Exercise Intensity and Older Adults: Finding the Balance

Written By: Dr. Brittany Saia, PT, DPT, GCS and Healthy Aging Physical Therapist

You’ve done it! You started your exercise routine and you’re sticking with it (well, most of the time.) But are you getting the most out of yourself and the full impact that exercise can achieve? In this post, we’ll discuss exercise intensity, and if it’s safe when considering exercise in older adults.

The Changing Landscape of Aging

Aging brings about various physiological changes, including a decline in muscle mass, bone density, cardiovascular function, and metabolism. As a result, older adults are more susceptible to issues such as sarcopenia (muscle loss), osteoporosis (brittle bones), cardiovascular diseases, and metabolic disorders like diabetes. However, regular exercise has been shown to mitigate these age-related declines and improve overall health outcomes.

Understanding Exercise Intensity

Exercise intensity refers to the level of exertion during physical activity. It's commonly measured using parameters such as heart rate, perceived exertion, or metabolic equivalents (METs). For older adults, exercise intensity plays a crucial role in achieving desired health benefits. While low-intensity activities like walking or gentle yoga provide some benefits, higher-intensity exercises offer additional advantages that are particularly valuable for older adults.

Benefits of High-Intensity Exercise for Older Adults

1. Muscle Strength and Mass: High-intensity resistance training stimulates muscle growth and enhances strength, which is vital for maintaining mobility and independence as we age. Strong muscles also help support joints and reduce the risk of falls and fractures.

2. Bone Health: Weight-bearing and high-impact exercises promote bone density, reducing the risk of osteoporosis and fractures. Activities like jumping, running, or strength training with weights can help preserve bone health in older adults.

3. Cardiovascular Fitness: High-intensity aerobic exercises, such as cycling,

   swimming, or interval training, improve cardiovascular function, lower blood

   pressure, and enhance circulation. A robust cardiovascular system is essential for maintaining overall vitality and reducing the risk of heart disease.

4. Metabolic Health: High-intensity interval training (HIIT) and vigorous aerobic

   activities can improve insulin sensitivity, glucose regulation, and metabolic rate, thereby reducing the risk of type 2 diabetes and obesity-related complications.

5. Cognitive Function: Emerging research suggests that high-intensity exercise may benefit cognitive health by promoting neuroplasticity, improving brain function, and reducing the risk of cognitive decline and dementia.

Finding the Right Balance

While high-intensity exercise offers numerous benefits, it's essential to strike a balance and consider individual fitness levels, health conditions, and preferences. Older adults should consult with a physical therapist a PCP before starting any new exercise program, especially if they have pre-existing medical conditions or concerns.

Incorporating High-Intensity Exercise into Your Routine

1. Start Slow: Begin with low to moderate-intensity exercises and gradually increase the intensity as your fitness improves. Especially if you’re new to exercise, starting slow can help prevent overly sore muscles and help build confidence in your abilities.

2. Mix It Up: Incorporate a variety of activities, including strength training, aerobic exercises, and balance exercises, to target different aspects of fitness.

3. Interval Training: Incorporate intervals of higher intensity into your workouts,

   alternating between bursts of intense activity and periods of rest or lower

   intensity.

4. Listen to Your Body: Pay attention to how your body responds to exercise and adjust the intensity accordingly. It's essential to challenge yourself while also respecting your limits and avoiding overexertion.

5. Stay Consistent: Consistency is key to reaping the benefits of exercise. Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity exercise per week, spread across multiple days.

Embracing the Power of Exercise Intensity

In conclusion, exercise intensity is a critical factor in promoting health, vitality, and longevity in older adults. By incorporating high-intensity exercise into their fitness routine, older adults can enhance muscle strength, bone density, cardiovascular fitness, metabolic health, and cognitive function. However, it's essential to approach high-intensity exercise with caution, gradually increasing intensity and listening to your body's signals. With the right balance and guidance, older adults can harness the power of exercise intensity to thrive in their later years.

Essential Summer Exercise Tips for Older Adults: Stay Safe and Healthy in the Heat

Written By: Dr. Allison Leonard, PT, DPT and Healthy Aging Physical Therapist

With summer heat here to stay, it’s crucial to be prepared to avoid heat-related illnesses, especially for older adults. As we age, our bodies become more susceptible to dehydration and injury, making it important to take extra precautions when exercising in hot weather. Older adults may have a diminished sense of thirst, reduced sweat production, and often take medications that can affect hydration levels. Additionally, the body’s ability to regulate temperature decreases with age, increasing the risk of heat-related issues. To help you stay safe and active this summer, here are some valuable tips to keep in mind:

1. Exercise Early or Late: Schedule your workouts during the cooler parts of the day, such as early morning or late evening.

2. Stay Hydrated: Drink plenty of water before, during, and after your workout. Avoid alcohol and caffeinated drinks as they can dehydrate you.

3. Wear Lightweight Clothing: Choose loose-fitting, light-colored, and breathable clothing to help keep your body cool.

4. Use Sunscreen: Apply a broad-spectrum sunscreen with at least SPF 30 to protect your skin from harmful UV rays.

5. Take It Indoors: Consider indoor alternatives such as gyms, swimming pools, or home workouts. Indoor malls, big box stores like Target or Costco are great options for getting in your steps.

6. Lower the Intensity: Reduce the intensity of your workout to avoid overheating. Listen to your body and take breaks as needed. Use less weight/resistance, shorter periods of exercise and longer rest periods.

7. Acclimate Gradually: If you're not used to the heat, gradually increase the duration and intensity of your outdoor workouts over a week or two.

8. Know the Signs of Heat Exhaustion: Be aware of symptoms like dizziness, headache, nausea, excessive sweating, and rapid heartbeat. If you experience any of these, stop exercising, move to a cooler place, and hydrate.

9. Cool Down Effectively: Use cooling towels, take cold showers, or apply ice packs to lower your body temperature after exercising.

By following these guidelines, you can stay active and healthy even during periods of extreme heat. Stay cool AND stay active!

Enjoy Summer WITHOUT Back Pain: Effective Strategies to Reduce Back Pain in Older Adults

Written By: Dr. Tracey Berman, PT, DPT and Healthy Aging Physical Therapist

It is a beautiful summer day, and you bend over to grab your bag to go to the beach. Suddenly, ouch! You feel pain in your lower back. Back pain is never fun to deal with and can put a damper on your summer plans. But remember, you are not alone. According to the National Institute of Health, back pain is one of the most common reasons people visit their doctors. As we age, various factors can contribute to back pain. Sometimes it is muscular, and sometimes it is structural. Finding the cause of your back pain can direct your course of treatment, and most treatments will involve some type of therapeutic exercise.

Understanding the Causes of Back Pain in Older Adults

Osteoarthritis: A Common Structural Cause

As we age, one of the structural causes of back pain is osteoarthritis. This is the breakdown of cartilage, the tissue that covers the ends of bones where they form a joint. When this tissue breaks down, bones are left unprotected and rub together, causing inflammation and pain. Osteoarthritis can also narrow the small holes that direct the nerves of the spine, often resulting in tingling, numbness, and pain that can radiate down your leg, commonly known as sciatica.

Osteoporosis: Loss of Bone Mass

Another reason for back pain as we age is osteoporosis, or the loss of bone mass. Your vertebrae can weaken to the point that you lose height, develop a hunched posture, and experience back pain. In some cases, this weakening can lead to fractures in the vertebrae, which can be quite painful.

Muscular Changes and Their Impact on Back Pain

Decreased Flexibility

Flexibility, or how limber you are, diminishes as we go through life. Normal aging involves a loss of collagen, which increases stiffness in our spine and joints and reduces the elasticity of muscles and tendons. This stiffness can make us want to move less because some motions cause pain, creating a cycle of moving less and becoming stiffer.

Sarcopenia: Loss of Muscle Mass

Sarcopenia, the loss of muscle mass and strength, can begin as early as your 30s. Physically inactive people can lose as much as 3% to 5% of their muscle mass each decade after age 30. Weaker muscles make you more prone to injuries like back sprains and strains.

How Back Pain Affects Daily Activities

Back pain can significantly impact how we move throughout the day, interfering with activities like standing in line at the grocery store, sitting to watch TV, reaching up in cupboards, climbing stairs, or picking up grandchildren. This pain can cause us to move less to avoid discomfort, but sometimes movement can actually help reduce pain by increasing blood flow and fighting inflammation.

The Role of Exercise in Reducing Back Pain

Aerobic Exercise

Walking is a fabulous low-impact aerobic exercise that can help reduce back pain. Swimming and cycling, whether on the road or a stationary bike, are also excellent options. Aerobic exercise promotes blood flow, bringing nutrients to the spine and boosting endorphins, the body’s natural painkillers.

Strength Training

Strength training builds muscle strength and doesn’t require a gym membership or heavy weights. Your physical therapist can guide you through appropriate strength training exercises using body weight, resistance bands, and light weights. Strengthening your core muscles is crucial for protecting your spine. Core muscles include your obliques, transverse abdominals, and rectus abdominals, which form a “corset-like” support for your spine.

Stretching

Stretching improves flexibility and can alleviate pressure on joints, especially for those with osteoarthritis. Incorporating yoga poses like child’s pose and cat-cow, along with static stretching routines for your hamstrings, hip flexors, and trunk muscles, can be beneficial.

Balance and Stability Exercises

Balance exercises, such as standing on one leg or walking with slow head movements, activate the small postural muscles in your back that help you stay upright. Stronger postural muscles provide more support for your back, reducing pain. Tai Chi is an excellent exercise for improving balance and incorporating deep breathing, which helps decrease muscle tension.

Starting an Exercise Program Safely

Getting Started

First, get medical clearance from your doctor before starting any exercise program if you have any unstable medical conditions or other health concerns. Start slowly and for short periods, keeping a journal to track your progress. Listen to your body and recognize signs of overexertion, such as fast breathing, dizziness, or chest pain. Warm up before exercising, and cool down afterward to allow your heart rate and blood pressure to return to pre-exercise levels.

Avoiding Common Mistakes

Proper technique and form are crucial to prevent injury. Avoid bouncing in a position, ignoring your limitations, and lifting weights that are too heavy. Consult a physical therapist or reputable instructional videos for guidance.

Diet and Sleep: Supporting Your Back Health

Maintaining a Healthy Weight

Carrying excess weight can strain your back. Aim to maintain a healthy weight through a balanced diet and regular exercise. Incorporate anti-inflammatory foods like tomatoes, olive oil, green leafy vegetables, nuts, fatty fish, and fruits such as strawberries and blueberries. The Mediterranean diet is a great example of an anti-inflammatory diet.

Proper Sleep Positions

Supporting your back during sleep is crucial. If you’re a side sleeper, place a pillow between your legs to keep your spine aligned. If you sleep on your back, place a pillow under your knees to relax your back muscles. Try to avoid sleeping on your stomach, but if you must, place a pillow under your hips to reduce strain on your back.

Back pain doesn’t have to ruin your summer plans. By understanding the causes and implementing a comprehensive management plan that includes exercise, diet, sleep, and other pain management tools, you can ease the pain and enjoy your favorite summer activities. Talk to a physical therapist to develop a personalized plan to keep your back healthy and pain-free.

Treatment Tuesday: focus on Osteoporosis

WHAT IS OSTEOPEROSIS?

Osteoporosis is a disorder of progressive bone loss. While all bones normally cycle through a series of bone degradation (resorption) and new bone creation (deposition), bone loss occurs when the rate of bone resorption becomes faster than the rate of bone deposition. While we all experience age-related bone loss beginning around age 35, bone tissue deterioration can become pathological when it progresses < 1 ‘standard deviation’ (SD) from normal. Osteopenia is defined as between 1-1.25 SD below normal or a T score (measure of bone density) between -1 to 1.25. Osteoporosis is defined when bone density drops 2.5 SD or more below normal, or T score falls below - 2.5. Symptoms of low bone density typically include increased risk of fracture, increased thoracic kyphosis and pain. Osteoporosis can impact breathing and digestion if/when structural changes affect posture and spinal structure. Women are at higher risk for bone loss than men; women are 8x more likely to experience Type I osteoporosis(postmenopausal and related to loss of estrogen), and 2x more likely to experience type II (senile osteoporosis that occurs after 70 years old).

You can decrease your risk of developing Osteoporosis and/or improve your management of this disease by making certain changes in your lifestyle and activity:

✓ Participate in Regular Aerobic Activity and Strengthening: Participation in moderate to high intensity weight bearing aerobic exercise with a cyclical movement pattern has been shown to be beneficial to people with osteoporosis. Strengthening improves bone mass by the transfer of mechanical stress to bone via tendons and reduces your risk of falls.

✓ Improve your Balance and Reduce your Risk of Falls: Given the increased risk of facture in the setting of osteoporosis, it is critical to improve your balance and stay on your feet. Additionally, learning how to fall properly can protect your spine and joints in the case that you do lose your balance. Consult a physical therapist to determine how to best address these issues and incorporate a balance program as part of your normal routine.

✓ Postural Awareness and Use of Proper Body Mechanics: If you have already been diagnosed with osteopenia or osteoporosis, it is important to use proper posture and body mechanics to protect your spine and reduce risk of compression fractures. Excessive spinal flexion (bending forward) and twisting motions can increase risk of these types of fractures. Avoid activities that require these movement patterns and focus instead on spinal extension (leaning back) and improving your neutral posture and postural control.

✓ Follow any Medication and Diet Recommendations Provided by your Doctor: There are many good, effective pharmacologic treatments available for the treatment of osteopenia and osteoporosis. Your doctor may prescribe dietary supplements or bisphosphonates to slow bone degradation and encourage new bone deposition. Follow your doctor’s directions and make regular follow-ups routine.

BENEFITS OF EXERCISE

✓ Improved bone density

✓ Decreased risk of falls and fracture associated with falls

✓ Improved aerobic capacity, oxygen utilization, blood pressure and improved cardiac efficiency

✓ Improved sleep, mood and decreased daytime fatigue

✓ Improved weight management

CAUTIONS AND CONTRAINDICATIONS

While it is safe to exercise with osteoporosis, you should avoid high impact activities and exercises that involve twisting of the spine. This can protect your vertebrae from compression fracture.

Further Reading and Resources

Choose PT Guide to Osteopenia

Choose PT Guide to Compression Fractures

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