(12/8/07)- New guidelines of minimal recommended exercise for maintaining health and lowering the risk of disease in older adults have been issued by the American College of Sports Medicine and the American heart Association. The guidelines make allowances for individualized physical activity levels for those with functional limitations or chronic conditions.

The activity should involve the large muscle groups (e.g., walking, running, cycling, and swimming). The level of intensity (target heart rate) for this physical activity should be at least 55% to 65% of your maximum heart rate. (You can estimate your maximum heart rate by subtracting your age from 220.) You can quickly determine if your intensity is too high by taking the "talk test"; if you cannot maintain a conversation with your exercise partner while exercising, then your intensity is too high.

The Surgeon General has determined that lack of physical activity is detrimental to your health and recommends moderate activity: 150 calories per day or 1000 calories per week. Cardiovascular fitness improvement is dependent upon the exercise program (mode, frequency, duration, and intensity of exercise) as well as the individual participant (fitness level, age, and health status). "Regular exercise can provide tremendous health benefits, but more than half of Americans don’t get enough physical activity," said AMA President Ronald M. Davis, M.D., FACPM. "We encourage patients and physicians to work together to incorporate physical activity into a patient’s daily routine and better protect their health."

The minimum recommendations are divided into 5 categories: moderate intensity, vigorous intensity, muscle strengthening, flexibility activity and balance exercise. The latter is for those persons who have substantial risks of falls. Moderate intensity activity is defined as those exercises that noticeably accelerate heart rate and cause one to break a sweat while still being able to carry on a conversation. Moderate exercise should be done for 30 minutes 5 days per week. It could be broken up into 10-minute periods.

Vigorous intensity physical activity guidelines indicate they need to be done for 20 minutes at least 3 days per week. The vigorousness of the activity is relative to the fitness level of the individual. The perceived exertion is rated on a scale of 1 (resting) to 10 (all-out effort).

The guidelines provide various exercises that can be used for muscle strengthening that can be done 2-3 non-consecutive days per week, doing 8-10 exercises with 10-15 repetitions each. The goal of these exercises is to prevent loss of muscle mass and bone as well as balance for older adults at risk for falling.

If you are not currently exercising, please consult your physician before beginning any exercise program. Consistency is the key to success in any exercise program; choose an activity that you enjoy and are likely to continue throughout your adult life.

(2/17/07)-The National Heart, Lung and Blood Institute (NHLBI) has published a guide offering information on physical activity to maintain a healthy heart. The guide can be downloaded free from the NHLBI Web site at http://www.nhlbi.nih.gov or ordered from its Information Center by calling 301-592-8573.

(11/17/06) P.K. Garg and his group in a multisite study appearing in the journal Circulation 2006; 114:242-248 indicate that exercise reduces functional decline in those with peripheral artery disease (PAD) and furthermore that it increases longevity. Participants were 460 men and women with PAD (mean age 71.9±8.4 years) followed up for 57 months. At 57-month follow-up, 134 participants (29%) had died, including 75 participants (33%) who wore accelerometers. In conclusion, the researchers state: " PAD patients with higher physical activity during daily life have reduced mortality and cardiovascular events compared with PAD patients with the lowest physical activity, independent of confounders. Further study is needed to determine whether interventions that increase physical activity during daily life are associated with improved survival in patients with PAD."

(10/14/06) The literature continues to support the maxim that exercise can be a buffer to handle the aging process. Venkatra and Fernandes (Aging Clin Exp res 1997; 9:42-46) analyzed epidemiological studies and showed that life-long exercise has a positive effect on life-expectancy by decreasing total mortality, while overweight has opposite effect.

Siebens and colleagues "designed a study to test whether a hospital initiated exercise program could improve hospital outcomes in medical and surgical patients aged 70 years and older." They tested the primary hypothesis "that the hospital program would help patients recover more quickly and thereby reduce their length of hospital stay. They also "expected that the additional prescribed home program would yield better functional and physical health outcomes at one month after discharge. They found that "an exercise program started during hospitalization and continued for one month did not shorten length of stay but did improve functional outcome at one month. (Siebens, H, Aronow DE, Ghesemi Z. A Randomized Controlled Trail of Exercise to Improve Outcomes of Acute Hospitalization in Older Adults. J. Am. Geriatr. Soc. 2001;48:1545-1552.)

Researchers have shown that the multiple effects of disease on muscle include muscle atrophy, with loss of myofibrillar protein, inability of motor center in the brain to recruit motor neurons and increased fatigability of these motor units that remain functional. The mechanism of this loss in strength may be decreased muscle protein synthesis. This decreased protein synthesis can be inhibited with resistance training.

The MacArthur Study of Successful Aging followed 1186 healthy individuals between 70 and 79 years of age for 7 years looking for factors that could account for successful aging. The selected subjects underwent a 90-minute personal interview that included a detailed assessment of physical and cognitive capabilities, overall health status, and social, lifestyle, and psychological characteristics. The subjects were then followed for an average of seven years, from 1988/89 through 1995/96, through periodic interviews, to monitor their status as they aged.

Lung function (peak flow) proved important in impeding physical decline in older age. Also, those who followed a schedule of regular physical activity, either moderate or strenuous, were only half as likely to show physical decline as those who were inactive. Lung function and lung capacity are influenced by physical activity. Most interesting was the finding that the benefit of moderate walking and strenuous physical activities was equal.

Also good news is the fact that even participants who had chronic conditions when they began the study experienced the protective effects of exercise and socialization. So it truly never is too late to adapt healthy life habits.

(12/27/03)- Recent studies have determined that exercise improves the health of both older and younger individuals. According to a study published in the Journal of Gerontology "Elderly men not only can tolerate these very high workloads, but will exhibit muscular changes similar to their younger counterparts." Scientists at Ohio University in Athens, Ohio performed some tests on healthy men who kept active, but did not perform regular weight training exercises.

The men did 10 repetitions at 50% of the maximum they could lift at one time. They then performed three sets of six to eight repetitions at 80% to 85% of their one-time maximums. The men did this twice a week. Another group of healthy men did no weight training exercises at all. The exercise capabilities of both groups were similar at the beginning. After 16 weeks the group that did the weight training exercises averaged 50% better on extension, 72% better on the press and 84% better on the half squats. The hearts of the men who performed the weight training had to work less hard at a given intensity in the treadmill test. Leg muscle strength increased up to 84% over 16 weeks among men ages 60 to 75 that did weight-training exercises.

A free, 100 page illustrated exercise guide for persons age 50 and older is obtainable from National Institute of Aging. Its called "Exercise: A guide from the NIA". You can call toll free 1-800-222-2225 or
order by email <NIAinfo@access.digix.net.>

Peripheral Arterial Disease (PAD) affects nearly nine million Americans and is a potentially dangerous condition. It is estimated that only 12% of the people with this disorder are being treated. It effects primarily the peripheral circulation in the legs and feet, causing pain and tingling during physical activities. Fatty deposits, not allowing for oxygen-rich blood to get to the leg and feet muscles, are blocking arterial circulation. The result is painful leg cramps (claudation) generally in the calf of the leg.

PAD can be prevented, reduced or even eliminated by exercising, modifying your diet or stopping smoking. Physician should be consulted at the first signs of these symptoms and therapeutic steps to be taken. This is one of those disorders where exercise may prove helpful.

Remember that people vary in terms of the kinds and amount of exercise needed to maintain a healthy status. You have to consider your needs, your medical status as well as physiological status. Physical fitness is an adaptive state, composed of three different components: cardiovascular fitness, musculoskeleton function and body composition (body fatness and metabolic factors). There are four components to a physical fitness program: warm-up, muscle conditioning, aerobics and cool down. Warm-up includes stretching and walking. Muscular conditioning includes calisthenics and weight training. Aerobics include walking, jogging, swimming, dancing, stair stepping. Cool down includes walking and stretching.

Always start an exercise program at a low level and use slow to moderate progression making for gradual adaptation. By setting up intermediary goals that are obtainable, you usually can motivate yourself to continue in a exercise program. Make it as enjoyable and refreshing as possible. By cultivating a positive attitude toward exercise, you enhance the probability of long-term adherence. Consult your physician before starting any exercise program.

Research in the area of exercise suggests that the initial exercise program emphasize stretching and low level muscle conditioning exercises. Recommended is a combination of walking and jogging or fast and slow walking performed on a regular basis three to five times per week.

For those individuals who have not exercised in a long time, the recommendation is to restrict your initial exercise to 5 to 15 minutes per session, and so it twice per day until you begin to feel comfortable with the exercise program.

It is known that physical activity protects against the development of coronary heart disease, stroke, hypertension, obesity, non-insulin dependent diabetes mellitus, osteoporosis, some cancer and even clinical depression.

Exercise involves the transformation of chemical energy stored in muscles into mechanical energy. As this stored chemical energy is used up, new sources of this chemical energy must be tapped to regenerate the energy. This involves muscular glycogen and triglycerides as well as circulatory glucose and fatty acids from adipose tissue. The result is improved functional capacity of your body that can delay the infirmities of disabilities of old age. All this improvement can be measured and is reflected in functional improvement of the enzyme system, augmented blood flow in skeletal muscles due to increased diameters of blood supplying arteries, as well as increased numbers of capillary vessels.

Behaviorally, you don't tire as easily as you did before exercising and you have more energy, thus enabling the body to maintain, repair and improve itself.

Recent studies indicate the importance of physical exercise in the elderly as a way of retarding the process of physical degeneration and enhancing the quality of life of the elderly. The goal is to maintain muscle tone as well as retard the development of chronic diseases. A study appearing in the Archives of Internal Medicine (2003; 161: 2565-2571) is a prime example of the role of physical exercise in maintaining functioning.

What was especially significant about this study was that it followed a group of women over 14 years (prospective study), while most studies do not extend out more than one year. The population studied consisted of 229 women, mean age 74.2, who were involved in a randomized controlled walking intervention (about 7 miles per week) from 1982 to 1985 and were subsequently followed up until 1999. The researchers were able to complete an evaluation of 171 women in person and 17 over the phone (total 188 out of the original 225).

The researchers evaluated data collected at three points over the 14 years (1985, 1995, and 1999). This involved a physical activity questionnaire and a physical activity monitor. At the end point of the study, 1999, the functional status of the women was assessed by self-report and performance based measures. The findings were: "Women who were always active had the best functional status and women who were always inactive had the worst functional status." This study, done by Jennifer S. Brach and her group, concluded: "There exists a significant relationship between physical activity during a 14 year period and current functional status in older women thus suggesting that physical activity plays a role in maintaining functioning."

Before starting any physical exercise program, consult your medical doctor. Set reasonable goals for yourself. Be consistent in your exercise program. It may help to have a companion do the exercise with you.

Reference
Brach JS., Fitzgerald S., Newman AB., Kelsey S., et al. Physical Activity and Functional Status in Community Dwelling Older Women: A 14 year Prospective Study. 2003; 163:2565-2571.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"

Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated December 8, 2007

http://www.therubins.com

To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com

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