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Because its there. George Leigh Mallory (1924). My Get-Up-and-Go Has Got Up and Gone Presented by Jeffrey Pearson, D.O. Industrial & Sports Medical Center.

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Presentation on theme: "Because its there. George Leigh Mallory (1924). My Get-Up-and-Go Has Got Up and Gone Presented by Jeffrey Pearson, D.O. Industrial & Sports Medical Center."— Presentation transcript:

1 Because its there. George Leigh Mallory (1924)

2 My Get-Up-and-Go Has Got Up and Gone Presented by Jeffrey Pearson, D.O. Industrial & Sports Medical Center San Marcos, CA

3 Parts of this talk stolen from

4 Anyone can get old. All you have to do is live long enough. Groucho Marx

5 Our Older Population n People >65 years of age make up 12.5% of the population. –By 2050, estimated to be ~25%. n Americans have an increasing life expectancy: –Women live 18.6 years past 65. –Men live 14.7 years past 65.

6 Problems associated with aging n Elderly tend to be more sedentary than their younger colleagues. n Tend to suffer from medical problems that result in –functional impairment –less independence –greater utilization of healthcare services

7 How fitness can help n Healthy lifestyle leads to a healthier life. n With exercise, people lead a more carefree life-style. n Exercise leads to less time spent in hospital/medical office.

8 Old age is when everything that doesnt hurt doesnt work. Anonymous

9 With maturity comes change... n Cardiovascular – maximum heart rate [HR max =220-age] n Neurologic – nerve conduction velocities; proprioception n Musculoskeletal – bone loss, muscle strength, flexibility – vertebral disc size/strength n Other –respiratory system, metabolism

10 When do disabilities begin? n Onset around age 60 for both sexes. n Nearly ¹/³ of people over 65 years of age have some impairment in performing activities such as walking.

11 If I'd known I was gonna live this long, I'd have taken better care of myself. Eubie Blake

12 Benefits of exercise: general n Serves 2 major purposes –preventive n lifetime pattern of physical activity ameliorates the ravages of aging. n flexibility and strengthening program may reduce incidence of falls and bedsores. –therapeutic n Patients with strokes, arthritis, and fractures may regain some function.

13 Benefits of exercise: specifics n Cardiovascular –cardiac output/cardiovascular fitness, cholesterol profile, BP control n Respiratory capacity/function n Bone and muscle strength, flexibility, coordination n Psychological –mood,self-esteem –socialization

14 Exercise is Work SI units of work are Joules (J) (1 Joule = 1 Newton meter). W = KE f - KE i KE = ½mv 2 W = Fs W = (ma)s = (v 2 - v 0 2 )/2 W = 1/2m(v 2 - v 0 2 ) = KE f - KE i PE g = mgy

15 Work distance gravity

16 I'm not afraid of death, I just dont want to be there when it happens. Woody Allen

17 Exercise: How safe is it? n Cardiovascular (CV) Disease –Leading cause of death in U.S. –Sudden/unexpected death is common in populations w/ high rates of CV disease. –Most sudden deaths occur in middle-aged and older individuals w/ advanced CAD and occur during a variety of activities, including exercise. –NOTE: cause of death in these cases is due to CAD and not exercise (although may be contributing factor).

18 Exercise: How safe is it? n Risk of death transiently increased during actual exercise period, but decreased for the rest of the day. –The overall risk of cardiac arrest for active men is much lower than sedentary men. Studies consistently show lower all-cause death rates in more physically active groups.

19 Exercise: How safe is it? n In Summary: –The risk of serious medical complications during exercise is low, but is higher than during sedentary activities. –The overall benefit/risk ratio for an active way of life is favorable. –Moderate exercise has the potential to enhance the health of many sedentary individuals and should be widely recommended.

20 I have the rest of my life to improve, but it may take longer than that. Ashleigh Brilliant

21 Beginning an exercise program n Physicians assessment –review patients needs and goals –outline progressive steps to achieve goals –refocus unrealistic goals! –Patient education n avoiding injuries n nutrition

22 The Medical Evaluation n History –past/current illnesses; previous injuries (and level of rehabilitation achieved); current medications –functional capacity n Examination –assess function n cardiovascular and musculoskeletal systems n sensory: vision, hearing, proprioception –assess nutrition

23 The Exercise Prescription n Mode of activity n Intensity of exercise n Duration of exercise n Frequency of exercise n Rate of progression

24 Mode of activity n Any activity that uses –large muscle groups –can be maintained for a prolonged period –rhythmic in nature n Key purpose of most exercise prescriptions is to increase or maintain functional capacity –aerobic endurance activities

25 Endurance Activities n Group 1 –easily maintained at a constant intensity and inter-individual variability in energy expenditure is low n walking, jogging, cycling

26 Endurance Activities n Group 2 –rate of energy expenditure related to skill, but for given individual may provide constant intensity n swimming, cross-country skiing n Group 3 –Highly variable in intensity n dancing, basketball, racquetball

27 Q: How many 50-year-olds does it take to screw in a light bulb? A: None; their screwing days are long gone. Old Joke (Pre-Viagra)

28 Intensity of exercise n Conditioning sessions should be maintained at 40-85% of functional capacity. –Healthy adults typically: 60-70% –Cardiac patients: start at 40-60% Ideally, the participant should feel rested, and not fatigued, within an hour following exercise.

29 Heart Rate Method #1 Example: = 170 bpm Hr max 170 x.70 =119 bpm170 x.85 = 145 bpm Target exercise range: bpm n Simple fixed percentage of HR method n 70-85% of maximal heart rate corresponds to about 60-80% of functional capacity. HR max =220-age

30 Heart Rate Method #2 n Heart Rate Reserve/Range Method –60-80% of the HRR corresponds to 60-80% of the functional capacity. –Calculate the HRR n HR max - HR resting = Heart Rate Reserve (HRR) –Calculate conditioning intensity n Multiply HRR by desired intensity –Calculate target HR n Add HR resting

31 Lower LimitHigher Limit Maximal HR Resting HR HRR Conditioning intensity x.60 x Resting HR Target HR Example: 60 y.o. with resting HR of 70 bpm

32 How doctors look at intensity (Feel free to forget this stuff right away) n METs –one MET is equivalent to the amount of energy used at rest (oxygen uptake of 3.5 ml/kg/min) –Varies with speed of movements and changes in resistance –ADLs require 5 METs

33 Leisure activities in METs n Billiards n Bowling n Boxing (sparring) n Climbing hills n Cycling (pleasure) n Dancing (social, square, tap) n Dancing (aerobic) n Fishing (from bank) n Football (touch) n Golf (cart) ( Walking/carrying bag) ( Walking/carrying bag) n Handball n Rope skipping n Running (12 minute mile) n Shuffleboard n Tennis n 2.5 n n 8.3 n n n n n n n n n n 9 n 8.7 n n 4 - 9

34 Rating of Perceived Exertion Category RPE ScaleCategory-Ratio RPE Scale 60Nothing at all 7Very, very light0.5very,very weak 81Very weak 9Very light2Weak 103Moderate 11Fairly light4Somewhat strong 125Strong 13Somewhat hard6 147Very strong 15Hard Very hard10Very, very strong 18*Maximal 19Very, very hard 20

35 Time is a great teacher, but unfortunately it kills all its pupils. Hector Berlioz

36 Duration of activity n Conditioning period (excludes warm up and cool down periods) may vary from minutes –typically minutes –this length required to improve or maintain functional capacity

37 Frequency of Exercise Sessions n Depends, in part, upon the duration and intensity of the exercise session n Functional capacity <3 METs –5 minute sessions, several times/day n Functional capacity 3-5 METs –1-2 daily sessions n Functional capacity >5 METs –at least 3x/wk on alternate days (aim for 5 days total)

38 Rate of Progression n Initial conditioning stage –usually lasts 4-6 weeks, but depends upon initial functional capacity and rate of adaptation. –Should include light calisthenics and low level aerobic activities with which the participant experiences a minimum of muscle soreness. n Discomforts usually arise when program fails to allow for gradual adaptation.

39 Rate of Progression n Improvement conditioning stage –Typically lasts 4-5 months. –Aerobic conditioning is progressed at a more rapid rate. n Intensity increased to target level n Duration increased every 2-3 weeks –Less fit individuals may need more time. n Duration of exercise should be increased to minutes before increasing the intensity.

40 Rate of Progression n Maintenance conditioning stage –Usually begins after first 6 months of training –Participant reaches satisfactory level of cardiorespiratory fitness –Should review the conditioning objectives –More enjoyable or variable activities may be substituted for those used previously n helps avoid dropping out due to boredom of repetition

41 Sample Progression Program

42 I am sick of all this nonsense about beauty being only skin deep. Thats deep enough. What do you want, an adorable pancreas? Jean Kerr

43 Other Fitness Components n Flexibility –Lack of flexibility may be associated with increase risk for low back pain and other injuries –Stretching exercises should be performed slowly, in a controlled manner n seconds per repetition n 4 repetitions of a particular stretch per set n at least 3x/week

44 Other Fitness Components n Muscular strength and endurance –No direct relationship to cardiorespiratory fitness or functional capacity n however, many tasks require some degree of strength, e.g. lifting/moving objects n The stronger the individual, the less stress placed upon the body performing tasks –Strength exercises help to maintain muscle mass as we become older (Use it or lose it.)

45 Other Fitness Components n Muscular strength and endurance –Begin with low resistance, high repetitions to develop muscle tone n reps with light weight per set –Optimal strength gains occur when the resistance allows for no more than 5-8 repetitions of a movement, for 3 sets n you can still make strength gains with lower resistances


47 Catflexing

48 Catflexing

49 Nutrition n Carbohydrates for fuel –60% + of total daily calories –complex>simple n Protein for re-building –15% + of total daily calories n Fat for energy storage (1 lb. = 3500 Kcal) –25% (or less) of total daily calories –avoid saturated and hydrogenated types

50 Nutrition n Fluids –Plain water best for most people –Drink 1-2 eight ounce glasses before exercise –Repeat every 20 minutes of exercise n Sodium –Normal daily intake about 2000 mg –Never consume salt tablets on hot days!

51 Injury/Illness Treatment and Prevention n Ice is nice! –P.R.I.C.E.S. n Sunscreen –SPF 15 or greater n Proper footwear –Tie shoelaces!

52 The secret of staying young is to live honestly, eat slowly, and lie about your age. Lucille Ball

53 The End Thank you!

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