Physical Activity Considerationsfor the
Older Adult
Introduction
Since the fitness revolution began in the 1970s, more and more people are enjoying the benefits of regular exercise. However, this revolution was primarily aimed at the young and fit and for the most part excluded one segment of society, the older adult. Only over the last few years has the number of older adults who regular exercise dramatically increased.

Ageing is associated with gradual deterioration in both physiological and psychological functioning, which may or may not lead to loss of independence.

Advancing age is generally associated with the development of several major chronic diseases (see table below), a lack of mobility and loss of independence. The aging process depends on many factors such as:

	Genetics
	Behavioural - smoking, drinking or late nights for example
	Nutritional ( a good nutrition intake can decrease the effects of fee radicals, for example that speed the aging process)
	Environmental factors - modern day living, pollution, reduced quality of food, exposure to chemicals in the from of beauty products etc.

However, many of the physical, psychological and social hazards linked to ageing can be slowed down, avoided or even reversed by remaining physically active.

Chronic Diseases Associated with Ageing
Cardiovascular:	Musculoskeletal:	Respiratory:
Coronary heart disease Hypertension	Osteoarthritis Rheumatoid arthritis Osteoporosis	Asthma Chronic Obstructive Pulmonary Disorder (COPD)
Metabolic:	Neurological:	Sensory:
Diabetes Obesity	Parkinson's disease Alzheimer's Disease	Visual disorders Auditory disorders

It is because of these reasons that extra screening may be necessary before providing an exercise programme for an older adult.

Several key issues need to be considered when working with an older individual. These include, knowledge of the effects of ageing, age related diseases, the physical and mental limitations to exercise participation and the many societal barriers (i.e. fear of going out) older adults' face to physical participation.

Age-Related Changes in Anatomy and Physiology

Skeletal:

	From 35 to 40 years of age there is a gradual loss of bone
	A reduction in joint range of movement (ROM), a thickening of ligaments, a loss of elasticity to connective tissue and muscles, and wear and tear to cartilage found on bone ends, thus leading to degenerative changes to joint structures

Neuromuscular:

	A large percentage of elderly find difficulty in simply standing from a seated position due to an age-related decline in muscle functioning.
	Ageing leads to a decrease in the number of functioning fast twitch muscle fibres and an increase in functioning slow twitch muscle fibres.

Cardio-respiratory:

	Cardiorespiratory function declines in response to aging
	A decline in VO2max is thought to be due to reduction in maximal heart rate and stroke volume. Fitness can be measured by the volume of oxygen you can consume while exercising at your maximum capacity. VO2max is the maximum amount of oxygen in millilitres, one can use in one minute per kilogram of body weight.
	Arteries and arterioles begin to lose their elasticity and are less capable of vasodilation. In response, blood pressure goes up due to an increase in peripheral resistance.
	Age-related lung function changes include, the stiffening of the thorax, a loss of lung elasticity and a loss of alveoli per unit of lung volume.

Body composition:

- after the age of 35, men and women tend to progressively add weight until the fifth and sixth decade. It is generally accepted that a person's body fat increases and lean muscle tissue decrease with age.

Posture and balance (postural control):

Decline in posture control is synonymous with ageing, this is evidenced by the high incidence of falls in the elderly (Spirduso, 1995).

Benefits of Physical Activity:

	Increase structural (bone) health.
	Increase muscle strength and mobility.
	Increased cardiorespiratory function.
	Reduced the risk of falling (see table below).
	Improved social functioning.
	Emotional and mental well-being.
	Improved self-efficacy.

General Exercise Recommendations

It is always advisable that older individuals obtain medical clearance from their doctor prior to exercise participation. Before designing an exercise programme for older individuals, I'll be considering the following:

	The older individual's circumstances (e.g. current health/fitness status, etc).
	We shall stop exercise immediately and seek medical assistance if symptoms of angina or MI occur during physical exertion.
	The intensity and duration of exercise will be considered.
	Good posture throughout will be encouraged .
	Aerobic, strength, balance and flexibility work will be included.
	Training in groups can provide for a social, fun and enjoyable experience.
	Longer warm up and cool down will be considered (sudden vigorous exercise or abruptly stopping strenuous exercise can unnecessarily stress the heart).
	Mobility exercises will be included (it takes longer time to lubricate joints).
	All of the major joints and muscles will be worked where possible.
	We should always be aware of balance issues (risks of falling).
	Medication may affect the exercise response.
	Stretch exercises will be applied with caution (joint conditions).
	We shall always use common sense and be patient.

Aerobic Exercise Recommendations
Frequency	3-5 sessions / week
Intensity	Resting Heart Rate (RHR) + 20 beats per minute up to 40 - 70% Heart Rate Reserve (HRR)
Time	20-30 minutes moderate activity
Type	aerobic physical activity, continuous or interval training. Low impact aerobics, walking, swimming, or cycling

Aerobic exercise considerations:

	Equipment that does not impose orthopaedic stress should be chosen.
	Walking is an excellent form of exercise for many older adults.
	Aquatic exercise for those who cannot tolerate periods of weight bearing exercise should be considered.

Resistance Training Exercise Recommendations:
Frequency	at least twice a week
Intensity	Form failure - 10-15 repetitions Perceived exertion rating 12-13
Time	At least 1 set per exercise, 8-10 exercises Complete a total body workout within 20-30 minutes
Type	All major muscle groups Machines/free-weights depending on ability

Resistance training considerations:

	We'll begin with minimal resistance to allow time for the older individuals to adapt.
	We will focussing on compound exercises.
	Older individuals will be instructed to maintain normal breathing patterns while exercising.
	All exercises shall be performed in a controlled manner.

Flexibility Recommendations:
Frequency	minimum of 2-3 x / week
Intensity	Incorporate slow movement, e.g. static to a position of mild discomfort.
Time	10-15 seconds per hold for maintenance. 10-15 seconds, repeated with 6-8 second contractions for development 3-4 repetitions for each stretch
Type	All major muscle groups used in the sessions and any hypertonic muscle

Resistance considerations:

	Stretching exercises should be preceded with some type of warm up.
	Bouncy jerky movements should be avoided.
	Do not stretch a joint beyond pain free (ROM).
	We shall gradually ease into each stretch.