According to the Centers for Disease Control and Prevention (CDC 2009), by 2030 the portion of the U.S. population aged 65 and older will double to about 71 million. The growing number of older Americans will put unique demands on public health, aging services and the nation’s healthcare system. The CDC suggests that chronic diseases (e.g., cardiovascular disease, stroke, cancer and diabetes) place a profound health and economic burden on older adults, owing to associated long-term illness, diminished quality of life and greater healthcare costs.
Although the risk of disease and disability does increase with advancing age, the CDC proposes that poor health is not an inevitable result of aging. Health promotion initiatives of the CDC include healthy lifestyle behaviors (e.g., avoiding tobacco use, engaging in regular physical activity, eating a healthy diet) and early-detection practices (e.g., screening for breast, cervical and colorectal cancers, diabetes and depression). This research roundup reviews some principal age-related topics and then outlines practical suggestions for exercise professionals on how best to apply these findings.
Article Reviewed. Keogh, J.W.L., et al. 2009. Physical benefits of dancing for healthy older adults: A review. Journal of Aging and Physical Activity, 17, 479–500.
Proposed benefits of resistance training, balance drills and aerobic exercise include improvements in muscular strength, muscular endurance, body composition, cardiovascular fitness, and functional independence in activities of daily living, along with reduced risk of falling. However, much less is known about the health benefits of dancing for the senior population. Many different forms of dancing may be quite appealing to a range of older individuals of various ages. In addition, dancing may promote social interaction, a sense of belonging to a community and long-term dancing compliance among older adults.
Keogh and colleagues’ comprehensive study reviews 15 training studies and three cross-sectional investigations (i.e., an
observation of the senior population at a specific point in time) of apparently healthy adults (>60 years of age). The forms of dancing include ballroom, line dancing, folk dancing and some traditional dance forms from certain cultures, including Korean, Argentine tango, Turkish folkloristic, Greek and Caribbean. The results of this original investigation show that dancing can
improve aerobic power, lower-body muscular endurance, strength, flexibility, balance, agility and gait speed for older males and females. It will also reduce cardiovascular health risk and can be central in the prevention of falls.
Practical Application. As exercise professionals widen their “net” of ways to involve special populations in more health-
promoting activities, the idea of adding dance classes/sessions to an exercise program may be quite alluring.
Deleterious Effects of Diabetes Mellitus
Article Reviewed. Araki, A., & Ito, H. 2009. Diabetes mellitus and geriatric syndromes. Geriatrics & Gerontology International, 9, 105–14.
Many older adults have geriatric syndrome, which refers to a multifactorial health condition that occurs when several of the body’s regulating systems (e.g., musculoskeletal, cardiovascular, respiratory, nervous, endocrine, immune and digestive) are impaired. Diabetes has been shown to increase the prevalence (total widespread numbers) and incidence (rate of occurrence) of geriatric syndrome. The Araki and Ito study reviews the association of diabetes with functional ability, depression, falls, malnutrition and cognitive function.
Functional Ability. One of the more serious problems of diabetes is its impairment of functional ability. Investigations show that some diabetic older adults (>60 years of age) are unable to walk a quarter of a mile, do housework or climb stairs. Others are more severely affected, with limitations in their abilities to bathe, dress and feed themselves. Araki and Ito state that diabetes-related diseases contributing to functional disability
include coronary heart diseases, obesity, stroke, peripheral artery disease, neuropathy (a disease that impairs sensation and movement in the arms and legs), arthritis and depression.
Depression. It is attention-grabbing to note that depressive symptoms are more common in elder diabetic populations than in their nondiabetic counterparts. In fact, 30% of people with
diabetes have depressive symptoms. Araki and Ito go on to state that the impact of depression on older diabetic individuals is quite extensive, reducing their quality of life, happiness, life satisfaction, morale and overall well-being.
Falls. Falls can lead to fractures and a significant reduction in the quality of life for older adults. Araki and Ito mention that a considerable amount of evidence points to diabetes mellitus as one of the foremost predictors of risk of falling. It is suggested that diabetes negatively affects walking gait and balance. Other factors that contribute to falls and are very much related to diabetes include coronary heart disease, arthritis, poor lower-
extremity function, overweight, poor vision, musculoskeletal pain and insulin resistance.
Malnutrition. Older adults with diabetes may be at greater risk for malnutrition deficiencies. More specifically, Araki and Ito observe that these adults tend to have sarcopenic obesity, a physiological syndrome that involves gaining excess body fat while concurrently losing muscle mass. Dietary insufficiencies (particularly in vitamin B1, B2, B6, B12 and folate) may exaggerate this declining condition in elderly diabetic individuals.
Cognitive Function. Diabetes has also been shown to impair memory, learning, information processing, psychomotor skills and overall cognitive function in older individuals. It is proposed that high blood glucose and a decrease in cerebral blood flow negatively affect the function and health of the central nervous system.
This study emphasizes that exercise therapy is paramount for the treatment of diabetic patients with geriatric syndrome. Cardiovascular exercise and resistance training are highly recommended to maintain blood glucose and prevent further disability. The authors also recommend a fall prevention program, as well as specific home environment modifications (e.g., replacing rectangular tables that have sharp edges, taking away carpet pads, moving extension cords off the floor, adding brighter lights in underlit areas and lubricating door hinges for easy opening and closing). They further note that psychological counseling may be needed for elder clients with depressive symptoms and a low sense of well-being.
Practical Application. There is a commanding need for trained exercise professionals to intervene in what is perhaps one of the fastest-growing health problems of this century: diabetes and geriatric syndrome. Supervised programming—strategically designed and including cardiovascular exercise, resistance training, fall prevention, healthy nutrition education (within scope of practice), nonexercise activity (i.e., spontaneous physical activity) guidance, and metabolic profiling (see “Too Much Sitting Is Hazardous to Your Health,” IDEA Fitness Journal, 6 , 14–17)—is a major professional area of opportunity for personal trainers who wish to help older clients enjoy a more satisfying life.
Article Reviewed. Vondracek, S.F., & Linnebur, S.A. 2009. Diagnosis and management of osteoporosis in the older senior. Clinical Interventions in Aging, 4, 121–36.
With advancing age, the risk of osteoporosis and bone fracture increases. Case in point—the prevalence of osteoporosis, based on hip bone density, has been estimated at 4% in women 50–59 years of age and 44% in women ≥80 years of age. Vondracek and Linnebur state that hip fractures and their associated costs could double or triple throughout the world by 2040. They add that hip fracture risk rises dramatically with age, with only 50% of people able to return to their “prefracture” movement ability level. Sadly, 20%–40% of patients die within the first year following a hip fracture.
The risk of falling increases noticeably with age. Vondracek and Linnebur highlight the fact that 50% of seniors 85 years of age and older will fall at least once per year. Causes include impaired balance, limited gait and mobility, poor vision, reduced muscle strength, declining cognition and use of multiple medications. They also note that older seniors tend to fall backward or sideward and are thus unable to catch themselves or break the fall.
Vitamin D deficiency is highly associated with poor bone strength and falls. According to Vondracek and Linnebur, data suggest that most older men and women in the U.S. are low in vitamin D. This same vitamin is important for maintaining function and strength in muscles, particularly those weight-bearing muscles of the lower body. Muscle weakness in older adults is characterized by difficulty in climbing steps, rising from a chair, walking distances and participating in outdoor activities. Older adults with vitamin D deficiency may tire easily with weight-bearing physical movement and may feel heaviness in the legs.
All seniors with osteoporosis should receive adequate vitamin D and calcium. Supplementation is almost always recommended, since diet alone is usually unsatisfactory. Calcium and vitamin D supplementation has been found to significantly reduce fracture risk and bone loss in the spine, note Vondracek and Linnebur. They recommend 1,200–1,500 milligrams of calcium daily, divided into two to three doses. To avoid deficiency in vitamin D, the authors propose taking 800–1,000 IU vitamin D3 daily or 50,000 IU vitamin D2 every 2–4 weeks. To treat vitamin D deficiency, the authors recommend 50,000 IU of vitamin D2 every week.
Smoking cessation has also been shown to promote an increase in bone mineral density in older seniors. Quitting smoking reduces hip fracture risk as well. Notably, the degree to which smoking cessation decreases the risk of cardiovascular and pulmonary disease makes this behavior change essential for older adults.
Exercise, smoking cessation and adequate intake of calcium and vitamin D are recommended to preserve bone mineral density and reduce the risk of falling in older adults (see the sidebar “Highlights of the 2009 ACSM Exercise and Physical Activity Guidelines for Older Adults”). Bone-loading exercises for the spine and hip (e.g., squats and lunges with resistance) should be included in a well-developed exercise plan for seniors. A fall prevention program and a home environment modification plan (as discussed above) are advocated for older men and women.
Practical Application. Based on existing data showing that older adults are at high risk for osteoporosis, personal trainers and exercise professionals are advised to use the current older-adult guidelines summarized by Vondracek and Linnebur, together with the ACSM guidelines in the sidebar, to help their senior clients fully enjoy the benefits of an active physical lifestyle.
Article Reviewed. Ceceli, E., et al. 2009. The comparison of balance, functional activity, and flexibility between active and sedentary elderly. Topics in Geriatric Rehabilitation, 25 (3), 198–202.
With aging, many seniors begin to adopt a sedentary lifestyle, which is associated with deleterious health effects (e.g., cardiovascular disease, type 2 diabetes, some cancers). The authors explain that aging (and inactivity) also results in connective-tissue changes in muscle that reduce a person’s range of motion.
The purpose of this study was to see if performing flexibility exercises has any effect on balance and functional ability. The study subjects (primarily women ≥65 years of age) included 25 seniors in the flexibility group and 21 subjects in the sedentary control group. A physiotherapist led and supervised the exercises. Both upper- and lower-body flexibility stretches were performed in a supine position (on a mat), using 10 repetitions of each stretch. All exercises were performed to the subject’s endpoint range of motion (i.e., full range of motion). Sessions were held 3 times per week for 20 minutes for a period of 4 months.
Balance was tested with a Sharpened Romberg (SR) test and a one-legged stance test. SR testing involves the subject standing for 60 seconds in a heel-to-toe position with the dominant foot behind the nondominant foot. For this assessment, the arms remain by the subject’s side as he or she tries to avoid moving the feet (eyes closed in one trial and open in a second trial). With the one-legged stance (eyes closed in one trial and open in a second), the arms are kept by the sides. Subjects are allowed to move the arms (for balance) during the sustained testing period (up to 30 seconds). Functional activity was evaluated with a 30-meter walking test and a functional reach test. Anterior trunk flexion and left/right lateral trunk flexion were also measured before and after training.
The study results indicated that flexibility training has a significant positive effect on functional ability and flexibility. Results also showed a positive (though not statistically significant)
increase in balance ability.
Practical Application. Currently, much of the research on seniors relates to cardiorespiratory fitness and resistance training, which are indeed critical components of fitness. In this instance, it is praiseworthy to see a modern, data-based, controlled training study that documents the benefits of full-range-of-motion flexibility training for seniors. It is hoped that when exercise professionals share the meaningful outcomes of this flexibility training study with senior clients, they will be inspired to adhere to
a daily stretching program.
Article Reviewed. Yaffe, K., et al. 2009. Predictors of maintaining cognitive function in older adults: The Health ABC Study, Neurology, 72, 2029–35.
One unique area of scientific inquiry is involved with understanding, defining and predicting successful aging. Most investigators in this area have focused on understanding healthy aging from a physical health perspective and have largely ignored cognitive health. However, the research of Yaffe and colleagues looks at cognitive function in a sample population of 2,509 elder men and women (70–79 years of age at the start of the study) over a period of 8 years. The results show that doing moderate to vigorous exercise, not smoking and volunteering in the community are major predictors of optimal cognitive function. Interestingly, volunteering with older adults has been demonstrated to reduce mortality and increase a person’s sense of well-being. Yaffe et al. suggest that volunteering provides great emotional gratification for older adults, while also increasing their social network. In fact, the authors affirm that those seniors with positive cognitive function typically do not live alone. Higher levels of educational attainment throughout life are also associated with optimal cognitive function.
Practical Application. Personal trainers and exercise professionals have the unique advantage of providing social networking opportunities (e.g., group workouts on the beach, golf course or park; or theme training events, such as a New Year’s Eve 5K race, Halloween costume workout or partner/small-group personal training). Encouraging clients to learn more about exercise, nutrition and metabolism may help them challenge their minds while concomitantly improving their cognitive health.
Source. Aging Statistics From the Administration on Aging, Department of Health and Human Services. www.aoa.gov/AoARoot/Aging_Statistics/index.aspx; retrieved Nov. 13, 2009.
The following is a synthesis of current information from the Administration on Aging (U.S. Department of Health and Human Services, or HHS) website, which brings together a wide variety of up-to-date statistical information about the growing senior population of men and women (≥ 65 years of age).
Education. In 1965, 24% of senior citizens had graduated from high school, and 5% had bachelor’s degrees. By 2007, 76% were high-school graduates, and 19% had at least a bachelor’s degree.
Income. Incomes of older adults gradually rose between 1974 and 2006. The percentage of seniors with incomes below the poverty line went from 15% to 9%; those categorized with low income dropped from 35% to 26%; those with high incomes increased from 18% to 29%. More older people, especially women, continue to work past the age of 55.
Health Status. According to the HHS, functional limitations among people aged 65 and older have declined in recent years. However, life expectancy in the U.S. is lower than in many high-income countries, such as France, Japan, Sweden and Canada. Americans who survive to age 65 can expect to live an average of 18.7 more years.
Physical Activity and Obesity. There was no significant change in the percentage of older people engaged in physical activity between 1997 and 2006, with 22% of people aged 65 and over engaging in regular leisure-time physical activity. The proportion of leisure time devoted to sports, exercise, recreation and travel declines with age. On an average day, most Americans ≥65 years of age spend at least half of their leisure time watching television. The percentage of people ≥65 years of age who were obese increased from 22% to 31% over 12 years (from 1994 to 2006).
Health Care. Healthcare costs, particularly for prescription drugs, have risen dramatically for older Americans. In 2004, over half of out-of-pocket healthcare spending (excluding health
insurance premiums) by community-dwelling older people was on prescription drugs. These costs are expected to decline
because of the savings available through the Medicare prescription drug program.
Leisure Time. The fraction of leisure time that older Americans spend socializing—for example, visiting friends or
attending social events—modestly declines with age, from 13% for those aged 55–64 to 10% for those aged 75 or older.
Older adults are the most physically inactive group of any population (Chodzko-Zajko et al. 2009). While every person has a biological clock, the health benefits (see Figure 1) of a physically active lifestyle for seniors clearly indicate that many age-related illnesses and diseases can be impressively slowed down. Exercise professionals are exemplary role models who can advocate,
inspire and promote physical activity and exercise in this special population. Take charge and do it!
Chodzko-Zajko, W.J., et al. 2009. Exercise and physical activity for older adults. Medicine & Science in Sports & Exercise, 41 (7), 1510–30.
Elmadfa, I., & Meyer, A.L. 2008. Body composition, changing physiological functions and nutrient requirements of the elderly. Annals of Nutrition & Metabolism, 52 (Suppl. 1), 2–5.
Taylor, A.W., & Johnson, M.J. 2008. Physiology of Exercise and Healthy Aging. Champaign, IL: Human Kinetics.
Weindruch, R. 2006. Calorie restriction and aging. Scientific American Reports (Dec.), 54–61.