Benefits and Contra-indications of Exercise Training in the Elderly
(9/14/09)- People who added about 60 minutes of mild exercise or 30 minutes of moderate exercise per week had increased levels of heart-healthy HDL, according to a study of more than 15,000 middle-aged black and white men and women. Researchers also found that whites had significant decreases in harmful triglycerides, women had improved levels of LDL cholesterol and black women had lower total cholesterol levels. The study was published in the Journal of Lipid Research
(11/23/99)- Everyday in our search of the professional literature, we reference research articles that indicate positive health and functioning as result of exercise. The research by Suzanne G, Leveille and her group at the National Institute of aging is an excellent example of what effects exercise has on aging and disability. She found "[P]hysical activity was a key factor in predicting non-disability before death. There was a twofold-increased likelihood of dying without disability among the more physically active group compared with sedentary adults. These findings provide encouraging evidence that disability prior to death is not an inevitable part of a long life but may be prevented by moderate physical exercise. (Italics added for emphasis.)
But when should the elderly avoid exercise? Certain medical conditions absolutely negate exercise. These conditions include:
There are other conditions that would contra-indicate exercise on a case by case basis, and should not be done unless you have medical approval. These conditions include:
In general, exercise should be considered as a robust adjunct to standard medical treatment where any disease or medical condition exists. It is not a matter of one or the other and the level of exercise will vary with the medical condition. Always consult your physician before any exercise training.
For healthy older adults, physical activity has a protective effect against disease and also enhances level of functioning. Exercise does not have to be strenuous. There are indications that moderate exercise improves sleep quality, decreases pain from arthritis, increases bone density, resting metabolism rate, lowers blood pressure in persons with hypertension and can improve plasma lipoprotein profiles. The big question is what is considered to be moderate. One study, of about 72,000 women aged 40 to 65, looking at the role of walking exercise, defined "brisk walking" as walking at least three miles in one hour. Vigorous exercise was defined as sports, jogging, heavy gardening etc. Exercises that built up a sweat would be considered vigorous. They also found that as little as an hour a week of brisk walking helped reduce heart attack risk.
The Reykjavik study by Agnarson and his group concluded "that in men, leisure time physical activity maintained after 40 years of age protected against ischemic stroke." A parallel study conducted in Northern Manhattan by Sacco and his group confirmed the relationship between leisure-time physical activity and ischemic stroke risk.
The word sarcopenia refers to a deficiency of relative skeletal mass. Muscle mass decreases with age (e. g. atrophy of the small muscles of the hand is encountered in 50% of the elderly) and is associated with impaired functional performance, increased physical disability and increased risks of falls. Physical inactivity has been proposed as an mechanism underlying muscle loss and physiological changes in elderly people. Protein synthesis in skeletal muscle is decreased as result of reduction in anabolic factors or an increase in catabolic factors. This muscle metabolism decrease reduces the amount of stored glycogen (protein synthesis in skeletal muscle is decreased) which causes the body to increase amino acid metabolism. To consume carbohydrates before or during exercise to improve your energy level puts this information into practice. It enhances the chances for better physical performance by elderly individuals.
With all this research on the role of exercise, one can only wonder why about 60% of our population are sedentary, putting themselves at risk for heart disease, obesity and diabetes.
See our article "Exercise and Disease"
References:
1. Agnarsson U., Gudmundur T., Sigvaldason H., Sigfusson N. Effects of leisure-time physical activity and ventilatory function on risk for stroke in men: The Reykjavik Study. Annuls of Internal Medicine 1999;130(12):987-990.
2. Leveille SG., Guralnik JM., Ferrucci L. & Langlois JA. Aging successfully until death in old age: Opportunities for increasing active life expectancy. Amer J. of Epidemiology 1999; 149(7): 654-664.
3. Sacco, RL. Gan R., Boden-Albala B., Lin IF., Karpman DE., Hauser WA., et al. Leisure-time physical activity and ischemic stroke risk: The Northern Manhattan Stroke Study. Stroke 1998:2049-2054.
4. Stuerenburg, H & Kunze K. Age effects serum amino acids in endurance exercise at the aerobic/anaerobic threshold in patients with neuromuscular diseases. Archives of Gerontology and Geriatrics. 1999;28:183-190
Other references:
1.Ettinger WH, Burns R, Messier SP et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: the Fitness Arthritis & Seniors Trial JAMA, 1997; 272:25-31 (Long term randomized trial indicates that resistance and aerobic exercise can reduce disability and pain in older people with arthritis, a major cause of disability in older adults.)
2. Aleari, Cathy A. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: Do sleep and agitation improve. Journal of the American Gerontology Society 47:784-791.
3. Muffet JK, Torgenson D, Bell-Syer S, Jackson D, Llewlyn-Philllips H, Farrin A, Barber J. Randomized controlled trial of exercise for low back pain: clinical outcomes, costs and preferences. British Medical Journal 1999; 3:279-283. (Exercise class was more clinically effective than traditional general practitioner management, regardless of patient preference and was cost effective.)
4. Butler RN, Davis R, Lewis CB, Nelson ME, Strauss E. Physical fitness: how to help other patients live stronger and longer. Part I of a round table discussion. Geriatrics 1998; 53(Sept): 26-40 and Part II Benefits of physical activity by age and level of function 46-62.
5. Lumsden, D(avid), Baccala A(ngelo), Martire J(oseph) T’ai chi for osteoarthritis: An introduction for primary care physicians. Geriatrics 1998; 53(2):84-88. ("Further investigation is necessary to clarify the specfific response participants have to T’ai chi training, but research to date has been suggestive of benefits…may help those suffering with osteoarthritis by strengthening the joint musculature and increasing range of motion and flexibility…an adjunct to standard treatment").
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated September 14, 2009
http://www.therubins.com
To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com