Transcript My Get-Up-and-Go has Got Up and Gone - Medicine-in

“Because it’s there.”
George Leigh Mallory (1924)
My Get-Up-and-Go
Has
Got Up and Gone
Presented by
Jeffrey Pearson, D.O.
Industrial & Sports Medical Center
San Marcos, CA
Parts of this talk stolen from
“Anyone can get old. All you have to
do is live long enough.”
Groucho Marx
Our Older Population

People >65 years of age make up
12.5% of the population.
– By 2050, estimated to be ~25%.

Americans have an increasing life
expectancy:
– Women live 18.6 years past 65.
– Men live 14.7 years past 65.
Problems associated with aging
Elderly tend to be more sedentary than
their younger colleagues.
 Tend to suffer from medical problems
that result in

– functional impairment
– less independence
– greater utilization of healthcare services
How fitness can help
Healthy lifestyle leads to a healthier life.
 With exercise, people lead a more
carefree life-style.
 Exercise leads to less time spent in
hospital/medical office.

“Old age is when everything that doesn’t
hurt doesn’t work.”
Anonymous
With maturity comes change...

Cardiovascular
–  maximum heart rate

[HRmax=220-age]
Neurologic
–  nerve conduction velocities; proprioception

Musculoskeletal
–  bone loss,  muscle strength,  flexibility
–  vertebral disc size/strength

Other
– respiratory system, metabolism
When do disabilities begin?
Onset around age 60 for both sexes.
 Nearly ¹/³ of people over 65 years of
age have some impairment in
performing activities such as walking.

“If I'd known I was gonna
live this long, I'd have taken
better care of myself.”
Eubie Blake
Benefits of exercise: general

Serves 2 major purposes
– preventive


“lifetime pattern of physical activity ameliorates
the ravages of aging.”
flexibility and strengthening program may
reduce incidence of falls and bedsores.
– therapeutic

Patients with strokes, arthritis, and fractures
may regain some function.
Benefits of exercise: specifics

Cardiovascular
– cardiac output/cardiovascular fitness,
cholesterol profile, BP control
Respiratory capacity/function
 Bone and muscle strength, flexibility,
coordination


Psychological
– mood,self-esteem
– socialization
SI units of work are Joules (J) (1 Joule = 1 Newton meter).
W = KEf - KEi
Exercise
is Work
KE = ½mv 2
W = Fs W = (ma)s
= (v 2 - v02)/2 W = 1/2m(v 2 - v02) = KEf - KEi
PEg = mgy
Work
gravity
distance
“I'm not afraid of death, I just
don’t want to be there when it
happens.”
Woody Allen
Exercise: How safe is it?

Cardiovascular (CV) Disease
– Leading cause of death in U.S.
– Sudden/unexpected death is common in
populations w/ high rates of CV disease.
– Most sudden deaths occur in middle-aged and
older individuals w/ advanced CAD and occur
during a variety of activities, including exercise.
– NOTE: cause of death in these cases is due to
CAD and not exercise (although may be
contributing factor).
Exercise: How safe is it?

Risk of death transiently increased
during actual exercise period, but
decreased for the rest of the day.
– The overall risk of cardiac arrest for active men is
much lower than sedentary men.
Studies consistently show lower all-cause death
rates in more physically active groups.
Exercise: How safe is it?

In Summary:
– The risk of serious medical complications
during exercise is low, but is higher than
during sedentary activities.
– The overall benefit/risk ratio for an active
way of life is favorable.
– Moderate exercise has the potential to
enhance the health of many sedentary
individuals and should be widely
recommended.
“I have the rest of my life to improve,
but it may take longer than that.”
Ashleigh Brilliant
Beginning an exercise program

Physician’s assessment
– review patient’s needs and goals
– outline progressive steps to achieve goals
– refocus unrealistic goals!
– Patient education


avoiding injuries
nutrition
The Medical Evaluation

History
– past/current illnesses; previous injuries (and
level of rehabilitation achieved); current
medications
– functional capacity

Examination
– assess function


cardiovascular and musculoskeletal systems
sensory: vision, hearing, proprioception
– assess nutrition
The Exercise Prescription
Mode of activity
 Intensity of exercise
 Duration of exercise
 Frequency of exercise
 Rate of progression

Mode of activity

Any activity that uses
– large muscle groups
– can be maintained for a prolonged period
– rhythmic in nature

Key purpose of most exercise
prescriptions is to increase or maintain
functional capacity
– aerobic endurance activities
Endurance Activities

Group 1
– easily maintained at a constant intensity
and inter-individual variability in energy
expenditure is low

walking, jogging, cycling
Endurance Activities

Group 2
– rate of energy expenditure related to skill,
but for given individual may provide
constant intensity


swimming, cross-country skiing
Group 3
– Highly variable in intensity

dancing, basketball, racquetball
Old Joke (Pre-Viagra)
Q: How many 50-year-olds does it
take to screw in a light bulb?
A: None; their screwing days are
long gone.
Intensity of exercise

Conditioning sessions should be
maintained at 40-85% of functional
capacity.
– Healthy adults typically: 60-70%
– Cardiac patients: start at 40-60%
Ideally, the participant should feel rested, and not
fatigued, within an hour following exercise.
Heart Rate Method #1

Simple fixed percentage of HR method
 70-85% of maximal heart rate corresponds
to about 60-80% of functional capacity.
HRmax=220-age
Example:
220 - 50 = 170 bpm Hrmax
170 x .70 =119 bpm
170 x .85 = 145 bpm
Target exercise range: 119 - 145 bpm
Heart Rate Method #2

Heart Rate Reserve/Range Method
– 60-80% of the HRR corresponds to 60-80%
of the functional capacity.
– Calculate the HRR

HRmax - HRresting = Heart Rate Reserve (HRR)
– Calculate conditioning intensity

Multiply HRR by desired intensity
– Calculate target HR

Add HRresting
Example: 60 y.o. with resting HR of 70 bpm
Lower Limit
Higher Limit
Maximal HR
160
160
Resting HR
-70
-70
HRR
90
90
x .60
x .80
54
72
Resting HR
+ 70
+ 70
Target HR
124
142
Conditioning intensity
How doctors look at intensity
(Feel free to forget this stuff right away)

METs
– one MET is equivalent to the amount of
energy used at rest (oxygen uptake of 3.5
ml/kg/min)
– Varies with speed of movements and
changes in resistance
– ADL’s require 5 METs
Leisure activities in MET’s
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Billiards
Bowling
Boxing (sparring)
Climbing hills
Cycling (pleasure)
Dancing (social, square, tap)
Dancing (aerobic)
Fishing (from bank)
Football (touch)
Golf (cart)
(Walking/carrying bag)
Handball
Rope skipping
Running (12 minute mile)
Shuffleboard
Tennis
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2.5
2-4
8.3
5 - 10
3-8
3.7 - 7.4
6-9
2-4
6 - 10
2-3
4-7
8 - 12
9
8.7
2-3
4-9
Rating of Perceived Exertion
Category RPE Scale
Category-Ratio RPE Scale
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
0
0.5
1
2
3
4
5
6
7
8
9
10
*
Very, very light
Very light
Fairly light
Somewhat hard
Hard
Very hard
Very, very hard
Nothing at all
very,very weak
Very weak
Weak
Moderate
Somewhat strong
Strong
Very strong
Very, very strong
Maximal
“Time is a great teacher, but
unfortunately it kills all its pupils.”
Hector Berlioz
Duration of activity

Conditioning period (excludes warm up
and cool down periods) may vary from
15-60 minutes
– typically 20-30 minutes
– this length required to improve or maintain
functional capacity
Frequency of Exercise Sessions
Depends, in part, upon the duration and
intensity of the exercise session
 Functional capacity <3 METs

– 5 minute sessions, several times/day

Functional capacity 3-5 METs
– 1-2 daily sessions

Functional capacity >5 METs
– at least 3x/wk on alternate days (aim for 5
days total)
Rate of Progression

Initial conditioning stage
– usually lasts 4-6 weeks, but depends upon
initial functional capacity and rate of
adaptation.
– Should include light calisthenics and low
level aerobic activities with which the
participant experiences a minimum of
muscle soreness.

Discomforts usually arise when program fails to
allow for gradual adaptation.
Rate of Progression

Improvement conditioning stage
– Typically lasts 4-5 months.
– Aerobic conditioning is progressed at a
more rapid rate.


Intensity increased to target level
Duration increased every 2-3 weeks
– Less fit individuals may need more time.
 Duration of exercise should be increased to 2030 minutes before increasing the intensity.
Rate of Progression

Maintenance conditioning stage
– Usually begins after first 6 months of
training
– Participant reaches satisfactory level of
cardiorespiratory fitness
– Should review the conditioning objectives
– More enjoyable or variable activities may
be substituted for those used previously

helps avoid dropping out due to boredom of
repetition
Sample Progression Program
“I am sick of all this nonsense about
beauty being only skin deep. That’s
deep enough. What do you want, an
adorable pancreas?”
Jean Kerr
Other Fitness Components

Flexibility
– Lack of flexibility may be associated with
increase risk for low back pain and other
injuries
– Stretching exercises should be performed
slowly, in a controlled manner



15-20 seconds per repetition
4 repetitions of a particular stretch per set
at least 3x/week
Other Fitness Components

Muscular strength and endurance
– No direct relationship to cardiorespiratory
fitness or functional capacity


however, many tasks require some degree of
strength, e.g. lifting/moving objects
The stronger the individual, the less stress
placed upon the body performing tasks
– Strength exercises help to maintain muscle
mass as we become older
(“Use it or lose it.”)
Other Fitness Components

Muscular strength and endurance
– Begin with low resistance, high repetitions
to develop muscle tone

20-30 reps with light weight per set
– Optimal strength gains occur when the
resistance allows for no more than 5-8
repetitions of a movement, for 3 sets

you can still make strength gains with lower
resistances
“Catflexing”
“Catflexing”
Nutrition

Carbohydrates for fuel
– 60%+ of total daily calories
– complex>simple

Protein for re-building
– 15%+ of total daily calories

Fat for energy storage (1 lb. = 3500 Kcal)
– 25% (or less) of total daily calories
– avoid saturated and hydrogenated types
Nutrition

Fluids
– Plain water best for most people
– Drink 1-2 eight ounce glasses before exercise
– Repeat every 20 minutes of exercise

Sodium
– Normal daily intake about 2000 mg
– Never consume salt tablets on hot days!
Injury/Illness
Treatment and Prevention

Ice is nice!
– P.R.I.C.E.S.

Sunscreen
– SPF 15 or greater

Proper footwear
– Tie shoelaces!
“The secret of staying young is to live
honestly, eat slowly, and lie about your
age.”
Lucille Ball
The End
Thank you!