1. Exercise and the Elderly

2. Physiological Changes With Aging Aging or decrease in activity? Quality years

3. Changes in maximal oxygen consumption Muscle mass – sarcopenia –Muscular Strength and Endurance Fat deposition and body composition Bone mineral density –Osteopenia –Osteoporosis Diagnosed using T-Score cmoparing to normal young adults

4. World Health Organization Criteria for Classifying BMD Classification T-Score Normal BMD-1.0 or greater Osteopenia-1.01 to -2.49 Osteoporosis-2.5 or less Severe Osteoporosis-2.5 or less + fragility fracture

5. Osteoporosis Bone turnover –PTH and vitamin D3 hormone Peak BMD –Trochanter and femoral neck in mid to late teens –Spine in mid 20s Determinants of peak BMD –70-80% genetics –20-30% lifestyle

6. Bone loss –Age related 0.5 – 1%/year –Menopause 1-2%/year for a 5-10 year period –Loss of BMD will continue to pre-adolescent levels

7. Fragility fracture –Women - Forearm ↑ at age 45-50 leveling off at 65 Men – no ↑ –Women - Vertebral ↑ age 55-60 rising linearly with age Men – ↑ 60-70 yrs –Women – Hip ↑ at age 65 and rises exponentially thereafter Men – ↑ 70-75 yrs

8. Distal forearm fractures –Excellent marker for future risk –Wedge fracture at L2 →

9. Exercise Testing Functional tests Potential effects of osteoarthritis Impact of muscular endurance

10. Training the Elderly Still adapt normally to exercise –↑ fitness levels associated with reduced mortality and ↑ life expectancy Differences between training frail versus healthy elderly –Functional capacity and balance –Simple functional tests

11. Training the Elderly Flexibility training Resistance Training –Important to ADLs and RMR –Careful evaluation of HTN elderly –Arthritics train through pain-free ROM –Reps 2-3s concentric, 4-6s eccentric, 8-12 reps to failure, 2d/wk, progress every 2-3 wks Breathing

12. Reducing risks Calcium intake –Vitamin D ExercisePosture