KINE 4646 - Exercise to Aging Final Exam

Stigma while delivering exercise to older adults?

Preconceived expectations of physical abilities in later life can lead to older adults to being treated differently or unfairly in exercise contexts:

- by exercise pros

- by peers

Stereotypes of older adults that reinforce weakness and fraility may result in a lack of appropriate opportunities to participate in exercise.

- role of government

- role of public support

Social factors of aging:

Socioeconomic status, lived environment, accessibility, culture, communities, supportive networks, education.

Psychological factors of aging:

Mental health, illness, trauma, our ability to cope with hardships.

Age Stereotypes

Beliefs about older people as a generalized group ("all older people are xyz").

Agesim

Devaluing and stigmatization of an individual based on their membership with a specific age group (more action based; acting on these beliefs).

How do we develop aging beliefs?

Our social environment teaches us from a young age that society values youthfulness.

We internalize beliefs about aging that create our perceptions and guide our behaviours.

Beliefs about aging impacts multiple domains of health, including:

-Physiology

-Cognitive function

-Physical function

-Memory performance

-Motor learning

-Longevity

Common beliefs about aging in a sport and fitness context

Youthfulness dominates the sport and fitness industry.

Physical activity used primarily to avoid/delay "aging".

Belief that older adults should slow down.

Images of older adults in sport are typically:

1. Low intensity, stereotypical "old age" activities

2. High intensity, defying aging expectations

How do healthcare professionals treat according to age?

Health professionals often treat according to chronological age rather than considering individual physical condition and exercise ability.

General based prescription, instead of focusing on the individual's abilities.

Important Life Transitions for Older Adults

- Change in employment status

- Becoming a grandparent

- Grief

- Relocating

Decline in the sense of personal control over health and physical functioning in later life can lead to low motivation for action.

Psychosocial types of outcomes

- Aging related

- Cognitive/perceptual

- Emotional

- Social

Psychosocial outcomes: Aging identity

New identity when starting new sport later in life.

Sustained personal identity through continued involvement

Improvement aging self-image - making sense of, and coping with, aging

Using sport to resist/deny aging

Health is the result of complex interactions between:

-Biological factors

-Psychological factors

-Social factors

Biological factors of aging:

Genetics, muscle mass, physical health, bone health, chronological age, fat mass, how bodies are composed.

Psychosocial outcomes: Cognitive/Perceptual

Cognitively demanding sports enhances cognitive flexibility

Psychosocial outcomes: Emotional

- Fun and enjoyable activity

- Increase self-comptence

- Frustration and fear of aging

- Gender differences

Psychosocial outcomes: Social

Building and benefiting from supportive relationships

Opportunity to interact with and meet new people

Negotiating criticism from others

Physical Function can also be referred to as...

Physical capacity; functional independence; physical disability.

These three highlight the ability to perform basic activities/ADLs

Frailty definition

Frailty is "a distinctive health state related to the aging process in which multiple body systems gradually lose their built-in reserves"

Strongest predictor of frailty?

Age

Signs that frailty is sinking in

-Unintentional weight loss

- Reduced muscle strength

- Reduced gait speed

- Self-reported exhaustion

- Low energy expenditure

Risks of Fraility

- Falls

- mobility issues

- delirium

- incontinence

- Hospitalization

- Disability

- Comorbidity

What contributes to balance...

Knowing our body's orientation to where we are in space. Visual stimuli. Sensory to detect, is a big part of this. Motor response to react. We process this through cognitive processes.

visual + sensory + motor

Sensory Changes = Vision

Structural changes in the eye lead to alterations in light entering the eye and transmission to the retina

Results in changes in:

Visual acuity; Contrast sensitivity; depth perception.

Formula for Vision

Vision = Exteroceptive (external environment) + Proprioceptive (body position in space)

Sensory Changes = Somatosensation (touch and pressure)

Sensitivity of the cutaneous receptors to different levels of touch and pressure

- declines with age as do the number of sensory pathways innervating these receptors

- older adults experience a two-to tenfold increase in the vibration threshold needed to detect sensations

- reduced ability to feel quality of contact between feet and surface below

- Leads to less accurate knowledge of limb position, particularly when the body is moving.

Sensory Changes = Vestibular

Changes in the vestibular system begin as early as age 30 with a gradual decline in the density of hair cells that serve as the biological sensors of head motion.

Older adults feel increasingly unsteady in complex visual environments.

- Sensations of dizziness or vertigo add to their perception of instability and higher fall risk.

Motor System Changes

- loss of large motor neuron function

- decline in important neurotransmitters such as dopamine

- significant decline in nerve conduction velocity

Reaction time is significantly impaired

Linked to reductions in strength, power and muscle endurance

Decreases in joint range of motion (ROM) are also inevitable as a result of aging

Motor System Changes are exacerbated by situations where:

The functional base of support is reduced (e.g., tandem, one-legged stance)

The support surface is compliant or unstable

Visual input is altered

A rapid response must be made to a loss of balance

Cognitive Changes

Changes occurring in the processes of attention, memory, and intelligence

Likely to affect the older adult's ability to anticipate and adapt to changes occurring in the environment.

To achieve a normal gait pattern, four major attributes must be present:

Sufficient lower-body strength and trunk stability

Adequate range of joint mobility

Appropriate timing of muscle activation

Unimpaired sensory input

What's the biggest change related to gait in older adults?

SPEED.

Age-Associated Changes in Gait

The most pronounced changes occur in the variables influencing gait speed.

Specific Gait Changes

-decrease in step length

-Increased double support time

-Reduced toe clearance

-reduced arm swing

-A reduced rotation of the hips, knees, and ankles during the gait cycle

-Increased stride-to-stride variability

-A reduction in gait adaptability

Falls

"An unexpected event in which the participant comes to rest on the ground, floor, or lower level."

Falls Stats

According to the World Health Organization (WHO), falls are the second leading cause of accidental or unintentional injury deaths worldwide, with the greatest number of fatal falls experienced by adults older than 65 years of age

According to the most recent Canadian data, 4 out of 5 injury hospitalizations involving seniors were due to falls.

Intrinsic Risk Factors for Falls

Demographic, systems of the body, symptoms and diseases.

Extrinsic Risk Factors for Falls

Medications, hazards in and around the home, hazards in the community. footwear, clothing, assistive devices

Hip Fracture

Hip fractures are associated with significant morbidity, mortality, loss of independence, and financial burden

"I'd like to get more active...how much exercise should I do?"

It really does depend on how active you are.

Presence of health conditions

What are their goals/what do they want to get out of this?

Why is it good to be active?

- Function / performance

- Safety / injury prevention

- Independence

- Compression of morbidity

- Psychosocial benefits

How are guidelines/recommendations put together?

Periodic re-assessment of the evolution of research on PA to ensure recommendations are up-to-date.

Advisory committees typically formed to guide the process.

Systematic review(s) of literature

Peer review and KT strategy

Are there any special considerations that make the creation of physical activity / exercise guidelines more challenging for this older population?

Tolerance to exercise; volume and intensity; speed of recovery; wide range of mobility; nutrition and energy intake.

Abilities and impairments.

PA Guidelines for Adults and Older Adults

Move more, sit less

150 minutes moderate intensity; 75 minutes high intensity

We need 5 hours a week for additional health benefits

Should do muscle strengthening activities 2 or more days a week.

Incorporate balance when possible.

A Healthy 24 Hours Includes:

PA = moderate to vigorous activity for 150 mins a week minimum. Muscle strengthening activities twice a week. Challenging balance.

Sleep = 7 to 8 hours a night; consistent wake up and bed times.

Sedentary = break up times of sitting; no more than 3 hours of screen time daily.

What would be the first thing you do if you were training an older adult?

Asking questions about things about the individual!

-Why is it important?

-Who should be screened?

-What happens if you don't?

Why Screen?

Health history; getting goals; ensure appropriateness of movements/exercises; baseline of where to start; not liable as the coach/trainer; create individualized programs

PA Participation Risks Vs. Benefits...

Well established that physical inactivity is a leading contributor to death and disability among older adults

Small risk of mortality during an acute bout of exercise, especially in adults who have become predominantly sedentary or who have underlying chronic disease.

Risk factors for increased likelihood of adverse cardiac event

- Age

- Male sex

- Increasingly vigorous activity (6 METs and above)

- Absence of PA history

When do we Pre-Screen?

- Before initiating any new PA program

- When returning from injury/hiatus from PA

- Upon changes in health

- Check ins every couple of months/weeks

Screening: 5 Step Approach

Step 1: Informed Consent

Step 2: PAR-Q+, Get Active, or ACSM

Step 3: Physician Clearance (if necessary)

Step 4: Health History / Lifestyle Assessment

Step 5: Feedback to clients and confidentiality

Step 1: Informed Consent

1. Providing information

2. Receiving consent

Step 2: PAR-Q+, Get Active, or ACSM

Evidence informed risk document.

If you say no to everything, you're good to go for activity. If you say yes to any, then there are a multitude of extra questions to answer before being able to start.

If we answer yes to the follow-up questions, then we HAVE to go through someone to be cleared.

Pros and Cons to PAR-Q+

Pros:

Safety net.

Cons:

Feels tedious, they feel as if this is a block to their exercise, and will not continue due to this. Tainted their experience and momentum to get physical change.

ACSM Pre-Screen - PAR-Q+ Alternative

Revised ACSM guidelines rely on a Pre-Exercise Screening Algorithm, which is better and allows more people to exercise. 2.6% referral rate.

Notably, in its revision of screening guidelines, the ACSM removed age from the assessments.

1. Current participation in physical activity,

2. Presence or absence of known cardiovascular, metabolic, or renal diseases or any signs or symptoms suggestive of disease, and

3. Desired level of exercise intensity.

Step 3: Physician Clearance (if necessary) + Additional Screening

Could just be a conversation if they already know you; additional testing could take place

- Role of ePARmedX and QEPs

- Cardiac Stress Testing/GXT

"Stress test"

exercising harder and screening the body to see what raises higher in the body that we cannot see at rest/normally. Involves the cardiovascular system.

Step 4: Health History / Lifestyle Assessment

Optional / Situation-specific screening

- CV Risk Factor Assessment; Measurement of resting blood pressure; Identification of goals; Identification of barriers

Step 5: Feedback to clients and confidentiality

Importance of 2 way communication - feedback should be frequent and timely

PHIPA & Program Design

Adult = Overload/Progression

Adding exercise stimulus, improving our ability to function. This is our progressive overload. Adding to stimulus = progression.

Adult = Specificity/SAID Principle

Specific

Adaptations

Imposed

Demands

→ Type of stimulus, and type of adaptation. Imposed demand is the exercise stimulus! Specific adaptation to a specific stimulus. Our body reacts and adapts to different stimuli for different people.

Adult = Rest and Recovery

- Important for injury prevention and for adaptation

- Active rest and recovery... NOT SEDENTARY BEHAVIOUR

→ This is the time where adaptation takes place. Overtraining with no rest can cause more damage to the body instead of improvement.

Older Adult = Functional Relevance

Selecting exercises that simulate the movements of everyday activities.

Performed in environments that are similar to those regularly encountered

Older Adult = Challenge (similar to overload)

Selected activities or exercises need to challenge, but not exceed, an individual's intrinsic capabilities (e.g., strength, cognition, sensorimotor ability).

--> Changing task demands and environmental demands

Older Adults = Adaptation/Tailoring

Individualised exercise prescriptions and solutions coupled with appropriate modifications to session goals, structure, or exercise content are necessary to accommodate age- and disease-specific changes that place older adults at higher risk for adverse events in exercise settings

Warming up:

Increases the internal body temperature

Prepares the cardiopulmonary, neuromuscular, and metabolic systems for intensity movements

Warming up results in increased blood saturation of the muscles, tendons, and joints, thereby significantly reducing their susceptibility to injury.

Activities for Warm Up

Rhythmic movements/dynamic movements

Whenever possible, incorporate large-muscle movements,

Similar to movements you plan to introduce later in workout, but at a slower tempo and lower intensity.

Guidelines for Developing a Warm-Up

Perform ~10 minutes of progressive physical activity; all warm-ups (not just aerobic).

Use continuous, rhythmic activities

Monitor Intensity

Incorporate dynamic stretching

Include 5-10 elements.

Cool-Down

Your body cools down physically! HR comes down at a resting pace/state. Everything comes down from a healthy stressed state to a normal resting state.

Physiological Benefits of a Cool-Down

- Decreases body temperature

- Enhances venous return

- Increases the removal of lactate

- Decreases the level of catecholamines (epinephrine and norepinephrine) in the blood

Guidelines for an Effective Cool-Down

Continuous rhythmic exercises progressively decreasing in intensity for 5 to 10 minutes, depending on participants' fitness levels

A stretching phase that includes a focus on flexibility

A variety of simple mind-body activities, such as yoga and tai chi

A relaxation phase to facilitate the transition from the exercise class to the rest of the day

Aerobic Exercise Benefits

Health

Functional capacity - ADLs and LTPA

Quality of life

FITT Principle

Frequency, Intensity, Time, Type

FITT Principle based on healthy 24 hours... (example)

Frequency:

≥3d per week

Intensity:

dependant on ability; moderate to vigorous

Time:

150 min aerobic

Start with less if needed and progress as tolerated

Bouts

Short duration movement.

Type:

Large muscle groups

Rhythmic/continuous

Types of Aerobic Exercise Training

Continuous Training

Interval Training

Why Interval over Continuous?

Interval conditioning provides a flexible, systematic framework for progressing aerobic endurance training for older adults with a broad range of functional and fitness levels

Principles of Program Design - Aerobic

Overload / Progression for older adults

Functional Relevance for Older Adults

Challenge

Accommodation or Adaptation

Intensity Monitoring

Heart Rate

Rating of Perceived Exertion (RPE)

Metabolic Equivalent Values (METs)

METs

1 MET = 3.5ml/kg/min of O2 consumption

METs can be helpful for gauging and prescribing exercises

Safety - General Best Practices

-avoided in extremes of heat or cold

-progress slowly and cautiously.

-adequate warm-up and cool-down.

-Sudden twisting or turning movements should be avoided

-Ensure proper hydration

-Older adults should not exercise if they have new or worsened symptoms

-Older adults should not exercise after a recent injurious fall

Health Benefits from RT

Increased lean tissue mass, improves bone health, glucose tolerance, reduce lower back pain, benefits on blood lipid profiles, increase balance and improve gait characteristics

Performance-Related Benefits from RT

Speed, strength, agility, motor coordination

Key for participation in recreational sport/LTPA + ADLs

Principles of Training - RT

Progressive Overload

SAID Principle

Rest/Recovery

Variation

Change the intensity, number of repetitions, amount of weight lifted. Frequency can be more often. Speed of contraction, what type of contraction are we doing? Manipulate the way you can make your prescription!

FITT - Resistance Training: Frequency

Total body workouts 2 (to 3) days per week: preference in most people.

Allowing 48 hours for recovery time.

FITT - Resistance Training: Intensity

Avoid "training to failure" when selecting reps

Reps usually 8-12

Full ROM is the goal - if possible + pain free.

FITT - Resistance Training: Time

Not typically used as a prescriptive tool in RT

Decrease recovery time throughout sets; do bodyweight squats for 30 seconds, then build from there. Use time as a quantity for certain exercises. Usually circuit based

FITT - Resistance Training: Type

Various modalities

Machines

Free weights

Resistance bands

Household items

RT Sub-Types

As resistance/ intensity/ %1RM goes up...

- Fewer reps

- More sets (maybe if strength is your goal)

- More REST

As resistance/ intensity / %1RM goes down...

- More reps

- Less rest

Power in RT

High-speed contractions

Loading modified as per joint and goal

Recovery as per target

Can adapt to target certain goals!

Prescription RT can depend on a number of factors;

The individuals training status

The training patterns / types of muscle contraction

The goals of the program

The resistance training protocol/style adopted

Different Muscle Groups that need to be Stimulated

Legs, core, chest, back, arms

Safety - RT

Warm up muscles 4-10 minutes before training.

Gradually add reps & intensity

Discontinue any exercise that causes pain.

Conduct exercises through a full, pain-free range of motion.

Wait 48 hours for recovery.

Age related changes with flexibility...

Stiffness

Sarcopenia

Changes in active ROM

Link to performance of ADLs

Ways to help flexibility

Proprioceptive neuromuscular facilitation (PNF), Traditional flexibility exercises, Dance, Tai chi

Types of Stretching

Static

- moving the joint through a single movement plane

Dynamic

- smooth and sustained motion; single joint or multi joint.

Incorporating Flexibility Training

In Warm-Up

Dynamic stretching; Involve the muscle groups that will be used in the movements planned for the activity/class; use ROM

Incorporating Flexibility Training In Cool-Down

Static flexibility exercises are preferred during the cool-down or at another point in the class when the muscles are thoroughly warmed up

Stretches that require longer holds will be more effective and safer to perform when the muscles are warm.

General Precautions with Flexibility/Stretching

dynamic stretches during the warm-up; move slowly; tension, but not pain, hold static for 10 to 90 seconds; breathe!

Balance and Mobility Trio

Task Demands; environmental constraints; individual capabilities.