exercise as we age ped demographics 36 million older individuals projected to double to 70 million...
TRANSCRIPT
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Exercise As We Age
PED
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Demographics
36 million older individuals Projected to double to 70 million Average Life Span
– 1900 – 48.3 for males, 51.1 for females– 1990 – 72.1 for males, 79 for females
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Life Span
Decreased childhood mortality Better medical care Enhanced living conditions Availability of health care Improved health and sanitation Better nutrition Media keeps us informed
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Factors Affecting Life Span
Race % of people over age 65 years
– White – 11%– Hispanic – 3.6%– African American 2.4%
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Factors
The wealthy live longer. Married males live 8 years longer than
unmarried. Married females live 3 years longer than
unmarried.
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Factors
People who handle stress live longer People with more social contact live longer People who exercise live longer!!!!!!!!
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Will the Average Life Span Continue to Increase??
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Significance for the 21st Century
Less likely to be married More likely to live alone Less likely to belong to volunteer organizations Less likely to visit informally Less likely to be active in daily activities Becoming resistant to antibiotics Environmental Problems Stress!! Technology
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Economics
We currently spend about $50 billion annually on health care and if the life expectancy does continue to lengthen this will only increase.
That is where people involved in health and wellness come in.
Exercise is cheap.
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Topics
Measuring Body Comp Muscle Changes Osteoporosis Joints and Flexibility Cardiovascular Pulmonary Cognition
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Topics
Emotions
Hormones Thermoregulation Eye/Ear/Balance/Nervous System Diseases Exercise Prescription Recommendations Contraindications
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Body Composition
1. The distribution of fat changes with age– Men with age accumulate fat around the torso and
internally around organs– Women fat increases internally as well
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Body Comp
2. % of fat increases with age– Why?– Genetics– Changes in diet– Slowing of metabolism (about 10%/decade)– DECREASE IN PHYSICAL ACTIVITY!!
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Body Comp
Study of masters athletes – they had lower body fat than their inactive counterparts but still were 5-10% higher than younger athletes
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Methods of Estimating
UWW Skinfolds BIA
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Estimating % Fat in an Older Individual
UWW Problems 1. Changes in mineral content (FFW) 2. Changes in total body water 3. Equations we use may not be accurate 4. Difficult to UWW these individuals due to
ambulatory/physical limitations
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Estimating % Fat in the Older Individual
Skinfold Problems 1. Elderly distribute fat more internally so
subcutaneous skinfolds may not be accurately depicting the amount of total fat in the body
2. Equations for the old and oldest groups have not been developed
3. Equations are developed using UWW
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Estimating % Fat
BIA Problems 1. Affected by hydration status and total body
water (the conductance of an electrical current)
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Changes in Muscle
1. Decreased Muscle Mass – lose 3kg/decade 2. Higher % ST than younger people 3. Changes in blood distribution to muscles 4. Decreased pH in a muscle cell 5. Stiffer muscles 6. Decreased Strength
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Graph
Strength vs. Age
020406080
100
0 10 20 30 40 50 60 70 80
Age
Str
en
gth
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Graph
0
20
40
60
80
100
0 10 20 30 40 50 60 70 80
Age
Str
en
gth RT
No RT
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Study
Fiatarone 1990 10 subjects 86-96 yrs CAD, osteoarthritis, hypertension, osteoporosis 8 weeks of resistance training; 3 x/week Knee extensors
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Results
Average increase in strength 174% and was not beginning to plateau at the end of 8 weeks
Improved gait speed 48% Two subjects eliminated use of their canes One subject who couldn’t rise from a chair
could This was only one muscle group!!
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Exercise and Muscle Changes
1. Increased Strength 2. Increased Mass 3. Decreased loss of motor neurons 4. Increased perfusion of muscle 5. Increase in nerve conduction velocity to
muscle 6. Change in fiber types???
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Osteoporosis
About the 3rd decade the rate of bone formation fails to keep pace with bone loss (start losing about 1%/year)
Especially women– Diet– Less bone mass to begin with– Longer life span– Depletion during pregnancy and lactation– Hormones (Calcitonin, PTH, Vitamin D, Estrogen)
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Osteoporosis
Prevention
1. Estrogen Replacement Therapy
2. Calcium Supplementation
3. Weight Bearing Exercise
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Joints and Flexibility
It would serve little purpose to have strong bones and muscles if the bones cannot be moved through their range of motion.
Therefore, flexibility is an essential component of fitness!!
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Flexibility
Maintained by using the joints and by participating in physical activity
When a joint is unused the muscles that cross the joint shorten and reduce the ROM
Flexibility naturally leads to more physical activity
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Other Considerations
Osteoarthritis – chronic degenerative disease of the joints that affect ~80% of adults over 65
Compensatory physical movements may result in:– Metabolically less efficient movements– Biomechanical changes that lead to misalignment
and injury
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Exercise and Joint Flexibility
1. Enhances tensile strength of the tendons and ligaments
2. Maintains strength of the muscles crossing the joint
3. Reduces pain seen with osteoarthritis so ROM can be maintained
4. Increases sense of well-being
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Cardiovascular System
Too many to name them all!!! 1. Mechanical and Anatomical Changes in the
Heart/Blood Vessels 2. Decrease in Max HR 3. Increase in BP 4. Postural Hypotension 5. Change in Recovery HR
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Cardiovascular
6. Amount of blood pumped with each beat decreases (SV)
7. Change in Blood Constituents (RBC, hemoglobin, cholesterol)
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Exercise and Cardiovascular
1. Decrease BP
2. Increase SV (blood ejected per beat)
3. Increase RBC production
4. Conditions the heart
5. Lowers bad cholesterol,
raises good
6. Recover from exercise
faster
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Pulmonary Function
1. Chest Deformities 2. Increased upper airway infections 3. Narrowing of smaller airways 4. Decreased surface area of lungs
– 75m2 at age 20– 50-60 m2 at age 80
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Pulmonary Function
5. Loss of lung elasticity/tissue 6. Changes in lung volumes 7. COPD
– Shortness of breath– Cough– Poor exercise tolerance– Infections– Excess mucous
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Will Exercise Help With Pulmonary Function?
1. Prevent osteoporosis (changes in chest) 2. Condition ventilatory muscles 3. Tissue damage may be irreversible 4. Improved immune function
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Cognition
Memory/Reasoning/Comparison/Perception of Effort etc…
Tend to lose cognitive function with age
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Exercise and Cognition
Hypotheses 1. Increased Blood Flow to Brain 2. Increase in Neurotransmitters of brain 3. Helps us remain alert and stimulates
attention processes 4. Anatomical changes in the brain
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Emotions
1. Increased depression– Decline in health– Loss of physical ability– Death of loved ones– No job– Worries about money– Fear of being alone– Almost twice as many people over age 65 commit
suicide compared to those under 65
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Emotion
2. Ability to deal with stress– When old rats are stressed they can initiate a stress
response but cannot turn it off (state of chronic stress)
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Exercise and Emotion
1. Improves mood 2. Increases our ability to cope with stress 3. Decreases depression 4. Distraction 5. Mastery 6. Social interaction and approval
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Hormones
Many changes!! Bone Regulation Hormones Growth Hormone Insulin
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GH
Decreases with age.
Supplement as a treatment for aging??
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Insulin
Decreased Sensitivity of Beta receptors of the pancreas
Decreased Response at the cellular level Increased Levels of Blood Glucose Diabetes
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Exercise and Hormones
Stimulates bone formation Increased Protein Synthesis (muscle) Helps maintain Blood Glucose Increases sensitivity of the cells to insulin
Will lose concentration of certain hormones but can counteract the losses
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Thermoregulation
1. Possibly lower baseline body temps 2. Dehydrated??
– Dysfunctional thirst mechanism– Decreased renal function
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Thermoregulation
3. Impaired Heat Stress Response– Decreased skin blood flow to cool off– Decreased sweating rate– Dehydrated
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Exercise and Thermoregulation
1. Increases skin blood flow 2. Increases efficiency of sweating 3. Helps retain the thirst mechanism 4. Increases blood volume
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The Aging Eye
1. Inability to dilate pupils 2. Cataracts 3. Glaucoma 4. Drooping eyelids 5. Sunken eyeballs 6. Difficulty Distinguishing colors
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The Aging Ear
Decreased Hearing Capacity Result:
– Isolation from society– Difficulty in communicating– Loneliness– Difficulty in determining direction a sound came
from– Don’t hear the beeps of machines
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Nervous System Diseases
1. Myasthenia Gravis 2. Parkinson’s 3. Alzheimers
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Balance
1. Poor Depth Perception. 2. Loss of peripheral vision. 3. Lose ability to detect spatial info. 4. Cutaneous receptors. 5. Muscle receptors (reflexes).
– Long latency reflexes.
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Sleeping
Narcolepsy Sleep Apnea Difficulty going to sleep
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Exercise Prescription
1. Consultation with doctor 2. Gradual Progression – start slow – 40-50%
HR reserve, 10-20 minutes, multiple sessions of 10 minutes, etc…
3. Use a combination of HR reserve and RPE to set exercise intensities
4. Increase duration rather than intensity
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Prescription
5. Consider ambulatory capabilities. 6. Non-threatening/intimidating environment or
facility. 7. Poor vision – bike over treadmill. 8. Orthopedic problems/immobility. 9. Realize that they may have a lower
capability than you are used to.
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Prescription
10. Do not assume anything 11. Know what is going on in their lives 12. Increase treadmill grade rather than speed 13. Make them drink!! 14. Longer warm-ups and cool-downs 15. Activities that don’t require high
coordination
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Prescription
16. Emphasis on the social aspect 17. Understand nervous system diseases 18. Emphasis placed on lifestyle changes 19. Bands or machines instead of free weights 20. Weight training at least twice a week
(especially for this population) 21. Breathing very important with resistance
training
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Prescription
22. Emphasis on technique. 23. Don’t strength train arthritic patients during
active periods of inflammation. 24. Stretching/Flexibility emphasized. 25. You may notice what family members do
not.
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Prescription
26. You may be the only social contact that they have.
27. Change in routine should be slow and gradual.
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Persons Who Should Not Resistance Train
1. Abnormal BP response to a GXT 2. Poor left ventricular function (<30% ejection
fraction) 3. Uncontrolled angina, hypertension,
arrhythmias 4. Severe CAD 5. Severe aortic stenosis 6. Low Aerobic Functionality (<5 METS)
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Contraindicatons to Exercise
Absolute ContraindicationsAbsolute Contraindications Recent significant change in resting ECGRecent significant change in resting ECG Severe CAD: Unstable angina and/or acute MISevere CAD: Unstable angina and/or acute MI Acute CHFAcute CHF Uncontrolled ventricular arrhythmia’sUncontrolled ventricular arrhythmia’s
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ContraindicationsContraindications
Uncontrolled atrial arrhythmias (compromising Uncontrolled atrial arrhythmias (compromising cardiac function)cardiac function)
Third degree AV block w/o pacemakerThird degree AV block w/o pacemaker Suspected or known dissecting aneurysmSuspected or known dissecting aneurysm Aortic stenosisAortic stenosis Myocarditis or pericarditisMyocarditis or pericarditis Thrombophlebitis or intracardiac thrombiThrombophlebitis or intracardiac thrombi Recent systemic or pulmonary embolusRecent systemic or pulmonary embolus
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ContraindicationsContraindications
Acute infectionsAcute infections Significant emotional stressSignificant emotional stress
Relative ContraindicationsRelative Contraindications:: Hypertension: Resting DP > 110 mmHg or resting Hypertension: Resting DP > 110 mmHg or resting
SP > 200mmHgSP > 200mmHg Moderate valvular diseaseModerate valvular disease Electrolyte abnormalitiesElectrolyte abnormalities Fixed rate pace-makerFixed rate pace-maker
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ContraindicationsContraindications
Frequent or complex ventricularFrequent or complex ventricular ectopyectopy Ventricular aneurysmVentricular aneurysm Uncontrolled metabolic disease (i.e., Uncontrolled metabolic disease (i.e.,
diabetes)diabetes) Chronic infectious diseaseChronic infectious disease Neuromuscular, musculoskeletal, or Neuromuscular, musculoskeletal, or
rheumatoid disorders exacerbated by rheumatoid disorders exacerbated by exerciseexercise