There is now a wealth of data that supports the value of aerobic and resistance exercise for the geriatric population. Improvements are seen in weight and body composition, greater insulin sensitivity, decreased falls/improved balance, better psychological health, less frailty and improved function. With exercise, the resting blood pressure lowers, and there is a reduction in the risk of all-cause mortality.1 Studies have shown that the stronger the back and leg muscles are, the higher the bone density is in the region.2 These benefits are so wide-spread, that they should encourage us to recommend exercise to our older patients. But both doctors and patients often hesitate to pursue exercise for the aged, due to several concerns.
Hardening and constriction of the arteries cause a decrease in blood flow, especially to the extremities. The heart responds by increasing the blood pressure, trying to force the blood through the restricted areas. When resting measurements are consistently above 140 mmHg (systolic) and/or 90 mmHg (diastolic), the person has hypertension. Some patients will need medication to control their high blood pressure, especially in the higher age ranges. While the drugs do decrease the likelihood of strokes and heart attacks, many patients are hesitant to exercise, and they become even more sedentary. There is good evidence that exercise is not contra-indicated, and is actually beneficial for patients taking blood pressure medications.3
Degenerative arthritis is a common musculoskeletal disorder in older adults, causing significant amounts of physical disability. Osteoarthrosis afflicts an estimated 20 million Americans, with the knee being the most commonly affected weight bearing joint.4 In addition to pain with movement, the involved joint(s) lose flexibility and strength. Contrary to what is commonly believed, moderate exercise does not increase the risk for osteoarthrosis or exacerbate it; rather, it has been found to improve function and reduce pain.5
Deconditioning/Low Muscle Mass
National surveys reveal that 70% or more of older adults do not engage in any regular exercise.6 This compounds the loss of strength and muscle mass, and increase in body fat that is normally seen in aging. In fact, this change in body composition is tied to many factors, including poor nutrition, decreased physical activity, increased disability and disuse, type II muscle fiber atrophy, and drug side effects.
Two major organizations-the American College of Sports Medicine7 and the National Strength and Conditioning Association8-have published recommendations to be followed when advising older adults to exercise. Both state that aerobic and resistance exercises for older populations are generally safe and can be very effective, both for treating specific problems as well as avoiding general disability. These guidelines encourage the use of regular physical activity, along with specific exercises to improve endurance, strength, and proprioception. Current research has found that even high-intensity training of frail men and women in their 90’s is safe and leads to significant gains in muscle strength and functional mobility.9
Since isometric exercises may increase the systolic blood pressure, isotonic (or “dynamic”) exercises are considered safer for building strength.10 Elastic resistance tubing is an excellent method to provide strengthening dynamic exercise without the need for machines or heavy weights. Older adults often have difficulty figuring out complex machines and may not be able to handle exercise weights and barbells. A home-based program using elastic tubing can provide significant gains in strength and flexibility.11 These exercises can be done standing or sitting, providing an additional weight-bearing stress to the muscles and bones.
Selecting the best exercise approach for an older patient is not difficult, but does require some special considerations. A review of the patient’s health history is necessary, in order to identify any complicating or restricting factors. A closely monitored home exercise program allows the doctor of chiropractic to provide cost-efficient, yet very effective, exercise recommendations for patients of all ages.
John K. Hyland, D.C., M.P.H. D.A.C.B.R., D.A.B.C.O., C.S.C.S., C.H.E.S. is board-certified in two chiropractic specialties, and is also certified as a Strength and Conditioning Specialist and a Health Education Specialist. He has 20 years of clinical practice; for eight years he specialized in chiropractic rehabilitation. He is currently a Research Associate at Parker College of Chiropractic, and an Adjunct Professor of Clinical Sciences at the University of Bridgeport’s College of Chiropractic. You can contact him at [email protected].
1. Blair SN, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996; 276:205-10.
2. Sinaki M, Offord KP. Physical activity in postmenopausal women: effect on back muscle strength and bone mineral density. Arch Phys Med Rehabil 1988; 69:277-80.
3. LaFontaine T. Resistance training for patients with hypertension. Strength & Conditioning J 1997; 19:5-7.
4.Lawrence RC, et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41:778-99.
5. Casper J, Berg K. Effects of exercise on osteoarthritis: a review. J Strength Condition Res 1998; 12:120-5.
6. Clark DO. Racial and educational differences in physical activity among older adults. Gerontologist 1995; 35:472-80.
7. American College of Sports Medicine. Exercise and physical activity for older adults. Med Sci Sports Exerc 1998; 30:992-1008.
8. Pearson D, et al. The national strength and conditioning association’s basic guidelines for the resistance training of athletes. Strength & Conditioning J 2000; 22(4):14-27.
9. Fiatarone, et al. High-intensity strength training in nonagenarians: effects on skeletal muscle. JAMA 1990; 263:3029-34.
10. American College of Sports Medicine. Exercise prescription for special populations. In: Guidelines for exercise testing and prescription; 1991. p. 166.
11. Jette AM, et al. Exercise- it’s never too late: the strong-for-life program. Am J Publ Health 1999;