ACSM’s Exercise for Older Adults
Edited by Wojtek J. Chodzko-Zajko, PhD
Professor
and Head
Department of Kinesiology and Community Health
University of Illinois at Urbana-Champaign Urbana, Illinois
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Library of Congress Cataloging-in-Publication Data
Chodzko-Zajko, Wojtek J.
ACSM’s exercise for older adults / Wojtek J. Chodzko-Zajko. p. cm.
Includes bibliographical references and index.
E-ISBN: 978-1-4698-2528-1
1. Exercise for older people. 2. Aging Physiological aspects. I. Title. II. Title: Exercise for older adults.
GV482.6h.C46 2014 613.7′0446 dc23
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To my mother, Ewa Maria Zofia Chodzko-Zajko
In the chapters of this book, you will learn about the many reasons why older adults should engage in regular physical activity. The world renowned group of researchers and practitioners selected as chapter authors have presented a compelling case for physical activity, summarizing the physiological, psychological, social, and other benefits that accrue to people of all ages who are able to maintain a physically active lifestyle. You will be exposed to a substantial body of scientific evidence that indicates that regular physical activity can bring dramatic health benefits to people of all ages and abilities and that these benefits extends over the entire life-course. Simply put, physical activity offers one of the greatest opportunities to extend years of active independent life, reduce disability, and improve the quality of life for midlife and older persons.
Unfortunately, despite a wealth of evidence about the benefits of physical activity for mid-life and older persons, there has been little success in convincing Americans older than 50 years to adopt physically active lifestyles. For example, the Centers for Disease Control and Prevention estimates that between one-third and one-half of Americans older than 50 years get no leisure-time physical activity at all. ACSM’s Exercise for Older Adults will assist you to identify and understand some of the barriers faced by older adults when they attempt to increase their physical activity and to outline specific strategies for helping them to overcome these barriers.
For those of us who make our living advocating for healthy and physically active lifestyles, it may come as a surprise to realize how little many older adults know about physical activity. However, most older adults were educated at a time and in a culture in which little was known about the health benefits of physical activity, and professionals and members of the
public were skeptical about the need to remain physically active after retirement. In the pages of this book, you will find a succinct and easy to read summary of the current evidence base in the area of exercise and physical activity for older adults. As an exercise professional, one of the most important things you can do for your clients is to help them to understand that there are different ways to be active. By following some of the strategies and suggestions presented in this book, you can help your older clients realize a lot of benefits associated with a physically active lifestyle.
FEATURES
Chapter Introductions and Chapter Outlines at the beginning of each chapter provide an overview of important concepts. Key Point boxes illustrate terms, definitions, and ideas. Real Life Stories, or vignettes, describe older adults who have successfully implemented physical activity programs. Questions for Reflection help students review what they have learned and encourage students to engage in critical thinking.
SUPPLEMENTAL MATERIALS
Supplemental materials for students and instructors are available at http://thepoint.lww.com/activate. Instructors can access:
• Power Point Lecture Outlines
• Image Bank, including all figures and tables from the text.
• Full Text Online Students can also access the Full Text Online.
Foremost, I would like to acknowledge the contributions of my colleagues who have willingly agreed to share their expertise and experience by writing chapters for this book. Your hard work, enthusiasm, and dedication to this project are greatly appreciated. You have been a joy to work with! Next, I would like to thank the American College of Sports Medicine and all of its staff and officers for your commitment to our profession and your dedication to the dissemination of the scientific evidence about the benefits of physical activity. Finally, I would like to express my personal thanks to my colleague and partner, Dr. Andiara Schwingel.
Wojtek J. Chodzko-Zajko, PhD
Professor and Head
Department of Kinesiology and Community Health University of Illinois at Urbana-Champaign Urbana, Illinois
Jennifer L. Etnier, PhD
Professor and Director of Graduate Studies
Department of Kinesiology University of North Carolina at Greensboro Greensboro, North Carolina
Ellen M. Evans, PhD
Associate Professor Department of Kinesiology University of Georgia Athens, Georgia
Bo Fernhall, PhD
Dean and Professor College of Applied Health Sciences University of Illinois at Chicago Chicago, Illinois
Dolores D. Guest, PhD, RD
Clinical Research Assistant Department of Clinical Research
The Parkinson’s Institute & Clinical Center Sunnyvale, California
William B. Karper, EdD
Associate Professor
Department of Kinesiology
University of North Carolina at Greensboro
Greensboro, North Carolina
Abbi Lane, MS
Department of Kinesiology and Nutrition
University of Illinois at Chicago
Chicago, Illinois
Elizabeth K. Lenz, PhD
Assistant Professor
Department of Kinesiology, Sport Studies, and Physical Education
The College at Brockport SUNY Brockport, New York
Pamela “Pommy” Macfarlane, PhD
Professor Emeritus
Kinesiology and Physical Education Department
Northern Illinois University
DeKalb, Illinois
James R. Morrow, Jr, PhD, FACSM, FNAK
Regents Professor
Department of Kinesiology, Health Promotion and Recreation
University of North Texas Denton, Texas
Anne E. O’Brien, PhD
Temporary Assistant Professor
Department of Kinesiology
University of Georgia
Athens, Georgia
Michael E. Rogers, PhD, FACSM
Professor and Chair
Department of Human Performance Studies
Director
Center for Physical Activity and Aging
Wichita State University
Wichita, Kansas
Nicole L. Rogers, PhD
Assistant Professor
Department of Public Health Sciences
Wichita State University Wichita, Kansas
Agnes F. Schrider, PT
Nelson Physical Therapy and Wellness Center
Roseland, Virginia
Andiara Schwinge, PhD
Assistant Professor
Department of Kinesiology and Community Health University of Illinois at Urbana-Champaign Champaign, Illinois
Scott J. Strath, PhD
Associate Professor Department of Kinesiology University of Wisconsin-Milwaukee Milwaukee, Wisconsin
Rudy Valentine, PhD
Post-Doctoral Researcher
Diabetes and Metabolism Research Unit
Boston University School of Medicine Boston, Massachusetts
Jakob L. Vingren, PhD, CSCS, FACSM
Assistant Professor
Department of Kinesiology, Health Promotion and Recreation
University of North Texas Denton, Texas
Mary Frances Visser, PhD
Professor Department of Human Performance Minnesota State University, Mankato Mankato, Minnesota
Diane Whaley, PhD
Professor, Applied Developmental Science & Director, Lifetime Physical Activity Program
Curry School of Education University of Virginia Charlottesville, Virginia
Anne-Lorraine T. Woolsey, BA
Department of Kinesiology, Health Promotion and Recreation University of North Texas
Denton, Texas
Huimin Yan, MS
Department of Kinesiology and Community Health
University of Illinois at Urbana-Champaign
Urbana, Illinois
Helaine Alessio, PhD, FACSM
Miami University Oxford, Ohio
Stephen D. Ball, PhD
University of Missouri Columbia, Missouri
Marybeth Brown, PhD, FACSM
University of Missouri Columbia, Missouri
Meredith Butulis
Globe University/Minnesota School of Business Richfield, Minnesota
Carol Cole
Associate Professor Sinclair Community College Dayton, Ohio
Angela Fern, MS
Beaumont Health System Royal Oak, Michigan
Eric J. Fuchs, ATC, EMT
Director, Athletic Training Education Program
Associate Professor
Eastern Kentucky University Richmond, Kentucky
Matthew J. Garver, PhD
Assistant Professor
Abilene Christian University
Abilene, Texas
Greg K. Kandt, EdD
Fort Hayes State University
Hays, Kansas
Raymond Leung
Graduate Deputy
Brooklyn College of the City University of New York Brooklyn, New York
Sarah MacColl
Personal Trainer Cape Elizabeth, Maine
Marilyn K. Miller, PhD
Associate Professor
Bloomsburg University of Pennsylvania
Bloomsburg, Pennsylvania
MaryAnn Molloy
Personal Trainer
Healthy Body Fit Mind South Portland, Maine
Jeffrey L. Roitman, EdD, FACSM
Rockhurst University Kansas City, Missouri
Karin Singleton
Personal Trainer
Fitness Personified Raleigh, North Carolina
Pam Soto
Department Chair, Professor Health & Kinesiology
Austin Community College Austin, Texas
Lucille Sternburgh, MS
Beaumont
Health & Wellness Center
Rochester Hills, Michigan
Preface
Acknowledgments
CHAPTER 1 Understanding Human Aging
Andiara Schwingel
CHAPTER 2 Physical and Psychological Benefits of Physical Activity and Exercise for Healthy Older Adults
Jenny L Etnier and William B Karper
CHAPTER 3 Active Living—Options and Benefits for Seniors
Scott J. Strath and Elizabeth EK. Lenz
CHAPTER 4 Motivating Older Adults to Initiate and Maintain a Physically Active Lifestyle
Diane Whaley and Agnes Schrider
CHAPTER 5 Physical Activity Options for Healthy Older Adults
Mary Frances Visser and Pam MacFarlane
CHAPTER 6 Active Options for Older Adults with Special Issues and Concerns
Bo Fernhall, Abbi Lane, and Huimin Yan
CHAPTER 7
CHAPTER 8
Assessing Physical Activity, Fitness, and Progress in Older Adults
Jakob L Vingren, Anne-Lorraine T Woolsey, and James R Morrow, Jr
Healthy Lifestyles in Old Age: Integrating Physical Activity with Nutrition to Maintain a Healthy Body Composition and Prevent Disability
Ellen M. Evans, Dolores D. Guest, Rudy J. Valentine, and Anne E. O’Brien
CHAPTER 9
CHAPTER 10
Helping Older Adults Select the Physical Activity Program That’s Right for Them
Michael E. Rogers and Nicole L. Rogers
Frequently Asked Questions about Physical Activity
Wojtek Chodzko-Zajko
APPENDIX
Exercise and Physical Activity for Older Adults Index
C H A P T E R O U T L I N E
• Introduction
• Definitions of age and the aging process
• Chronological age
• Biological age
• Psychological age
• Social age
• Biological theories of aging
• Cellular theories of aging
• Genetic theories of aging
• Control theories of aging
• Successful aging
• Summary
INTRODUCTION
Aging is an experience that every human being shares but no one fully understands. Human aging is associated with a wide range of physical, psychological, and social changes that impact our everyday functioning, leave us more vulnerable to a number of diseases and conditions, and make us more susceptible to death (1). This chapter examines some of the underlying processes thought to be responsible for structural and functional decline with advancing age. The chapter begins with a brief discussion of different definitions of age and the aging process. Although aging is usually defined with reference to the passage of time, even the most rapid examination of the gerontology literature reveals that chronological age alone is an inadequate measure of senescence and that more complex definitions of both age and aging are needed if we are to increase our understanding of the complex biological and psychological processes accompanying
human aging.
Furthermore, this chapter examines the underlying biological mechanisms responsible for the aging process Despite more than 50 years of research and the concerted efforts of many researchers, little progress has been made toward the identification of a single, cohesive theory of biological aging. Indeed, current research suggests that it may be more appropriate to consider aging as an umbrella term covering a wide variety of changes that occur at molecular, cellular, and systemic levels, all of which together have the effect of decreasing the body’s ability to respond to internal and external stressors Although structural decay and associated functional decline appear to be an inescapable consequence of advancing age, there are often considerable individual differences with respect to both the rate and the extent of this decline. It is now well established that it is possible for individuals to deviate from expected patterns of aging and, at least for some time, postpone the consequences of aging. The chapter will conclude with a discussion around successful aging regarding some of the lifestyle modifications that have been proposed to influence the time course of human aging
DEFINITIONS OF AGE AND THE AGING PROCESS
For the average person, it may seem unnecessary to have to define aging. Most of us are used to thinking of age as simply the number of years, months, or days that we have lived. The most commonly accepted measure of aging is the passage of calendar time. It is very clear, however, that we do not all age at the same rate and that definitions of aging that focus exclusively on calendar time are incomplete. More complex and sophisticated definitions of both “age” and “aging” are needed if we are to understand the intricacies of human aging. To understand the aging process, it is important to consider a broader perspective that combines biological, psychological, and social aspects of growing older.
Chronological age
Chronological age refers to the length of time a person has lived. It is usually expressed by the number of years or months since birth, and its measurement is independent of physiological, psychological, and sociocultural factors. However, because it cannot differentiate between individuals who share the same age but differ markedly along physiological and/or psychosocial
parameters, chronological age alone does not tell us much about how a person is doing as he or she grow older. Most gerontologists accept that in order to increase our understanding of individual differences in the aging process, it is necessary to supplement chronological age with other measures of aging that are designed to differentiate between individuals of the same chronological age. These alternative measures of senescence are sometimes described as indices of functional age. The most common measure of functional age is biological age, although gerontologists have also identified other functional ages, including psychological age and social age.
Real Life Story 1-1
Jeanne Calment Profile of a Chronologically Remarkable Older Adult
In 1965, Jeanne Calment, aged 90, signed a deal, common in France, to sell her condominium apartment to François Raffray (then aged 47) on a contingency contract. François agreed to pay her a monthly sum of approximately US$550 until she died, an agreement sometimes called a “reverse mortgage.” At the time of the deal, the value of the apartment was equal to 10 years of payments. This would have been a good business arrangement for François; however, he was dealing with the world’s longest lived person. In fact, Jeanne survived for more than 30 years after the deal, and François died before her of cancerat the age of 77, leaving his widow to continue the payments for 2 years. Jeanne Calment lived until 122 years and 164 days, and she stands as a remarkable illustration of long chronological aging.
Biological age
Rather than focusing on elements of calendar time as the principal measure of aging, biological age focuses on age-related changes in biological or physiological processes. A wide variety of approaches have been adopted for the measurement of biological age (2–4). A common goal of all biological age inventories is the determination of relative age of an individual, or the extent to which an individual is aging faster or slower than an average person of the same chronological age. For example, an individual who is aging successfully may have a biological age that is substantially less than his or her chronological age, whereas a person who is suffering from multiple medical complications in old age may be found to have a biological age that
is greater than his or her chronological age.
There have been literally dozens of approaches proposed for the calculation of biological age. Biological age assessment usually involves a number of tests that measure biological variables known to deteriorate with advancing age. An overall score on a test battery is generated for each person taking the test, and this score is then compared with scores for other persons of the same chronological age. Unfortunately, little consensus has developed with respect to exactly how biological age should be measured (5), and recent years have shown a reduction in the number of papers published using biological age as the primary measure of senescence.
Real Life Story 1-2 David — Profile of a Biologically “Younger”
Older Adult
David has been physically active for virtually his entire adult life He started his lifelong activity program shortly after leaving the navy, having seen action in the Pacific Islands during World War II He retired as paymaster of a large pharmaceutical company in the mid-1990s, but retirement did little to slow him down At 83, he is far more active than most persons half his age Every Monday through Friday, 52 weeks a year, David runs 5 miles through the streets of his small northern Illinois town. On weekends, he takes time out from his running schedule to join his wife Elaine and their walking group on long, not so leisurely, hikes throughout the Illinois countryside. I have had the distinct pleasure of sharing several enjoyable runs with David. I never cease to be amazed at what an exquisitely trained older athlete he is. Waneen Spirduso of the University of Texas has described elite older athletes like David as a measure of what it is possible to achieve in old age. They serve as an inspiration to individuals many years their junior, and they remind us that aging need not necessarily result in physical decline and decay (6).
Psychological age
Psychological age refers to person’s capabilities along with a number of dimensions of mental or cognitive functioning, including self-esteem and self-efficacy, as well as learning, memory, and perception. In much the same way that people of the same chronological age often differ biologically, it is now recognized that it may be possible for people to have different psychological ages. Birren (7) suggests that some older persons demonstrate psychological adjustments that are typical for their chronological age,
whereas others behave as though they were psychological younger (or older) than their contemporaries. As with biological age, there is no consensus with respect to how to measure psychological age (8); nonetheless, it is apparent that psychological health and adjustment is an integral component of successful aging and that the assessment of psychological integrity is at least as important as the assessment of physical status in experimental gerontology (9).
