Physical Performance Battery (SPPB) and a walking speed test) and the risk of falling (www.vivifrail.com) which can be implemented during unsupervised sessions.143‐145
In acutely hospitalised patients, exercise prescription can follow the above‐mentioned exercise recommendations for frail elders. However, because these patients are at near‐constant bed rest, exercise, especially resistance training, should be performed every day if medical condition allows until their hospital discharge. To make it more tolerable for them, the training session can be split into two sessions (i.e.,morning and afternoon).179 Additionally, it is crucial to pay special attention to clinical vital signs before performing the physical exercise intervention, to prevent adverse events.
Conclusions:
There is no age above which physical activity ceases to have benefits across a wide range of diseases and disabilities.20,203 Insufficient physical activity and excess sedentary behaviour are lethal conditions; physical activity is the antidote, and geriatricians and other healthcare practitioners can serve as well‐educated leaders and role models in the effort to enhance functional independence, psychological well‐being, and quality of life through the promotion of exercise for all older adults, whether fit or frail, of any age.19,20 Exercise should be prescribed, as is all other medical treatment, with consideration of patient risks and benefits; knowledge of appropriate modality and dose (intensity, frequency, volume); monitoring for drug interactions, benefits, and adverse events; and utilisation of the strongest possible behavioural medicine techniques known to optimise adoption and adherence. Given the dose‐response relationships demonstrated between the volume and intensity of physical activity engagement and disease treatment and mortality, recommendations focusing on simply reducing sedentary behaviour are insufficient as a robust treatment for common diseases/syndromes in this cohort, including depression, diabetes, peripheral vascular disease, sarcopenia/wasting syndromes, falls, osteoporosis, arthritis, chronic lung disease, Parkinson’s disease, stroke, cognitive impairment, functional decline, and frailty, for example. By contrast, the evidence is very strong for the benefits of a targeted exercise prescription and high levels of adherence as treatment for these and many other conditions.203 Since most patients will present with more than one disease, an efficient prescription to optimise both safety and efficacy as described in this chapter is required.
Key points
The reduction in exercise capacity typical of the older adult is largely explained by reduced muscle mass and function, decreased maximum heart rate and cardiac output, and impairment of central and peripheral nervous system processing, recruitment, and conduction velocity.
Ageing and a sedentary lifestyle or disuse syndromes have very similar effects on a multitude of physiological changes attributed to chronological age that reduce exercise capacity.
Habitual physical activity increases average life expectancy by about two years, but the mechanism of this effect is probably multifactorial and not precisely defined.
Many of the typical changes attributed to biological ageing can be prevented with chronic participation in physical activity, particularly alterations in body composition: decreased muscle mass, decreased bone mass and strength, and increased adipose tissue mass and its central deposition.
Prevention and/or treatment of many of the most common chronic diseases that afflict older adults – including obesity, cardiovascular disease, type 2 diabetes, hypertension, osteoarthritis, osteoporosis, stroke, peripheral vascular disease, renal failure, dementia, and depression – are possible with targeted, robust doses and modalities of exercise.
References
1 1. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee Scientific Report. 2018. https://health.gov/paguidelines/second‐edition/report.
2 2. Gates NJ, Fiatarone Singh MA. Exercise and cognitive function in older adults. In: Diet and Exercise in Cognitive Function and Neurological Diseases. John Wiley & Sons, Inc; 2015:279–294. doi:10.1002/9781118840634.ch24.
3 3. Wang S, Yin H, Wang X, et al. Efficacy of different types of exercises on global cognition in adults with mild cognitive impairment: a network meta‐analysis. Aging Clin Exp Res. 2019; 31(10):1391–1400. doi:10.1007/s40520‐019‐01142‐5.
4 4. Cadore EL, Moneo ABB, Mensat MM, et al. Positive effects of resistance training in frail elderly patients with dementia after long‐term physical restraint. Age (Omaha). 2014; 36(2). doi:10.1007/s11357‐013‐9599‐7.
5 5. Cadore EL, Sáez de Asteasu ML, Izquierdo M. Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization. Exp Gerontol. 2019; 122:10–14. doi:10.1016/j.exger.2019.04.007.
6 6. Cadore EL, Izquierdo M. Muscle Power Training: A Hallmark for Muscle Function Retaining in Frail Clinical Setting. Vol 19. Elsevier Inc.; 2018:190–192. doi:10.1016/j.jamda.2017.12.010.
7 7. American College of Sports Medicine, Chodzko‐Zajko WJ, Proctor DN, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009; 41(7):1510–1530. doi:10.1249/MSS.0b013e3181a0c95c.
8 8. Clemson L, Fiatarone Singh MA, Bundy A, et al. Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ. 2012; 345(aug07 1):e4547–e4547. doi:10.1136/bmj.e4547.
9 9. WHO. Physical activity and older adults. WHO. 2015.
10 10. WHO. WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva; 2020. https://apps.who.int/iris/bitstream/handle/10665/325147/WHO‐NMH‐PND‐2019.4‐eng.pdf?sequence=1&isAllowed=y%0Ahttp://www.who.int/iris/handle/10665/311664%0Ahttps://apps.who.int/iris/handle/10665/325147.
11 11. WHO. Preventing Chronic Diseases: a Vital Investment. World Health. 2005. doi:10.1093/ije/dyl098.
12 12. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non‐communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet. 2012. doi:10.1016/S0140‐6736(12)61031‐9.
13 13. Ekelund U, Steene‐Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta‐analysis of data from more than 1 million men and women. Lancet. 2016. doi:10.1016/S0140‐6736(16)30370‐1.
14 14. Bennie JA, De Cocker K, Teychenne MJ, Brown WJ, Biddle SJH. The epidemiology of aerobic physical activity and muscle‐strengthening activity guideline adherence among 383,928 U.S. adults. Int J Behav Nutr Phys Act. 2019; 16(1):34. doi:10.1186/s12966‐019‐0797‐2.
15 15. Cruz‐Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019; 48(1):16–31. doi:10.1093/ageing/afy169.
16 16. Izquierdo M, Rodriguez‐Mañas L, Casas‐Herrero A, Martinez‐Velilla N, Cadore EL, Sinclair AJ. Is it ethical not to precribe physical activity for the elderly frail? J Am Med Dir Assoc. 2016; 17(9). doi:10.1016/j.jamda.2016.06.015.
17 17. Cadore EL, Casas‐Herrero A, Zambom‐Ferraresi F, et al. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Omaha). 2014; 36(2):773–785. doi:10.1007/s11357‐013‐9586‐z.
18 18. Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012. doi:10.1002/cphy.c110025.
19 19. Lazarus NR, Izquierdo M, Higginson IJ, Harridge SDR. Exercise deficiency diseases of ageing: the primacy of exercise and muscle strengthening as first‐line therapeutic agents to combat frailty. J Am Med Dir Assoc. 2018.