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This chapter addresses the following Geriatric Fellowship Curriculum Milestones: #9, #14, #29, #42, #53

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LEARNING OBJECTIVES

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Learning Objectives

  • Describe the changes in endurance exercise capacity and in skeletal muscle strength and power that occur with aging.

  • Describe the effects of aerobic and resistance exercise training on endurance exercise capacity, skeletal muscle strength and power, and physical function in older adults.

  • Identify common geriatric disorders for which exercise may be beneficial for prevention or treatment.

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Key Clinical Points

  1. The physiologic responses to aerobic and resistance training on endurance exercise capacity and muscle strength and power are preserved in older adults.

  2. Because the relation between physiologic impairment and functional limitations is nonlinear, older adults with little or no physiologic reserve may realize large functional improvements with exercise.

  3. Older adults can safely engage in even high-intensity exercise; exercise and physical activity recommendations should be specific and tailored to the individual to enhance long-term adherence.

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AGING, DISUSE, AND DISEASE

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A common belief among the lay public, as well as among many health care professionals, is that much of the disease and loss of function that accompanies aging is inevitable and a result of the “aging process” itself. However, much of the physical decline and reduced physiologic reserve previously blamed on aging is, in fact, caused by complex interactions of true genetically determined aging, disease (often subtle or subclinical), disuse, and environmental exposure.

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The myriad of possible interrelationships among these factors makes it difficult to ascribe specific causality for the loss of physical vigor or function. Thus, for example, preconceived societal notions about aging may predispose to greatly reduced expectations with regard to physical as well as mental performance. Such preconceptions may promote inactivity and disuse in women at an even earlier age than in men. With years of ensuing inactivity, disuse not only exaggerates and enhances any true age-related loss of endurance, strength, and flexibility, leading to further inactivity and disuse, but may also exacerbate previously subtle or subclinical conditions such as intra-abdominal obesity, glucose intolerance, osteopenia, hypertension, dyslipidemia, and coronary artery disease. These physiologic disorders, the drugs used in their treatments, and the associated functional impairments and disability can, in turn, further limit activity and continue a vicious downhill spiral.

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Physical activity level (and measured fitness) appears to be inversely related to the risk of mortality and is associated with a greater average lifespan. An inverse dose–response relationship has also been noted between physical activity and the risk of developing many chronic diseases including cardiovascular disease (CVD), stroke, hypertension, type 2 diabetes, osteoporosis, obesity, colon and breast cancer, depression, and dementia. Many of these reports included older adults. Despite the clear advantages to physical activity, only 35% of persons more than 60 years of age meet the Centers for Disease Control and Prevention recommendations for physical activity (ie, 150 min/week of moderate-intensity or ...

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