Chapter 7: Exercise Prescription Management of the Older Adult: An Evidence-Based Approach, 2nd Edition 5 CCUs
By: Odessa Addison, DPT, PhD Learning objectives After completing this course, the learner will be able to: Describe the changes that take place in the cardiovascular, respiratory, endocrine, and musculoskeletal systems with aging. Describe the benefits and explain an appropriate exercise intervention to mitigate age-related changes. Course overview America is aging. By the year 2030, more than 19% of the U.S. population is expected to be over the age of 65, and the number of older Americans is expected to double to more than 70 million over the next 20 years (Vincent & Velkoff, 2010). More than 60% of older adults are considered to be inactive, making older adults the least physically active of any age group (Hallal et al., 2012a). The cost of inactivity is high and is estimated to cause more than 5.3 million premature deaths worldwide per year (Lee et al., 2012). Aging is known to contribute to a multitude of systemic changes within the cardiovascular, respiratory, endocrine, and musculoskeletal systems that result in decreased health, mobility, and function in older adults. Many of these systemic changes are exacerbated by inactivity. Increased physical activity and exercise may slow or even reverse many of these deleterious effects, thereby improving health, mobility, and function in older adults (Chou, Hwang, & Wu, 2012; de Vries et al., 2012). As outlined in Healthy People 2020, the U.S. government has made increasing the physical activity of older adults a priority and is seeking to increase the number of older adults who participate in routine physical activity (US Department of Health and Human Services Administration on Aging, 2012). According to the American Physical Therapy Association’s Vision 2020, physical therapists should be the “practitioners of choice” for removing the barriers against movement, function, and health (American Physical Therapy Association, 2012). In its 2013 Vision Statement of the Physical Therapy Profession, the American Physical Therapy Association placed renewed emphasis on the importance of movement by stating: The physical therapy profession will define and promote the movement system as the foundation for optimizing movement to improve the health of society. Recognition and validation of the movement system is essential to understand the structure, function, and potential of the human body. The physical therapist will be responsible for evaluating and managing an individual’s movement system across the lifespan to promote optimal development; diagnose impairments, activity limitations, and participation restrictions; and provide interventions targeted at preventing or ameliorating activity limitations and participation restrictions. The movement system is the core of physical therapist practice, education, and research (American Physical Therapy Association, 2013). Because America’s population is aging, most physical therapists and physical therapist assistants will engage with older adults in routine practice. These physical therapists and physical therapist Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious
Explain common barriers to exercise in older adults. Identify appropriate tests for clinical use to measure change after an aerobic or resistance exercise intervention. Explain special considerations when prescribing exercise for older adults with comorbid conditions.
assistants are ideally placed to prescribe and manage exercise to counteract a sedentary lifestyle and problems associated with aging. Older adults experience a host of physiological changes of which physical therapists and physical therapist assistants need to be aware when working with and prescribing exercise for this population. In 2007, the American College of Sports Medicine provided new guidelines for prescribing exercise for older adults (Nelson et al., 2007) and followed this up with a position statement in 2009 (Chodzko-Zajko et al., 2009) detailing the evidence for the importance of physical activity for older adults. The past 10 years have also generated a large amount of evidence concerning the physiological changes that take place with aging and how exercise may affect these changes. For example, it was once thought that adipose tissue was an inert storage depot; however, in the past 10 years research has emerged that suggests adipose tissue is the largest endocrine organ in the body, capable of releasing a host of harmful hormones that may contribute to muscle atrophy, strength loss, and mobility difficulties (Addison, Lastayo, Dibble, & Marcus, 2011; Addison, Marcus, Lastayo, & Ryan, 2014; Stehno-Bittel, 2008). In order to successfully intervene with older adults, physical therapists and physical therapist assistants must be aware of the relevant new research and know how to implement the recommendations. This intermediate-level course is designed to educate physical therapists and physical therapist assistants on the implementation of exercise prescriptions in older adults. This course will review the multiple age-related systemic changes that take place in the cardiovascular, respiratory, endocrine, and musculoskeletal systems and describe how exercise may mitigate these changes. This course will also provide recommended exercise prescriptions according to the most recent American College of Sports Medicine guidelines for older adults and discuss common barriers for exercise participation in older adults. It will also describe how changes after an exercise intervention can be measured by providing several clinical measures that can routinely and easily be implemented in clinical practice. Finally, this course will discuss special concerns, such as the need for medical screening prior to establishing a new exercise program, and special considerations when prescribing exercise for individuals with comorbid conditions common in older populations, such as osteoarthritis, diabetes, dementia, and obesity. At the end of this course, physical therapists and physical therapist assistants should be able to comfortably prescribe, implement, and evaluate a comprehensive exercise program for older adults.
and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic
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