Exercise and Physical Activity for the Older Adultand Frailty

Question 1

What is the difference between physical activity and exercise for older adults ?

Answer 1

• Physical activity has lower intensity (3-6 METs) and can include leisure activities or ADLs.
• Exercise is goal-oriented, aiming to increase strength, flexibility, or aerobic conditioning.

Question 2

According to the CDC, how often should older adults engage in moderate-intensity aerobic activity and strength training?

Answer 2

• 150 minutes of moderate-intensity aerobic activity per week and muscle-strengthening activities on 2 or more days a week that work all major muscle groups.

Question 3

What are the alternative CDC guidelines for vigorous-intensity aerobic activity for older adults?

Answer 3

• 75 minutes of vigorous-intensity aerobic activity per week, plus muscle-strengthening activities on 2 or more days a week.

Question 4

What is ‘sedentary death syndrome’?

Answer 4

It refers to the severe health risks associated with physical inactivity, contributing to chronic conditions and disabilities.

Question 5

What is the ‘Slippery Slope of Aging’?

Answer 5

It refers to the progressive decline in strength and function with stages including Fun, Function, Frailty, and Failure.

Question 6

At what rate does strength decrease in adults starting at age 30?

Answer 6

• Strength decreases at a rate of 10% per decade starting at age 30
• Accelerating to 15% per decade after around age 60.

Question 7

What is frailty?

Answer 7

A clinically recognizable state of increased vulnerability due to aging-related decline in reserve and function across multiple physiologic systems.

Question 8

What are the five phenotypic criteria for frailty defined by Fried et al.?

Answer 8

• Low grip strength
• Low energy
• Slowed walking speed
• Low physical activity
• Unintentional weight loss.

Question 9

How is grip strength used to identify frailty?

Answer 9

Reduced grip strength is associated with increased risk of mortality and is a simple, quick, and inexpensive means of assessing cardiovascular risk.

Question 10

What does the presence of fatigue indicate in older adults?

Answer 10

Fatigue is a common reason for activity restriction and disability, often self-reported among older adults.

Question 11

What gait speed indicates frailty in the 4-meter walk test?

Answer 11

A typical gait speed of less than 0.8 meters per second indicates frailty.

Question 12

What is the Physical Activity Scale for the Elderly (PASE)?

Answer 12

It is a scale used to measure the level of physical activity in older adults.

Question 13

What constitutes unintentional weight loss in older adults?

Answer 13

Losing more than 10 pounds unintentionally over a one-year period.

Question 14

What are the clinical consequences of involuntary weight loss in older adults?

Answer 14

• Functional decline
• Infections
• Decubitus ulcers
• Exacerbation of cognitive and mood disorders
• Increased use of acute and long-term care facilities

Question 15

What is sarcopenia?

Answer 15

The degenerative loss of skeletal muscle mass, quality, and strength associated with aging.

Question 16

What is the primary cause of functional limitations and disabilities in older adults?

Answer 16

Loss of strength, rather than medical conditions, is typically the cause of functional limitations and disabilities.

Question 17

What did Dr. Thomas L. DeLorme contribute to strength training?

Answer 17

He developed the Progressive Resistance Exercise protocol post-WWII, which involved multiple sets of resistance exercises for rehabilitation.

Question 18

How does the Physical Stress Theory (PST) relate to tissue stress?

Answer 18

PST states that both excessive and insufficient stress can lead to tissue damage or atrophy, and usual stress should be 40-60% of maximum.

Question 19

What is ‘Life Space’ and its importance in older adults’ health?

Answer 19

Life space measures the spatial area a person moves through daily, and lower life space mobility is associated with increased frailty and mortality risk.

Question 20

What are the primary factors contributing to unintentional weight loss in older adults?

Answer 20

Factors include eating less than one meal per day, reduced overall food intake, decreased appetite, severe malnutrition, and issues with swallowing.

Question 21

What is the role of physical activity in preventing mobility disability?

Answer 21

Physical activity helps maintain strength and function, reducing the risk of mobility disability and chronic conditions.

Question 22

What are some techniques PTs can use to help patients move to a higher category (Fun, Function, Frailty, Failure)?

Answer 22

Using normative data to set goals, and implementing strength training and physical activity interventions.

Question 23

How does grip strength relate to cardiovascular risk?

Answer 23

Weak hand grip strength in later life is a risk factor for disability, morbidity, and mortality, making it a central measure in assessing cardiovascular risk.

Question 24

What is the significance of a gait speed less than 0.8 m/s?

Answer 24

It is a diagnostic criterion for sarcopenia and indicates increased risk of frailty and mobility issues.

Question 25

What is the prevalence of self-reported fatigue among older adults in primary and long-term care?

Answer 25

Approximately 25% in primary care and 98% in long-term care.

Question 26

How can muscle interventions benefit older adults?

Answer 26

Initiating muscle interventions early can build muscle reserve and delay functional limitations and disabilities.

Question 27

What did the 80s aerobic craze focus on, and how did it change?

Answer 27

It focused on cardiovascular fitness, with strength training recommendations added by the ACSM in the 1990s.

Question 28

What is the principle of overload in resistance training?

Answer 28

A training stimulus presents an overload when it exceeds the usual maximum threshold and is greater than recent historical stimuli.

Question 29

What is the concept of ‘progressive overload’ in strength training?

Answer 29

Progressive overload involves gradually increasing the training stimulus to promote continued strength and muscle gains.

Question 30

What does ‘relative intensity’ mean in resistance training?

Answer 30

Relative intensity, or Reps in Reserve (RIR), estimates the intensity of effort in resistance exercises, helping to gauge progression.

Question 31

How does physical inactivity contribute to chronic conditions in older adults?

Answer 31

Physical inactivity is a significant risk factor for chronic conditions and increases the risk of additional disability in the presence of chronic conditions.

Question 32

What are the structural adaptations from resistance exercise?

Answer 32

Resistance exercise increases muscle mass (hypertrophy), strength (neuromuscular adaptations), and rate of force production/power (neuromuscular adaptations).

Question 33

What are the metabolic stress factors that stimulate hypertrophy?

Answer 33

Mechanical tension, muscular damage, and metabolic stress stimulate hypertrophy, even at low loads if taken to concentric failure.

Question 34

How does sarcopenia affect muscle fibers?

Answer 34

Sarcopenia involves a decrease in Type II muscle fiber circumference, with Type I fibers largely unchanged, and denervated Type II fibers converting to Type I fibers.