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Exercise Physiology
CLINICAL GUIDELINES
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Conditions Effectively Managed with Exercise Physiology
Diabetes - Exercise Physiology guided physical activity (EP) is an effective treatment of diabetes in older adults. As muscle is the largest glucose sink in the human body, exercise improves blood glucose sink in the human body, exercise improves blood glucose control by decreasing insulin resistance, thereby reducing the need for medication.
High Blood Pressure - EP lowers resting heart rate, and the resultant increased diastolic time improves both coronary blood flow and cardiac output, thus lowering blood pressure.
Hypercholesterolaemia - EP lowers level of low-density lipoproteins.
Obesity - The myoglobin content of muscles is increased, improving the transfer of the oxygen from blood cells to muscle cells. Inside the cell, the number of mitochondria increases, enhancing aerobic metabolism.
Cardiac conditions - EP increases in demand on the myocardium improves oxygen utilisation. Capillaries dilate and multiply to improve the delivery of oxygen and other nutrients to muscles.
Medications and its effect on physical activities
Diuretics - is an antihypertensive medication. Older adults who exercise in warm conditions and take diuretics are at risk of dehydration. Less common adverse effect include hyperglycaemia and increased uric acid. EPs must closely monitor the intensity of the exercises as vigorous activities can lead to postural hypotension, which leads to lightheadedness and fainting. EPs may suggest older patients to take their diuretic after their exercise sessions to avoid urinary urges.
Beta blockers - are used to treat hypertension, angina, heart failure, and cardiac dysrhythmias. They can restrict endurance based activity capacity especially in older adults. EPs should pay attention to exccessive tireness, heart palpitations, shortness of breath and nausea in patients, and arrange regular rests.
Angiotensin Receptor Blockers (ACE) - taken in the management of hypertension. Older adults may be subjective to activity-related dehydration and dizziness.
Insulin - Exercises can cause hypoglycaemia, with symptoms such as sweating and fatigue that are similar to normal exertion during activity. EPs must closely monitor glycaemic control and symptom during any of the patient’s physical activity. At the first indication of hypoglycaemia, patient should ingest oral carbohydrate/small sweet. Insulin drugs may need to be reduced prior to exercise sessions to avoid hypoglycaemia.
Exercise Contraindications
Before any individual increases their levels of physical acitivites, pre-participation cardiac screening should be implemented to identify at-risk individuals to avoid exacerbation of an existing condition. The risk for acute exercise-induced cardiovascular events is highest among sedentary older people who perform unaccustomed vigorous intensity phyical activity. EPs must find out if the patient recently have:
ECG changes
Myocardial Infarction
Unstable Angina
Uncontrolled Arrhythmia
Other Cardiac issues such as atrioventricular block, cardiac insufficiency, cardiomyopathies, and uncontrolled metabolic diseases.
If the individual does not have any contraindications to physical activity, he/she can commence an exercise program setout by our EP.
Comorbidities
Osteoporosis
Musculoskeletal Pain
Chronic Systemic conditions
Falls risk
Our EPs (Exercise Physiologists) will take into serious precautions of patient’s comorbidities, and will design and lead exercises that will encompass these comorbidities.
Deciding on Exercise Intensity
The WHO recommends that everyone should aim for at least moderate-intensity physical activity throughout the week, and can balance it with ore vigorous activity for additional health benefits
Our clinicians have a deep understanding of exercise prescription for people and recongises the signs and symptoms that need to be addressed during the exercise sessions. It is necessary for most older adults with sedentary lives to be led and superised by an EP.
Monitoring Intensity - Intensity of the exercise can be measured subjectively or objectively by:
RPE (Rate of Perceived Exertion) - Using Borg’s RPE scale
HR (Heart Rate) - using Pulse Oximetre
VO2 (Oxygen consumption) - using Pulse Oximetre
Clinicians may perform measurements of these parametres during, and after the exercise sessions. This is especially important to ensure the physiological wellbeing of our patients.
For inactive older adult - the first goal of exercise prescription is to reduce sitting time. EPs will devise an agreed physical activity plan of engaging activities that are functional, task-specific, relevant to the individual, and incorportate into daily activies. We take a “Start-low, go slow” approach, setting short-term goals that are easily attainable. The exercise session should aim to increase intensity and duration by no more than 5% per week. A Home-exercise program would be prescribed with the aim of acculating 30 minutes a day of moderately intense physical activty on most days of the week that includes a combination of aerobic, strength, balance, and flexibility training.
For generally active older people
Resistance Exercise - individuals must learn the correct movement techniques, posture and breathing patterns for each exercises. Valsalva manoevre should be avoided, particularly in older people, who are more prone to postural hypotension and syncope than younger people. Lifts should be separated by 2 seconds of rest. Aim to perform one or two sets of 10-15 repetitions per sets with 2-3 minutes of rest between sets. The patient should aim to lift a weight that is 60-70% of their 1 RM (according to ASMI).
Whilst a singele set of a particular lift may be sufficient to overload the muscles of a newly starting older adult, multiple sets are recommended once they can tolerate a greater volume of exercise. Resistance training should be performed on at least 2 days per week, with multple days of rest in between sessions.
Aerobic Training - should be oerformed at a moderate intensity at a level which the individual notices an increase in heart rate and breathing while still be able to speak in full sentences). Activities that may be attactive to individuals include repetitive step-ups, air cycling, side steps, and brisk walking.
Managing Expectations
Patient Expectations - participants of our exercise program should expect to come in to the clinic and conduct a series of exercises designed for them. It is important for EPs and clinicians to outline that the effect of regularly supervised exercises outweighs the potential injury or exerbation that may come with it. Participants should be encouraged to provide feedback of how they feel during and post exercise, especially if muscle sorness exceeded 48 hours post exercise.
WARNING - Post Exercise soreness - many people are unaware that post-exercise-muscle-soreness is normal and should be seen as beneficial. Warnings are to be given to each individual after every exercise sessions. Outline that 24-48 hours of soreness post exercise is normal, and the muscles are building. Without warning and encouragement, many patients see this soreness as harmful to them and that fear will contribute to non-compliance of the exercise program.
Realistic Expectations of exercise effect and timeframe - a positive outcome for heart related issues may include lowering blood pressure, lowering cholesterol, higher muscle mass, and reduced dependency on insulin. These outcomes may take from 5 -10 weeks to bear fruit - with regular and sufficient exercises followed by other behavioural changes such as dietary changes. It is important that clinicians prescribe exercises with motivational interviewing, setout an agreement with patients on their commitment, and to make an referral back to their doctor for tests following a period of exercise program.