Exercises for older adults

Aerobic Exercise
Measurement:
Most clinical applicable measure to determine it is measuring target heart rate Formula used known as Karvonen method (will yield higher amount than the traditional method) Subjective measures of perceived exertion: the Borg Rating of Perceived Exertion scale monitors exercise intensity in older adults (especially usefull if the pt. has a blunted heart rate response or taking -blockers) Talk Test: when exercise reaches an intensity where the pt can barely respond in conversation = safe and appropriate 6 min walk test Table 5.5 pg 75

Indications for aerobic exercise:

Pts who lack ability to sustain an activity for a certain amount of time due to decreased cardiovascular efficiency

Contraindications and Safety:

Pts with joint pain and/or mm. weakness must first be strengthened prior to aerobic exercise(may prevent multiple contractions needed) Resting heart rate > 100bpm Systolic blood pressure > 200 mmHg Diastolic blood pressure > 120 mmHg Unstable cardiac conditions Monitor blood press and heart rate (instruct pt) Be knowledgeable of pts medications

Equipment and opportunities: Indoors

Treadmil Elliptical trainer Stair stepper Rower Stationary bike

Outdoors
Walking or hiking Skating Jogging Cycling Remember: individuals preference and ability!!

Aquatic exercise
Aquatic exercise allows individuals who cannot tolerate landbased stresses (eg. Joint pathology) to exercise by decreasing the forces needed to move.

Measurement:
heart rate- same formulas BUT will be lower in the pool aquatic heart rate reduction should be included in the formula (-1min in-pool heart rate from 1 min land-based heart rate)

Indications:
Painful joints in weight-bearing Osteoarthritis Overweight Recent surgery Significant balance disorders or fear of falling

Contraindications and safety:

Monitor patients walking over slippery surfaces and into/ out of pool Open wounds not allowed Emergency communication equipment Automated external defibrillator

Equipment:
Flotation devices (support or resistance) Devices like underwater treadmill

Strengthening Exercise
They gain strength same way younger people do!!

Measurement:
Muscle dynamometry Isokinetic dynamometers very expensive Repetitive maximum test gold standard

Indications:
Patients functional activities impaired Add reserve to protective effect during enforced bed rest 1st line intervention for symptoms of chronic disease eg. COPD

Contraindications and safety:

No absolute contraindications Care taken to avoid patient holding his breath Monitor proper form, especially during high speed and intensities

Equipment and exercise:

Overload results in strength gains
Added resistance Elastic bands Weights Hand-held blades

NB variety and creativity = enthusiasm = results!!

Stretching Exercises

Older adults adopt certain movement and positioning patterns, that can lead to muscles and soft tissue being held in a shortened or lengthened position.

Measurement:
Age-based normal ranges

Indications:
Painful joint ROM Abnormal movement patterns Painful postures Prevention of future potential problems

NB muscles in older adults that need stretching are:

Suboccipital mm Pectoralis minor Extensors of lumbar spine Hip flexors and external rotators Ankle plantar flexors

Contraindications and safety:

Presence of joint instability (would contribute to the instability) Ensure stretching force is only on target muscle or joint Neural tissue may present as a pins and needles sensation

Table 5.9 and 5.10 pg 82

Plyometrics
Definition: Plyometric exercise is an attempt to use the stretch reflex of the muscle spindle and the elastic energy that is stored in a stretched muscle to enhance the immediate reciprocal contraction of the muscle. It involves eccentric contraction followed by a concentric contraction of the same muscle.

Measurement:
An isokinetic dynamometer can be used to test for muscle power
Exercise is meant to result in increase in the ballistic ability of the muscle

Any functional test measuring time taken to complete a task:

Gait speed Floor transfer Stair climbing

Roses Fullerton balance test

Jumping task indicating muscles capability to produce a forceful rapid contraction.

Indications:
Loss of power during activities Bone formation (Wolffs law) Decreasing fall risk

Application:
Beginner patients may not have soft tissue and muscle integrity needed for the exercise As they progress in their program, the speed of contraction should be used as a method of overload.

Tai Chi
Tai Chi originated as a form of marshal arts. It involves learning multiple poses that are linked together with slow movements, emphasizing control and balance.

Measurement:
No direct measurement has been reported However, balance measurements such as the Berg balance score have been used.

Indications: Chronic conditions: Arthritis Cancer Cardiovascular disease Diabetes Stress Also improves balance and fitness, thus decreasing falls and lessening the risk.

It is believed that the slow body movements superimposed on the ankle musculature that must react rapidly to maintain the position provides an overload stimulus for ankle power and proprioception Tai Chi can be taught in schools by experienced teachers, or can be learnt from books and videos.