FITT for aerobic exercise recommendations As it relates to optimizing CRF, the FITT principle of aerobic
exercise prescription can be viewed in Table 5. Table 5: Aerobic Exercise Recommendations FITT Recommendations F requency • At least 3 days a week.
• Days should be spread out across 3–5 days of the week.
I ntensity
• Moderate and/or vigorous.
T ime
• Most adults should accumulate 30–60 minutes per day of exercise totaling ≥150 minutes a week of moderate intensity. • OR 20–60 minutes a day totaling ≥75 minutes of vigorous intensity. • Aerobic exercise performed in continuous or intermittent manner that involves most major muscle groups. • At least 25% of aerobic exercises should also challenge balance.
T ype
Note : Adapted from Liguori & American College of Sports Medicine (2020); WHO (2020). Older adults, like all adults, need regular physical activity and should participate in regular aerobic activity to avoid the deleterious consequences of sedentary behavior. A minimum of 30 minutes a day five days a week (two to three nonconsecutive days) of moderate-intensity exercise or 20 minutes a day three days a week of vigorous-intensity exercise is recommended
intensity of 5 or 6. An activity that results in a large increase in effort, heart rate, and breathing would be rated as a vigorous activity, or 7 to 8 on the scale (Liguori & American College of Sports Medicine, 2020). To attain a moderate to vigorous level of activity for the most benefit, aerobic activity should be between 5 and 8 (Liguori & American College of Sports Medicine, 2020). Older adults who have never participated in exercise before may not immediately understand this scale. When prescribing a home exercise program to an individual who is unfamiliar with exercise, several supervised exercise sessions should take place first. During these sessions, the participant should be educated about what constitutes moderate versus vigorous physical activity so that they can understand the recommended and desired level of effort. Some older adults may be cautious about exercising at a higher intensity and may require verbal encouragement to help them understand the desired level of activity. As their fitness improves, older adults should be encouraged to increase both the duration and the intensity of their exercise sessions, as it is known that additional activity above the minimum recommendations results in further improvements in health (Liguori & American College of Sports Medicine, 2020). The mode of aerobic exercise should be any activity that is enjoyable. For sedentary older adults who are unfamiliar with exercise equipment, the prospect of completing exercise on a treadmill or an elliptical machine at a local gym may be daunting. Education concerning the variety of activities that constitute aerobic activity should be given when providing any older adult with an exercise prescription. Proper posture and technique should also be emphasized in all activities. Aerobic activity can include anything that results in increased effort, heart rate, and breathing, such as walking, dancing, swimming, or even running and playing with grandchildren. It should be an enjoyable activity because people are more likely to continue with an activity they find to be enjoyable. Asking older adults what activities they have enjoyed in the past may provide clues that will help them find a lasting enjoyable activity. Aerobic activity suggestions can be found in Table 6.
(Liguori & American College of Sports Medicine, 2020). A combination of vigorous- and moderate-intensity exercise can also be used to meet the minimum recommendations (WHO, 2020). Exercise frequency can be increased to six or seven days a week to facilitate weight loss (Liguori & American College of Sports Medicine, 2020). Activity above these guidelines is encouraged because the completion of exercise above the minimum duration can lead to additional health benefits (WHO, 2020). However, even older adults who are unable to meet these minimum levels of activity due to comorbid complications, frailty, or simply gross deconditioning should still be encouraged to participate in any duration of aerobic activity they are able to tolerate, with a goal of a minimum of 30 minutes of accumulated daily physical activity at moderate intensity at least five days a week (HHS, 2018; WHO, 2020). Ten minutes of aerobic activity done multiple times a day has been suggested for those who are unable to complete 30 continuous minutes (Liguori & American College of Sports Medicine, 2020). What is meant by moderate aerobic activity? While exercise intensity has traditionally been prescribed as a percentage of HR max , this is frequently not feasible in older adults because age and comorbid conditions may blunt the heart rate response to exercise. Instead, it is recommended that perceived intensity, relative to the individual’s fitness level, be used to measure exercise intensity in older adults. It is generally recognized that while a short walk may be a moderate-intensity exercise for a typical healthy adult, it may be of vigorous intensity for a frail older individual. The American College of Sports Medicine recommends the use of a 10-point scale to determine the intensity of an activity. On this scale, 0 is resting, and 10 is maximal effort. Any activity that produces a noticeable increase in effort, heart rate, and breathing would be rated at a moderate
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