Download Anatomic and physiologic changes with age

Chapter 5
Exercise for Senior Adults
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Aging
• Gerontology—the study of the aging process
• Chronologic age—a person’s age in years
• Biologic age—a person’s physiologic age based on level
of performance of various body systems
Chronologic age and biologic age are not
necessarily the same
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Lifestyle behaviors that influence health
and biologic age
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Anatomic and physiologic changes with
age
• Integumentary system
– Epidermis, dermis, and hypodermis thin
– Langerhans cells suffer from UV exposure
– Melanocytes diminish and become less active
– Number of nerve receptors declines
– Number of sweat glands drops
– Number of blood vessels diminishes
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Consequences of aging on skin
• Prone to injury
• Slow to repair
• Susceptible to infection
• Unable to regulate body temperature
• Likely to wrinkle
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Anatomic and physiologic changes with
age (cont’d)
• Skeletal system
– Bone mass diminishes
– Bone becomes brittle
– Intervertebral disks compress
– Articular cartilage wears away
– Sprains, bursitis, and arthritis become more common
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Anatomic and physiologic changes with
age (cont’d)
• Sprains
– Occur when connective tissues associated with joints are
overstretched
• Bursitis
– Occurs when bursa sacs associated with joints become
inflamed
• Arthritis
– Occurs when joints become inflamed
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Anatomic and physiologic changes with
age (cont’d)
• Osteoarthritis
– Also known as degenerative arthritis
– Long-term use wears down articular cartilage
– Loss of cartilage can expose bone surfaces
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Osteoarthritis
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Anatomic and physiologic changes with
age (cont’d)
• Rheumatoid arthritis
– An autoimmune disease
– Immune cells attack the synovial membrane
– Synovial membrane produces a grainy synovial fluid
– Grainy fluid abrades articular cartilage
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Anatomic and physiologic changes with
age (cont’d)
• Muscular system
– Number of blood vessels, myoglobin, and
mitochondria drops
– Number of myofibrils decreases
– Glycosomes disappear
– Number of fast and intermediate fibers decreases
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Anatomic and physiologic changes with
age (cont’d)
• Nervous system
– Total number of neurons drops
– Neurotransmitter levels decrease
– Brain size diminishes
– Memory, hearing, balance, vision, smell, and taste
acuity are impaired
– Reflexes slow
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Anatomic and physiologic changes with
age (cont’d)
• Endocrine system
– Gland size and activity change
• Thymus gland
• Pituitary gland
• Parathyroid glands
• Pancreas
• Pineal gland
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Anatomic and physiologic changes with
age (cont’d)
• Cardiovascular system
– Changes in blood vessels
• Blood vessels develop plaque
• Elastic arteries lose elastic fibers
• Venous valves weaken
• Total number of blood vessels diminishes
• Blood pressure tends to increase
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Anatomic and physiologic changes with
age (cont’d)
• Cardiovascular system (cont’d)
– Changes in heart
• Elasticity of heart wall decreases
• Heart valves thicken
• Heart can atrophy or hypertrophy
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Anatomic and physiologic changes with
age (cont’d)
• Respiratory system
– Coughing reflex slows
– Macrophages in lungs become less active
– Mucus thickens
– Number of cilia drops
– Other changes are directly proportional to exposure
to environmental pollutants
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Anatomic and physiologic changes with
age (cont’d)
• Lymphatic system
– Thymus shrinks
– Cytotoxic T cells become less active
– Macrophage activity slows
– Wound healing is delayed
– Ability to develop fever diminishes
– Inflammation occurs frequently
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Anatomic and physiologic changes with
age (cont’d)
• Digestive system
– Teeth are lost
– Gums become inflamed
– Medications can interfere with absorption
– GI tract lining thins
– Ability to produce secretions diminishes
– Risk of lactose intolerance increases
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Lactose intolerance
• Inability to digest lactose found in dairy products
• Lactose remains in GI tract lumen and attracts water
– Results in cramping and bloating
– GI tract bacteria ferment lactose and produce gas
• Promotes bone loss if other sources of calcium and
vitamin D are not consumed
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Managing lactose intolerance
• Consume dairy products in moderation
• Eat other food types along with dairy
• Take enzyme tablets with meals
• Consume enzyme-enriched foods
• Consume fermented products like yogurt
• Read food labels—many products contain lactose
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Anatomic and physiologic changes with
age (cont’d)
• Urinary system
– Kidney size diminishes as nephrons are lost
– Ability to remove wastes diminishes
– Reabsorption of water, glucose, and other useful
materials diminishes
– Urinary bladder loses elasticity
– Seniors become less sensitive to urge to void
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Anatomic and physiologic changes with
age (cont’d)
• Reproductive system
– Male
• Prostate gland enlarges
• Risk for prostate cancer increases
• Testosterone levels remain fairly stable
Protects bone tissue
Maintains secondary sex characteristics
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Anatomic and physiologic changes with
age (cont’d)
• Reproductive system (cont’d)
– Female
• Ovary structure changes
 Affects monthly cycle
 Affects hormone levels
• Estrogen levels drop significantly postmenopause
 Increases risk for heart disease and osteoporosis
 Might impair immune system functioning
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Precautions during exercise
• Inability to regulate body temperature
– Loss of blood vessels impairs radiative cooling
– Loss of sweat glands impairs evaporative cooling
– Loss of subcutaneous fat impairs heat retention in
cold environments
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Precautions during exercise (cont’d)
• Loss of range of motion
– Spine loses flexibility and stiffens
– Articular cartilage wears away, promoting
inflammation
– Synovial fluid production slows
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Precautions during exercise (cont’d)
• Decrease in lean tissue
– Also known as sarcopenia
– Accompanied by loss of strength
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Precautions during exercise (cont’d)
• Loss of balance
– Balance issues arise from loss of muscle mass,
weakened joints, and decreased flexibility
– Balance problems often promote falling
– Falling often results in broken bones
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Precautions during exercise (cont’d)
• Loss of cardiorespiratory functioning
– Heart’s functional ability declines
– Maximal heart rate drops
– Ejection fraction decreases
– Blood pressure rises
– VO2max decreases
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Barriers to exercise
• Fear of injury
• Lack of knowledge
• Lack of transportation to a facility
• Lack of skills, abilities, and confidence
• Physical limitations resulting from disease
• Limited income
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Benefits of exercise
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Exercise testing
• Use standard testing procedures for generally healthy
seniors
– Initial workload should be 2–3 METs
– Use a cycle ergometer for those with balance issues
– Be flexible during testing
– Be aware that exercise-induced dysrhythmias are
common in seniors
– Note that the ECG has higher sensitivity and lower
specificity in seniors than in younger populations
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Stop exercise testing if
• Systolic blood pressure drops by more than 10 mm Hg
from baseline despite an increase in workload
• Moderately severe angina develops
• Dizziness, incoordination, or loss of consciousness occur
• Cyanosis or pallor develop
• Subject requests to stop
• Ventricular tachycardia is sustained
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Exercise prescription
• Cardiovascular training
– Begin each session with at least 5 minutes of low-intensity
activity
– Encourage 30–60 minutes of activity (RPE = 5 or 6 on a 0
to 10 scale) on at least 5 days per week
– If high-intensity activity (RPE = 7 or 8), adjust frequency
to 3 times per week
– Avoid activities with rapid changes in direction
– Avoid high-impact activities
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Exercise prescription (cont’d)
• Resistance training
– Perform 1 set of 10–15 repetitions for 8–10 different
exercises targeting major muscle groups
– Intensity should be moderate (RPE = 5 or 6) to vigorous
(RPE = 7 or 8)
– Pay extra attention to body alignment
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Exercise prescription (cont’d)
• Flexibility training
– Stretch the hip, back, shoulders, knees, upper trunk, and
neck
– Hold static stretches at the point of tightness but not pain
for 15–30 seconds each
– Perform 2–4 repetitions per stretch
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Additional tips for exercise
• Avoid strenuous exercise during hot, humid weather
• Avoid exercise during flare-ups of arthritis or other chronic
conditions
• Encourage low-impact activities like walking, stationary
cycling, water aerobics, and swimming
• Limit high-impact activities like running, jumping, and
bouncing
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Sample exercise program
• Upper body strength training
– Chest press with elastic tubing
– Lateral pull-downs with elastic tubing
– Shoulder press with dumbbells
– Biceps curls on machine
– Triceps extension on cable machine
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Sample exercise program (cont’d)
• Lower body strength training
– Step-ups
– Squats
– Calf raises
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Exercise for the frail senior
• Warm up for 3–5 minutes
– Begin with seated marching, arms relaxed
– Tap toes to front then side
– Tap heels to front then side
– Add arm movements and repeat
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Exercise for the frail senior (cont’d)
• Strength training
– Split the workout into two sessions, 15 minutes each
(one in the morning, one in the evening)
– Work upper body one day; lower body another
– Participant’s weight might be adequate resistance
• If more intensity is needed, trainers can apply
resistance with their own hands
• Elastic bands or very light weights are also fine
• Sometimes practicing everyday activities is
sufficient
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Lower body strengthening exercise
• Sit-to-stand
• Single-knee extension on chair
• Seated single-leg curl
• Seated heel raises
• Seated toe raises
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Upper body strengthening exercise
• Chest flies using elastic tubing
• Seated row using elastic tubing
• Lateral shoulder raises
• Biceps curls with 1-pound dumbbells
• Triceps dips in a chair
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Nutritional considerations
• Water
– Important for body temperature regulation
– Often deficient because seniors lose sense of thirst
– Inadequate because seniors deliberately restrict
intake to avoid embarrassing incontinence
– Minimum recommendation is 6 glasses of water/day
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Signs of dehydration
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Carbohydrates, protein, fat
• Carbohydrates: minimum of 130 g per day
• Fats: 20–35% total daily intake
– AI for linolenic acid = 1.6 g per day for men and 1.1
g per day for women
– AI for linoleic acid is 14 g per day for men and 11 g
per day
• Protein: about 0.8 g of protein/kg of body weight
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Special concerns for the elderly
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Vitamins and minerals
• Vitamin B12 = 2.4 g per day
• Vitamin D = 10–15 g per day
• Calcium = 1200 mg per day
• Vitamin C = 90 mg per day for male seniors; 75 mg per
day for female seniors
• Vitamin E = 15 mg
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