Physical activity benefits all body organs as well as the psyche. The most dramatic benefits have been found in the cardiovascular system. Exercise interventions in older patients with coronary heart disease decreased morbidity, mortality and symptoms, and reduced cardiac re-hospitalizations.
Benefits of Exercise
Numerous mechanisms may contribute to these benefits. Increased demand on the myocardium improves oxygen utilization. Capillaries dilate and multiply to improve the delivery of oxygen and other nutrients to muscles. The myoglobin content of muscle is increased, thus improving the transfer of oxygen from the red blood cells to muscle cells. Inside the cell, the number of mitochondria increases, enhancing aerobic metabolism. There is also an increase in the glycogen storage sites of muscle. Here following are the exercise benefits:
- Exercise tends to lower the resting heart rate and the resultant increased diastolic time allows improved coronary blood flow. Stroke volume increases.
- Exercise also has an effect on blood lipid levels, raising levels of high-density lipoprotein cholesterol, the cardio protective lipid, and lowering levels of low-density lipoprotein cholesterol.
- Exercise lowers blood pressure and reduces obesity. A combination of these two factors, in addition to the reduction in cholesterol, decreases the risk of ischemic heart disease.
- Exercise may also improve exercise tolerance in older people with chronic obstructive pulmonary disease. They will also benefit from the associated benefits of aerobic fitness.
- Exercise may improve blood sugar control in people with diabetes by decreasing insulin resistance, and may reduce the need for medication.
- Resistance training and high-impact activities help maintain bone mass in the elderly.
- An exercise program may also be beneficial for older people with osteoarthritis by improving joint mobility and increasing muscle strength.
- Exercise in the form of strength and balance training has been shown to reduce an older person’s risk of falling.
- Along with the physical benefits of exercise, the older athlete benefits from improved sleep, cognitive function and mood.
- The muscle control and weight loss associated with exercise may lead to improvements in body image and reverse the elderly person’s fear of activity.
- Exercise reduces anxiety in elderly patients, especially in those recovering from illness.
- Exercise can lessen depressive symptoms and perhaps even reduce the risk of developing depression.
Risks of Exercise in the Elderly
The risks associated with a sedentary lifestyle are well known although difficult to quantify objectively and compare with the risks associated with exercise in later years. Underlying co-morbidity is often cited as a reason to preclude exercise despite the overwhelming evidence to support the benefits of exercise in many common and chronic diseases.
From a safety standpoint, clinicians prescribing exercise for older people are concerned that exercise may induce myocardial ischemia and, in turn, precipitate myocardial infarction or sudden death. Gill and colleagues have provided recommendations regarding precautions that can be taken to minimize the risk of serious adverse cardiac events among previously sedentary older persons who do not have symptomatic cardiovascular disease and are interested in starting an exercise program.
Reducing the Risks of Exercise
Before starting an exercise program, all older persons should have a complete history and physical examination performed by a physician. Contraindications to exercise outside of a monitored environment include: myocardial infarction within six months, angina or physical signs and symptoms of congestive heart failure, and a resting systolic blood pressure of 200 mm or higher. A functional test of cardiac capacity is to ask the patient to walk 15 m (50 ft) or climb a flight of stairs. A resting ECG/EKG should be reviewed for new Q waves, ST segment depressions or T-wave inversion.
Persons who have features of cardiovascular disease should be referred for appropriate management. If the patient has no overt cardiovascular disease, and no other medical or orthopedic contraindications to exercise, he or she can begin a low-intensity exercise program.
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