8.11: Exercise Recommendations

Having reviewed how exercise benefits the elderly, we will now consider information and suggestions that have been found important in achieving these benefits.

First, as with other mechanisms that maintain homeostasis, adjustments made in body systems to each form of exercise represent attempts to minimize or prevent disturbances in internal conditions. Furthermore, adjustments and improvements made by the body are specific to the demands placed on it. For example, if conditions in leg muscles are significantly disturbed by lifting heavy loads, those muscles will become stronger and therefore will be less affected when the loads are lifted a few days later. By contrast, if conditions in leg muscles are disturbed by an activity involving many repeated actions that do not require much strength, such as walking briskly for a long distance, the adjustments in the body will increase stamina for walking but will have little effect on muscle strength.

Set Goals

The first step in preparing to increase exercise is to establish specific goals. Then activities can be selected that will cause the body to make the adjustments needed to achieve those goals. For example, if an increase in the range of motion of the arms is desired, activities requiring movement of the arms over wide angles can be selected. If increasing the grip strength of the hands is a goal, activities using strong grasping should be undertaken. As more goals are identified, a greater number and variety of exercises or activities must be employed.

In a more general way, if exercise is being used to improve the functioning of the circulatory and respiratory systems, a number of activities demanding faster blood flow and increased respiration can produce the desired results. Examples include walking or riding a bicycle at a fast pace, running, and swimming.

Evaluate and Individualize

When one is deciding on exercises, attention must be paid to the condition of the person who is participating in the exercises. Careful attention to an elderly person's physical condition is particularly important because of the higher incidence of disease and the increased heterogeneity among older people. At this point, a qualified professional should perform a physical examination and evaluation of the participant and the information obtained should be used to determine the appropriateness of the anticipated activities. At least one follow-up examination and evaluation should be performed several days or a few weeks after the individual has taken up the new level of activity. Data from the first and later examinations and evaluations should be used to determine what changes are occurring because of the increased exercise and to suggest improvements in the activities.

Plan a Program

Once appropriate activities have been selected and the condition of the participant has been ascertained, decisions about the intensity and the length of exercise can be made. The time allotted for exercise should include time for warming up and cooling down. The frequency with which the activity will be performed can also be established. A healthy person should exercise at least 30 minutes each session, with sessions occurring at least every three days.

Generally, starting a program of exercise with a fairly low level of intensity and a short duration of activity is best, especially for very sedentary or frail individuals, who can achieve substantial benefits from relatively low levels of exercise. Also, such individuals are more likely to sustain injuries or other adverse effects from a sudden increase in physical activity. Beginning with low levels of exercise also helps prevent negative attitudes by minimizing the discomfort caused by an increase in exercise.

Consideration might also be given to the number of weeks or months during which the participant expects to perform the activity. Exercise programs lasting only a few weeks produce little benefit, while those lasting several months or longer yield significantly better results. Longer-lasting programs are especially important for older people since the rate of improvement caused by exercise decreases with age. Sustained participation in the exercise program is aided by using positive feedback and other motivational strategies, such as combining exercise sessions with social activities. Since the exercise program should last for an extended time, it is important to provide for proper nutrition.

As the exercise program continues, the intensity or duration of each exercise or the frequency with which it is performed each week should be increased gradually so that the participant continues to improve. If the exercise is not increased, the participant's level of physical fitness will soon stabilize, and boredom may become a problem if there is no variation. Furthermore, the psychological benefits of exercise become most apparent once a high intensity and greater frequency have been achieved.

Minimize Problems

Although the benefits are directly proportional to the intensity, duration, and frequency of exercise, care must be taken not to exceed reasonable limits. As levels of exercise increase, so do the risks of overheating, being physically injured, and developing complications from existing diseases.

Very strenuous activities present a special danger to those with atherosclerosis because people tend to hold their breath while pulling or pushing with great force. Blood pressure rises to a very high level during such maneuvers, placing a great burden on the heart and arteries. A heart attack, a stroke, or damage to the retina or vitreous humor can result. When the straining ends, there is a sudden drop in blood pressure, placing additional burdens on the heart and sometimes causing dizziness, fainting, and falling. These problems can be largely avoided by minimizing exercises requiring great strength and maximizing activities involving free movement of parts of the body.

Consider Alternatives

When one is discussing exercise, focusing on activities whose primary purpose is exercise is easy (e.g., aerobics, weight lifting, jogging). Using such activities and the many available exercise machines and devices provide means of carefully regulating the amount of exercise obtained and measuring physical status and improvements in physical fitness.

While some individuals enjoy such purposeful exercise, others find it unpleasant, expensive, or unavailable. These individuals can still obtain plenty of beneficial exercise through activities with other primary purposes. Examples include recreational activities such as dancing, sports, and hiking and activities related to occupations requiring physical work. Activities performed in caring for one's home and family, such as gardening and mowing a lawn, shopping, and doing laundry, can provide opportunities to get healthful exercise. Choosing to walk or climb stairs rather than riding can add substantially to the amount of beneficial exercise obtained.

Achieving the benefits of increasing exercise often involves nothing more than substituting muscle power for motor power. What may be needed first, however, is replacement of the notion that using minimal physical effort means living well with the realization that only through regular physical exercise can an older person achieve "the good life."