The document discusses the importance of exercise for the elderly, highlighting its benefits in preventing chronic illnesses, improving quality of life, and maintaining physical and cognitive function. It provides recommendations for exercise frequency, intensity, and type, emphasizing a combination of aerobic, strength, flexibility, and balance training. Additionally, it notes the growing elderly population and the need for tailored exercise prescriptions to enhance health and safety.

1. Doly Bokalial (BPT) (CMT)
M.Sc Rehabilitation Science , Part II.
Exercise Prescription in Geriatric Population

2. Introduction
• Exercise plays a major role in human life; it may be to
remain fit or may be to recover from a disease or
impairment in all age groups.
• Lots of study has been done to prove the benefit of
exercise and its uses in different condition.
• Study says that there are undeniable suggestions that
regular exercise prevents primary and secondary
complications resulting from Chronic Illness
(Warburton D.E. et al., 2006).
• Elderly people who participate in any extent of physical
activity gain some health benefits, including
maintenance of good physical and cognitive function.
• Some physical activity is better than none, and more
physical activity provides greater health benefits.

3. • Study also found that the physical activity is
directly proportional to health status i.e. the
more you spend time doing exercise the more
physically and mentally healthy you are
(Warburton et al., 2006).
• The benefits of physical activity for elderly
people are well documented. It improves
cardiorespiratory function, reduces risk
factors for coronary artery disease, and most
importantly improves the ability to perform
daily activities (Lim J.Y , 1999).

4. • There are few clear evidence that exercise will improve
longevity, but there are lots of evidence that it
improves the quality of life in old age. It maintains
endurance, strength, and joint mobility while it reduces
the incidence and severity of hypertension,
osteoporosis, obesity, and diabetes mellitus (Singh,
M.A.F., 2002).
• Among older adults, higher level of physical activity
are associated with increased survival, better physical
functioning, low ill-health risk and better mental
health (Santos D.A et al., 2012).
• A combination of aerobic activity, strength training,
and flexibility exercises, along with increased general
daily activity can reduce medication dependence and
health care costs while maintaining functional
independence and improving quality of life in older
adult (Mcdermott A.Y and Mernitz H, 2006).

5. Prevalence of Elderly Population
Worldwide
• Almost one third of the world population is growing older in age,
according to the “World Population Aging-2013” report published
by United Nation Department of “the number of older persons
(aged 60 years or over) is expected to more than double, from 841
million people in 2013 to more than 2 billion in 2050”.
• About two thirds of the worlds’ older persons live in developing
countries, because the older population in developing countries is
growing faster than developed regions.
• By 2050, nearly 8 in 10 of the world’s older population will live in
the developing regions (UN, Department of Economic and Social
Affairs, population division-2013).
• Sri Lanka has the fastest growing ageing population in South Asia.
The proportion of older people (aged ≥60 years) is 13.1% at present
and is expected to increase to 22% by 2030, higher than the 14% in
India, 8% in Pakistan, and 10% in Bangladesh (Perera, B. et al.,
2015).

6. Current situation
Australia:
• Through a study among older South Australian it has
been found that rates of participation among adults
age 60 years and over in walking and vigorous physical
activity (68.1% and 11.7%, respectively) were
significantly lower than for those age 18–59 years
(77.6% and 38.9%, respectively). Walking was the most
popular activity among those ages 60 and over. The
result of the study says that increases in physical
inactivity coupled with declines in functional ability
with advancing age (Hamdorf ,P et al., 2002).

7. India:
• Based on survey overall 392 million individuals
are inactive in India. This is a surprising amount
and indicates a huge population at risk for
developing non-communicable diseases and age
related complications (Anjana, R.M et al.,2014).
South Asian Countries:
• In the South Asian regions females, skilled
workers, professionals and those with higher
education were more inactive.
• Majority of South Asian adults were inactive
during their leisure time and this shows the
chances of sufferings of these population at old
age (Ranasinghe, C.D et al., 2013).

8. Recommended Exercise for the Elderly
People
• The Overall Recommendations on Physical Activity for
Health published by the World Health Organization in
2010 state that adults over 18 years of age must do at
least 150 mins/week of moderate-intensity or 75
min/week of vigorous-intensity aerobic physical
activity or an equivalent combination of both.
• It also suggests that adult should perform muscle
strengthening training 2 days per week focusing on all
group of muscles.
• Adults over 65 years of age are advised to follow the
adult recommendations if possible or (if this is not
possible) they are advised to be as physically active as
they are able.

9. Basic Principle of Exercise Prescription:
• There are more chances of orthopedic injuries
and cardiovascular complications and systemic
diseases in elderly adults so prior assessment
is necessary to prevent from complications.
Furthermore, proper instruction on correct
and safe method of exercise is essential prior
to exercise prescription to reduce the risk of
injury as well as other health-related
complications.

10. i. Warm-up:
As we all know elasticity of muscle and connective tissue
reduces along with aging and there is also gradual
increase in stiffness so a proper warm–up is compulsory
in reducing the risk of injury in older population.
ii. Frequency:
As elderly individuals beginning a resistance training
program generally have reduced muscle strength and
mass compared with their younger counterparts,
significant improvements in muscle strength are
consistently observed with a training frequency of 2 to 3
days/week. While increasing the training frequency to 4
to 5 days/week may result in further gains in strength.

11. iii. Exercise Intensity:
• Elderly individuals beginning a resistance
training program should start at a low
intensity and gradually progress over time.
• The intensity is generally prescribed as a
percentage of the individual’s 1-repetition
maximum (1-RM: the maximum amount of
weight that can be safely lifted 1 time).
• If they are looking for an increase in muscle
strength, it is generally recommended to use a
lower intensity weight that can be lifted for
more repetitions.

12. iv. Exercise Duration:
Currently, there is considerable debate regarding the
volume of resistance training necessary to produce
optimal benefits in muscle strength. Typically, multiple
sets (2 to 3 sets) of 8- to 15-RM are prescribed.
However, a number of studies suggest that a single set
can result in similar strength gains when compared with
the use of multiple sets. A single set resistance training
program can be completed in a shorter period of time
which has been suggested to increase compliance and
reduce the rate of dropouts.
Regardless, it is clear that a single set is sufficient to
produce significant strength gains. Multiple sets can be
employed if the potential for greater strength gains is
desired.

13. V. Exercise Type/Mode:
Each repetition should be performed slowly through the
full range of motion, allowing adequate time to lift the
weight (concentric contraction) as well as to lower the
weight (eccentric contraction).
From an equipment viewpoint, variable resistance
machines using weight stacks are desirable for this
population, for a number of reasons:
(i) they reduce the risk of injuries to hands and feet
(ii) they decrease the risk of injury to the lower back
(iii) they are associated with a reduced risk of exercised-
induced hypertension
(iv) the weights can be adjusted in small increments
(v) resistance can generally be applied through the full
range of motion.

14. Other specific exercises recommended
for elderly people:
Aerobic Training:
It is also called strength training, cardiovascular training, or
cardiorespiratory training. Aerobic activity includes walking,
swimming, cycling, dancing, or stair climbing. Walking is one
of the most easiest form of aerobic training to perform as it
does not required any special skills or training.
An elderly person can walk almost anywhere (inside or
outside) without any special equipment except a good pair of
shoes. Warm –up for at-least 5 min is necessary before
starting any activity. New walkers need to start slowly. It
should be according to the elderly person physical status.
Following steps need to follow:
1. Walk short distances.
2. Walk at a comfortable pace
3. Be sure the older adult can talk while walking.

15. Strength Training
Exercises for Upper & Lower Limbs:
• Based on several studies it is said that strength-
training program should be performed 2-3
times/week.
• It should be 20-30 min depending upon the elderly
person’s capacity. 8-15 repetition is recommended for
each type of exercises. If they cannot repeat it for 8
times then weight should be reduced to a lighter one &
they can perform 15 repetitions of each exercise.
• Once they completed 8 to 15 repetitions, rest for 1 to 2
minutes
• Repeat the exercise for another 8 to 15 repetitions.
Likewise they should complete 1-2 sets for all the
exercises

16. Flexibility Training:
• If an elderly person is more flexible, he or she
is less likely to become injured or have low
back pain.
• At the beginning, choose 4 to 6 stretches for
the upper body and 2 to 4 stretches for the
lower body. 2 to 3 times/ week are
recommended.
• Stretches should be repeated 3 to 4 times
each and held for 15-30 seconds.
• Exhalation should be done when moving into
the stretch and inhalation should be done
when returning to the starting position

17. Balance Training:
• Balance exercises are specific activities that
help build lower extremity (leg) muscle
strength as well as improve balance.
• Balance exercises can help an elderly people
to stay independent without any disabilities
and complication of falls.

18. Special consideration for the elderly
during exercise
Before starting any of the exercises by the elderly people
should do a health check-up in order to find out his/her
health status.
The health care provider should inform/ guide the elderly
person to stop exercising immediately if he or she
experiences any of the following symptoms:
• Chest pain
• Dizziness or numbness
• Unusual shortness of breath
• Abnormal joint or muscle pain/swelling
• Irregular or racing heart rate

19. Safety While Walking Outdoors:
• Walk in groups.
• Wear colors that are bright and reflect in the
night.
• Walk in areas where there is more of lights.
• Carry a whistle or cell phone to use if they need
help.
• Inform someone at home when they’re going for
a walk and when they will comeback.
• If walking alone, suggest them to take a route
that is highly visible to other people- if others
can see them, they’ll increase their safety.
• Use crosswalks when crossing streets and obey
traffic signals.

20. Benefits of Exercise in Elderly
• Exercise has lots of benefits at physical as well
as psychological level.
• Reduces the chances of:

21. Conclusion:
• Physical activity in elderly is a less popular
area of research, especially in a developing
country, where the aging population is
increasing rapidly.
• Exercise recommendation should be included
in the mainstream of other healthcare
recommendation.
• Attention should be given to increasing
confidence in the elderly to overcome barriers
to exercise and achieve relevant fitness
outcomes in exercise programs.

22. References:
• Anjana, R.M., Pradeepa, R., Das, A.K., Deepa, M., Bhansali, A., Joshi, S.R., Joshi, P.P., Dhandhania,
V.K., Rao, P.V., Sudha, V. and Subashini, R., 2014. Physical activity and inactivity patterns in India–
results from the ICMR-INDIAB study (Phase-1)[ICMR-INDIAB-5]. International Journal of Behavioral
Nutrition and Physical Activity, 11(1), p.26.
• Brassington, G.S., Atienza, A.A., Perczek, R.E., DiLorenzo, T.M. and King, A.C., 2002. Intervention-
related cognitive versus social mediators of exercise adherence in the elderly. American journal of
preventive medicine, 23(2), pp.80-86.
• DiPietro, L., 2001. Physical activity in aging changes in patterns and their relationship to health and
function. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(suppl
2), pp.13-22.
• Hamdorf, P., Starr, G. and Williams, M., 2002. A survey of physical-activity levels and functional
capacity in older adults in South Australia. Journal of Aging and Physical Activity, 10(3), pp.281-289.
• Kisner, C. and Colby, L.A., 2012. Therapeutic exercise: foundations and techniques. Fa Davis.
• Kirk-Sanchez, N.J. and McGough, E.L., 2014. Physical exercise and cognitive performance in the
elderly: current perspectives. Clin Interv Aging, 9, pp.51-62.
• Lim, J.Y., 1999. Exercise testing and prescription for the senior population. The Sport Jour Sparling,
P.B., Howard, B.J., Dunstan, D.W. and Owen, N., 2015.
• Mcdermott, A.Y. and Mernitz, H., 2006. Exercise and older patients: prescribing guidelines.
American family physician, 74(3).
• Perera, B., Watt, M., Ostbye, T., Rajapakse, H., Ranabahu, S. and Maselko, J., 2015. Perceptions of
successful ageing in Sri Lankan older people: A qualitative study. Asian Journal of Gerontology &
Geriatrics, 10(1), pp.22-30.

23. • Ranasinghe, C.D., Ranasinghe, P., Jayawardena, R. and Misra, A., 2013. Physical
activity patterns among South-Asian adults: a systematic review. International
Journal of Behavioral Nutrition and Physical Activity, 10(1), p.116.
• Santos, D.A., Silva, A.M., Baptista, F., Santos, R., Vale, S., Mota, J. and Sardinha,
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functional fitness in older adults. Experimental gerontology, 47(12), pp.908-912.
• Shiu-Thornton, S., Schwartz, S., Taylor, M. and LoGerfo, J., 2004. Older adult
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