This document discusses the role of physical activity and exercise in aging populations. It covers factors for successful aging, characteristics of study populations according to physical activity levels, and the health benefits and goals of exercise for both younger-old and older-old age groups. The document also summarizes studies on the relationship between physical activity and reduced risks of mortality, cardiovascular disease, and other health outcomes. It provides guidelines for endurance and resistance training programs as well as screening recommendations for exercise in older adults.

1. Physical activity and cardio-vascular preventionGraziano OnderCentro Medicina dell’InvecchiamentoUniversità Cattolica del Sacro CuoreRome - Italy

2. Factors for successful aging Male and female agingEnvironmental factorsMetropolitan/rural area, personal environmental, injuries Social factorsEducation, social support, prevention, abuseEconomical factorsType of work.Personal factorsBiology, genetic factorsSuccessful aging Social and Health servicesPromotion of health, primary and secondary prevention, long-term careLife style Physical activity, nutrition, smoke, alcohol, drugs abuse 0NU 2002

3. EXERCISE IN THE ELDERLYTHE ROLE OF EXERCISE IN THE ELDERLYIn the young-old, exercise has much the same function as in the young: - prevention of disease - maintenance of aerobic capacity - maintenance of muscle strength - psychological well-being

4. b) In the old-old, exercise is still used for its preventive effects, but more often for: - secondary or tertiary prevention - rehabilitation from pre-existing chronic conditionsc) Some of the most important goals of exercise in the frail elderly are: - the improvement of muscle strength and endurance capacity to allow increased functional independence

6. Characteristics of study poplulation according to physical activity

7. Risk of disability according to physical activity

8. the prevention of falls and fall- related injuries- maintenance of fat-free mass cardiovascular reconditioning, treatment of peripheral vascular

9. adjunctive treatment of depression, anxiety, isolation, insomnia, dementia- rehabilitation from neurologic diseases

10. increased survival

11. Crude and adjusted relative risk of mortalityAdjusted for gender and for all other possible risk factors for death (gender, physical and cognitive disability, cardiovascular diseases, pneumonia, cancer, stroke, diabetes, chronic obstructive pulmonary disease, renal failure, Parkinson’s disease, depression, delirium, and arthritis).

12. Preventive Medicine 47 (2008) 422–426

13. Crude and adjusted relative risks (RRs) of mortality in the Italian cohorts of the ilSIRENTE study, examined at baseline between 2003 and 2004 and after 24 monthsSedentary: subjects walking less than 1 h per day; Active: subjects walking 1 h or more per day.Adjusted for age, gender and for other possible risk factors for death (functional and cognitive disability, congestive heart failure, hypertension, osteoarthritis, depression, number of medications, body mass index, cholesterol and C reactive protein).

14. Incidence of Coronary Heart DiseaseHonolulu HeartProgram2678 activemenAge: 71-93 yearsFU: 2 to 4 yearsHakimet al. Circulation 1999

15. Estimated rates of AMIMenWomenMenWomenMittleman et al. NEJM 1993

16. Association between physical activity and strokeCase controlstudy1047 men and womenAge: 70 yearsSacco et al. Stroke 1998

17. Mediators ?

18. Physicalactivity - LipidsObservationalstudy380 men and womenAge: 68 yearsFU: 10 years% changePetrellaet al. Diabetes Care 2005

19. Physicalactivity – Body composition173 women Age: 55-70 yearsIrwinet al. JAMA 2003

20. Physicalactivity – Diabetes3234 non-diabeticAge: 50 years FU 2.8 yearsKnowleret al. NEJM 2003

21. Physicalactivity – Glucoseintolerance424 menAge: 74 years FU 5 yearsVan Dam et al. Med Sci SportsExerc 2002

22. Physicalactivity and inflammationGaffkenet al. Am J Epidemiol. 2001

23. Physicalactivity – HypertensionWheltonet al. AnnInternMed 2002

24. MediatorsAntiatherogeniceffectsAntithromboticeffects↓plasma fibrinogen levels↑ plasminogen activator↑ active tissue plasminogen activator↓ plasminogenactivatorinhibitorEndothelialfunctionalterationrelease of endothelium-derivedrelaxing (NO)Fletcher et al. Circulation 2002

25. MediatorsAutonomicfunctionalchanges↑ parasympatheticactivityAnti-ischemiceffects↓ myocardial work (↓ BP and HR)Antiarrhythmiceffectsimproved myocardial oxygen supply-demand balance↓ in sympathetic tone and catecholaminerelease↑ ventricularfibrillation duringstrenuousexerciseFletcher et al. Circulation 2002

26. Whichtype of intervention?Dynamicaerobic (endurance) exercise – running or walkingDynamicresistanceanaerobic (strength) exercise – weight lifting

27. Endurance

28. Endurance

29. Resistance

30. Resistance

31. Endurance trainingBloodpressureCardiac outputVascularresistanceStroke volumeHeart rateCornelissenet al. Hypertension 2005

32. Resistance trainingCornelissenet al. J Hypert 2005

33. Resistance and endurance trainingWilliams et al. Circulation 2007

34. Resistance trainingFor persons at moderateto high risk of cardiac events, RT can be safely undertaken withproper preparation, guidance, and surveillance … given the extensive evidence of the benefits of aerobicexercise training on the modulation of cardiovascular risk factors,RT should be viewed as a complement to rather than a replacementfor aerobic exercise.Williams et al. Circulation 2007

35. Training - GuidelinesFrequencyIntensityDurationModalityEndurance training3–5 days/week 50%–70% max HR 20–60 min Lower extremity: walking, jogging/running,stairclimber Upper extremity: arm ergometryCombined: rowing, cross- country ski machines, combinedarm/leg cycling,swimming, aerobicsResistance training2–3 days/week 1–3 sets of 8–15 RM Lower extremity: leg for each musclegroup extensions, leg curls, leg press, adductor/abductor Upper extremity: biceps curl, triceps extension, bench/overhead press. Fletcher et al. Circulation 2002

36. Age-AssociatedAlterations in PhysiologicalResponsetoAerobicExerciseReduced aerobic capacity: decline in V˙ O2 max of 8% to 10% per decade in nontrainedpopulationsReduced maximal heart rate of 1 beat/min per yearMore rapid increase in systolic blood pressure with exerciseAttenuated rise in ejection fractionFletcher et al. Circulation 2002

37. Classification of Physical Activity IntensityMET=metabolic equivalents1 MET = resting metabolic rate of 3.5 mL O2 * kg-1 * min-1Fletcher et al. Circulation 2002

38. BottleexercisePHYSICAL ACTIVITY = MEDICINE If exercise could be packed into a pill, it would be the single most widelyprescribed, and beneficial,medicineRobert N. Butler, M.D. Director, National Institute on Aging

39. Potential risksGeneral Muscle soreness

40. Soft tissue injury

41. Falls

42. Fractures Resistance training Detached retina

43. Hernia

44. Hemorrhage

45. Lumbar disk hernia Potential risks Vigorous exercise Sudden death

46. Acute myocardial infarction

47. Hypoglycemia in persons with diabetes

48. Orthostatic hypotension