life expectancyIndependency
Cardiorespiratory ( heart rate, blood pressure)
Muscle strength and mass
Flexibility (muscle/tendon, ligament)
Bone strength and mass
Balance or ?Body composition
Metabolic effect (blood glucose, lipid)
Mental and cognitive functionSocial wellness
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Health Screening
All elderlyIdeally undergo PPE/health screening before engage in
exercise testing and exercise training
ACSM Stratification of CV risk for individual based on CV risk factor and
sign & simptom of disease (CV, metabolic)
Risk Factor Sign & Symptom
Family history Angina
Cigarette smoking Dyspnea
Hypertension Orthopnea/PND
Dyslipidemia dizziness/syncope
Impaired fasting glucose Ankle edema
Obesity Palpitation/tachycardia
Sedentary Intermitten claudication
Heart murmur
Unusual fatigue
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ACSM Risk Stratification (cardiovascular risk)
Low risk primary health services(in the future?)
Moderate risk secondary
services
High risk
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Contraindication of Exercise Testing & Exercise Training
Absolute
- ECG ischemia, MCI
- Unstable angina
- Uncontrolled cardiac dysrhtmias
- Aortic stenosis
- Uncontrolled heart failure
- Pulmonary infarction or embolism
- Acute myocarditis or pericarditis
- Suspect or known dissecting aneurysm
- Acute systemic infection
Relative
- Left main coronary stenosis
- Valvular heart disease
- Electrolyte abnormalities
- Severe arterial hypertension
- Tachy/bradydysrhythmias
- Hyperthropic cardiomyopathy
- Neuromuscular, musculoskeletal or rheumatoid disorders
- Atrioventricular block
- Ventricular aneurysm
- Uncontrolled metabolic disease
- Chronic infectious disease
- Mental/physical impairment
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Exercise Risk
Musculoskeletal injury
Health problems Cardiovascular event: sudden cardiac death, MCI coronary plaque
rupture
Low incidence 1:15.000-18.000 old > younger
Vigorous > leisure activity
sedentary > active lifestyle
HEALTH SCREENING/PPE
SUPERVISION during exercise session
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Exercise Training in Elderly
Principles of Training
Progressive & Overload
Specificity
Reversibility
Fitness Component FITNESS TEST
Cardiorespiratory Muscle strength and endurance
Flexibility
Balance
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Fitness Test
Cardiorespiratory: 6 MWT, Rockport 1 mile
walk, step test, ergocycle/treadmill
Muscle strength-endurance: push-up/sit up
test, dynamometer, 1-RM test
Flexibility: sit and reach test, Appley scratch,
goniometer
Balance: single leg balance, Romberg test
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Cardiorespiratory
Type : aerobic exercise (rec: walking)
Frequency : everydaystart 3 x/wk, progress gradually
Intensity : moderate (Borg 5-6)
Duration : min.30 minutes,
start 10-15 minutes, progress
gradually
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Muscle Strength
T : calisthenics, free weight, elasticrubber band (isotonic exercise)
8-10 exercise large muscle groups
F : 2-3 x/week
I : (moderate, Borg 5-6) 2-3 set each
movement @10-15 repetition
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Flexibility
T : static stretching, major muscle
groups
F : (3-4 x/wk)
I : hold 15-30 s each movement, 3-4
set
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Balance
T : static & dynamic balance (e.gsingleleg balance, tandem walk,tai chi)
F : 3-4 x/week
(I) : (mild-moderate)
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Exercise in Osteoporosis
Silent disease, women>men
Goal of exercise: Decrease risk of falling
Increase bone mass, muscle strength, balance and flexibility Increase cardiorespiratory fitness
Exercise programming (ACSM) Weight bearing cardiorespiratory exercise (4x/wk) Resistance training (2-3x/wk) Flexibility exercise (5-7x/wk) Balance exercise (3-4x/wk)
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Example: Osteoporosis dance exercise (by Perosi) 3 x/wk low impact aerobic dance + resistance exercise (dumbell/heavy stick),
balance exercise, flexibility exercise
Do not do:
high impactexercise(e.g hopping/jumping, jogging/running)
Vertebral hyperflexion( e.g sit-up) Lift heavy weight above head Body pivot Exercise in slippery/rough surface
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Exercise in Osteoarthritis
OA: most common arthritis, overweight as one of risk factor
Location: hand joint, weight bearing joint
Goal of exercise: Normal daily activity without pain Decrease swelling and pain of affected join Decrease overweight Increase CR, musculoskeletal, flexibility fitness
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Exercise programming in OA:
Stretching exercise Static stretching, 1-2x/day, 5-7x/wk, on swelling joint pain free
ROM
2-4 set/session @15-30 s
Muscle strengthening exercise Resistance exercise/weight training/calisthenics joint stability,
2-3x/wk, especially around affected joint
8-10 movement, 1-2 set/session @ 3-20 reps
Cardiorespiratory exercise Exercise in pool/hydrotherapy, ergocycle, walking, low impact
aerobic dancing
3-5 x/wk, moderate intensity, per sesion begin 10-15 min.increase periodically to 30-45 min.
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Precaution of exercise in OA:
Not recommended, strengthening exercise & cardio
exercise when the joint still inflammed
No high intensity exercise, no profuse stretching
Avoid exercise in the morning when the joint is stiff.
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SUMMARY
Exercise has many beneficial effect for Elderly
Health screening/PPE is ideal
Exercise programming is design individually(tailor made)
Exercise programme include cardiorespiratory,
muscle strength, flexibility, balance exercise
It is important to supervised during session of
exercise
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