Start Exercising Already!

Start Exercising Already!
A Physician's Step-by-step Guide to Prescribing Exercise for Elderly Patients

Dr. A. S. Abdulla, BSC, MD, LMCC, CCFP, DipSportMed

Introduction
I have spent many years counselling patients on the merits of dietary modifications in diabetes, hypercholesterolemia, and obesity. I have advocated the avoidance of salt and caffeine for hypertensives, adequate calcium and vitamin D intake for the prevention of osteoporosis, cessation of smoking for the improvement of cardiac and pulmonary risk factors, and cognitive therapy for depression and anxiety disorders. However, I have never found anything to have a more profound impact on all of the above medical conditions, as well as on a patient's general well-being, than a properly prescribed and facilitated exercise regimen. This article will briefly review the epidemiology of sedentarianism and the general benefits and risks of exercise, and will include a short primer on types of exercises along with a step-by-step approach to exercise prescription. The aim of this article is to help you increase the level of activity among your geriatric patients safely and to work through the basics of exercise prescription. The medical approach to dealing with more advanced levels of physical activity is beyond the scope of this article.

Exercise Programs Offset Age-Related Disabilities

Much Needed Inpatient and Outpatient Fitness Programs Available in Toronto

Kathleen Jaques Bennett, BSc, BSc, MSc

Seniors, especially those over 75 years of age, are far more likely to be hospitalized for their illnesses and injuries and stay longer in the hospital than their younger counterparts.¹ Canadian seniors are also less likely to engage in regular exercise despite its benefits in preventing or relieving a variety of illnesses.^2,3 Inpatient and outpatient fitness programs for the elderly play an important role in health maintenance, pain reduction and rehabilitation after illness and injury.

Programs available
The availability of geriatric fitness programs may vary considerably with the size of the community. In the Toronto area, a number of geriatric fitness programs are available through Sunnybrook and Baycrest Hospitals, and outpatient programs for seniors with osteoporosis are also available through clinics such the Pro Program at the Toronto Rehabilitation Institute.⁴ In smaller communities, exercise programs are not always designed specifically for geriatric rehabilitation and fitness; nor is every program offered at every hospital in an area. Some less popu-lated areas have adopted the approach of assigning specialized programs to different hospitals within the region.

There are many types of exercise programs which are aimed at prevention, rehabilitation or maintenance.

Use it or Lose it! Is Weakening Musculature a Result of Aging or Muscle Disuse?

Nadège Chéry, PhD

If physical appearance owes its beauty to strong, shapely muscles, it is a rather short-lived feature of human charm, as nice biceps, sculpted thighs and other graceful or bulging aspects of our musculature eventually wither as we age. Far more than our attractive physique is altered, unfortunately, since with advancing age the loss of muscle strength and mass also greatly contributes to frailty (resulting in falls and fractures).¹ Nevertheless, this undeniable consequence of the aging process is not entirely unavoidable. Indeed, simple, effective strategies that can significantly slow (or perhaps reverse) the age-related decline in muscular performance exist, yet they are often overlooked (or even feared) by the elderly.

In an individual between 30 and 80 years of age, muscle, the largest tissue of the human body,1 undergoes important decreases (up to 40%) in both strength and mass.¹⁰ This age-related loss of muscle strength and mass is typically referred to as "sarcopenia".^3,9,10 The expression "muscle wasting" is also used in geriatric medicine in reference to unintentional loss of weight, when fat mass and fat-free mass decrease, as occurs following starvation (at any age) or in geriatric failure to thrive.^7,8

The extent of the loss of strength is not the same across different types of muscles, and also varies greatly among individuals.

Physical Activity Found Beneficial in Oncology Rehabilitation

Nat Jackson

The benefits of physical activity are well known throughout the health care profession. Exercise has found its way into programs for patients with conditions such as heart disease, and it is becoming part of standard care. Studies have now begun to look at whether or not the success of programs which include exercise can also be realized with cancer patients. This form of care seems to have met with success.^1,2,3,4

It now appears that rehabilitation has been defined as the process by which a person is restored to an optimal physiological, psychological, social and vocational status.² In the case of cancer patients, rehabilitation can be a challenge due to the significant side-effects of cancer treatment: fatigue, weakness, impaired nutritional status, difficulty sleeping and nausea. The patient often sees a decrease in normal physical performance, and the resumption of regular activities after therapy is often delayed. New studies have shown that including exercise within the rehabilitation program reduces the above-mentioned side effects, and even shortens the length of stay in the hospital following treatment.¹ In one study, patients who participated in an exercise program during high-dose chemotherapy were discharged, on average, sooner than patients in a control group.

Benefit in Vigorous Exercise and Proper Nutrition Regardless of Age

Barry Goldlist, MD, FRCPC, FACP

Ever since the landmark article by Fries in the 1980 New England Journal of Medicine, entitled 'Aging, natural death, and the compression of morbidity,' investigators, elderly people, and probably many younger people, have wondered whether the progressive frailty and dependency traditionally associated with aging are, in fact, inevitable. Preventive medicine, which originally meant preventing death early in life, is now being applied to preventing disability in the elderly. There is persuasive evidence presented by the MacArthur Foundation Study of Aging in America that the lifestyle choices we make are important factors in how we age. This information is clearly and effectively presented by Rowe and Kahn in the 1998 publication, 'Successful Aging.' They make a persuasive argument that while most of the chronic degenerative diseases of aging have a significant genetic basis, manipulating environmental factors can still be incredibly important.

Rowe and Kahn present their most persuasive argument in touting nutrition and physical exercise in preventing age-related frailty. My reading of the literature over the past few years is that although any exercise is better than no exercise, very vigorous exercise is better than moderate exercise. While early detection of specific diseases is important as well (e.g. cancer screening, diabetes detection, hypertension detection and treatment), I for one am firmly convinced that exercise and diet will provide the 'biggest bang for the buck.' Although lifelong commitment to preventive health care is the optimum, it seems like there is benefit in vigorous exercise and proper nutrition regardless of the age at which it is started.

The maintenance of normal cognitive function with aging is a much more difficult issue. We do know that higher levels of education are associated with less cognitive decline in old age, but it is unsure if there is any causal link. Certainly maintenance of good physical health will help maintain good mental health as well. There is really no evidence at the present time that 'mental gymnastics' such as crossword puzzles, or specific diets (e.g. rich in antioxidants), will help in maintaining cognitive function.

In the textbook 'Principles of Geriatric Medicine and Gerontology,' Professor Hazzard writes a chapter on preventive gerontology that emphasizes the lifelong health practices that promote successful aging. It seems that it is never too early to plan for a healthy old age. Fortunately, it is also never too late to start.