Exercise As We Age

PED

Demographics

36 million older individuals Projected to double to 70 million Average Life Span

– 1900 – 48.3 for males, 51.1 for females– 1990 – 72.1 for males, 79 for females

Life Span

Decreased childhood mortality Better medical care Enhanced living conditions Availability of health care Improved health and sanitation Better nutrition Media keeps us informed

Factors Affecting Life Span

Race % of people over age 65 years

– White – 11%– Hispanic – 3.6%– African American 2.4%

Factors

The wealthy live longer. Married males live 8 years longer than

unmarried. Married females live 3 years longer than

unmarried.

Factors

People who handle stress live longer People with more social contact live longer People who exercise live longer!!!!!!!!

Will the Average Life Span Continue to Increase??

Significance for the 21st Century

Less likely to be married More likely to live alone Less likely to belong to volunteer organizations Less likely to visit informally Less likely to be active in daily activities Becoming resistant to antibiotics Environmental Problems Stress!! Technology

Economics

We currently spend about $50 billion annually on health care and if the life expectancy does continue to lengthen this will only increase.

That is where people involved in health and wellness come in.

Exercise is cheap.

Topics

Measuring Body Comp Muscle Changes Osteoporosis Joints and Flexibility Cardiovascular Pulmonary Cognition

Topics

Emotions

Hormones Thermoregulation Eye/Ear/Balance/Nervous System Diseases Exercise Prescription Recommendations Contraindications

Body Composition

1. The distribution of fat changes with age– Men with age accumulate fat around the torso and

internally around organs– Women fat increases internally as well

Body Comp

2. % of fat increases with age– Why?– Genetics– Changes in diet– Slowing of metabolism (about 10%/decade)– DECREASE IN PHYSICAL ACTIVITY!!

Body Comp

Study of masters athletes – they had lower body fat than their inactive counterparts but still were 5-10% higher than younger athletes

Methods of Estimating

UWW Skinfolds BIA

Estimating % Fat in an Older Individual

UWW Problems 1. Changes in mineral content (FFW) 2. Changes in total body water 3. Equations we use may not be accurate 4. Difficult to UWW these individuals due to

ambulatory/physical limitations

Estimating % Fat in the Older Individual

Skinfold Problems 1. Elderly distribute fat more internally so

subcutaneous skinfolds may not be accurately depicting the amount of total fat in the body

2. Equations for the old and oldest groups have not been developed

3. Equations are developed using UWW

Estimating % Fat

BIA Problems 1. Affected by hydration status and total body

water (the conductance of an electrical current)

Changes in Muscle

1. Decreased Muscle Mass – lose 3kg/decade 2. Higher % ST than younger people 3. Changes in blood distribution to muscles 4. Decreased pH in a muscle cell 5. Stiffer muscles 6. Decreased Strength

Graph

Strength vs. Age

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Study

Fiatarone 1990 10 subjects 86-96 yrs CAD, osteoarthritis, hypertension, osteoporosis 8 weeks of resistance training; 3 x/week Knee extensors

Results

Average increase in strength 174% and was not beginning to plateau at the end of 8 weeks

Improved gait speed 48% Two subjects eliminated use of their canes One subject who couldn’t rise from a chair

could This was only one muscle group!!

Exercise and Muscle Changes

1. Increased Strength 2. Increased Mass 3. Decreased loss of motor neurons 4. Increased perfusion of muscle 5. Increase in nerve conduction velocity to

muscle 6. Change in fiber types???

Osteoporosis

About the 3rd decade the rate of bone formation fails to keep pace with bone loss (start losing about 1%/year)

Especially women– Diet– Less bone mass to begin with– Longer life span– Depletion during pregnancy and lactation– Hormones (Calcitonin, PTH, Vitamin D, Estrogen)

Osteoporosis

Prevention

1. Estrogen Replacement Therapy

2. Calcium Supplementation

3. Weight Bearing Exercise

Joints and Flexibility

It would serve little purpose to have strong bones and muscles if the bones cannot be moved through their range of motion.

Therefore, flexibility is an essential component of fitness!!

Flexibility

Maintained by using the joints and by participating in physical activity

When a joint is unused the muscles that cross the joint shorten and reduce the ROM

Flexibility naturally leads to more physical activity

Other Considerations

Osteoarthritis – chronic degenerative disease of the joints that affect ~80% of adults over 65

Compensatory physical movements may result in:– Metabolically less efficient movements– Biomechanical changes that lead to misalignment

and injury

Exercise and Joint Flexibility

1. Enhances tensile strength of the tendons and ligaments

2. Maintains strength of the muscles crossing the joint

3. Reduces pain seen with osteoarthritis so ROM can be maintained

4. Increases sense of well-being

Cardiovascular System

Too many to name them all!!! 1. Mechanical and Anatomical Changes in the

Heart/Blood Vessels 2. Decrease in Max HR 3. Increase in BP 4. Postural Hypotension 5. Change in Recovery HR

Cardiovascular

6. Amount of blood pumped with each beat decreases (SV)

7. Change in Blood Constituents (RBC, hemoglobin, cholesterol)

Exercise and Cardiovascular

1. Decrease BP

2. Increase SV (blood ejected per beat)

3. Increase RBC production

4. Conditions the heart

5. Lowers bad cholesterol,

raises good

6. Recover from exercise

faster

Pulmonary Function

1. Chest Deformities 2. Increased upper airway infections 3. Narrowing of smaller airways 4. Decreased surface area of lungs

– 75m2 at age 20– 50-60 m2 at age 80

Pulmonary Function

5. Loss of lung elasticity/tissue 6. Changes in lung volumes 7. COPD

– Shortness of breath– Cough– Poor exercise tolerance– Infections– Excess mucous

Will Exercise Help With Pulmonary Function?

1. Prevent osteoporosis (changes in chest) 2. Condition ventilatory muscles 3. Tissue damage may be irreversible 4. Improved immune function

Cognition

Memory/Reasoning/Comparison/Perception of Effort etc…

Tend to lose cognitive function with age

Exercise and Cognition

Hypotheses 1. Increased Blood Flow to Brain 2. Increase in Neurotransmitters of brain 3. Helps us remain alert and stimulates

attention processes 4. Anatomical changes in the brain

Emotions

1. Increased depression– Decline in health– Loss of physical ability– Death of loved ones– No job– Worries about money– Fear of being alone– Almost twice as many people over age 65 commit

suicide compared to those under 65

Emotion

2. Ability to deal with stress– When old rats are stressed they can initiate a stress

response but cannot turn it off (state of chronic stress)

Exercise and Emotion

1. Improves mood 2. Increases our ability to cope with stress 3. Decreases depression 4. Distraction 5. Mastery 6. Social interaction and approval

Hormones

Many changes!! Bone Regulation Hormones Growth Hormone Insulin

GH

Decreases with age.

Supplement as a treatment for aging??

Insulin

Decreased Sensitivity of Beta receptors of the pancreas

Decreased Response at the cellular level Increased Levels of Blood Glucose Diabetes

Exercise and Hormones

Stimulates bone formation Increased Protein Synthesis (muscle) Helps maintain Blood Glucose Increases sensitivity of the cells to insulin

Will lose concentration of certain hormones but can counteract the losses

Thermoregulation

1. Possibly lower baseline body temps 2. Dehydrated??

– Dysfunctional thirst mechanism– Decreased renal function

Thermoregulation

3. Impaired Heat Stress Response– Decreased skin blood flow to cool off– Decreased sweating rate– Dehydrated

Exercise and Thermoregulation

1. Increases skin blood flow 2. Increases efficiency of sweating 3. Helps retain the thirst mechanism 4. Increases blood volume

The Aging Eye

1. Inability to dilate pupils 2. Cataracts 3. Glaucoma 4. Drooping eyelids 5. Sunken eyeballs 6. Difficulty Distinguishing colors

The Aging Ear

Decreased Hearing Capacity Result:

– Isolation from society– Difficulty in communicating– Loneliness– Difficulty in determining direction a sound came

from– Don’t hear the beeps of machines

Nervous System Diseases

1. Myasthenia Gravis 2. Parkinson’s 3. Alzheimers

Balance

1. Poor Depth Perception. 2. Loss of peripheral vision. 3. Lose ability to detect spatial info. 4. Cutaneous receptors. 5. Muscle receptors (reflexes).

– Long latency reflexes.

Sleeping

Narcolepsy Sleep Apnea Difficulty going to sleep

Exercise Prescription

1. Consultation with doctor 2. Gradual Progression – start slow – 40-50%

HR reserve, 10-20 minutes, multiple sessions of 10 minutes, etc…

3. Use a combination of HR reserve and RPE to set exercise intensities

4. Increase duration rather than intensity

Prescription

5. Consider ambulatory capabilities. 6. Non-threatening/intimidating environment or

facility. 7. Poor vision – bike over treadmill. 8. Orthopedic problems/immobility. 9. Realize that they may have a lower

capability than you are used to.

Prescription

10. Do not assume anything 11. Know what is going on in their lives 12. Increase treadmill grade rather than speed 13. Make them drink!! 14. Longer warm-ups and cool-downs 15. Activities that don’t require high

coordination

Prescription

16. Emphasis on the social aspect 17. Understand nervous system diseases 18. Emphasis placed on lifestyle changes 19. Bands or machines instead of free weights 20. Weight training at least twice a week

(especially for this population) 21. Breathing very important with resistance

training

Prescription

22. Emphasis on technique. 23. Don’t strength train arthritic patients during

active periods of inflammation. 24. Stretching/Flexibility emphasized. 25. You may notice what family members do

not.

Prescription

26. You may be the only social contact that they have.

27. Change in routine should be slow and gradual.

Persons Who Should Not Resistance Train

1. Abnormal BP response to a GXT 2. Poor left ventricular function (<30% ejection

fraction) 3. Uncontrolled angina, hypertension,

arrhythmias 4. Severe CAD 5. Severe aortic stenosis 6. Low Aerobic Functionality (<5 METS)

Contraindicatons to Exercise

Absolute ContraindicationsAbsolute Contraindications Recent significant change in resting ECGRecent significant change in resting ECG Severe CAD: Unstable angina and/or acute MISevere CAD: Unstable angina and/or acute MI Acute CHFAcute CHF Uncontrolled ventricular arrhythmia’sUncontrolled ventricular arrhythmia’s

ContraindicationsContraindications

Uncontrolled atrial arrhythmias (compromising Uncontrolled atrial arrhythmias (compromising cardiac function)cardiac function)

Third degree AV block w/o pacemakerThird degree AV block w/o pacemaker Suspected or known dissecting aneurysmSuspected or known dissecting aneurysm Aortic stenosisAortic stenosis Myocarditis or pericarditisMyocarditis or pericarditis Thrombophlebitis or intracardiac thrombiThrombophlebitis or intracardiac thrombi Recent systemic or pulmonary embolusRecent systemic or pulmonary embolus

ContraindicationsContraindications

Acute infectionsAcute infections Significant emotional stressSignificant emotional stress

Relative ContraindicationsRelative Contraindications:: Hypertension: Resting DP > 110 mmHg or resting Hypertension: Resting DP > 110 mmHg or resting

SP > 200mmHgSP > 200mmHg Moderate valvular diseaseModerate valvular disease Electrolyte abnormalitiesElectrolyte abnormalities Fixed rate pace-makerFixed rate pace-maker

ContraindicationsContraindications

Frequent or complex ventricularFrequent or complex ventricular ectopyectopy Ventricular aneurysmVentricular aneurysm Uncontrolled metabolic disease (i.e., Uncontrolled metabolic disease (i.e.,

diabetes)diabetes) Chronic infectious diseaseChronic infectious disease Neuromuscular, musculoskeletal, or Neuromuscular, musculoskeletal, or

rheumatoid disorders exacerbated by rheumatoid disorders exacerbated by exerciseexercise