exercise for seniors
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Introduction
see exercise prescribing for 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 elcerly 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]
- both aerobic exercise & resistance training improve cognitive function in elderly women[10]
- 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
- 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]
- 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]
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 Seynnes O, Fiatarone Singh MA, Hue O, Pras P, Legros P, Bernard PL. Physiological and functional responses to low-moderate versus high-intensity progressive resistance training in frail elders. J Gerontol A Biol Sci Med Sci. 2004 May;59(5):503-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15123761
- ↑ 2.0 2.1 Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol A Biol Sci Med Sci. 1997 Jan;52(1):M27-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9008666
- ↑ 3.0 3.1 Singh NA, Clements KM, Fiatarone MA. A randomized controlled trial of the effect of exercise on sleep. Sleep. 1997 Feb;20(2):95-101. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9143068 A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol A Biol Sci Med Sci. 1997 Jan;52(1):M27-35. PMID: https://www.ncbi.nlm.nih.gov/pubmed/9008666
- ↑ Hirsch CH et al Physical activity and years of healthy life in older adults: results from the cardiovascular health study. J Aging Phys Act. 2010 Jul;18(3):313-34. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20651417
- ↑ 5.0 5.1 Liu-Ambrose T et al Resistance training and executive functions: a 12-month randomized controlled trial. Arch Intern Med. 2010 Jan 25;170(2):170-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20101012
- ↑ Venturelli M et al Positive effects of physical training in activity of daily living-dependent older adults. Exp Aging Res. 2010 Apr;36(2):190-205 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20209421
- ↑ 7.0 7.1 Stessman J Physical activity, function, and longevity among the very old. Arch Intern Med. 2009 Sep 14;169(16):1476-83 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19752405
- ↑ 8.0 8.1 Jackson AS, Sui X, Hebert JR, et al. Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med 2009; 169(19):1781-1787
- ↑ 9.0 9.1 9.2 Hunter GR, Bickel CS, Fisher G et al Combined aerobic and strength training and energy expenditure in older women. Med Sci Sports Exerc. 2013 Jul;45(7):1386-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23774582
- ↑ 10.00 10.01 10.02 10.03 10.04 10.05 10.06 10.07 10.08 10.09 10.10 Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019 - ↑ 11.0 11.1 Etgen T, Sander D, Huntgeburth U et al Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Arch Intern Med. 2010 Jan 25;170(2):186-93. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20101014
- ↑ 12.0 12.1 Rosano C, Venkatraman VK, Guralnik J et al Psychomotor speed and functional brain MRI 2 years after completing a physical activity treatment. J Gerontol A Biol Sci Med Sci. 2010 Jun;65(6):639-47. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20348185
- ↑ 13.0 13.1 13.2 Pahor M et al Effect of Structured Physical Activity on Prevention of Major Mobility Disability in Older AdultsThe LIFE Study Randomized Clinical Trial. JAMA. Published online May 27, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24866862 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1875328
- ↑ Elsawy B, Higgins KE Physical activity guidelines for older adults. Am Fam Physician. 2010 Jan 1;81(1):55-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20052963
- ↑ Morey MC, Peterson MJ, Pieper CF The Veterans Learning to Improve Fitness and Function in Elders Study: a randomized trial of primary care-based physical activity counseling for older men. J Am Geriatr Soc. 2009 Jul;57(7):1166-74. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19467149
- ↑ 16.0 16.1 Chen KM, Li CH, Chang YH et al. An elastic band exercise program for older adults using wheelchairs in Taiwan nursing homes: a cluster randomized trial. Int J Nurs Stud. 2015;52(1):30-38. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25037651
- ↑ Valenzuela T. Efficacy of progressive resistance training interventions in older adults in nursing homes: a systematic review. J Am Med Dir Assoc. 2012;13:418-428 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22169509
- ↑ 18.0 18.1 Newman AB et al. Cardiovascular events in a physical activity intervention compared with a successful aging intervention: The LIFE Study randomized trial. JAMA Cardiol 2016 Jun 29 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27439082 <Internet> http://cardiology.jamanetwork.com/article.aspx?articleid=2530563
- ↑ 19.0 19.1 19.2 19.3 Northey JM, Cherbuin N, Pumpa KL et al Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. British J Sports Medicine. April 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28438770 <Internet> http://bjsm.bmj.com/content/early/2017/03/30/bjsports-2016-096587
- ↑ 20.0 20.1 Brach JS, Perera S, Gilmore S et al. Effectiveness of a timing and coordination group exercise program to improve mobility in community-dwelling older adults: A randomized clinical trial. JAMA Intern Med 2017 Aug 14; PMID: https://www.ncbi.nlm.nih.gov/pubmed/28806436
- ↑ 21.0 21.1 Trombetti A, Hars M, Hsu FC et al Effect of Physical Activity on Frailty: Secondary Analysis of a Randomized Controlled Trial. Ann Intern Med. 2018. Jan 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29310138 <Internet> http://annals.org/aim/article-abstract/2668215/effect-physical-activity-frailty-secondary-analysis-randomized-controlled-trial
Brown RT, Covinsky KE. Frailty as an Outcome in Geriatrics Research: Not Ready for Prime Time? Ann Intern Med. 2018. Jan 9 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29310132 <Internet> http://annals.org/aim/article-abstract/2668420/frailty-outcome-geriatrics-research-ready-prime-time - ↑ 22.0 22.1 Stern Y, MacKay-Brandt A, Lee S et al Effect of aerobic exercise on cognition in younger adults: A randomized clinical trial. Neurology. 2019 Feb 26;92(9):e905-e916. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30700591
- ↑ 23.0 23.1 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: https://www.ncbi.nlm.nih.gov/pubmed/31141585 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734709
- ↑ 24.0 24.1 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: https://www.ncbi.nlm.nih.gov/pubmed/31162569 https://jamanetwork.com/journals/jama/article-abstract/2735075
- ↑ Exercise for Older Adults: NIH Senior Health http://nihseniorhealth.gov/exercise/toc.html
Exercise Stories: NIH Senior Health http://nihseniorhealth.gov/exercise/stories/stories.html - ↑ 26.0 26.1 Bull FC, Al-Ansari SS, Biddle S et al World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020 Dec;54(24):1451-1462 MID: 33239350 https://bjsm.bmj.com/content/54/24/1451
Lambert EV, Kolbe-Alexander T, Adlakha D et al Making the case for 'physical activity security': the 2020 WHO guidelines on physical activity and sedentary behaviour from a Global South perspective. Br J Sports Med 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33239348 https://bjsm.bmj.com/content/54/24/1447.long - ↑ 27.0 27.1 Palta P et al. A prospective analysis of leisure-time physical activity in mid-life and beyond and brain damage on MRI in older adults. Neurology 2021 Jan 6; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33408144 https://n.neurology.org/content/96/7/e964
- ↑ 28.0 28.1 28.2 Aengevaeren VL et al. Exercise volume versus intensity and the progression of coronary atherosclerosis in middle-aged and older athletes: Findings from the MARC-2 study. Circulation 2023 Jan 4; [e-pub] PMID: https://www.ncbi.nlm.nih.gov/pubmed/36597865 Free article https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.061173
- ↑ 29.0 29.1 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: https://www.ncbi.nlm.nih.gov/pubmed/37169245
- ↑ 30.0 30.1 30.2 Laird E, Rasmussen CL, Kenny RA, Herring MP. Physical Activity Dose and Depression in a Cohort of Older Adults in The Irish Longitudinal Study on Ageing. JAMA Netw Open. 2023 Jul 3;6(7):e2322489. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37428505 PMCID: PMC10334250 Free PMC article.
- ↑ 31.0 31.1 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: https://www.ncbi.nlm.nih.gov/pubmed/37643788 PMCID: PMC10463053 Free PMC article. https://www.bmj.com/content/382/bmj-2023-074787