Final Exam Older Adults Flashcards
Aging and Muscle Strength Loss: UE vs. LE, declines and decades of life, women vs. men
- loss in UE and LE strength, but more severe losses in LE
- maintained through 5th decade, declines ~15% per decade in 6th and 7th decades, additional 25-30% loss in 8th decade
- relative losses similar between men and women, but women start at lower absolute strength levels
What type/s of strength is/are maintained for the most part throughout aging?
eccentric
Average power vs. average force and aging
power reductions substantially greater than force reductions
Summary of Skeletal Muscle Changes Associated with Aging: Decreases (14)
- gross muscle size
- type 2 fiber area
- muscle fiber number
- muscle density (due to increases in fat & CT)
- maximal strength
- maximal shortening velocity (speed)
- rate of force development
- muscle power
- specific tension (force/area because decrease density)
- capillarity density
- activity of oxidative enzymes
- mitochondrial density
- total number of motor units
- steadiness of maintaining submaximal forces
Skeletal Muscle Changes Associated with Aging: Increases (3)
- intramuscular connective tissue
- intramuscular fat
- motor unit size
Skeletal Muscle Changes Associated with Aging: Little to No Change (4)
- fiber type distribution or %
- type 1 fiber area
- relative muscle endurance (endurance at a specific % max)
- glycolytic capacity of muscle
Proposed Mechanisms Leading to Decreases in Muscle Strength and Power with Aging
- altered physical activity level
- decreased testosterone and GH
- poor nutrition or disease
- changes in NS
- muscle atrophy
Sarcopenia –> decrease strength, power, muscle endurance –> increases in what?
increased difficulty with weight bearing tasks
increased risk of falls and fracture
increased fatigability
which decreases PA and increases disability –> (+)
Cardiovascular Changes with Aging
- aerobic capacity decreases about 1% each year
- max HR decreases 1 bpm each year
- max SV decreases, but can be maintained with training
- total blood and plasma volume decrease
- small reductions in hemoglobin con’t
Respiratory Changes with Aging
- RV increases
- VC and FEV1.0 decrease linearly with age
- TLC unchanged
- RV:TLC increases (less air can be exchanged)
- minute ventilation decreases
- elasticity decreases (can be reduced with endurance training)
- pulmonary ventilation capabilities of endurance trained athletes are only slightly decreased with aging
- arterial oxygen saturation does not decreased during strenuous exercise for normally active older adults
VO2 and Aging
- prior training offers little advantage to endurance capacity later in life unless you stay active
- aging along may not necessarily decrease VO2max
- keeping training intensity and volume high, then rate of decrease in SV and VO2max with aging slows
Did you know? VO2
If body comp and physical activity are kept constant, VO2max decreases only 2-5% per decade, rather than the 10% per decade normally attributed to aging.
Effects of Aging vs. Reduced PA
Since PA tends to decline substantially as we age, distinguishing between the effects of aging and those of reduced PA is difficult when studying lifelong changes in physiological function
Relationship Between Skeletal Muscle Strength and Functional Status
- In a hierarchy of functional tasks with a strength threshold, strength influences the difficult of a task
- Once past the threshold, increases or decreases in strength may have no impact depending on how close you are to threshold
Functional Reserve or Reserve Capacity & Independence
- the better you are going into an illness or injury, the better your physiological and functional reserve and therefore the potential for optimal outcome
- With less reserve, the older person will struggle with an activity that a person with a higher reserve may find easy
Strength vs. Aerobic Training in preventing strength loss
- Strength training is only exercise to prevent reductions in strength
- Aerobic training does not maintain or increase muscle strength b/c it has little force generation
- American Guidelines recommend both resistance and aerobic training
Fiatarone et al. Study: baseline –> after resistance training
- old muscle is very responsive to resistance training
- strength and CSA increases
- functionality (6 min walk test increased)
Fiatarone et al. Follow Up Study: resistance training group, supplement group, control group, exercise + supplement group
- functionality improves
- nutritional supplementation had no effect on primary outcome measures
- strength related to function!!!!!!!
- increased activity levels later in life because of improved strength and/or aerobic capacity
Resistance Training Increases what in Independent Older Adults? (7)
- maximal walking speed
- stair climbing speed
- dynamic standing balance
- leg press strength
- knee extensor strength
- upper body strength
- muscle & fiber CSA
Resistance Training Does Not Increase What in Independent Older Adults? (2)
- self selected walking speed
2. static standing balance
Osteopenia, Osteoporosis, Nontraumatic fracture
- Osteopenia: low bone mass (1 to 2 SD below that of a sex matched younger adult)
- Osteoporosis: development of nontraumatic fractures as a result of low bone mass (BMD
Most Common Fractures with Osteoporosis (female to male ratio)
- distal forearm 1.5:1
- thoracic and lumbar verts 7:1
- proximal femur 2:1
*annual expenditure on care follow hip fracture alone exceeds $10 billion in the US
Resistance Training and BMD
- high intensity strength training has a positive effect on the following risk factors for osteoporotic fractures in women 50-70 yo: bone density, muscle mass, muscle strength, dynamic balance, and overall PA activity
- nutritional or pharmacological approaches along maintain or slow the loss of bone, but can’t improve the above factors
Sarcopenia: effects of aging, RT, aerobics
- muscular strength
- muscle mass
- muscle power
- muscle quality (less force/area)
Aging: decreases all (strength the most)
RT: increases all (strength the most)
Aerobics: does not influence any
CHD: effects of aging, RT, aerobics
- VO2max
- endurance performance
- plasma lipoprotein lipid profile
- hypertension
Aging: decrease VO2 max and endurance performance, increase hypertension, decrease/no change in lipid profile
RT: no change VO2max, increase endurance performance, increase/no change lipid profile, decrease hypertension
Aerobics: increase VO2max, endurance performance, lipid profile, decrease hypertension
Diabetes: effects of aging, RT, aerobics
- glucose intolerance
- insulin resistance
Aging: increase both
RT: decrease both
Aerobics: decrease both
Changes in height and weight with aging
- height declines 1 cm per decade during 40s and 50s, then accelerates after 60 (women > men) = discs compress, pronounced thoracic curvature
- less fat free mass, more fat
Abdominal Obesity: effects of aging, RT, aerobics
- total body fat
- intra abdominal fat
- RMR
Aging: increase in body fat and abdominal fat, decrease in RMR
RT: decrease body and abdominal fat, increase RMR
Aerobics: decrease body and abdominal fat, no effect on RMR
Osteoporosis: effects of aging, RT, aerobics
- BMD
- risks of falls
- flexibility or ROM
- osteoarthritis
Aging: decrease BMD and flexibility, increase risk of falls and osteoarthritis
RT: increase BMD, decrease risk of falls, no change in flexibility, decrease osteoarthritis (decrease in pain, increase in fxn)
Aerobics: increase BMD if weight bearing, no change in falls, no change in flexibility, decrease osteoarthritis (decrease pain, increase fxn)
Aging and Skeletal Muscle: muscle CSA, type 1 vs. type 2 fiber area and fiber number
- decrease muscle CSA
- no change in % of type 1 or type 2
- decrease # of type 1 and type 2 fibers
- decrease in type 2 fiber area/size
Resistance Training Program Design Variables for Older Adults: 7
- Needs Analysis
- Exercise Selection
- Training Frequency
- Order of Exercises
- Training Load and Reps
- Volume (sets)
- Rest Periods
- Needs Analysis
- health and performance benefits of exercise for older individuals should be made clear
- pattern of activities/interests, activity levels in last 2-3 months, barriers or concerns regarding exercise, level of interest/motivation, social preferences
Common Contraindications for High Intensity Exercise (5)
recent fractures (unstable) advanced CHF unstable CV disorders cancer in musculoskeletal system acute illness
- Exercise Selection (# of exercises, weaknesses)
- safety
- movement analysis of ADLs, occupation, recreational specific skills
- technique experience
- equipment availability
- 8 to 10 exercises for all major muscle groups
- hip ADD and extensors and glutes are common weakness
- machines then free weights
Commonly Employed Strength Training Exercises in SNF (5)
- leg press
- rowing
- low back extensions
- dips
- cervical extension
Elderly Exercise Precautions (3)
- leg press and machine squat - shoulder loading
- lateral raise - shoulder impingement
- cervical - RA, radicular sx
- Frequency (days/week)
- the more deconditioned the individual…the
- generally, more intense and high volume the training, the…
- 2 to 3 days per week for general health and fitness (1 day of rest between); 1 to 2 days per week for strength maintenance
- more deconditioned the individual, the higher frequency and lower intensity
- more intense and high volume the training, the lower the frequency
- Exercise Order
- thought of in terms of major muscle groups or bodyparts
- 1 exercise for each muscle group at least
- Training Load & Reps (% 1RM and reps recommended)
- relationship between load and reps (80% 1RM = ? reps)
- options for determining starting loads
- what do older adults respond well to
- 60 to 80% 1RM or variation of loads and reps
- 8 to 12 reps (ACSM recommends 10-15 reps)
- 80% 1RM = 8 reps
- options: trial and error, testing 1 RM and using % of 1RM, estimating 1 RM from multiple reps by using prediction equation
- older adults respond well to higher reps and low loads
Momentary Muscle Failure Assessed by: 4 things
- are last few reps difficult to perform?
- speed of last few reps?
- look of concentration and/or determination
- RPE
- Volume
- volume tolerated is related to training status
- anywhere from 1-3 set programs
- Rest Periods
- general recommendation for older adult beginners
- strength/power, hypertrophy, endurance
- 2 to 3 minutes rest generally recommended
- used as variable to vary intensity of training
- educate them not to stop and rest between REPS
- strength/power = 2 to 5 min
- hypertrophy = 20 to 90 sec
- endurance = less than 30 sec for 12-19 reps, 2 to 3 min for greater than 20 reps