Exercise and

Physical
Activity for
Older Adults
 OBJECTIVE
To discuss the role of physical activity and
exercise, effects of a sedentary lifestyle,
elements of an effective exercise prescription,
and the different types of exercise
applications for older adults.
 Health Benefits Associated with Regular Physical Activity
For Older Adults

 Lowers risk of all-cause mortality.

 Lowers risk of CV disease mortality.
 Lowers risk of CV disease (heart disease & CVA).
 Lowers risk of Htn.
 Lowers risk of Type II DM.
 Lowers risk of adverse lipid profile.
 Lowers risk of Ca (bladder, breast, colon, endometrium,
esophagus, kidneys, lungs, and stomach).
 Reduces risk of dementia (including Alzheimer’s).
 Improves quality of life.
 Reduces anxiety.
 Reduces risk of depression.
 Improves sleep.
 Slows or reduced weight gain.
 Weight loss combined with reduced calorie intake.
 Prevents weight regain.
 Improves bone health.
 Improves physical function.
 Lowers risks of falls.
 Lowers risk of fall-related injuries.
EXERCISE and PHYSICAL ACTIVITY
for ACTIVE OLDER ADULTS
 Guidelines for physical activity for adults and active older adults

 Adults should move more and sit less throughout the day.

 For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes)
to 300 minutes (5 hours) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes)
to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity,
or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably,
aerobic activity should be spread throughout the week.

 Additional health benefits are gained by engaging in physical activity beyond the equivalent of
300 minutes (5 hours) of moderate-intensity physical activity a week.

 Adults should also do muscle-strengthening activities of moderate or greater intensity and that
involve all major muscle groups on 2 or more days a week, as these activities provide
additional health benefits.
 Guidelines for physical activity just for older adults

 As part of their weekly physical activity, older adults should do multicomponent physical
activity that includes balance training as well as aerobic and muscle-strengthening
activities.

 Older adults should determine their level of effort for physical activity relative to their
level of fitness.

 Older adults with chronic conditions should understand whether and how their conditions
affect their ability to do regular physical activity safely.

 When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week
because of chronic conditions, they should be as physically active as their abilities and
conditions allow
 Examples of Physical Activities for Older
Adults
Aerobic Activities Muscle-Strengthening Activities
• Walking or hiking • Strengthening exercises using exercise
• Dancing bands, weight machines, or hand-held
• Swimming weights
• Water aerobics • Body-weight exercises (push-ups, pull-
• Jogging or running ups, planks, squats, lunges)
• Aerobic exercise classes • Digging, lifting, and carrying as part of
• Some forms of yoga gardening
• Bicycle riding (stationary or outdoors) • Carrying groceries
• Some yard work, such as raking and • Some yoga postures
pushing a lawn mower
• Some forms of tai chi
• Sports like tennis or basketball
• Walking as part of golf
Sedentary Death Syndrome -dramatize the deleterious
effects of inactivity.

Mobility disability - inability to walk one quarter of a mile

and to climb a flight of stairs. - brought about through a
temporary sedentary lifestyle such as a consequence of a
hospitalization or prolonged r
Fun - physical ability to do whatever one wants, whenever one desires, for
as long as desired.

Function - those who have to make choices about their activities based on
some decreased physical capacity.

Frail - those who require help with instrumental and basic activities of daily
living (IADLs and BADLs).

Failure - those who are completely dependent and often bedbound.

Leg strength - most important predictor of subsequent institutionalization,

and it is more important than physiological markers or disease
Balance Measure:
 The Romberg Test
Type of Balance Assessed:
 Examines standing balance with the feet together.

Items Included:
 Standing with feet together with eyes closed and hands crossed and touching the opposite shoulders for 30 seconds.

Equipment Required:
 Stopwatch

Interpretation of Scores:
 Substantial increase in sway or loss of balance (positive Romberg) indicates sensory loss distally; clinician should test distal
sensation.

Administration:
 Easy to administer; simple and safe.

The Main Use of the Measure in Older Adult Population:

 Used to detect distal sensory loss in older adults.
Balance Measure:
 The Tandem (sharpened) Romberg Test
Type of Balance Assessed:
 Examines standing balance with one foot in front of the other.

Items Included:
 Standing with one foot in front of the other with eyes closed and hands crossed and touching the opposite shoulder for 60
seconds.

Equipment Required:
 Stopwatch

Interpretation of Scores:
 Difficult to perform in older adults.

Administration:
 Easy to administer; simple and safe.

The Main Use of the Measure in Older Adult Population:

 Used to detect distal sensory loss in older adults.
Balance Measure:
 Single-leg Stance (SLS)
Type of Balance Assessed:
 Examines standing balance on one leg.

Items Included:
 Standing on one leg with eyes open and hands crossed and touching the opposite shoulders for 30 seconds.

Equipment Required:
 Stopwatch

Interpretation of Scores:
 Sensitivity of 95% and specificity of 58% in separating older adults who fell from those who did not.

Administration:
 Easy to administer; simple and safe.

The Main Use of the Measure in Older Adult Population:

 Used to examine lower extremity musculature strength.
Balance Measure:
 Functional Reach
Type of Balance Assessed:
 Examines dynamic standing while reaching.

Items Included:
 Standing and reaching forward.

Equipment Required:
 Yardstick fixed on the wall.

Interpretation of Scores:
 A reach < 6in. Predicted the risk of falling within the next 6 months.

Administration:
 Easy to administer; simple and safe.

The Main Use of the Measure in Older Adult Population:

 Used to assess the maximum forward reach to the edge of the BOS.
Balance Measure:
 The Multidirectional Reach Test (MDRT)
Type of Balance Assessed:
 Examines dynamic standing while reaching in four (4) directions.

Items Included:
 Standing and reaching forward, backward, and laterally.

Equipment Required:
 Yardstick fixed to a telescoping tripod at the level of the acromion.

Interpretation of Scores:
 Fear of falling may prevent people from reaching further.

Administration:
 Easy to administer; simple and safe.

The Main Use of the Measure in Older Adult Population:

 Used to determine maximal reach in multiple directions, which provides insights into risk of falling. It is dynamic standing
test with no gait included.
Balance Measure:
 Five times sit to stand test (FTSST)
Type of Balance Assessed:
 Examines dynamic sit to stand.

Items Included:
 The time required for an older adult to perform sit to stand five time as quickly as possible.

Equipment Required:
 Chair and stopwatch.

Interpretation of Scores:
 Scores > 15sec; abnormal in healthy older adults. A score of > 12sec had a sensitivity of 0.66 and a specificity of 0.55 and a
likelihood ratio of 1.47 in the tool’s ability to discriminate between non-multiple fallers and multiple fallers.

Administration:
 Easy to administer; simple and safe.

The Main Use of the Measure in Older Adult Population:

 Poor performance in rising from a chair was found to be a strong predictor of fall risk in community-dwelling older adults.
 Physical Stress
Theory
- predictable response of
tissues, organs, and
systems to mechanical and
physiological stressors.

 PTs use the principles of the

PST when they prescribe
aerobic exercise to improve
cardiovascular capacity or
weight-bearing and
resistive exercises to
improve bone strength.
 Remember the following in Developing an
Exercise Program for the Elderly:
1. Medical screening/ Clearance
2. Informed Consent
3. Baseline Functional Capacity
4. Consideration of the mode, intensity, frequency and duration
5. Gradual progression
6. Safety
7. Motivation
8. Regular Re-evaluation
 Exercise and
Physical Activity
for Older Adults
 OVERLOAD PRINCIPLE
Progressive overload - Increase the training stimulus as the
body adapts​.

Strengthening: increased resistance to the muscle​.

Endurance training: increased the time to a muscle

contraction​.
Assessment of Overload Stimulus
 SPECIFICITY PRINCIPLE
Prescribing exercises that match:
 muscle contraction
 speed of contraction
 consideration of the functional movement

Functional Strengthening- concept of strengthening a movement

rather than a muscle.

Example: Goal- Increase ability to get out of chair.

 FUNCTIONAL TRAINING
Overloading the movement or activity of interest to
challenge whole neuromuscular system rather than simply
challenging a muscle.

Examples:
Goal: Improve transfers.
Goal: Improve outdoor ambulation.
 Functional Training
• Progression:
1. Movement?
2. Speed?
3. Surfaces?
4. Vision?
5. Form vs. Intensity?
6. BOS?
 Functional Training
6. Speed and Power
Power- the time rate of
force development.
Prognosis: Power > Force
Speed may be used to
challenge.

7. Types of Contractions
Concentric, Eccentric, or
Isometric
 MOTOR LEARNING
Minimum 6 weeks to
achieve TRUE
strengthening in muscle
BUT improved
performance is immediate
d/t motor learning.

Occurs with repetition and

sufficient stimulus.
 FREQUENCY

Number of exercise
sessions per week
that are necessary or
advisable to obtain
optimum results.
 SETS and DURATION
Exercise bouts- the Amount of time of
number or sets each exercise bout or
performed during each the length of time an
exercise session. exercise session.

Skills are practiced

20-30 mins./ session.
 •*Regressive
loading.

1. Determine 10 RM.
2. 10 reps @ 100%
of the 10 RM.
3. 10 reps @ 75% of
the 10 RM.
4. 10 reps @ 50% of
Oxford PRE the 10 RM.
Regimen
 •*Heavy resistance
training or load-
resisting exercise.

1. Determine 10 RM.
2. 10 reps @ 50% of
the 10 RM.
3. 10 reps @ 75% of
the 10 RM.
4. 10 reps @ 100%
DeLorme PRE of the 10 RM.
Regimen
Types of
Exercises
for Older
Adults
 AEROBIC EXERCISE
• Exercise Stress Test - gold
standard for determining
readiness to exercise.

• Principles: ​
• Change the workload – speed,
grade or resistance​.
• Initial workload – based on
pt.’s aerobic threshold.​
• Each workload – 1 min. or longer​.
• Terminate – onset
of Sx or abnormalities of ECG .
 Termination of Stress Testing
Endpoints requiring termination of the test period:

Progressive angina.
A significant drop in systolic pressure in response to an
increasing workload.
Light-headedness, confusion, pallor, cyanosis, nausea, or
peripheral circulatory insufficiency.
 Termination of Stress Testing
Endpoints requiring termination of the test period:

Excessive rise in blood pressure.

No increase in HR with an increase in exercise intensity​.
Onset or change in heart rhythm.
Subject wishes to stop.
Observed or reported symptoms of severe fatigue.
 AEROBIC EXERCISE
Clinical Functional Measurement
1. 6-minute walk test (6MWT)-
measure of how far a person can
walk in 6 minutes.
2. 400-m walk test – distance to
walk versus a length of time.
Strengthening exercises may need
to be done prior to participation in
aerobic conditioning to achieve the
most optimum result, especially if
the person complains of pain or
fatigue.
 Intensity of Aerobic Exercise
Heart Rate​

Maximum Heart Rate​

220-age​

Karvonens Formula​
THR= RHR + (60-70%) (MHR - RHR) ​
 Intensity of Aerobic Exercise
Maximum HR – should be symptom limited.
​
Healthy individuals – 60 – 70% maximum HR.
​
Deconditioned – 40-50%​.

Cardiopulmonary disease – 40-60%​.

 Compute for the Target Heart Rate
• Resting heart rate: 75 beats/min​
• Age: 67 y/o
• Condition: CAD
• Resting blood pressure: 110/70 mmHg​
• Resting respiration rate: 20 breaths/min​
• THR = RHR + 40-60% (MHR-RHR)​
= 75bpm + 40-60% (153-75)​
= 75 + 40 to 60% (78)​
= 75 + 31.2 to 46.8​
= 106.2 to 121.8 bpm​
= 106-122 bpm
 Duration of Aerobic Exercise
Poor functional capacity ​
• 5 - 10 minutes​
Beginners​
• 10 - 20 minutes​
Average​
• 15 - 45 minutes​
Fit​
• 30 – 60 minutes​
 Frequency of Aerobic Exercise
Poor functional capacity ​
• Daily

Beginners​
• Every other day
 Frequency of Aerobic Exercise
Optimal frequency​:
3-4 times a week​.
2 times a week does not generally evoke CV changes for well
population​.
Increase in frequency beyond optimal range, increases risk
for musculoskeletal complications​.
30-45 mins 3x a week protects against CV disorders​.
 Contraindications and Safety
Pts. with unstable cardiac conditions or risk signs for cardiac
disease.

Absolute contraindications:
resting heart rate greater than 100 bpm
systolic blood pressure higher than 200 mmHg
diastolic blood pressure higher than 120 mmHg
 AQUATIC EXERCISE
The buoyancy of the
water decreases the forces
needed to move and
decreases the forces on
the joint.

Improving function in
water is only the first step
to having the patient be
able to complete
functioning on land.
 Indications for Aquatic Exercise
Osteoarthritis
Overweight/ Obesity
Recently undergone surgery
Significant balance disorders
Fear of falling
 Contraindications and Safety
Individuals with open wounds should not be allowed in the
water until the wound is well healed.
 STRENGTHENING EXERCISE
• Strengthening exercises at Many older adults become
sufficient intensity to achieve a uninterested in their exercise
strength training effect is the program because of insufficient
hallmark of any skilled physical challenge, lack of progress, or the
therapy intervention for older appearance of irrelevancy of the
adults. exercise program to their personal
goal.
 STRETCHING EXERCISE
Muscle shortening often occurs from
the lack of movement through its full
range.
Physical activity + strengthening
exercises, will improve flexibility.
Specific stretching may not be
necessary for those postural
conditions that arise from prolonged
positioning such as sitting.
 STRETCHING EXERCISE
MEASUREMENT FOR
FLEXIBILITY
 modified sit and reach
 back scratches just like
the Apley’s Scratch Test
STRETCHING EXERCISE
 PLYOMETRICS
Older adults of all abilities need
to be encouraged to move
quickly, a form of explosive
power.
An eccentric contraction ff by a
concentric contraction of the
same muscles.
Examples: Jumping, Brisk
Walking, Rapid Foot Movements
 Good evidence for the
TAI CHI use of Tai Chi in fall risk
reduction, the evidence
for other medical benefits
is less consistent.
Tai Chi’s values lie in
balance training and
mental focus and can
provide an interesting
addition to a
comprehensive exercise
program.
 #rciconnects

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