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?

-

-

-

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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Documents

05. Exercise for Elderly