Exercise Prescription and Rehabilitation Considerations for Older Adults: Summary 78
• Reduced mortality risk • Reduced number of falls and fall-associated injuries • Improved physical function • Improved cognition Stretching With time and aging, muscles and other soft tissue structures become shortened or lengthened. Stretching improves posture and movement patterns in older adults. Joint range of motion deficits can lead to: • Pain syndromes • Painful postures • Abnormal movement patterns • Loss of function Common muscles requiring stretching in older adults: • Suboccipital muscles • Pectoralis minor and protractors of the shoulder girdle Recommendations for stretching with older adults: • Stretching requires longer hold times in older adults in order to be effective • 30 second hold times are sufficient in a younger adult • In older adults 60 second hold times are necessary • Most effective stretching regimen: four repetitions of a stretch, each one held for 60 seconds, performed 5-7x/week • Static stretching is recommended over dynamic stretching Contraindication: Joint instability is the only absolute contraindication to stretching. Plyometrics Plyometrics involve exercises that use the stretch reflex of the muscle spindle. Plyometrics use the elastic energy that is stored in a stretched muscle to enhance an immediate reciprocal contraction of the muscle. They consist of an eccentric or lengthening contraction followed by a concentric or shortening contraction of the same muscle or muscles. ○ Example : squat followed by a jumping motion Plyometrics increase the ballistic ability of the specific muscle and increase the explosiveness or forcefulness of a muscle contraction. The loss of power with aging is more pronounced than the loss of strength; occurs at 20-30% per decade after 30. Muscle power or speed of movements is a better indicator of function than muscle strength in older adults. With progression of exercises, plyometrics or speed of contractions can be incorporated into an exercise program. • Extensors of the lumbar spine • Hip flexors and external rotators • Ankle plantar flexors
POSTURE AND STRETCHING IN OLDER ADULTS Posture Shortened Muscles Movement to Correct Posture Forward head Suboccipitals Chin tucks
Forward downward sloping shoulders
Serratus anterior Shoulder
retraction and upward rotation
Excessive lumbar lordosis – hip flexion tightness
Abdominals and hip extensors
Abdominal bracing and hip flexor stretch
Hip external rotation
Gluteus minimus, tensor fascia lata, gracilis, pectineus
Internal rotation with hip and knee bent to 90 degrees -in prone, supine or sitting Heel cord stretch into dorsiflexion on stair
Plantarflexion tightness
Gastrocnemius and soleus
Quick reciprocal movements is one way to increase speed of muscle contractions: • Begin by jumping in place, then progress this to jumping off and back onto a low step • Jump from foot to foot, then progress this to jumping forward or sideways Some types of plyometrics may not be realistic for many older adults. Even walking quickly and encouraging older adults to walk quickly will result in training in this area. EXAMINATION OF AEROBIC CAPACITY History and screening : patients will reveal if the patient has experienced signs or symptoms that indicate cardiovascular or pulmonary disease. Test and Measures • Baseline vital sign: provide essential information regarding physiological state • Patient symptoms indicate physiological state: ○ Fatigue, shortness of breath, and weakness during all exercise may all seem non-specific enough to provide the clinician with useful information ○ These symptoms can be measured in scales which can then turn this information into a more useful or objective form ○ Scales can be used to measure dyspnea, angina, claudication, and perceived exertion: ■ Borg RPE Scale ■ Intermittent Claudication Rating Scale ■ Angina Scale
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