Elderly Exercise

Introduction
Types of Exercise
When Should You Ask a Doctor?
An Exercise Prescription
Summary

Introduction

If you are an older person who has become more sedentary over time, you might well ask, “Why exercise?” Many of my older patients look at me skeptically when I suggest they exercise more. Yet the evidence supporting the beneficial effects of exercise is growing, and almost every day a new article appears in medical literature to suggest the same. The Surgeon General has declared that a sedentary lifestyle is hazardous to your health, and the American Heart Association has added lack of physical activity to its list of preventable risk factors for coronary heart disease, which is by far the number-one killer of people over 65 years of age. Exercise has been shown to build muscle and bones, reduce high blood pressure and the incidence of heart disease, diabetes, and colon cancer, and alleviate the pain of arthritis and depression. It improves the quality of sleep and one’s sense of well-being. And many, many studies have shown that exercise contributes to longevity, even for someone who goes from being a couch potato to slightly more active. So what are you waiting for?
 

Types of Exercise

Approaches to increasing exercise and improved fitness fall into three categories:

  • Lifestyle modification
  • Resistance training
  • Aerobic exercise
Lifestyle modification Lifestyle modification means finding opportunities to stay active within your usual daily routine, such as getting off the subway or the bus one station before your stop, parking your car in a far corner of the parking lot, vacuuming or mopping your floors at a faster pace, or taking the stairs instead of the elevator. In fact, numerous organizations including the Surgeon General’s office, the National Institutes of Health, the Center for Disease Control, and the American College of Sports Medicine recently agreed that sedentary people who wish to become more physically active need only 30 minutes of moderately intensive physical activity during the course of each day, and that those 30 minutes can be made up of the types of activities referred to above, rather than traditional programmed exercise. That means that you can walk to the bus stop for ten minutes, then later during the day you can either walk another 20 minutes, or vacuum the carpet vigorously for 20 minutes, and voila! You have become a physically active person. But you must be consistent, and do this every day.

Resistance training
During resistance training, you increase muscle strength over time by progressively increasing the resistance against which a muscle generates force. For example, you can lift weights and progressively increase the amount of weight over several days. A highly acclaimed study written by Fiatarone et al, published in JAMA, June 15, 1990,   looked at resistance training in healthy older adults. The researchers showed substantial increases in physical functioning in very elderly persons, over 90 years old, who participated in resistance training. Generally two sessions of 20 to 30 minutes per week are recommended. Resistance training helps to reduce the muscle atrophy and bone loss that accompany aging in older adults. Lower extremity resistance training is especially beneficial, since it increases strength, balance, and bone mass. This provides excellent protection against falls and hip fracture, one of the foremost causes of physical disability in old adults.

Aerobic exercise is the type of activity we usually think of when we think of exercise. It results in increased heart rate for an extended period of time, and includes activities like jogging, swimming, and jumping rope. Even walking, bicycling, and dancing can be considered aerobic exercise if you do them briskly enough, which means that you achieve a certain heart rate calculated for your age. Measuring your heart rate is very simple: Right after you stop exercising take your pulse. You can place the tips of your second and third fingers lightly over one of the blood vessels on your neck just to the left or the right of your Adam’s apple. Alternatively, you can try the pulse spot in the inside of your wrist just below the base of your thumb. Count your pulse for ten seconds and multiply the number by 6: that is your heart rate or pulse. Your target heart rate for aerobic exercise is anywhere between 50 to 70 percent of your maximum predicted heart rate, which you calculate simply by subtracting your age from 220. So, for example, if you are 70 years old, your maximum predicted heart rate is 220 - 70 = 150. Your target heart rate would be 50 to 70 percent of 150, or between 75 and 113.

Another type of exercise, Tai Chi, has been used in the Far East for centuries as a martial arts form, and has also been used in the United States as an exercise, mostly by older individuals of Asian heritage, to improve balance and fitness. As the beneficial effects of Tai Chi have become more widely known, it is gaining in popularity, and can currently be learned at many health clubs and senior centers. It is based on a sequence of slow uninterrupted movements called forms. These slow and graceful movements are inspired by nature, like a cloud floating or a stream running. The arms move in a relaxed, circular fashion. Steps are either taken very slowly or the feet may remain firmly rooted to the ground. As one takes small steps, body weight shifts gently from one side to the other. A short form takes about eight minutes to complete and should be done daily.
 

When Should You Ask a Doctor?

You have probably heard it suggested that older people should see a doctor before they start exercising. Many people do not need to see a doctor before starting a sensible, gradual exercise program. However, it would be wise to check with your doctor before you start an exercise program or increase your level of exercising if you:

  • suffered a heart attack
  • have a heart condition
  • are taking medicine for high blood pressure or for a heart condition
  • you are over 50 years old and not used to regular vigorous exercise
Your doctor may even request a cardiac stress test, which may or may not involve running on a treadmill while your heart is monitored. Two major national organizations, the American College of Sports Medicine and the American Heart Association, published guidelines for exercise stress testing. Each set of guidelines recommends exercise stress testing before starting a vigorous exercise program for anyone with a known heart condition and for older adults who have been sedentary, even in the absence of known or suspected cardiovascular disease. Guidelines are vague and open to interpretation if one does not have a heart condition or is starting a moderate exercise program. Thus, the decision about whether or not to stress test must be tailored to the individual.

An Exercise Prescription

Here is my prescription for individuals who want to get the most benefit from a moderate exercise program:

  • Burn 3,500 calories per week by walking one hour per day, or doing more intense physical activity such as bicycling or dancing for 30 minutes a day.
  • Stamina exercises, which increase your heart rate to 70 percent of maximum for 20 minutes, three times a week.
  • Weight training for 10 to 20 minutes two or three times a week.


Summary

Remember, almost all individuals will benefit from increasing their activity level. It’s important to choose an exercise program that will be interesting and enjoyable, and that fits into your daily activities. Start slowly and gradually build up to the full prescription described above. Always listen to your body. Don’t ignore any warning symptoms like dizziness, fainting, or pain or pressure in your chest. Keep your physician informed about your progress. Avoid outdoor exercise on hot days, and drink lots of water before, during, and after exercising. Set goals for yourself, and do your best to achieve them. Most of all, have fun!
 

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