1. Aging & the Preventitive Role of Exercise

2. DEFINITION OF AGING
Everyone from newborn to super senior citizen (old - old) ages.
Old and aging depends on the age and experience of the speaker.
Chronological age - number of years lived
Physiologic age - age by body function
Functional age - ability to contribute to society

3. CHRONOLOGICAL CATEGORIES
Young-Old - (ages )
Middle-Old - (ages )
Old-Old - (age 85 and older)

4. PHYSIOLOGICAL THEORIES OF AGING
What causes the body to age?

5. PROGRAM THEORY
Cells replicate a specific number of times and then die. Happens again, and again in lab experiments.

6. ERROR THEORY The structure of DNA is altered as people age
Due to alterations, DNA not read correctly
Results in transcription and translation malfunction
Results in aging/illness/ cancer directly, or indirectly

7. Normal wear and tear causes cells to function improperly
CELLULAR THEORY
Normal wear and tear causes cells to function improperly

8. FREE RADICAL THEORY
Lipids in cell membranes are exposed to radiation or free radicals
Cell membrane ruptures and cell dies
In test tubes this actually occurs

9. NUTRITIONAL MODEL THEORY
If animal fed 50-60% less than it eats on its own - lives longer
Assumption: Lean mass, as opposed to adipose tissue results in greater health

10. COLLAGEN THEORY OF AGING
As we age, collagen in body ages also. Causes hypertension and other organ malfunctions

11. MUTATING AUTO-IMMUNE THEORY
Cells have normal functions - secrete normal proteins
As cells age - mutate and secretions viewed as foreign by body
Solicits immune response
Shuts cell down
Cause biological errors and entire organ malfunctions

12. NEURO-AGING THEORY All cells undergo nervous system degeneration
Results in changes in hormonal release
Leads to decline in cell function

13. NONE OF THESE THEORIES TOTALLY ACCEPTED
Scientists hypothesize it might be combination of several or all

14. PHYSIOLOGICAL AGING OF THE HUMAN BODY BY SYSTEMS

15. RESPIRATORY SYSTEM Lungs become more rigid
Pulmonary function decreases
Number and size of alveoli decreases
Vital capacity declines
Reduction in respiratory fluid
Bony changes in chest cavity

16. CARDIOVASCULAR SYSTEM
Heart smaller and less elastic with age
By age 70 cardiac output reduced 70%
Heart valves become sclerotic
Heart muscle more irritable
More arrhythmias
Arteries more rigid
Veins dilate

17. REPRODUCTIVE SYSTEM Male: Reduced testosterone level
Testes atrophy and soften
Decrease in sperm production
Seminal fluid decreases and more viscous
Erections take more time
Refractory period after ejaculation may lengthen to days

18. REPRODUCTIVE SYSTEM Female: Declining estrogen and progesterone levels
Ovulation ceases
Introitus constricts and loses elasticity
Vagina atrophies - shorter and drier
Uterus shrinks
Breasts pendulous and lose elasticity

19. NEUROLOGICAL SYSTEM
Neurons of central and peripheral nervous system degenerate
Nerve transmission slows
Hypothalamus less effective in regulating body temperature
Reduced REM sleep, decreased deep sleep
After 50 lose 1% of neurons each year

20. MUSCULOSCELETAL SYSTEM
Adipose tissue increases with age
Lean body mass decreases
Bone mineral content diminished
Decrease in height from narrow vertebral spaces
Less resilient connective tissue
Synovial fluid more viscous
May have exaggerated curvature of spine

21. Preventitive Exercise and Aging

22. SWBAT Develop an understanding of normal aging.
Incorporate various types of exercise into prevention first and then treatment plans for the elderly.
Pre-exercise assessment by doctor and/or therapist.

23. Exercise and aging physiology

24. Notable Physiological Changes with Aging
Decreased -
Muscle mass
Muscle strength
Muscle power
Muscle endurance
Muscle contraction velocity

25. Decreased Physiological Changes with Aging
Maximal and submaximal aerobic capacity
Cardiac contractility
Maximal heart rate
Stroke volume and cardiac output
Nerve conduction velocity
Balance
Proprioception
Gait velocity
Gait stability
Insulin sensitivity
Glucose tolerance
Immune function
Bone mass/strength/density
Collagen cross-linkage, thinning cartilage, tissue elasticity

26. Physiologic Questions
Increased
Arterial stiffness
Myocardial stiffness
Systolic blood pressure
Diastolic blood pressure
Visceral fat mass
Total body fat
Intramuscular lipid accumulation

27. Use It or Lose It
Sedentary people lose large amounts of muscle mass (20-40%)
6% per decade loss of Lean Body Mass (LBM)
Aerobic activity not sufficient to stop this loss
Only resistance training can overcome this loss of mass and strength
Balance and flexibility training contributes to exercise capacity

28. What is exercise? Lifestyle Choices Sports Play House Chores
Activitive work
Lawn and Gardening

29. Increase Muscle Mass Endurance training emphasis
Walking isn’t enough
Progressive resistance training
DM prevention?
Dependency prevention?
Falls and fractures
Disuse
Sarcopenia
Frailty

30. Use it or Lose It or Use It and Lose Less of It
Resistance training improves strength by a range of
40-150%
Lean body mass increases 1-3 kg
Muscle fiber area 10-30%

31. Body composition Genetic, lifestyle and disease factors
Metabolic, cardiovascular and musculoskeletal systems impacted
Lifestyle is under patient’s control
Weight management

32. Burning Fat Decreases in total body adipose (fat) tissue
Aerobic and resistive training
Energy restricted diets and/or high volume exercise (5-7 hours/week)
Visceral fat selectively mobilized

33. Exercise and prevention

34. Diabetes and Osteoporosis
Insulin Resistance
Improves insulin sensitivity
Detraining may reduce exercise effect
Primary prevention demonstrated
Osteoporosis prevention and treatment
Stabilization or increase in bone density in pre- and postmenopausal women with resistive or weight bearing exercise
1-2% per year difference from controls

35. Dyslipidemia Not a lot of data in elderly
No clear primary and secondary prevention data
Exercise associated with less atherogenic profiles
Duration and frequency factors
Weight loss (or fat loss) associated with increased HDL
Gender differences with training
Less training effect on HDL in women

36. Hypertension Most trials cross sectional and cohort
Lower pressures in active individuals
5-10 mmHg
Type and intensity
Greater training effect in those with mild to moderate hypertension
6-7 mmHg drop in systolic and diastolic pressure
Effect present in low-to-moderate exercise

37. CVD Exercise training beneficial in CVD
Reduced claudication pain
Greater walking distance
Improved functional endpoints
Benefit in selected patients with coronary artery disease.

38. Arthritis Improved functional status Faster gait Lower depression
Less pain
Less medication use
Strength and endurance training benefit

39. Cancer Potential protective benefits with Breast Cancer Colon Cancer
Prostate

40. Exercise treatment of chronic disease
May treat symptoms and disuse and not the underlying disease
Parkinson’s
COPD
Claudication
Chronic renal failure
May reduce recurrence of disease
CVD
Falls

41. Exercise and emotional health and well being

42. Emotional Well Being
Genetic, social, personality, and psychological constructs
Leading cause of death and disability in developed countries

43. Exercise and Mental Health
Positive psychologic attributes
Lower prevalence and incidence of depressive symptoms
Reversal of hippocampal volume loss?
Reversal of cognitive loss?
Increased aerobic and resistance training
Higher intensities
Meaningful improvements in depression

44. Exercise and disability

45. Function relates to strength
Non-linear relationship between strength and function
Concept of Threshold
Physically active patients at baseline less likely to develop disability
Exercise improves functional limitations
Functional balance tasks
Gait speed
Arthritis

46. Exercise and Longevity

47. Exercise Evaluation

48. Contraindication
A contraindication is a specific situation in which a drug, procedure, therapy and/or surgery should not be used because it may be harmful to the person.
There are two types of contraindications:
Relative contraindication means that caution should be used when two drugs or procedures are used together. (It is acceptable to do so if the benefits outweigh the risk.)
Absolute contraindication means that event or substance could cause a life-threatening situation. A procedure or medicine that falls under this category must be avoided.

49. Contraindications Relative Acute illness Undiagnosed chest pain
Uncontrolled diabetes
Uncontrolled hypertension
Uncontrolled asthma
Uncontrolled CHF
Musculoskeletal problems
Weight loss and falls
Absolute
Inoperable Aortic Aneurysm
Cerebral aneurysm
Malignant ventricular arrhythmia
Critical aortic stenosis
End-stage CHF
Terminal illness
Behavioral problems

50. Exercise Prescription
Modes
General activities
Aerobic
Walking
Sports
Anaerobic exercise
Resistance
Supervision/technique
Benefit with one set
Flexibility
Static stretch
Balance
Risk assessment
Dynamic and static balance
Mode governed by:
Duration
30 minutes
Frequency
Most days
Intensity
55-75% of MHR
M/HR

51. ACSM guidelines for healthy aerobic activity
Exercise 3-5 days each week
Warm up 5-10 minutes before aerobic activity
Maintain intensity for minutes
Gradually decrease intensity of workout, then stretch to cool down during last 5-10 minutes
If weight loss is goal, 30 minutes five days a week

52. Aging and Aerobic Capacity
Peak between 15-30
Declines with age
Approximately 10% per decade after age 25-30
Masters Athletes: 5% per decade
Overall: 0.55 decline per year in VO2 max
Anaerobic threshold: occurs at lower work rates

53. Benefits of Regular Physical Activity
Cardiovascular health
Cholesterol, HDL, LDL, VO2, RHR
Muscular health
Strengthens bone
LBM enhanced/preserved
BMR improved/maintained
Endurance/strength improves

54. More Benefits of Regular Physical Activity
Reduces health risks associated with obesity
Enhances insulin action
Reduces body fat
Reduces cancers risk
Reduces susceptibility to infections
Improves peristaltic functions
Fewer injuries
Reduced health care costs
Psychological health
Stress and depression
Improved QOL

55. What’s fat got to do with it?
Metabolic syndromes
Sleep apnea
Vascular disease
Breast cancer
Osteoarthritis
Colon cancer
Gallbladder disease
Endometrial cancer
Diabetes
Impotence
Hypertension
Dyslipidemia
Depression
 elevation of plasma cholesterol
Overall Disabilities