Exercise Prescription and Rehabilitation Considerations for Older Adults: Summary 77
Measuring Perceived Exertion Borg Rate of Perceived Exertion: monitors exercise intensity: ○ A rating of 11-15 corresponds to 60-80% of heart rate max BORG RPE SCALE – RATING OF PERCEIVED EXERTION 6
• B-blockers decrease the force of the heart’s contractions as well as the heart rate which will keep it low during exercise • RPE is the preferred method of monitoring these patients • Monitor insulin dependent diabetics closely, exercise can change their insulin needs Strengthening Exercise Strengthening exercise is essential in older adults! Loss of strength = loss of function Increases in strength will increase function up to a certain point; then further strength increases will lead to increases in reserve but not further changes in function. Ways to test strength include manual muscle tests, muscle dynamometry, isokinetic dynamometers, and repetition max tests. • Repetition maximum (RM) : is the gold standard for measuring strength: ○ Determine the maximum number of times a person can move a weight with good form ○ There are tables that can be used to convert a multiple RM to a 1 RM or 10 RM in order to make comparisons or to determine the weight/ resistance to use with that individual that would equate to proper training ○ For strengthening to occur, 60% of 1 RM is needed: ■ To determine this, you would need to know the amount of weight the person can lift one time in a controlled manner with good form and then take 60% of that ■ 60% of 1 RM is the same as 15 repetitions Perceived exertion scales can also be used to measure individual effort during strength training exercises. Rates of perceived exertion of 11-15 on a scale such as the Borg represent a training level of 60-80%. • Manual Muscle Testing (MMT) : valuable when looking at functional strength ○ Standing heel raise on one leg is equivalent to a 3/5 MMT grade for the gastroc-soleus (calf) muscle: ■ Many older adults can not generate this type of force so this can be a very useful test ■ Gastrocnemius and soleus strength have been associated with gait speed Functional tests such as the 30 second chair stand test can also assess strength. There are no absolute contraindications for strengthening exercises for older adults. Monitor for form and for proper breathing. Clinicians need to keep exercises interesting, variable, creative and specific to what that individual needs. In muscle wasting diseases, such as sarcopenia, exercise is beneficial and is NOT contraindicated. Long-term exercise training (>1 year) has many benefits such as:
7 8 9
Very, very light
How you feel when lying in bed or sitting in a chair relaxed. Little or no effort.
Very light
10 11 12 13 14 15 16 17 18 19 20
Fairly light
Somewhat hard
Target range: How you should feel with exercise or activity.
Hard
Very hard
How you feel with the hardest work you have ever done. Don't work me this hard!
Very, very heard
Maximum exertion
Talk Test represents the ability to engage in conversation during exercise. When the patient reaches an intensity where they can barely respond in conversation then that is an intensity that is considered safe and appropriate for cardiovascular adaptations to occur. The talk test is a great tool to use when older adults are beginning an exercise program. Aerobic Exercise Contraindications and Precautions Contraindications : • Resting Heart Rate >100 beats per minute • Systolic blood pressure (BP) >200 mmHg and/or diastolic BP >120 mmHg Precautions : • Unstable cardiac conditions or risks for cardiac disease: monitoring of BP and HR should be performed regularly • Monitor for dizziness, lightheadedness, profuse sweating or nausea
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