Lec 7 Active Ageing: Physical Activity in Older Adults

Physical Activity

Any bodily movement produced by skeletal muscles that result in energy expenditure.

Exercise

Subcategory of PA that is planned, structured, and repetitive

Physical Function

Capacity of an individual to perform the physical activities of daily living

what mediates the relationship between sarcopenia and ability to complete activities of daily living?

Gait speed

Short Physical Performance Battery (SPPB)

10-minute, objective clinical tool assessing lower extremity function in older adults via three timed tests: Gait speed (4-meter walk), Standing balance (10s holds of side-by-side, semi-tandem, tandem), Repeated chair stands (5 times)

what do SPPB scores range from?

0-12 (best)

10–12: High function, low risk.

• 7–9: Moderate function.

• <6: Low function, high risk for mobility decline

what does SPPB predict?

disability (i.e., mobility impairment), hospitalization (e.g., fall risk),

and mortality.

why is canada described as “super aged”

At least 20% of the nation’s population is aged 65 years and older

Do life expectancy gains correlate with decreased morbidity

No, At least one-third of older adults in Canada live with 2 or more chronic conditions, and this rises to almost one-half after age 85 years

what are WHO recommendations for OA

• 150–300 minutes of moderate-to-vigorous physical activity per week.

• Resistance (strength) exercises 2 times per week.

• Multicomponent exercises with a focus on balance 3 times per week (e.g., yoga

what type of resistance exercise does WHO recommend?

• 2–3 sets of 1–2 exercises per major muscle group.

• 5–8 repetitions or achieving intensities of 50%–80% of their 1-rep max.

whats moderate exercise intensity

5 or 6 for effort; result in a heart rate increase to 64%–76% of the person’s maximum

whats Vigorous-intensity exercise

t 7 or 8 for effort; result in a heart rate increase to

95% of their maximum

what are some benefits of PA for OA?

improves…

• cognitive health, QoL (reduces loneliness, inc social contact + self-efficacy), fall prevention, mental health, joint+muscle health, functional independence

reduces

• fraility, risk of noncommunicable disease (T2D), all-cause mortality

how much exercise is enough to elicit benefits in VO2 max with OA?

90 min submax exercise/week for over 16-20 wks

which exercise types are the best for improving cognitive function (best first)

aerobic, then resistance, neuromotor (tai chi), multicomponent

what are some conditions that PA is a risk factor for?

Coronary artery disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, depression, dementia, and some types of cancer

Can PA act as an adjunct to treatment or, in some cases, remove the need for medication or surgery?

yes

what has the potential to greatly reduce health care costs associated with treatment of preventable disease

PA

what % of adults do not meet the recommendations of the Canadian Physical Activity Guidelines?

80%

what is the Transtheoretical Model of Change (TTM)

a comprehensive and integrated model of behavior change, aimed at encouraging habits, useful in creating interventions to promote PA behaviours

stages of change

levels of motivation to change, from no intention to change to actually making behaviour change

what are the stages of change?

precontemplation, contemplation, preparation, action, maintenance

Cognitive Processes of change

thinking, attitudes, awareness (conciousness raising, dramatic relief, env re-evaluation, self re-evaluation, social liberation)

behavioural processes of change

Actions (counter conditioning, helping relationship, reinforcement management, self-liberation, stimulus control)

Processes of change

how people change. The strategies+ techniques that people use to change/modify their behaviour. two categories: cognitive and behavioural

decisional balance

• belief about pros and cons of making a behaviour change

• differences in decisional balance, tends to correspond to different stages of change (earlier stages perceive more barriers, late stage perceive more benefits)

Self-efficacy

• belief in capacity to execute behaviours necessary to produce specific performance+achieve goals

• high scores in exercise SE tend to be more active

• high levels of exercise SE= more sustained and inc PA for older adults

5 step framework for PA promotion (WHO)

Assessing current physical activity level and assessing risks and

contraindications.

• Advising on the specifics of physical activity (how much, what type, etc.)

and the reduction of sedentary behaviour.

• Agreeing on a physical activity goal informed by individual preferences.

• Assisting with support strategies (problem-solving common barriers to

physical activity, such as time and financial commitment).

• Arranging a follow-up for reassessment.

Diseases where exercise is a risk

Cardiovascular disease, Cancer, Type 2 diabetes mellitus, Hypertension, Chronic obstructive pulmonary disease, Frailty, Osteoarthritis, Osteoporosis

risks of PA: heart disease

high intensity, conduct stress testing to guide intensity + volume, PAR Q+

Cancer

blood tests+ imaging, type of cancer determines modality, freq, vol

T2D

autonomic neuropathy inc hypotension at high intensity, look for retinal + renal complications. peripheral neuropathy may inc fall risk

hypertension

exercise at 90-100% VO2 max avoided, as well as caution w/ overhead + isometric exercise. BP measurement

COPD

functional O2 testing to identify safe threshold to maintain saturation

OA

avoid excessive joint loading with pain, minimize injury risk. aquatics

osteoporosis

check BMD, consider fracture risk. limit impact exercises

what is the greatest modifiable risk factor for dementia prevention and can contribute to dementia risk as much as genetics?

PA

what happens when he body is not sufficiently active

for good health?

metabolic complications emerge, increasing one’s risk of dementia.

what did exercise interventions that involve regular walking or jogging do for older adults?

Inc in cardiovascular fitness, inc in hippocampal blood volume, improved memory

greater benefits with a variety of exercises

How does L-lactate (produced by exercising muscles) help the body?

travels to hippocampus, activates BDNF which promotes neuroplasticity, increasing cognitive function

what are the FITT principles?

Frequency, Intensity, Type, Time

if someone picks up exercise mid life, do we see an improvement in cognition?

yes, sedentary older adults between 55-80 years who began walking, resistance training or Tai Chi 3x/week for a year saw improvements in cognition

What is the minimum amount of moderate/vigorous activity according to FITT principles?

70 moderate, 35 vigorous /week

What is the optimal amount of moderate/vigorous activity according to FITT principles?

140 moderate, 75 vigorous /week

Are FITT principle guidelines same as WHO or ACSM

No, Frequency and time vary. ACSM recommends 150 min of mod-vig/week. FITT is more flexible because it focuses on benefits of cognitive improvements

what is the cognitively challenging portion of FITT

include cognitive tasks (new terrains, new locations), multi-component exercises (more beneficial then singular exercise), socially stimulating (at least one weekly activity with others, in person or virtually).