Annette Morales - Community Base Exercise Programs for the Elderly

 Community Base Exercise Programs for the Elderly 

By: Annette Morales

Exercise has many health benefits for both young and older adults, yet many exercise programs that are provided by communities do provide exercises that are actually beneficial for elderly. 

Background Knowledge:

Physical activity benefits the elderly because it is a way to help them stay independent, which helps their mental health stay in a positive state. As people age their body goes through physiological changes that affect muscle skeletal system, cardiovascular system, pulmonary system, and bone mineral density.

Muscle Skeletal Changes  

Sarcopenia is an age related loss of skeletal muscle mass. This can begin as early as age 25. Adults lose approximately 10% of muscle mass between the ages 25 and 50. An additional 40% loss of muscle mass is lost between the ages 50 and 80. Skeletal muscle decreases in size which means the muscle fibers within the muscle are also affected. 

Dynapenia is age related loss of skeletal muscle strength. Muscles are composed of both Type I and Type II fibers. The image on the left show both Type I as the lighter colored circles and Type II fibers as the darker circles.   Type I fibers are associated with aerobic exercises such as running, swimming, and walking. Type II fibers are associated with anaerobic exercises and produce more power than type I fibers, some exercises for type II fibers are weight lifting, jumps, and quick sprints. As people age their muscle loses power because their Type II fibers convert to Type I fibers, which means they are unable to produce the same force as before because the Type II fibers are then ones that allow the muscle to produce strength. 

These muscular changes affects elderly people because they lose functional independence, which can ultimately lead to isolation and depression. 

Cardiovascular Changes

Simplistically specking the heart is composed of the right atrium, right ventricle, aorta, left atrium, and left ventricle. The heart consists of four chambers in which blood flows. Blood enters the right atrium and passes through the right ventricle. The right ventricle pumps the blood to the lungs where it becomes oxygenated (meaning that the blood contains oxygen). The oxygenated blood is brought back to the heart by the pulmonary veins which enter the left atrium, then entering the left ventricle which pumps blood to the aorta. The aorta sends oxygenated blood to all the body. This process continues in circular motion. 

 Generally speaking the cardiovascular system becomes stiffer and less compliant as aging occurs, which affects the structure of the heart and blood vessels. This can be seen in cardiac hypertrophy. Cardiac hypertrophy is the thickening of the left ventricle wall, followed by a thickening of the left atria. This thickening affects the amount of oxygenated blood that is pumped back into the body. 

In addition atherosclerosis also affects the cardiovascular system. Atherosclerosis is a specific type of arterial stiffening related to plaque build-up. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows arteries. This limits the flow of oxygenated blood to organs and other parts body. In addition other risk factors associated with atherosclerosis are heart high blood pressure, diabetes, thrombosis (meaning blood coagulation within blood vessel), embolism (meaning a piece of the plaque buildup moves downstream from the plaque causing blockage elsewhere in the body), and heart attacks. 

Pulmonary Changes

The pulmonary system has been said to be over-engineered, meaning that is has the capacity for gas exchange well beyond what is needed in a healthy young adult. Life style choices can either slow or accelerate the rate of age-related decline of pulmonary structure and function. An age related structural change that occurs in the pulmonary system is airway narrowing. This occurs after the age of 40. Airway narrowing has profound effects on airflow resistance of the lungs, and the elastic recoil of the lungs. One can think of the lungs as a rubber band, the more one stretches it out the less it is going to recoil back to to its original state. The decrease in the elastic recoil of the lungs in older adults, means there is less resistance to expanding, or an increase in compliance of the lungs (meaning that older adults work harder to produce x amount of oxygen). Total lung capacity  is the volume of air in the lungs upon the maximum effort of inspiration. The total lung capacity in older adults increases slightly but the reduced recoil negatively effects the ability to exhale rapidly. 

Bone Changes

Bones are composed of cells called osteoclast and osteoblast. Osteoclast remove old bone and osteoblast form new bone. In growing children osteoblast cells are more present than osteoclast cells, meaning that bones grow in density and diameter. As aging occurs osteoblast slow down while osteoclast continue at the same rate, resulting in bone density to decrease because the cells are deteriorating the bone. 

Exercise Helps 

Proper exercise can help all of the systems from above slow down the aging process. For example, bone mineral density is improved with physical activity because the more ground reaction forces (impact of gravity) and dynamic muscular contraction can stimulate osteoblast, thereby improving the quality of bone mineral density. Weight bearing, high-impact, aerobic activities prevent bone loss. A way to prevent atherosclerosis is by eating healthy and exercise. Since plaque build-up is made up of fatty substances, physical activity reduces of the fatty substances within the blood. In addition when exercising the heart pumps faster than at rest, which means more blood flows through the ventricles and more blood goes through the oxygenating process. If there is more oxygenated blood in the body that means that the body parts will receive more oxygen. Having a higher oxygen intake allows the lungs to stay healthy and slow down the aging process of the lungs. 

What are the recommendations of physical activity for older adults?

In order for elderly to receive all the physiological benefits of exercise one must follow the recommendations for resistance training. 

Variables	Guidelines
Frequency	2-4 days per week with alternating training/rest days
Intensity	Various intensities and various velocities
Repetitions & sets	Beginner: 1-3 sets; 8-12 repetitions Advanced: 2-6 sets; 1-8 repetitions
Duration	30-60 min
Exercises	Larger muscles groups before smaller muscle groups Start with machines and progress to free weights
Progression	Adjust program variables once per month

What types of exercises work?

• exercises with resistance bands
• strength training
• brisk walking
• running
• swimming
• free weight lifting
• stretching (yoga, pilates)
• water aerobics
• tai chi
  

It is very important to know the limitations of elderly people so that no injury occurs with the exercise. 

What the Community Provides vs. What they Should Provide

I took some time to look at what the city of South Gate provides for the elderly. On their city website I noticed that they provide lots of activities like karaoke, senior art circle, senior bingo, senior crafts, but interestingly they only provide two physical activity classes which are tai chi, and dancing. Although these classes may be partially beneficial to seniors they will not give seniors the full benefits because they are not strength activities. If community centers offered senior strength training classes it would be more beneficial for them because it will help them stay independent and strong. 

Why this is important to me? 

This topic is very important because I am majoring in Kinesiology specifically therapeutic and rehabilitation exercise. From my previous classes I have seen the health implications that come when people don't exercise. In addition some of my loved ones have had heart problems due to lack of physical activity. Therefore I truly cherish the value of physical activity. Being active helps both physical and mental health, there are articles that indicate exercise produces neurological activity that helps people stay happy and strong. 

References 

Senior Activities: South Gate, CA - Official Website. (n.d.) Retrieved October 30, 2020, from https://www.cityofsouthgate.org/202/Senior-Activities

Bouchard, Danielle. Human Kinematics. Exercise and Physical Activity for Older Adults. 2021. from ISBN: 978-1-7182-0329-7