FITNESS: EXERCISE FOR OLDER ADULTS

Congratulations! You are joining an elite team of women and men who appreciate that exercise is one of the healthiest things you can do.

Think about making a one-month commitment to exercise. If you are able to increase your physical activity for 30 days, that's a good sign that you are on your way to making exercise and physical activity regular, life-long habits. Let's get started!

The notion that exercise is good for you has been around for quite a while, but until recently, older adults have been left out of the picture. Today, new information is emerging from research: people of all ages and physical conditions benefit from exercise and physical activity.

Scientific studies show that staying physically active and exercising regularly can help prevent or delay many diseases and disabilities. Scientists find that even moderate exercise and physical activity can improve the health of people who are frail or who have diseases that accompany aging.

Exercise and physical activity are among the healthiest things you can do for yourself, but some older adults are reluctant to exercise. Some are afraid that exercise will be too strenuous or that physical activity will harm them. Yet, studies show that exercise is safe for people of all age groups and that older adults hurt their health far more by not exercising than by exercising.

An inactive lifestyle can cause older people to lose ground in four areas that are important for staying healthy and independent: strength, balance, flexibility and endurance. But research suggests that exercise and physical activity can help older people maintain or partly restore these four areas.

Growing older doesn't mean people have to lose their strength or their ability to do everyday tasks. Exercise can help older adults feel better and enjoy life more, even those who think they're too old or too out of shape.

Increasing strength and endurance make it easier to climb stairs and carry groceries. Improving balance helps prevent falls. Being more flexible may speed recovery from injuries. If you make exercise a regular part of your daily routine, it will have a positive impact on your quality of life as you get older.

If you are at high risk for any chronic diseases such as heart disease or diabetes, or if you smoke or are obese, you should check first with your doctor before becoming more physically active.

In general, men older than age 40 and women older than age 50 should check with their doctor before doing vigorous activity. Most older adults, regardless of age or condition, will do just fine in increasing their physical activity to a moderate level.

Consult your doctor if you have:

· Any new, undiagnosed symptom

· Chest pain

· Irregular, rapid or fluttery heartbeat

· Severe shortness of breath

Consult your doctor if you have:

· Ongoing, significant and undiagnosed weight loss

· Infections, such as pneumonia, accompanied by fever, which can cause rapid heart beat and dehydration

· An acute blood clot

· A hernia that is causing symptoms such as pain and discomfort

Consult your doctor if you have:

· Foot or ankle sores that won't heal

· Persistent pain or problems walking after a fall — you might have a fracture and not know it

· Eye conditions, such as bleeding in the retina or a detached retina. Also consult your doctor after a cataract removal or lens implant, or after laser treatment or other eye surgery

Consult your doctor if you have:

· A weakening in the wall of the heart's major outgoing blood vessel called an abdominal aortic aneurysm

· A narrowing of one of the heart's valves called critical aortic stenosis

· Joint swelling

If you have had hip repair or replacement:

· Check with your doctor before doing lower-body exercises.

· Don't cross your legs.

· Don't bend your hips farther than a 90-degree angle.

· Avoid locking the joints in your legs into a strained position

Four types of exercise are important for staying healthy and independent: strength exercises, balance exercises, stretching exercises and endurance exercises.

Strength Exercises
Strength exercises build muscle as well as increase your metabolism, which helps keep your weight and blood sugar in check.

Safety tips:

· Don't hold your breath during strength exercises. This could affect your blood pressure.

· Use smooth, steady movements to bring weights into position.

· Avoid jerking or thrusting movements.

· Avoid locking the joints of your arms and legs into a strained position. Breathe out as you lift or push a weight and breathe in as you relax.

· Muscle soreness lasting a few days and slight fatigue are normal after muscle building exercises.

· Exhaustion, sore joints and painful muscle pulls are not normal.

1. Sit in a chair with your back straight.

2. Keep feet flat on the floor even with your shoulders.

3. Hold hand weights straight down at your sides with palms facing inward.*

* You can use as little as 1- or 2-pound hand weights or you can substitute cans of soup. Some people start without weights.

4. Raise both arms to side, shoulder height.

5. Hold the position for one second.

6. Slowly lower arms to the sides. Pause.

7. Repeat eight to 15 times.

8. Rest. Do another set of eight to 15 repetitions.

1. Place pillows against back of chair.

2. Sit in middle or toward front of chair, knees bent, feet flat on floor.

3. Lean back on pillows in half-reclining position, keeping your back and shoulders straight.

4. Raise upper body forward until sitting upright, using hands as little as possible — or not at all, if you can. Your back should no longer lean against the pillows.

5. Slowly stand up, using hands as little as possible.

6. Slowly sit back down. Keep back and shoulders straight throughout exercise.

7. Repeat eight to 15 times. Rest. Then repeat eight to 15 times more.

1. Sit in armless chair. Keep feet flat and even with shoulders.

2. Hold hand weights at sides, arms straight, palms facing toward your body.

3. Slowly bend one elbow, lifting weight toward chest. Be sure to rotate palm to face shoulder while lifting weight.

4. Hold position for one second. Slowly lower arm to starting position.

5. Repeat with other arm. Alternate until you have repeated the exercise eight to 15 times on each side.

6. Rest. Then do another set of eight to 15 alternating repetitions.

1. Sit near the front edge of the chair, feet flat on floor and even with shoulders.

2. Hold a weight in one hand, raise that arm straight toward the ceiling, palm facing in.

3. Support arm below the elbow with the other hand.

4. Slowly bend raised arm at elbow, bringing hand weight toward same shoulder.

5. Slowly re-straighten arm toward ceiling. Hold position for one second.

6. Slowly bend arm toward shoulder again.

7. Pause, then repeat the bending and straightening until you have done the exercise eight to 15 times. Repeat eight to 15 times with your other arm.

8. Rest. Then repeat another set of eight to 15 repetitions on each side.

1. Stand straight, holding onto table or chair for balance.

2. Slowly bend one knee as far as possible, so foot lifts up behind you. Don't move your upper leg at all; bend your knee only.

3. Hold position.

4. Slowly lower foot all the way back down.

5. Repeat with other leg.

6. Alternate legs until you have eight to 15 repetitions with each leg.

7. Rest. Then do another set of eight to 15 alternating repetitions.

How Much, How Often?
Do strength exercises for all your major muscle groups at least twice a week. Don't do strength exercises of the same muscle group on any two days in a row. Depending on how fit you are, you might need to start out using as little as 1 or 2 pounds of weight, or no weight at all, to allow your body to adapt to strength exercises.

Lift a minimum of weight the first week, then gradually build up the weight. Starting out with weights that are too heavy can cause injuries. Remember that you have to add gradually a challenging amount of weight in order to benefit from strength exercises. If you don't challenge your muscles, you won't get stronger.

When doing a strength exercise, do eight to 15 repetitions in a row. Wait a minute, then do another set of eight to 15 repetitions in a row of the same exercise. Tip: While you are waiting, you might want to stretch the muscle you just worked or do a different strength exercise that uses a different set of muscles.

Take three seconds to lift or push a weight into place. Hold the position for one second, and take another three seconds to lower the weight. Don't let the weight drop — lowering it slowly is very important.

It should feel somewhere between hard and very hard for you to lift or push the weight. It should not feel very, very hard. If you can't lift or push a weight eight times in a row, it's too heavy for you and you should reduce the amount of weight. If you can lift a weight more than 15 times in a row, it's too light for you. Increase the amount of weight.

Balance Exercises
Balance exercises build leg muscles and help prevent falls. Each year, U.S. hospitals have 300,000 admissions for broken hips, and falling is often the cause of those fractures. Balance exercises can help you stay independent by helping you avoid disabilities that may result from falling.

There is a lot of overlap between strength and balance exercises. Lower body exercises for strength also help balance.

Safety tips:

· Hold onto a table or chair for balance with only one hand. As you progress, try holding on with only one fingertip.

· Next, try the following exercises without holding on at all. Ask someone to watch you the first few times in case you lose your balance.

· If you are very steady on your feet, move on to doing the exercises using no hands, with your eyes closed. Have someone stand close by if you are unsteady.

1. Stand straight, directly behind table or chair, feet slightly apart.

2. Hold table or chair for balance.

3. Slowly lift one leg to side, 6 inches to 12 inches out to the side. Keep your back and both legs straight. Don't point your toes downward — keep them facing forward. Hold position.

4. Slowly lower leg. Repeat with other leg.

5. Keep back and knees straight throughout exercise.

6. Alternate legs until you repeat exercise eight to 15 times with each leg.

7. Rest. Do another set of eight to 15 alternating repetitions.

1. Stand straight; hold onto a table or chair for balance.

2. Slowly bend one knee toward chest, without bending waist or hips.

3. Hold position for one second.

4. Slowly lower leg all the way down. Pause.

5. Repeat with other leg.

6. Alternate legs until you have done eight to 15 repetitions with each leg.

7. Rest; then do another set of eight to 15 alternating repetitions.

8. Add modifications as you progress.

1. Stand 12 inches to 18 inches from a table or chair, feet slightly apart.

2. Bend forward at hips at about 45-degree angle; hold onto a table or chair for balance.

3. Slowly lift one leg straight backwards without bending your knee, pointing your toes, or bending your upper body any farther forward.

4. Hold position for one second.

5. Slowly lower leg. Pause.

6. Repeat with other leg.

7. Alternate legs until you have done eight to 15 repetitions with each leg.

8. Rest; then do another set of eight to 15 alternating repetitions.

9. Add modifications as you progress.

Anytime-Anywhere exercises improve your balance. You can do them almost anytime, anywhere, and as often as you like, as long as you have something sturdy nearby to hold onto if you become unsteady.

Here are other exercises you can do anytime, anywhere to improve your balance:

· Walk heel-to-toe. Position your heel just in front of the toes of the opposite foot each time you take a step. Your heel and toes should touch or almost touch.

· Stand on one foot (for example, while waiting in line at the grocery store or at the bus stop). Alternate feet.

· Stand up and sit down without using your hands.

To check your progress:

1. Time yourself as you stand on one foot, without support, for as long as possible.

2. Stand near something sturdy to hold onto in case you lose your balance.

3. Repeat the test while standing on the other foot.

4. Test and record your scores each month.

How Much, How Often?
Don't do more than your regularly scheduled strength exercise sessions to incorporate these balance modifications — remember, it can do more harm than good to do strength exercises too often. Simply do your strength exercises and incorporate these balance techniques as you progress.

Stretching Exercises
Stretching exercises are thought to give you more freedom of movement to do the things you need and like to do. Stretching exercises alone will not improve your endurance or strength.

Safety tips:

· Always warm up before stretching exercises by doing them after endurance or strength exercises or by doing some easy walking or arm-pumping first.

· Stretching should never cause pain, especially joint pain.

· Mild discomfort or a mild pulling sensation is normal.

· Never bounce into a stretch — make slow steady movements instead.

1. Hold one end of a towel in right hand.

2. Raise and bend right arm to drape towel down back. Keep your right arm in this position and continue holding onto the towel.

3. Reach behind your lower back and grasp bottom end of towel with left hand.

4. Climb left hand progressively higher up towel, which also pulls your right arm down. Continue until your hands touch, or as close as you can comfortably go.

5. Reverse positions.

6. Repeat three to five times each session. Hold stretch for 10 to 30 seconds.

1. Lie on floor on your back, knees bent and feet flat on the floor.

2. Keep shoulders on floor at all times.

3. Keep knees bent together and gently lower legs to one side as far as possible without forcing them.

4. Hold position for 10 to 30 seconds.

5. Return legs to upright position.

6. Repeat toward other side.

7. Repeat three to five times on each side.

How Much, How Often?
Stretch after you do your regularly scheduled strength and endurance exercises. If you can't do endurance or strength exercises for some reason, and stretching exercises are the only kind you are able to do, do them at least three times a week, for at least 20 minutes each session. Note that stretching exercises, by themselves, don't improve endurance or strength.

Do each stretching exercise three to five times at each session. Slowly stretch into the desired position, as far as possible without pain, and hold the stretch for 10 to 30 seconds. Relax, then repeat, trying to stretch farther.

Endurance Exercises
Endurance exercises are any activity — walking, jogging, swimming, raking — that increases your heart rate and breathing for an extended period of time. Build up your endurance gradually, starting with as little as five minutes of endurance activities at a time, if you need to.

Examples of moderate endurance activities for the average older adult are listed below. Older adults who have been inactive for a long time will need to work up to these activities gradually.

· Walking briskly on a level surface

· Swimming

· Gardening, mowing, raking

· Cycling on a stationary bicycle

· Bicycling

The following are examples of activities that are vigorous. People who have been inactive for a long time or who have certain health risks should not start out with these activities.

· Climbing stairs or hills

· Shoveling snow

· Brisk bicycling up hills

· Digging holes.

Gradually working your way up is especially important if you have been inactive for a long time. It may take months to go from a very long-standing sedentary lifestyle to doing some of the activities suggested in this section.

Safety tips:

· Stretch after your activities, when your muscles are warm.

· Drink water.

· Dress appropriately for the heat and cold.

· To prevent injuries, use safety equipment such as helmets for biking.

· Endurance activities should not make you breathe so hard that you can't talk and should not cause dizziness or chest pain.

How Much, How Often?
Your goal is to work your way up to a moderate-to-vigorous level that increases your breathing and heart rate. It should feel somewhat difficult to you. Once you reach your goal, you can divide your exercise into sessions of no less than 10 minutes at a time, if you want to, as long as they add up to a total of at least 30 minutes on most or all days of the week.

Doing less than 10 minutes at a time won't give you the desired cardiovascular and respiratory system benefits. The exception to this guideline is when you first make the decision to begin endurance activities, and you are just starting out.

It can be very motivating to chart your progress. These simple tests measure endurance, lower-body power, strength and balance. Test yourself before starting to exercise to get a baseline score.

· For endurance exercises, see how far you can walk in exactly six minutes. Write down how far you walked — in feet, blocks, laps, miles, number of times you walked up and down a long hallway, or whatever is convenient for you. Test and record your scores each month.

· For lower-body strength, time yourself as you walk up a flight of stairs as fast as you can safely. Test and record your scores each month.

· For upper-body strength exercises, record how much weight you lift and how many times you lift that weight.

· For balance exercises, time yourself as you stand on one foot, without support, for as long as possible. Stand near something sturdy to hold onto in case you lose your balance. Repeat the test while standing on the other foot. Test and record your scores each month.