Physical Activity and the Elderly

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Physical Activity and the Elderly

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1. Physical Activity and the Elderly Laurel Hadsell Sarah Glenn Whitney Kindell Candice Harper

2. Evidence Based Practice Question “In the community dwelling elderly population, ages 60 years and older, does purposeful cardiovascular exercise at least two times a week, compared to no exercise at all, result in a constant or increase of mental and physical health?”  

3. Why this is a problem Adults aged 65 and older compose the most rapidly growing component of the United States population, in fact, it is estimated that nearly one quarter of the American population will exceed 65 years of age by 2050! An inactive lifestyle is a major risk factor for acute and chronic illnesses and disabilities in the elderly. Physical inactivity has been related to functional decline and high disease incidence in the elderly (Yanowitz and LaMonte, 2002). An increasing prevalence of inactivity among the elderly may create a potential burden to the health-care system.

4. Physical activity levels among most elderly adults are insufficient to confer health benefits. The majority of adults over 65 years reported no leisure or physical activity. Studies show with increasing age, there is a deterioration of physical function and neuromotor performance that is associated with an increase number of falls and disability in older adults.

5. Statistics A 5-year study of Medicare costs indicates that older adults who are healthy but sedentary, average $6,780 MORE in Medicare costs than those who engage in low-intensity exercise. Less active, less fit individuals, have a 30-50% greater risk of developing hypertension. It is estimated that only 30% of individuals over the age of 65 exercise on a regular basis. Oklahoma ranks 46th in the nation for a lack of physical activity. One study showed that 75% of the 60 functionally independent persons over 75 years of age admitted to the hospital for an acute illness were no longer independent at discharge, and 15% were discharged to nursing home” A lack of physical activity can lead to colon cancer, diabetes, cardiovascular disease, stroke, cognitive decline, osteoporosis, depression, obesity, and a weak immune system. The magnitude of the effects of exercise on the physical, mental abilities, and health of a person are very high for Oklahomans and all Americans. The average American is increasingly overweight, and the majority of Americans are considered aging adults with a high risk of decreasing mental capabilities. Exercise could have the potential to affect many lives in a positive manner, increasing the overall health and contributing to a better quality of life. , One study showed that 75% of the 60 functionally independent persons over 75 years of age admitted to the hospital for an acute illness were no longer independent at discharge, and 15% were discharged to nursing home” A lack of physical activity can lead to colon cancer, diabetes, cardiovascular disease, stroke, cognitive decline, osteoporosis, depression, obesity, and a weak immune system. The magnitude of the effects of exercise on the physical, mental abilities, and health of a person are very high for Oklahomans and all Americans. The average American is increasingly overweight, and the majority of Americans are considered aging adults with a high risk of decreasing mental capabilities. Exercise could have the potential to affect many lives in a positive manner, increasing the overall health and contributing to a better quality of life. ,

6. Statistics After age 30, the maximum aerobic dynamic performance capacity decreases by an average of 8% per decade. Approximately 250,000 deaths per year in the U.S. are associated with physical inactivity. Almost 15,000 people, ages 65 and older, die from falls every year. Unintentional injuries or accidents are listed as the seventh leading cause of death in persons 65 and older and make up the majority of accidents in this population. Physical endurance training can reduce this oxygen depletion by 30-50% Unintentional injuries or accidents are listed as the seventh leading cause of death in persons 65 and older and make up the majority of accidents in this population. Physical endurance training can reduce this oxygen depletion by 30-50%

7. Statistics Healthy persons in their 7th and 8th decade of life have, on average, 20-40% less static and dynamic muscle strength than younger persons. After age 30, approximately 6% of the muscle fibers necrotize every decade. On average the maximum oxygen uptake capability falls by 8% every decade.

8. The aging process Decrease in maximum cardiac output Reduction in lung performance Loss in skeletal muscle mass Decrease in myoglobin in muscle cells Reduced insulin sensitivity Reduction of bone density and loss of minerals Decline in short term memory Changes in hormonal regulation Diminished capability in immune system

9. Review of Research Cross-sectional studies -assess physical fitness measures -examine the relationship between physical fitness measures and general health and social support -assess feasibility of measuring physical fitness in the primary care setting Integrative reviews of literature -examine the relationship between physical activity and its relationship to cardiovascular health and mortality among multiple research articles So far in the literature, there have been several different methods for studying exercise in the elderly population. The first one is Cross-sectional studies -assess physical fitness measures, which should include measures such as what type, duration, intensity, and frequency of exercise is beneficial for mental and physical health. -examine the relationship between physical fitness measures and general health and social support we ask ourselves what correlation does physical fitness have with the patient’s overall general health and social support. We want to clarify that social support can be a wide variety of things such as a community social support comprised of just an elderly population or it can be family support. -assess feasibility of measuring physical fitness in the primary care setting which also include a variety of physical fit testing using multiple types of not only exercise, but also strength, balance, and flexibility. second is Integrative reviews of literature -examine the relationship between physical activity and it relationship to cardiovascular health and mortality among multiple research articles So far in the literature, there have been several different methods for studying exercise in the elderly population. The first one is Cross-sectional studies -assess physical fitness measures, which should include measures such as what type, duration, intensity, and frequency of exercise is beneficial for mental and physical health. -examine the relationship between physical fitness measures and general health and social support we ask ourselves what correlation does physical fitness have with the patient’s overall general health and social support. We want to clarify that social support can be a wide variety of things such as a community social support comprised of just an elderly population or it can be family support. -assess feasibility of measuring physical fitness in the primary care setting which also include a variety of physical fit testing using multiple types of not only exercise, but also strength, balance, and flexibility. second is Integrative reviews of literature -examine the relationship between physical activity and it relationship to cardiovascular health and mortality among multiple research articles

10. Review of Research Physical activity testing -to determine the effects of exercise on the health related quality of life and functional status of the elderly population Memory and information processing scales -assess memory processing, including learning, retention and retrieval abilities Quality of life, Depression and Life satisfaction scales -assess functional and mental cognition related to quality of life and lifestyle Cognitive function testing -examine the relationship between level of cognitive functioning and variables such as age, education, depression, and functional status Physical activity testing -to determine the effects of exercise on the health related quality of life and functional status of the elderly population different types of exercise can be used in physical activity testing and the biggest concern that we have with using physical activity testing is the research is unclear about the specific types, duration, frequency, and intensity is the most beneficial for health. The last three methods that are used are specific to mental cognition and physical activity Memory and information processing scales -assess memory processing, including learning, retention and retrieval abilities Quality of life, Depression and Life satisfaction scales -assess functional and mental cognition related to quality of life and lifestyle Cognitive function testing -examine the relationship between level of cognitive functioning and variables such as age, education, depression, and functional status and its relationship with physical activity. Physical activity testing -to determine the effects of exercise on the health related quality of life and functional status of the elderly population different types of exercise can be used in physical activity testing and the biggest concern that we have with using physical activity testing is the research is unclear about the specific types, duration, frequency, and intensity is the most beneficial for health. The last three methods that are used are specific to mental cognition and physical activity Memory and information processing scales -assess memory processing, including learning, retention and retrieval abilities Quality of life, Depression and Life satisfaction scales -assess functional and mental cognition related to quality of life and lifestyle Cognitive function testing -examine the relationship between level of cognitive functioning and variables such as age, education, depression, and functional status and its relationship with physical activity.

11. Summery of Literature Carvalho-Bastone & Filho, 2004 -Benefits functional improvement -Decreases depressive symptoms -Prevents mental status decline Chan el at., 2005 -Cardiovascular and/or Mind Body exercises enhanced memory function and learning ability Fahlman el at., 2007 -Resistance and aerobic training increased strength and endurance -Reduced morbidity and mortality rates Carvalho-Bastone & Filho, 2004 Physical activity has benefits for the elderly population that include functional improvement, reduction in depressive symptoms and prevention of decline in mental status based on exercise compared to no exercise. Improvements include functional improvement, reduction in depressive symptoms, and prevention of decline in mental status. Chan el at., 2005 Reveal positive effects of cardiovascular and mind body exercises on late life memory preservation in a Chinese population. Older adults who practiced cardiovascular and/or mind body exercises demonstrated a similar level of memory function, and their learning and memory was better than individuals who did not exercise regularly. Fahlman el at., 2007 Resistance training and a combination of resistance plus aerobic training are capable of producing significant strength and endurance increases in the functionally limited older adult as well as maintaining independence and for reducing morbidity and mortality Carvalho-Bastone & Filho, 2004 Physical activity has benefits for the elderly population that include functional improvement, reduction in depressive symptoms and prevention of decline in mental status based on exercise compared to no exercise. Improvements include functional improvement, reduction in depressive symptoms, and prevention of decline in mental status. Chan el at., 2005 Reveal positive effects of cardiovascular and mind body exercises on late life memory preservation in a Chinese population. Older adults who practiced cardiovascular and/or mind body exercises demonstrated a similar level of memory function, and their learning and memory was better than individuals who did not exercise regularly. Fahlman el at., 2007 Resistance training and a combination of resistance plus aerobic training are capable of producing significant strength and endurance increases in the functionally limited older adult as well as maintaining independence and for reducing morbidity and mortality

12. Fahlman el at., 2007 -Moderate exercise 3x a week improves functional ability -Increased measures of strength and endurance Houde & Melillo, 2002 -Integrative review stating physical activity is considered an important factor in the quality of life of the elderly population, and is proven to reduce mortality rates. Although, there is a lack of clarity regarding OPTIMAL level of physical activity. Kalapotharakos el at., 2006 -Aerobic exercise can maintain or reverse the decline of physical and neuromotor performance Fahlman el at., 2007 Moderate exercise conducted three times per week resulted in a improvement in performance on measures of fitness and functional ability. An exercise program in the older adult population can lead to increased measures in functional ability, strength, and endurance . Houde & Melillo, 2002 An integrative review to correlate physical activity and its relationship to cardiovascular risk factors and mortality. Physical activity is considered an important factor in the quality of life of the elderly population and is proven to reduce mortality rates, but there is a lack of clarity regarding optimal level of physical activity. Kalapotharakos el at., 2006 Results suggest that an aerobic exercise program can maintain or even reverse the decline in physical and neuromotor performance in the inactive older adult. Patients can benefit from daily aerobic exercise. Fahlman el at., 2007 Moderate exercise conducted three times per week resulted in a improvement in performance on measures of fitness and functional ability. An exercise program in the older adult population can lead to increased measures in functional ability, strength, and endurance . Houde & Melillo, 2002 An integrative review to correlate physical activity and its relationship to cardiovascular risk factors and mortality. Physical activity is considered an important factor in the quality of life of the elderly population and is proven to reduce mortality rates, but there is a lack of clarity regarding optimal level of physical activity. Kalapotharakos el at., 2006 Results suggest that an aerobic exercise program can maintain or even reverse the decline in physical and neuromotor performance in the inactive older adult. Patients can benefit from daily aerobic exercise.

13. Lindwall el at., 2008 -Active older adults performed better on cognitive function tests -Delay mental problems and mental crisis Muraki el at, 2001 -Difference in functional performance Purath & Kark, 2008 -Physical activity increases upper and lower body strength -Increases aerobic endurance -Increase balance -Decreases chronic conditions Lindwall el at., 2008 Active older adults performed better than inactive older adults on a wide range of cognitive function tests. Exercise can be beneficial in the delaying of mental problems and mental crisis based on performance on cognitive function testing. Muraki el at, 2001 Correlates physical activity level of the elderly population with different lifestyles using depression and life satisfaction scales. The studied showed a difference in functional performance using daily physical activity and QOL that indicated that there was no difference in gender but marital status should be considered. Depression and Life Satisfaction Scales can be used in a primary care setting as a standard in assessments and screenings for more effective therapy and treatment as well as activity level. Lindwall el at., 2008 Active older adults performed better than inactive older adults on a wide range of cognitive function tests. Exercise can be beneficial in the delaying of mental problems and mental crisis based on performance on cognitive function testing. Muraki el at, 2001 Correlates physical activity level of the elderly population with different lifestyles using depression and life satisfaction scales. The studied showed a difference in functional performance using daily physical activity and QOL that indicated that there was no difference in gender but marital status should be considered. Depression and Life Satisfaction Scales can be used in a primary care setting as a standard in assessments and screenings for more effective therapy and treatment as well as activity level.

14. Stiggelbout el at., 2004 -Once weekly participation in exercise program is not sufficient -Twice weekly will produce benefits of increased functional status and health related quality of life Uffelen el at., 2008 -Aerobic fitness contributes to improvement or maintenance of cognitive function -Exercise improves memory, information processing abilities, and executive function Purath & Kark, 2008 Based on physical fitness measures, including physical fitness, general health, social support, and access to resources, physically active older adults had significantly better upper and lower body strength, aerobic endurance, and dynamic balance as well as fewer chronic conditions than those older adults who were not physically active. Physical fitness measures can give primary care providers objective information to develop a physical activity program for their patients. Stiggelbout el at., 2004 For benefits of functional status and health related quality of life, once a week participation in an exercise program is not sufficient. An exercise program consisting of exercise at least twice weekly is recommended. Uffelen el at., 2008 Changes is aerobic fitness contribute to the improvement and/or maintenance of cognitive function. Patients showed improvements using different exercise programs and improvements in memory, information processing abilities, executive function, and overall general cognitive functioning. Purath & Kark, 2008 Based on physical fitness measures, including physical fitness, general health, social support, and access to resources, physically active older adults had significantly better upper and lower body strength, aerobic endurance, and dynamic balance as well as fewer chronic conditions than those older adults who were not physically active. Physical fitness measures can give primary care providers objective information to develop a physical activity program for their patients. Stiggelbout el at., 2004 For benefits of functional status and health related quality of life, once a week participation in an exercise program is not sufficient. An exercise program consisting of exercise at least twice weekly is recommended. Uffelen el at., 2008 Changes is aerobic fitness contribute to the improvement and/or maintenance of cognitive function. Patients showed improvements using different exercise programs and improvements in memory, information processing abilities, executive function, and overall general cognitive functioning.

15. Pros Allocating exercise into the patients schedule Promote quicker healing Reduce morbidity and mortality Individual physical activity program Functional independence Reduce co-morbid conditions Reduce healthcare costs Self-care Leisure time Incorportating specific times and durations for exercise into a patient’s schedule can allow the patient to pick the exercise that they enjoy doing and at what time they want to perform it at will most likely increase the patient compliance with the exercise program and lead to improved muscle strength, mobility, and reaction time of the individual. Incorporating more physical activity into the elderly population can facilitate and promote quicker healing. Physical activity has been shown to reduce morbidity and mortality. Physical fitness measures can give primary care providers objective information to develop a physical activity program individually tailored to the elderly patient. Exercise can lead to the elderly maintaining a greater level of functional independence. Combining structured exercise with an active lifestyle can assist the elderly in maintaining a greater likelihood of personal independence. Reduce co-morbid conditions associated with aging by up to one third. Reductions in healthcare costs such as Medicare. Improvements in the ability to participate freely in self-care and leisure time activities. Incorportating specific times and durations for exercise into a patient’s schedule can allow the patient to pick the exercise that they enjoy doing and at what time they want to perform it at will most likely increase the patient compliance with the exercise program and lead to improved muscle strength, mobility, and reaction time of the individual. Incorporating more physical activity into the elderly population can facilitate and promote quicker healing. Physical activity has been shown to reduce morbidity and mortality. Physical fitness measures can give primary care providers objective information to develop a physical activity program individually tailored to the elderly patient. Exercise can lead to the elderly maintaining a greater level of functional independence. Combining structured exercise with an active lifestyle can assist the elderly in maintaining a greater likelihood of personal independence. Reduce co-morbid conditions associated with aging by up to one third. Reductions in healthcare costs such as Medicare. Improvements in the ability to participate freely in self-care and leisure time activities.

16. Cons Lack of clarity Barriers to participation Individualized Physical fitness assessments More research Barriers in the primary care setting Lack of clarity regarding physical fitness measures, intensity, frequency, and duration of exercise and also different types of exercise that is most beneficial for health. Interventions are needed to circumvent barriers to participation. Some of these barriers include available resources, motivation, and social support. Exercise programs should be individualized to the patient to increase the likely hood of the patient continuing with the exercise regimen. And in many cases physical fitness assessments are not being utilized in the primary care setting. Primary care providers need to adopt a comprehensive physical fitness assessments program that should include aerobic and strength training supplemented with balance and flexibility. More research is needed in order for healthcare providers to establish a physical fitness assessment program into the primary care setting along with physical fitness measures that include type, intensity, frequency, and duration of exercise. And last Barriers to the primary care setting include measuring free-living physical activity, determining the amount of physical activity required to make a change in health, strategies for assessing and modifying the physical activity level of the elderly population, and increasing awareness among health care providers as to the importance of physical activity to the health of the elderly population. Lack of clarity regarding physical fitness measures, intensity, frequency, and duration of exercise and also different types of exercise that is most beneficial for health. Interventions are needed to circumvent barriers to participation. Some of these barriers include available resources, motivation, and social support. Exercise programs should be individualized to the patient to increase the likely hood of the patient continuing with the exercise regimen. And in many cases physical fitness assessments are not being utilized in the primary care setting. Primary care providers need to adopt a comprehensive physical fitness assessments program that should include aerobic and strength training supplemented with balance and flexibility. More research is needed in order for healthcare providers to establish a physical fitness assessment program into the primary care setting along with physical fitness measures that include type, intensity, frequency, and duration of exercise. And last Barriers to the primary care setting include measuring free-living physical activity, determining the amount of physical activity required to make a change in health, strategies for assessing and modifying the physical activity level of the elderly population, and increasing awareness among health care providers as to the importance of physical activity to the health of the elderly population.

17. Recommendations Physical exercise participation at least twice a week for aging individual. Moderate exercise for duration of greater than 30 minutes. Strength training, resistance training, and flexibility exercises, performed in conjunction with aerobic conditioning. -Capable of producing significant strength, endurance, and functioning increases in the elderly population.

18. Recommendations Warm up and cool down phases of 5-10 minutes in duration, including flexibility and aerobic exercises. - Important due to the risk of hypotension and musculoskeletal complications. Aerobic training should be initiated gradually, at light-intensity levels, with progression to a moderate intensity. - Assists in injury prevention by increasing the elasticity of the muscle and connective tissue.

19. Recommendations Participation in group physical activity to provide social support and frequency of participation. - Resulted in an increased probability of the patient engaging in physical activity.

20. Evaluating Effectiveness Certified Personnel to Assess: Patient’s health status, including living conditions, support, depression or life satisfaction scales, mini Mental Examination Scale, Geriatric Depression scale, physical assessments, and physical fitness. Long-time measurements : Include the overall effects of decreased national mortality rates, increased life expectancy rates, and prevalence of chronic diseases within the population defined .

21. Evaluating Effectiveness Staff satisfaction of new policy acquisition: Can be measured by job satisfaction questionnaires, surveys, and by formal or informal communication of the staff to the charge nurse or unit manager. Informant interviews should reveal an increase satisfaction of tasks and beneficence to the served population by the implementation of new interventions.

22. Suggestions for Further Studies Studies need to be carried out over longer periods of time. More studies need to focus on a specific type of exercise and compare the differences in the amount of benefits. -What is the optimal intensity, duration, and frequency? Examine the benefits of combining different types of exercise. -Which types of exercises are better for cognition? Physical attributes?

23. References: Carvalho-Bastone, A. & Filho, W.J. (2004). Effect of an exercise program on functional performance of institutionalized elderly. Journal of Rehabilitation Research & Development. 41(5): 659-668. Chan, A.S., Yim-chi Ho, M., Cheung, M., Albert, M.S., Chiu, H., & Lam, L. (2005). Association between mind-body and cardiovascular exercise and memory in older adults. Journal of the American Geriatrics Society. 53(10): 1754-1760. DeJong, A. & Franklin, B.A. (2004). Prescribing Exercise for the elderly: Current research and recommendations. Current Sports Medicine Reports. 3: 337-343. Fahlman, M.M., McNevin, N., Topp, R., & Boardley, D. (2007). Combination training and resistance training as effective interventions to improve functioning in elders. Journal of Aging and Physical Activity. 15(2): 195-205.

24. Fahlman, M.M., Topp, R., McNevin, N., Morgan, A.L., & Boardley, D.J. (2007). Structured exercise in older adults with limited functional ability. Journal of Gerentological Nursing. 33(6): 32-39. Houde, S.C. & Melillo, K.D. (2002). Cardiovascular health and physical activity in older adults: An integrative review of research mehtodology and results. Journal of Advanced Nursing. 38(3): 219-234. Kalapotharakos, V.I., Michalopoulos, M., Strimpakos, N., Diamantopoulos, K., & Tokmakidis, S.P. (2006). Functional and neuromotor performance in older adults : Effect of 12 wks of aerobic exercise. American Journal of Physical Medicine &Rehabilitation. 85(1): 61-67. Lindwall, M., Rennemark, M., & Berggren, T. (2008). Movement in mind: The relationship of exercise with cognitive status for older adults in the swedish national study on aging and care (SNAC). Aging and Mental Health. 12(2): 212-220.

25. Muraki, T., Nagao, T., & Ishikawa, Y. (2001). A preliminary investigation to explore the effects of daytome physcial activity patterns on health-related QOL in healthy community-dwelling elderly subjects. Physical & Occupational Therapy in Geriatrics. 19(2): 51-62. Purath, J., Buckholz, S.W., & Kark, D.L. (2008). Physical fitness assessment of older adults in the primary care setting. Journal of the American Academy of Nurse Practitioners. 21: 101-107. Stiggelbout, M., Popkema, D.Y., Hopman-Rock, M., DeGreef, M., & Van Mechelen, W. (2004). Once a week is not enough: Effects of a widely implemented group based exercise program for older adults; a randomized control trial. Epidemail Community Health. 58: 83-88. Uffelen, J.G., Chin, A.P., Marijke, J.M., Hopman-Rock, M., & Van Mechelen, W. (2008). The effects of exercise on cognition in older adults with and without cognitive decline: A systematic review. Clinical Journal of Sport Medicine. 18(6): 486-500.

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