2. Jared Blitz, MLSt, ACSM-CPT, PAPHS Department of Exercise Science Mesa Community College The Health Benefits of Physical Activity in Aging

3. - Physical inactivity has an astonishing breadth of harmful health implications - There appears to be a linear relationship between physical activity and health status - Exercise is an underutilized therapy for treatment and prevention of chronic disease - The association between disease and an inactive and unfit way of life persists in virtually every subgroup of the population Physical inactivity is The Major Public Health Problem of our time

4. Review a sampling of the proven health benefits of exercise on older adults Recommended ACSM guidelines and position stand for exercise prescription in older adults Suggest that exercise is a form of medicine and older adults need to take it Propose a merging of fitness and health

6. 1900 – 47 years Teddy Roosevelt died in 1919 at age 60 2000 – 78 years Ronald Reagan became President in 1981 at age 70 He died in 2004 at age 93

7. CauseNumber of Deaths Heart Disease599,413 Cancer567,628 Chronic Lower Respiratory Disease137,353 Stroke128,842 Accidents118,021 Alzheimer’s Disease79,003 Diabetes68,705 Influenza and Pneumonia53,692 Renal Disease48,935 Suicide36,909

9. Loss of skeletal muscle mass, or sarcopenia, and bone mass, or osteoporosis Loss of muscle fibers, particularly Type II in men and women, around 50 when muscle atrophy most noticeable Decreased ability to produce force (max strength) Decreased ability to maintain muscle endurance

10. Changes in elderly skeletal muscle could be due to: Nutritional deficiencies Endocrine status Lack of PA http://www.acsm.org/docs/c urrent- comments/physiologyofaging.pdf

11. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of a sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. Ideally, exercise for healthy aging should include a combination of aerobic, strengthening, and flexibility exercises.

12. A combination of regular aerobic and resistance training exercises is more effective at combating the effects of the aging process than either form of training alone. Individuals who are at risk for falling or mobility impairment should also perform specific exercises to improve balance.

13. Although higher-intensity training programs are effective, physical activity does not need to be high- intensity to prevent chronic conditions. Exercise must be performed consistently to have lasting benefits. The benefits of a single exercise session are relatively short-lived.

14. In addition, the Position Stand provides evidence that exercise provides psychological benefits for older adults, including lowered risk of dementia, and helps improve day-to-day functionality.

15. 55/65 to 90% of Hrmax (220-age), or 40/50 to 80% of Heart Rate Reserve ((HRmax – HRrest) * % intensity + HRrest) 3-5 days/wk 20-60 min in duration or Three (3) 10 minute bouts http://www.acsm.org/docs/current- comments/exerciseandtheolderadult.pdf http://www.medscape.com/viewarticle/ 820472

16. 2-4 days/wk 48 hours b/w sessions “Total body” routine or “split” routine for beginners 20-45 minute duration Multi-joint exercises Machines before free weights 1-2 exercises per muscle group http://www.acsm.org/docs/current- comments/resistancetrainingandtheoa.pdf

17. Static (hold) vs. Dynamic (movement) Daily Start with stable foundation Gradual progression Utilize balance tools when a challenge is needed Balance Pillow Balance Disc Bosu Ball Stability Ball http://www.acsm.org/docs/brochures/selecting-and- effectively-using-balance-training-for-older-adults.pdf

18. Diabetes Mellitus Cancer (breast and colon) Hypertension Depression Osteoporosis Dementia Coronary Heart Disease All-cause and cardiovascular-related death

19. Meyers; NEJM; 2002

20. Better to be fit and fat than skinny and unfit level of fitness is a bigger risk factor for mortality than mild- moderate obesity Benefits of PA are the same, regardless of your weight Blair et al. JAMA. 2007.

21. Blair & Wei, Am Journal of Health Promotion 2000; 15:1-8 Among 2,135 Age-Grouped Men

22. Larsen EB et al. Ann Int Med 2006; 144: 73-81

23. Dunn A et al. Amer J Prev. Med 2005 Drug therapy and cognitive behavioral therapy produce remission in approximately 40% of clinically depressed individuals.

24. Better concentration and mental performance Better sleep, energy, and stamina Improved self-esteem, image, and confidence Less anxiety, hostility, tension, and depression

25. Estimated 250,000 premature deaths annually in the U.S. attributable to inactivity Medical costs attributed to obesity nationwide is $147 billion (CDC) Physical activity and obesity are second only to tobacco use as leading cause of preventable death in the U.S. It follows that the “big 3” (exercise, smoking, and BMI) should be assessed at every doctor’s visit Health care spending expected to increase 25% by 2030, 75% of increase due to chronic disease

26. Safdar et al. Endurance Exercise. McMaster Univ. 2011

27. If we had a pill that conferred all the proven health benefits of exercise, physicians would prescribe it to every patient and our healthcare system would find a way to make sure every patient had access to this wonder drug. And Anyone Can Take It!

28. Functional limitations Injury or Illness Too tired Social isolation Environment Sedentary habits

29. Dispel misconceptions Exercise sharpens the mind More activity, the better QOL Pain management Identify personal goals! Normal daily function Competitive Activity More ideas Find an exercise partner or group 5K walks/runs Interactive video games

30. Enhances ability of muscle cells to handle oxygen More efficient heart and increase in max SV Increase in VO2 = decrease in stress at given workload Morphologic changes “Athletic Heart”

31. Review of 30 training studies (since 1990) w/ M & F subjects 64+ yrs Investigated relationship of aerobic activity, aging, and VO2max Study Lengths 8-10 weeks (5 studies) 12-18 weeks (14 studies) 24-52 weeks (11 studies) Shephard, R. (2008). Maximal oxygen uptake and independence in old age. BJSM

32. Men: VO2max tends to drop 5ml/kg/min after each decade starting at age 20 (drop from 45ml/kg/min) Women: VO2max tends to drop 5ml/kg/min after each decade starting at age 35 (drop from 38/ml/kg/min) Decline largely due to physical inactivity and increased body fat Once VO2max drops to 18ml/kg/min for men and 15ml/kg/min for women there is loss of functional independence

33. Aerobic activity (brisk walking) can SLOW this decline significantly 8-10 weeks training: VO2max improves 12.9% 12-18 weeks training: VO2max improves 14.1% 24-52 weeks training: VO2max improves 16.9% Shephard, R. (2008). Maximal oxygen uptake and independence in old age. BJSM

34. Higher intensities = Greater gains = 25% increase in VO2max (an additional increase of 6ml/kg/min) “Equivalent to gaining back 12 years of vigor and delaying dependency by same margin” Shephard, R. (2008). Maximal oxygen uptake and independence in old age. BJSM

35. Bulking up more difficult for older adults than young http://www.acsm.org/about-acsm/media-room/acsm-in-the- news/2011/07/06/bulking-up-more-difficult-for-older-adults-than-young Lifting weights can help seniors stay independent longer http://www.acsm.org/about-acsm/media-room/acsm-in-the- news/2011/08/01/lifting-weights-can-help-seniors-stay-independent-longer Interactive video games help meet exercise recommendations http://www.acsm.org/about-acsm/media-room/acsm-in-the- news/2011/08/01/interactive-video-games-help-meet-exercise-recommendations Older adults: Build muscle and you’ll live longer (UCLA, March 2014) http://www.sciencedaily.com/releases/2014/03/140314095102.htm

36. Nationwide exercise initiative Every patient; every visit; every treatment plan Physical Activity recorded as vital sign and patients advised to do: 30 min of moderate exercise, 5 days/wk Walk, jog, bike Message should be same from every medical provider, regardless of specialty We must begin to merge the healthcare industry with the fitness industry

37. National initiative sponsored by the ACSM and AMA Website - Exerciseismedicine.org National launch in November 2007, in Washington, D.C. Dr. Robert Sallis Dr. Regina Benjamin, US Surgeon General

38. To make physical activity assessment and exercise prescription a standard part of the disease prevention and treatment paradigm for all patients

40. Evidence is overwhelming on health burden of inactivity in older adults Benefits of exercise treatment and prevention of chronic disease is irrefutable Exercise is the vaccine needed to prevent chronic disease and improve quality of life Activity should be addressed at each visit with a doctor It’s never too late to begin cardiovascular, resistance, and balance training Merge the fitness industry with the healthcare industry Physicians should be prescribing exercise to all of their patients, especially seniors Exercise is medicine, and it’s free!