INFS Health Series: Nutrition for elderly Part 3: Aging and exercise

Author:

Aditya Mahajan

Assessment Division,

Institute of Nutrition and Fitness Sciences (INFS)

 

Key Points:

  • Aging results in the number of changes in the musculoskeletal system which results in a decline in physical functions and abilities like strength, flexibility, and power are compromised. Regular exercise is known to be an effective intervention for reversing this age-related decline and provides a myriad of health benefits in the aging population.
  • It is increasingly apparent that resistance training alone or with the combination of aerobic training and Yoga is a cost-effective intervention for the prevention of sarcopenia, certain chronic diseases, improving several health factors and the overall quality of life.

Keywords: Ageing, exercise, resistance, sarcopenia, aerobic

Introduction:

India’s older population is expected to increase dramatically over the next four decades. Fortunately, there is growing evidence that suggests that old age need not necessarily be accompanied by physical decline and independence loss. In fact, there is growing evidence that regular exercise can improve the quality of life and promote independence in the aging population.

As in the case of younger adults, regular exercise has been shown to provide a multitude of benefits in elderly. Regular exercise has been shown to decrease all-cause mortality and morbidity in aging adults and decreases the inflammatory markers . Improvement in metabolic, cardiovascular and physiological health are well documented and this holds true even for adults who were not active until late in life. Thus, it is never too late to reap benefits from the physical activity.

Resistance exercise:

In aging adults, due to sarcopenia, muscle strength and power reduce by 15% per decade after the age of 50 and 30% per decade after age 70. This reduction of strength can lead to an enhanced risk of immobility and decreased life quality. Impaired mitochondrial function, associated with inactivity, may also be a contributing factor to the development of sarcopenia and insulin resistance .

Resistance exercise has the potential to improve strength and reducing frailty in older adults . Along with that, resistance training can also decrease the symptoms of numerous diseases and chronic conditions including arthritis, diabetes, osteoporosis, back pain etc. Progressive resistance training results in the improvement in aerobic capability, glucose tolerance, muscular strength, power and muscle ‘quality’ (defined as the ability of the muscle to efficiently partition substrates for energy) .

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Training guidelines:

  1. Pre-participation screening is important at this age where the risk factors, health conditions, physical limitation and the initial fitness levels of the elderly individual should be carefully examined. Chronic health conditions should not stop the individuals from strength training. It’s likely that he/she will still be able to participate in a resistance training program even if he/she have arthritis, osteoporosis, diabetes, congestive heart failure, or have recently suffered a heart attack, once the appropriate evaluation and treatment have been initiated.
  2. Exercise selection: Initially sedentary older adults should start slowly and gradually progress their training volume and intensity. Begin with simple exercises such as wall push-ups, toe raises, repeatedly sitting and rising from a chair etc. Once the basic form is comprehended and enough mobility is attained, training needs to be progressively more intense by introducing a variety of exercises including external resistance and increasing weight to further drive strength gains. 7-8 Exercises should be included targeting all the major muscle groups like quadriceps, hamstrings, gluteus, biceps, pectorals, deltoids, triceps etc .
  3. Training frequency: Training should be done on the alternate days, beginning with a rate of 2-3 days per week .
  4. Load, repetitions, and sets: Individuals should start at a relatively safer intensity of 40% ORM, performing 2-3 sets of 8-12 repetitions for each exercise . The intensity should increase as appropriate.

Other types of training:

Along with resistance training, aerobic training has shown several benefits in the older population. Aerobic training promotes cardiorespiratory fitness , increases the brain volume , has the potential of remodeling the myofibers and increasing the muscle strength . It also improves the gait pace, quality of life years (QALY) and is a cost-effective intervention . As in resistance training, sedentary individuals should begin aerobic exercises at the very low level and gradually progress the exercise intensity.

Concurrent training (combined aerobic and resistance training into the same session) has been shown to be beneficial in aging population . However, the exercise order in which aerobic and resistance exercise should perform is also critical for the efficacy of the training program. Performing resistance training prior to aerobic training has shown to reduce arterial stiffness in elderly, with no effect on muscle mass and strength .

In India and all over the world, yoga has recently gained a lot of interest as another mode of physical activity. A recently systematic review concluded that therapeutic yoga may assist in decreasing fall risks and improve the sleep quality in older adults .

seniors-yoga Several other studies reported a positive association between yoga and other health markers such as total cholesterol, LDL, VLDL, pulse, respiratory rate, blood pressure and blood glucose . Thus, this indicates that yoga can also be included as a part of training and conditioning program for older adults.

Conclusion:

Regular involvement in an exercise in an effective strategy to maintain or improve quality of life and physical health in the elderly people. Resistance training can improve strength and muscle mass, and reduce the signs and symptoms of many chronic diseases like osteoporosis, arthritis, diabetes etc. Aerobic training is effective in promoting cardiovascular health and reducing arterial stiffness. Thus, these two training modes can also be combined to derive maximum benefits. Along with that, yoga has shown to be beneficial in improving the physical and physiological health and improving the certain health markers in elderly.

References:

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  3. Abbatecola, Angela Marie, et al. “Discovering pathways of sarcopenia in older adults: a role for insulin resistance on mitochondrial dysfunction.” The journal of nutrition, health & Aging 15.10 (2011): 890-895.
  4. Fiatarone MA, O’Neill EF, Ryan ND, et al. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med. 1994;330:1769–1775.
  5. Fiatarone MA, Marks EC, Ryan ND, et al. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA. 1990;263:3029–3034.
  6. Marini M, Sarchielli E, Brogi L, et al. Role of adapted physical activity to prevent the adverse effects of the sarcopenia. A pilot study. Ital J Anat Embryol. 2008;113:217–225.
  7. Morganti CM, Nelson ME, Fiatarone MA, et al. Strength improvements with 1 yr of progressive resistance training in older women. Med Sci Sports Exerc. 1995;27:906–912.
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  9. Bull, F. C. E. W. G., Biddle, S., Buchner, D., Ferguson, R., Foster, C., & Fox, K. (2010). Physical activity guidelines in the UK: review and recommendations. School of Sport, Exercise and Health Sciences, Loughborough University
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  16. Bulthius Y, Mohammad S, Braakman-Jansen LM, et al. Cost-effectiveness of intensive exercise therapy directly following hospital discharge in patients with arthritis: Results of a randomized controlled clinical trial. Arthritis Rheum. 2008; 59:247–254.
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  19. Willis, L. H., Slentz, C. A., Bateman, L. A., Shields, A. T., Piner, L. W., Bales, C. W., … & Kraus, W. E. (2012). Effects of aerobic and/or resistance training on body mass and fat mass in overweight or obese adults. Journal of applied physiology, 113(12), 1831-1837.
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  21. Spiewak, Christina, et al. “A Systematic Review of the Outcomes of Therapeutic Yoga With Older Adults.” American Journal of Occupational Therapy 71.4_Supplement_1 (2017): 7111505134p1-7111505134p1.
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  23. Park, Seong-Hi, and Kuem Sun Han. “Blood Pressure Response to Meditation and Yoga: A Systematic Review and Meta-Analysis.” The Journal of Alternative and Complementary Medicine (2017).

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