Exercise for the Older Adult:Nutritional Implications

Chapter 19

Introduction

• Age-related changes– Body composition– Exercise capacity

• Physical activity and exercise• “Normal aging”

– Related to an energy imbalance

• Exercise prescription

Importance of Exercisefor Older Adults

• Physical activity exerts benefits at multiple levels– Amelioration of the biological changes of aging– Prevention or delay in development of risk factors

for chronic diseases– Primary prevention of some of the most common

chronic diseases– Treatment for disabling geriatric syndromes– Adjunctive treatment for established diseases

Importance of Exercisefor Older Adults

• Pharmacotherapy may carry side effects– Combination of exercise

and standard care for treatment• Progressive

resistance training• Nutrition

supplementation© LiquidLibrary

Physiologic Changes of Agingthat Affect Exercise Capacity

• Physiologic alterations that affect exercise capacity

• Ability of exercise training to slow the progression or reverse “signs of aging”

Insert Figures 19-1A and 19-1B

MRI Scans of Sedentary and Active Women

Courtesy of Professor Maria A. Fiatarone Singh

Nutritional Disorders in the Older Adult and their Impact on Exercise

• Functional Capacity– Protein-calorie malnutrition

• Leads to loss of lean body mass• Sarcopenic obesity

– Micronutrient status• Protein supplementation• Vitamin D• Calcium, magnesium, potassium

Optimizing body Compositionwith Exercise in Older Adults

• Body composition changes– Decrease in muscle and bone mass

• Low-intensity, high-velocity power training – Increase and redistribution of adipose tissue

• Obesity– One of the most important nutritional problems in

older adults– Linked to increased rates of chronic diseases

Optimizing body Compositionwith Exercise in Older Adults

• Benefits of physical activity at reducing abdominal and visceral fat in overweight and obese individuals– Lifestyle management programs– Minimize fat tissue and maximize muscle tissue

Assessing the Exercise Capacity and Needs of the Older Patient

Assessing the Exercise Capacityand Needs of the Older Patient

• Suggest one new physical activity at a time for sedentary adults and those new to regular activity

• Behavioral modification• Barriers to appropriate physical activity• Medical problems that place older patients at

higher risk for exercise-related adverse events

Assessing the Exercise Capacityand Needs of the Older Patient

• Exercise prescriptions need to be clearly written and treated like a medication prescription

• The American College of Sports Medicine and American Heart Association recommendations:– “Regular physical activity, including aerobic

activity and muscle-strengthening activity, is essential for healthy aging”

Assessing the Exercise Capacityand Needs of the Older Patient

• Older adults should be encouraged to be as physically active as their situation allows

• Set up personalized behavioral programs with exercise prescriptions– Short-term and long-term goals– Exercise calendar– Motivational tokens– Plan for feedback on his or her progress– Review of perceived benefits and adverse events– Modify goals as functional status improves

Medical Screening for theExercise Prescription

• Exercise carries with it the possibility of complications and adverse events– Cardiovascular– Minor musculoskeletal injuries

• “Is this patient safe to exercise?”• “Is this patient safe to be sedentary?”• Identify depression, anxiety, or insomnia on

screening

Medical Screening for theExercise Prescription

• Screen for aggressive or disruptive behavior, poor safety awareness and judgment, or uncontrolled alcohol intake

• Exercise is being explored as a preventive and therapeutic treatment for cognitive impairment and dementia

• Make appropriate changes for those with visual problems

The Use of Exercise in the Prevention and Treatment of Common Geriatric

Symptoms

The Use of Exercise in the Prevention and Treatment of Common Geriatric

Symptoms

• Four major components of fitness– Strength– Endurance– Flexibility– balance

Nutritional Considerations

• Energy requirements may increase with exercise

• Energy balance• Increased protein may be required for

anabolic adaptation to resistance training• Be aware of nutrition quackery

Practical Implementationof Exercise Programs

• Important to integrate exercise with other components of the care plan– Intermittent supervision– Strong behavioral change program with ongoing

support, feedback, and self-monitoring of behavior

– Provide incentives for exercise adherence– Interactive video games

Conclusion

• Physical fitness is not merely a medical prescription or treatment; it is a right of individuals, both fit and frail, to minimize and delay what was once considered “normal aging.”

• Health care practices and policies must be enlarged to promote fitness, activity, and independence to the fullest extent possible as an important component of overall quality of life.