This Article deals with the scientific aspects of exercise for Geriatric Population. In particular , this article attempts to provide a comprehensive overview of systematic Client Evaluation, geriatric exercise program designing and prescription.
Exercise is medicine. Ergo just as therapeutic drugs, exercise prescription and administration should be optimal. Inadequate and excessive exercise may often yield either no results or hazardous outcomes. The volume , frequency and mode of exercise are so important when it comes geriatric exercise than any other population. As geriatric population often suffers from a cluster of aging related physiological changes, physical changes and chronic ailments. However, research strongly supports the fact that, systematic exercise serves as a supportive and prophylactic therapy in preventing and improving the physio-psychological aspects of older adults suffering from ailments raging from cardio-pulmonary conditions , Metabolic and osteo-arthrological conditions to even Cancer.
However, There is a tendency among exercising older population and among personal Trainers to put the older client into some form of exercise without considering the frequency , volume and duration. In my own personal experience as an exercise specialist, I have come across with clients who have suffered from chronic and excessive exercise induced joint related problems in particular lumbago, knee pain, plantar fasciitis , shoulder and rotator cuff injuries etc. All though there have been a number of contributing factors to it, the most common causes are focusing just on one or two aspects of motor qualities , unscientific frequency , inadequate rest, poor exercise techniques, inadequate nutrition, poor pre-participation health screening and most of the time failure of the exercise practitioner to design and monitor a personalized training program based on the physical , physiological, psychological and medical aspects of the client. Discussing all these aspects in detail is beyond the scope of this article. However, in this article I would like to give an overview of systematic client evaluation and general guidelines for geriatric exercise program designing & prescription. Based on current research and ACSM -AHA guidlines.
Client Evaluation
During client interview and Evaluation , the Exercise Practitioner (EP) should strive to obtain a detailed Social , Family, Occupational, dietary, previous exercise and Medical History. The EP should do a through physical and physiological evaluation.
In Physical evaluation -Special emphasis should be placed postural analysis. If you identify any postural abnormalities do not jump into correcting it, until and unless you understand the pathology behind it. For instance , if you come across with a case of kypho-scoliosis in a 70 year old woman and if you try to touch that before understanding the pathology of vertebral joints and bones, it may end -up so badly. In such situation advice the client to consult her GP and obtain a clinical clearance. As in this case if it is due to chronic fusion of spinal joints and if there is formation of osteophytes, a corrective exercise may harm.However, if you develop a clinical understanding of the condition, you may in fact be able to tailor a clinically sound exercise regimen that can improve her quality of life and may help to prevent the condition from worsening. It should always be remembered that , all though exercise is medicine, it is not always so. Hence, it is vital to know the do's and do not's.
In physiological evaluation- It is always important to do a through evaluation of cardio-pulmonary system which should include BP , PFT, ECG. Any abnormality should be ruled out with the help of a Medical practitioner, exercise physiologist or a clinical exercise physiologist.
In Neurological and musculoskeletal evaluation - Strength, flexibility and balance and co-ordination using standard Manuel Tests.
In Metabolic profile Evaluation - Blood routine, Blood glucose level and lipid profile should be obtained.
In Nutritional evaluation- You should obtain a detailed summery of the type of food , amount of food and frequency + timing. This will be an important thing in determining between calorie in put vs out put. Well it may also connote clues that have clinical significance.
Social, Family and occupational evaluation- This will help the EP to develop an understanding about the psycho-behavioral aspects of the client and motivation behind exercise. Perhaps the occupational Hx alone will help the EP to make out the etiology of some of the musculoskeletal conditions that troubles the client. So that the EP can modify the exercise patterns,anticipate the prognosis with exercise, develop effective motivational strategies to support the client. Moreover it will help to develop a confident relationship between the client and practitioner.
In fact a systematic Evaluation of the client is the most important and most underestimated aspect of Exercise testing and prescription. It is important for all categories of clients.
Guidelines for Geriatric Exercise Program Designing.
Again , these are only guidelines and not protocols. Hence it should be used based on the on the basis of Client Evaluation and scientific judgement of the Exercise Practitioner. These guidelines are based on American College of Sports Medicine ( ACSM) and American Heart Association (AHA) Recommendations and based on current research.
Cardiovascular Training
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Strength Training
Flexibility Training
Balance and Co-ordination Training
I hope My colleagues and other Fitness and exercise science professional will find this article informative.
Siby C Chacko MPE ( Exercise Physiology )
References:
1) http://www.todaysgeriatricmedicine.com/news/ex_092210_03.shtml
2) Kashinath Padhiary , The art of history taking 2nd edition (2009)
3) Kay.A .Van Norman , Exercise and wellness for Older Adults:2nd Edition ( 1995)
4) Wojtek Chodzko _Zajko PhD ACSM's Exercise for Older Adults ( 2013)
