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A record number of maturing adults and elderly individuals are initiating exercise regimens or continuing exercise and sports regimens.

New Exercise Guidelines for the Elderly

Adults should add flexibility exercises to their fitness regimens, and those over age 65 should follow a regular exercise program to prevent some of the functional decline associated with aging, according to updated exercise guidelines released this week by the American College of Sports Medicine (ACSM). The last ACSM guidelines were released in 1990.

"The recommendations are for 3 to 5 days per week of aerobic exercise, walking, jogging, (or) different types of activities that use the major muscle groups, at moderate to moderately high intensities," said Dr. Michael Pollock, director of the Center for Exercise Science at the University of Florida. "The main thing is that you get out there and burn calories to get the fitness benefits."

The new recommendations place greater emphasis on the total amount of time spent exercising for the elderly and for the first time, they call for flexibility training as a way to maintain joint range and fitness for adults in general. The ACSM recommends stretching of major muscle groups 2 to 3 times a week, exercise that becomes even more important with aging.

Elderly adults need to focus on strength and balance training first, and may work up to moderate intensity aerobic exercise, according to the College.

"When you are older, you may choose different, lower impact activities, such as walking versus running, because of the injury factor," said Pollock. "The higher the impact, the more injuries."

The need for greater physical activity among the elderly was also the subject of a position statement released by the World Health Organization (WHO) this week.

The WHO's "Guidelines for the Promotion of Physical Activity for Older Persons" is based on evidence that suggests that most elderly persons can benefit from a physically active lifestyle, according to Dr. Wojtek J. Chodzko-Zajko, a professor of exercise science at Kent State University in Kent, Ohio. The type of physical activity is less important than simply being active, he noted.

"There are many different kinds of physical activity which are beneficial for older persons," he said. "We know that traditional forms of cardiovascular exercise are very beneficial. Strength training is beneficial, flexibility exercises are helpful, but also physical activity as part of everyday living is useful in the prevention of diseases that are associated with inactivity and sedentary lifestyles."

Exercise should be tailored to meet the needs of individuals, taking into account any ailments or risk factors.

"There is no single physical activity that is optimal," says Chodzko-Zajko. "Most scientists would agree that a balanced program of physical activity would include stretching, calisthenics, strength training, and cardiovascular exercise. The specific combination would depend on the individual case."
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It's Never Too Late To Exercise

New research shows that if you've reached middle age or have long since passed it, it's still not too late to exercise. According to researchers from the Royal Free Hospital School of Medicine in London, maintaining exercise habits or initiating light to moderate physical activity later in life reduces overall mortality risk as well as lowers the risk of heart attack in older men - including those with existing cardiovascular disease.

The researchers reviewed data collected from middle-aged men who were part of a large study looking at cardiovascular disease. The men answered questionnaires about their health and exercise habits, first in the late 1970s and again in the early 1990s. The 7,735 men who answered the first questionnaire were 40 to 59 years old. Nearly 6,000 participated in the second questionnaire. Their average age at that time was 63. These men were followed for an additional 4 years

Men who described themselves as inactive or occasionally active in the first questionnaire but who had begun "at least light activity" by the time of the second questionnaire reduced their risk of death by about 45%. Even men with preexisting cardiovascular disease appeared to benefit from exercising. Regular moderate exercise seems to confer the greatest benefit. Light physical activities included walking, gardening, swimming, and cycling.

More vigorous activities, such as participating in sports, "do not appear to give any additional benefit to health for older men, and our findings suggest that frequent light physical activity may be more appropriate," the authors write.

For older men, and, presumably, older women as well, "encouragement... to increase their physical activity gradually and regularly would help to maintain mobility, to prolong independence, and to reduce the risk of heart attacks and mortality," say the researchers.

1. The Lancet 1998;351:1603-1608.
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Exercise Benefits in the Elderly

Exercise has a number of vital benefits in the aging population. Studies substantiating these benefits are published weekly. Some of the interesting recent studies on exercise and physical activities benefit in the aging include:


 Exercise Lowers Death Risk in the Elderly

Regularly walking or cycling for at least 20 minutes 3 times weekly was associated with reduced (death risks from) cardiovascular diseases and all cause(s) in men over the age of 64, according to Dutch and American researchers. The 10-year investigation (1985-1995) examined the death rates of a group of 802 Dutch men, all of whom were at least 64 years of age at the beginning of the study. The authors divided the men into three groups - those who engaged in physical activity for an average of 15 minutes per day, 1 hour per day, or 3 hours per day.

The authors report that nearly half of the men (46.5%) had died by the study's end. However, they found that after adjusting for various lifestyle factors (smoking and drinking, for example) and the presence of cardiovascular disease, "men in the highest activity (group) had a 30% lower risk compared with men in the lowest activity (group)."

Overall, they estimate that among the men who died during the study, 15% of the deaths due to heart disease and 12% of the deaths as a whole "could have been avoided by a physically active lifestyle."

Reductions in death risk seemed to rise along with increases in exercise intensity. For example, the authors found that overall risks for fatal stroke were 60% lower among men who regularly engaged in high-energy workouts, compared with men who opted for less strenuous exercise routines. The authors stress that "these heavy-intensity activities did not necessarily include strenuous activities, which is illustrated by the fact that gardening and bicycling at normal speed ...were classified into this category."

They conclude that the same life-prolonging exercise guidelines already recommended for other adult age groups - exercise for at least 20 minutes three times per week - "may also be applicable to elderly men." The authors believe their "findings may also be extrapolated to elderly women."

1. Archives of Internal Medicine 1998;158:1499-1505.
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Moderate Exercise Lowers Fracture Risk in the Elderly

Older women who exercise even moderately, and for as little as 1 hour a week, reduce their risk of hip fractures. According to the recent Annals of Internal Medicine study, "Moderately to vigorously active women had statistically significant reductions of 42% and 33% in risk for hip and vertebral fractures, respectively, compared with inactive women."

The 9,704 women aged 65 years and older were contacted by researchers from the Centers for Disease Control and Prevention every 4 months over an average of 7.6 years. Women were questioned on the frequency and duration of their participation in 33 social and recreational activities, plus walking and stair climbing and were also asked whether they had experienced any fractures.

According to the study, "Women who did moderately intense or vigorous activities, such as aerobic and other forms of dance, tennis, and weight training, had greater reductions in hip and vertebral fracture risk than did women who did lighter activities, such as walking and gardening, particularly if they were active for at least 2 hours per week." The study also stated, "women who did lower-intensity activities, such as walking, gardening, or social dancing, for at least 1 hour per week also had significant reductions in risk for hip fracture."

Relatively inactive women - sat for at least 9 hours per day -had a 43% higher risk of hip fracture than those who were sedentary for less than 6 hours per day.

The researchers concluded that exercise "may enable a protective response in the event of a fall through enhanced balance, reaction time, coordination, mobility, and muscle strength."

1. Annals of Internal Medicine 1998;129:81-88, 133-134.
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Exercise Cuts Diabetes Risk in Older Adults

Regular exercise can lead to improved glucose (blood-sugar) tolerance in older adults - which can reduce their risk of developing diabetes, according to researchers.

The effects of moderate levels of aerobic exercise are even more important in older people with high blood glucose levels (hyperglycemia) and insulin resistance, they report.

"Moderate-intensity aerobic training has a favorable effect on glucose tolerance," conclude investigators at Yale University School of Medicine in New Haven, Connecticut.

Glucose tolerance - the ability of the body to regulate blood sugar levels - decreases with age, but excess weight gain and decreased physical activity also play a role. Decreased glucose tolerance is believed to be a step in the development of type 2 (adult onset) diabetes. Since obesity has been linked to impaired glucose tolerance, many experts have assumed that only those exercise regimens which resulted in weight loss could bring the condition under control.

That may not always be the case, however. In the Yale study, published in the July issue of The Journal of the American Geriatrics Society, researchers placed 16 elderly men and women on a four month regimen of either aerobic exercise or non-aerobic yoga and stretching. Those in the aerobic exercise group were encouraged to walk and run on mini-trampolines equipped with handrails.

Those who participated in the non-aerobic regimen, four months of stretching and yoga, saw no changes in fitness level or glucose metabolism, according to a statement issued by the journal.

The four month aerobic regimen produced no "appreciable weight or fat loss" in elderly participants. However, blood tests revealed that people in the aerobic exercise group who had impaired glucose tolerance at the beginning of the study showed a 25% improvement in the way their body handled glucose.

The researchers also noted that blood levels of free fatty acids fell by 24% in the aerobic exercise group, leading the researchers to suggest that "training-related improvements in glucose regulation... may be modulated by decreases in (free fatty acid) concentrations."

The study team also conclude that "use of the mini-trampoline allows a safe, enjoyable, and effective mode of exercise for older people, who may otherwise be at risk for musculoskeletal injury from more traditional forms of weight-bearing aerobic exercise."

1. The Journal of the American Geriatrics Society 1998;46:875-879.
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Low Intensity Exercise Lowers Blood Pressure in the Elderly Hypertensive Patients

According to a recent study, low intensity aerobic training significantly reduced blood pressure in elderly hypertensive (high blood pressure) patients who were receiving antihypertensive (high blood pressure) medication.

A group of elderly patients performed 30 minutes of low intensity exercise on a treadmill 3-6 times per week for 9 months while another group acted as controls - receiving no exercise. The average age of the groups was 75 and 73, respectively.

According to the study, "... blood pressures decreased significantly after 3 months of training and the blood pressure of all participants stabilized at a significantly lower level by the end of the 9 months in the training group, whereas no significant changes in blood pressure were found in the control group."

1. Med. Sci. Sports Exerc., Vol. 30, No. 6, pp. 818-823, 1998.
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Exercise Protects Against Alzheimer's Disease

Participating in regular exercise throughout the adult years appears to reduce the chances of developing Alzheimer's Disease later in life, according to researcher Robert Friedland, M.D.

Alzheimer's disease is a progressive, degenerative disease of the brain affecting one in 10 persons over the age of 65 and nearly half of those over the age of 85.

Friedland and colleague Arthur Smith, M.D., neurologists with Case Western Reserve University, compared the adulthood exercise habits of 126 elderly Alzheimer's patients with 315 elderly individuals without Alzheimer's Disease. Their results indicated that overall the Alzheimer's patients led far greater sedentary lifestyles and scored much lower on an activity rating scale than did their healthy counterparts. Some of the activities associated with the reduced Alzheimer's risk included regular participation in biking, swimming, golf, tennis, racquetball, running, ice skating and weight training. The activity periods studied were those between the ages of 20 and 59.

1. 50th Annual Meeting of the American Academy of Neurology, Minneapolis, Minnesota. April 1998.
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Sports Injuries Rising in the Elderly

According to a recent report from the US Consumer Product Safety Commission, sports injuries rose by 54% in Americans age 65 years and older between 1990 and 1996.

The rise in elder sports injuries outstrips the 8% increase in the number of Americans in this age group over the same period, notes the agency. "The increase in injuries is most likely attributable to increasingly active lifestyles and to increased participation in sports activities by older Americans," according to the report.

The Commission also notes that Americans are remaining physically active into their 70s, 80s, and even 90s. And more elderly people are participating in "more active" sports such as bicycling, weightlifting, and skiing.

The report is based on data from the National Electronic Injury Surveillance System, which samples 101 hospitals nationwide drawn from 5,000 hospitals with 24-hour emergency departments.

The study showed that between 1990 and 1996, sports-related injuries increased much more among older active people than among younger age groups. In contrast to the 54% increase noted in those over age 65, sports-related injuries increased by 18% in the 25 to 64 age group.

In actual numbers, there were 34,000 sports injuries in the 65 and older age group in 1990, rising to 53,000 in 1996. "The increased incidence of injury occurred not only among the youngest of the 65 and older population, but also among those 75 years and older," according to the report. "Sports-related injuries to persons 75 and older increased by 29%."

But the Commission report also notes that the average cost for treating sport-related injury in the emergency room fell between 1990 and 1996. "While more injuries are occurring, they appear, on the average, to be less costly and severe," the report authors write.

While injuries from "less active" sports such as fishing, golf, bowling, and shuffleboard increased only slightly or not at all between 1990-1996, injuries sustained while participating in "more active" sports increased significantly in those 65 and older. Bicycling injuries were most common in this age group, and bike-related injuries increased by 75% in this age group. Most (60%) of these injuries resulted from falls, and 21% were head injuries. More injuries were also noted among older people using weights or other exercise equipment, and in older skiers.

"It is interesting to note that there were a small number of injuries (in those age 65 and older) seen for the first time in 1996 involving 'extreme' or more physically challenging sports such as snowboarding and in-line skating," note the study authors.

The report also notes that in both 1990 and 1996, about 60% of sports injuries in the geriatric age group occurred in men.

The hospitalization rate for sports injuries in the 65 and older age group is 10%, less than the 18% rate for injuries with all consumer products in this age group. "The lower hospitalization rate for sport-related injuries suggests that the population participating in sport activities is healthier overall than those who are not participating in sports," comments the Commission.

The study authors recommend that individuals participating in sports "use safety gear and take appropriate safety precautions, especially in active sports such as in-line skating and use of exercise equipment and weights."

They also note that "virtually none" of the elderly people with a head injury following a cycling accident were wearing a helmet at the time of the incident. "Bicycle helmets reduce the risk of serious head injury," advise the Commission.

"By getting regular exercise - and doing it safely - older Americans can enjoy a healthier life," they conclude.
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