level 3 award in adapting exercise for independently ... · national data indicate that this ......

Level 3 Award in

Adapting Exercise for

Independently Active, Older

People

Day 1 Agenda

• Introduction, H&S/housekeeping

• Introduce yourself to other learners

• Understand how the course is structured

• Look at the assessment overview and understand how to use your LAR’s

• Write the dates in your LARs

• Start delivering Unit 1

• Note: slides and resources will be available here: https://puretraininganddevelopment.co.uk/courses/hlh-staff-only-resources-revision-content/

https://puretraininganddevelopment.co.uk/courses/hlh-staff-only-resources-revision-content/












Qualification Structure

Two units

• Considerations for safe and effective exercise for independently active, older people

• Plan and adapt exercise programmes for independently active, older people

Learning Objectives

• Know who ‘independently active, older people’ are

• Understand the ageing process and demographics

• Know the effects of ageing and inactivity

• Understand the special considerations that must be taken into account when programming and delivering exercise for independently active, older people

• Understand the benefits of physical activity and exercise for independently active, older people

Learning Objectives

• Understand how to support and motivate the independently active, older adult in exercise

• Understand how to promote exercise for independently active, older people

• Understand the impact of ageing on planning and delivery of safe exercise for independently active, older people

• Understand the components of a pre-exercise consultation with independently active, older people

• Be able to conduct a pre-exercise consultation with independently active, older people

Learning Objectives

• Understand how to plan and adapt exercise for independently active, older people

• Understand how to adapt session instruction for independently active, older people

• Be able to plan a progressive programme for independently active, older people

Assessments

• Two assessments:

• Multiple Choice Theory Paper – completing Wednesday 13th September

• Learner Assessment Record (LAR) contains worksheet and case study – due 12th October

Let’s look through the LAR briefly…

Any Questions at this point?

Unit 1

Considerations for safe and effective

exercise for independently active, older

people

Assessment 1

• Theory paper

• Related to ‘considerations for safe and effective exercise for independently active, older people’

• 45 minutes*

• 70% pass rate

• Minimum of 21/30 marks

*depending on agreed circumstances

Introduction to Older Adults

Functional Classification Model

• Physically elite

• Physically fit

• Physically independent

• Physically frail

• Physically dependent

Spirduso, M (2005)

Older Population Classifications

Older Population Classifications

Physically Dependent/ Frail

People who need

assistance with basic ADL or IADLs

Physically Independent

Fully functional people now, but low activity

levels may cause physical declines leading

to frailty

Physical Fit/Elite

Highly active people who should remain mobile into late life,

barring injury or illness

Spirduso, M (2005)

30% 65% 5%

IADLs = instrumental activities of daily living

What kind of ageing terms are there?

ACTIVITY: pair the ageing term with the definition.

Definition

Ageing Process

Ageing Process

Physiological:

• Progressive decline of physical functioning

Biological:

• Genetic and biological factors which we have no control over

Chronological:

• Numerical age

Ageing Process

Psychological:

• Theories explore the psychological development including self-efficacy, self esteem and resilience

Functional:

• Rate at which an individual ages according to their capacity to perform tasks or activities

Terms for Ageing

Usual • Ageing in the absence of disease, excluding positive

factors such as physical activity

Successful • Active life expectancy or the number of years an

individual may expect to maintain ability to perform basic activities and ADL without significant disease

Pathological • Rate of ageing with chronic pathologies, predisposing

them to poor quality of life and loss of independence

Inclusion Groups

• Groups able to safely and effectively engage in physical activity • Physically fit

• Physically independent

• Department of Health (2011) defined independently active, older people and exercise guidelines

• See ‘start active, stay active: a report on physical activity from the four home countries’ • See hand-out provided RESOURCES\PA guidelines for

older adults factsheet.pdf

RESOURCES/PA guidelines for older adults factsheet.pdf




Inclusion Groups

‘the actives’

‘Is used to describe those older adults who are identified as already active, either through daily walking, an active job and/or who are engaging in regular recreational or sporting activity. This group may benefit from general increases in activity or a specific activity to improve particular aspects of fitness or function as well as sustaining their current activity levels’

Start Active, Stay Active (2011)

RESOURCES\Interpreting the UK guidelines for older adults.pdf

RESOURCES/Interpreting the UK guidelines for older adults.pdf




Inclusion Groups

‘Those in transition’ – those whose physical function is declining due to low levels of activity, too much sedentary time, who may have lost muscle strength and balance, and/or are overweight but otherwise remain reasonably healthy. National data indicate that this makes up the largest proportion of older adults and that they have a great deal to gain in terms of reversing loss of function and preventing disease.

Start Active, Stay Active (2011)

RESOURCES\Interpreting the UK guidelines for older adults.pdf





Exclusion Groups

• Individuals which do not meet the criteria

• Physically dependent

• Physically frail

• These groups are considered to be contraindicated based on the category of ‘independently active, older adults’

What are key physical activity outcomes?

5 mins

Physical Activity Outcomes

• Maintaining independence

• Improving functional fitness (everyday activities and

leisure pursuits)

• Reducing likelihood of certain age-associated medical conditions

• Ability to manage existing medical conditions and minimise the effect on function

• Socialisation and other psychological factors

Statistics for Ageing Population

• Growing in size in the UK

• People aged 65+ has ↑ by 20% to 10.3 million between 1985-2010

• Aged 85+ doubled over same period to 1.4 million

• 17% of the population were 65+

• 2.3% of the total population were 85+

• Ages <16 fell from 21% to 19% UK National Statistics,2012

Statistics for Ageing Population

• Life expectancy is longer

• Probability of poor health for longer or disability increases

• Age associated medical conditions develop

• Mortality rates are falling due to medical advances and treatments (Office for National Statistics,

2010).

Inactivity in the Older Population

• An occasion refers to activity lasting at least 30 minutes of an intensity likely to be sufficient enough to produce a health benefit

• ‘Sedentary’ can be defined as:

• Less than once per week (i.e. less than four occasions in the past 4 weeks, including no such occasions)

• ‘Frequently Active’ can be defined as:

• at least five occasions per week on average

(Skelton, 1999; Allied Dunbar National Fitness Survey Technical Report)


• Sedentary behaviour is not defined simply as a lack of physical activity. It refers to a group of behaviours that occur whilst sitting or lying down and that typically require very low energy expenditure (Pate et al,

2008). The low energy requirements distinguish sedentary behaviours from other behaviours that also occur whilst seated, e.g., chair based exercise, but which require greater effort and energy expenditure. (CMO guidelines)


• ‘Physical inactivity is the fourth leading risk factor for global mortality

(accounting for 6% of deaths globally)’ (Start Active, Stay Active, 2011)

• 50% of 65-74 year olds spent 6 or more hours being sedentary (men

and women equally)

• Increased on a weekend to 53% for men and 51% for women*

• More than 60% of 75+ year olds spent 6 hours or more being

sedentary (women more than men)

• Equal amounts of sedentary time spent at the weekends too

• ‘The estimated direct cost of physical inactivity to the NHS across the

UK is £1.06 billion. (Start Active, Stay Active, 2011)

Health Survey for England, 2008 * Figures interpreted by chart

Inactivity in

the Older

Population

• Health Survey for England, 2008

* Figures interpreted by chart

Pair the medical condition to

the definition. Use different

coloured pens.

Activity

10-15 minutes

In small groups, list as many

anatomical and physiological

adaptations you think occur

with ageing

Activity

15-20 minutes

Take a 15 minute break

Break Time

Effects of Ageing and Inactivity

Skeletal System

Ageing and Inactivity - Skeletal System

What are osteoblasts responsible for?

What are osteoclasts responsible for?


• Bone constantly changes

• Calcium deposited and reabsorbed in a cycle throughout life

• Osteoblast = laying down calcium and mineral salts

• Osteoclast = removes old bone by replacing a new framework of collagen fibres (avoid brittle bones)

• Osteoblast and osteoclast activity is equal at peak bone density until ~35 years of age

• During ageing process, osteoclast activity exceeds osteoblast and decreased bone mineral density & mass occurs

• Women lose more calcium than men

• Women lose ~ 1% of bone mass per year

• Men lose ~ 0.5% of bone mass per year

• Following menopause, 3-5% losses can occur per year


• Cause of calcium loss is unknown

• Reduced vitamin D affects absorption of calcium (especially most menopausal)

• Increased reliance on skeleton to maintain circulating calcium levels


• Decrease in bone density

• Reduced mineral content

• Joints become less flexible

• Increased risk of osteoporosis

• Increased risk of arthritis

• Increased risk of fractures


• Skeleton changes occur

• Risk of spinal curvatures

• Poor posture

• Potential pain in joints

• Temporary ischaemic attacks


• Degenerative changes affect intervertebral discs and vertebrae

• Loss in height & become dehydrated

• Facet irritation, spondylytic changes and stenosis foramenal gaps reduce neural impingement

• Facet Joint Video

• Spondylosis Video


Sourced from http://cnx.org

http://www.spine-health.com/video/facet-joint-syndrome-video

http://www.spine-health.com/video/spondylosis-video

COPYRIGHT © PURE TRAINING AND DEVELOPMENT

Osteoporosis

• Estimated 3 million people in UK suffer with osteoporosis

• 1 in 2 women and 1 in 5 men over 50 will break a bone due to poor bone health

• Cost of hospital and social care for hip fractures is more than 2.3 billion per year in the UK

The National Osteoporosis Society (NOS) 2013

Skeletal System - Osteoporosis

• Common bone disease

• Means ‘porous bones’

• Common fracture sites are spine, wrist & hips

• Due to high trabecular bone (spongy)

P14


• Compression or wedge fractures are common

• Causing kyphotic posture or ‘dowagers hump’

P14


"722 Feature Osteoprosis of Spine" by Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013. - OpenStax College. Licensed under CC BY 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:722_Feature_Osteoprosis_of_Spine.jpg#mediaviewer/File:722_Feature_Osteoprosis_of_Spine.jpg

P14


P14

What do you think are

MODIFIABLE & NON

MODIFIABLE factors in the

development of osteoporosis?


5 minutes

Modifiable Non Modifiable

Poor diet low in calcium, vitamin D Gender

Sedentary lifestyle Age

Smoking Hormone

Alcohol Intake Heredity and family history

Caffeine Body type, low body fat

Carbonated drinks Ethnicity

Long term corticosteroid use Nulliparity (number of children)

Some medical conditions


• Various treatments and supplements introduced – see p15 of manual

• Dietary improvements and physical activity have been reported to slow down the onset of osteoporosis

P14


• Weight bearing activity can maintain bone mineral density

P16

Research suggests if women exercised for 20 mins, 4x week over 10 years before onset of menopause, osteoporosis would be unlikely

1 hour of exercise a day can reduce hip fracture

by 50%

Skeletal System – Osteoporosis & PA

• Jogging, tennis, biking and vigorous walking considered relevant

• Swimming is beneficial for strength

• Golf and gardening did not reduce hip fracture rates

• Pilates is beneficial – core stability, strength, endurance and flexibility


• Functional movement patterns

• 4 point kneeling

• Standing, seated and side lying

• Spine extension movements – strengthen back extensors

• Spinal articulation and extension through thoracic spine

P14


P17

American College of Sports Medicine – Guidelines to exercise for people with Osteoporosis

Cardiovascular Strength Flexibility Functional

Frequency 3-5 days a week 2-3 days a

week 5-7 days a week

3-5 days a week Balance 2-3 days a week

Intensity 40-70% MHR 75% of 1RM

2 sets of 8-10 reps

Prolonged holding

Time 30-60 min each

session 20-40 min 30 seconds

Type

Large muscle activities depending

on BMD. Walking, cycling, elliptical, swimming, water,

running, sports

Dumbbells, machines, cuff weights, floor

work, vibration machines

Chair based

Increase ADL, improve

balance and decrease risk of

falls

• Exercise considerations

• These are guidelines

• Ensure you tailor specifically to your client

• Osteoporotic clients are likely to be more deconditioned

• Progress to 75% of 1RM

• Use a whole body approach

• Be aware of postural changes

• Use pages 17 & 18 for specific exercises



Arthritis

Skeletal System – Joints

• Reduction in synovial fluid • More viscous, reducing lubrication

• Calcification of cartilage • Less water and more calcium salt deposits affect

cartilage • Affects shock absorption of the spine

• Reduction in joint stability • Wear and tear • Thickening of ligaments and joint capsule • Ligament laxity

• Common condition

• More than 100 types of rheumatic diseases affecting the joints

• Inflammation or degeneration of a joint

• Cartilage, joint membrane and bones can be affected

• Most common types are:

• Osteoarthritis • Rheumatoid arthritis • Ankylosing spondylitis • Gout

Arthritis Overview

• 8.5 million people in UK affected

• Causes articular cartilage to degenerate

• No clear cause

• Related to genetic predisposition, stress on joints, biomechanical factors, lifestyle

• Cartilage replacement slows down

• Bones are exposed = spurs are called osteophytes

Skeletal System – Osteoarthritis

Osteoarthritis Image

Arthritis Research UK

• Can occur with and without symptoms of pain and weakness

• Arthritis can affect any joint in the body but commonly affects hips, knees, spine and hands

• Changes occur to the entire joint, not just the cartilage and bone which is what causes the visible physical changes.


• Discomfort

• Pain

• Stiffness

• Swelling

• Decreased range of motion

• Physical changes

Symptoms & Signs of Osteoarthritis

• PA does not make the condition worse

• Strength training decreased pain by 43%

• Good for posture, functional movement and less falls

• Tai chi and Pilates are good for balance, stability and strength


• Focus on protecting joint

• Low impact activities – swimming, cycling, walking

• Gradually increase exercise intensity

• Aim to increase flexibility & increase ROM

• Avoid overstretching

• Avoid kneeling positions, impact work, repetitive stress, flexion or extreme stretching


Approximately 400,000 people in UK with rheumatoid arthritis (RA) (NICE, 2008)

P22

Rheumatoid Arthritis

• Chronic inflammatory disease

• Inflammation of the synovial membrane

• Tends to affect the smaller joints i.e. hands, feet, ankles, elbows and wrists

• Cause not fully known

• Triggered by bacterial or viral infection

• Commonly thought that auto-immune disease – body attacks itself

• Synovial membrane thickens to heal itself

• Joint swells as synovial fluid accumulates

Skeletal System – Rheumatoid Arthritis

Arthritis Research UK 2014


• Inflammation erodes cartilage

• Scar tissue ossifies

• Remissions and flare ups

• Finally bone ends fused and/or deformed.

• More common between 20-40 years.

Rheumatoid Arthritis


https://www.youtube.com/watch?v=TwqR7JTctw0

• Flare ups and remissions

• Pain

• Inflammation

• Damage to joint tissues

• Fever

• Joint deformity

• Limited ROM

• Symptoms during a flare up include: • Fatigue

• Loss of appetite

• Muscle aches

• Red, swollen and painful joints

Symptoms of Rheumatoid Arthritis

• Non weight bearing (to start)

• Do not exercise during a flare up or feeling unwell – hot and painful joints

• Gradually ease clients into exercises


P17

American College of Sports Medicine Exercise Guidelines – Osteoarthritis and Rheumatoid Arthritis

Cardiovascular Musculoskeletal Flexibility

Frequency 3-5 days a week 2-3 days a week Before aerobic or strength training

Intensity 60-80% MHR RPE 11-16/20

Not specified Within pain threshold

Time 5-10 mins each session

building to 30 mins each session

1 or more sets of 2-3 reps building to

10 reps Not specified

Type Large muscle activities,

walking, cycling, swimming, water aerobics, dance

Circuit training, free weights,

machines, bands, Pilates mat and

equipment based sessions

Increase/maintain ROM


Total Hip Replacement

• Surgical procedure to replace all or part of diseased joint

• Artificial one

• Unstable following operation, be aware of dislocation

• Period of caution is 3 months

• Full recovery after 6 months (no complications)

Skeletal System – Total Hip Replacement

• Gradually increase the strength in all the main associated muscle groups; hip abductors/adductors, flexors and extensors

• Gradually increase ROM

• Create all round conditioning

• Deep water classes are ideal

• Limit abduction initially

• Avoid adduction across centre line of body

• Avoid hip flexion beyond 90 degrees


• Caution with rotation

• Avoid breaststroke

• Avoid swivelling on the spot

• Target the gluteal muscles – very important

• Gluteal bridge and lying leg circles are excellent for hip stability

• Avoid side lying exercises


45 minutes to 1 hour lunch

Lunch Time


Muscular System

• Peak muscle mass is achieved by ~age 30

• Progressive loss in skeletal muscle and organs (except lungs), increase in fat

• Average loss of 30% muscle mass between 30-80 years of age

• Due to loss of muscle fibres within tissue

Ageing and Inactivity - Muscular System

Do you know the scientific name for loss of muscle mass associated with ageing?

• Sarcopenia is the decrease in muscle mass associated with ageing

• Results from neurological and hormonal processes

• Physical inactivity plays a role too


• Strength and power decline at rate of 1.5% & 3.5% per year, respectively

• Active lifestyles help maintain more muscle mass

• However, healthy older people still experience huge losses in muscle and bone mass.



• Loss in quantity of muscle fibres

• Quantity of motor neurons • Muscular strength

decreases

• Motor neurons can sprout from healthy neurons and re-innervate adjacent fibres

Original Source: Mosby's Medical Dictionary, 8th edition.

• Results in reductions:

• Power

• Strength

• Endurance

• Fine control

• Heat production

• Immune function


• Reduced muscular endurance due to:

• Reduced capillarisation

• Reduction in the number and size of mitochondria

• Reduction in ATP and energy stores

• Reduced contractile protein concentration

• Reduced elasticity of ligaments and tendons


So although there are varying factors contributing to decreased muscular endurance, if someone has been active throughout their life then the extent to which this affects them is going to be significantly less.

P27

Ageing and Inactivity – Muscular System

P28

Ageing and Inactivity – Muscular System

• Pelvic floor and deep core stabilising muscles also become weaker

• People can start to experience continence issues, particularly when laughing or coughing

• Can contribute to back pain and postural changes too

• These changes can affect

peoples day to day routines.

• Lean muscle strongly associated with BMD

• Numerous gains in strength training (both physiologically and

psychologically)

• Decreases risk of osteoporosis and fear of falls

• Look at studies in manual p28

Muscular System & Exercise

• Changes occur in pelvic floor and deep core stabilising muscles

• Exercises that focus on these areas are important

• Reduced incontinence

• Decreases in back pain

• Improved posture and body awareness

• Improved self esteem

• Increased ability to perform functional activity

Muscular System & Exercise


Frozen Shoulder

• Known as adhesive capsulitis

• Shoulder joint is complex, various articulations and joints

• Surrounded by loose fitting, tough, fibrous capsule

• Covered by rotator cuff muscles and tendons

• Frozen shoulder is the shrinking and scarring which can cause inflamed and thickening

• Limits movement of humerus

Muscular System – Frozen Shoulder

• Typically affects people between the ages of 40-60 years of age.

• Develops very spontaneously and without warning or from injury/trauma

• Can develop from illnesses or conditions such as:

• Diabetes

• Thyroid problems

• Heart or lung conditions

• Shoulder injury


• Can last up for 12 months or longer as the healing process is slow.

• Typically affects the non dominant side of the body

• Still makes daily activities such as getting dressed, making dinner, reaching for objects and driving very challenging and

painful.

Frozen Shoulder

P28

Signs & Symptoms:

• Stiffness and pain that ranges up to severe

• Reduction of all movements by 50% or greater

• Pain when performing activities of daily living

P29

Frozen Shoulder

• Treatment initially is rest and ice

• May need to exercise other areas of the body to prevent them from becoming sedentary

• Exercise within pain free movement ranges (non acute stage)

• Mobility exercises include: – Wall clocks

– Pendulum swinging motions from arm (nordic walking)

• Once ROM improves focus on developing stability


Frozen Shoulder Explanation Video

Frozen Shoulder

http://www.youtube.com/watch?v=mgXknwC2X7g


Nervous System

Ageing and Inactivity – Nervous System

• There are substantially less adaptations that occur to the nervous system compared to other systems of the body

• Observed changes are likely to be a combination of adaptations to the cardiovascular, muscular and skeletal systems plus the role of inactivity as opposed to nervous system changes alone.


Potential consequences of ageing and inactivity:

• Reduced reaction time • Slower pace of learning • Increased time required to respond to instructions • Reduced short term memory • Reduced balance • Increased falls • Decreased hearing • Increased sight difficulties • Reduced speed of movement • Decreased co-ordination • Reduced kinaesthetic awareness

• Decrease in nerve supply

• Can not be replaced

• Speed of message transmission is reduced

• Central processing is slower, affecting daily tasks and reactions • More attributed to inactivity as opposed to

physiological changes

• Attributed to decreased cerebral blood flow (Skelton and Dinan-Young, 2008)


• Brain loses ~100,000 brain cells every day • Unlimited neural pathway development

• Example is a stroke

• Reduced motor neurons in spinal cord = lost motor units

• Muscle fibres are not activated • Fat and fibrous tissues replace these fibres

(Lexell,1997)

• Decreasing strength • Muscle fibre to neuron ratio needs to improve


• Dendrites become thinner and lose contact between synapses

• Slower connections, reactions, responses, less balance


Synapse

• Hand to eye co-ordination is stronger one limb at a time (exercise programming consideration)

• Lower extremities lose proprioceptive sensitivity

• Reduced balance and decreased range of movement – particularly ankle

• Important to focus on improving movement and strength in lower body


• Cerebral hypoxia occurs with age

• Physical activity improves this area

• Neurotransmitters decline (dopamine and noradrenaline)

• Reduced dopamine can cause Parkinson's disease

• Inability to control movements


• Nerve cells lose their myelin coating (demyelination)

• Decreases co-ordination

• Multiple sclerosis is linked

• Inability to co-ordinate movement efficiently


• Postural hypotension occurs due to decreased SNS activity

• Inability to constrict vessels effectively


As people get older they can also experience sight, hearing and balance issues and all of these stem from the nervous system.

Changes to Sensory Organs:

Sight:

• Elasticity of eye lens reduces

• Reduced ability to focus close up


Sight:

• Diabetics and arteriosclerosis may have further issues due to lack of oxygen and nutrients

• Perform clear large demonstrations, clear cards, reminder of obstacles


Hearing:

• From age 60, hearing reduces

• Hard to hear with background noise

• Rely on visual cues

Balance:

• Central processing time decreases

• Proprioceptive activity is reduced (muscle spindles & golgi tendon organs)


• Exercise improves all contributory systems plus it can have a positive effect on neuromuscular pathways

• Allow for practice time and break down challenging choreography

• Include simple and hard combinations

• Unilateral exercises will be beneficial

• Allow sufficient transition time

• Ensure clear adaptations are available too

Nervous System & Exercise

• Include exercises to test balance, co-ordination and memory

• Project your voice, use large visual cues

• Encourage brain stimulation outside of class too!

Nervous System & Exercise


Diabetes Mellitus

• Occurs as a result of increased insulin resistance or lack of production

• Type 1 = lack of insulin production

• Type 2 = insulin deficiency or resistance

Diabetes Mellitus

• When the condition is not controlled:

• Increased risk of retinopathy leading to blindness

• Kidney damage

• Peripheral neuropathy

• Increased risk of infection to the immune system

Diabetes Mellitus

Exercise Benefits:

• Improves blood glucose control

• Improves insulin sensitivity

• Maintains ideal body weight

• Increases CV fitness

• Reduces stress

• Prevention of type II diabetes

Nervous System & Diabetes Mellitus

American College of Sports Medicine’s exercise guidelines for Diabetes

Aerobic MSE Flexibility

Frequency Four to seven days a week Two-three days a

week Two - three days a

week

Intensity 50-80% * MaxHR Low resistance, high

reps

Maintain/increase ROM (limited

research available)

Time 20-60 minutes 20 minutes 20 minutes

Type Large muscle activities MSE Static, yoga, Pilates

* 40-70% Max HR for most individuals with type II diabetes (ACSM, 2009)


Exercise Considerations:

• Be aware of medication times and meals

• Integrate CV and resistance training exercises

• Start with a lower intensity and build up

• Peripheral neuropathy needs fitted footwear and be aware of damage to feet

• Angina sufferers will need low intensity programme


It’s good practice to know the signs of hyperglycaemia and hypoglycaemia so you can take the appropriate action.

Hyperglycaemia: • Individuals become bone dry

• Signs of shallow breathing

• Smelling of acetone (sweet smelling breath)

• Vomiting and showing signs of confusion

• Treatment: call 999 as this requires urgent action

Diabetes Mellitus & Exercise

Hypoglycaemia: • Individuals become agitated, sweaty, confused and

aggressive

• Show signs of rapid, weak pulse

• Treatment: recommend the individual consumes a simple sugary snack immediately, followed by a complex carbohydrate snack

Diabetes Mellitus & Exercise


Cardiovascular System

See page for author [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0 (http://creativecommons.org/licenses/by-sa/3.0/)], via Wikimedia Commons

Take a minute to refresh your

memory of the hearts anatomy…

Ageing and Inactivity – CV System

• Ageing does not significantly affect CV system unless there is disease

• Hard to determine between age related & inactivity related affects

• Certain adaptations will occur regardless

• ↓ Cardiac muscle and heart volume

• ↓ Maximum heart rate

• ↓ Efficiency of circulatory system/ compliancy of

heart and vessels

• ↓ Capillary network

• ↑ Systolic BP/ ↑ BP

• Blood pressure affected by impaired vasoconstriction and vasodilation

• Decreased sensitivity of baroreceptors

• Body becomes less efficient at adjusting to pressures

Ageing & Inactivity – Cardiovascular System

• ↓ Oxygen delivery

• ↓ Oxygen exchange in the muscle

• ↓ Fat metabolism

• ↓ VO2max

• ↓ Tolerance to acidity and fatigue

• ↓ Temperature regulations

• Vessels become less responsive to hormones


Heart Rate (HR) = number of times the heart beats per minute

Stroke Volume (SV) = the amount of blood

ejected from the heart per beat

Cardiac Output (Q)= the amount of blood

pumped from the heart per minute

Quick Refresher

• Reduced ability for heart to relax during diastole

• Reduce oxygen being perfused into the myocardium

• Results in reduced ability to perform high intensity activities

• LV contractions decrease by 50% between 20-70 years

• Heart mass decreased therefore less strength


• Stroke volume moderately reduced

• Decrease in preload or increase in afterload caused by increased peripheral resistance

• Or reduced cardiac power


Revised from 2007 Nursing Education Consultants Inc.


• Left ventricle increases in thickness to compensate for the increase in systolic BP that occurs with ageing

• The additional overload from high BP makes the wall thicker


• RHR remains relatively the same

• Maximum HR decreases by 5-10 beats per decade

• Changes in nervous stimulation therefore can not be changed

• Exercise can ↓RHR, ↑SV, ↑myocardial perfusion

• Enables higher intensity levels

• Recovery is slower


• Vessels lose their elasticity due to affinity of calcium (arteriosclerosis)

• Vasoconstriction and vasodilation are inhibited and affects vessels including aorta

• Causes BP to increase

• Blood becomes more viscose

• Reduced the amount of blood entering the heart

• Active older people have not been reported to demonstrate these declines

• Regular exercise can slow down ageing by 50%


• Build up of fatty plaque occurs = atherosclerosis

• Total peripheral resistance is increased by 1% each year after 40 years of age


• Capillary network reduces causing oxygen exchange to decrease

• VO2 max decreases

• Due to decreased in maximal heart rate and inactivity

• Fatigue occurs due to less muscle fibres and neurons

• Lower anaerobic threshold, increasing lactic acid

• Causes breathing rate to increase to reduce the acidity of the blood

• Physical activity and exercise can help prevent these negative impacts of inactivity and ageing


Overall, the consequences to reduced cardiovascular function include:

• A reduced anaerobic threshold

• Tasks then require greater percentage of maximum heart rate

• Reduced ability to sustain activity


What are the benefits of exercise?

Benefits of Exercise:

• Enhanced stroke volume

• Increased maximal oxygen uptake

• Increased total blood volume

• Reduced vascular resistance

• Decreased resting heart rate

• Increased HDL lipids – possible decrease in LDL lipids


End of Day 1

Well done!

Any Questions?

What’s next…?

What’s next…

1. Read back through your manual to recap what we covered today.

2. Test yourself on our online quiz 3. Head to:

https://puretraininganddevelopment.co.uk/courses/hlh-staff-only-resources-revision-content/ to find slides from today and recap quizzes

Any questions, my email is:

[email protected]

See you tomorrow at 9.30am














mailto:[email protected]

level 3 award in adapting exercise for independently ... · national data indicate that this ......

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