Geriatric Medicine Clinical Practice Module

Physical Exercise for the Elderly

R. Wishnu Hidayat Sports Medicine Department FMUI Jakarta 2010/2011

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Outline
Introduction Exercise Benefit Preparticipation Examination Fitness component Summary

Introduction
Learning objective:
Ability to give advice for older Elderly/senior citizen healthy lifestyle based on knowledge of fitness and exercise principles

Elderly in Indonesia

Number? Problems? - - - etc.

Body Changes in Aging

Structural changes - anatomical - Organ, tissue, cell

Functional changes - sensoric - motoric - cognitif
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Physiological Changes in Aging

Nieman, Fitness and your health, 2006

Aerobic Capacity Change in Aging

Nieman, Fitness and your health, 2006

Muscle Strength Change in Aging

Willmore, Physiology of sports and exercise, 2008

Effect of Cardiorespiratory Training

Nieman, Fitness and your health, 2006

Motoric center

CNS Vasomotor, respiratory center, sympathetic system Neuroendocrine system

Increase skeletal muscle work /musculoskeletal system

Cardiovascular system: increase SV, BP

Respiratory system: increase ventilation

Fat tissue, pancreas, liver

Increase energy need

Increase O2 transport (& glucose/FFA)

BODY MOVEMENT

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Exercise Benefit in Elderly

Life expectancy Independency Cardiorespiratory ( heart rate, blood pressure) Muscle strength and mass Flexibility (muscle/tendon, ligament) Bone strength and mass Balance Body composition Metabolic effect (blood glucose, lipid) Mental and cognitive function Social wellness

or ?

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Health Screening
All elderly Ideally undergo PPE/health screening before engage in exercise testing and exercise training ACSM Stratification of CV risk for individual based on CV risk factor and sign & simptom of disease (CV, metabolic)
Risk Factor Family history Cigarette smoking Hypertension Dyslipidemia Impaired fasting glucose Obesity Sedentary Sign & Symptom Angina Dyspnea Orthopnea/PND dizziness/syncope Ankle edema Palpitation/tachycardia Intermitten claudication Heart murmur

Unusual fatigue

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ACSM Risk Stratification (cardiovascular risk)

Low risk
primary health services (in the future?)

Moderate risk High risk

secondary services

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Contraindication of Exercise Testing & Exercise Training

Absolute ECG ischemia, MCI Unstable angina Uncontrolled cardiac dysrhtmias Aortic stenosis Uncontrolled heart failure Pulmonary infarction or embolism Acute myocarditis or pericarditis Suspect or known dissecting aneurysm Acute systemic infection Relative Left main coronary stenosis Valvular heart disease Electrolyte abnormalities Severe arterial hypertension Tachy/bradydysrhythmias Hyperthropic cardiomyopathy Neuromuscular, musculoskeletal or rheumatoid disorders Atrioventricular block Ventricular aneurysm Uncontrolled metabolic disease Chronic infectious disease Mental/physical impairment
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Exercise Risk
Musculoskeletal injury Health problems

Cardiovascular event: sudden cardiac death, MCI coronary plaque rupture

old > younger Vigorous > leisure activity sedentary > active lifestyle

Low incidence 1:15.000-18.000

HEALTH SCREENING/PPE SUPERVISION during exercise session

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Exercise Training in Elderly

Principles of Training Progressive & Overload Specificity Reversibility Fitness Component FITNESS TEST
Cardiorespiratory Muscle strength and endurance Flexibility Balance
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Fitness Test
Cardiorespiratory: 6 MWT, Rockport 1 mile walk, step test, ergocycle/treadmill Muscle strength-endurance: push-up/sit up test, dynamometer, 1-RM test Flexibility: sit and reach test, Appley scratch, goniometer Balance: single leg balance, Romberg test

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Cardiorespiratory
Type Frequency Intensity Duration : aerobic exercise (rec: walking) : everyday
start 3 x/wk, progress gradually

: moderate (Borg 5-6) : min.30 minutes,

start 10-15 minutes, progress gradually

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Muscle Strength
T : calisthenics, free weight, elastic
rubber band (isotonic exercise)

F I

8-10 exercise large muscle groups : 2-3 x/week : (moderate, Borg 5-6) 2-3 set each
movement @10-15 repetition

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Flexibility
T F I : static stretching, major muscle groups : (3-4 x/wk) : hold 15-30 s each movement, 3-4 set

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Balance
T F (I) : static & dynamic balance (e.g single
leg balance, tandem walk,tai chi)

: 3-4 x/week : (mild-moderate)

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Exercise in Osteoporosis
Silent disease, women>men Goal of exercise:
Decrease risk of falling Increase bone mass, muscle strength, balance and flexibility Increase cardiorespiratory fitness

Exercise programming (ACSM)

Weight bearing cardiorespiratory exercise (4x/wk) Resistance training (2-3x/wk) Flexibility exercise (5-7x/wk) Balance exercise (3-4x/wk)
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Example: Osteoporosis dance exercise (by Perosi)

3 x/wk low impact aerobic dance + resistance exercise (dumbell/heavy stick), balance exercise, flexibility exercise

Do not do:
high impact exercise(e.g hopping/jumping, jogging/running) Vertebral hyperflexion( e.g sit-up) Lift heavy weight above head Body pivot Exercise in slippery/rough surface

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Exercise in Osteoarthritis
OA: most common arthritis, overweight as one of risk factor Location: hand joint, weight bearing joint

Goal of exercise:
Normal daily activity without pain Decrease swelling and pain of affected join Decrease overweight Increase CR, musculoskeletal, flexibility fitness

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 Exercise programming in OA:

Stretching exercise
Static stretching, 1-2x/day, 5-7x/wk, on swelling joint pain free ROM 2-4 set/session @15-30 s

Muscle strengthening exercise

Resistance exercise/weight training/calisthenics joint stability, 2-3x/wk, especially around affected joint 8-10 movement, 1-2 set/session @ 3-20 reps

Cardiorespiratory exercise
Exercise in pool/hydrotherapy, ergocycle, walking, low impact aerobic dancing 3-5 x/wk, moderate intensity, per sesion begin 10-15 min. increase periodically to 30-45 min.

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 Precaution of exercise in OA:

Not recommended, strengthening exercise & cardio exercise when the joint still inflammed No high intensity exercise, no profuse stretching Avoid exercise in the morning when the joint is stiff.

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SUMMARY
Exercise has many beneficial effect for Elderly Health screening/PPE is ideal Exercise programming is design individually (tailor made) Exercise programme include cardiorespiratory, muscle strength, flexibility, balance exercise It is important to supervised during session of exercise
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