Exercise Prescription and Rehabilitation Considerations for Older Adults: Summary 76
ABDOMINALS, ERECTOR SPINAE, GLUTEUS MAXIMUS Gluteus maximus, medius, obturator externus, piriformis, quadriceps Abdominals, erector spinae, gluteus maximus and medius, obturator externus, piriformis, quadriceps, anterior tibialis and gastric-soleus
BRIDGING, PLANK, PRONE HIP EXTENSION, SIDE PLANKS
BED MOBILITY Transfers and Squats Ambulation and Stair Climbing
• Sit to stand, squats with knees abducted and hips ER, leg press, wall slides • Bridging, plank, prone hip extension, step ups (varied heights), eccentric step downs, forward and backward stepping with and without resistance, heel raises (single and double), toe tapping with and without • Kneeling with trunk rotations, extension, UE movements • Quadruped trunk rotations and hip extension • Skipping, fast foot placement on target, hopping, fast walking and jogging for short distance
Floor Transfers
Abdominals, erector spinae, gluteus maximus and medius, obturator externus, piriformis, quadriceps, and gastroc-soleus
Fast Gait and Jumping
Gastroc-soleus, gluteus maximus and medius, quadriceps
PHYSICAL ACTIVITY & EXERCISE ACSM RECOMMENDATIONS
Progressing the Exercise Prescription • Lift a heavier load: increases intensity • Increase the number of transfers: increase repetitions • Increase work time: duration • Perform multiple movement patterns at once as opposed to a single movement: task specificity • Work on a variable surface: environmental challenge • Work more quickly or more slowly: time rate of force development Aerobic Exercise Intensity • Typically measured by target heart rate • The accepted formula for older adults is the Karvonen method: ○ Target Heart Rate = [(max HR − resting HR) × %Intensity] + resting HR ○ Max HR = [207 – 0.7 x Age] • Exercise intensity can also be calculated using perceived exertion scales or tests: ○ Example: 6 Minute Walk Test (6MWT). The 6 MWT measures how far a person can walk in 6 minutes. It is a valid and reliable indicator of aerobic fitness: ■ The 6MWT is a useful objective baseline measure, it has established normative values based on age and gender, and has established minimal clinically important differences ■ Vital signs should be taken before and after the test. RPE should be recorded at the end of the test. Subjects can stop and rest (stand) during the test but if they need to sit down then the test ends
Frequency ACTIVITY
FREQUENCY
Aerobic training
3-5 times/week As intensity increases the frequency can decrease
Skills (motor, learning, balance)
Daily
Stretching
5-7 times/week
Strengthening
2-3 times/week for each muscle group
Duration • Skills and balance exercises: 20-30 minutes each session • Motor theory: several thousand repetitions or several hours of practice are needed to learn a new movement pattern • Optimal stretching time is 60 seconds x 4 repetitions for older adults • One set at 10 RM for strengthening • In really untrained individuals, may need to start at 15 RM and progress to 10 RM • One set of each exercise is as effective as performing multiple sets for older adults
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