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Exercise in the Elderly

Condition: Exercise is physical activity that is performed to become stronger and healthier.

Background: Only 16% of individuals aged 65-74 years get the recommended 30 minutes or more of moderate physical activity 5 or more days a week. Thus, the baby boomer generation exhibits an epidemic of sedentary lifestyle-related disease.

Risk Factors: Obesity, mobility challenges, low confidence, and disease burden impact an individual’s ability to maintain physical activity levels during aging. Patients who are primary caregivers are less likely to exercise. Osteoarthritis and heart and lung diseases are common challenges that affect older adults participating in an exercise program. Older individuals also have reduced ability to regulate body temperature, rendering exercise in extreme heat or cold more dangerous.

History and Symptoms: Older patients often over-report their activity levels, while a detailed medical history will reveal a truly sedentary lifestyle. The presence of osteoarthritis in knees and hips is associated with pain following exercise. Decreased range of motion, activity restrictions, and muscle tightening occur with inactivity and increase the risk of muscle sprains and inflammation. Decreases in blood flow, heart rate response, lung function, range of motion, balance, temperature regulation, and protein metabolism and an increase in body fat lead to a decrease in exercise capacity.

Physical Exam: Physical examination should emphasize range of motion, joint function, and stability.

Diagnostic Process: Functional assessment, including analysis of walking, is indicated for older adults beginning an exercise program. Exercise stress testing is also recommended. The use of fitness-tracking devices to objectively monitor exercise is beneficial and provides motivation for some patients.

Rehab Management: Patients should receive counseling about risks of falls and about the benefits of exercise. Rehabilitation professionals can address musculoskeletal concerns following increased physical activity. Exercise-related symptoms should be reported for further evaluation by a primary care provider or cardiologist. Control of pain and physical therapy are standard practices and allow implementation of a new exercise program.

Other Resources for Patients and Families: Patient education regarding safety (fall prevention, temperature regulation, hydration, and nutrition) is important. Encouraging family members to participate in the exercise program with the older relative may improve participation. Education of family members about the benefits of physical activity may help the patient overcome barriers to physical activity.


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