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AGING AND EXERCISE – YOUR PERSONAL FITNESS TRAINER HAS THE ANSWERS

By Tammy Petersen, MSE 

The surgeon General has issued a report warning people-including older adults-that physical inactivity is a major risk to their health.

The aging of the American population has created a large group of older adults who are even more susceptible to the detrimental effects of physical inactivity than are younger people. This is not news to those of us in the fitness industry, but many of us are not prepared to deal with this growing segment of the population.

So, first lets look at a few statistics. In the year 2000, roughly 35 million people (13 percent of the population) were age 65 or older. By 2030, the number is expected to double to 70 million. According to the Active Aging Partnership National Blueprint, 88% of these people have at least one chronic health condition that in many cases may be improved or managed with physical activity. They also report that 35%-50% of women age 70-80 have difficulty with general mobility tasks like walking a few blocks, climbing a flight of stairs or doing housework. Dr. Mark Williams, who is a professor at Creighton University of Medicine in Omaha, says this statistic reports a disproportionate amount of women, because although women make up about 60% of the elderly population (>65years), the female predominance increases exponentially after age 65 since women tend to live longer than men. Women who reach age 65 have an additional life expectancy of 19 years, compared with less than 16 years for men of the same age.

Once adults pass the physical prime of their teens and 20’s, they lose an average of 10 ounces of lean body mass a year, and this is mostly in the form of muscle tissue. And since few people actually lose 10 ounces of weight a year, instead, most gain about a pound a year, the loss of lean tissue is masked. Another way to look at this is the average person gains about 1 pound and 10 ounces of body fat per year. It is a process that is more insidious and crippling than osteoporosis but one few people notice until they realize it is getting difficult to climb the stairs or heft themselves off the sofa. Unchecked, the gradual loss of muscle strength is the main reason elderly Americans have difficulty performing the tasks of daily living and ultimately lose their independence. This phenomenon, which we call sarcopenia, derived from Greek words for “vanishing flesh,” is NOT an inevitable consequence of aging. It is instead an inevitable consequence of disuse.

 Another important reason for older people to strength train is that evidence suggests that exercise may decrease the rate of bone loss associated with osteoporosis and reduce the likelihood of falls that result in hip fractures. A frightening statistic is that almost 24% of people over age 50 who have hip fractures die within a year. Falling is a serious public health concern among elderly people because of its frequency, the morbidity associated with falls, and the cost of the necessary healthcare. According to Dr. Mary Tinetti, Yale University, approximately 30% of the people who live in the community fall each year. Unintentional injury, which most often results from a fall, ranks as the sixth leading cause of death among people over 65 years of age. Muscle weakness has been identified as one of the biggest potentially modifiable risk factors for falling. In the late 80’s, early 90’s, studies began being done which proved that despite a decrease in muscle fibers and strength, muscle function can be maintained and or improved with training, even in the very old.  

A slight increase in muscle strength at any age can improve quality of life-and stave off the frailty that used to be considered a normal part of getting old. While strength training is not the only type of exercise that is important for older adults, it should be easy to understand that the frailer a person becomes, the greater the importance of strength training. And sometimes, strength training and flexibility are the only types of exercise in which the elderly can engage until they gain enough muscle strength to allow them to work on their endurance or aerobic capacity, and balance. In an article by Wayne Westcott, PhD, published in the October 1995 issue of American Fitness Quarterly, twelve health and fitness benefits were outlined that result from strength training by older adults. They were, avoid muscle loss, avoid metabolic rate reduction, increase muscle mass, increase metabolic rate, reduce body fat, increase bone mineral density, increase glucose metabolism, increase gastrointestinal transit, reduce resting blood pressure, improve blood lipids levels, reduce low back pain, and reduce arthritic pain.

Although the benefits of strength training have been discussed exclusively to this point, older inactive adults also loose ground in three other areas that are important for staying healthy and independent, these are endurance, balance and flexibility. Endurance training can maintain and improve cardiovascular function and can reduce risk factors associated with chronic diseases associated with aging such as diabetes, colon cancer, heart disease, stroke, and others and reduce overall death and hospital rates. Balance exercises help to prevent falls and flexibility exercises help to keep the body limber by stretching muscles and tissues that hold the body’s structure in place. Flexibility may also play a part in preventing falls.

Some types of exercise improve just one area of health or ability, but more often, an exercise has many different benefits. So, elderly adults should be encouraged to increase both the types and amounts of exercise and physical activity they do. According to an article in the winter 2002 newsletter, Aging Successfully, published by the St Louis School of Medicine and Geriatric Research, for the older adult, the goals of exercise should be to minimize the effects of aging and chronic diseases; to reverse the effects of disuse; and to maximize psychological health. This is different than those of younger adults for whom exercise helps prevent disease and increase life expectancy.  

So in summary, contrary to traditional thinking, regular exercise helps, not hurts, most older adults. Older people become sick or disabled more often from not exercising than from exercising. Almost all older adults, regardless of age or condition, can safely improve their health and independence through exercise and physical activity. There are few reasons to keep them from exercising, and “too old” and “too frail” are not among them!!  

References

1.    Binder, E.F., Schechtman, K.B., Ehsani, A.A., et al. Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc 50(12):1921-1928, 2002.  

2.    Blumenthal, J.A., Babyak, M.A., Moore, K.A., Craighead, W.E., Herman, S., Khatri, P., Waugh, R., Napolitano, M.A., Forman, L.M., Appelbaum, M., Doraiswamy, P.M., Krishnan K.R. Effects of exercise training on older patients with major depression. Arch Intern Med Oct 25;159(19):2349-56, 1999.

3.    Centers for Disease Control and Prevention. Early release of selected estimates based on data from the January-June 2003 National Health Interview Survey. URL: www.cdc.gov/nchs/about/major/nhis/released200312.htm.

4.    Centers for Disease Control and Prevention. Promoting active lifestyles among older adults. Atlanta: CDC, National Center for Chronic Disease Prevention and Health Promotion. Nutrition and Physical Activity. URL: http://www.cdc.gov/nccdphp/dnpa/physical/lifestyles.htm

5.    Chau, D.L., Edelman, S.V. Osteoporosis and diabetes. Clinical Diabetes 20(3):153-157, 2002

6.    Cooper, Kenneth. Regaining the Power of Youth. Nashville, TN: Thomas Nelson, Inc., 1998.

7.    Evans, W.J. Exercise as the standard of care for elderly people. J Gerontol A Bio Sci Med Sci 57(5):M260-M261, 2002.

8.    Häkkinen, A., Sokka, T., Hannonen, P. A home-based two-year strength training period in early rheumatoid arthritis led to good long-term compliance: A five-year followup. Arthritis Care & Research, 51(1):56-62, 2004.

9.    Hurley, B. Does strength training improve health status? Strength and Conditioning Journal, 16:7-13, 1994.

10.    Judge, J.O., Kenny, A.M., Kraemer, W.J. Exercise in older adults. Conn Med. 67(8):461-464, 2003.

11.    Häkkinen, K., Kraemer, W.J., Pakarinen, A., et al. Effects of heavy resistance/power training on maximal strength, muscle morphology, and hormonal response patterns in 60-75-year-old men and women.  Can J Appl Physiol. 27(3):213-231, 2002.

12.    Lord, S.R., Sherrington, C., Menz, H.B. Falls in Older People: Risk Factors and Strategies for Prevention. New York: Cambridge University Press, 2001.

13.    Meneilly, G.S., Tessier, D. Diabetes in elderly adults. J Gerontol A Biol Sci Med Sci 56(1):M5-M13, 2001.

14.    The Merck Manual of Geriatrics. Merck & Co., Inc, 2004.

15.    Mokdad, A., Marks, J., Stroup, D., Gerberding, J. Actual Causes of Death in the United States, 2000. JAMA 291:1238-1245, 2004.

16.    Mosca, L.,  Appel, L.J., Benjamin, E.J., et al. Evidence based guidelines for cardiovascular disease prevention in women. Circulatio 109(5):672-693, 2004.

17.    National Center for Health Statistics. Life expectancy, preliminary data 2000. National Vital Statistics Reports, 49(12). URL: www.cdc.gov/nchs/fastats/lifexpec.htm, 2003.

18.    Nelson, M., Fiatarone, M., Morganti, C., Trice, I., Greenberg, R., & Evans, W. Effects of high_intensity strength training on multiple risk factors for osteoporotic fractures. Journal of the American Medical Association, 272(24):1909-1914, 1994.

19.    Partnership for Prevention. Creating communities for active aging. Washington, DC: Partnership for Prevention, 2002. (http://www.prevent.org).

20.    Physical Activity and Older Americans: Benefits and Strategies. June 2002. Agency for Healthcare Research and Quality and the Centers for Disease Control. http://www.ahrq.gov/ppip/activity.htm

21.    Singh, M.A., Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol Biol Sci Med Sci, 57(5) M262-M282, 2002.

22.    Spirduso, W. Physical Demensions of Aging. Champaign, IL: Human Kinetics. 1995.

23.    Van der Bij, A.K., Laurent, M.G.H., Wensing, M. Effectiveness of physical activity interventions for older adults: a review. Am J Preventive Med 22(2):120-33, 2002.

24.    Westcott, W., & Guy, J. A physical evolution: Sedentary adults see marked improvements in as little as two days a week. IDEA Today, 14(9), 58-65, 1996.

 
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