exercise for seniors
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Introduction
see exercise prescribing & exercise testing
minimal amount of exercise to prevent mobility disorders is 50 minutes/week[10]
Indications
- exercise is beneficial to mood & cognition & may slow cognitive loss in elderly with mild cognitive impairment[10]
- 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]
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 elderly 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]
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 10.11 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
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 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