Transcript File - Apex

The Aging Population and
Optimal Living
A Fitness Guide to the Fountain of
Youth
Alex Tieri
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Certified Medical Exercise Specialist
Orthopedic Exercise Specialist
Performance Enhancement Specialist
Advanced Health and Fitness Specialist
– American Council on Exercise
– Highest certification, 1 of 1000 in U.S. (7/2012)
– Specializing in:
• CVD, CAD, CHD
• Hypertension and Dyslipidemia,
• Diabetes and The Metabolic Syndrome
• Asthma
• Arthritis and Osteoporosis
• Elderly Optimal Living
• Nutritional Consultant (AFPA)
To Be Discussed:
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Physical changes associated with aging
Balance and gait challenges in older adults
Assessments
Functional training
Arthritis
Osteoporosis
Physically elite
Nutritional considerations
Studying Aging
• The National Institute of Health(NIH) created the National
Institute of Aging(NIA), which studies gerontology the
processes of Aging, with a goal to close the gap between
Lifespan(122 years) and life expectancy.
• 80% of older Americans live with 1 chronic condition, and
50% are living with at least 2 (CDC, 2003).
• CDC 2007 study revealed:
• 43% aged 65-75 reported very good health, compared to
34% aged 75-84; and 28% aged 85 and older.
• Functional age differs from chronological age in that it takes
into account; biological, psychological, and social
characteristics to create a profile of age as a whole.
• Senesence – term used to describe loss of function that
increases risk of disability or death with aging.
Physical changes associated with aging
• Cardiovascular – aging, CHD, and hypertension stress the heart
muscle to supply muscles with oxygen and nutrients need to perform
tasks.
– the left ventricle of the heart increases in thickness by 30%
between the ages of 25 and 80 (lakatta, 1990).
– The aorta and arterial tree become thicker and stiffer,
noncompliant vessels and increased peripheral resistance are the
major contributors of hypertension in older adults (Safar, 1990).
– Maximum heart rate declines 5-10 beats per minute per decade
(Shepard, 1997).
– Reactivity to catecholamine (epinephrine and norepinephrine)
which acts to increase heart contractility declines (Fleg et al,
1994).
Respiratory System
• With aging elasticity of the chest wall and the joints
about the rib stiffen requiring increased effort for
breathing, elevating respiratory work rate (Crapo,
1993).
• Residual volume also increases to about 40% in
older adults compared to 20% in younger adults,
resulting in dyspnea during exercise (Spirduso,
2005).
• Bronchial tree decreases in ciliary function, and an
increased risk of aspiration due to impaired
swallowing and coughing reflexes, can increase the
risk of viral and bacterial infections, but does not
seem to affect physical performance (Tockman,
1994).
Aerobic Capacity
• Maximal oxygen consumption declines by 1%
each year of a sedentary adults life. By 65 it is 3040% less than a young adult (Shepard, 1987).
• Very low aerobic capacity leads to constant
fatigue in the elderly. It is estimated that 4 METs
is needed for independent living (shepard, 1987).
• Reduction in heart rate, muscle tissue and it’s
ability to use oxygen, and a diminished ability to
redirect blood flow from organs to working
muscles, all decrease aerobic capacity (Spiraduso,
Francis, & MacRae, 2005).
Musculoskeletal System
• Sarcopenia – natural atrophy that occurs with aging,
decreasing muscle fiber size and specifically number of
muscle fibers (Aoyagi & Shepard, 1992).
• In sedentary individuals muscle mass decreases about 23%
between the ages of 30 and 70 (NIH, 2006).
• Strength decreases by 15% in the 6th and 7th decades of
life, and 30% thereafter (Danneskoild-Samoe et al, 1984).
• This decrease in muscle mass, decreases the ability to
maintain dynamic balance, walk, prevent falls, move
quickly, produce power, and slows metabolism.
• Isometric strength and eccentric strength are better
maintained than dynamic and concentric strength.
Bone Loss
• Women are more prone to the effects of bone
loss than men, because they reach a lower
lifetime peak calcium content and have an
accelerated loss of calcium for five years around
the time of menopause (Riggs & Melton, 1992).
• 55% of Americans aged 50 and older have
osteopenia or osteoporosis (NOF, 2008).
• Bone loss and fracture prevention is greatly
reduced by those who have consumed adequate
calcium and performed vigorous load bearing
exercises from youth into later life.
Osteoporosis
• An estimated 50% women and 20% of men over 50 will suffer an
osteoporotic fracture (U.S. Dept. of Health and Human Services, 2004).
• During young adulthood bone formation (osteoblasts) activity is greater
than bone resorption (osteoclasts), leading to greater bone density.
However, as we age resorption becomes dominant leading to weaker
bones.
• Risk factors – having a small frame, being Caucasian or Asian;
postmenopausal; family history; cancer or thyroid medication or
glucocorticoids for three or more months; diet low in calcium; lack of
physical activity; excessive smoking or drinking.
• Exercise and bone response – those who regularly engage in high force
and loading magnitudes, such as plyometrics and weight lifting, display
higher bone mineral density(BMD), than those who participate in lowintensity, or non-weightbearing exercises (Bellew & Gehrig, 2006).
• These exercises must be done for 6-9 months to see a benefit, and
continued to maintain increases in BMD (Khan et al., 20001).
• Clients diagnosed with osteoporosis should not engage in: jumping
activities, or deep forward truck flexion exercises such as rowing, toe
touches, and full sit-ups (Beck & Snow, 2003)
• ADA recomends calcium intakes of calcium between 1000-1200mg per
day; and vitamin D intakes of 200-600IU.
Flexibility
• When muscle fibers atrophy, they are replaced
by fatty fibrous collagen tissue, and 15% of
body water is lost between ages 30 – 80,
contributing to body stiffness (ACE, 2005).
• Greatest flexibility loss is found in the spine
and ankle joints, increasing the likelihood of
falling (Einkauf et al., 1987).
• Flexibility of the ankle is lost by, 50% in
women; while men lose 35% between the age
of 55 – 85 (Vandervoort et al., 1992).
Osteoarthritis(OA)
• Results from a degeneration of synovial fluid and generally progresses into a loss
of articular cartiliage, which typically presents itself as localized joint pain and a
reduction of range of motion (Buckwater & Martin, 2006).
• Rheumatoid arthritis(RA) is an autoimmune disease that inflames the synovium,
leading to long term joint damage, chronic pain, and loss of function or
disability.
– 3 stages: 1st swelling of the synovial lining, pain, stiffness, warmth, redness, and
swelling of the joint; 2nd synovium thickens from rapid division and growth of cells;
3rd inflamed cells release enzymes that break down bone and cartilage, causing the
affected joint to lose structure and alignment.
• OA occurs when a joint becomes injured, the once pristine articular cartilage
surface does not receive sufficient blood supply or nutrients to get it back to
normal. Cartilage is also free of pain fibers, allowing wear and tear of the joint
to continually degenerate it until the subchondral bone which is full of pain
fibers experiences friction and swelling.
• Symptoms are next day discomfort and stiffness from chemical synovitis, and
will continue to progress as the joint degenerates leading to intense pain for
longer durations until the pain is constant, as the joint become bone on bone.
• Exercise increases muscular strength and endurance, enhancing stability of the
joints, improving ROM, and reducing passive tension of tissues surrounding the
joints, helping to improve function and quality of life.
Nervous System
• Aging declines cerebral function, vision, hearing,
reaction time, short-term memory, cognition, and
information processing .
• Habitual physical activity enhances cognitive
performance in older adults (Chodzko-Zajko &
Moore, 1994).
• Neuromuscular coordination is the ability to
activate large and small muscle groups with the
correct amount of force in the most efficient
sequence to accomplish a task, such as running or
lifting something diminishes.
Balance Challenges
• Reduced stability limits is caused by weak ankle muscles, reduced ROM
in the ankle, neurological disturbances, and fear of falling.
• Falls cause 90% of hip fractures, and 50% of spine fractures. Exercise to
improve muscle weakness, postural instability, and functional mobility.
• Dynamic balance is maintaining center of gravity(COG) as it moves across
the base of support(BOS), such as reaching for something or walking.
• The central nervous system(CNS) holds the key to balance. It receives
input from visual, vestibular, and somatosensory systems, all of which
decline with age. However, one system can be trained to compensate for
the loses of another system.
• Confidence can detract from balance, causing older adults to avoid places
where they risk falling, moving less on their own for fear of falling and
getting injured; they don’t want to be a burden on their families,
however this type of attitude will only decrease their balancing abilities,
continually moving and exercising is key to maintaining optimal balance.
Gait Challenges
• The gait cycle which is the time between the first heel contact of
one foot and the next time that heal strikes, declines with age.
• Older adults move 20% slower than younger adults (Elble et
al.,1991)
• Strength losses in the lower body, result in failure to lift the foot
high enough during the swing phase of gait resulting in tripping.
• A strong relationship between quadriceps and ankle strength and
habitual gait speed has been found (Fiatarone et al., 1990).
• Slower gait speeds have been correlated with shorter stride lengths
to preserve motion economy (Larish, Martin & Mungiole, 1988).
• Adaptations include: loading the limb more cautiously during weight
acceptance; a flatter foot contact; less forward limb advancement;
reduced flexion during swing phase; and approaching obstacles 17%
more slowly than their younger counter parts.
Assessing
• Physically elite – sports competition; Senior Olympics;
high risk and power sports.
• Physically fit – moderate physical work; endurance
sports, games, and hobbies.
• Physically independent – very light physical work and
hobbies (gardening, walking, social dance, golf, and
driving).
• Physically frail – light house keeping; food preparation;
grocery shopping; may be homebound.
• Physically dependant – walking, bathing, dressing, eating,
needs home or institutionalized.
• Disabled – needs medical attention.
– Take medications into account they can impede balance and
function.
Functional Training
• Cardio – 3-5 days of 60-90% HRMax; greater than 30 min
daily.
• Resistance – 2-3 days of 8 exercises for different muscle
groups, with 8-15 reps.
• Flexibility – 3-7 days stretching all major muscles groups
2-4 times to tightness but not to pain for 15-30 seconds.
• Functional exercises should mimic those of daily
movements and chores, they should be done standing,
but can be done seated or in the water.
• Weight bearing exercises and resistance are preferred for
increasing bone strength.
• Exercise can be sport specific or mimic sport movements
such as golf, tennis, cycling, rowing.
• See a Fitness Specilist for safe exercise prescription and
monitoring of safe and proper form!
Why Now?
• The sooner the better, as diseases progress it may
become harder to exercise.(physical capabilities,
medications, etc.)
• As the theoretical model would state, you are in the
contemplation stage, maybe even in the preparation
stage, this leads to the taking action stage. So strike
while the iron is hot!!!
• You have the information.
• You have a willing leader to guide you along the way.
• All you have to do is make the commitment to yourself.
Your body, family, and friends will thank you.
Physician Clearance Needed If
• Older than 69
• Doctor stated you have a heart condition and should
only engage in physical activity recommended by your
doctor.
• Chest pain with physical activity.
• Had a chest pain in the past month without engaging in
physical activity.
• Ever lost balance or consciousness, feeling dizzy or
nauseous.
• Bone or joint problem that may worsen with increased
physical activity.
• Currently taking prescription drugs for blood pressure,
or a heart condition.
• Blood pressure greater than 144/94
Continued:
• Risk factors for cardio vascular disease:
– Less than 30 min of physical activity most days of
the week.
– Current smoker, or quit within last 6 months.
– High blood pressure or high cholesterol reported
by physician.
– Excessive accumulation of fat around the waist.
– Family history of heart disease.