in both aerobic and resistive exercise as well as flexibility and balance exercises is essential for older adults to combat the numerous changes that occur in the body as a result of aging. Exercise also helps with adapted immunity for older adults, and post-COVID clients will benefit from exercises to decrease neuropathic pain at fascial levels (Papp et al., 2021). The next section will talk about the three recommended exercise categories of aerobic exercise, resistance exercise, and balance exercise, then will discuss special considerations. for much longer (Maarbjerg et al., 2011; Zanuso et al., 2017). Though it is currently unknown why insulin sensitivity increases with exercise, it is known that the muscle contractions required to move the body during aerobic exercise can result in glucose uptake that is 20 times that seen at rest (Maarbjerg et al., 2011; Zanuso et al., 2017). Aerobic exercise and increasing physical activity in older adults can be a powerful intervention to improve insulin sensitivity. A study examining the effects of water-based exercise on individuals with diabetes showed not only a primary effect of weight loss, but also secondary effects that included a significant reduction of blood pressure, a reduction in HbA1c (A1C) levels, and improved VO 2max (Devine et al., 2022). Just as important as the effect that aerobic exercise has on physiologic function is the beneficial effect it may have on physical function and mobility, even in previously frail or sedentary older adults. A large clinical trial of over 1,600 older adults at high risk for disability found that a physical activity intervention aimed at meeting the American College of Sports Medicine guidelines was able to reduce the onset of major disability (defined as an inability to walk 400 meters in 15 minutes) by 18% (Liguori & American College of Sports Medicine, 2020; Pahor et al., 2014). Perhaps even more impressive, the researchers found that individuals who participated in the exercise intervention had a 28% lower risk for ongoing mobility problems compared to the control group that did not exercise (Pahor et al., 2014). This is in agreement with two meta- analyses demonstrating that even low-intensity aerobic exercise benefits frail older adults and results in improved physical function, mobility, and gait speed (Gine- Garriga et al., 2014). Aerobic exercise in frail individuals resulted in an increased gait speed of 0.07 m/sec, which matches or exceeds the minimal clinically important difference for gait speed reported in other studies (Chou et al., 2012; Gine- Garriga et al., 2014). Older frail adults should be “explicitly” encouraged to exercise due to the potential benefits to physical function and mobility (Gine-Garriga et al., 2014, p. 765). The benefits of aerobic exercise for older adults’ physiologic and physical functioning is clear. However, an exercise prescription for older adults may be more complex and present additional difficulties compared to prescribing exercise for a young healthy adult. Occupational therapy practitioners are most concerned with using exercise to help increase range of motion, strength, coordination, endurance, and cardiovascular fitness to maintain a state of well-being; to prevent contractures; and to enable occupational performance in daily life. comorbid conditions of many older adults, along with the need to encourage increased activity, the American College of Sports Medicine, along with the American College of Cardiology, issued new guidelines in 2020 for prescribing exercise for adults over age 65. The guidelines are also suggested for any adults age 50 or older who suffer from a significant chronic condition, such as heart disease or diabetes, that requires regular medical care, and for adults who experience any functional limitations that impair their ability to participate in exercise (Liguori & American College of Sports Medicine, 2020).
Frequent aerobic and resistive exercise can delay the onset of physical frailty, reduce the biomarkers related to aging, and even improve health and function in frail older adults who have already experienced a significant decline in function (Englund et al., 2021). Despite the well-known health benefits of regular physical activity, physical inactivity has become a global pandemic (Liguori & American College of Sports Medicine, 2020). With this knowledge, the federal government has made increasing older adults' physical activity a major goal. Engaging Aerobic exercise benefits Aerobic exercise provides cardiovascular conditioning. “Cardiorespiratory fitness (CRF) reflects the functional capabilities of the heart, blood vessels, lungs and skeletal muscles to transport and utilize oxygen to perform physical work” (Liguori & American College of Sports Medicine, 2020, p. 144). Aerobic exercise can delay the loss of cardiorespiratory fitness, as measured via VO 2max , that is typically seen with aging (Booth et al., 2011). While decreased VO 2max still occurs with aging in active individuals, the rate of decline is much slower than in sedentary individuals. An active 80-year-old who has maintained a high level of physical activity has a VO 2max comparable to that of a sedentary 50-year- old (Booth et al., 2011). In previously sedentary older individuals, the implementation of an aerobic exercise program can also result in increased cardiorespiratory fitness (Papp et al., 2021). Increasing fitness in older adults is of critical importance because a low VO 2max is correlated with increased mortality in older adults, and either an increase or a decrease in VO 2max alters mortality risk (Booth et al., 2011; Kokkinos et al., 2010). A study of 70- to 82-year-old men found that older men who increased their cardiorespiratory fitness from low to high aerobic fitness decreased their mortality risk by almost 50% (Kokkinos et al., 2010). However, the converse was also true. Older males who transitioned from high to low cardiorespiratory fitness actually increased their risk of mortality by 50% (Kokkinos et al., 2010). One reason that aerobic exercise may result in decreased mortality risk is the benefit to the heart and lungs. Aerobic exercise is known to decrease blood pressure as well as to prevent and even reverse arterial stiffness that contributes to increased blood pressure and heart dysfunction (Booth et al., 2011; Ohta et al., 2012). A recent study of 26 older women demonstrated that just 12 weeks of aerobic exercise resulted in decreased arterial stiffness (Ohta et al., 2012). Improvements in mortality with improved physical fitness may also be related to the beneficial changes in body fat that occur with increased physical activity. More recently, it has been found that increased aerobic activity in previously sedentary individuals may actually result in decreased visceral and intramuscular fat (Addison et al., 2014; Villareal, 2017). Previously sedentary older adults who have never exercised may benefit from starting an exercise program (WHO, 2020). A single session of aerobic exercise results in both an immediate increase in glucose uptake that lasts for several hours after the cessation of exercise and increased insulin sensitivity that lasts Aerobic exercise prescription Prescribing exercise for older adults presents a unique set of challenges. The previously described body system changes that occur with aging, along with the comorbid conditions that many older adults face, result in a need to alter the typical exercise prescription for both the duration and the intensity of exercise. For example, many older adults are prescribed beta blockers as a treatment for high blood pressure. Beta blockers blunt the rise in heart rate, and thus using heart rate to monitor the intensity of exercise is not an option for some older adults. Older adults may also be deconditioned from illness or a lifetime of sedentary activity, resulting in the need to modify aerobic exercise prescriptions. Taking into account the physiological changes and
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