# Exercise as it relates to Disease/Resistance training guidelines for the elderly
### Musculoskeletal issues associated with ageing

Ageing causes many physiological changes within the body, this page will deal with the age bracket of 50 years and older. The musculoskeletal system changes significantly with age, the most noticeable change is a decrease in skeletal muscle mass and strength, this is called sarcopenia.[1,7,11] This decreased muscle mass and strength has many negative consequences on the mobility and independence of elderly people. Decreased muscle mass and strength means a decrease in postural stability, which is a serious consequence for older adults as it leads to an increased falls risk, and therefore an increased injury risk. [1,4,6] Decreased strength also makes it harder for elderly people to perform everyday tasks, e.g. Lifting household objects, climbing stairs, gardening, and even walking; this significantly decreases their independence and quality of life.[1,6,7,11]. Resistance training has been found to be the only form of exercise to counteract sarcopenia[11], and it’s for this reason that elderly people should incorporate a resistance training program into their lifestyle. Osteoporosis is another condition that affects elderly people, and resistance training has been found to be effective at preventing/limiting the effects of the disease. [1,5,7] As people age, they lose bone mineral density, which along with decreased muscle mass, increases fragility. Regular resistance training has been found to be able to increase bone mineral density[9,10], thus reducing fragility.

### Benefits of resistance training in the elderly

There are many benefits of resistance training for the elderly, including physical, social, mental, and emotional benefits:
* improved posture[1,6,7]
* better support for joints[1,5,7]
* Reduced injury risk/falls risk[1,4,6,7,11]
* Reduced skeletal muscle loss, and possible hypertrophy[1,2,3,4,5,6,7,11]
* Prevention of osteoporosis[1,7]
* Rehabilitation from injury/surgery[8]
* Social interaction from joining a gym/sports club, this leads to mental/emotional benefits[1]
* Increased bone mineral density[9,10]
* Increased functional strength, which has been shown to increase general activity levels throughout the day, and makes performing everyday tasks easier (increased mobility & independence).[1]
* Minimise fragility [1]

### Limitations

Elderly people will have limitations on the physical activity they can perform. These limitations should be identified by a health practitioner prior to the commencement an exercise program with the use of a pre-screening questionnaire. Common limitations include:
* Adherence (higher in resistance training programs (87%) compared to aerobic programs (81%))[4]
* Old injuries that cause a limited range of motion
* Lack of motivation during a training session
* Lack of confidence to go to a gym/sports club[1]
* As age progresses and more skeletal muscle is lost, people have a tendency to become more sedentary, which further increases the rate of muscle loss and further decreases motivation to train.[1]

## Recommendations

Before any training program is commenced, the participant should visit a health practitioner and answer a pre-screening questionnaire to determine if they are in a healthy state to exercise. Once cleared to exercise, an individualised training program should be made for the participant by a qualified trainer, taking into account the specific limitations of the individual. General guidelines include:
* If limited range of motion, just perform in the pain free range of motion[5]
* Use mainly compound isotonic movements to work the shoulders, arms, back and legs [5]
* Take 2–3 seconds for the concentric phase, and 4–6 seconds for the eccentric phase[5]
* Inhale before the lift, exhale during the concentric phase, and inhale during the eccentric phase[5]
Research has found that programs that contain only a single set per exercise, of 8-10 compound exercises, using a rep range of 6 to 15 repetitions per set, with at least two sessions per week, yield the best results for strength, hypertrophy, and program adherence.[1,5,7] An example of a training program that can be tailored to an individual is:
| Exercise number | Exercise | Sets | Repititions |
| 1 | Squat | 1 | 6-15 |
| 2 | Seated dumbbell shoulder press | 1 | 6-15 |
| 3 | Barbell bicep curl | 1 | 6-15 |
| 4 | Lat. Pulldown | 1 | 6-15 |
| 5 | Leg press | 1 | 6-15 |
| 6 | Bent over barbell row | 1 | 6-15 |
| 7 | Flat bench press | 1 | 6-15 |
| 8 | Leg extension | 1 | 6-15 |

## Conclusion

Older adults can benefit more from resistance training than any other age group.[1] Resistance training twice or more a week, using 8-10 sets of up to 15 repetitions, can minimise the impacts of sarcopenia and osteoporosis, improve postural stability(decreasing falls risk), and increase mobility and independence of the elderly.[1,2,3,4,5,6,7,8,9,10,11]

## Further reading

For further reading, take a look at this paper that studied the combination of nutritional intervention along with the resistance training.[12]

## Bibliography

1. Evans, William J. Exercise training guidelines for the elderly. Medicine & Science in Sports & Exercise. 31(1):12-17, January 1999.
2. N McCartney, A L. Hicks, J Martin, E. Webber. Long-term Resistance Training in the Elderly: Effects on Dynamic Strength, Exercise Capacity, Muscle, and Bone. J Gerontol A Biol Sci Med Sci (1995)
3. G Pyka, E Lindenberger, S Charette, R Marcus. Muscle Strength and Fiber Adaptations to a Year-long Resistance Training Program in Elderly Men and Women. J Gerontol (1994)
4. Pollock ML, Carroll JF, Graves JE, Leggett SH, Braith RW, Limacher M, Hagberg JM. Injuries and adherence to walk/jog and resistance training programs in the elderly. Medicine and Science in Sports and Exercise [1991, 23(10):1194-1200]
5. M S. Feigenbaum, M L. Pollock. Prescription of resistance training for health and disease. Journal of the American college of Sports Medicine. 1998.
6. Liu-Ambrose T, Khan K, Eng J, Janssen P, Lord S, McKay H. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. Journal Of The American Geriatrics Society [serial online]. May 2004;52(5):657-665.
7. Hunter, G. R., McCarthy, J. P., & Bamman, M. M. (2004). Effects of resistance training on older adults. Sports Medicine, 34(5), 329-348.
8. Ada L, Dorsch S, Canning C G. Strengthening interventions increase strength and improve activity after stroke: a systematic review. Australian Journal of Physiotherapy. 2006;52(4):241-248.
9. J. Whiteford, T. R. Ackland, S. S. Dhaliwal, A. P. James, J. J. Woodhouse, R. Price, R. L. Prince, D. A. Kerr. Effects of a 1-year randomized controlled trial of resistance training on lower limb bone and muscle structure and function in older men. Osteoporosis International September 2010, Volume 21, Issue 9, pp 1529–1536.
10. Vincent, Kevin R.; Braith, Randy W. Resistance exercise and bone turnover in elderly men and women. Medicine & Science in Sports & Exercise. Issue: Volume 34(1), January 2002, pp 17–23
11. Evans, W. What is sarcopenia? J. Gerontol. 50A:5-8, 1995.
12. B Esmarck, J L Andersen, S Olsen, E A Richter, M Mizuno, M Kjær. Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans: J Physiol. 2001 August 15; 535(Pt 1): 301–311