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exercise for seniors

see exercise prescribing & exercise testing minimal amount of exercise to prevent mobility disorders is 50 minutes/week [10] Adverse effects: - very vigorous activity > 9 MET hours/week (running at an 8 minute per mile pace or faster, high-intensity interval training, cross-country skiing uphill) is associated with progression in coronary artery calcification [28]* * vigorous activity 6-9 MET hours/week is associated with attenuation of coronary artery calcification [28] Management: Types of recommended exercise for seniors - aerobic exercise - 20-30 minutes 3-4 times/week - moderate intensity aerobic exercise at least 30 minutes/day 5 days/week (150 minutes/ week) even in patient with walkers [10] - vigorous exercise at least 25 minutes 3 times/week (75 minutes/week) [10] - aerobic exercise & resistance training (40 minutes) twice a week improves fitness as much as more frequent exercise in elderly women [9] - 50 minutes of exercise per week mimumum necessary to prevent difficulty with mobility in ensuing 2 years in elderly 70-90 years [10] - exercise 4 times per week maximizes activity-related energy expenditure [9] - long-term, moderate-intensity physical activity reduces major mobility disability among at-risk older adults more effectively than a health education program [13] - aerobic exercise improves executive function in adults (20-67 years), with older adults seeing greater improvements [22] - Walking at least 4400 steps daily might help improve survival in older women; promoted goal is 10,000 steps/day [23] - strength training (resistance training, weight training) - > 2 days/week for 20-30 minutes - supervised, high-intensity free weight training is safe in the elderly & more effective than low-intensity training in improving functional performance [1] - progessive resistance training in the elderly improves muscle strength, mood, morale, & quality of life [2] - weight lifting exercise improves subjective sleep quality, depression, strength, & quality of life without significantly changing habitual activity in the elderly [3] - adults >= 65 years should do multicomponent physical activities that focus on functional balance & strength training >= 3 times a week (WHO) [26] - resistance training with elastic bands in wheelchair-bound nursing home patients may improve ability to perform activities of daily living, reduce incidence of depression & improve sleep efficiency [16] - significant antidepressant benefits observed for moderate to vigorous physical activity at doses below current recommendations for overall health [30] - greater doses of physical activity are associated with greater benefits [30] - exercise benefits cognition in elderly - both aerobic exercise & resistance training improve cognitive function in elderly women [10] - executive function with largest benefit - combination better than either alone - women benefit more than men [10] - exercise benefits for cognition in men & women > 50 years of age [19] - aerobic exercise, resistance training , training with multiple components, & tai chi all beneficial [19] - cognitive benefits observed with moderate-intensity exercise that last 45-60 minutes [19] - greater late life moderate-to-vigorous physical activity may protect against late-life structural brain abnormalities, via cerebrovascular mechanisms [27] - flexibility - 10 minutes of stretching daily [10] - balance training - >= 3 days/week [10] - approach that incorporates walking biomechanics & coordination more effective than general exercise [20] - combined walking, strength training, balance & flexibility moderate-intensity exercises may benefit elderly [21] - whole-body vibration training may improve lower limb muscle strength & physical performance in older adults [29] * adequate nutrition, including adequate protein Clinical trials: - Health, Aging & Body Composition Study - PrAISED randomized clinical trial: - an intensive program of exercise & functional activity training did not improve activities of daily living, physical activity, or quality of life; reduce falls; or improve any other secondary health outcomes in elderly (80 years) with mild cognitive impairment or early dementia, despite good compliance [31] Notes: - consider risk of falls in the elderly [10] - regular exercise decreases cardiovascular & non-cardiovascular mortality in older adults (GRS9) [10] - no cardiovascular benefits from starting exercise in sedentary elderly (mean age = 79 years) [18] - improvements in functional mobility noted [13] - home exercises 3x/week + 30 minutes walking twice weekly in elderly >= 70 years who have fallen in the prior year reduces fall risk from 2.1 to 1.4 per person-year [24] - sustained physical activity in the very old improves cognitive function [5,7,8] - moderate or high physical activity is associated with a reduced incidence of cognitive impairment in the elderly [11] - persistent engagement in physical activity may have beneficial effects on psychomotor processing speed [12]

Related

exercise & Alzheimer's disease geriatrics

Specific

whole-body vibration training (WBVT)

General

exercise

References

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  23. Lee IM, Shiroma EJ, Kamada M et al Association of Step Volume and Intensity With All-Cause Mortality in Older Women. JAMA Intern Med. Published online May 29, 2019. PMID: 31141585 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734709
  24. Liu-Ambrose T, Davis JC, Best JR et al Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall. A Randomized Clinical Trial. JAMA. 2019;321(21):2092-2100 PMID: 31162569 https://jamanetwork.com/journals/jama/article-abstract/2735075
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  29. Tan X, Jiang G, Zhang L et al. Effects of Whole-Body Vibration Training on Lower Limb Muscle Strength and Physical Performance Among Older Adults: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil. 2023 May 10:S0003-9993(23)00242-3 PMID: 37169245
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  31. Harwood RH, Goldberg SE, Brand A et al. Promoting Activity, Independence, and Stability in Early Dementia and mild cognitive impairment (PrAISED): randomised controlled trial. BMJ. 2023 Aug 29;382:e074787. PMID: 37643788 PMCID: PMC10463053 Free PMC article. https://www.bmj.com/content/382/bmj-2023-074787