Exercise and the ElderlyExercise and the Elderly

Physiological Changes With AgingPhysiological Changes With Aging

Aging or decrease in activity?Aging or decrease in activity?

Quality yearsQuality years

Changes in maximal oxygen consumptionChanges in maximal oxygen consumption

Muscle mass – sarcopeniaMuscle mass – sarcopenia– Muscular Strength and EnduranceMuscular Strength and Endurance

Fat deposition and body compositionFat deposition and body composition

Bone mineral density Bone mineral density – OsteopeniaOsteopenia– Osteoporosis Osteoporosis

Diagnosed using T-Score cmoparing to normal Diagnosed using T-Score cmoparing to normal young adultsyoung adults

World Health Organization Criteria World Health Organization Criteria for Classifying BMDfor Classifying BMD

ClassificationClassification T-Score T-Score

Normal BMDNormal BMD -1.0 or greater-1.0 or greater

OsteopeniaOsteopenia -1.01 to -2.49-1.01 to -2.49

OsteoporosisOsteoporosis -2.5 or less-2.5 or less

Severe OsteoporosisSevere Osteoporosis -2.5 or less + -2.5 or less +

fragility fracturefragility fracture

OsteoporosisOsteoporosis

Bone turnoverBone turnover– PTH and vitamin D3 hormonePTH and vitamin D3 hormone

Peak BMDPeak BMD– Trochanter and femoral neck in mid to late Trochanter and femoral neck in mid to late

teensteens– Spine in mid 20sSpine in mid 20s

Determinants of peak BMDDeterminants of peak BMD– 70-80% genetics70-80% genetics– 20-30% lifestyle20-30% lifestyle

Bone lossBone loss– Age related 0.5 – 1%/yearAge related 0.5 – 1%/year– Menopause 1-2%/year for a 5-10 year periodMenopause 1-2%/year for a 5-10 year period– Loss of BMD will continue to pre-adolescent Loss of BMD will continue to pre-adolescent

levelslevels

Fragility fractureFragility fracture– Women - Forearm Women - Forearm ↑↑ at age 45-50 leveling off at age 45-50 leveling off

at 65at 65Men – no Men – no ↑↑

– Women - Vertebral Women - Vertebral ↑↑ age 55-60 rising linearly age 55-60 rising linearly with agewith age

Men – Men – ↑↑ 60-70 yrs 60-70 yrs

– Women – Hip Women – Hip ↑↑ at age 65 and rises at age 65 and rises exponentially thereafterexponentially thereafter

Men – Men – ↑↑ 70-75 yrs 70-75 yrs

Distal forearm fracturesDistal forearm fractures– Excellent marker for future riskExcellent marker for future risk– Wedge fracture at L2 Wedge fracture at L2 →→

Exercise TestingExercise Testing

Functional testsFunctional tests

Potential effects of osteoarthritisPotential effects of osteoarthritis

Impact of muscular enduranceImpact of muscular endurance

Training the ElderlyTraining the Elderly

Still adapt normally to exerciseStill adapt normally to exercise– ↑ ↑ fitness levels associated with reduced mortality fitness levels associated with reduced mortality

and ↑ life expectancyand ↑ life expectancy

Differences between training frail versus Differences between training frail versus healthy elderlyhealthy elderly– Functional capacity and balanceFunctional capacity and balance– Simple functional testsSimple functional tests

Training the ElderlyTraining the Elderly

Flexibility trainingFlexibility training

Resistance TrainingResistance Training– Important to ADLs and RMRImportant to ADLs and RMR– Careful evaluation of HTN elderlyCareful evaluation of HTN elderly– Arthritics train through pain-free ROMArthritics train through pain-free ROM– Reps 2-3s concentric, 4-6s eccentric, 8-12 Reps 2-3s concentric, 4-6s eccentric, 8-12

reps to failure, 2d/wk, progress every 2-3 wksreps to failure, 2d/wk, progress every 2-3 wks

BreathingBreathing

Reducing risksReducing risks

Calcium intakeCalcium intake– Vitamin DVitamin D

ExerciseExercise

PosturePosture