Exercise

There has been a gradually growing awareness among policy makers and health care professionals of the great importance of appropriate exercise habits to major public health outcomes. It has been known for decades that physical activity prevents heart disease, but data now suggest that, on average, physically active people outlive those who are inactive and that regular physical activity helps to maintain the functional independence of older adults and to enhance the quality of life for people of all ages. The basic elements of an exercise prescription for older adults are presented in Table 1.

• • Examples of balance enhancing activities include T'ai chi movements, standing yoga or ballet postures, tandem standing and walking, standing on one leg, stepping over objects, A brochure that urges senior citizens to develop an exercise program to help maintain a healthy lifestyle. (Brochure © Maria Fiatarone Singh. Reproduced with permission.) climbing up and down steps slowly, turning, and standing on heels and toes.
• • Intensity is increased by decreasing the base of support (e.g., progressing from standing on two feet while holding onto the back of a chair to standing on one foot with no hand support); by decreasing other sensory input (e.g., closing eyes or standing on a foam pillow); or by perturbing the center of mass (e.g., holding a heavy object out to one side while maintaining balance, standing on one leg while lifting the other leg out behind the body, or leaning forward as far as possible without falling or moving the feet).

The rationale for the integration of a physical activity prescription into health care for older adults is based on four essential concepts. First, there is a great similarity between the physiologic changes that are attributable to disuse and those An unidentified 72-year-old woman works out on a treadmill, which is an excellent form of low-impact aerobic exercise. (Corbis photo by Laura Dwight.) which have been typically observed in aging populations, leading to the speculation that the way in which people age may in fact be greatly affected by activity levels. Second, chronic diseases increase with age, and exercise has now been shown to be an independent risk factor and/or potential treatment for most of the major causes of morbidity and mortality in Western societies, a potential that currently is vastly underutilized. Third, traditional medical interventions do not typically address disuse syndromes accompanying chronic disease, which may be responsible for much of their associated disability. Exercise is particularly good at targeting syndromes of disuse. Finally, many pathophysiological aberrations that are central to a disease or its treatment are specifically addressed only by exercise, which therefore deserves a place in the mainstream of medical care, not as an optional adjunct. Therefore, understanding the effects of aging on exercise capacity and how habitual physical activity can modify this relationship in the older adult, including its specific utility in treating medical diseases, is critical for health care practitioners of all disciplines.

Table 1 General Exercise Recommendations for Older Adults SOURCE: Author