Exercise RX for older adults

physical stress theory

changes in level of physical stress causes a predictable response in all biological tissue

levels of stress below maintenance levels

decrease tissue tolerance to stress, atrophy

maintenance levels

does not change tissue

stresses that exceed maintenance levels

increase tissue tolerance to stress, hypertrophy

components of physical stress theory

specificity, overload, progression, recovery, reversibility

specificty

training will only improve those parts of body being trained

overload/intensity

tissue must be exposed to a load which is not normally exposed to improve function

progression

prescribe optimal dose of exercise and progress intensity levels to continue to provide overload stimuli (at patients pace)

recovery

cannot rush training, body needs time to allow physiological mechanisms required for activity to adapt

reversibility

use it or lose it (balance stress and rest)

FITT principle

frequency, intensity, time, type (volume and progression)

warm up for older adults

longer to increase protection and allow slower systems to warm up before movement begins

passive warm up

increase temp by external means

general warm up

increase temp with nonspecific movements

specific warm up

increase temp with movement you intend to use strenuously after

cool down

gradual tapering off of intensity to prevent blood pooling, decrease hypotension, and promote removal of waste from muscles

aerobic/endurance frequency

3-7 days/week, more frequency with lower intensity

to determine intensity, use

stress testing to determine max HR

best method for MHR

tanaka method: 220 - (agex0.7)

THR =

(% ex intensity x HRR) + RHR

HRR =

MHR-RHR

ACSM recommends healthy adults exercise within a HRR range of

40-80%

moderate intensity

40-60% HRR

vigorous intensity

60-90% HRR

RPE scale

helps PT account for pt exertion, pain, fatigue, etc. - must use with beta blocker

target range of intensity for changes

fairly light-hard (40-80% HRR)

time of aerobic/endurance

>/=150 min/week of moderate or 75 of vigorous

based on pt tolerance

multiple bouts of short duration exercise can be beneficial

types of aerobic training

HIIT, peaking threshold, circuit training, cross training

volume of aerobic training

150min/week moderate, 500-1000 MET-min/week

progression of exercise is dependent on

health status, functional capabilities, activity preferences, age and tolerance of activity

initial stage

longer warm up 10-15 min, mod intensity with intervals, longer cool down 10-15 min, stretch 3-4 days/week for 15-30 min (1-6 weeks)

improvement stage

warm up 5-10 min, increase intensity (60-85%), cool down 5019 min with stretching 3-5 days/week for 25-40 min

maintenance stage

warm up 5-10min, intensity 70-85%, cool down 5-10 min, stretch 3-5 days/week for 20-60 minutes

gradual progression of

exercise time, frequency OR intensity

aerobic endurance training will

increase levels of functional capabilities, facilitate maintenance of independence, improve sleep and improve quality of life

aerobic exercise is also proven to be beneficial for

brain health and cognition

balance training frequency

7 days is preferred for older adults

intensity of balance training

must challenge limits of stability both statically and dynamically

RPE scale goal for balance

level 3-4 for HEP (a little to somewhat unsteady), level 5-6 in PT clinic (somewhat or very unsteady)

balance exercise rx considers activities that

the pt perceives as challenging

time for balance training

10-15 min specified or incorporated into ADLS

type of balance training

double leg stance, side stepping, walk on toes, etc., can be anticipatory or reactive

volume of balance training

not enough by itself - takes time for improvement

static balance progression

change BOS or floor surface, etc

dynamic balance progression

impose body movements, change speed, head turns, arm movement, trunk movement

flexibility training frequency

2-7 days/week for all major muscle groups

flexibility intensity

slight sensation of resistance and mild discomfort (not pain)

time flexibility

ideally 30 seconds, 60 seconds is most effective for older adults

flexibility type

sustained static, proprioceptive neuromuscular facilitation, ballistic (controversial for older adults)

static flexibility

slow stretch with hold, active or passive

dynamic flexibility

gradual transition from body positions, no bouncing, controlled and smooth

volume flexibility

60 seconds total for each stretch, 2-4 reps - prioritize for time

static stretching can immediately

decrease strength and power for short duration of time

dynamic stretching can

increase power and increase neuromuscular activation

GAIT/locomotive frequency

5-7 days/week

intensity of GAIT training

must challenge limits of gait and locomotion

time of GAIT/locomotion

incorporate along with aerobic capacity/endurance program into daily activities

type of GAIT/locomotion

incorporate into postural control exercises, high and low intensity resistance training for LEs, aerobic capacity, balance and daily activities

strength training frequency active older adult

2-3x/week per major muscle group

strength training frequency inactive older adult

1x/week with light-moderate intensity

time strength training

dependent on tolerance, muscle groups and diagnosis

type of strength training

elastic bands, tubes, free weights, machines, body weight, etc.

intensity of strength training

80% of 1RM is safe and will show significant strength gains in a short period of times (avoid DOMS, higher intensity=lower reps_

1RM determination for older adults

not recommended

can use RPE and max number of reps to

fatigue

fatigue is indicated by

deteriorating form, speed changes (faster), inability to complete full ROM

average person performing good quality exercise at 70-80% of 1RM will experience momentary muscle fatigue at

8-17th rep

average person performing good quality exercise at 40-60% of 1RM will experience momentary muscle fatigue at

18-30th rep

aging adults with certain diagnoses should exercise at

lesser intensities from 30-60% of 1RM

with strength training - it is most important to minimize

risk of injury with slow movement, full pain free ROM and good form

at 40-60%, if pt performs 30+ reps the prior session for a muscle group

increase exercise resistance 10%

at 40-60%, if pt performs more than 17 but less than 30 reps for a muscle group

keep same amount of resistance

at 70-80%, if pt performs 17 or more reps in prior session for a muscle group

increase exercise resistance 5%

at 70-80%, if pt performs more than 8 but less than 17 reps for a given muscle group

use the same amount of resistance

research shows that the slower the movement

the better the strength gain (correct speed is one in which exerciser is able to "stop on a dime")

once given an optimal stimulus

it doesnt need to be given again - if working to fatigue 1 set is sufficient

with strength training, focus on

quality not quantity (more time for other exercises, increased compliance and less injury risk with 1 set)

strength training frequency active older adult