Presentation on theme: "“Because it’s there.” George Leigh Mallory (1924)"— Presentation transcript:
1“Because it’s there.” George Leigh Mallory (1924) A famous English journalist and adventurist, Mallory provided this famous retort in response to repeated questioning as to why he wanted to climb Mt. Everest. Mallory died on the mountain and his remains were finally found just a few years ago.
2My Get-Up-and-Go Has Got Up and Gone Presented byJeffrey Pearson, D.O.Industrial & Sports Medical CenterSan Marcos, CA
4“Anyone can get old. All you have to do is live long enough.” Groucho Marx
5Our Older PopulationPeople >65 years of age make up 12.5% of the population.By 2050, estimated to be ~25%.Americans have an increasing life expectancy:Women live 18.6 years past 65.Men live 14.7 years past 65.
6Problems associated with aging Elderly tend to be more sedentary than their younger colleagues.Tend to suffer from medical problems that result infunctional impairmentless independencegreater utilization of healthcare services
7How fitness can help Healthy lifestyle leads to a healthier life. With exercise, people lead a more carefree life-style.Exercise leads to less time spent in hospital/medical office.
8“Old age is when everything that doesn’t hurt doesn’t work.” Anonymous
9With maturity comes change... Cardiovascular maximum heart rate [HRmax=220-age]Neurologic nerve conduction velocities; proprioceptionMusculoskeletal bone loss, muscle strength, flexibility vertebral disc size/strengthOtherrespiratory system, metabolismCardiovasculardecreased maximu, heart rateElevated systolic and diastolic blood pressuredecreased cardia output and stroke volumeRespiratoryIncrease in work of breathing by 20%Renaldecreased ability to strain bloodMetabolicdecreased water contentincreased body fat.Decreased glucose tolerancedecreased musle massDecline in resting metabolic rateNeuropsychdecreased brain mass and cognitive functiondecreased nerve conduction
10When do disabilities begin? Onset around age 60 for both sexes.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
12Benefits of exercise: general Serves 2 major purposespreventive“lifetime pattern of physical activity ameliorates the ravages of aging.”flexibility and strengthening program may reduce incidence of falls and bedsores.therapeuticPatients with strokes, arthritis, and fractures may regain some function.
13Benefits of exercise: specifics Cardiovascularcardiac output/cardiovascular fitness, cholesterol profile, BP controlRespiratory capacity/functionBone and muscle strength, flexibility, coordinationPsychologicalmood,self-esteemsocialization
14SI units of work are Joules (J) (1 Joule = 1 Newton meter). W = KEf - KEiKE = ½mv 2Exercise is WorkHave to carry my sorry carcass x distance….W = Fs W = (ma)s= (v 2 - v02)/2 W = 1/2m(v 2 - v02) = KEf - KEiPEg = mgy
16“I'm not afraid of death, I just don’t want to be there when it happens.” Woody Allen
17Exercise: How safe is it? Cardiovascular (CV) DiseaseLeading 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).
18Exercise: How safe is it? 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.Everything is relative:There has been a considerable increase in adult exercise participation over the past 20 years without a concomitant increase in sudden death rates in the United States.Studies consistently show lower all-cause death rates in more physically active groups.
19Exercise: How safe is it? 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
21Beginning an exercise program Physician’s assessmentreview patient’s needs and goalsoutline progressive steps to achieve goalsrefocus unrealistic goals!Patient educationavoiding injuriesnutrition
22The Medical Evaluation Historypast/current illnesses; previous injuries (and level of rehabilitation achieved); current medicationsfunctional capacityExaminationassess functioncardiovascular and musculoskeletal systemssensory: vision, hearing, proprioceptionassess nutritionConditions requiring cautionviral infection or coldchest painirregular heart beatexercise-induced asthmaprolonged, unaccustomed physical activityconduction disturbances in heartConditions requiring moderationextreme heat and high relative humidityextreme cold (especially with strong winds)following heavy mealshigh altitudessignificant musculoskeletal injuries
23The Exercise Prescription Mode of activityIntensity of exerciseDuration of exerciseFrequency of exerciseRate of progression
24Mode of activity Any activity that uses large muscle groupscan be maintained for a prolonged periodrhythmic in natureKey purpose of most exercise prescriptions is to increase or maintain functional capacityaerobic endurance activities
25Endurance Activities Group 1 easily maintained at a constant intensity and inter-individual variability in energy expenditure is lowwalking, jogging, cycling
26Endurance Activities Group 2 Group 3 rate of energy expenditure related to skill, but for given individual may provide constant intensityswimming, cross-country skiingGroup 3Highly variable in intensitydancing, basketball, racquetballWhen precise control of exercise intensity is necessary, as in early stages of a rehabilitation program, Group 1 and 2 activities are recommended.Group 3 activities can be extremely useful because of the enjoyment provided in a physically active setting and because they may direct participatn’s attention away from anxieties, worries, and boredom.
27Old Joke (Pre-Viagra)Q: How many 50-year-olds does it take to screw in a light bulb?A: None; their screwing days are long gone.
28Intensity of exerciseConditioning 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 notfatigued, within an hour following exercise.
29Target exercise range: 119 - 145 bpm Heart Rate Method #1Simple fixed percentage of HR method70-85% of maximal heart rate corresponds to about 60-80% of functional capacity.HRmax=220-ageExample: = 170 bpm Hrmax170 x .70 =119 bpm 170 x .85 = 145 bpmTarget exercise range: bpm
30Heart Rate Method #2 Heart Rate Reserve/Range Method 60-80% of the HRR corresponds to 60-80% of the functional capacity.Calculate the HRRHRmax - HRresting = Heart Rate Reserve (HRR)Calculate conditioning intensityMultiply HRR by desired intensityCalculate target HRAdd HRresting
31Example: 60 y.o. with resting HR of 70 bpm Lower Limit Higher LimitMaximal HRResting HRHRRConditioning intensity x x .80Resting HRTarget HR
32How doctors look at intensity (Feel free to forget this stuff right away) METsone 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 resistanceADL’s require 5 METsMETSExercise capacity as measured in METS provides clinically relevant data. Patients should be able to meet a minimal exercise requirement of 5 METS, which corresponds to basic activities of daily living. Those who cannot achieve this level, even with a normal ECG, generally have a poor prognosis. Another important marker is 10 METS. If patients with CAD can reach this level, they are considered aerobically fit and their prognosis is likely to be similar whether they're treated with medical therapy or revascularization.Beyond 13 METS, abnormal ECG findings are more likely to be falsely positive, and the patient's prognosis tends to be good. Arrhythmias in an elite athlete exercising above 13 METS, for example, often can be attributed to athletic heart syndrome, and a work-up may not be necessary.
34Rating of Perceived Exertion Category RPE Scale Category-Ratio RPE ScaleNothing at all7 Very, very light very,very weakVery weak9 Very light 2 WeakModerate11 Fairly light 4 Somewhat strongStrong13 Somewhat hard 6Very strong15 Hard 817 Very hard Very, very strong* Maximal19 Very, very hard20Using the 15-point scale:- a perceived exertion rating of corresponds to approximately 60% of the heart range range- A rating of 16 corresponds to approximately 85% of the heart range range.- Consequently, most participants should exercise within the RPE range of (“somewhat hard” to “hard”).[NOTE: small percentage of participants tend to select unrealistic PRE scores, hence this method may be inappropriate for them.“Fast enough so that you can talk, but not sing.”
35“Time is a great teacher, but unfortunately it kills all its pupils.” Hector Berlioz
36Duration of activityConditioning period (excludes warm up and cool down periods) may vary from minutestypically minutesthis length required to improve or maintain functional capacitySignificant cardiovascular improvements have been obtained with exercise sessions of 5-10 minutes duration with an intensity of more than 90% of functional capacity. However, high intensity-short duration sessions are not desirable for most participants and better results are obtained with lower intensities and longer durations.Such programs are preferred because they may carry lower risk of orthopedic injury.Multiple short bouts (approximately 10 minutes) of exercise distributed throughout the day may be optimal for some participants.
37Frequency of Exercise Sessions Depends, in part, upon the duration and intensity of the exercise sessionFunctional capacity <3 METs5 minute sessions, several times/dayFunctional capacity 3-5 METs1-2 daily sessionsFunctional capacity >5 METsat least 3x/wk on alternate days (aim for 5 days total)
38Rate of Progression 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.Discomforts usually arise when program fails to allow for gradual adaptation.Person with low fitness level or limited by CAD may spend as many as 6-10 weeks in the initial phase, while the participant with a higher fitness level may not need to participate more than a few weeks in the initial phaseNecessity for individual modifications cannot be overemphasized; health status must be considered in the rate of progression.At onset of exercise program, individual goals need to be established. Must be realistic. Develop a system of rewards (tangible or intangible), too.
39Rate of Progression Improvement conditioning stage Typically lasts 4-5 months.Aerobic conditioning is progressed at a more rapid rate.Intensity increased to target levelDuration increased every 2-3 weeksLess fit individuals may need more time.Duration of exercise should be increased to minutes before increasing the intensity.
40Rate of Progression Maintenance conditioning stage Usually begins after first 6 months of trainingParticipant reaches satisfactory level of cardiorespiratory fitnessShould review the conditioning objectivesMore enjoyable or variable activities may be substituted for those used previouslyhelps avoid dropping out due to boredom of repetition
42“I am sick of all this nonsense about beauty being only skin deep “I am sick of all this nonsense about beauty being only skin deep. That’s deep enough. What do you want, an adorable pancreas?”Jean Kerr
43Other Fitness Components FlexibilityLack of flexibility may be associated with increase risk for low back pain and other injuriesStretching exercises should be performed slowly, in a controlled manner15-20 seconds per repetition4 repetitions of a particular stretch per setat least 3x/week
44Other Fitness Components Muscular strength and enduranceNo direct relationship to cardiorespiratory fitness or functional capacityhowever, many tasks require some degree of strength, e.g. lifting/moving objectsThe stronger the individual, the less stress placed upon the body performing tasksStrength exercises help to maintain muscle mass as we become older (“Use it or lose it.”)
45Other Fitness Components Muscular strength and enduranceBegin with low resistance, high repetitions to develop muscle tone20-30 reps with light weight per setOptimal strength gains occur when the resistance allows for no more than 5-8 repetitions of a movement, for 3 setsyou can still make strength gains with lower resistances
49Nutrition Carbohydrates for fuel Protein for re-building 60%+ of total daily caloriescomplex>simpleProtein for re-building15%+ of total daily caloriesFat for energy storage (1 lb. = 3500 Kcal)25% (or less) of total daily caloriesavoid saturated and hydrogenated typesSimple/Refined sugars:refining strips substance of nutritional valueHigh simple sugars promote insulin release;Insulin stores fat in cells.Protein: fat often found in protein sources, so be careful.Choose lean meat; trim visible fat;
50Nutrition Fluids Sodium Plain water best for most people Drink 1-2 eight ounce glasses before exerciseRepeat every 20 minutes of exerciseSodiumNormal daily intake about 2000 mgNever consume salt tablets on hot days!
51Injury/Illness Treatment and Prevention Ice is nice!P.R.I.C.E.S.SunscreenSPF 15 or greaterProper footwearTie shoelaces!
52“The secret of staying young is to live honestly, eat slowly, and lie about your age.” Lucille Ball