EXERCISE FOR

OLDER ADULTS -
INTRODUCTION
Introduction
Within Australia the average age of the population is increasing. Australian Bureau of Statistics fgures
indicate that in 1987 the median age of the population was 31 years. This had increased to 37 years by
2007. The number of adults aged over 65 years also increased from 10.7% in 1987 to 13.1% in 2007.
Most population projections indicate that this trend will continue. Taking into consideration the increasing
levels of overweight and obesity, the image of the healthy, sporty Australian may be very inaccurate!
The aims of the course are to provide:
An understanding of the physiology of ageing and the benefts associated with participation in regular
exercise
An understanding of the health status of older adults and their associated needs
Skills to assist in the design of an exercise program to suit the needs of the older adult
An understanding of appropriate and effective communication techniques
Practice in developing programs for older adults
With the increasing age of the population all ftness instructors and personal trainers will be exposed to
this client group. It is hoped that this program will enable instructors and trainers to develop skills and
knowledge for working with older adults.
What Is Ageing ?
Ageing is an extension of the physiological processes of growth and development and is characterised
by a gradual decline in body function, leading to physical impairments, functional limitations, disease, and
eventually the onset of disability and death. Ageing is an interaction between age-related changes that
are not disease-dependant (primary/biological ageing) and the effects of the environment and disease
(secondary/pathological ageing).
The rate of normal ageing tends to follow a linear pattern over the life span. Disease and accident can
increase this rate of deterioration, but as people age they become increasingly more diverse in their
medical, psychological and physical status.
Defning Ageing
The most common indicator used to defne age is chronological age, which is the passage of time from
birth in years as follows:
Age Categories
Description Age (years) Decade
Infant 0-2 1st
Child 3-12 1st - 2nd
Adolescent 13-17 2nd
Young adult 18-24 2nd 3rd
Adult 25-44 3rd 5th
Middle aged adult 45-64 5th 7th
Young old 65 - 74 7th 8th
Old 75 - 84 8th 9th
Old-old 85 - 99 9th 10th
Oldest-old 100+ 11th
(Spirduso et al 2005 p6)
FIA/Fitnation 3 Exercise for older Adults - Introduction
Age can also be defned in terms of functional ftness in comparison with others of the same age.
Impairments in physical ftness parameters such as aerobic endurance, musculoskeletal integrity, fexibility,
body composition and the sensorimotor system have a direct impact on a persons functional abilities
(walking, stair climbing, and rising from a chair). Functional limitations eventually lead to physical disabilities
and a loss of independence.
Some physical decline can be expected as a biological consequence of age, but much of what is observed
as the effects of ageing could be attributed to years of physical inactivity, and as people become more
sedentary, organs and tissues start to decline.
The progressive decline starts slowly at frst then proceeds more rapidly with prolonged inactivity. Declines
in one system can have profound effects on other systems in the body therefore compounding the
decrease in functional mobility and performance and the risk of frailty and disability.
Those who remain physically active throughout life demonstrate much slower rates of physical decline than
do the sedentary. A growing body of research indicates that those who have been sedentary for many
years can experience signifcant improvements by beginning an exercise program even at very advanced
ages (Swain, D.P. & Leutholz, B.C. 2002).
For many years exercise was not recommended for older adults as it was thought to be too hazardous
and likely to result in falls and/or debilitating injury that would affect quality of life or shorten life expectancy.
It is now acknowledged that physical activity is benefcial for all ages but several issues continue to be
discussed and have yet to be resolved. These issues are:
The effects of exercise on adults at different levels of base function.
The intensity, duration, rest intervals, and type of exercise appropriate for older adults at the various
levels of physical function.
The role of pain in exercise and recovery.
The appropriateness of exercise for the very frail and disabled.
Physiological Changes And Ageing
The following section of the manual outlines the physiological changes associated with ageing. While it may
seem all doom and gloom it should also be recognised the benefts associated with regular exercise in
the minimisation of these physiological changes. Specifc types of exercise may not only reduce the rate of
decline, it can also increase physiological capabilities in certain aspects.
Humans reach a physiological peak generally between the ages of 25 30 years. By this, we mean that
components of ftness such as strength, endurance, power and fexibility tend to reach their maximum
levels. The following physiological changes commence from approximately 35 years of age.
The Musculoskeletal System
The musculoskeletal system consists of the bones and muscles of the skeleton. Some of the changes with
age include:
Sarcopenia
Muscle mass decreases by approximately 10% with each decade. Sarcopenia refers to the degenerative
loss of skeletal muscle. It is thought that a decline in activity levels combined with a reduction in the
secretion of hormones such as growth hormone and the sex hormones (testosterone and oestrogen) may
play a role. The combination of sarcopenia and osteoporosis result in the frail appearance seen in many
older adults.
FIA/Fitnation 4 Exercise for Older Adults - Introduction
As a result of sarcopenia there will be changes in muscular strength, power and endurance. While much
research has centred upon the relative decline in these ftness components there is conjecture as to
the rate of decline. It is important to emphasize that the rate of decline is reduced with regular exercise,
particularly exercise specifc to the ftness component. Furthermore, research has indicated that previously
sedentary individuals can actually increase strength, power and endurance if they commence an exercise
program in older adulthood.
In one study, decreases in grip strength of 60% were identifed from the age 30 of to 80 years. Lower-
extremity strength was lost at a relatively faster rate than upper-extremity strength.
Other research indicated that strength declines more rapidly than muscular endurance. This is mainly due
to decreased activity of glycolytic enzymes in fast twitch fbres being greater than that of oxidative enzymes
in slow twitch fbres.
Changes in nerve conductivity may also impact on contraction times resulting in a slower time to achieve
peak muscle tension. This results in a decline in muscle power.
Connective Tissue
The water and collagen content in tendons and ligaments decreases resulting in a loss of elasticity and
strength. Ligaments and tendons become brittle, resulting in a reduction in stability and support and an
increasing likelihood of damage. The composition of cartilage also changes reducing the shock absorbing
capacity.
Osteoporosis
A reduction in the mineral component of bones results in the loss of bone mass and density. The bones
become fragile and prone to fracture. This is known as osteoporosis.
While it is more common in post-menopausal women, it also develops in elderly men. Osteoporosis is
detected via bone mass testing. However, it is often not detected until a fracture happens.
The most common sites of osteoporosis include the vertebral column and hips but it can occur in most
bones. In Australia, 1 in 2 women and 1 in 3 men over 60 years of age will have an osteoporotic fracture.
Two thirds of fractures of the spine are not identifed or treated, even though they nearly all cause pain
and some disability. Often people believe that the symptoms of spine fracture back pain, height loss or
rounding of the spine are just due to old age.
Re-occurrence of osteoporotic fractures is also very high with 50% of people suffering a second fracture.
There are a number of modifable factors to reduce risk of osteoporosis while medications and weight
bearing activity will also assist in prevention of the condition.
The modifable risk factors include:
Inactivity
Low body mass index (BMI)
Alcoholism
Tobacco smoking
Malnutrition
Interestingly, excessive strenuous exercise (over-training) particularly in females has been linked with the
development of osteoporosis later in life. It is thought that amenorrhea (loss of the menstrual cycle) that
sometimes occurs with strenuous exercise results in a reduction in oestrogen production which in turn,
impacts on bone mass.
FIA/Fitnation 5 Exercise for older Adults - Introduction
Brain And Nervous System
Similar to the research on musculoskeletal changes, there have been many studies investigated the
effects of ageing on the brain and central nervous system.
While it has been identifed that structural changes occur and result in a deterioration of brain function, it
should be emphasised that the changes are reduced with on-going use of these systems. Hence if we
continue to participate in brain stimulating activities into older adulthood we maintain the capability to do
so. The main changes occurring to the brain and central nervous system include:
A decrease in the weight of the brain possibly due to fuid loss within the cells and a reduction in
blood fow.
Decrease in the number of neurons within the brain
Alterations in the neural pathways from the brain to the skeletal muscles. It is likely the neural
pathways exist but have become dormant through inactivity.
Loss of the myelin sheath surrounding and insulating the neurons. This may impact on the
conduction velocity and the actual message being transmitted. Note, the severe loss of myelin
occurs in conditions such as multiple sclerosis.
Changes in brain enzymes, receptors and neurotransmitters and the electrical activity patterns within
the brain (known as waves).
The alterations in the nervous system may result in a slight reduction in reaction time and control of
movement. This impacts on balance and may contribute to risk of falls. It may also mean that the older
adult loses confdence in their ability to participate in activity. They believe that it will lead to injury or
increase the incidence of falls.
The changes to the brain and nervous system will also impact on cognitive functions as follows:
Cognitive impairment is an important risk factor for increased risk of falls.
Adverse changes occurring in the processes of attention, memory and intelligence affect the older
adults ability to anticipate and adapt to changes occurring in the environment.
Older adults fnd it diffcult to store and manipulate information in working memory simultaneously when a
second task that requires cognition is presented, particularly when one of the tasks requires balance.
Cardio-Respiratory System
In the cardiovascular system, the impact of age is minimal at rest. However, the affects increase when
under the stress of exercise when the demand for oxygen is at its greatest.
The Heart
Within the heart the following changes occur:
Muscle mass - Reduction in muscle mass and decreased thickness of the walls of the ventricles
Ventricle Size - Little or no change in ventricular volume
Heart rate - Maximum heart rate decreases by approximately 10 beats per minute per decade. This
may be due to a slowing of the rhythm of the cardiac pacemaker that regulates heart rate.
Stroke Volume - Decrease in stroke volume due to increased stiffness of the ventricular wall and
slower ventricular flling. The stroke volume is the amount of blood expelled from the left ventricle
with each beat.
Cardiac output - The combined effect of the decrease in heart rate and strokevolume results in a
decrease in the cardiac output. The cardiac output is the total amount of blood expelled from the
heart per minute.
Coronary circulation - The delivery of oxygen to the myocardium may also be impaired by sclerotic
arteries in the coronary circulation. The coronary circulation provides blood and oxygen to the
muscle of the heart itself.
FIA/Fitnation 6 Exercise for Older Adults - Introduction
Blood Vessels And Circulation
Both systolic and diastolic blood pressure may increase with age due to a decrease in the elasticity of the
smooth muscle in the walls of the vessels. Sclerosis within the vessels will also contribute to increased
blood pressure.
There may also be a decrease in the peak arterial venous oxygen difference which means that the older
adult is less capable of extracting oxygen from the blood.
Circulation to skeletal muscles may diminish through inactivity and there will be redistribution of blood fow
to other areas. For example, blood fow to the skin will increase to assist in the release of heat built up as a
result of increased subcutaneous fat stores.
Blood plasma volumes and blood cell concentrations do not seem to be altered signifcantly with age.
Haemoglobin levels are more dependent on nutrition and activity levels than age. Due to the reduced
secretion release of regulatory hormones the production of red blood cells may be slowed.
Respiratory System
The major changes associated with the respiratory system involve:
Alveoli - A decrease in the available surface area within the alveoli in the lungs. There appears to be
more dead space within the alveoli resulting in a smaller area for gas exchange to occur.
Breathing - Loss of muscle mass and strength in the respiratory muscles and those of the thorax
assisting in the mechanical process of breathing.
Lung Volume - While the total lung volume does not change signifcantly, the lungs lose their elastic
recoil and there is an increased residual volume.
Ventilatory Rate - During periods of increased demand for oxygen such as exercise, older adults are
less able to increase and maintain ventilation at high levels. Ventilatory muscle fatigue is quite likely to
occur early due to the altered physiology of skeletal muscle.
The combined effect of the respiratory changes will result in a decreased maximum oxygen uptake
(VO2 max). The adult will be less capable of taking in oxygen and extracting it from the airways into the
bloodstream. Furthermore, the perfusion of blood to the working muscles will be reduced, resulting in a
decreased availability of oxygen. This will impact on endurance performance and will result in earlier fatigue.
Other Physiological Changes
The affects of ageing will also be evident when comparing the senses of older adults to their younger
counterparts. Fitness trainers and instructors need to be aware of the changes to the senses not only
because they will impact on participation in exercise but also because they will infuence the method of
communication.
Vision
With increasing age the lens within the eyes lose their ability to change shape to focus images on the
retina. This may result in reduced depth perception.
The lens may also scatter the light rays making the eyes more sensitive to glare.
The number of neurons within the retina decreases, hence images will not be as clear or sharp. This
may result in reduced acuity (clearness or sharpness of perception) and peripheral vision.
The iris becomes more rigid and the pupil takes longer to respond to changes in light.
The following common changes in vision result in slower processing of sensory information, less effcient
integration of visual input with those received from other sensory systems and possibly altered perception
of the bodys vertical orientation.
FIA/Fitnation 7 Exercise for older Adults - Introduction
Common age related diseases of the visual system are:
Cataracts
Glaucoma
Macular degeneration
The changes in vision will impact on the clients ability to track objects, particularly those moving at speed.
This has implications for participation in ball sports such as tennis and squash. It is also a consideration
when demonstrating exercises to older adults. It is important to ensure lighting is suffcient and the client is
suitably positioned to be able to see the demonstration.
Hearing
Anatomical changes associated with the structures of the inner ear can lead to impairment of hearing.
While this may not directly impact on exercise performance, again it is an important consideration for
trainers and instructors in their communication with the client.
Proprioception
Proprioception is the sense of spatial awareness of the position of the body parts in relation to each other.
The awareness is derived by the senses combining to provide information to the brain. Internal sensors are
also located in the joints, tendons and muscles which provide information on the degree of tension and
relative position.
Proprioception contributes to the control of coordinated movement. It is improved through regular
movement and affected by injury and other conditions that limit movement of the body parts.
Proprioception also deteriorates with age, particularly if the person is inactive. However, it can be regained
once activity levels increase. Proprioception will contribute greatly to the ability to swing a golf club in a
coordinated manner or throw a basketball through a hoop from several metres away.
Homeostasis
Homeostasis refers to the ability to regulate your own internal environment. In humans, homeostasis
enables us to maintain a constant body temperature irrespective of the external environment, called
thermoregulation. It also enables us to regulate internal concentrations of the blood and electrolytes within
the cells, called osmoregulation.
Most homeostatic regulation is controlled by the release of hormones which initiate a physiological
response. For example the hormone insulin, regulates blood glucose concentrations.
The bloodstream and excretory systems assist in homeostasis. When excessive heat production occurs,
blood fow to the skin increases allowing heat to be released via the sweating mechanism and evaporation.
When the electrolyte balance within the body needs adjustment, fuid absorption will either increase or
decrease to maintain a constant internal concentration. There will be a resultant change in urine production.
Older adults are usually less effcient in thermoregulatory adjustments. There is less heat production due to
reductions in muscle mass though this may be counteracted by increased subcutaneous fat levels providing
insulation. Sweat production is decreased and may take longer to be initiated.
Impaired kidney function can impact on osmoregulation. Decreased hormone production can also slow the
homeostatic response which will be magnifed when the client is exercising.
Body Composition
It is common for subcutaneous and visceral fat stores to increase with age. Visceral stores refer to fat
accumulation around internal organs such as the heart. It increases the potential risk of disease including
diabetes and heart disease.
While there may be signifcant changes in body composition, the body mass index may remain relatively
stable. Losses in muscle mass will be counteracted by gains in fat deposits. There may also be a reduction
in height due to osteoporosis and changes in posture.
FIA/Fitnation 8 Exercise for Older Adults - Introduction
Posture
The term posture is used to describe the alignment of the skeletal
system when stationery or moving. It is called static and dynamic
posture, respectively.
Good posture is functional posture. It relates to natural body movements
that enable you to perform actions in an effcient and pain-free manner.
Most people develop poor postural habits whether it be due to lifestyle
issues or injuries. The combined effects of sarcopenia and osteoporosis
also lead to changes in posture with age. Reduced vision may also
contribute to the postural alterations.Some of the postural conditions
evident in older adults include:
Hanging Or Protruding Head
This is a condition where the head and neck protrudes forward rather than directly above the shoulders
Rounded Shoulder (Protracted Shoulders) And Kyphosis
In this condition the shoulders are medially (internally) rotated and protracted (protruding forward). Kyphosis
is often associated with rounded shoulders. It is an exaggerated (kyphotic) curve in the thoracic spine that
in serious conditions, appears as a hump or lump.
Lordosis
It is an exaggerated lordotic curve in the lumbar spine. This is a common condition that produces a sway
back appearance. It is associated with an anterior pelvic tilt (the top of the pelvis is tilted forwards).
Anterior Pelvic Tilt
The condition is often associated with lumbar lordosis. The pelvis is tilted anteriorly which results in the
ischial tuberosity (attachment for the hamstrings) moving superiorly and posteriorly. It causes increased
tension within the hamstrings because they are in a permanently stretched position.
Pelvic Lateral Tilt
Poor control of the hip abductors and adductors allows the contra-lateral hip to drop during the swing
phase in walking and running leading to excessive lateral. It causes tightness in the hip rotators (such
as piriformis) and increased tension within the tensor fasciae latae, and iliotibial band. Often it is a major
contributor to knee injuries (including patellar tracking syndrome).
Scoliosis
Scoliosis is characterised by a C or S shaped curve in the spine
when viewed posteriorly. The curve may occur along the length of the
spine from the cervical to the lumbar region.
The common forward fexed head and kyphotic posture (increased
posterior curve of the thoracic spine) restricts movement and in
severe cases puts the individual at a higher risk of falling backwards.
Asymmetrical standing postures are also common and associated
with cerebrovascular accident (stroke), uncorrected leg length
discrepancy, arthritis related pain in certain joints.
Good posture requires biomechanical alignment of each body part
as well as orientation of the body as a whole to the environment. Once achieved it minimises the amount
of energy expended in maintaining a stable body position. The exercise program for the older adult
should include both strengthening and stretching exercises to assist the maintenance of good posture.
The emphasis should be on strengthening the deeper muscles that are used specifcally to support the
skeleton. These include erector spinae, transverse abdominis, soleus, multifdus andthe splenius capitis in
the neck. Exercises to develop these muscle groups will be included later in the manual.
Fitnation Pty Ltd 2008 Exercise Ior Older Adults Introduction 15

exaggerated (kyphotic) curve in the thoracic spine that in serious conditions, appears as
a 'hump' or lump.


From www.osteoporosis.org

LORDOSIS
t is an exaggerated lordotic curve in the lumbar spine. This is a common condition that
produces a sway back appearance. t is associated with an anterior pelvic tilt (the top of
the pelvis is tilted forwards).

ANTERIOR PELVIC TILT
The condition is often associated with lumbar lordosis. The pelvis is tilted anteriorly
which results in the ischial tuberosity (attachment for the hamstrings) moving superiorly
and posteriorly. t causes increased tension within the hamstrings because they are in
a permanently stretched position.

PELVIC LATERAL TILT
Poor control of the hip abductors and adductors allows the contra-lateral hip to drop
during the swing phase in walking and running leading to excessive lateral.
Fitnation Pty Ltd 2008 Exercise Ior Older Adults Introduction 16

t causes tightness in the hip rotators (such as piriformis) and increased tension within
the tensor fasciae latae, and iliotibial band. Often it is a major contributor to knee
injuries (including patellar tracking syndrome).

Scoliosis is characterised by a 'C' or 'S' shaped curve in the spine when viewed
posteriorly. The curve may occur along the length of the spine from the cervical to the
lumbar region.


The common forward flexed head and kyphotic posture (increased posterior curve of
the thoracic spine) restricts movement and in severe cases puts the individual at a
higher risk of falling backwards.

Asymmetrical standing postures are also common and associated with cerebrovascular
accident (stroke), uncorrected leg length discrepancy, arthritis related pain in certain
joints.

Good posture requires biomechanical alignment of each body part as well as orientation
of the body as a whole to the environment. Once achieved it minimises the amount of
energy expended in maintaining a stable body position.

The exercise program for the older adult should include both strengthening and
stretching exercises to assist the maintenance of good posture. The emphasis should
be on strengthening the deeper muscles that are used specifically to support the
FIA/Fitnation 9 Exercise for older Adults - Introduction
Gait
Gait speed decreases by approximately 20%, largely attributable to a decrease in stride length.
Reduction in stride length also results in other negative consequences of gait including: Reduced arm
swing
Reduced rotation of the hips, knees and ankles
Increased double support time
More fat footed contact with the ground during the stance phase prior to toe-off
In Summary
Obviously ageing is an inevitable process that leads to a decline in physiological functioning. However, it
should be emphasised that regular activity can be an affective method of resisting the impact of ageing.
There are many examples of exceptional physical and mental performance from people considered to be
elderly. Similarly the responses of elderly people commencing exercise programs provide extremely positive
outcomes. There is no doubt that regular exercise can improve quality of life and assist in fghting the
effects of age-related disease.
Psychological Changes And Ageing
In the previous section it was emphasised that the decline in physical capacity associated with ageing
could be reduced with activity. It is again important to recognise that many of the following psychological
changes can be minimised through a combination of physical and mental stimulation.
The psychological changes experienced by older adults include:
Adjustment to decreased physical capacity reduced strength, power, endurance, fexibility, etc
Adjustment to decreased health and wellbeing increased likelihood of disease and illness
Changes in employment status reduction or cessation of employment results in changes to living
circumstances, lifestyle patterns and also fnancial position. The older adult may need to alter their habits
because they are no longer earning a regular salary.
The alteration in lifestyle is also signifcant when regular employment ceases. It results in an adjustment to
the daily routine and while it may free up time for participation in leisure and social activity, it may also lead
to inactivity.
Living arrangements in some circumstances, the older adult may undergo signifcant changes in
living arrangements. Down sizing from a larger house to a smaller apartment or moving into an aged
care facility impacts on the persons psychological wellbeing. There may also be increased responsibility
involved in caring for sick or infrmed partners or relatives.
Coping with death - the deaths of spouses, relatives and friends occurs more often, reducing the
availability of those who can offer psycho-emotional and social support. The opportunity for nurturing and
being nurtured decreases with increasing age. With these factors, one of the greatest challenges for the
older adult is coping with the fears and changes associated with ageing such as:
The fear of being old and ill
The fear of being poor and a burden to family and friends
The fear of change and uncertainty
The fear of losing liberty, identity and human dignity
The fear of death
The fear of poor care and abuse.
FIA/Fitnation 10 Exercise for Older Adults - Introduction
Goals Of Exercise In Relation To The Ageing Process
Although there is still much to learn about the principles of effective exercise for older adults it is known
that the goals of an exercise program are different for older adults, and include the following:
Minimise biological changes associated with ageing
Increase mobility and function
Reach and maintain optimal body mass and composition
Maximise psychological health
Prevention of cardiovascular disease, cancer and diabetes
Rehabilitation from acute or chronic disease
Combat frailty caused by inactivity
Improve social contact
Categories Of Older Adults
What age constitutes old? If someone is 50 years of age do we automatically assume they are an older
adult and develop a gentle exercise program incorporating low intensity and long recovery? The answer is
defnitely No!
In the past, old was defned by chronological age. In the early 1900s, a 40 year old man may have been
considered old. However, in modern times with improvements in health and increased life expectancy it is
not uncommon for 80 year olds to be physically ft and active.
In categorising older adults it is best to consider how well the person can function; physically, mentally
and emotionally. This may vary considerably between individuals of different age.
As personal trainers and ftness instructors you will come across many individuals who exhibit excellent
health and ftness well into the ages that we would consider to be old. These people can and do
participate in the same types of exercise as their younger counterparts.
Under what circumstances would we need to modify the exercise program to cater for the persons age?
The following information will assist you to identify the type of older adult you are dealing with and the
considerations for their exercise program.
Acsm Initial Risk Stratifcation
The following list of criteria can be used to classify older adults. It is based on the identifcation of risk
factors within the client. The information was developed by the American College of Sports Medicine and
has been used as a guideline by Sports Medicine Australia.
FIA/Fitnation 11 Exercise for older Adults - Introduction
The following screening questionnaire is used to identify risk factors.
Exercise Screening Questionnaire Using Acsm Criteria
To assess the risk category of your older client, the following questionnaire can be used:
Risk Factors (score 2 = moderate risk)
1. Have any of your parents, brothers or sisters had a heart attack, bypass surgery, angioplasty, or
sudden death prior to the age of 55 (male relatives) or 65 (female relatives)?
Answer score 1 point for a yes answer
2. Have you smoked cigarettes in the past 6 months? Answer score 1 point for a yes answer
3. What is your usual blood pressure ( 140/90)? Do you take blood pressure medication?
Answer score 1 point for BP 140/90 or for a yes answer to taking medication.
4. What is your LDL cholesterol, HDL cholesterol, total cholesterol?
Answer score 1 point for high LDL or total cholesterol (have it checked if you dont know)
5. What is your fasting glucose ( 6.1 mmol/L)?
Answer score 1 point for a score > 6.1mmol/L (have it checked if you dont know)
6. What is your height and weight? Also, what is your waist girth?
Answer score 1 point for a BMI 30 or waist girth > 100cm (males) and > 90cm (females)
7. Do you get at least 30 minutes of moderate physical activity most days of the week (or its equivalent)?
Answer score 1 point for a no answer
Symptoms (score 1 = moderate risk)
1. Do you ever have pain or discomfort in your chest or surrounding areas? (i.e. ischemia)
Answer score 1 point for a yes answer
2. Do you ever feel faint or dizzy (other than when sitting up rapidly)?
Answer score 1 point for a yes answer
3. Do you ever fnd it diffcult to breathe when you are lying down or sleeping?
Answer score 1 point for a yes answer
4. Do your ankles ever become swollen (other than after a long period of standing)?
Answer score 1 point for a yes answer
5. Do you ever have heart palpitations, or an unusual period of rapid heart rate?
Answer score 1 point for a yes answer
6. Do you ever experience pain in your legs (i.e. intermittent claudication)?
Answer score 1 point for a yes answer
7. Has a physician ever said you have a heart murmur? Answer score 1 point for a yes answer
8. Do you feel unusually fatigued or fnd it diffcult to breathe with usual activities?
Answer score 1 point for a yes answer
Classifcation Criteria
LOW RISK Younger individuals (men under 45 years and women under 55 years) who
are asymptomatic and have no more than one risk factor.
MODERATE RISK Older individuals (men 45 years or older and women 55 years or older) or
individuals of any age having two or more risk factors.
HIGH RISK Individuals with one or more signs or symptoms of cardiovascular or
pulmonary disease or individuals with known cardiovascular, pulmonary or
metabolic disease.
FIA/Fitnation 12 Exercise for Older Adults - Introduction
Other
1. How old are you? Answer score 1 point for male > 45 yrs or female > 55 yrs
2. Do you have any of the following diseases: heart disease, chronic obstructive pulmonary disease
emphysema or chronic bronchitis), asthma, interstitial lung disease, cystic fbrosis, diabetes mellitus,
thyroid disorder, renal disease, or liver disease?
Answer a yes answer places the individual in the high risk category
3. Do you have any bone or joint problems, such as arthritis or a past injury that might get worse with
exercise? (Exercise testing may need to be delayed or modifed.)
Answer score 1 point for a yes answer
4. Do you have a cold or fu, or any other infection? (Exercise testing must be delayed or modifed)
Answer score 1 point for a yes answer
5. Are you pregnant? (Exercise testing may need to be delayed or modifed).
Answer score 1 point for a yes answer
6. Do you have any other problem that might make it diffcult for you to do strenuous exercise?
Answer score 1 point for a yes answer
Interpretation
Low risk = young and no more than 1 risk factor: can do maximal testing and participate in a vigorous
exercise program.
Moderate risk = older, or 2 or more risk factors: can do submaximal testing and participate in a moderate
exercise program.
High risk = one or more symptoms or disease: can do no testing without physician present; cannot
participate in a program without physician
Frail Older Adults
The term frail is also used as a classifcation for older adults. A frail older adult may be a moderate or high
risk client. Frailty may be brought on by:
A medical condition
Loss of one or more of the senses
A chronic disorder
Sarcopenia
Osteoporosis
Physical inactivity
Very old age
Both frailty and risk may be temporary of permanent conditions. For example, a client may be classifed as
high risk and frail because they have sarcopenia and reduced bone density. The client may have recently
undergone surgery for a medical condition.
However, the client may recover from the surgery and recommence participation in a regular physical
activity program. Through the program muscle mass and bone density may improve to the point where he
/ she is no longer considered frail or high risk.