Because its there. George Leigh Mallory (1924). My Get-Up-and-Go Has Got Up and Gone Presented by Jeffrey Pearson, D.O. Industrial & Sports Medical Center.

““Because it’s there.”Because it’s there.”George Leigh Mallory (1924)George Leigh Mallory (1924)

My Get-Up-and-Go My Get-Up-and-Go Has Has

Got Up and GoneGot Up and Gone

Presented byPresented by

Jeffrey Pearson, D.O.Jeffrey Pearson, D.O.

Industrial & Sports Medical Industrial & Sports Medical CenterCenter

San Marcos, CASan Marcos, CA

Parts of this talk stolen Parts of this talk stolen fromfrom

“Anyone can get old. All you have to do is live long enough.”

Groucho Marx

Our Older PopulationOur Older Population

People >65 years of age make up People >65 years of age make up 12.5% of the population. 12.5% of the population. – By 2050, estimated to be ~25%.By 2050, estimated to be ~25%.

Americans have an increasing life Americans have an increasing life expectancy:expectancy:– Women live 18.6 years past 65.Women live 18.6 years past 65.– Men live 14.7 years past 65.Men live 14.7 years past 65.

Problems associated with Problems associated with agingaging

Elderly tend to be more sedentary Elderly tend to be more sedentary than their younger colleagues.than their younger colleagues.

Tend to suffer from medical Tend to suffer from medical problems that result inproblems that result in– functional impairmentfunctional impairment– less independenceless independence– greater utilization of healthcare greater utilization of healthcare

servicesservices

How fitness can helpHow fitness can help

Healthy lifestyle leads to a Healthy lifestyle leads to a healthier life.healthier life.

With exercise, people lead a more With exercise, people lead a more carefree life-style.carefree life-style.

Exercise leads to less time spent in Exercise leads to less time spent in hospital/medical office.hospital/medical office.

“Old age is when everything that doesn’t hurt doesn’t work.”

Anonymous

With maturity comes With maturity comes change...change...

CardiovascularCardiovascular maximum heart rate [HRmaximum heart rate [HRmaxmax=220-age]=220-age]

NeurologicNeurologic nerve conduction velocities;nerve conduction velocities; proprioception proprioception

MusculoskeletalMusculoskeletal bone loss, bone loss, muscle strength, muscle strength, flexibility flexibility vertebral disc size/strengthvertebral disc size/strength

OtherOther– respiratory system, metabolismrespiratory system, metabolism

When do disabilities When do disabilities begin?begin?

Onset around age 60 for both Onset around age 60 for both sexes.sexes.

Nearly ¹/³ of people over 65 years Nearly ¹/³ of people over 65 years of age have some impairment in of age have some impairment in performing activities such as performing activities such as walking.walking.

“If I'd known I was gonna live this long, I'd have taken better care of myself.”

Eubie Blake

Benefits of exercise: Benefits of exercise: generalgeneral

Serves 2 major purposesServes 2 major purposes– preventivepreventive

““lifetime pattern of physical activity lifetime pattern of physical activity ameliorates the ravages of aging.” ameliorates the ravages of aging.”

flexibility and strengthening program may flexibility and strengthening program may reduce incidence of falls and bedsores.reduce incidence of falls and bedsores.

– therapeutictherapeutic Patients with strokes, arthritis, and Patients with strokes, arthritis, and

fractures may regain some function.fractures may regain some function.

Benefits of exercise: Benefits of exercise: specificsspecifics

CardiovascularCardiovascular– cardiac output/cardiovascular fitness, cardiac output/cardiovascular fitness,

cholesterol profile, BP controlcholesterol profile, BP control Respiratory capacity/functionRespiratory capacity/function Bone and muscle strength, flexibility, Bone and muscle strength, flexibility,

coordinationcoordination PsychologicalPsychological

– mood,self-esteemmood,self-esteem– socializationsocialization

Exercise Exercise is Workis Work

SI units of work are Joules (J) (1 Joule = 1 Newton meter).

W = KEf - KEi

KE = ½mv 2

W = Fs W = (ma)s

= (v 2 - v02)/2 W = 1/2m(v 2 - v0

2) = KEf - KEi

PEg = mgy

WorkWork

distance

gravity

“I'm not afraid of death, I just don’t want to be there when it happens.”

Woody Allen

Exercise: How safe is it?Exercise: How safe is it?

Cardiovascular (CV) DiseaseCardiovascular (CV) Disease – Leading cause of death in U.S.Leading cause of death in U.S.– Sudden/unexpected death is common in Sudden/unexpected death is common in

populations w/ high rates of CV disease.populations w/ high rates of CV disease.– Most sudden deaths occur in middle-aged and Most sudden deaths occur in middle-aged and

older individuals w/ advanced CAD and occur older individuals w/ advanced CAD and occur during a variety of activities, including during a variety of activities, including exercise.exercise.

– NOTE: cause of death in these cases is due to NOTE: cause of death in these cases is due to CAD and not exercise (although may be CAD and not exercise (although may be contributing factor).contributing factor).

Exercise: How safe is it?Exercise: How safe is it?

Risk of death transiently increased Risk of death transiently increased during actual exercise period, but during actual exercise period, but decreased for the rest of the day.decreased for the rest of the day.– The overall risk of cardiac arrest for active The overall risk of cardiac arrest for active

men is much lower than sedentary men.men is much lower than sedentary men.

Studies consistently show lower all-cause death rates in more physically active groups.

Exercise: How safe is it?Exercise: How safe is it?

In Summary: In Summary: – The risk of serious medical complications The risk of serious medical complications

during exercise is low, but is higher than during exercise is low, but is higher than during sedentary activities.during sedentary activities.

– The overall benefit/risk ratio for an active The overall benefit/risk ratio for an active way of life is favorable.way of life is favorable.

– Moderate exercise has the potential to Moderate exercise has the potential to enhance the health of many sedentary enhance the health of many sedentary individuals and should be widely individuals and should be widely recommended.recommended.

“I have the rest of my life to improve, but it may take longer than that.”

Ashleigh Brilliant

Beginning an exercise Beginning an exercise programprogram

Physician’s assessmentPhysician’s assessment– review patient’s needs and goalsreview patient’s needs and goals– outline progressive steps to achieve outline progressive steps to achieve

goalsgoals– refocus unrealistic goals!refocus unrealistic goals!– Patient educationPatient education

avoiding injuriesavoiding injuries nutritionnutrition

The Medical EvaluationThe Medical Evaluation HistoryHistory

– past/current illnesses; previous injuries past/current illnesses; previous injuries (and level of rehabilitation achieved); (and level of rehabilitation achieved); current medicationscurrent medications

– functional capacityfunctional capacity ExaminationExamination

– assess function assess function cardiovascular and musculoskeletal systemscardiovascular and musculoskeletal systems sensory: vision, hearing, proprioceptionsensory: vision, hearing, proprioception

– assess nutritionassess nutrition

The Exercise PrescriptionThe Exercise Prescription

Mode of activityMode of activity Intensity of exerciseIntensity of exercise Duration of exerciseDuration of exercise Frequency of exerciseFrequency of exercise Rate of progressionRate of progression

Mode of activityMode of activity

Any activity that usesAny activity that uses– large muscle groupslarge muscle groups– can be maintained for a prolonged periodcan be maintained for a prolonged period– rhythmic in naturerhythmic in nature

Key purpose of most exercise Key purpose of most exercise prescriptions is to increase or prescriptions is to increase or maintain functional capacitymaintain functional capacity– aerobic endurance activitiesaerobic endurance activities

Endurance ActivitiesEndurance Activities Group 1Group 1

– easily maintained at a constant easily maintained at a constant intensity and inter-individual intensity and inter-individual variability in energy expenditure is variability in energy expenditure is lowlow

walking, jogging, cyclingwalking, jogging, cycling

Endurance ActivitiesEndurance Activities Group 2Group 2

– rate of energy expenditure related to skill, but for given individual may provide rate of energy expenditure related to skill, but for given individual may provide constant intensityconstant intensity

swimming, cross-country skiingswimming, cross-country skiing

Group 3Group 3– Highly variable in intensityHighly variable in intensity

dancing, basketball, racquetballdancing, basketball, racquetball

Q: How many 50-year-olds does it take to screw in a light bulb?

A: None; their screwing days are long gone.

Old Joke (Pre-Viagra)Old Joke (Pre-Viagra)

Intensity of exerciseIntensity of exercise

Conditioning sessions should be Conditioning sessions should be maintained at 40-85% of functional maintained at 40-85% of functional capacity.capacity.– Healthy adults typically: 60-70%Healthy adults typically: 60-70%– Cardiac patients: start at 40-60%Cardiac patients: start at 40-60%

Ideally, the participant should feel rested, and not fatigued, within an hour following exercise.

Heart Rate Method #1Heart Rate Method #1

Example: 220 - 50 = 170 bpm Hrmax

170 x .70 =119 bpm 170 x .85 = 145 bpm

Target exercise range: 119 - 145 bpm

Simple fixed percentage of HR methodSimple fixed percentage of HR method

70-85% of maximal heart rate corresponds 70-85% of maximal heart rate corresponds to about 60-80% of functional capacity.to about 60-80% of functional capacity.

HRmax=220-age

Heart Rate Method #2Heart Rate Method #2 Heart Rate Reserve/Range MethodHeart Rate Reserve/Range Method

– 60-80% of the HRR corresponds to 60-60-80% of the HRR corresponds to 60-80% of the functional capacity.80% of the functional capacity.

– Calculate the HRR Calculate the HRR HRHRmaxmax - HR - HRrestingresting = Heart Rate Reserve (HRR) = Heart Rate Reserve (HRR)

– Calculate conditioning intensity Calculate conditioning intensity Multiply HRR by desired intensityMultiply HRR by desired intensity

– Calculate target HRCalculate target HR Add HRAdd HRrestingresting

Lower Limit Higher Limit

Maximal HR 160 160

Resting HR -70 -70

HRR 90 90

Conditioning intensity x .60 x .80

54 72

Resting HR + 70 + 70

Target HR 124 142

Example: 60 y.o. with resting HR of 70 bpm

How doctors look at How doctors look at intensity intensity (Feel free to forget this (Feel free to forget this stuff right away)stuff right away)

METsMETs

– one MET is equivalent to the amount one MET is equivalent to the amount of energy used at rest (oxygen uptake of energy used at rest (oxygen uptake of 3.5 ml/kg/min)of 3.5 ml/kg/min)

– Varies with speed of movements and Varies with speed of movements and changes in resistance changes in resistance

– ADL’s require 5 METsADL’s require 5 METs

Leisure activities in MET’sLeisure activities in MET’s BilliardsBilliards BowlingBowling Boxing (sparring)Boxing (sparring) Climbing hillsClimbing hills Cycling (pleasure)Cycling (pleasure) Dancing (social, square, tap)Dancing (social, square, tap) Dancing (aerobic)Dancing (aerobic) Fishing (from bank)Fishing (from bank) Football (touch)Football (touch) Golf (cart)Golf (cart)

((Walking/carrying bag)Walking/carrying bag) HandballHandball Rope skippingRope skipping Running (12 minute mile)Running (12 minute mile) ShuffleboardShuffleboard TennisTennis

2.52.5 2 - 42 - 4 8.38.3 5 - 105 - 10 3 - 83 - 8 3.7 - 7.43.7 - 7.4 6 - 96 - 9 2 - 42 - 4 6 - 106 - 10 2 - 32 - 3 4 - 74 - 7 8 - 128 - 12 99 8.78.7 2 - 32 - 3 4 - 94 - 9

Rating of Perceived Rating of Perceived ExertionExertion

Category RPE Scale Category-Ratio RPE Scale6 0 Nothing at all

7 Very, very light 0.5 very,very weak

8 1 Very weak

9 Very light 2 Weak

10 3 Moderate

11 Fairly light 4 Somewhat strong

12 5 Strong

13 Somewhat hard 6

14 7 Very strong

15 Hard 8

16 9

17 Very hard 10 Very, very strong

18 * Maximal

19 Very, very hard

20

“Time is a great teacher, but unfortunately it kills all its pupils.”

Hector Berlioz

Duration of activityDuration of activity

Conditioning period (excludes Conditioning period (excludes warm up and cool down periods) warm up and cool down periods) may vary from 15-60 minutes may vary from 15-60 minutes – typically 20-30 minutestypically 20-30 minutes– this length required to improve or this length required to improve or

maintain functional capacitymaintain functional capacity

Frequency of Exercise Frequency of Exercise SessionsSessions

Depends, in part, upon the duration and Depends, in part, upon the duration and intensity of the exercise sessionintensity of the exercise session

Functional capacity <3 METsFunctional capacity <3 METs– 5 minute sessions, several times/day5 minute sessions, several times/day

Functional capacity 3-5 METsFunctional capacity 3-5 METs– 1-2 daily sessions1-2 daily sessions

Functional capacity >5 METsFunctional capacity >5 METs– at least 3x/wk on alternate days (aim for 5 at least 3x/wk on alternate days (aim for 5

days total)days total)

Rate of ProgressionRate of Progression

Initial conditioning stageInitial conditioning stage– usually lasts 4-6 weeks, but depends usually lasts 4-6 weeks, but depends

upon initial functional capacity and rate upon initial functional capacity and rate of adaptation.of adaptation.

– Should include light calisthenics and low Should include light calisthenics and low level aerobic activities with which the level aerobic activities with which the participant experiences a minimum of participant experiences a minimum of muscle soreness.muscle soreness.

Discomforts usually arise when program fails Discomforts usually arise when program fails to allow for gradual adaptation.to allow for gradual adaptation.

Rate of ProgressionRate of Progression

Improvement conditioning stageImprovement conditioning stage– Typically lasts 4-5 months.Typically lasts 4-5 months.– Aerobic conditioning is progressed at Aerobic conditioning is progressed at

a more rapid rate.a more rapid rate. Intensity increased to target levelIntensity increased to target level Duration increased every 2-3 weeksDuration increased every 2-3 weeks

– Less fit individuals may need more time.Less fit individuals may need more time. Duration of exercise should be increased Duration of exercise should be increased

to 20-30 minutes before increasing the to 20-30 minutes before increasing the intensity.intensity.

Rate of ProgressionRate of Progression

Maintenance conditioning stageMaintenance conditioning stage– Usually begins after first 6 months of Usually begins after first 6 months of

trainingtraining– Participant reaches satisfactory level of Participant reaches satisfactory level of

cardiorespiratory fitnesscardiorespiratory fitness– Should review the conditioning objectivesShould review the conditioning objectives– More enjoyable or variable activities may More enjoyable or variable activities may

be substituted for those used previouslybe substituted for those used previously helps avoid dropping out due to boredom of helps avoid dropping out due to boredom of

repetitionrepetition

Sample Progression Sample Progression ProgramProgram

“I am sick of all this nonsense about beauty being only skin deep. That’s deep enough. What do you want, an adorable pancreas?”

Jean Kerr

Other Fitness ComponentsOther Fitness Components FlexibilityFlexibility

– Lack of flexibility may be associated with Lack of flexibility may be associated with increase risk for low back pain and other increase risk for low back pain and other injuriesinjuries

– Stretching exercises should be performed Stretching exercises should be performed slowly, in a controlled mannerslowly, in a controlled manner

15-20 seconds per repetition15-20 seconds per repetition 4 repetitions of a particular stretch per set 4 repetitions of a particular stretch per set at least 3x/weekat least 3x/week

Other Fitness ComponentsOther Fitness Components

Muscular strength and enduranceMuscular strength and endurance– No direct relationship to cardiorespiratory No direct relationship to cardiorespiratory

fitness or functional capacityfitness or functional capacity however, many tasks require some degree of however, many tasks require some degree of

strength, e.g. lifting/moving objectsstrength, e.g. lifting/moving objects The stronger the individual, the less stress The stronger the individual, the less stress

placed upon the body performing tasksplaced upon the body performing tasks

– Strength exercises help to maintain muscle Strength exercises help to maintain muscle mass as we become older mass as we become older (“Use it or lose it.”)(“Use it or lose it.”)

Other Fitness ComponentsOther Fitness Components

Muscular strength and enduranceMuscular strength and endurance– Begin withBegin with low resistance, high low resistance, high

repetitions to develop muscle tonerepetitions to develop muscle tone 20-30 reps with light weight per set20-30 reps with light weight per set

– Optimal strength gainsOptimal strength gains occur when the occur when the resistance allows for no more than 5-8 resistance allows for no more than 5-8 repetitions of a movement, for 3 setsrepetitions of a movement, for 3 sets

you can still make strength gains with you can still make strength gains with lower resistanceslower resistances

““Catflexing”Catflexing”

““Catflexing”Catflexing”

NutritionNutrition

Carbohydrates for fuelCarbohydrates for fuel– 60%60%++ of total daily calories of total daily calories– complex>simplecomplex>simple

Protein for re-buildingProtein for re-building– 15%15%++ of total daily calories of total daily calories

Fat for energy storage Fat for energy storage (1 lb. = 3500 Kcal)(1 lb. = 3500 Kcal)– 25% (or less) of total daily calories25% (or less) of total daily calories– avoid saturated and hydrogenated typesavoid saturated and hydrogenated types

NutritionNutrition

FluidsFluids– Plain water best for most peoplePlain water best for most people– Drink 1-2 eight ounce glasses before Drink 1-2 eight ounce glasses before

exerciseexercise– Repeat every 20 minutes of exerciseRepeat every 20 minutes of exercise

SodiumSodium– Normal daily intake about 2000 mgNormal daily intake about 2000 mg– Never consume salt tablets on hot days!Never consume salt tablets on hot days!

Injury/Illness Injury/Illness Treatment and PreventionTreatment and Prevention

Ice is nice!Ice is nice!– P.R.I.C.E.S.P.R.I.C.E.S.

SunscreenSunscreen– SPF 15 or greaterSPF 15 or greater

Proper footwearProper footwear– Tie shoelaces!Tie shoelaces!

“The secret of staying young is to live honestly, eat slowly, and lie about your age.”

Lucille Ball

The EndThe End

Thank you!