Flexibility training. Too little research has been done to permit the design of systematic programs to improve flexibility in older people. Nonetheless, the ACSM recommends exercises that have been shown to increase joint range of motion, such as walking, aerobic dance, and stretching.

Moderate level aerobic training can begin after frail people have improved their joint stability, muscle strength and balance—the reverse of what is usually done, the ACSM says. Walking is preferred, but people who have disabilities can improve their aerobic capacity with water activities or exercise machines.  Patients should first reach a frequency target of three days per week before working up to a duration of at least twenty minutes, and then to an intensity of 40% to 60% of their maximum heart rate.

Remaining Challenges

The real importance of this document lies in its emphasis on strength training and its recognition of protein inadequacies in some older people's diets, says Thomas L. Schwenk, MD, professor and chair in the Department of Family Medicine at the University of Michigan Medical School in Ann Arbor. Many functional impairments that older patients have are caused by simple weakness rather than chronic disease, and the spontaneous activity that can result from strength increases is impressive, says Schwenk. "Elderly patients socialize more, can care for themselves, go out, and shop because of greater confidence in their strength."

He applauds the report's recognition of postural stability as an important goal of exercise, but says physicians should realize that fear of falling may be an older patient's greatest exercise obstacle. "They talk among themselves of friends who fell, had a hip fracture, went to the hospital, and died," Schwenk says.

More resources have to be be devoted to identifying the most practical, effective, and cost-efficient ways to counsel older patients about exercise, he says. "These recommendations support the importance of exercise but offer little guidance for how to add this preventive approach to an already overloaded medical visit that tends to emphasize the care of chronic diseases."

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Dietary Supplements and Weights   Longevity Exercise And Weight  Why People Stay Away From The Gym  Strength Training For Seniors

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