New York Physical Therapy Ebook Continuing Education

As a result of physical inactivity and increased systemic disease, many older adults experience increased vulnerability to any challenges body systems may face from illness and injury. These changes may diminish an older adult’s ability to survive a serious illness, a fall, or any other event—including life-saving surgery—that stresses the body systems. Whether senescence is beneficial or detrimental, immune system efficiency declines as cellular surveillance and response declines (Davan-Wetton et al., 2021) A study by Papp et al. (2021) showed that adults who were previously sedentary for at least three months prior and then participated in a moderate-intensity exercise protocol showed increased immunity, which was shown through significant changes in naive and memory lymphocyte ratios (Papp et al., 2021). The study also showed that heavy resistance/ repetitions and vigorous-intensity workouts were linked to immune dysregulation and illness, which illustrates the necessity of customized exercise prescriptions (Papp et al., 2021). The tailored protocol in the Papp et al. (2020) can be seen in Table 3. Table 3: Adaptive-Immunity Exercise Recommendations FITT Recommendations F requency • 2 days a week. • Days should be spread out/not successive. I ntensity • Moderate. T ime • 60 minutes per session. • 120 total minutes a week.

including a reduction in the function of all the special senses, which results in loss of hearing and smell. Slowing dermal and epidermal cell turnover (part of the interstitial system) leads to a thinning of the skin, decreased wound healing, and an increased risk of infection (Davan-Wetton et al., 2021; Humbert et al., 2016). Physiological and pathological consequences of senescence can be considered beneficial or detrimental and lead to a number of health conditions related to aging. Beneficial physiologies (seemingly a misnomer) have age-related consequences include hypertension, nerve degeneration, myocardial infarction, rheumatoid arthritis, atherosclerosis, skin fibrosis (Davan-Wetton et al., 2021). Detrimental consequences include Parkinson’s disease, brain atrophy, disc degeneration, atherosclerosis, type 2 diabetes, metabolic dysfunction, osteoarthritis, muscle degeneration, and cancer (Davan-Wetton et al., 2021). Although some changes may be inevitable with aging, physical inactivity can actually hasten the aging process, resulting in more rapid decline in most major body systems. FITT for adaptive immunity exercise recommendations To optimize immunity, the FITT principle of exercise prescription for the study by Papp et al. (2021) can be viewed in Table 3. Considering the recent move away from 10-minute bouts of exercise, the protocol times can be changed so that over the course of a week, they total 150–300 minutes of moderate- intensity exercise. Before recommending an exercise intervention for older adults, it is critical to understand the changes that typically occur in the body with aging, as many of these changes will affect not only the ability of older adults to participate in exercise but also their response to it. A solid understanding of the anatomical and physiological changes that take place with aging is necessary to both recommend and monitor an exercise intervention in older adults. Cardiovascular system changes Age is a major risk factor for cardiovascular disease (CVD), which carries the greatest burden for the older population. Coronary heart disease (CHD) correlates strongly with age and is the leading cause of death in Europe and the U.S. (Paneni et al., 2017). In the next 20 years it is estimated that the U.S. prevalence of CVD in those over age 65 will increase by 10% (especially in those over age 80), 27 million additional people will have hypertension, 8 million will have CHD, 4 million will have a stroke, and 3 million will have heart failure (Paneni et al., 2017). Blood pressure Blood pressure , also called pulse pressure, is an independent risk factor for cardiovascular (CV) events (Paneni et al., 2017). With aging, the aorta stiffens due to increased collagen and elastin. The alterations in the aorta’s extracellular matrix contribute to loss of distensibility (its capacity to swell as a result of pressure from the inside; Paneni et al., 2017). The increased stiffness raises reflected waves and elevates systolic pressure, though diastolic pressure tends to decline with age. As aortic pulse wave velocity increases, pulse pressure rises. This type of hypertension is called isolated systolic hypertension and accounts for the majority of uncontrolled hypertension in Americans over age 50 years (Paneni et al., 2017). As arteries become increasingly thick and stiff, they are less able to adapt to changes of blood flow within. In a young and healthy individual, as increased blood is pumped through the arteries, the arteries are able to expand to maintain a relative amount of pressure in the arterial system

T ype

• 10 minutes aerobic low intensity: ○ Warm-up with treadmill/elliptical/ bicycle. • 20 minutes aerobic moderate intensity: ○ Aerobics. • 20 minutes resistance exercise: ○ Resistance/closed-chain. • 10 minutes flexibility exercise: ○ Stretching.

Note : Adapted from Papp et al. (2021).

(Paneni et al., 2017). However, as aging occurs, the arteries are no longer able to expand and adapt to changes in blood flow. As the arteries are less able to adapt to both increases and decreases in blood flow, older adults are more likely to experience increased blood pressure and orthostatic hypotension, or decreased blood pressure when moving to a standing position. A decrease of more than 20 mm Hg in systolic pressure or 10 mm Hg in diastolic pressure is diagnostic of orthostatic hypotension (MedlinePlus, 2022). Hypotension affects an estimated 6% of Americans, including between 10% and 30% of older adults (MedlinePlus, 2022). Perhaps even more troubling than orthostatic hypotension is the systemic rise in blood pressure that is also related to the decreased compliance of the arteries. An increase in blood pressure increases the pressure against which the heart must pump, which results in additional left ventricular hypertrophy (North & Sinclair, 2012). Many older adults experience an increase in systolic blood pressure with aging that may be partially attributed to increased stiffness of the arteries (Chester & Rudolph, 2011; North & Sinclair, 2012). However, while systolic blood pressure increases, after age 50, diastolic blood pressure typically decreases (Strait & Lakatta, 2012). This leads to progressively larger differences between systolic and diastolic pressures. The difference between systolic blood pressure and diastolic blood pressure, known as the pressure product, is an important indicator of arterial health in older adults. An increase in the pressure product, resulting

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Book Code: PTNY1024 Physical-Therapy

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