Exercise For Older Adults With
Chronic Diseases |
People older than 65 years constitute one of
the fastest growing population segments. This age group
also exhibits the greatest proportion of chronic disease,
disability, and healthcare utilization. Coronary artery
disease, high blood pressure, heart failure, diabetes, arthritis,
osteoporosis, and cognitive disorders are a few of the more
common diseases that become more prevalent as people age.
Regular exercise has been proven to benefit
overall health and function of individuals of all ages. Moreover,
risk factors for chronic disease respond to exercise interventions
in younger adult populations. The same is most likely
true for older adults. Unfortunately, inactivity tends
to increases as people age. There is a perception that
chronic disease is a part of the normal aging process, and
that elderly cannot respond to lifestyle interventions; both
of which are false. People who adopt lifestyle modifications,
including exercise, can expect an increase in life expectancy,
decrease in disability, and reduced healthcare costs.
Here is a review of some common chronic
diseases, and the impact of regular exercise on the course
of each disease (Please note, people with chronic disease(s)
should consult their primary care doctor prior to initiating
any exercise program!):
Cardiovascular
Disease
Sedentary lifestyle is a risk factor for
cardiovascular disease. Clinical studies have shown that
higher activity levels can reduce blood pressure, total cholesterol
and LDL ("bad") cholesterol, as well
as triglycerides. Also, exercise has been proven to increase
HDL ("good") cholesterol.
Hypertension
The maintenance of an optimal body weight,
along with regular exercise will help to lower blood pressure. The
best exercises for people with high blood pressure include
aerobic exercises, such as walking, swimming, dancing, or jogging. It
is recommended to start off slowly, doing aerobic exercises
for 30 minutes, three times a week. The 30 minutes can
be in one segment, or broken up into smaller segments. The
optimal benefit for patients with high blood pressure is seen
with 50-60 minutes of moderate aerobic exercise 3-4 days a
week. This amount of exercise has been proven to reduce
blood pressure more effectively than more vigorous exercise. Also,
it has not been proven that weight-training exercises can lower
high blood pressure. Be aware that if a regular exercise
program is adopted, you may need to reduce your blood pressure
medication doses, once again reiterating the importance of
staying in close contact with your primary care physician if
you decide to begin exercising.
Heart Failure
In years past, bed rest was recommended
for patients with heart failure. The last two decades,
however, have seen a dramatic change in how these patients
are treated in regard to physical activity. Although
several questions remain to be answered, it is generally accepted
that mild aerobic exercise as well as mild resistive exercises
(with weights) improves endurance, blood flow to the legs,
breathing, and heart failure symptoms.
Recommendations for specific exercises
include mild aerobic exercises (walking, swimming) in combination
with one to three sets of resistive exercises (12-15 repetitions
per set). These resistive exercises should initially
be done with minimal weight, in the large muscle groups (legs). Add
smaller muscle groups (arms) later. Once 15 repetitions
can be done on a weight, resistance can be increased.
New research shows that interval training
may benefit heart failure patients. This involves alternating
short bursts (30 seconds) of maximal aerobic exercise with
60 seconds of rest for 10-20 cycles. This is a relatively
new practice, and refinements may be expected.
Diabetes (Type 2 - Adult
Onset)
There is a strong association between aging
and the development of glucose intolerance. There is
evidence that this may be due to an increased level of inactivity. Regular
exercise may reduce the incidence of the development of Type
2 diabetes. Physical activity in established diabetics
promotes cardiovascular fitness as well as increases insulin
sensitivity, which may in turn decrease the needed dosage of
a patients oral hypoglycemic medications.
Mild aerobic training for prolonged periods,
such as walking, seems to be more effective than high-intensity
training (such as running) for short periods of time. This
accompanied by diet compliance, hydration management while
exercising, glucose monitoring, proper footwear, and adequate
warm-up and cool-down periods are all essential components
of the diabetic exercise program. As with high blood
pressure medications, exercise may alter the dosage or oral
hypoglycemic medications needed to maintain proper glucose
levels.
Osteoarthritis
Older adults with osteoarthritis can see
improvements in pain control, proprioception (balance), strength,
flexibility, and endurance with exercise. However, pain
often limits how much exercise a person with arthritis can
do. Bracing, stretching, doing fewer repetitions, and
appropriately using analgesia people can increase their exercise
tolerance.
Range of motion and strength exercises
are both important for the arthritic patient. Strength
training can be either isotonic (weight lifting) or isometric
(muscle contraction without joint movement). Also, try
non-weightbearing exercises (water aerobics, swimming, cycling). Watch
for activity that is too vigorous. If joint pain lasts
for more than two hour after exercise, this is a sign you have
over done it.
Osteoporosis
Approximately 30 % of postmenopausal women
have osteoporosis. There is controversy concerning exercise
for preventing postmenopausal bone loss. Studies show
that exercise (walking, running, aerobics) significantly reduce
bone mineral loss in the lumbar spine, but not in the forearm
or femur. It is generally accepted that exercise does
reduce hip fracture, if not by increased bone mineralization,
by increasing muscle strength. Even older adults with
low levels of activity have few hip fractures than those who
were inactive.
The best treatment to treat osteoporosis
is combining therapies. Exercise, plus calcium supplementation
and possibly hormone replacement therapy are options. Exercises
should include weight bearing activities like low impact aerobics
and walking.
Cognitive Disorders
Studies have shown that improvements in
cognition (memory, attention, reaction time, and intelligence)
occur in older participants in aerobic fitness programs. Safety
is the primary issue in exercise programs for older adults
with cognitive deficits. Injury prevention secondary
to proper attire, optimal environmental conditions, and simple
equipment are essential. Also, supervision is a must. Chair
exercises with household items (a knotted towel), accompanied
by familiar music is effective at promoting patient participation
and functional gains.
Summary
In summary, exercise for older adults with
chronic disease can help to improve the symptoms they are experiencing. By
working with their doctors, older adults may be able to develop
an exercise program that will reduce their symptoms, and increase
their functional capacity. |
