The Benefits Effects of The Benefits Effects of Exercise for over 65sExercise for over 65s

Anna HaendelAnna Haendel

PhysiotherapistPhysiotherapist

Functional Capacity Functional Capacity

ObjectivesObjectives

Describe the normal changes that occur Describe the normal changes that occur with aging. with aging.

How Physical Activity affects these How Physical Activity affects these changeschanges

How much physical activity is needed How much physical activity is needed

The Facts........The Facts........

The normal changes with aging reduce your The normal changes with aging reduce your functional capacity.functional capacity.

The rate of decline in bodily function can be The rate of decline in bodily function can be modified.modified.

Healthy aging is an issue of increasing Healthy aging is an issue of increasing importance as the size of the older importance as the size of the older population continues to grow population continues to grow

The facts.......The facts.......

With advancing age, wear & tear occurs in With advancing age, wear & tear occurs in most of the body, even in the absence of most of the body, even in the absence of disease disease impacts on Activities of Daily impacts on Activities of Daily LivingLiving

Changes in:Changes in: Fitness CapacityFitness Capacity MuscleMuscle Body CompositionBody Composition

Cardiovascular ChangesCardiovascular Changes

Cardiac FunctionCardiac Function Heart Rate, heart Heart Rate, heart output and volume of output and volume of blood ↓blood ↓

Vascular FunctionVascular Function Arteries stiffen & Arteries stiffen & hardenharden

Blood PressureBlood Pressure BP @ rest BP @ rest ↑↑

BP receptors become BP receptors become less sensitiveless sensitive

Muscular ChangesMuscular Changes

Muscle Strength & Muscle Strength & PowerPower

↓ ↓ ~40years~40years

Lower limb ↓ > Upper Lower limb ↓ > Upper LimbLimb

Muscle EnduranceMuscle Endurance DeclinesDeclines

Motor PerformanceMotor Performance Speed of simple and Speed of simple and repetitive movement repetitive movement slows. slows.

Flexibility and joint range Flexibility and joint range of movementof movement

DeclinesDeclines

Body Composition ChangesBody Composition Changes

WeightWeight ↑ ↑ 30-50yrs, until ~70yrs, 30-50yrs, until ~70yrs, then ↓then ↓

Body FatBody Fat Body fat Body fat ↑30-50 yrs. ↑30-50 yrs.

Muscle MassMuscle Mass Loss of MM= Loss of MM= ↓ muscle ↓ muscle speedspeed

Bone DensityBone Density Peaks in late 20s. BMD Peaks in late 20s. BMD ↓ 0.5%.yr after ~40↓ 0.5%.yr after ~40

Complications of InactivityComplications of Inactivity

Blood Clots – usually in the legsBlood Clots – usually in the legs Swelling of feet and lower legsSwelling of feet and lower legs Pressure soresPressure sores Contractures of joints leading to deformityContractures of joints leading to deformity ConstipationConstipation FallsFalls DepressionDepression

Benefits of ExerciseBenefits of Exercise

Improve life expectancyImprove life expectancy Reduce the effect of chronic diseasesReduce the effect of chronic diseases Restore function to inactive adultsRestore function to inactive adults Improve quality of older lifeImprove quality of older life

TerminologyTerminology

Aerobic exercise training (AET): large muscles Aerobic exercise training (AET): large muscles move in a rhythmic manner for sustained periodsmove in a rhythmic manner for sustained periods

Resistance exercise training (RET): muscles Resistance exercise training (RET): muscles work or hold against an applied force or weightwork or hold against an applied force or weight

Moderate intensity: Moderate intensity: ↑↑ heart rate and breathing heart rate and breathing but still able to hold a conversation. but still able to hold a conversation.

Aerobic Exercise CapacityAerobic Exercise Capacity

Can improve Can improve functional capacity in older functional capacity in older adultsadults (3 times per week) (3 times per week)

Larger improvements typically observed Larger improvements typically observed with longer training periods (20-30wks) but with longer training periods (20-30wks) but not necessarily higher training intensities. not necessarily higher training intensities.

Cardiovascular EffectsCardiovascular Effects

3 or more months result in:3 or more months result in: Lower heart rate @ rest and Lower heart rate @ rest and

moderate exercisemoderate exercise Smaller rises in mean BPSmaller rises in mean BP Improvements in Oxygen Improvements in Oxygen

uptake capacities of musclesuptake capacities of muscles BP Receptors become more BP Receptors become more

efficient efficient

Body FatBody Fat

Moderate intensity Aerobic exercise has Moderate intensity Aerobic exercise has been shown to be effective in reducing been shown to be effective in reducing total body fat. total body fat.

However However Aerobic exercise does not Aerobic exercise does not improve skeletal muscle growth or improve skeletal muscle growth or strengthstrength

Body FatBody Fat

BUTBUT Strengthening exercises ↑ muscle & Strengthening exercises ↑ muscle & ↓ Fat↓ Fat

Systematic Review: older adults Systematic Review: older adults demonstrate ↑ muscle tissue of 10-62%demonstrate ↑ muscle tissue of 10-62%

Bone HealthBone Health

Aerobic exercise does not increase bone Aerobic exercise does not increase bone densitydensity

But may be effective in counteracting age But may be effective in counteracting age related losses in Bone Density in related losses in Bone Density in postmenopausal womenpostmenopausal women

Muscle Mass & StrengthMuscle Mass & Strength

Older adults can significantly Older adults can significantly ↑ strength↑ strength

Muscle PowerMuscle Power

Power capabilities: Substantial Power capabilities: Substantial ↑ in ↑ in muscular power have been demonstrated muscular power have been demonstrated after RET (e.g. stair climbing) in older after RET (e.g. stair climbing) in older adultsadults

Muscle EnduranceMuscle Endurance

May determine an older adult’s May determine an older adult’s functional independence functional independence

Moderate- intensity improves Moderate- intensity improves enduranceendurance

Moderate intensity: Patients with Moderate intensity: Patients with respiratory conditions & muscle respiratory conditions & muscle weaknessweakness Improved endurance Improved endurance

Ageing and ExerciseAgeing and Exercise

Typical “ageing effects” are greatly Typical “ageing effects” are greatly influenced by regular exerciseinfluenced by regular exercise

The precise extent is unknownThe precise extent is unknown

Sedentary living: losses in functional Sedentary living: losses in functional capacity that are at least as great as the capacity that are at least as great as the effects of aging itselfeffects of aging itself

Epidemiological EvidenceEpidemiological Evidence

Strong association between regular Strong association between regular physical activity / physical fitness and all physical activity / physical fitness and all causes of deathcauses of death

Nursing Home Study Nursing Home Study Strengthening exercises vs multinutirent Strengthening exercises vs multinutirent

supplementation 100 frail nursing home residents over supplementation 100 frail nursing home residents over 10wks10wks

Mean Age 87.1 yrs; 83% cane or walker; 66% falls Mean Age 87.1 yrs; 83% cane or walker; 66% falls

High-intensity Strengthening of hip & knee extensors 45 High-intensity Strengthening of hip & knee extensors 45 mins 3 days.wkmins 3 days.wk

Nutritional supplementation: 1/dayNutritional supplementation: 1/day augment caloric augment caloric intake by 20% & provide 1/3 of the RDA of vitamins and intake by 20% & provide 1/3 of the RDA of vitamins and minerals. minerals.

ResultsResultsExercising Exercising GroupGroup

Non-Exercising Non-Exercising GroupGroup

Muscle StrengthMuscle Strength ↑ ↑ 113±8% 113±8% ↑ ↑ 3±9% 3±9%

Walking SpeedWalking Speed ↑↑ 11.8±3.8% 11.8±3.8% ↓↓ 1.0±3.8% 1.0±3.8%

Stair climbing Stair climbing power power

↑↑ 28.4% 28.4% ↑↑ 3.6% 3.6%

Cross sectional Cross sectional thigh muscle thigh muscle area area

↑↑ 2.7% 2.7% ↓↓ 1.8% 1.8%

Other Nursing Home StudiesOther Nursing Home Studies

Large gain in strength (174%) & walking Large gain in strength (174%) & walking speed after 8 weeksspeed after 8 weeks

Combination of isometric and low intensity Combination of isometric and low intensity weight lifting for 6weeksweight lifting for 6weeks gain in strength gain in strength (15%)(15%)

Strengthening ExercisesStrengthening Exercises

Can improve muscle size & strength in frail Can improve muscle size & strength in frail elderly people elderly people

Improvement in mobility and an increased Improvement in mobility and an increased level of spontaneous physical activity can level of spontaneous physical activity can also be seenalso be seen

Subjects initially the weakest had the largest Subjects initially the weakest had the largest benefitbenefit

How much exercise is needed?How much exercise is needed?

Physical activity guidelines for older adults Physical activity guidelines for older adults (65+) published 2011(65+) published 2011

Older activesOlder actives Older transitionalsOlder transitionals Older frailOlder frail

How much is enough?How much is enough?

150 minutes per week150 minutes per weekoror30 minutes x 5 days30 minutes x 5 days

or for the frail....build up from 10 minutes or for the frail....build up from 10 minutes per day.per day.

However..............However..............

Physical Activity GuidelinesPhysical Activity Guidelines

Muscle Strengthening activitiMuscle Strengthening activitiesIN ADDITION TO

the recommended 150 minutes per weekthe recommended 150 minutes per week

But not every day! Twice per week.But not every day! Twice per week.

Physical Activity GuidelinesPhysical Activity Guidelines

Balance and Co-ordination activitiesBalance and Co-ordination activitiesIN ADDITION TOIN ADDITION TO

the recommended 150 minutes per week

AT LEAST TWICE PER WEEK!

ConclusionConclusion AHPs and Carers have the opportunity and AHPs and Carers have the opportunity and

responsibility to promote regular exercise. responsibility to promote regular exercise.

Regular exercise can minimise the damaging Regular exercise can minimise the damaging effects of sedentary livingeffects of sedentary living

Combination of Resistive and Aerobic exerciseCombination of Resistive and Aerobic exercise

SOME EXERCISE IS BETTER THAN NONE!SOME EXERCISE IS BETTER THAN NONE!

THANK YOU!THANK YOU!