Exercise for the Elderly

 

We all know that exercise is something that we should be doing throughout our lives due to the many health benefits associated with exercise. As we age we tend to drop away from sports – athletes and sports performers in football, rugby, hockey are thought to be ‘past it’ when they reach early to mid thirties. Why should we keep exercising beyond these ‘retirement’ years?  What about the master athletes, people who are exercising into the years beyond 60? What exercise should they be doing? Should we ever stop exercising?  Is it ever too late to start?

The current physical activity guidelines, recommend by the American College of Sports Medicine, for older adults, those aged over 65 years of age, is at least 150 minutes of ‘moderate-intensity’ aerobic activity per week or if you are already achieving this, comparable benefits can be achieved with 75 minutes of vigorous-intensity exercise, carried out throughout the week. This could be 30 minutes of moderate-intensity exercise or 15 minutes of vigorous-intensity exercise five days a week. The recommendation is to also strength train twice a week. The recommendation fact sheet can be found here.

As we get older, our training may not change, but the reasons why we train may. Generally, alongside the health benefits from exercise, we all train to improve our performance for a sport, lose fat or increase muscle mass.  Ageing is universal and inevitable as we go through the cycle of life we will see increases and decreases in our sensory, motor, cognitive functions, muscle mass and aerobic functions. Is this part of the aging process we must simply accept or is there something we can do to help combat these declines?  Does resistance training and cardiovascular training help older aged adults with health related quality of life?

As is the case with any athlete, older adults can develop their current physical capabilities (strength, flexibility, aerobic capacity) beyond their current levels by increasing their activity levels and intensity, following a well-designed periodised plan. By helping older people change or continue with healthy exercise habits we can help people significantly improve their quality of life.

A major health problem among the elderly is injuries caused by falls. Research from Vella et al. (1997) used a simple assessment of one-leg balance for the predictor of injurious falls in the elderly. It had been reported that the most important risk factors to falls was leg weakness, impaired gait and balance dysfunction.  In the study by Vella et al. (1997) it was found that one-leg standing balance was a reasonably good clinical predictor for those at a greater risk of fall. This study is interesting because the time for which subjects had to balance for on their chosen leg was only 5 seconds. This is not a sufficient length of time to see if a person is at an increased risk of trips and falls. The image below shows how our posture changes as we age.

Image One:

elderly posture

Poor posture can cause limited range of movement; discomfort from the head leading forwards; decrease in lung capacity (squashed chect); lower back pain.

Cardiovascular Training
As previously mentioned, the American College Sports Medicine guidelines of exercise for older adults (those aged over 65 years of age) recommend at least 150 minutes of moderate-intensity aerobic activity per week or 75 minutes of vigorous-intensity exercise. This vigorous-intensity can be performed using high intensity interval training (HIIT).  The concern with the intensity of the exercise is that it takes longer for older adults to recover from the session when compared to younger adults.  This should be taken into consideration when putting together a training plan. Herbert et al. (2015) found older aged adults  (63 + 3.4 years) peak muscle power took 5 days to recover from a HIIT session compared to 3 days for younger men (21 + 2.1 years). The HITT session consisted of six sprints of 30 seconds at 50% peak power output with 3 minutes recovery at 0-50W, between sprints.

Why is HIIT gaining an increase in popularity? The benefits of HIIT are seen with a shorter session, but at a higher intensity. A study by Knowles et al. (2015, p25) reports that HIIT ‘appears to enhance health related quality of life and exercise motives (especially appearance/weight management) in otherwise healthy sedentary ageing males’. This study used the protocol previously reported in Herbert et al. (2015). Knowles et al. (2015) study compared sedentary older adults (63+5 years) with lifelong exercise (61+5 years). HIIT had the greatest effect in the sedentary group compared to the lifelong exercisers; this however could have been due to the intensity of the HIIT session not being great enough to elicit greater adaptations in the lifelong exercise group.  Had a higher peak power training intensity been used, for example 70% peak power output, for the lifelong exercise group we may have seen greater adaptations for this group.

Strength Training
Strength training is important not only to help fight the loss of muscle mass as we age; we reportedly lose 5-10% of our muscles mass between 20-50 years of age and we may lose an additional 30-40% between 50-80 years of age (Hunter et al. 2004). But, strength training has many other advantageous benefits that we may not even consider.

When we age the bones go through a deminerlisation process, which is known as osteoporosis. This causes the bones to become very brittle often leading to fractures of the hip, wrist and spine; common fracture sights in older. Englund et al. (2005) research, on women aged between 66-87 years of age, showed that a weight bearing training program which included strengthening, aerobic, balance and coordination exercises and a positive influence on increasing bone mineral density, ability to stand on one leg (balance issues associated with risk of falls), increase in walking speed and isometric grip strength.  Englund et al. (2005, p.1122) goes on to say that this ‘combined training program may subsequently have a protective effect to reduce the risk of osteoporosis fractures’.

The neuromuscular system is a combination of the nervous system and the muscles working together to produce movement. We should look to train this system in order to transfer messages from the brain to the muscles i.e. if we stumble we want to be able to adjust our feet quickly enough to prevent a fall. Strength training has a positive impact on our gait, meaning our stride length stay open and wide, opposed to a short shuffle as we walk. A poor gait is associated with greater risk of falls.

De Backer et al. (2007) study looked at resistance training and interval training intervention with people in cancer rehabilitation. The study found that a combination of cardiovascular training and resistance training had an improvement in subjects quality of life. Cancer and its treatment can have significant physical and mental side effects on patients (muscle atrophy, decrease in muscle strength, reduced aerobic capacity). De Backer et al. (2007) found subjects who carried out resistance and interval training benefited from an improved quality of life, they felt less fatigued (even though training) and their muscle strength increased. This was with a range of male’s (24-73 years) and female’s (26-71 years) subjects, who had various types of cancers and treatments.

The evidence to continue and/or start exercising when we are older is strong, if it were available as a pill it would be taken by everyone.  It is never too late to start and there are no reason’s why we should look to stop. The research for continuing to be active the older we get is positive, Hunter et al. (2004) review of the research shows that older adults:

  • Markedly increase muscle mass
  • Increase strength and power
  • Decrease in difficulty performing daily tasks
  • Increases energy expenditure
  • Promotes participation in spontaneous physical exercise

Exercise Routine
All you need for this routine is an exercise band – get one suitable for your fitness level.

If you are new to an exercise routine, consult a professional before throwing yourself straight in. Start slowly at low intensity and light resistance and progress as the weeks go on. Also if you are receiving treatment for any medical condition you should also consult your general practitioner. It is always best to consult with your GP to check your blood pressure and for any heart conditions – these are not illnesses that can be seen with the naked eye so it is always best to check first.

The loading percentages are no different to those for younger exercises. Hunter et al. (2004) recommend an intensity of 60-80% 1 repetition maximum, 2-4 sets of 8-15 repetitions carried out 2-3 days a week. With two days a week looking more beneficial to women compared to three days.  Women should also include doing quicker reps on one day per week with 40% 1 repetition maximum.

A progressive resistance training plan guide can be seen below. Look to start with a mobility drill circuit followed by the strength training.

  Week One Week Two Week Three Week Four
Warm Up Circuit 2x 3x 4x 4x
 
Strength
Intensity 60% 70% 80% 75%
Reps 15 12 8 10
Sets 2 3 4 3

*Intensity is the percentage of your one repetition maximum.

In a gym this would mean increasing the weight each week, for example say in week one are lifting 18kg then then in week two you are lifting 21kg.

*If using a resistance band and it is a struggle to get to 8 reps the first week, do not worry, simply switch the routine around and try to get more reps out each week. Week One 2×8 / Week Two 3×8 / Week Three 3×12 / Week Four 3×15, you will be getting stronger as you can perform more repetitions with the same weight.

Part One -mobility
Mobility and Pulse Raising exercises to get the body ready for the session ahead, these exercises target the neuromuscular system and balance.  Perform these in a mini circuit (labelled warm up circuit in the table above), you should look to complete 10-15 repetitions or 30s on each exercise before moving to the next.
Body Weight Squat
Leg Swings
Thoracic Rotations
Banded Dislocations
Door Way Slides
Balance – single leg and with a something stable to hold onto near by should you go off balance. Progressions should include closing your eyes; standing on a foam pad; throwing a tennis ball against the wall and catching all the time whilst keeping your balance.
Fast Feet Drills – 5-8 seconds on each side, in these clips they use a hoop but imagine a line in front of your right foot take the right foot over and back as quickly as possible. Repeat on the left. Now turn to the side and do the same but sideways/laterally.

Part Two – strength training
Strength Time, looking to carry our 5-6 exercises that target the whole body, specifically the leg and back muscles- for stronger legs and to help with posture.

Leg Exercises – both of these each workout
Hip Bridge
Squats

Back Exercises – chose two of these exercises each workout
Banded Pull Aparts
Face Pulls
Seated Row

Chest Exercises – only one of these exercises each workout
Press Ups Assisted
Press Up Resisted

Core – two of these exercises each workout
Quadruped
Single Leg Lowering
Reverse Crunch
Anti-rotation

Part Three – cardiovascular training
What we refer to as conditioning but cardiovascular training. If you are new to exercise or returning after a long break look to start of with low intensity exercises such as walking, walking up hill, or cycling, with a stationary bike or if comfortable out and about. Slowly increase the intensity/effort level. You can use the heart rate for this or a simple Borg Scale.

If a lifelong exerciser and in good health you may wish to try HIIT. Again start slowly and build the intensity over the weeks.

We are never too old to start exercising. Positive adaptations to our health and mental well-being can occur at any time, it just takes US to start the process.

 

Bibliography
Englund, U., Littbrand, H. and Sondell, A. (2005). A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women.

Vella, B.J., Wayne, S.J., Romero, L., Baumgartner, R.N., Rubenstein, L.Z., and Garry, P.J. (1997).  Journal American Geriatric Society. 45 : 735-738

Herbert, P., Grace, F.M., and Sculthorpe, N. (2015). Exercise Caution: prolonged recovery to a single session of high intensity interval training in older men. Journal of American Gerontol Society. 63 : 4.

Hunter, G.R., McCarthy, J.P. and Bamman, M.M. (2004). Effects of resistance training on older adults. Sports Medicine, 34 (5) : 329-348.

De Backer, I.C., Van Breda, E., Vreugdenhil, A., Nijziel, M.R., Kester, A.D., and Schep, G. (2007). High-intensity strength training improves quality of life in cancer survivors. Acta Oncologica. 46 :1143-1151.

gov.uk – Physical Activity Guidelines

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