Specific exercises can prevent disabilities and slow the ramifications of aging for your older patients
Many of the physical conditions associated with aging can be prevented and at least partially reversed with exercise. While any physical activity is better than none, there are specific exercises that should be included in any regular routine designed to slow down the march of time. When these exercises are combined with regular chiropractic care and optimal nutrition, our patients have a better chance of a vibrant older age.
In planning an anti-aging exercise program, it is useful to consider some of the physical problems often seen in older patients. Conditions such as osteoporosis, hypertension, cardiovascular disease, and adult-onset diabetes can be prevented or mitigated by regular exercise. As doctors of chiropractic, we frequently encounter elders who are limited in daily activities by back problems, as well as joint arthritis in the shoulders and knees. By recommending the right exercises, we can provide guidance regarding the most effective forms of exercising to prevent disability and slow aging.
Young at Heart and Body
There are several signs of aging due to physical imbalances and weaknesses that can be addressed with a few simple exercises. The stooped posture of old age, the limited gait due to joint stiffness and poor leg strength, the fear of breaking bones weakened by osteoporosis, and even limitations in joint movements can all be prevented without much difficulty. The problem is that, as we age, we become more sedentary. National surveys reveal that 70% or more of older adults do not engage in any regular exercise.1 This is the main reason for the gradual loss of strength and muscle mass and the increase in body fat that is normally seen with aging. It is not the years, but the lack of regular physical activity that brings on many of these problems.
First, 30 minutes of aerobic exercise should be accomplished at least 3 days per week. Then, a few strengthening exercises using elastic tubing can reestablish muscle balance and proper biomechanics around critical joints. When done correctly, these exercises are well tolerated, even by those who are already into their advanced years.
Aerobic exercise. While any form of aerobic exercise will strengthen the heart and lungs, walking has a much wider range of beneficial effects than swimming. Start with 20 minutes at a moderate pace, and work up to 30 minutes of vigorous walking. When you reach the anaerobic threshold (out of breath stage), you are at the stage that has been shown to increase bone mineral density in the elderly.2 Unfortunately, women who participate in regular swimming programs have no significant difference in bone mass than women who do not exercise.3 This is even true of a standard weight-bearing, water-based exercise program (aquacise).4 A regular, vigorous walking program is an important component to keeping a functional gait and strong bones.
Functional strength. Although general strengthening exercises are good, there are a few specific ones that should be performed two or three times each week to prevent age-related deficits. Since isometric exercises may increase systolic blood pressure, strengthening should employ isotonic, or dynamic exercises.5 Elastic resistance tubing is an excellent method to provide strengthening dynamic exercise without machines or heavy weights. A home-based program using elastic tubing can provide significant gains in both strength and daily function.6 Strengthening exercises should be done standing or sitting, thereby providing additional, controlled weight-bearing stress to the muscles and bones. The stronger the back and leg muscles are, the higher the bone density in the region.7
In general, all exercises are more effective when done in an upright, weight-bearing position, since the entire body is in a closed chain position during the training. The stabilizing muscles, the cocontractors, and the antagonist muscles all learn to coordinate with the major movers during movements performed during closed-chain exercising. This is particularly valuable for the elderly, not just for increasing bone density, but also for preventing stumbles and falls. Contrary to what is commonly believed, moderate exercise does not increase the risk for osteoarthritis or exacerbate it; rather, it has been found to improve function and reduce pain.8
Yes, Spring Chickens
Spinal aging is often associated with poor postural support, most commonly an increase in the thoracic kyphosis, in both men and women. Specific, corrective exercises relieve the postural strain on the spine and to prevent the development of vertebral wedging and possible compression fractures. This is especially necessary for postmenopausal women. Avoiding exercise is the worst approach to an aging patient with osteoporosis. Back strengthening exercise constitutes a powerful intervention for reducing pain and increasing functional capacity. In fact, exercises that strengthen the back extensor muscles can decrease the thoracic kyphosis seen in many older women.9
For patients with spinal osteoporosis, the most harmful activities are those that put an anterior load on the vertebral bodies. Patient education must emphasize the dangers of lifting in flexion and of performing flexion exercises. One exercise study found an increase in new vertebral deformities when postmenopausal women performed flexion exercises, such as forward stretches and abdominal curls, while those who performed only spinal extension exercises had a significant reduction in the number of vertebral compressions.10
The American Geriatrics Society recently reviewed the literature that demonstrates the wide range of benefits that are obtained when older patients exercise.11 Current research has found that even high-intensity training of frail men and women in their 90s is safe and leads to significant gains in muscle strength and functional mobility.12 Improvements are seen in weight and body composition, decreased falls/improved balance, better psychological health, less frailty, and improved function. With exercise, the resting blood pressure lowers, and there is a reduction in the risk of all-cause mortality.13 These are all signs of a physiologically younger body. The combination of a regular, vigorous walking program and strengthening exercises performed in upright, functional positions can hold off the usual signs of aging for many years. CP
Kim D. Christensen, DC, CCSP, DACRB, CSCS, founded the SportsMedicine & Rehab Clinics of Washington in Ridgefield. He is currently a postgraduate faculty member of numerous chiropractic colleges, president of the American Chiropractic Association (ACA) Rehab Council, and a lecturer and author. Christensen can be reached at Chiropractic Rehabilitation Consulting, 18604 NW 64th Ave, Ridgefield, WA 98642, or via email: kimdchristensen@hotmail.com.
References
1. Clark DO. Racial and educational differences in physical activity among older adults. Gerontologist. 1995;35:472–480.
2. Hatori M, Hasegawa A, Adachi H. The effects of walking at the anaerobic threshold level on vertebral bone loss in postmenopausal women. Calcif Tissue Int. 1993 52:411–414.
3. Orwoll ES, Ferar J, Oviatt SK. The relationship of swimming exercise to bone mass in men and women. Arch Intern Med. 1989;149:2197–2200.
4. Bravo G, Gauthier P, Roy PM. A weight-bearing, water-based exercise program for osteopenic women: its impact on bone, functional fitness, and well-being. Arch Phys Med Rehabil. 1997;78:1375–1380.
5. American College of Sports Medicine. Exercise prescription for special populations. In: Guidelines for Exercise Testing and Prescription. 1991:166.
6. Jette AM. Exercise—it’s never too late: the strong-for-life program. Am J Publ Health. 1999;89:66–71.
7. Sinaki M, Offord KP. Physical activity in postmenopausal women: effect on back muscle strength and bone mineral density. Arch Phys Med Rehabil. 1988;69:277–280.
8. Casper J, Berg K. Effects of exercise on osteoarthritis: a review. J Strength Condition Res. 1998;12:120–125.
9. Itoi E, Sinaki M. Effect of back-strengthening exercise on posture in healthy women 49 to 65 years of age. Mayo Clin Proc. 1994;69:1054–1059.
10. Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. 1984;65:593–596.
11. Christmas C, Andersen RA. Exercise and older patients: guidelines for the clinician. J Am Geriatr Soc. 2000;48:318–324.
12. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians: effects on skeletal muscle. JAMA. 1990;263:3029–3034.
13. Blair SN. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA. 1996;276:205–210.
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