Physical Activity Programming

1
Physical Activity Programming

• Requires more care thought than any other age
  group
• Necessary in part because of dire medical
  consequences of incorrect programming
• Wide spectrum of physical abilities - indicates
  this need for special programming
• Need to distinquish between
• Young old ---- 65-74
• Old------------- 75-84
• Old-old-------- 85-99
• Oldest-old---- 100

2
Testing

• Stress Testing
• Treadmill Testing
• Bruce Protocol
• Balke
• Sidney Shephard
• Bicycle Testing
• Advantages weight supporting, balance, security
  for test termination
• Recommend test 6-9 min 75-85 HRmax
• Stepping
• Common activity - ease of orientation
  unimposing unthreatening

3
Programming

• Physician clearance, medical history, exercise
• Low-impact exercise is advisable
• Encouraged to be more physically active in all of
  their daily activities
• Optimum frequency, intensity, duration, mode of
  exercise
• Existence of a threshold level of intensity for
  training older adults
• Significance insure safe improvement/adaptation

4
Programming - Exercise Prescription

• Mode or type of activity
• Modified based on pre-existing medical
  conditions
• Degenerative joint disease
• Orthostatic hypotension
• Progression
• Slower
• Changes in program based on current response to
  exercise regimen
• Medical health limitations
• Goals

5
Group Exercise Guidelines for Seniors

• Pace of all movement should be slow to moderate
• Several modes and positions of exercise should be
  used
• A variety of equipment used - sustain motivation
• Special care taken for participants taking
  medications
• Continual monitoring of exertion levels
• Need additional staff member assisting instructor
  - observe participants reactions
• Use layered clothing - less tolerant of heat and
  cold
• Microphone used when in large area w/poor
  acoustics
• Charts demonstrating progress - use yellow,
  orange red

6
Maximal Volitional Treadmill Test

• Groups N Age VO2
  (ml/kg/min) HR
• Mean S.D.
  Mean S.D. Mean S.D.
• Young old
• Male 13 72.15 4.2 20.12
  2.8 130.69 8.7
• Female 42 70.23 5.7 18.90
  3.9 135.17 12.4
• Old-old 24 85.54 6.1 9.51
  2.5 114.79 13.2
• Unpublished data (University of Wisconsin),
  1978-1980

7
Fitness Trail Training - University of Wisconsin

• Traditional aerobic training involve high rate of
  attrition.
• Spouses and close friends were urged to attend -
  negative effect on attrition
• Park setting aesthetically pleasing environment
  to exercise
• Significant shading, colorful flower gardens,
  terrain mostly level
• Program convened early in A.M. to avoid extreme
  heat, dress lightly, hydrate adequately
• Small groups (4-5) based on fitness level
  different trails

8
Fitness Trail

• Safety - physical examination, 12-lead submaximal
  treadmill test during program, blood pressure
  and HR monitored, weekly and daily, respectively
  constant supervision
• Training
• 1 hr (10-15 min warm-up), 3x/wk, 12 weeks
• Trail subdivided into 1/4 mi. lengths
  w/exercise stations located at these intervals
  (strength flexibility)
• 1st wk ave. distance covered 1 mile 2 mi 4th
  week 3 mi 8th week
• Results
• Increase in predicted VO2max vigor Decrease
  in BP, WT and Fatigue

9
Physical Activity and Life Expectancy

• Can regular exercise lengthen life expectancy?
• Paffenbarger studies
• Life expectancy was 2.15 y greater for those who
  expended more than 2,000 Calories a week compared
  with those who expended lt 500 Calories

10
ACSMs Statement on Exercise

• Frequency 3-5 days/week
• Intensity 50-85 of VO2MAX
• Duration 20-60 minutes of continuous aerobic
  activity
• Mode Utilizing large muscle groups,
  continuously, rhythmical in nature
• Resistance Training of moderate intensity

11
Effect of Endurance Training on CV Disease Risk
in Older Healthy Men and Women

• Cross-sectional and intervention studies in older
  adults consistently indicate
• Lower fasting and glucose-stimulated plasma
  insulin levels
• Improved glucose tolerance (if initially
  impaired) and insulin sensitivity
• Lower blood pressure response with training at
  50 VO2max
• 1-4 decrease in overall percent of body fat
• Schwartz et al., 1991 reported intraabdominal fat
  decreased by 25 in older men who lost only 2.5
  kg of body weight

12
Recommendations for CV Training

• Walking, running swimming cycling are large
  muscle rhythmic aerobic forms of exercise
• The only consistent beneficial CV response to
  light-to moderate intensity training in older
  adults has been a reduction in blood pressure in
  previously hypertensive subjects

13
Strength Training Protein Needs

• Campbell et al. , 1994 suggest safe protein
  intake for elderly adults is 1.25 g.kg-1.d-1
• ACSM position stand recommends 1.0-1.25 g of high
  quality protein .kg-1.d-1
• A large age of homebound older adults consuming
  habitual dietary protein intake (0.67 g mixed
  protein .kg-1.d-1 ) were shown to be in negative
  nitrogen balance

14
Strength Training Recommendations

• Heavy resistance training has profound anabolic
  effects in older adults
• Improves nitrogen balance improves nitrogen
  retention w/all protein intakes
• Positive effects on bone health in postmenopausal
  women
• No specific guidelines in ACSM position stand
  (1998)

15
Exercise for the Frail and Very Old

• Goals
• Minimizing biological change of aging
• Reversing disuse syndromes
• Control of chronic diseases
• Maximizing psychological health
• Increasing mobility and function
• Assist with rehabilitation from acute and chronic
  illnesses

16
Exercise for the Frail and Very Old

• Biological aging, chronic disease, malnutrition,
  and extreme sedentariness prime contributors to
  physical frailty syndrome
• Muscle weakness and atrophy may be the most
  functionally relevant and reversible parameters
  related to exercise in this population
• All exercise programs for this population should
  include progressive resistance training of the
  major muscle groups of the upper and lower
  extremity

17
Exercise for the Frail and Very Old

• Frequency at least 2, preferably 3 days/week
• 2-3 sets (1 set may be sufficient) studies are
  lacking
• If possible, some standing postures with free
  weights are to be used ? enhancing balance and
  muscle coordination
• Clinically relevant muscle groups include hip
  extensors, knee extensors, ankle plantar flexors
  and dorsiflexors, biceps, triceps, shoulders,
  back extensors and abdominal muscles
• Balance training should be incorporated as part
  of strength training or separate modality
• One llegged stand, tandem walk, circle turns

18
Exercise Guidelines for the Elderly

• ACSM Guidelines
• Enhancing ability to perform ADLs
• Maintaining quality of life
• Application of the exercise prescription
• Be aware of degree of fraility, fatigue,
  orthopedic injury, potential CV problems
• Activities of low impact on musculoskeletal/joint
  structures

19
Exercise Program Components - Modified for Elderly

• Warm-up Cooldown - more emphasis
• Muscular conditioning prior or after aerobic
  portion
• Low-impact aerobic endurance activity is
  emphasized

20
Advantages of Resistance Training Machines

• Weight intensity can be applied at a low level
  increased in small increments
• Equipment designed to protect the lower back,
  lower potential for injury
• Variable resistance allows stimulus to be applied
  more evenly through ROM
• Designed to prevent handgrip maneuver
• Some machines can be double pinned, thereby,
  limiting ROM

21
Endurance Training Low Impact Moderate
Intensity

• Aerobic conditioning should follow strength
  balance training.
• Tolerance to weight-bearing activity, like
  walking, may be improved by first improving
  muscle strength, jt. Stability and balance
• After muscle strength has been improved
• Intensity 40-60 Heart rate reserve, or 11-13
  on Borg
• May be increased by adding hills, inclines, steps
  and stairs, pushing an occupied wheel chair, or
  adding arm and dance movements rather than
  increasing velocity or changing to running
• Duration at least 20 min
• Frequency at least 3 days/week

22
Exercise for the Frail and Very Old

• Most Frail elderly live in environments and among
  caregivers for whom exercise is still an
  unfamiliar or frightening concept
• Great need to change the physical surroundings,
  recreational programming options and staff
  training to allow for institution in private
  homes, senior apartment complexes, nursing homes,
  etc.

23
Progression of Endurance Training

• Pollock, Wilmore Fox recommend a 40 increase
  in time should be allowed for adaptation to
  training for each decade after 30
• Thus, if 30 year old participants progress every
  week, then 50 year olds will progress every 2
  weeks and 70 year olds every 3-4 weeks.