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07/15/2009 - Articles

Exercise Programs - a Primer

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Introduction

Older people are repeatedly told about the benefits of physical exercise - how it can help in losing weight, lower blood pressure, improve cholesterol levels, lower blood sugar and slow down osteoporosis.

Unfortunately, practical advice is often lacking. The US National Institute on Aging has published a 110-page booklet to help inform people on this subject, and have made a version of it available on the Internet. This summary is intended to introduce the most important topics, giving links to the corresponding pages on the WEB site.

To begin with, people often wonder if it's safe to start exercising at an advanced age. In fact, there are few health reasons to discourage the elderly from exercising. In particular, chronic diseases, such as diabetes or even heart failure, need not be a barrier so long as they are under control. Exercise can actually improve such conditions, when done correctly with the full approval of your physician. Much more on this can be found in an easy-to-read format at: http://weboflife.ksc.nasa.gov/exerciseandaging/chapter2.html . There is a helpful list of checkpoints you can use to see if you need to contact your physician before continuing with your exercise program. Any man over 40 or woman over 50 should talk to their physician before starting any vigorous physical activity, whether it is endurance or resistance training.

Endurance Exercise

Quite often, carrying out simple activities like making beds, dressing or undressing may use 50% of an elderly person's maximal physical capability. In other words, their cardiovascular ability (or aerobic capacity) has declined with age, so that exertion beyond a certain level causes a lack of adequate oxygen circulation. Aerobic capability can be increased by appropriate exercise, thereby greatly improving functional ability, maintaining independence and the quality of life. (It will also help with weight control, if that's a problem). To be really effective, aerobic exercise must be sustained for 15 to 20 minutes at a time; this should build up to gradually, starting with 5 minutes of endurance activity. The goal should be a total of at least 30 minutes of endurance exercise, on most or all days of the week. Simple instructions are given at: http://weboflife.ksc.nasa.gov/exerciseandaging/chapter4_endurance.html .

A new participant starts gradually, proceeding from moderate to vigorous exercise, if their physician approves. Moderate exercise includes recreational sports like swimming, cycling and tennis, as well as some energetic activities around the house - mowing or raking the lawn, or scrubbing floors. Examples of vigorous exercise are climbing hills (or stairs), shoveling snow, skiing, hiking and jogging. Whatever the activity, you should incorporate an adequate warm-up and stretching period before starting, and ensure a cool-down and stretching period afterwards.

It's important to do enough exercise, but not to overdo it. There are several ways to "dose" the right amount of endurance exercise. The best makes use of your calculated target heart rate (THR).

The THR is a common way of judging how hard you should exercise during endurance activities. It tells you how fast the average person should try to make his or her heart beat during endurance sessions. Making it beat faster than the upper end of the range is not advisable.

It's not always best for older people to decide how hard to exercise, because many have long-standing medical conditions or take medications that change their heart rate. If this applies to you, check with your doctor about how to plan your endurance exercise.

DO NOT use the THR method if you take medications that change your heart rate, you have a pacemaker for your heart, you have an irregular heart rhythm called "atrial fibrillation," or you have any other condition that affects your pulse rate.
Any of these situations can give you inaccurate readings. For example, many older persons take medications of a type called "beta blockers" for high blood pressure or some heart conditions. Some eye drops used to treat glaucoma also contain beta blockers. Your doctor can tell you if your heart, blood-pressure or eye medicine is a beta blocker, or if you have any other conditions or medications that will affect your pulse rate during exercise

The target heart range for a 75 year-old with an Resting Heart Rate (RHR) of 88 is calculated as follows:

  • 220-age = Maximal Heart Rate (MHR): 220-75 = 145
  • MHR-RHR= Heart Rate Reserve: 145 - 88 = 57
  • Take 30% and 45% of Heart Rate Reserve: 30% x 57 = 17 / 45% x 57 = 26
  • Finally, add these numbers to the Resting Heart Rate (RHR): 88 + 17 = 105 / 88 + 26 = 114

 

This person's target heart rate range would be between 105 and 114
Calculate your Target Heart Rate (THR)

Another method is to use the Rating of Perceived Exertion Scale (RPE). You rate your perception of overall effort, according to a scale ranging from 7 - "very, very light", through 13 - "somewhat hard", to 19 - "very, very hard". You start low on the scale, and work up to a higher level. However, the RPE scale should not be used alone for regulating exercise intensity in older persons; you should supplement it by checking your pulse at intervals, to see that you are still within your target range.

A simple additional check is the talk-sing test. If you can't talk comfortably during exercise, you are probably exercising in the vigorous range. On the other hand, if you can sing a song, you are not really exerting yourself enough.

Initially, people should start their exercise program in a supervised setting. You should stop endurance exercising promptly if you have any chest pain, dizziness, severe shortness of breath, extreme fatigue, or pain in your legs. Take ample fluids, and avoid extremes of heat or cold when exercising.

Strength Exercise

Strength training is increasingly recognized as playing an important role in the health of the elderly.

People lose 20% to 40% of their muscle tissue as they get older. Strength or resistance exercises help restore this muscle tissue, and improve flexibility, coordination and balance. They can also help with weight control (though not to the same extent as endurance training). Increased muscle strength can protect vulnerable joints and the lower back, and resistance training can slow the loss of bone that occurs in osteoporosis. Most strength exercises involve lifting or pushing a weight against gravity, repeated a number of times (reps); the weight and the number of repetitions determine the effort expended. Usually two or three "sets" of 8 to 15 reps are done for each muscle group.

Participants should do resistance training on two or more days a week, but they should not exercise the same muscle group on any two days in a row. Starting with a minimum weight, 8 reps/set initially are increased gradually to 15 reps/set. Then the weight is increased slightly, with a drop back to 8 reps/set. The effort should feel hard to very hard (15 to 17 on the RPE scale). One should breathe out during the main effort part of the lift (or push), and breathe in during the return movement. Slow movements are better than fast - e.g. 3 seconds for the lift/exhale, 1 second hold, 3 seconds for the lower/exhale. Specific exercises are given at the site: http://weboflife.ksc.nasa.gov/exerciseandaging/chapter4_strength.html. .

As with aerobic exercise, warm-up and stretching before, and stretching after the training session is important. Don't exercise if it produces pain anywhere. Difficulties can usually be avoided by increasing weights and reps slowly, and emphasizing correct breathing.

Balance Exercises

Falls in the elderly are common causes of hospitalization and disability. Balancing exercises, which are often modified leg and hip strength exercises, can help prevent falls. One goes through the leg and hip exercises, gradually releasing the hand holds. Such exercises are given at the site: http://weboflife.ksc.nasa.gov/exerciseandaging/chapter4_balance.html

In recent years, Tai Chi, a gentle form of ancient Chinese martial arts, has gained acceptance as a program that is especially beneficial in improving balance in the elderly. Tai Chi should only be started if your physician finds that you are healthy enough to undertake a regular exercise program, and you train with an approved instructor.

Stretching Exercises

Stretching exercises often seem to be an unnecessary, boring preliminary to the real exercise you are going to do. In fact, they are very important. Muscles tend to shorten during exercise, and stretching reduces the risk of muscle cramps. Each stretch should be held for at least 10 seconds (just beyond what is comfortable) and there should be no "bouncing", which only increases the muscle tension by stimulating the "opposite" muscles. Examples of suitable stretching exercises can be found at: http://weboflife.ksc.nasa.gov/exerciseandaging/chapter4_stretching.html

If you can't do endurance or strength exercises for some reason, stretching exercises offer an alternative. Again, you should get your physician's approval first. Certain conditions (e.g. after hip replacement, or osteoporosis) demand great care in designing such exercises. They should be done at least 3 times a week, for about 20 minutes each session. Prior warm-up is then necessary - walking or arm-pumping. To start with, a stretch exercise program must be supervised, until you are sufficiently experienced to do it at home.

Links

  • If you want to read the entire on-line version of the National Institute of Aging Exercise Guide, click here

More articles about Cholesterol

Created on: 01/30/2002
Reviewed on: 07/15/2009

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