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Exercise in older people (Comorbidiities (Visual impairment (retinal…

- - - - Improved muscle size and strength, bone density, aerobic capacity
        
        Improved gait and balance, mobility
        
        Improved functional independence
        
        Improved depression, morale, insomnia, quality of life
        
        Prevention of metabolic syndrome, impaired glucose tolerance, type 2 diabetes, cardiovascular disease in epidemiological studies
        
        Reduced risk of overall and CV mortality
  - - - serobic capacity
      - nervouse system function
      - Endothelial dysfunction
      - Gait instability
      - Decrease energy requirements and appetite
      - impaired immune function / chronic inflammation
    - - Chronic diseases
        
        HBP
        
        HBC
        
        Overweight
        
        impaired glucose tolerance
        
        Mental illness
        
        Psychological well being
        
        imporvedself efficacy
        
        reduced anxiety, acute stress response
        
        Less sleep disturbance , fatigue
        
        imprived morale
        
        enhanced social engagement
        
        imporved QOL
        
        Truma
        
        Stress
- - - - Bone health
        
        Factors
        
        Genes
        
        Inadequate PA
        
        Loss of muscle mass and strength
        
        Vitamin D deficiency
        
        poor nutrition
        
        SMoking and alcohol
        
        Causes
        
        loos of height
        
        pain
        
        Respiratory dysfunction
        
        falls
        
        Fractures
        
        PA and fracture risk
        
        Mechanical loading of the bone
        
        High loading forces
        
        Progressive with intermittent stimulus
        
        1 more item...
        
        non skeletal risk factors
        
        Strength
        
        Balance
        
        coordination
        
        alterations in nutritional status
        
        Energy intake
        
        1 more item...
        
        Nitrogen balance
        
        Approach to prevention of osteoporotic fracture
        
        identification
        
        History
        
        Screening
        
        Risk factors
        
        Falls
        
        modifiable by PA
        
        As early as possible
        
        mobility impairment
        
        depression
        
        Institutionalization
  - - - Effective exercise modalities
        
        High impact exercise
        
        Older adults
        
        dance
        
        aerobice
        
        Marching / stamping
        
        Aerobic training with moderate to high impact
        
        Progressive resistance training/ power training
        
        high intensity
        
        low reps 2-3/7
        
        Clinically relevant muscle groups
        
        Progressive loading of muscle and bone
        
        Dynamic exercises
        
        avoid flexors
        
        through full ROM
        
        watch aligment
- - - - Dyspnea at lower workloads
  - - - difficulty with complex, rapid, coordinated skills
  - - - early diastolic filling
      - arterial compliance
      - peripheral oxygen utilization
      - maximal and sub maximal aerobic capacity
        
        anaerobic threshold
    - - PVR
      - Arterial stiffness
- - - - through life
      - decrease disease risk
  - - - Do not commence exercise
      - Only commence is considered stable by doctor
    - - Any unstable, consider absolute
  - - - Aerobic
        
        Small change in body weight
        
        Small change in fat mass
        
        moderate decrease in vis fat
        
        no change in bone density
        
        no change in muscle mass
      - Resistance
        
        no change in BW
        
        Small change in fat mass
        
        Variable decrease in Vis fat
        
        Increase in bone density
        
        Increase in muscle mass
  - - - 35% risk reduction
      - 61% reduction in 80 to 86 stringer individuals
- - - - especially T2D
    - - joint pain , instability,
      - RC tears, knee and hip OA
      - Glutes medius tears , bursitis, ROM, pain and swelling
  - - - signs of intoxication
      - chnge or fluctuatons of mental status
      - cognitive impairments
      - aggresive or disruptive behavior
      - depression
      - fear of falling
      - poor juggement or risky behavior
  - - - fitness participation
      - disease management
      - compliance with treatment
  - - - T2D and CVD
      - obese sendentary women, isolated older adults
      - both aerobic and resistance exercise is effective for treatment if depresson
    - - self rating symptom check
      - Refer if moderate to severe
      - suicidality esp older men
      - concurrent substance abuse or those living alone
  - - - worsening of proliferative retinopathy
  - - - ifoot ulcers, falls, mobility, hip fractures, Poor QOL
        
        Check feet r foot wear
        
        especially impt in diabetes and PVD
        
        wear shoes with lowest comfortable heel , nn slip shoes, thick socks
      - good foot wear and frequent exams required
    - - NWB resistance exercise
        
        replace aerobic exercise temporarily or permanently
      - avoid closed chain exercises
  - - - intense exercise may cause micro albuminuria
        
        no increase in risk of renal failure
  - - - Aerobic exercise associated with less orthostatic hypotension; not known if PRT has same benefit
      - Both aerobic and resistance training improve HR variability and endothelial dysfunction common in autonomic neuropathy
- - - - Cost
      - allowance of easy progression
    - - Fully supervised provides best results
      - adherence depends on good behavioral program
    - - 3/7
      - one day of rest between sessions
    - - 2 x 8 reps 1 - 3 sets
      - 8 to 10 functionally important muscle groups
    - - targeted balances large muscle groups of UL and LL and trunk
    - - hard to very hard
      - judge on the first rep of the first set
        
        increase as strength increases
    - - add light weights to learn form and breathing
      - keep intensity by increasing weights
        
        when rating falls below hard
    - - mobility status
      - disease risk
      - Limitations in fraility
  - - - Hypertension, Hypotension
        
        Rapid rise or drop in bp with muscle contraction
        
        within one or two seconds
        
        Response not sustained as in aerobic exercise
        
        Dehydration
        
        Maintain fluid intake
        
        Venous pooling
        
        walk between exercises, alternate arms and legs
        
        end session with a 5 min cool down walk
      - Arterial stiffness
      - Aneurysm leak or rupture
      - Arrhythmias
      - Angina, Heart Attack
        
        Coronay perfusion pressure maintained during diastole
        
        Myocardial oxygen demand lower than aerobic exercise
      - Syncope, orthostasis
      - Retinal bleeding, Detachment
      - Claudication (vascular disease pain)
    - - Falls
      - Fractures
      - Sprains
      - Muscle Tears or Soft Tissue Injury
      - Hemorrhage
        
        anticoagulation/aspirin for atrial fibrillation, valve replacement, stroke, venous thrombosis, cardiac prophylaxis or surgery
      - Dislocations
      - Inflammation of Joint
      - Hernias
      - Delayed Onset Muscle Soreness
    - - insulin dosage and timing of exercise
      - Beta-blocker
      - Statins
      - Drugs causing orthostatic hypotension
  - - - women require preventative measures to offset muscle and bone loss