Recommendations for Exercise

The inclusion of regular physical activity into our daily lives is the greatest weapon that we have against the onset of age-related disease and disability.

While the two systems addressed primarily in this particular article have been the cardiorespiratory and musculoskeletal, the effects of regular physical activity, as simple as walking for 15 minutes each day, have also been shown to have a positive impact on mood (Joens-Matre & Ekkekakis, 2002; Strawbridge, Delegner, Roberts, & Kaplan, 2002).

While current recommendations assume that the individual is healthy, it is important to consult a physician before beginning any exercise program. We also recommend seeking the advice of an exercise professional who is certified by groups such as the American College of Sports Medicine (ACSM), National Strength and Conditioning Association (NSCA), or American Council of Exercise (ACE). The professional trainer can help to insure that the exercise program is safe and effective as well as one that can be maintained over the course of a lifetime.

The American College of Sports Medicine recommends that in order to develop and maintain cardiorespiratory fitness, an individual should participate in some form of physical activity that utilizes large muscle groups, is maintained for a continued period of time, and is rhythmic in nature (e.g., walking, aerobic dance, rowing, stair-climbing). While the primary recommendation suggests duration of 20 to 60 minutes, accumulating this amount of time over the course of one’s day is certainly acceptable for the individual who has previously been sedentary. To see the benefits of exercise one should participate in these activities 3 to 5 days per week at an intensity of between 55 and 65% to 90% of maximum heart rate. For the uninitiated, the simplest method of calculating age-estimated heart rate is to subtract one’s age from 220. The resulting number is the age-estimated maximal heart rate from which the appropriate intensity is calculated. While these values are appropriate for the healthy adult, intensity values of 55 to 64% of maximum heart rate are more appropriate for the individual who is quite unfit.

Perhaps an easier method for calculating one’s exercise intensity is to use what is often referred to as the "Talk Test." While exercising, an individual should be able to carry on a conversation comfortably with his or her exercise partner. If speaking is difficult (i.e., gasping or gulping for breath) then the intensity is too high and should be reduced. Conversely, if conversation is too easy, then the intensity should be increased. Also, it is important to remember that duration is dependent on intensity. Thus, a lower intensity activity should be conducted over a longer period of time (>30 minutes) while an activity of higher intensity should last at least 20 minutes or longer.

Resistance training should be an integral part of any exercise program as it promotes muscular strength and endurance as well as aids in maintaining fat-free mass, which is often lost as we age. Additionally, through the inclusion of strength training older adults have available to them a valuable tool in the prevention of bone-related diseases such as osteopenia and osteoporosis. Research suggests that as a result of the stress placed on bone during weight bearing and stress generating activities those cells responsible for laying down new bone tissue are stimulated, resulting in an increase in total bone density (Guyton & Hall, 1996).

Current recommendations from the ACSM suggest that resistance training be progressive in nature, individualized, and provide stimulus to all the major muscle groups. For example one might do a bicep curl and tricep press to enhance and develop strength in the upper arm. Similarly, including a chest press in the routine will improve general upper body strength, while doing a leg press would improve general lower body strength. For the healthy individual one set of 8 to 10 exercises, consisting of 8 to 12 repetitions, for each of the respective muscle groups should be done 2 to 3 days per week. For the previously sedentary individual, the issues of individualization and progression are even more important as beginning at too high a resistance level or progressing too quickly will not only result in unnecessary muscle soreness, but also increases the likelihood of injury. As such, it is important that any individual considering a resistance-training program consult an exercise professional for proper resistance levels and proper progression.

For the aging adult the inclusion of resistance training serves to preserve and protects one’s ability to perform, with ease, those activities referred to as the activities of daily living, or ADLs. These include, but are certainly not limited to, climbing stairs, unloading groceries, getting into and out of one’s vehicle, as well as rising from a seated position and engaging in activities that are of personal importance, or that bring personal satisfaction (i.e., hobbies) to an individual.

While resistance training is often thought of as an activity commonly engaged in at a fitness center or sports club, it is not necessary these activities occur in such arenas. Resistance training can be done in the comfort of one’s own home, in small groups, or in community-sponsored programs. Additionally, while resistance training is commonly associated with weight machines and free-weight equipment, for the general population resistance training can be done with simple household items such as a full gallon of milk, a container of canned food, or resistance band type equipment. While decidedly more "low-tech" when compared to their "high-tech" counterparts, these items work just as well as those found in fitness centers and sports clubs.

In addition to resistance training, flexibility training should be incorporated into one’s musculoskeletal program, as well as into the overall fitness program. Flexibility training serves to develop and maintain range of motion (ROM) and should include exercises that address the major muscle groups. Examples of these might include the hurdler’s stretch to improve hamstring flexibility or "scratching the back" to improve upper arm and shoulder flexibility. Similar to resistance training, flexibility training should be done 2 to 3 days per week and should include the appropriate static and/or dynamic stretching techniques.

Just as strength training serves to preserve, protect and develop those abilities related to the successful completion of ADLs, flexibility training is beneficial in that it develops and maintains one’s ROM. The combination of sufficient muscular strength and endurance coupled with adequate flexibility insures that one will be able to complete those ADLs with much less effort. Consider, for example, the importance of lower back flexibility in every day living. Through the inclusion of regular flexibility training the ROM of an individual is improved such that bending over to put away groceries or to remove an item from the oven becomes that much easier.

When we take the time to consider just how important freedom of movement and flexibility are in everyday living, it becomes easier to see the significant role that flexibility training can play in maintaining one’s quality of life. For a more complete understanding of the current recommendations regarding physical activity and the healthy adult, the reader should refer to the position statement offered by the American College of Sports Medicine (Pollock et al., 1998) or online at www.acsm-msse.org.

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