2. Exercise Programs In The Elderly : Risks and Benefits Constance Bayles, Ph.D.; FACSM Program Director Center for Healthy Aging “A Center for Disease Control Prevention Center” Graduate School of Public Health University of Pittsburgh Pittsburgh, Pennsylvania

3. Exercise Programs In The Elderly Presentation Outline Pathophysiology Benefits: Physiological/Psychological Preliminary Program Guidelines Exercise Testing and Prescription Medications and Exercise Programming Position Stands: CDC (HAN Group)/ACSM Summary/Conclusions/Questions and Answers

4. Exercise Programs In The Elderly Physical Decline Normal Aging Disease Disuse

5. Exercise Programs In The Elderly Physical Frailty A state of reduced physiological reserves associated with increased susceptibility to disability.

6. Exercise Programs In The Elderly Frailty Extreme Old Age Disability Multiple Chronic Disease/Geriatric Syndromes Multiple Medications

7. Exercise Programs In The Elderly Frailty Frail Older Adults: Dependent Acute Illnesses Falls and Other Injuries Recover from Illness/Injuries Slowly Institutionalized or Hospitalized

8. Exercise Programs In The Elderly Frailty Increased Mortality/Morbidity Increased Physical Decline Functional Impairment

9. Exercise Programs In The Elderly 12.6 million people have coronary heart disease 1.1 million people suffer from a heart attack in a given year 50 million people have high blood pressure American Heart Association. 2002 heart and stroke statistical update. Dallas, TX: American Heart Association, 2001.

10. Exercise Programs In The Elderly 17 million people have diabetes 90% to 95% of cases are type 2 diabetes, associated with obesity and physical inactivity approximately 16 million people have “pre diabetes” Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2000. Atlanta, GA: U.S. Department of Health and Human Services, CDC, 2002.

11. Exercise Programs In The Elderly 107,000 people are newly diagnosed with colon cancer each year American Cancer Society. Cancer facts & figures 2002. Atlanta, GA: American Cancer Society. Inc. 2002 Vainio H, Bianchini F. Eds. Weight control and physical activity. IARC Handbooks of Cancer Prevention. IARC Press Vol 6, 2002

12. Exercise Programs In The Elderly 300,000 people suffer from hip fractures each year Popovic JR. 1999 National Hospital Discharge Survey: Annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Statistics 13(151).2001

13. Exercise Programs In The Elderly 50 million adults (age 20-74) are obese 61% of the adult population are either obese or overweight

14. Exercise Programs In The Elderly Research has shown that all individuals, regardless of age can benefit from regular physical activity, vigorous or moderate Mobility and functioning in older adults, including the frail, can be improved through physical activity Regular physical activity reduces morbidity and mortality from chronic diseases

15. Exercise Programs In The Elderly Physical Inactivity for U.S.Men and Women

16. Exercise Programs In The Elderly Physiological Changes Cardiovascular Respiratory Nervous System Musculoskeletal Renal Metabolic Systems

17. Exercise Programs In The Elderly Physiological Benefits Increased Cardiovascular and Cardiorespiratory Function Increased Muscle Mass, Strength, & Efficiency Increased Flexibility,Coordination, and Balance Decrease Cholesterol Levels Improve Weight Control and Nutrition Aides Digestion & Reduces Constipation

18. Exercise Programs In The Elderly Psychological Benefits Decreased Anxiety and Tension Increased Self-Esteem Increased Energy Level Better Sleeping Patterns Improved Socialization Improved Quality of Life

19. Exercise Programs In The Elderly Preliminary Program Guidelines Medical History Medication History Social History Exercise History Participant Consent Physician Consent Physiological Assessment Psychological Assessment

20. Exercise Programs In The Elderly Exercise Tests/Physiological Assessments Walk Bicycle Strength Balance Flexibility Functional Performance Tests

21. Exercise Programs In The Elderly Exercise Tests/Psychological Cognitive Tests Depression Health Perception

22. Exercise Programs In The Elderly Purpose of Exercise Testing To Establish A Degree of Risk Associated With Exercise To Establish Appropriate Intensities For Exercise To Review Individual Objectives

23. Exercise Programs In The Elderly Factors Influencing Exercise Low Oxygen Capacity (VO2) Increased Fatigability Increased Need to Monitor Poor Balance Decreased Strength Less Ambulatory Ability Poor Coordination Decreased Cognitive Status

24. Exercise Programs In The Elderly Medications and Exercise Polypharmacy/Self Medication Renal Excretion of Chemicals is Reduced IMPORTANT Know Medications and Side Effects

25. Exercise Programs In The Elderly Exercise Program Mechanics Start Low Go Slow Monitor Signs and Symptoms Decrease Workload If Needed Monitor Progress Provide Variety Motivate Make Exercise Fun

26. Exercise Programs In The Elderly Exercise Prescription Reflects Medical Needs Reflects Social Needs Primary Goal: Increase Functional Capacity and Independence Program: Individualized and Progressive Compliance: Important Issue

27. Exercise Programs In The Elderly Exercise Prescription Mode Intensity Duration Frequency Rate of Progression

28. Exercise Programs In The Elderly Parts of the Exercise Program Warm-Up Stimulus Cool Down

29. Exercise Programs In The Elderly Exercise Monitoring Heart Rate Blood Pressure Weight Ratings of Perceived Exertion (RPE)

30. Exercise Programs In The Elderly Risks and Contraindications To Exercise Abnormal Heart Action Pain/Pressure in the Chest Dizziness/Lightheadedness Poor Coordination Flare Up of an Arthritic Condition Nausea/Vomiting Extreme Breathlessness Muscular Pain Unusual Fatigue Mental Confusion

31. Exercise Programs In The Elderly Environmental Concerns Room Temperature Water Intake Meal Time Clothing

32. Exercise Programs In The Elderly CDC Position Stands “The CDC states that regular physical activity offers substantial improvements in health and well-being for the majority of Americans. Moderate physical activity performed on most days of the week can substantially reduce the risk of dying from heart disease, the leading cause of death in the United States and can reduce the risk of developing colon cancer, diabetes and high blood pressure.”

33. Exercise Programs In The Elderly CDC Position Stands Provides scientific and technical support to the states, national organizations, and professional groups to promote physical activity National Physical Activity Initiative is the primary focus. Reflects CDC commitment to reduce major risk factors for chronic disease in the United States

34. Exercise Programs In The Elderly HAN (Healthy Aging Network) University of California at Berkeley University of Colorado University of Illinois, Chicago University of North Carolina University of Pittsburgh University of South Carolina University of Washington – Lead Center CDC Healthcare and Aging Studies Branch

35. Exercise Programs In The Elderly CDC HAN (Healthy Aging Network) Mission Statement The mission of the Healthy Aging Research Network is to better understand the determinants of healthy aging in older adult populations; to identify interventions that promote healthy aging; and to assist in the translation of such research into sustainable community-based programs throughout the nation. Healthy aging is the development and maintenance of optimal physical, mental and social well-being and function in older adults. It is most easily achieved when physical environments and communities are safe and support the adoption and maintenance of attitudes and behaviors known to promote health and well-being; and by the effective use of health services and community programs to prevent or minimize the impact of acute and chronic disease on function.

36. Exercise Programs In The Elderly ACSM Position Stand, 1998 Exercise and Physical Activity for Older Adults Regular exercise reduces/prevents functional decline associated with aging Endurance training can maintain/improve cardiovascular function Strength training offsets loss of muscle mass Exercise can improve bone health, improve postural stability, increase flexibility and range of motion Reductions in risk factors improve health and affect life expectancy

37. Exercise Programs In The Elderly Summary Conclusions Questions & Answers Thank You! Have a Great Day!