New York Physical Therapy Ebook Continuing Education

Table 6: Examples of Light-, Moderate-, and Vigorous-Intensity Aerobic Activities Light Intensity (Perceived Exertion of 3–4) Moderate Intensity (Perceived Exertion of 5–6)

Vigorous Intensity (Perceived Exertion of 7–8)

• Cross-country skiing. • Jogging or running.

• Walking Briskly (2.5 miles per hour or faster). • Recreational swimming. • Bicycling slower than 10 miles per hour on level terrain. • Elliptical faster than 2.5 miles per hour. • Tennis (doubles). • Active forms of yoga (e.g., Vinyasa or power yoga). • Ballroom or line dancing. • General yard work and home repair work. • Exercise classes such as water aerobics. • Golfing without a cart.

• Walking (slower than 2.5 miles per hour). • Walking or moving in water but not swimming. • Passive forms of yoga. • Stretching. • Snowshoeing. • Dancing. • Cross-country skiing. • Tennis. • Golfing with a cart. • Playing with grandchildren. • Walking up stairs. • Light housework or gardening. • Bringing in groceries.

• Swimming laps. • Tennis (singles). • Vigorous dancing. • Bicycling faster than 10 miles per hour. • Jumping rope. • Heavy yard work (digging or shoveling, with increased heart rate). • Hiking uphill or with a heavy backpack. • High-intensity interval training (HIIT). • Exercise classes such as vigorous step aerobics or kickboxing.

Note : From HHS (2018). Resistance exercise benefits

● Helps manage and prevent chronic health conditions. ● Improves quality of life. ● Improves psychological well-being. ● Extends independent living. ● Reduces risk for falls and fractures. Resistance training also may improve the metabolic capacity of skeletal muscles by improving glucose homeostasis (described earlier in this course), thus preventing and managing the inflammation that is common with aging (also called “inflammaging”; Fragala et al., 2019). According to the 2018 Physical Activity Guidelines for Americans , adults should participate in at least one set of 8–12 repetitions each of resistance exercises at least two days a week (Liguori & American College of Sports Medicine, 2020). Older adults who have never engaged in resistance exercises may feel confused or intimidated at the prospect of starting a resistance training program. Older adults may have incorrectly learned that resistance exercise is not appropriate for those with high blood pressure, that resistance training leads to the addition of bulky muscle mass, or that resistance exercise is bad for the joints and will lead to increased injuries. For those unfamiliar with resistance exercises, it may be beneficial to initially undertake a period of supervised exercise until the individual feels comfortable performing the exercises independently. As with aerobic exercise, the American College of Sports Medicine and the American Heart Association have issued recommendations for resistance exercise for older adults, those with chronic conditions, and individuals with significant mobility limitations. To maximize the benefits from resistance exercise, older adults should perform them a minimum of two to three days a week at moderate to high intensity. During each exercise session, individuals should perform 8 to 10 exercises targeting most major muscle groups, with 10 to 15 repetitions of each exercise performed at a moderate to high level of intensity (Liguori & American College of Sports Medicine, 2020). It is generally expected that once individuals are familiar with resistance exercise, performing 10 to 15 repetitions of 8 to 10 exercises will take 20 to 30 minutes to complete. Adequate rest should be taken between exercises to ensure patient safety and comfort. In general, ≥2 minutes of rest between sets of exercises should be sufficient to allow recovery and to move safely to the next exercise (Fragala et al., 2019). However, for frail patients or those with high levels of deconditioning, longer rest breaks between exercises may initially be required.

Resistance exercises , also called muscle strengthening exercises, provide benefits not found with aerobic activity such as bone strengthening and muscular fitness (HHS, 2018). “The phrase muscular fitness refers collectively to the characteristics of strength, hypertrophy, power, and local muscular endurance” (Liguori & American College of Sports Medicine, 2020, p. 153). Even though the benefits of resistance training are now generally well accepted, fewer than 20% of older adults routinely engage in resistance training (Lee et al., 2017). Given the large number of benefits attributed to resistance exercise, most older adults should be encouraged to engage in both aerobic and resistance exercise. Resistance exercise, like aerobic exercise, results in whole- body adaptations that benefit the cardiovascular, respiratory, endocrine, and musculoskeletal systems. Participation in a properly designed resistance training program can improve mobility, physical functioning, and performance of ADL. It can also preserve the independence of older adults (Fragala et al., 2019). Resistance exercise can improve older adults’ resistance to injuries and catastrophic events such as falls (Fragala et al., 2019). Older adults can help improve their psychological well-being and perceived quality of life through participation in resistance exercise programs, no matter the exercise type: Dumbbells, theraband, or yoga (Fragala et al., 2019; Bartos et al., 2022). Resistance training programs can be adapted for people with frailty, mobility limitations, cognitive impairment, or other chronic conditions (Fragala et al., 2019). Adaptations can include portable equipment and seated exercise alternatives (Fragala et al., 2019). Fragala et al., in their position statement from the National Strength and Conditioning Association, identified and solved the problem of older adults needing evidence-based guidelines and recommendations for resistance training (2019). Through a literature synthesis, they illustrated many of the benefits of older adult participation in resistance training to counter the consequences of aging and disuse of muscles (Fragala et al., 2019): ● Counteracts muscle weakness and physical frailty. ● Attenuates age-related intramuscular adipose tissue infiltration. ● Improves physical performance. ● Increases muscle fiber area. ● Improves muscle quality. ● Improves bone density. ● Improves metabolic health and insulin sensitivity.

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