1
Because its there.George Leigh Mallory (1924)
2
My Get-Up-and-Go Has Got Up and Gone

• Presented by
• Jeffrey Pearson, D.O.
• Industrial Sports Medical Center
• San Marcos, CA

3
Parts of this talk stolen from
4
Anyone can get old. All you have to do is live
long enough. Groucho Marx
5
Our Older Population

• People gt65 years of age make up 12.5 of the
  population.
• By 2050, estimated to be 25.
• Americans have an increasing life expectancy
• Women live 18.6 years past 65.
• Men live 14.7 years past 65.

6
Problems associated with aging

• Elderly tend to be more sedentary than their
  younger colleagues.
• Tend to suffer from medical problems that result
  in
• functional impairment
• less independence
• greater utilization of healthcare services

7
How fitness can help

• Healthy lifestyle leads to a healthier life.
• With exercise, people lead a more carefree
  life-style.
• Exercise leads to less time spent in
  hospital/medical office.

8
Old age is when everything that doesnt hurt
doesnt work. Anonymous
9
With maturity comes change...

• Cardiovascular
• ? maximum heart rate HRmax220-age
• Neurologic
• ? nerve conduction velocities? proprioception
• Musculoskeletal
• ? bone loss, ? muscle strength, ? flexibility
• ? vertebral disc size/strength
• Other
• respiratory system, metabolism

10
When do disabilities begin?

• Onset around age 60 for both sexes.
• Nearly ¹/³ of people over 65 years of age have
  some impairment in performing activities such as
  walking.

11
If I'd known I was gonna live this long, I'd
have taken better care of myself. Eubie Blake
12
Benefits of exercise general

• Serves 2 major purposes
• preventive
• lifetime pattern of physical activity
  ameliorates the ravages of aging.
• flexibility and strengthening program may reduce
  incidence of falls and bedsores.
• therapeutic
• Patients with strokes, arthritis, and fractures
  may regain some function.

13
Benefits of exercise specifics

• Cardiovascular
• cardiac output/cardiovascular fitness,
  cholesterol profile, BP control
• Respiratory capacity/function
• Bone and muscle strength, flexibility,
  coordination
• Psychological
• mood,self-esteem
• socialization

14
Exercise is Work
SI units of work are Joules (J) (1 Joule 1
Newton meter).
W KEf - KEi
KE ½mv 2
W Fs W (ma)s
(v 2 - v02)/2 W 1/2m(v 2 - v02) KEf - KEi
PEg mgy
15
Work
gravity
distance
16
I'm not afraid of death, I just dont want to be
there when it happens. Woody Allen
17
Exercise How safe is it?

• Cardiovascular (CV) Disease
• Leading cause of death in U.S.
• Sudden/unexpected death is common in populations
  w/ high rates of CV disease.
• Most sudden deaths occur in middle-aged and older
  individuals w/ advanced CAD and occur during a
  variety of activities, including exercise.
• NOTE cause of death in these cases is due to
  CAD and not exercise (although may be
  contributing factor).

18
Exercise How safe is it?

• Risk of death transiently increased during actual
  exercise period, but decreased for the rest of
  the day.
• The overall risk of cardiac arrest for active men
  is much lower than sedentary men.

Studies consistently show lower all-cause death
rates in more physically active groups.
19
Exercise How safe is it?

• In Summary
• The risk of serious medical complications during
  exercise is low, but is higher than during
  sedentary activities.
• The overall benefit/risk ratio for an active way
  of life is favorable.
• Moderate exercise has the potential to enhance
  the health of many sedentary individuals and
  should be widely recommended.

20
I have the rest of my life to improve, but it
may take longer than that. Ashleigh Brilliant
21
Beginning an exercise program

• Physicians assessment
• review patients needs and goals
• outline progressive steps to achieve goals
• refocus unrealistic goals!
• Patient education
• avoiding injuries
• nutrition

22
The Medical Evaluation

• History
• past/current illnesses previous injuries (and
  level of rehabilitation achieved) current
  medications
• functional capacity
• Examination
• assess function
• cardiovascular and musculoskeletal systems
• sensory vision, hearing, proprioception
• assess nutrition

23
The Exercise Prescription

• Mode of activity
• Intensity of exercise
• Duration of exercise
• Frequency of exercise
• Rate of progression

24
Mode of activity

• Any activity that uses
• large muscle groups
• can be maintained for a prolonged period
• rhythmic in nature
• Key purpose of most exercise prescriptions is to
  increase or maintain functional capacity
• aerobic endurance activities

25
Endurance Activities

• Group 1
• easily maintained at a constant intensity and
  inter-individual variability in energy
  expenditure is low
• walking, jogging, cycling

26
Endurance Activities

• Group 2
• rate of energy expenditure related to skill, but
  for given individual may provide constant
  intensity
• swimming, cross-country skiing
• Group 3
• Highly variable in intensity
• dancing, basketball, racquetball

27
Old Joke (Pre-Viagra)
Q How many 50-year-olds does it take to screw
in a light bulb? A None their screwing days
are long gone.
28
Intensity of exercise

• Conditioning sessions should be maintained at
  40-85 of functional capacity.
• Healthy adults typically 60-70
• Cardiac patients start at 40-60

Ideally, the participant should feel rested, and
not fatigued, within an hour following exercise.
29
Heart Rate Method 1

• Simple fixed percentage of HR method
• 70-85 of maximal heart rate corresponds to
  about 60-80 of functional capacity.

HRmax220-age
Example 220 - 50 170 bpm Hrmax 170 x .70
119 bpm 170 x .85 145 bpm Target exercise
range 119 - 145 bpm
30
Heart Rate Method 2

• Heart Rate Reserve/Range Method
• 60-80 of the HRR corresponds to 60-80 of the
  functional capacity.
• Calculate the HRR
• HRmax - HRresting Heart Rate Reserve (HRR)
• Calculate conditioning intensity
• Multiply HRR by desired intensity
• Calculate target HR
• Add HRresting

31
Example 60 y.o. with resting HR of 70 bpm
Lower Limit Higher Limit Maximal
HR 160 160 Resting HR -70 -70 HRR
90 90 Conditioning intensity x .60
x .80 54 72 Resting HR
70 70 Target HR 124 142
32
How doctors look at intensity (Feel free to
forget this stuff right away)

• METs
• one MET is equivalent to the amount of energy
  used at rest (oxygen uptake of 3.5 ml/kg/min)
• Varies with speed of movements and changes in
  resistance
• ADLs require 5 METs

33
Leisure activities in METs

• Billiards
• Bowling
• Boxing (sparring)
• Climbing hills
• Cycling (pleasure)
• Dancing (social, square, tap)
• Dancing (aerobic)
• Fishing (from bank)
• Football (touch)
• Golf (cart)
• (Walking/carrying bag)
• Handball
• Rope skipping
• Running (12 minute mile)
• Shuffleboard
• Tennis

• 2.5
• 2 - 4
• 8.3
• 5 - 10
• 3 - 8
• 3.7 - 7.4
• 6 - 9
• 2 - 4
• 6 - 10
• 2 - 3
• 4 - 7
• 8 - 12
• 9
• 8.7
• 2 - 3
• 4 - 9

34
Rating of Perceived Exertion
Category RPE Scale Category-Ratio RPE
Scale 6 0 Nothing at all 7 Very, very
light 0.5 very,very weak 8 1 Very
weak 9 Very light 2 Weak 10 3 Moderate 11
Fairly light 4 Somewhat strong 12 5 Strong
13 Somewhat hard 6 14 7 Very
strong 15 Hard 8 16 9 17 Very
hard 10 Very, very strong 18 Maximal 19 V
ery, very hard 20
35
Time is a great teacher, but unfortunately it
kills all its pupils. Hector Berlioz
36
Duration of activity

• Conditioning period (excludes warm up and cool
  down periods) may vary from 15-60 minutes
• typically 20-30 minutes
• this length required to improve or maintain
  functional capacity

37
Frequency of Exercise Sessions

• Depends, in part, upon the duration and intensity
  of the exercise session
• Functional capacity lt3 METs
• 5 minute sessions, several times/day
• Functional capacity 3-5 METs
• 1-2 daily sessions
• Functional capacity gt5 METs
• at least 3x/wk on alternate days (aim for 5 days
  total)

38
Rate of Progression

• Initial conditioning stage
• usually lasts 4-6 weeks, but depends upon initial
  functional capacity and rate of adaptation.
• Should include light calisthenics and low level
  aerobic activities with which the participant
  experiences a minimum of muscle soreness.
• Discomforts usually arise when program fails to
  allow for gradual adaptation.

39
Rate of Progression

• Improvement conditioning stage
• Typically lasts 4-5 months.
• Aerobic conditioning is progressed at a more
  rapid rate.
• Intensity increased to target level
• Duration increased every 2-3 weeks
• Less fit individuals may need more time.
• Duration of exercise should be increased to 20-30
  minutes before increasing the intensity.

40
Rate of Progression

• Maintenance conditioning stage
• Usually begins after first 6 months of training
• Participant reaches satisfactory level of
  cardiorespiratory fitness
• Should review the conditioning objectives
• More enjoyable or variable activities may be
  substituted for those used previously
• helps avoid dropping out due to boredom of
  repetition

41
Sample Progression Program
42
I am sick of all this nonsense about beauty
being only skin deep. Thats deep enough. What
do you want, an adorable pancreas? Jean Kerr
43
Other Fitness Components

• Flexibility
• Lack of flexibility may be associated with
  increase risk for low back pain and other
  injuries
• Stretching exercises should be performed slowly,
  in a controlled manner
• 15-20 seconds per repetition
• 4 repetitions of a particular stretch per set
• at least 3x/week

44
Other Fitness Components

• Muscular strength and endurance
• No direct relationship to cardiorespiratory
  fitness or functional capacity
• however, many tasks require some degree of
  strength, e.g. lifting/moving objects
• The stronger the individual, the less stress
  placed upon the body performing tasks
• Strength exercises help to maintain muscle mass
  as we become older (Use it or lose it.)

45
Other Fitness Components

• Muscular strength and endurance
• Begin with low resistance, high repetitions to
  develop muscle tone
• 20-30 reps with light weight per set
• Optimal strength gains occur when the resistance
  allows for no more than 5-8 repetitions of a
  movement, for 3 sets
• you can still make strength gains with lower
  resistances

46
(No Transcript)
47
Catflexing
48
Catflexing
49
Nutrition

• Carbohydrates for fuel
• 60 of total daily calories
• complexgtsimple
• Protein for re-building
• 15 of total daily calories
• Fat for energy storage (1 lb. 3500 Kcal)
• 25 (or less) of total daily calories
• avoid saturated and hydrogenated types

50
Nutrition

• Fluids
• Plain water best for most people
• Drink 1-2 eight ounce glasses before exercise
• Repeat every 20 minutes of exercise
• Sodium
• Normal daily intake about 2000 mg
• Never consume salt tablets on hot days!

51
Injury/Illness Treatment and Prevention

• Ice is nice!
• P.R.I.C.E.S.
• Sunscreen
• SPF 15 or greater
• Proper footwear
• Tie shoelaces!

52
The secret of staying young is to live honestly,
eat slowly, and lie about your age. Lucille Ball
53
The End
Thank you!