Elderly

Effects of aging on body

• ↓ ROM

• Shrinking of vertebral discs/ ↓ height

• Altered bone remodeling

• ↓ lean body mass and muscle atrophy

• Joint degradation/ arthritic changes

• ↑ postural sway and ↓ balance

• Foot problems

↓ ROM

seen body-wide but mostly in hips and shoulders

Shrinking of vertebral discs/ ↓ height

disc mass and vertebrate shrink/ atrophy causes a ↓ in height

Altered bone remodeling

• bones don’t regenerate as quickly

• explains why elderly take longer to heal

↓ lean body mass and muscle atrophy

muscle becomes fat (sarcopenia)

Joint degradation/ arthritic changes

• joint pain and stiffness

• osteoarthritis is most common

↑ postural sway and ↓ balance

• ↑ sway=↓ balance

• base of support moves in front of COM=↓ balance

Foot problems

• bunions, hammer toes, callouses, etc. contribute to gait problems and falls

• loss of feeling in feet (neuropathy)

Older Adults

• 65+

• Key manifestations:

  • Reduced physical functioning

  • Fragility

  • Deconditioning

  • Age-associated diseases

• Result:

  • Loss of ability to perform ADL’s

  • Loss independence

Effects of Aging on Body System Functioning: Skeletal muscle

• ↓ musc mass by ~50% from youth to elderly

• ↓ muscle strength, velocity

• ↓ type II fibers

  • anaerobic fibers- allows us to move quickly (i.e. reflexes, sprinting)

Effects of Aging on Body System Functioning: Bone, cartilage, connective tissues

• ↓ BMD (= osteoporosis)

• ↓ thickness, elasticity, tensile strength

Effects of Aging on Body System Functioning: Body

composition

• ↓ lean mass

• ↑ % body fat

( fat replacing muscle= sarcopenia)

Effects of Aging on Body System Functioning: Cardiovascular

• ↑ arteriosclerosis (plaque build up)

  • = ↑ hypertension

• ↓ HRmax (age predicted)

• ↓ a-vO2 diff

• ↓ peak aerobic capacity

  • ↓ a-vO2 lead to ↓ peak bc body can’t use energy efficiently

Effects of Aging on Body System Functioning: Respiratory

• ↑ chest wall stiffening (breathing=hard)

• ↑ residual volume and dead space

  • due to weaker muscles

Effects of Aging on Body System Functioning: Metabolic

• ↓ resting metabolic rate

  • less cal burned from breathing

• ↓ insulin sensitivity

  • insulin loses ability to function= ↑ blood sugar=↑ diabetes

• ↓ liver size and liver blood flow

  • ↑ risk of diabetes

Effects of Aging on Body System Functioning: Thermoregulation

• ↓ thirst sense (and core temp and regulation)

  • ↑ core temp & ↓ regulation= ↑ heat stroke

• ↓ sweat production per gland

Effects of Aging on Body System Functioning: Renal

• ↓ kidney size

• ↓ renal blood flow

• ↓ glomerular filtration rate

GFR: measures kidney function

Effects of Aging on Body System Functioning: Central Nervous

System

• ↓ β-adrenergic sensitivity (SNS- epi/norepi)

  • ↓ receptors for epi/norepi= ↓ effective

• ↓ brain volume

• ↓ balance, coordination, hearing, vision

Male vs Female BMD

• Females have ↓ BMD and lose at faster rate bc of menopause

  • ↓ estrogen

Male vs Female Muscle Mass

• Men generally have more muscle mass to lose

• by ~75 we have ½ the muscle mass compared to youth

Male vs Female VO2

• Both lose VO2peak at same rate until ~55 y/o

• After 55 y/o women lose VO2peak at slower rate

World population

• Population of 65+ is expected to double by 2050

• Population of 80+ is expected to triple by 2050

Older Adults and Exercise

• People 65+

  • 20-25% exercise regularly

• People 85+

  • 5-10% exercise regularly

Exercise Response: Maximal Responses

*know arrows*

Benefits of Exercise Training

• slows physiologic changes of aging

• optimizes changes in body composition

• promotes psychological/cognitive well-being

• manages chronic disease

• reduces risks of developing physical disabilities

• increases longevity

Exercise Testing: Aerobic

• Initial workload should be low

  • < 3 METs (low-moderate)

• Small workload increments

  • .5-1.0 METs

  • Naughton Protocol (not Bruce, too intense)

• Cycle ergometer vs. treadmill

  • Cycle ergometer is more practical and better for safety

  • Treadmill is better for testing- more large muscle groups are activated

• Treadmill handrail support (makes easier)

Naughton Protocol

• Speed is maintained, only grade increases

• Grade increases by ½ MET every stage

• By the end it should be vigorous (6-6.5
  METs)

Exercise Testing: Aerobic (pre-test)

• A resting 12-lead ECG should be performed on all older adults prior to exercise testing (for those 50+)

  • Look for:

    • Significant changes in ST segment

    • Any incidence of dysrhythmias

Exercise Testing

• Resistance

  • Machines (better for safety)

  • Can estimate 1 RM (use 8-10 RM to estimate)

  • Focus on muscles used for ADLs (arms, legs)

• Flexibility

  • Goniometers

  • Sit and Reach

Medications

• Prevalence of those who take 5+ meds:

  • 44% of older men

  • 57% of older women

•  Common scenario for man in his 80s:

  • 3-4 antihypertensive drugs (BP)

  • 3-4 heart failure meds

  • aspirin or warfarin (circulation)

  • statin (cholesterol)

  • 1-2 diabetic drugs

Exercise Prescription

• Percent improvement in components of exercise is comparable to younger adults

  • ↑ VO2max= 20-25%

• Loss of independence (what does it look like?)

  • Low functional capacity

  • Muscle weakness

  • Deconditioning

• Should include exercises to improve:

  • Balance

  • Agility (ability to change directions quickly)

  • Proprioception (body awareness— WHERE IS MY DICK AT?!)

Balance Exercises

• Frequency: 2-3 days/week

• Exercises:

  • Progressively difficult postures that ↓ BoS

    • 2-legged stand, 1-legged stand

  • Dynamic movements that perturb COG

    • Circle turns (should take <4 steps to complete circle)

  • Various walking activities

    • Backwards, sideways, heel-to-toe

  • Reducing sensory input

    • Standing with eyes closed

Other Methods of Improving Balance

Get creative!

• Tai chi

  • Should be supplemented with aerobic, resistance exercise

• Using a bosu ball

  • Can improve balance and reduce falls

• Virtual reality

  • 6 wks of VR simulating obstacles during TM walking more effective with reducing fall risk vs. TM walking alone in 60-90 yr olds

Example exercise program

• looks similar to program for YA

• uses modified PRE for older adults (↓ HRmax)

Special Considerations

• Intensity/duration of exercise should be low at beginning

  • Especially for those who are:

    • highly deconditioned

    • Functionally limited

    • Afflicted with a chronic condition

• Progression of exercises should be individualized

• Gradually exceed recommended minimum amounts of exercise

Special Considerations (pt. 2)

• Initial training sessions for those using weight-lifting machines should be supervised

• Avoid the Valsalva maneuver (puts a lot of pressure internally)

• Very frail individuals:

  • Resistance training should precede aerobic training

• Incorporation of behavioral strategies