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EXERCISE FOR OLDER ADULTS WITH CHRONIC DISEASES

People older than 65 years constitute one of the fastest growing population segments.  This age group also exhibits the greatest proportion of chronic disease, disability, and healthcare utilization.  Coronary artery disease, high blood pressure, heart failure, diabetes, arthritis, osteoporosis, and cognitive disorders are a few of the more common diseases that become more prevalent as people age.

Regular exercise has been proven to benefit overall health and function of individuals of all ages.  Moreover, risk factors for chronic disease respond to exercise interventions in younger adult populations.  The same is most likely true for older adults.  Unfortunately, inactivity tends to increases as people age.  There is a perception that chronic disease is a part of the normal aging process, and that elderly cannot respond to lifestyle interventions; both of which are false.  People who adopt lifestyle modifications, including exercise, can expect an increase in life expectancy, decrease in disability, and reduced healthcare costs.

Here is a review of some common chronic diseases, and the impact of regular exercise on the course of each disease (Please note, people with chronic disease(s) should consult their primary care doctor prior to initiating any exercise program!):

Cardiovascular Disease
Sedentary lifestyle is a risk factor for cardiovascular disease.  Clinical studies have shown that higher activity levels can reduce blood pressure, total cholesterol and LDL ( " bad " ) cholesterol, as well as triglycerides.  Also, exercise has been proven to increase HDL ( " good " ) cholesterol.

Hypertension
The maintenance of an optimal body weight, along with regular exercise will help to lower blood pressure.  The best exercises for people with high blood pressure include aerobic exercises, such as walking, swimming, dancing, or jogging.  It is recommended to start off slowly, doing aerobic exercises for 30 minutes, three times a week.  The 30 minutes can be in one segment, or broken up into smaller segments.  The optimal benefit for patients with high blood pressure is seen with 50-60 minutes of moderate aerobic exercise 3-4 days a week.  This amount of exercise has been proven to reduce blood pressure more effectively than more vigorous exercise.  Also, it has not been proven that weight-training exercises can lower high blood pressure.  Be aware that if a regular exercise program is adopted, you may need to reduce your blood pressure medication doses, once again reiterating the importance of staying in close contact with your primary care physician if you decide to begin exercising.

Heart Failure
In years past, bed rest was recommended for patients with heart failure.  The last two decades, however, have seen a dramatic change in how these patients are treated in regard to physical activity.  Although several questions remain to be answered, it is generally accepted that mild aerobic exercise as well as mild resistive exercises (with weights) improves endurance, blood flow to the legs, breathing, and heart failure symptoms.

Recommendations for specific exercises include mild aerobic exercises (walking, swimming) in combination with one to three sets of resistive exercises (12-15 repetitions per set).  These resistive exercises should initially be done with minimal weight, in the large muscle groups (legs).  Add smaller muscle groups (arms) later.  Once 15 repetitions can be done on a weight, resistance can be increased. 

New research shows that interval training may benefit heart failure patients.  This involves alternating short bursts (30 seconds) of maximal aerobic exercise with 60 seconds of rest for 10-20 cycles.  This is a relatively new practice, and refinements may be expected.

Diabetes (Type 2 - Adult Onset)
There is a strong association between aging and the development of glucose intolerance.  There is evidence that this may be due to an increased level of inactivity.  Regular exercise may reduce the incidence of the development of Type 2 diabetes.  Physical activity in established diabetics promotes cardiovascular fitness as well as increases insulin sensitivity, which may in turn decrease the needed dosage of a patients oral hypoglycemic medications.

Mild aerobic training for prolonged periods, such as walking, seems to be more effective than high-intensity training (such as running) for short periods of time.  This accompanied by diet compliance, hydration management while exercising, glucose monitoring, proper footwear, and adequate warm-up and cool-down periods are all essential components of the diabetic exercise program.  As with high blood pressure medications, exercise may alter the dosage or oral hypoglycemic medications needed to maintain proper glucose levels.

Osteoarthritis
Older adults with osteoarthritis can see improvements in pain control, proprioception (balance), strength, flexibility, and endurance with exercise.  However, pain often limits how much exercise a person with arthritis can do.  Bracing, stretching, doing fewer repetitions, and appropriately using analgesia people can increase their exercise tolerance.

Range of motion and strength exercises are both important for the arthritic patient.  Strength training can be either isotonic (weight lifting) or isometric (muscle contraction without joint movement).  Also, try non-weightbearing exercises (water aerobics, swimming, cycling).  Watch for activity that is too vigorous.  If joint pain lasts for more than two hour after exercise, this is a sign you have over done it.

Osteoporosis
Approximately 30 % of postmenopausal women have osteoporosis.  There is controversy concerning exercise for preventing postmenopausal bone loss.  Studies show that exercise (walking, running, aerobics) significantly reduce bone mineral loss in the lumbar spine, but not in the forearm or femur.  It is generally accepted that exercise does reduce hip fracture, if not by increased bone mineralization, by increasing muscle strength.  Even older adults with low levels of activity have few hip fractures than those who were inactive.

The best treatment to treat osteoporosis is combining therapies.  Exercise, plus calcium supplementation and possibly hormone replacement therapy are options.  Exercises should include weight bearing activities like low impact aerobics and walking.

Cognitive Disorders
Studies have shown that improvements in cognition (memory, attention, reaction time, and intelligence) occur in older participants in aerobic fitness programs.  Safety is the primary issue in exercise programs for older adults with cognitive deficits.  Injury prevention secondary to proper attire, optimal environmental conditions, and simple equipment are essential.  Also, supervision is a must.  Chair exercises with household items (a knotted towel), accompanied by familiar music is effective at promoting patient participation and functional gains.

Summary
In summary, exercise for older adults with chronic disease can help to improve the symptoms they are experiencing.  By working with their doctors, older adults may be able to develop an exercise program that will reduce their symptoms, and increase their functional capacity.

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