Exercise as Medicine for Older AdultsJacob Rohloff

Definition of Terms• Functional Ability

Functional ability is known as the physical, psychological, cognitive and social ability to carry on normal activities of life (Concept Based Nursing, 2015).

Reference to functional ability throughout this presentation will be focused on a the physical aspect of normal, daily activity needed for survival Walking, climbing stairs, carrying groceries, preparing meals, toileting,

bathing etc.

We are living longer• 2011 statistics state that Canadians live an average of 81.7 years, an

increase of nearly 25 years since 1921• The mean age of Canadians continues to increase as the baby boomer

generation reaches age 65 or older• In 2011, one in seven Canadians was 65 or older• By 2036, one in four Canadians will be 65 or older

Statistics Canada, 2015. National Seniors Day… by the numbers

Historical age pyramid

Statistics Canada, 2015. National Seniors Day… by the numbers

Historical age pyramid

Statistics Canada, 2015. National Seniors Day… by the numbers

Why is an aging population problematic?• Aging populations has a large influence on the drivers of health care

costs, because older adults typically require more care than young, healthy adults. Chronic diseases are more prevalent in older populations, which puts a demand on health care systems (Deraspe, 2011).

• The Canadian Institute for Health Information (CIHI) in 2008 projected that older adults, 65 years of age and older account for 50% of the health care spending by the provinces. However, at the time, older adults only made up 13.7% of the Canadian population (CIHI, 2010). As the baby boomer generation ages, a higher population of people 65 and

older will increase health care costs.

Systemic Physiological Effects of Aging• Aging is a normal, cellular process that increasingly interferes with the

body’s ability to maintain homeostasis, even in the absence of disease (Tortora & Nielsen, 2013)

• Two main cellular-level causes of aging: Cessation of division of cells due to DNA telomere malfunction

Repeated cell divisions shorten the telomeres over time and become too short or non-existent to correctly carry out cell division

Agglomeration of proteins Glucose is added indiscriminately to essential proteins that construct irreversible

cross-links between proteins, contributing to stiffening and loss of elasticity in tissues

(Tortora & Nielsen, 2013)http://futurism.com/attempts-to-prevent-cancer-by-lengthening-telomeres-lead-tocancer/

Specific effects of aging on key body systems• Musculoskeletal system

Skeletal muscles in the body undergo a progressive loss of mass and cross-sectional area that is replaced by connective tissue and fat tissue beginning at age 30

Atrophy of the lower limb muscles typically occurs first, increasingly limiting functional ability

• Nervous system The nervous system ages by the decrease in overall brain mass Conduction velocity of impulses decrease, reflex times are increased and

voluntary motor movements are slowed down

• Cardiovascular/Respiratory system Decreased cardiac output, a decline in maximum heart rate, decreased

compliance of blood vessels and higher instances of atherosclerosis Decrease in overall lung capacity and therefore decrease the amount of oxygen

taken into the circulatory system, decreasing overall VO2max and exercise tolerance (Chodzko-Zajko et. al, 2009)

(Tortora & Nielsen, 2013)

(Ciolac, 2013)

Exercise as medicine• Performing regular physical activity and exercise has the ability to

curtail the physiological changes during the aging process and promote improvements in health (Ciolac, 2013; Chodzko-Zajko et al., 2009)

• Combination of resistance and aerobic training in Fahlman, Morgan, McNevin, Topp, & Boardley’s (2007) study demonstrated decreased time taken to descend a flight of stairs, decreased time in both descending and rising from the floor and an increased distance walked in six minutes.

Exercise as medicine• Wiszomirska, Krynicki, Kaczmarczyk and Gajewski (2015) state that

“well-designed programs of exercise can not only inhibit these [functional balance] changes, but even reverse them.”

• Serra-Rexach et. al (2011) put 40 nonagenarians through an eight-week light-to-moderate intensity resistance exercise program. There was a significant difference in the muscle strength of the study

participants The intervention group experienced an average of 1.2 fewer falls over the

study compared to the control group

(Calvani et. al, 2015)

Exercise Prescription Recommendations

CSEP, 2011

Prescription to get active

References• Calvani, R., Marinin, F., Cesari, M., Tosato, M., Anker, S.D., von Haehling, S.,…Marzetti, E. (2015). Biomarkers for physical fraility and

sarcopenia: state of the science and future developments. Journal of Cachexia, Sarcopenia and Muscle. doi: 10.1002/jcsm.12051• Chodzko-Zajko, W.J., Proctor, D.N., Fiatarine Singh, M.A., Minson, C.T., Nigg., C.R., Salem, G.J., & Skinner, J.S. (2009). American College of

Sports Medicine position stand: Exercise and physical activity for older adults. Medicine & Science in Sports & Exercise. doi: 10.1249éMSS.0b013e3181a0c95c

• CIHI (Canadian Institute for Health Information). (2010). National health expenditure trends, 1975 to 2010. Retrieved from https://secure.cihi.ca/free_products/NHEX%20Trends%20Report%202010_final_ENG_web.pdf

• Ciolac, E.G. (2013). Exercise training as a preventative tool for age-related disorders: a brief review. Clinics, 68(15), 710-717. doi: 10.6061éclinicsé2013(05)20

• CSEP (Canadian Society of Exercise Physiologists). (2011). Canadian physical activity guidelines for older adults – 65 years & older. Canadian Society of Exercise Physiologists. Retrieved from http://www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_older-adults_en.pdf

• Deraspe, R. (2011, October 21). Canada’s aging population and public policy: 3. The effects of health care. Library of Parliament Research Publications. Retrieved from http://www.lop.parl.gc.ca/content/lop/ResearchPublications/2011-122-e.htm#fn1

• Fahlman, M., Morgan, A., McNevin, N., Topp, R., & Boardley, D. (2007). Combination training and resistance training as effective interventions to improve functioning in elders. Journal of Aging and Physical Activity, 15, 195-205. doi: 10.1123/japa.15.2.195

• Mazzeo, R. S., Cavanagh, P., Evans, W.J., Fiatarone, M., Hagberg, J., McAuley, E., & Startzell, J. (1998). ACSM position stand: Exercise and physical activity for older adults. Medicine & Science in Sports & Exercise, 30(6), 992-1008. doi: 10.1249/MSS.0b013e3181a0c95c

• Serra-Rexach, J.A., Bustamante-Ara, N., Hierro Villaran, M., Gonzalez Gil, P., Sanz Ibanez, M.J., Blanco Sanz, N.,…Lucia, A. (2011). Short-term, light-to moderate-intensity exercise training improves leg muscle strength in the oldest old: A randomized controlled trial. Journal of the American Geriatrics Society, 59, 594-602. doi: 10.1111/j.1532-5415.2011.03356

• Statistics Canada. (2015, Nov 5). National Seniors day… by the numbers. Retrieved from http://www.statcan.gc.ca/eng/dai/smr08/2014/smr08_191_2014

• Tieu, A. (2015, July 29). Attempts to prevent cancer by lengthening telomeres lead to…cancer. Futurism. Retrieved from http://futurism.com/attempts-to-prevent-cancer-by-lengthening-telomeres-lead-tocancer

• Wiszomirska, I., Krynicki, B., Kaczmarczyk, K., & Gajewski, I. (2015). The impact of functional training on postural stability and body composition in women over 60. Journal of Sports Medicine and Physical Fitness, 55, 654-662.