in muscle mass, strength and power. Over time, the decline of the neuromuscular system can lead to a decreased ability to perform daily activities, highlighting the importance of exercise. Endurance training leads to central and peripheral adaptations which improve cardiovascular function and the capacity of the skeletal muscles to generate via oxidative metabolism (Cadore et al., 2014). Performing endurance training can help improve a person’s ability to participate in activity longer. This is also important for the older adult population because they often fatigue easier, which leads to a decline in activity and, therefore, a sedentary lifestyle with detrimental health consequences. If Recommendation for physical activity in older adults Research shows that exercise is the most effective intervention to counteract the effects of aging on the body. Exercise is important for both healthy individuals and those with conditions and diseases. Exercise can have a positive impact on all adults as they age. That said, it may be necessary to perform a pre- exercise evaluation to determine the appropriate exercise regimen for each individual. It is important to identify risk factors that may change the course of treatment. The U.S. Department of Health and Human Services (2008) recommends performing pre-exercise evaluations on adults with chronic conditions, such diabetes, heart disease or osteoarthritis, prior to beginning an exercise program. In addition, according to the American College of Cardiology/American Heart Association (2002), sedentary older adults and persons with known coronary artery disease, cardiac symptoms, or two or more coronary artery disease risk factors should undergo exercise stress testing before initiating a vigorous exercise program. Absolute contraindications to aerobic exercise and resistance training include recent myocardial infarctions, complete heart block, electrocardiography changes, acute congestive heart failure, unstable angina, and uncontrolled hypertension (American College of Sports Medicine, 1998; American Heart Association, 2000). Physical activity recommendations may differ for the older adult population when other disease conditions present. If a patient has co-morbidities, there may be special precautions or considerations in order to maximize the benefits of exercise while keeping the patient safe. Parameters for exercise may change depending on the type of disease or condition the patient may have. Patients may also benefit from preventative activity and exercise, as well as exercise for treatment of a condition. Four main ways a patient can improve general physical fitness for all older adults includes aerobics, resistance training, flexibility training, and lifestyle modification: 1. Repetitive aerobic exercise: ○ Uses large muscle groups and increases the heart rate for an extended period. ○ May include activities such as walking, dancing, cycling and swimming. 2. Progressive resistance training: ○ Requires muscle to generate the force to move or resist a given weight. ○ Weight resistance can be created using elastic bands, weight cuffs, free weights, weight machines, or the patient’s body weight. ○ Maintains or improves muscle mass, strength and endurance. ○ Improves balance, allowing the patient to perform daily activities more safely. ○ Emphasis on muscle power rather than strength alone may help patients retain the greatest amount of functional capacity as they age. ○ Regardless of age or health status, continual improvement requires a progressively increasing resistance as the patient becomes stronger.
a person participates in endurance training and maintains their activity level, they will decrease their risk of limiting their activity. Both strength and endurance training have a positive impact on the body and are an important part of maintaining an active lifestyle and improving overall health. Progressive resistance exercise, or PRE, can improve strength and lead to improved bone density (Rhodes et al., 2000). Flexibility exercises can improve mobility and range of motion which can decrease risk of injury and allow a person to remain active longer, while balance exercises are important in improving stability and decreasing risk of falls. 3. Flexibility: ○ The ability to move a joint through a complete range of motion. ○ Facilitates movement and can help prevent injury throughout life. ○ Poor lower back and hip flexibility may contribute to pain in the lower back muscles. ○ Limited range of motion in the hip, knee and ankle joints may increase the risk of falls and contribute to age- related gait changes. 4. Lifestyle modification: ○ Finding opportunities within a patient’s existing daily routine to increase activity (manually opening doors, taking the stairs rather than the elevator, parking further from the door). (McDermott & Mernitz H, 2006) Other exercise terminology : ● Balance training: Exercise that helps maintain stability during daily activities and other exercises, preventing falls. It can be static (single-leg balance) or dynamic (walk on a line), with hand support as needed. ● Exercise: Structured, planned and repetitive physical activity with the intent on improving physical fitness. ● Physical fitness: The summation of four factors: Cardiorespiratory endurance; muscle power; flexibility; and body compensation. ● Power: How quickly a muscle contracts. (McDermott & Mernitz H, 2006) The minimum activity recommendation for generally healthy older adults is two hours and 30 minutes of moderate-intensity aerobic activity per week, plus muscle-strengthening at least two days a week (Elsawy et al., 2010). Another minimum activity recommendation is to perform one hour and 15 minutes of vigorous-intensity aerobic activity per week, plus muscle- strengthening activities at least two days a week (Elsawy et al., 2010). Another way to achieve the minimum recommendation is by participating in a combination of moderate- and vigorous- intensity aerobic activity equivalent to the recommendations above, plus muscle-strengthening activities at least two days a week (Elsawy et al., 2010). Recommendations made to achieve additional health benefits include participating in five hours of moderate intensity aerobic activity per week and participating in muscle-strengthening activities at least two days per week (Elsawy et al., 2010). Older adults can also achieve the additional health benefits by participating in two hours and 30 minutes of vigorous intensity aerobic activity a week, plus muscle-strengthening activities at least two days a week (Elsawy et al., 2010). An individual can also perform a combination of moderate- and vigorous-intensity aerobic activity equivalent to the recommendations above, plus muscle strengthening activities at least two days a week (Elsawy et al., 2010). It is important to incorporate strength and endurance training into individuals’ programs in order to reach the maximum benefits of exercise. A study by Cadore et al., 2014, recommended that when performing concurrent training with strength and endurance, the activity should take place at a moderate weekly frequency or twice a week. The study
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