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p7b07 Sample03
p7b07 Sample03
p7b07 Sample03
Achieve added health benefitc 300 minutes/week of moderate- Continued as above; more sets of repetitions
intensity aerobic exercise may provide additional benefits
OR
150 minutes/week of vigorous-intensity
aerobic exercise
OR
Combination of above
Balance activities (for older 90 minutes/week of balance and moderate-intensity muscle-strengthening activities
adults at risk of falling) weekly plus moderate-intensity walking for about 60 minutes/week
Balance training at least 3 days/week and standardized progressive exercises in a
validated fall reduction program
Stretching/flexibility Stretching can improve flexibility when done properly and is important for regular
physical activity. Time dedicated to flexibility does not count toward aerobic or
muscle-strengthening guidelines
a
Older adults should increase their activity level gradually to safely reach fitness goals. Individuals with low fitness levels should be aware
of this when considering the duration and intensity of any regimen. On initiation, older adults should be as physically active as their abili-
ties and conditions allow, even if they are unable to initially achieve the 150-minute/week goal.
b
Including physical fitness; reduction in premature death; and cardiorespiratory, metabolic, musculoskeletal, and mental health.
c
Greater benefits from b plus weight maintenance and prevention of obesity.
routine light-intensity activities of daily living. Mus- metabolism. The many forms of aerobic cardiovascular
cle-strengthening activities and balance exercises are exercise include walking, swimming, vacuuming, and
also encouraged. In addition, activities that maintain dancing. The training method varies on the basis of fac-
or increase flexibility are recommended two times/ tors such as personal preference, access, injury poten-
week for at least 10 minutes each. All recommenda- tial, or health restrictions.
tions are consistent regarding exercise goals in inactive Older adults who exercise aerobically experience
older adults; however, an exercise program for inactive many physiologic and health advantages compared
adults should be gradually initiated. It may take months with their age-matched sedentary peers. These advan-
to achieve activity goals for individuals who start with a tages include a more favorable body composition pro-
low level of fitness. file, greater relative muscle mass, faster nerve conduc-
tion velocity, and slower development of disability.
Forms of Exercise Other benefits include an increased ability to use and
Aerobic Exercise transport oxygen and less cardiovascular and metabolic
Cardiovascular endurance training is character- stress during exercise. Individuals who exercise have
ized by large muscle groups contracting against gravity. a significantly reduced coronary risk profile, includ-
The intent is to maximize aerobic activity and decrease ing lower blood pressure, improved insulin sensitivity
the physiologic response and perceived difficulty of sub- and glucose homeostasis, lower systemic inflammatory
maximal aerobic workloads. Gains in exercise capacity markers, smaller waist circumference, and improved
occur because of adaptations within the cardiopulmo- lipid profile. Higher bone mineral density at weight-
nary system, peripheral skeletal muscle, circulation, and bearing sites has been shown, especially in women who
Pharmacists have a unique opportunity to play a role 2. Lang IA, Llewellyn DJ, Alexander K, Melzer D. Obesity,
physical function, and mortality in older adults. J Am
in recognizing and addressing the nutrition and exercise Geriatr Soc 2008;56:1474–8.
requirements of older adults. When formulating phar-
macotherapy plans, drug, nutrition, and exercise recom- The English Longitudinal Study of Ageing enrolled
3793 people in a prospective cohort evaluation of the
mendations should be included. For instance, a patient relationship between weight, physical function, and
with hypertension receiving customary drug therapy mortality. Individuals were observed for 5 years with
should also adhere to a diet that is low in sodium and both self-reported and measured evaluations of weight
that provides enough calories and protein to maintain and function. On study initiation, about three-fourths
a normal weight and skeletal mass, as well as participate of the population had a BMI greater than 29.9 kg/m 2 ,
in 150 minutes/week of aerobic activity weekly with and the average age was 65 years. A direct relationship
twice-weekly muscle strengthening. It is important to was found between increased BMI and increased phys-
be familiar with the various forms of exercise and their ical impairment. No association was found between a
BMI greater than 29.9 kg/m 2 and mortality. The num-
appropriate place in therapy, together with ideal candi- ber of individuals with BMIs greater than 35 kg/m 2
dates and potential benefits and risks. was small, making it difficult to evaluate patients with
The pharmacist can assist the individual who is under- the highest weights. This study confirms previous work
weight or who has experienced weight loss with medica- that failed to show a relationship between mortality
tion assessment to identify any drug-related causes and and overweight in the elderly and establishes a relation-
with recommendations about cost-effective ways to add ship between having loss of physical function and being
supplemental calories. In an institutional setting, orally overweight. These results could have major health care
administered drugs can be given with nutrition supple- consequences in an aging society.
ments rather than with water. In an outpatient or com-
3. Cruz-Jentoft A, Baeyens JP, Bauer JM, Borie Y, Ceder-
munity setting, a cost-effective recommendation is the holm T, Land F, et al. Sarcopenia: European con-
use of powdered breakfast drinks reconstituted with sensus on definition and diagnosis. Age Ageing
milk as a supplement versus a premixed formula. It is 2010;39:412–23.
important for pharmacists working in community set- Several European groups working in the areas of
tings to refer patients to other health care professionals nutrition and geriatrics created this uniform definition
as needed. Working on an interprofessional team with a for sarcopenia. The basis for this diagnosis includes loss
dietitian and a physical or exercise therapist is an ideal of muscle strength, mass, and performance. Older indi-
opportunity for the pharmacist to aid in promoting viduals with this condition suffer disability and physi-
nutrition and exercise for older adults. cal dysfunction that lead to a reduction in quality of
life and an increase in mortality. Sarcopenia has many
causes and contributing factors that include a decrease
Annotated Bibliography in protein synthesis and proteolysis leading to the loss
of muscle integrity. Age-associated decreases in hor-
1. Flicker L, McCaul KA, Hankey GJ, Jamrozik K, Brown
mone production, apoptosis, mitochondrial dysfunc-
WJ, Byles JE, et al. Body mass index and survival
tion, cachexia, and inadequate dietary intake to main-
in men and women aged 70 to 75. J Am Geriatr Soc
tain energy needs all play a role in this syndrome, which
2010;58:234–41.
is further accelerated by activation of the immune sys-
This 10-year cohort study, which included more than tem with release of inflammatory cytokines. Screen-
10,000 community-dwelling older adults in Australia, ing patients with a clinical evaluation of walking speed
evaluated which BMI level is associated with the lowest and grip strength can identify those who may require
mortality rate. A BMI of 25–29.9 kg/m 2 (overweight) further measurement of muscle mass through imaging
was associated with the lowest mortality rate; older techniques. With uniform criteria for sarcopenia, inter-
individuals who were overweight were 13% less likely to ventions that target physical exercise, nutrition, and
die (hazard ratio [HR] = 0.87; 95% confidence interval drugs such as hormone replacement can be evaluated.
Questions 10–13 pertain to the following case. 13. A.R. notes that her local senior center has hired a tai
A.R. is a 77-year-old widowed woman (weight 59 kg, chi instructor. Which one of the following would
height 64′′) who lives alone. Her diagnoses include most likely result if A.R. were to participate in
osteoporosis, hypertension, vertigo, and asthma. She twice-weekly tai chi?
has seen a nutritionist, and her diet consists of about A. Appreciable improvement in strength.
1650 kcal/day (15% protein, 60% carbohydrate). A.R. B. Significant improvement in flexibility.
is able to perform most routine activities of daily liv- C. Benefit of regular social activity.
ing but lacks the strength to carry her groceries into D. Improvement in aerobic capacity.
her house. She has about six steps to climb from her
back door to the kitchen. Her present exercise regimen Questions 14–17 pertain to the following case.
includes walking 30 minutes 3 days/week and lifting L.D. is a 65-year-old man who has just retired and is
2-lb weights twice weekly (10 repetitions for one muscle looking to begin an exercise program. He is not over-
group in the upper body and lower body each). weight but wants to improve his overall physical fitness.
L.D. states that he wants to age well with a high qual-
10. A.R. wishes to improve her functional abilities and ity of life. He takes furosemide 80 mg/day for hyper-
asks her pharmacist about the risks of increased tension, atorvastatin 40 mg/day for hyperlipidemia,
exercise. Which one of the following best and tiotropium 18 mcg/day for chronic obstructive
17. L.D. has been exercising regularly for several 20. The nurse on the interdisciplinary team asks which
months. However, he finds it difficult to maintain type of plan is best for weight reduction in R.B.
his program and asks you why it is important to Which one of the following responses is best?
exercise. Which one of the following is the best A. A 1000-kcal/day diet.
response to L.D.’s question? B. A 1500-kcal/day diet with strength and
A. It will improve his respiratory function. aerobic exercise.
B. It is associated with a long and high-quality C. A 2000-kcal/day diet with strength and
life. aerobic exercise.
C. It will help maintain blood pressure in the D. Aerobic exercise alone.
normal range.
D. It will help prevent weight gain.