Exercise and Aging PDF

Exercise and Physical Activity for Older Adults PT 704 CSUN 1 We are verydifferentwhen we are older 2 Aging Causes Aging (loss of function) Natural causes Disease...

Exercise and Physical Activity for Older Adults PT 704 CSUN 1 We are verydifferentwhen we are older 2 Aging Causes Aging (loss of function) Natural causes Disease Disuse (Eugeric) (pathogeric) Sedentary Pathology physicalactivityimportant 3 4  Aging Demographics in the US  In 2000, 35 million people age 65 or older in US  13% of total population.  In 2011, the “baby boomers” began to turn 65  by 2025, 25% of the population will be > 65  ~80 million  Those > 85 yrs will be fastest growing segment of population 5 Physical Therapy and Aging  Primary disease prevention measure for people of all ages fromtreating disease treating disease prevention to  Goal 1: Prolong life functionalandhealthylife  Goal 1a: Increase healthy years  Better living standard  34% of all health expenditures for > 65 yrs  Goal 2: Improve performance 6 NORMAL HUMAN AGING headston  Structural and Functional Decline  ↓ Physical Activity  ↑Chronic Disease Risk 7  Skeletal Muscle Changes with Aging  Decrease in ability to produce force. sacopeniasets in 60 Hypertrophy andforce isochinaticmachine NOmatter Kilifi decreases 8  Why does force decrease? 1. Decreased Cross Sectional Area (CSA)  CSA proportional to Force 9  Why does CSA decrease?  1. Disuse (especially in type II fibers) Physical activity level by age, men, 2003 Physical activity level by age, women, 2003 population 100% 100% Group 1 - Low 90% Group 2 - Medium 90% Group 3 - High 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 16-24 25-34 35-44 45-54 55-64 65-74 75 and 16-24 25-34 35-44 45-54 55-64 65-74 75 and above above Age group Age group 10  CSA  1a. Fiber size decrease  Max at 20 yrs old.  With resistance training, maintained up to 60 yrs older pplhavemuch greaterdeclinein strengththanenduranceIntensityhasto change 11  Decreased CSA (cont.) 2. Selective loss of type II motorneurons  Type II fibers are bigger Type I Type II 12 Older have higher % of type I fibers moreconnection tissue e.gfat 13  CSA and Force accelerateddecline  Force decreases ~40% from 65-80 yrs  Only ½ of decrease accounted for by CSA  Rest comes from type II  type I differences in force production and muscle composition differences. reallyimportant for older pplto lift heights 14  Muscle composition changes  25 yr old vs. 64 yr old  same body mass.  Muscle replaced by connective tissue, fat muscledoesn'tturninto fat 15  Muscle  ↓ size, # of muscle cells  Especially fast twitch (Type II die) most fiberstype I black 39 yrs old 57 yrs old 16 Biochemical and Metabolic Changes  All enzymes slow downsmetdi.it  ATPase restingmetabolinrate  RMR ↓  Muscle protein synthesis ↓  Fat oxidation ↓ 17  Overall  Decrease in force from  Reduced muscle size (CSA)atrophy  Reduced muscle contractility (quality) encynatiactivityreduced 18  Response to Damage  Exercise  Damage damagedolderpplmuch Sarcomeresvery more susceptible 19  Older adults  Greater susceptibility to damage  Delayed recovery  Atrophy (sarcopenia)  Disuse  Atrophy canhelpaugment musclefibers  Reduced satellite cell proliferation  Reduced adaptation to exercise Younger person can reducemoresatellitecellstohypertrophy muscles 20  Changes in Cardiovascular System with Aging  ↑ Vessel stiffness & ↓ blood vessel diameter lumensmaller 1. ↓ elastin/↑collagen fiber content stiffer Hypertension 2. Increased sympathetic tone 21  Vessel stiffness  ↑ bp  ↑ blood pressure (up to 40mmHg)  Less receptive arteries Stiffwalls  Left ventricle hypertrophy heart warningmuchharder 22  Heart Valves endsjoined  ↑ stiffness and stenosis  ↓ or hindered blood flow to body andlongs 23  Baroreceptors Sensepressurestretch  Delayed response time with aging  ↑ risk of orthostatic hypotension  After prolonged bedrest  With fast position changes They  With beta- and calcium-channel blocker usefishi Normallyyeahlayingdownand sitopHR I tomaintainBP as it 1 older ppl respondslowerTend to faint 24  Pacemaker cells  ↓ # of SA node (and AV node) cells bynext Egg  Slower HR at rest  ↓frequency/regularity of cardiac conduction  ↑ arrhythmias (irregular heart beat)  ↑ fibrillation (irregular electrical pattern)mostcommon the beingbradycardia doesn't always healthyMustlearnperson history 25  main Cardiac Output (Q)  Q=HR X SV  Only important during exercise farolderppl  Qmax decrease ~1%/year starting 30 canslevdownless  ↓ HR & SV and ↑ resistance w endurance ex  Resting Q stays same Justnot asbigthreshold for ex 26  Pulmonary System w/ Age Stiff rib cage 1. Thoracic kyphosis, costo-vertebral joint stiffness→ ↓ ribcage expansion) can effectshlder themtoo  20% ↑ work of breathing  ↓ lung expansion 2. ↓ respiratory muscle strength 3. ↓ surface area of lung tissue  ↓ # alveoli  ↑ size of remaining alveoli (wasted ventilation) 4. ↓ airway diameter and stiffness 5. ↑ lung stiffness 6. Altered lung volumes/capacities  ↓ FEV1 of air after a testbreath in Notmainsair as quickly  RV ↑ 30-50% residual volume  Vital Capacity ↓ 40-50% 27  Ventilation / perfusion mismatch  Ideally 1:1  Because of stiffening of vasculature and lungs, older adults have worse matching (more wasted air/blood flow)wastingair or wastingblood physiologicshut branch less when bloke I I nite IF I no bleedsupply 1 normal atIlgnyhanfedied min.hn physiologicdeadspace 13 28 normal  beuz Q Overall  Decline in Vo2max (~1%/yr)after 30 W decline0.5 exerciseonly  Worse w/o training Age-related decrease in Vo2m ax 5.00 4.50 4.00 Vo2 3.50 3.00 y = 3E-07x 5 - 9E-05x 4 + 0.0107x 3 - 0.6209x 2 + 17.909x - 200.4 R2 = 0.9805 2.50 35 40 45 50 55 60 65 70 75 29 Age  Decade differences? Older we arethesteeperwedeclineBateofdenim whenhe'reolder Age-related decline in Relative Vo2max 40s 50's 60's 65 70's 60 Linear (40s) 55 Linear (50's) 214declin Vo2max (ml/kg/min) 50 Linear (60's) Linear (70's) 45 40 35 30 25 20 15 40 45 50 55 60 65 70 75 80 85 Age 30  Reasons centrally peripherally  Decreased CO (~30% at 80yrs)  Decreased HR (~.7 beats/year)  Decrease muscle mass (sarcopenia)  Decreased a-vO2diff 31  Weight and Body Fat %  Body weight increases until ’50’s, stabilizes until 70, and then declines  % body fat increase with age until 70  ~15% to ~30% (cited from 1987) couldbe bcuz morbidly 32 obesepplhavediedbythat age  Preferential accumulation in the abdominal region Olderppl carrymore fat viscerallyinstead of subcutaneous  Height  ↓1 cm/decade in 40 & 50s, More > 60 yrs, ♀>♂  Vertebral disc compression  Thoracic curve ↑ 33  Bone Mineral Density T-score sumeasureBMD DEXA T scoreis your scene comparedto 34 25410 thtic Below 3.5 fracture risk from 8 to 1840 Beth  Fracture risk depends on age, too. iiiii.it over so postmenopausalwomen White Asianwomen morethanblack Glucocorticoids a shhuemtidarthritis Smakingalcoholclose out 0128 Anorexia par nutrition Sedentary 35  Decline in Cognitive Ability Youdeduce what's happening infton Iritnson 36  Nerve Loss?  ~10% tissue loss from 30-90 yrs old 37  Neuroanatomy  Neurons lose dendritic branches and spines.less communication 38  Peripheral NS  Movement, Sensory Difficulties  Loss of motor neurons Go la   No loss until 60 yr old, then ~25% to 100yrs iii Most of those lost are large, myelinated (type II) it  Smaller motor neurons (decreased diameter)  Slower transmission  Increased motor unit size (1 nerve, more fibers)  Fewer MU (less dexterity) movementharder fin 39 Declining Physical Activity  Less physically active  Type/time spent may be same as young, but lower intensity 40 Increased Chronic Disease Risk  CVD, DM II, obesity, certain cancers  Osteoporosis, arthritis, sarcopenia  Physical activity significantly reduces this risk 41  Do older adults respond to exercise?  Regular physical activity increases average life expectancy Not life span maxamantpersoncanlive 42 Factors Influencing Functional Decline in Aging ppl are differentwhenold very  People differ widely in how they age and how they adapt to an exercise program  Combination of genetic and lifestyle factors contribute to variability 43 Acute Aerobic and Resistance Response Similar to Young Adults  BP control lowerBP  Fuel use usesugarbettercanget off DMI needs  Dissipation of heat don't tolerateheathell  But, ↓ exercise tolerance if large muscle exercise AND heat/cold stress  May be partially due to lower aerobic fitness levels  Once older people stop aerobic training, rapid loss of CV and metabolic fitness, whereas strength training- induced (neural) adaptations more persistent 44 Physical Activity and Successful Aging  Exercise Regularly  Positive Mental Attitude  Social Network  Low BP  Low BMI  Glucose tolerance  Low triglyceride & LDL & high HDL 45 Physical Activity Prevents Chronic Disease 1. CVD 2. Stroke 3. HTN 4. DM II 5. Osteoporosis 6. Obesity 7. Cancer: colon, breast 8. Cognitive impairment dementia 9. Anxiety and depression 46 Physical Activity as Therapeutic Intervention  CHD  COPD  HTN  PVD  DM II  Obesity  High cholesterol  Osteoporosis  Osteoarthritis bloated  Claudication peripheral arteries are Lacticacidbuildup pplcangetcramping 47 Health Benefits of Long-Term Physical Activity: Strong Evidence  Lower risk of:  Early death  Coronary heart disease, stroke  High blood pressure, adverse lipid profile  Type 2 diabetes Can have itlaterthanparents  Cancers: Colon and Breast  Prevention of weight gain  Weight loss (with reduction of caloric intake)  Prevention of falls  Depression, cognitive function (older adults) 48  Aerobic Athletes 1. Body composition fatigueresistant 2. ↑ Oxidative and FR enzymes 3. ↑ Transport/use O2 4. ↑ SV heartisbigger 5. ↓ CV/met stress 6. ↓ coronary risk 7. ↑nerve conduction velocity 8. ↓disability 49  Resistance-trained Athletes  Less research  ↑ muscle massever.si  Leaner losefat  ~30-50% stronger Compared to AETatb  ↑ muscle mass  ↑ bmdbeanerydensity  ↑ strength/power older ppl needmoreprotein 50 1 1.5 s 14g BENEFITS OF EXERCISE TRAINING IN SEDENTARY  Vo2max: increase 0-30% (50 - 80 yr old) trained decline around 30 untruind Even to ex youngpplvarnax ul age sheeth 51  CV Effects – after > 3 months, mod-intensity  ↓ HR(rest & submax)  ↓ BP w/ exercise  ↑ (a-v)O2  ↑ cardioprotection HDL total cholesterol 52 Aerobic Exercise Training (AET)  ↓ total body fat  Counteracts age-related declines in BMD  Walking 3-5 days/week X 1 year  No to modest effect  Stairs, walking w/ weighted vests, jogging  More sig effects on BMD Addingut or impact 53 Resistance Exercise Training (RET) loss of strength ismajor component 1. ↑Strength (> 100%) of aging 2. ↑ Power (Torque X velocity) 3. Quality (perf X mass)how smoothlymuscle moves lessjerkymovement  Similar to young adults 4. Endurance  Scant evidence- reqs mod/high intensity 5. Body Comp – reqs mod/high intensity 6. Bone – high-intensity preserves or improves (1-2%) compared to sedentary 7. Metabolic - mixed 54 Strength/Power – Yes.  Very profound improvements Mostly neural   Attenuation of YEAR decrease in Type II  Less hypertrophy than young but still can counterparts  Adaptations more persistent when training stopped (similar to young adult) 55 BALANCE TRAINING  Tai Chi effective in ↓ injurious falls in people at risk for falls 56 Stretching and flexibility Training  Small # of studies  Some evidence that flexibility can ↑  How much/what types of ROM exs? 57 Exercise and ADLs  Effect of exercise on physical performance is poorly understood resistancetraining  RET impacts walking, chair stand, balance activities  Specificity of training –  Importance of prescribing higher-velocity movements using activities that mimic ADL 58 EXERCISE AND PSYCHOLOGICAL HEALTH  ↓depression/anxiety  ↑ self-esteem  ↓cognitive decline/dementia  Walking speed related to signs of neuro disease  QOL ?  Psychological health and well-being  High-intensity RET effective for depression 59 PHYSICAL ACTIVITY GUIDELINES Not responsible for all orgs onlytodays guidelines 60  The Exercise Training Paradigm Early guidelines & recommendations (AHA 1972, 1975, ACSM 1978, 1990) were based primarily on endurance exercise to enhance performance - especially cardiorespiratory fitness. Vigorous exercise ≥ 20 min ≥ 3 x week TRAINING PERFORMANCE RATIONALE: Increases in aerobic capacity are most rapidly achieved by increasing the intensity of endurance exercise and higher aerobic capacity is associated with reduced risk of CVD 61 Background - Physical Activity and CVD Prevention  In 1992 the American Heart Association made physical inactivity their 4th. major CHD risk factor (added to cigarette smoking, high blood pressure and high cholesterol).  In 1996 a NIH Consensus Development Panel concluded that physical inactivity was a major, independent risk factor for CHD.  In 1996 in Physical Activity and Health: A Report of the Surgeon General it was concluded that physical inactivity was a major, independent risk factor for CHD. 62  The Physical Activity - Health Paradigm Public health oriented guidelines since 1995 (CDC/ACSM, Surgeon General Report, NIH consensus panel). include the accumulation of ≥ 30 minutes of moderate intensity activity on most days Eii of the week & vigorous recommendation still applies.now ACTIVITY HEALTH RATIONALE: Data from observational and experimental studies demonstrate health-related outcomes from moderate intensity activity accumulated throughout the day. 63 Rationale to Update 1995 and 1996 Recommendations  Since 1995 substantial amount of new research published on health benefits of physical activity - some of it stimulated by 1995 recommendations.  There were a number of questions raised by how the the 1995 recommendations were stated.  Recommendations from other organizations were creating confusion, especially about the amount of exercise recommended - especially recommendations dealing primarily with prevention of unhealthy weight gain, weight loss and weight regain. 64  Dietary Guidelines for Americans - 2005 USDHHS & USDA, January 2005 PHYSICAL ACTIVITY  To reduce the risk of chronic disease in adulthood engage in at least 30 minutes of moderate-intensity physical activity, above usual activity on most days of the week.  For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration.  To help manage body weight and prevent gradual, unhealthy A body weight gain in adulthood: Engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days while not exceeding caloric intake requirements. 65  Dietary Guidelines for Americans - 2005 USDHHS & USDA, January 2005 PHYSICAL ACTIVITY (continued)  To sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity.  Achieve physical fitness by including CV conditioning, stretching exercises for flexibility, & resistance exercises or calisthenics for muscle strength & endurance. 66  CDC and DHHS - an Issue Regarding Federal Physical Guidelines  In 2002 development of update to 1995 PA & PH recommendations started by CDC and ACSM.  In 2006 when advanced draft of the two manuscripts were reviewed by CDC, they were required to obtain DHHS approval.  DHHS & CDC decided not to issue new recommendations because Federal Physical and Health Recommendations existed - as part of the Dietary Guidelines for Americans - 2005.  ACSM and AHA proceeded with publications of the updated 67 recommendations in 2007. Physical Activity Recommendations for Healthy Adults ≥ 65 Years of Age (ACSM/AHA 2007)  Aerobic Activity: ≥ 30 minutes of moderate intensity on 5 days/week or ≥ 20 minutes of vigorous intensity on 3 days/week. to dfurpr.gg  Muscle-strengthening activity: 8-10 exercises @ 10-15 reps performed on 2 non-consecutive days to reduce overuseinjury  Flexibility exercises: 10 minutes on ≥ 2 days/week(60 seconds)  Balance promoting activity: should perform activities that help maintain balance and prevent falls. ask.it iti.n  Other: more activity = greater benefit, can combined moderate with vigorous to meet goals, safety needs to be considered 68  Physical Activity Guidelines for Americans - 2008 Adults and Older Adults (DHSS)  All adults should avoid inactivity. Some activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.  For substantial health benefits, adults should do at least 150 minutes of moderate-intensity, or Itmt 75 minutes of vigorous-intensity activity each week (Public Health Target) 69 Physical Activity Guidelines for Americans - 2008 Adults and Older Adults  Mix moderate and vigorous intensity activity to meet the aerobic activity goal (500 - 1000 MET-minutes/week).  Aerobic activity can be accumulated in bouts of 10 minute or longer (e.g., 3 x 10 minutes/day)  Resistance exercise should be performed 2 x week: 1-2 sets (10-15 repetitions) of 8-10 exercises of major muscle groups.  Start low, build slowly - the major goal is long-term maintenance. 70  Persons With Disabilities Regular physical activity provides health benefits – Cardiovascular, muscular fitness olderpplrespond exactly – Improved mental health thesameasyounger ppl – Ability to do tasks of daily life In consultation with health-care provider – Understand how disability affects ability to do physical activity – If unable, adapt activity program to match abilities – Matching may require modifications such as: Using arm ergometer or wheeling on bike path 71 People With Chronic Health Conditions Provides many health benefits Type and amount of activity determined by person’s ability and the severity of health condition Should be under care of health-care provider Consult health-care provider about types and amounts of activity appropriate for them 72 73