The mode of aerobic exercise should be any activity that is enjoyable. For sedentary older adults unfamiliar with exercise equipment, the prospect of completing exercise on a treadmill or an elliptical machine at a local gym may be daunting. Education concerning the variety of activities that constitute aerobic activity should be given when providing any older adult with an exercise prescription. Proper posture and technique should also be emphasized in all activities. Aerobic activity can include anything that results in a rise in effort, heart rate, and breathing, such as walking, dancing, swimming, or even chasing grandchildren. It should be an enjoyable activity because people are more likely to continue with an activity they find to be enjoyable. Asking older adults what activities they have enjoyed in the past may provide clues for helping them find a lasting enjoyable activity. A number of suggestions for aerobic and resistance activity can be found in Table 2.
minimum recommendations results in further improvements in health (Nelson et al., 2007). Therapists should not be afraid to push older adults to a vigorous activity level. Two recent meta-analyses both concluded that vigorous-intensity aerobic exercise benefits both community-dwelling older adults with mobility difficulties and frail older adults (Chou et al., 2012; Gine-Garriga et al., 2014). Both of these populations are traditionally thought to be too ill or frail to participate in vigorous activity; however, even frail older adults were able to participate in vigorous aerobic exercise with no adverse events reported (Chou et al., 2012). While every case is unique, and therapists should always use their best judgment when prescribing exercise, the new emphasis on individual perception of intensity allows for and encourages even frail older adults to participate in vigorous physical activity. Table 2: Examples of Aerobic and Resistance Exercise Aerobic Exercise
Resistance Exercise
• Machine circuit workout. • Group resistance exercise classes. • Stairs. • Rowing. • Body weight resistance such as chair stands and wall push-ups.
• Pilates. • Yoga. • Free weights. • Tai chi.
• Cross-country skiing. • Tennis. • Golfing without a cart. • Playing with grandchildren. • Stairs. • Aerobics classes. • Heavy housework or gardening.
• Walking. • Elliptical trainer. • Biking. • Hiking. • Snowshoeing. • Dancing. • Nordic walking. • Swimming. • Water aerobics.
• Downhill walking. • Resistance bands.
Note . From Western Schools, 2018. Resistance exercise benefits
muscles increased when older adults ceased training, but with only 12 weeks of retraining their intramuscular fat was reduced almost back to the post-24-week training levels. This finding is encouraging because it suggests that even if older adults need to halt resistance training due to illness or injury, they should be able to quickly return to pre-exercise-cessation levels, at least in terms of increased intramuscular fat, with the resumption of resistance exercise. Decreases in body fat with resistance exercise may be one reason that resistance exercise leads to improvements in insulin sensitivity and is currently recommended for use in the management of diabetes for older adults (Strasser et al., 2010). Resistance exercise is known to result in improved blood glucose control for 24 hours after a single session in both those with impaired glucose control and those with type 2 diabetes (van Dijk et al., 2012). Even older adults with other comorbid conditions, such as a stroke, may gain metabolic benefits from participating in resistance exercise. In stroke survivors, 36 sessions of resistance exercise over 12 weeks resulted in a 31% increase in insulin sensitivity (Ivey & Ryan, 2013). Resistance exercise may also improve metabolic function by decreasing whole body inflammation. Several studies have found decreased whole body inflammation after a program of resistance exercise (Nicklas et al., 2008; Prestes et al., 2009; Stewart et al., 2007). In one important study Greiwe and colleagues demonstrated that even frail older adults with multiple mobility limitations were able to decrease inflammation within their leg muscles after 3 months of resistance exercise (Greiwe, Cheng, Rubin, Yarasheski, & Semenkovich, 2001). The findings of the benefits of resistance exercise in stroke survivors as well as in frail older adults are exciting because they indicate that even the frailest older individuals with mobility limitations benefit from resistance exercise. This information may be used as a great educational tool for any older adult who reports that he or she is too old or unfit to participate in resistance exercise. Resistance exercise also boasts a host of unique benefits not found with aerobic exercise alone. For example, while both aerobic and resistive exercise may lead to decreases in total
For several decades public health placed an emphasis on the benefits of aerobic exercise and neglected recommendations concerning resistance exercise (Westcott et al., 2009; Winett, Williams, & Davy, 2009). Initially, the healthcare community’s understanding of the benefits of resistance exercise were limited; in fact, it was once thought that resistance exercise might contribute to increases in arterial stiffening, thus worsening cardiac disease in older adults (Westcott, 2012). However, it is now known that resistance exercise is beneficial for improving many of the risk factors for heart disease, diabetes, and even some forms of cancer (Westcott, 2012). Even though the benefits of resistance training are now generally well accepted and known, fewer than 20% of older adults routinely engage in resistance training (Center for Disease Control and Prevention, 2016). Given the large number of benefits attributed to resistance exercise, most older adults should be encouraged to engage in both aerobic and resistance exercise. Resistance exercise, like aerobic exercise, results in whole body adaptations that benefit the cardiovascular, respiratory, endocrine, and musculoskeletal systems. Resistance exercise may result in decreases in both systolic and diastolic blood pressure (Strasser, Siebert, & Schobersberger, 2010; Westcott, 2009, 2012). A study of 1,600 adults aged 21 to 80 found that as few as 20 minutes of resistance exercise 2 days a week was sufficient to significantly decrease resting systolic and diastolic blood pressure (Westcott, 2009). Resistance exercise may also bring about decreases in body fat, resulting in an improved metabolic profile and a decreased risk for developing diabetes (Westcott, 2012). Participation in resistance exercise may also decrease ectopic fat deposits. Both older women and older men have demonstrated decreases in visceral adipose tissue after resistance exercise (Bacchi et al., 2012; Westcott, 2012), and resistance exercise has also resulted in decreased intramuscular adipose tissue in some older adults (Taaffe et al., 2009). Taaffe and colleagues followed 13 older adults for 24 weeks of resistance exercise, followed by 24 weeks of no training, and then 12 weeks of retraining with resistance exercise. This novel study found that intramuscular fat located in the leg
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