Chapter 3 ResistanceTraining Strategies for Older Adults Copyright

Advantages of Resistance Training • Helps modify aging patterns • Helps stabilize health profiles

Obstacles to Resistance Training • Multiple chronic medical conditions • Limited access to appropriate

Prevalence of Aging • More than 35 million Americans over age 65 – Approximately

Frail Older Adults Constitute • • 50 percent of all hospital care 80 percent

Physiology of Aging • Pervasive loss of fat-free mass – Skeletal muscle • Increases

Sarcopenia • Age-related loss of skeletal muscle mass and strength • Progressive atrophy of

Risks of Increased Body Fat • Predisposition to metabolic-based morbidities • Predictor of disability,

Cardiovascular Changes • Stiffening of large central arteries • Heart exerts more effort –

Inflammation • Caused by many non-cardiac diseases – E. g. , chronic obstructive pulmonary

Benefits of Resistance Training • Allays muscle weakening/atrophy – Can stimulate muscle growth •

Benefits of Resistance Training • Diminishes frailty • Preserves and/or restores more youthful, generally

Positive Impact on Aerobic Power • Facilitates increases in overall physical activity • Enables

Positive Impact on Sarcopenia • • • Increases fiber size Increases muscle mass and

Positive Impact on Body Fat • Fat reduction • Increased muscle mass leads to

Positive Impact on Body Fat • Enhanced insulin sensitivity in skeletal muscle decreases inflammation

Other Positive Impacts of Resistance Training • Bone mineral density – Increased muscle strength

Training Goals for Frail Adults • Slow progression of weakening/disability • Regain capacity for

Training Goals for Frail Adults • Begin with basic, simple movements – – Warm-up

Training Goals for Frail Adults • Advanced – Add resistance tubing, ankle weights, and

Training Goals for More Robust Adults • Include strategies to achieve maximum increases in

Exercise Prescription Strategies for Older Adults • ACSM guidelines use Borg scale of perceived

Exercise Prescription Strategies for Older Adults • Robust older adults can begin at lower

Exercise Prescription Strategies for Older Adults • Emphasize muscles in lower and upper extremities

Exercise Choices • Exercise machines – Provide greater safety – Make it easier to

Exercise Choices • Free weights – – Offer greater accessibility Provide cost advantages Require

Factors Influencing Exercise Prescription • • • Time of day Proper clothing and footwear

Factors Influencing Exercise Prescription • Rhythmic movements performed at moderate-to-slow, controlled speed through full

Factors Influencing Exercise Prescription • Use of unilateral movements to increase balance and decrease

Effects of Cardiovascular Diseases on Exercise Prescription • Program must include: – Clinical assessment

Effects of Cardiovascular Diseases on Exercise Prescription • Typically safer than aerobic training due

Barriers to Resistance Training • Fear of precipitating cardiac event or causing injury •

Barriers to Resistance Training • • Lack of transportation Poor nutrition Lack of sleep

Overcoming Barriers • Requires stepwise, individual approach • Apprehension – Education to prevent injuries

Overcoming Barriers • Sensory impairment – – Visual aids and signs with large fonts

Overcoming Barriers • Economic – Most challenging barrier to overcome – Classes offered in

Home-Based Exercise • Unsupervised • “Exercise & Physical Activity: Your Everyday Guide from the

Home-Based Exercise • Barriers to success: – Frail adults require personal instruction – Periodic

Community-Based Exercise • Occurs in health or fitness center • Supervised • Social Copyright

Advantages of Community-Based Exercise • Incorporates components of assessment, monitoring, and safety • Social

Successful Resistance Training • For older adults, requires: – Social support and positive reinforcement

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Advantages of Resistance Training • Helps modify aging patterns • Helps stabilize health profiles – Mitigates frailty • Helps preserve and (possibly) enhance functional capacity, vitality, and quality of life Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Obstacles to Resistance Training • Multiple chronic medical conditions • Limited access to appropriate programs or qualified instruction • Fear of injury • Logistical obstacles • Economic barriers Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Prevalence of Aging • More than 35 million Americans over age 65 – Approximately 12 percent of total population • By 2030, 70. 3 million adults over age 65 – More than 20 percent of population • Older adults susceptible to frailty, disease, and dependency Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Frail Older Adults Constitute • • 50 percent of all hospital care 80 percent of home care services 90 percent of all nursing home beds US spent approximately 66 percent of $585 billion on health care in 2000 on older adults Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Sarcopenia • Age-related loss of skeletal muscle mass and strength • Progressive atrophy of skeletal tissue • Rate of loss accelerates after age 50 • Results in functional limitations – Impaired activities of daily living Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Risks of Increased Body Fat • Predisposition to metabolic-based morbidities • Predictor of disability, physical limitation, declining mobility/quality, and higher mortality • Combined with sarcopenia, increases overall morbidity and mortality Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Cardiovascular Changes • Stiffening of large central arteries • Heart exerts more effort – Pushing blood downstream • Increased cardiac workload causes: – Exercise intolerance – Increased susceptibility to instability Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Inflammation • Caused by many non-cardiac diseases – E. g. , chronic obstructive pulmonary (COPD), infections, arthritis • Detriment to functional capacity in elderly • Visceral fat common source of systemic inflammatory peptides Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Benefits of Resistance Training • Allays muscle weakening/atrophy – Can stimulate muscle growth • Reduces body fat, inflammation, and catabolism • Increases function Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Positive Impact on Aerobic Power • Facilitates increases in overall physical activity • Enables safe initiation of physical activity • Increases posture, joint stability, balance, flexibility, and bone strength • Improves capacity for activities of daily living Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Positive Impact on Sarcopenia • • • Increases fiber size Increases muscle mass and intrinsic strength Mitigates oxidative stress Increases protective heat shock proteins Contributes to pattern of increased overall activity that reduces ambient inflammation Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Positive Impact on Body Fat • Fat reduction • Increased muscle mass leads to higher levels of physical activity • Reduced visceral fat mitigates associated risks for insulin resistance and hypertension Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Other Positive Impacts of Resistance Training • Bone mineral density – Increased muscle strength stimulates bone homeostasis • Helps mitigate osteopenia • Vasculature – Beneficial to vascular health Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Training Goals for Frail Adults • Slow progression of weakening/disability • Regain capacity for activities of daily living • Emphasize safety and behaviors conducive to long-term progression Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Training Goals for Frail Adults • Begin with basic, simple movements – – Warm-up and stretching Instruction on balance and breathing Low-intensity resistance using body weight Short sets • One to two sessions per week Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Training Goals for Frail Adults • Advanced – Add resistance tubing, ankle weights, and other weights over time – Increase repetition number before resistance Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Training Goals for More Robust Adults • Include strategies to achieve maximum increases in muscle mass, muscle strength, and function • High-intensity regimens achieve beneficial muscle and metabolic changes • Benefits among men and women similar Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Exercise Prescription Strategies for Older Adults • ACSM guidelines use Borg scale of perceived exertion • Intensity ranges from 12 to 19, two to three days per week, up to one hour • Older adults can maintain these goals with key refinements – Particularly when frail Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Exercise Prescription Strategies for Older Adults • Robust older adults can begin at lower intensities of 12 to 13 and then advance to 15 to 16 • Frail adults may advance to intensities of 12 to 13 Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Exercise Prescription Strategies for Older Adults • Emphasize muscles in lower and upper extremities that facilitate standing, walking, lifting, and reaching Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Exercise Choices • Free weights – – Offer greater accessibility Provide cost advantages Require thorough teaching and monitoring May be difficult for frail older adults Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Factors Influencing Exercise Prescription • • • Time of day Proper clothing and footwear Appropriate warm-up and cooldown Static stretching for each muscle group Proper breathing – Avoiding/Minimizing Valsalva maneuver Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Factors Influencing Exercise Prescription • Rhythmic movements performed at moderate-to-slow, controlled speed through full ROM • Supervised training of proper technique • Length of sessions – Begin with short sessions – Only advance as stamina/comfort increase Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Factors Influencing Exercise Prescription • Use of unilateral movements to increase balance and decrease total amount of work • Allowance for rest, as needed • Use of Borg scale to gauge exercise intensity Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Effects of Cardiovascular Diseases on Exercise Prescription • Program must include: – Clinical assessment – Coordinated care with primary physician – Monitoring • Does not preclude participation in program Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Effects of Cardiovascular Diseases on Exercise Prescription • Typically safer than aerobic training due to slower heart rate • Contraindications – Signs/Symptoms of unstable cardiac conditions Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Barriers to Resistance Training • Fear of precipitating cardiac event or causing injury • Embarrassment over incontinence or lack of skill • Apprehension caused by hearing/visual impairments, cognitive slowing, and economic constraints Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Overcoming Barriers • Requires stepwise, individual approach • Apprehension – Education to prevent injuries – Seated exercises to help prevent falls Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Overcoming Barriers • Sensory impairment – – Visual aids and signs with large fonts Consistent room organization Proper lighting Loud and clear manner of speaking Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Overcoming Barriers • Economic – Most challenging barrier to overcome – Classes offered in senior centers • Help with transportation issues • Low-cost transportation options often unavailable to older adults Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Home-Based Exercise • Barriers to success: – Frail adults require personal instruction – Periodic reassessment necessary – Lack of emergency care Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Advantages of Community-Based Exercise • Incorporates components of assessment, monitoring, and safety • Social reinforcement means higher adherence to routine • Achieves significant increases in lean mass and muscle strength • Better suited for frail older adults Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.

Successful Resistance Training • For older adults, requires: – Social support and positive reinforcement from friends, family, and physician – Comprehensive management strategy to maximize recruitment, increase teaching and safety, increase motivation, and minimize attrition • Review sample 24 -Week Program Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.