Conflict of Interest. Statistics. General Issues. Exercise Programs In The Elderly: Risks and Benefits. Aging and Physiology. Aging: General Concepts

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1 : Risks and Benefits Conflict of Interest I am currently not receiving any financial benefit from any organization I am providing (free) consultation to Onsight Fitness, which has been founded by UTC HHP (Exercise Science) alumni with philosophy of putting academic principles into practice and developing health focused exercise instruction. Note: Some of this presentation are tweaks of a presentation developed by Constance Bayles, PhD from the University of Pittsburgh Aging and Physiology A state of reduced physiological function associated with increased susceptibility to disability. (Negative health habits and life are catching up with the individual. Issues associated with aging are starting to happen at earlier ages.) Aging: General Concepts Normal Aging/Wear and Tear Disease/Physiologic Stressors Disuse/Unhealthy Behaviors Decreased Ability to Heal The wheels are coming off Statistics > million in 2005 to 47.8 million 2015 > million in 2015 projected to 14.6 million by % of population in TN >65 (Of which 10% live below the poverty line) USD HHS Administration for Community Living 2016 Living independently General Issues Living alone (more so women) Managing medications Health deficits Arthritis 53% Heart disease 35% Cancer 32% Diabetes 22% Hypertension 75% Obesity - 34% Osteoporosis 25% women, 5.5% men USD HHS Administration for Community Living

2 Blue Zones Independent living difficulty Self-care difficulty Ambulatory difficulty Cognitive difficulty Vision difficulty Hearing difficulty Any disability Figure 9: Percentage of Persons 65+ with a disability, % 7% 9% 15% 15% 23% 35% Areas where people are living to 100 at disproportionate rates (Sardina, Okinawa, Loma Linda, CA, Ikaria Greece, Nicoya, Costa Rica) Characteristics Generally healthy (mainly plant based) diet Regular (higher volume) moderate exercise High social worth (no isolation) Spirituality Purposely relax and disconnect Good Genetics 0% 20% 40% 60% 80% 100% What to do as a medical professional/health coach Refer Patients to Appropriate Professional Exercise Competent Exercise Physiologist (with a minimum of a BS degree) or Physical Therapist who can adequately address the elderly Must have a good understanding of physiology and aging Must have a holistic view Many PTs will rehab the injured area, but will not address the rest of the body or an overriding problem (such as obesity) This is therapy not lip service Comments on EP and PT ONLY the PT can handle acute injury ONLY the PT can provide therapeutic modalities Both can recommend therapeutic exercises to improve function and prevent dysfunction Exercise Physiologist typically addressed the whole body, while a PT addressed a specific issue Exercise Physiologist should have BS degree plus one of the following: ACSM Exercise Physiologist certification, ACSM Exercise is Medicine credential, NSCA Strength and Conditioning specialist, ACE Medical Fitness Specialist Medicine%20Certificate%20Program%20Presentation.pdf Addressing the following Disability Multiple Chronic Disease/Geriatric Syndromes Multiple Medications Personalize a program to the individual What should you expect from the EP/PT Address your concerns and questions. Both should provide feedback to medical professional (function, psyche well being, medication compliance, BP, body composition) Address the concerns and questions of the patient Complete an activity program that is realistic Complete a program that addresses functional improvement Cardiovascular Balance/Core Stability/Neuromotor function Strength 2

3 What should be done with the patient? Address priority issues (Medical Professional) Develop a specific plan that is individualized (EP/PT) Program should clearly state how each issue is being addressed. Program should clearly state how it is addressing scientifically accepted recommendations Pre and Post testing (data collection) Depending on the patient instill independence (They can do it on their own if possible) Preliminary Program Guidelines Medical History Medication History Social History Exercise History Participant Consent Physician Consent Physiological Assessment Psychological Assessment Purpose of Exercise Testing To Establish A Degree of Risk Associated With Exercise To Establish Appropriate Intensities For Exercise To Review Individual Objectives (Developed by medical professional and EP/PT) Exercise Tests/Physiological Assessments Walk Bicycle Strength Balance Flexibility Functional Performance Tests Exercise Tests/Psychological (Completed by psychologist) Cognitive Tests Depression Health Perception Medications and Exercise Polypharmacy/Self Medication Renal Excretion of Chemicals is Reduced IMPORTANT Know Medications and Side Effects 3

4 Factors Influencing Exercise Low Oxygen/Aerobic Capacity (VO2) Increased Fatigability Increased Need to Monitor Poor Balance Decreased Strength Less Ambulatory Ability Poor Coordination Decreased Cognitive Status Exercise Program Mechanics Start low and go slow Monitor signs and symptoms Exercise at the edge of ability Monitor progress Provide variety Address Issues of Function Motivate Make exercise fun Cool down is essential What should a program look like? Aerobic Activity Typically walking or stationary cycling 30 min/day for 5 to 7 days per week Activities such as gardening or housework are also acceptable Activity trackers are useful when the individual is does a fair amount of non-specific activity (Ideally 7,000 or greater steps per day) Strength, Function, Balance, and Neuromotor may be completed in combination Exercises for each major muscle group Make sure no area is neglected Strength traditional strength movements with light to moderate weight (Biceps curl, leg extension, triceps extension, etc.) Function, Balance, Neuromotor Activities that use the whole body (or many muscle groups) that mimic daily movement Getting up off the floor or a chair, get in and out of a car Modified push ups, planks, squats, etc. Exercise on the floor or possibly the bed Resistance Exercise Comments Try to maximize form (Typically, quality over quantity) Speed (power) some movements should be slow and controlled, but other should be as quick as possible Faster movements help improve neuromotor function and have been associated with faster (car) breaking Muscular Endurance Hold a movement increases core stabilization involvement (Plank) Remediate or advance a movement as is appropriate Address underlying deficits Muscle soreness should be mild to moderate, but the subject should never have orthopedic pain Exercise Monitoring Heart Rate Blood Pressure Weight Ratings of Perceived Exertion (RPE) 4

5 Risks and Contraindications To Exercise Abnormal Heart Action Pain/Pressure in the Chest Dizziness/Lightheadedness Poor Coordination Flare Up of an Arthritic Condition Nausea/Vomiting Extreme Breathlessness Muscular Pain Unusual Fatigue Mental Confusion Environmental Concerns Room Temperature Water Intake Meal Time Clothing Physiological Benefits Increased Cardiovascular and Cardiorespiratory Function Increased Muscle Mass, Strength, & Efficiency Increased Flexibility, Coordination, and Balance Maintain Bone Mineral Density Improve Weight Control and Nutrition Aides Digestion & Reduces Constipation Psychological Benefits Decreased Anxiety and Tension Increased Energy Level Increased Self-Esteem/Self Efficacy Better Sleeping Patterns Improved Socialization Improved Quality of Life Selected Exercise Programs I DO NOT ENDORSE NOR CONDEMN ANY SPECIFIC PROGRAM All programs should be evaluated by a professional to determine safety and efficacy Yoga and Tai Chi Good for core stability, muscular endurance, flexibility, function, neuromotor control Moderate Strength Poor Aerobic function, power/speed (flex action neuromotor function) Functional Programs Highly variable (Crossfit & Videos) Good addresses real life movements, improves strength, balance and neuromotor function, flexibility Moderate Aerobic function depending on intensity and rest intervals Concerning Some movements can increase the risk of injury. Movements can be too complex and thus performed in manner that is not safe. Remediation is often essential 5

6 Traditional Strength Training Use free weight rather than machines Free weight will incorporate more stabilizer muscles Good Improved strength, maintain bone density Moderate core stability, balance, and flexibility Poor aerobic conditioning Ballroom Dancing/Line Dancing Good aerobic conditioning, neuromotor and cognitive function (Follow directions while moving), social (Ballroom intimacy) Moderate strength and flexibility Chair Aerobics Comment as much as possible the participant should be getting out of the chair. This is only appropriate for individuals with severe cognitive and physical disability Moderate some movement and socialization Poor strength, neuromotor, balance, flexibility, and aerobic conditioning Water Aerobics Good Gets people out of the house, social, preparing for the session is functional Moderate some muscle strengthening and neural control Poor Aerobic function, core stability/balance, bone density effects Conclusions and Closing Statements Exercise and Physical Activity for Older Adults Proper exercise will provide the older adult with many orthopedic, physiologic, functional, and psychological benefits Medical Professionals should provide exercise referrals to an exercise physiologist or physical therapist Reinforce basic recommendations 150 moderate activity per week (30 minutes per day) Strength, balance and flexibility exercises twice a week Medical Professionals should help keep everyone accountable Develop priorities and evaluate outcomes (what is working) Alert patient and EP/PT of red flag issues EP/PT should provide you with feedback regarding the progress of the individual and address your concerns Thank You Nicholas Boér, PhD. MPH University of TN Chattanooga Health and Human Performance Department Nicholas-Boer@utc.edu