special subjects
Exercise in Older Adults
Exercise program
A comprehensive exercise program should include Aerobic activity Strength training Flexibility and balance training Variation (regular change in exercise to avoid over-adaptation to the same stimulus, but also to avoid minor injuries due to repetitive actions) Often a single program can be designed to achieve all exercise goals. Strength training improves muscular mass, muscular endurance, and strength. If strength training is done through a full range of motion, many exercises improve flexibility, and the enhanced muscle strength improves joint stability and, consequently, balance. Moreover, if rests between sets are minimal, cardiovascular function also improves. Alternatively, with certain exercises, adequate rest between sets (eg, 2 to 5 minutes with large muscle groups) can allow recovery of ATP stores sufficient to maximize performance on the following set, possibly maximizing gains in strength ( References ). Duration ofaerobic activityfor older people is similar to that for younger adults, but exercise should be less intense. Usually during exercise, the person should be able to comfortably converse, and intensity should be≤6/10 on a perceived scale of exertion. Older people who have no contraindications can gradually increase their target heart rate (HRmax) to the one calculated by use of age-based formulas. Some deconditioned older people need to improve their functional abilities (eg, by strength training) before they will be capable of aerobic exercise. Strength trainingis done according to the same principles and techniques as in adolescents and young adults. Lighter forces (loads/resistance) should be used initially (eg, using bands or weights as light as 1 kg or arising from a chair) and increased as tolerated. More aggressive training (the use of higher resistance initially) should be under the supervision of a qualified fitness professional. To help increaseflexibility,major muscle groups can be stretched daily, although stretching ≥ 3 times/week yields some improvements. Ideally, major muscle groups should be stretched after exercise when muscles are most compliant. traditionally involves challenging the center of gravity by undertaking exercises in unstable environments, such as standing on one leg or using balance or wobble boards. Balance training can help some people with impaired proprioception and is often used in an attempt to prevent falls in older people. However, it is often ineffective because any balance activity is skill specific (eg, good balance while standing on a balance board does not improve balance in dissimilar activities). For most older people, flexibility and strength training exercises prevent falls more effectively; they also mitigate the impact of Falls in Older Adults . Such a program develops strength around the joints and helps people hold body positions more effectively while standing and walking. In people who have difficulty standing and walking because of poor balance, more challenging balance tasks (eg, standing on a wobble board) are simply likely to facilitate injury and are contraindicated. 