Exercise Prescription and Rehabilitation Considerations for Older Adults: Summary 80
VITAL SIGNS AND CONSIDERATIONS • Resting bradycardia : often due to medications (example: Beta-blockers) • Resting tachycardia : could be due to hypotension, atrial fibrillation or flutter, cardiac autonomic disruption, or ventricular tachycardia • Systolic hypertension at rest : is often due to uncontrolled essential hypertension • Systolic hypotension at rest : could be due to low cardiac output which is a result of orthostatic hypotension, atrial fibrillation/flutter, heart failure, or volume deletion When a decrease in Heart Rate or Systolic Blood Pressure occurs with exercise, or fails to increase, then this is an indicator that the heart is unable to respond to the increased demand for oxygen in the body. A rise in Diastolic Blood Pressure during aerobic exercise may indicate coronary artery disease and could be an indicator of impaired safety because of reduced coronary perfusion. Oxygen desaturation during exercise often happens because there is increased pulmonary capillary flow which reduces the time for oxygen uptake in the presence of impaired diffusion. Oxygen desaturation with exercise does not indicate increased oxygen demand in the peripheral tissues (skeletal muscles). In most older adults the greatest limiting factor for aerobic capacity (and maximum oxygen consumption) is cardiac output. There is a strong correlation between cardiac output and aerobic capacity. FACTORS IMPACTING PROGNOSIS WITH IMPAIRED AEROBIC CAPACITY • Accessibility and availability of resources • Adherence to the intervention programs • Age • Caregiver consistency/ expertise • Severity of the medical condition • Level of impairment • Social determinants of health • Nutritional status • Overall health status • Potential discharge destinations • Premorbid conditions • Psychological or socioeconomic factors
Aerobic Capacity Interventions Therapeutic exercise is the cornerstone of these interventions. Normal, general principles of exercise prescription should be used when prescribing exercises for older adults with aerobic capacity impairment. • Overload principle : aerobic exercise load needs to be above the habitual aerobic workload to make improvements • Specificity of training : performing exercises that are most similar to the activity that the patient has limited aerobic capacity for Mode: Greatest improvements occur when the mode of exercise involves the use of large muscle groups over a prolonged period: • Can be weight-bearing or non-weight-bearing exercises Intensity : • Overall recommendation is 150 minutes of aerobic exercise each week for older adults at a moderate intensity or 75 minutes a week of vigorous intensity aerobic exercise • Aerobic exercise can be broken down into smaller sessions and spread throughout the week but should be performed for at least 10 minutes at a time • Aerobic exercise frequency for older adults is most days • Aerobic exercise duration is usually 20-60 continuous minutes when the goal is disease risk reduction • Discontinuous activity can be used in deconditioned individuals Duration & Frequency: • Clinicians can use a patient’s heart or perceived exertion to determine exercise intensity • HR should be 10-20 bpm below the onset of adverse signs of symptoms • When performing aerobic exercise another goal would be for HR to be 60-90% of maximal heart rate • RPE scales can be utilized: • Aerobic program can be progressed so that there is a focus on increasing or changing the mode, intensity, duration or frequency of the exercises • The final phase of an aerobic exercise program for older adults is the maintenance phase Physical Activity : • Aerobic capacity can be improved through aerobic exercise but also through increasing daily physical activity levels (increasing daily total energy expenditure) • Using devices such as pedometers can help promote an increase in physical activity level ○ Goal of 4-6 on a 10-point scale ○ Goal of 12-16 on a 15-point scale Progression :
• Cognitive status • Comorbidities, complications or secondary impairments • Concurrent medical,
• Social support • Stability of the condition • Psychomotor abilities • Level of physical function • Living environment
surgical, or therapeutic interventions
• Decline in functional independence
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