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Chapter 5

Chapter 5. Exercise for Senior Adults. Aging. Gerontology— the study of the aging process Chronologic age— a person’s age in years Biologic age — a person’s physiologic age based on level of performance of various body systems. Chronologic age and biologic age are not necessarily the same.

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Chapter 5

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  1. Chapter 5 Exercise for Senior Adults

  2. Aging • Gerontology—the study of the aging process • Chronologic age—a person’s age in years • Biologic age—a person’s physiologic age based on level of performance of various body systems Chronologic age and biologic age are not necessarily the same

  3. Lifestyle behaviors that influence health and biologic age

  4. Anatomic and physiologic changes with age • Integumentary system • Epidermis, dermis, and hypodermis thin • Langerhans cells suffer from UV exposure • Melanocytes diminish and become less active • Number of nerve receptors declines • Number of sweat glands drops • Number of blood vessels diminishes

  5. Consequences of aging on skin • Prone to injury • Slow to repair • Susceptible to infection • Unable to regulate body temperature • Likely to wrinkle

  6. Anatomic and physiologic changes with age (cont’d) • Skeletal system • Bone mass diminishes • Bone becomes brittle • Intervertebral disks compress • Articular cartilage wears away • Sprains, bursitis, and arthritis become more common

  7. Anatomic and physiologic changes with age (cont’d) • Sprains • Occur when connective tissues associated with joints are overstretched • Bursitis • Occurs when bursa sacs associated with joints become inflamed • Arthritis • Occurs when joints become inflamed

  8. Anatomic and physiologic changes with age (cont’d) • Osteoarthritis • Also known as degenerative arthritis • Long-term use wears down articular cartilage • Loss of cartilage can expose bone surfaces

  9. Osteoarthritis

  10. Anatomic and physiologic changes with age (cont’d) • Rheumatoid arthritis • An autoimmune disease • Immune cells attack the synovial membrane • Synovial membrane produces a grainy synovial fluid • Grainy fluid abrades articular cartilage

  11. Anatomic and physiologic changes with age (cont’d) • Muscular system • Number of blood vessels, myoglobin, and mitochondria drops • Number of myofibrils decreases • Glycosomes disappear • Number of fast and intermediate fibers decreases

  12. Anatomic and physiologic changes with age (cont’d) • Nervous system • Total number of neurons drops • Neurotransmitter levels decrease • Brain size diminishes • Memory, hearing, balance, vision, smell, and taste acuity are impaired • Reflexes slow

  13. Anatomic and physiologic changes with age (cont’d) • Endocrine system • Gland size and activity change • Thymus gland • Pituitary gland • Parathyroid glands • Pancreas • Pineal gland

  14. Anatomic and physiologic changes with age (cont’d) • Cardiovascular system • Changes in blood vessels • Blood vessels develop plaque • Elastic arteries lose elastic fibers • Venous valves weaken • Total number of blood vessels diminishes • Blood pressure tends to increase

  15. Anatomic and physiologic changes with age (cont’d) • Cardiovascular system (cont’d) • Changes in heart • Elasticity of heart wall decreases • Heart valves thicken • Heart can atrophy or hypertrophy

  16. Anatomic and physiologic changes with age (cont’d) • Respiratory system • Coughing reflex slows • Macrophages in lungs become less active • Mucus thickens • Number of cilia drops • Other changes are directly proportional to exposure to environmental pollutants

  17. Anatomic and physiologic changes with age (cont’d) • Lymphatic system • Thymus shrinks • Cytotoxic T cells become less active • Macrophage activity slows • Wound healing is delayed • Ability to develop fever diminishes • Inflammation occurs frequently

  18. Anatomic and physiologic changes with age (cont’d) • Digestive system • Teeth are lost • Gums become inflamed • Medications can interfere with absorption • GI tract lining thins • Ability to produce secretions diminishes • Risk of lactose intolerance increases

  19. Lactose intolerance • Inability to digest lactose found in dairy products • Lactose remains in GI tract lumen and attracts water • Results in cramping and bloating • GI tract bacteria ferment lactose and produce gas • Promotes bone loss if other sources of calcium and vitamin D are not consumed

  20. Managing lactose intolerance • Consume dairy products in moderation • Eat other food types along with dairy • Take enzyme tablets with meals • Consume enzyme-enriched foods • Consume fermented products like yogurt • Read food labels—many products contain lactose

  21. Anatomic and physiologic changes with age (cont’d) • Urinary system • Kidney size diminishes as nephrons are lost • Ability to remove wastes diminishes • Reabsorption of water, glucose, and other useful materials diminishes • Urinary bladder loses elasticity • Seniors become less sensitive to urge to void

  22. Anatomic and physiologic changes with age (cont’d) • Reproductive system • Male • Prostate gland enlarges • Risk for prostate cancer increases • Testosterone levels remain fairly stable • Protects bone tissue • Maintains secondary sex characteristics

  23. Anatomic and physiologic changes with age (cont’d) • Reproductive system (cont’d) • Female • Ovary structure changes • Affects monthly cycle • Affects hormone levels • Estrogen levels drop significantly postmenopause • Increases risk for heart disease and osteoporosis • Might impair immune system functioning

  24. Precautions during exercise • Inability to regulate body temperature • Loss of blood vessels impairs radiative cooling • Loss of sweat glands impairs evaporative cooling • Loss of subcutaneous fat impairs heat retention in cold environments

  25. Precautions during exercise (cont’d) • Loss of range of motion • Spine loses flexibility and stiffens • Articular cartilage wears away, promoting inflammation • Synovial fluid production slows

  26. Precautions during exercise (cont’d) • Decrease in lean tissue • Also known as sarcopenia • Accompanied by loss of strength

  27. Precautions during exercise (cont’d) • Loss of balance • Balance issues arise from loss of muscle mass, weakened joints, and decreased flexibility • Balance problems often promote falling • Falling often results in broken bones

  28. Precautions during exercise (cont’d) • Loss of cardiorespiratory functioning • Heart’s functional ability declines • Maximal heart rate drops • Ejection fraction decreases • Blood pressure rises • VO2max decreases

  29. Barriers to exercise • Fear of injury • Lack of knowledge • Lack of transportation to a facility • Lack of skills, abilities, and confidence • Physical limitations resulting from disease • Limited income

  30. Benefits of exercise

  31. Exercise testing • Use standard testing procedures for generally healthy seniors • Initial workload should be 2–3 METs • Use a cycle ergometer for those with balance issues • Be flexible during testing • Be aware that exercise-induced dysrhythmias are common in seniors • Note that the ECG has higher sensitivity and lower specificity in seniors than in younger populations

  32. Stop exercise testing if • Systolic blood pressure drops by more than 10 mm Hg from baseline despite an increase in workload • Moderately severe angina develops • Dizziness, incoordination, or loss of consciousness occur • Cyanosis or pallor develop • Subject requests to stop • Ventricular tachycardia is sustained

  33. Exercise prescription • Cardiovascular training • Begin each session with at least 5 minutes of low-intensity activity • Encourage 30–60 minutes of activity (RPE = 5 or 6 on a 0 to 10 scale) on at least 5 days per week • If high-intensity activity (RPE = 7 or 8), adjust frequency to 3 times per week • Avoid activities with rapid changes in direction • Avoid high-impact activities

  34. Exercise prescription (cont’d) • Resistance training • Perform 1 set of 10–15 repetitions for 8–10 different exercises targeting major muscle groups • Intensity should be moderate (RPE = 5 or 6) to vigorous (RPE = 7 or 8) • Pay extra attention to body alignment

  35. Exercise prescription (cont’d) • Flexibility training • Stretch the hip, back, shoulders, knees, upper trunk, and neck • Hold static stretches at the point of tightness but not pain for 15–30 seconds each • Perform 2–4 repetitions per stretch

  36. Additional tips for exercise • Avoid strenuous exercise during hot, humid weather • Avoid exercise during flare-ups of arthritis or other chronic conditions • Encourage low-impact activities like walking, stationary cycling, water aerobics, and swimming • Limit high-impact activities like running, jumping, and bouncing

  37. Sample exercise program • Upper body strength training • Chest press with elastic tubing • Lateral pull-downs with elastic tubing • Shoulder press with dumbbells • Biceps curls on machine • Triceps extension on cable machine

  38. Sample exercise program (cont’d) • Lower body strength training • Step-ups • Squats • Calf raises

  39. Exercise for the frail senior • Warm up for 3–5 minutes • Begin with seated marching, arms relaxed • Tap toes to front then side • Tap heels to front then side • Add arm movements and repeat

  40. Exercise for the frail senior (cont’d) • Strength training • Split the workout into two sessions, 15 minutes each (one in the morning, one in the evening) • Work upper body one day; lower body another • Participant’s weight might be adequate resistance • If more intensity is needed, trainers can apply resistance with their own hands • Elastic bands or very light weights are also fine • Sometimes practicing everyday activities is sufficient

  41. Lower body strengthening exercise • Sit-to-stand • Single-knee extension on chair • Seated single-leg curl • Seated heel raises • Seated toe raises

  42. Upper body strengthening exercise • Chest flies using elastic tubing • Seated row using elastic tubing • Lateral shoulder raises • Biceps curls with 1-pound dumbbells • Triceps dips in a chair

  43. Nutritional considerations • Water • Important for body temperature regulation • Often deficient because seniors lose sense of thirst • Inadequate because seniors deliberately restrict intake to avoid embarrassing incontinence • Minimum recommendation is 6 glasses of water/day

  44. Signs of dehydration

  45. Carbohydrates, protein, fat • Carbohydrates: minimum of 130 g per day • Fats: 20–35% total daily intake • AI for linolenic acid = 1.6 g per day for men and 1.1 g per day for women • AI for linoleic acid is 14 g per day for men and 11 g per day • Protein: about 0.8 g of protein/kg of body weight

  46. Special concerns for the elderly

  47. Vitamins and minerals • Vitamin B12 = 2.4 g per day • Vitamin D = 10–15 g per day • Calcium = 1200 mg per day • Vitamin C = 90 mg per day for male seniors; 75 mg per day for female seniors • Vitamin E = 15 mg

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