SUCCESSFUL AGING: EXERCISE IN THE OLDER ADULT Aaron Vaughan, MD - - PowerPoint PPT Presentation

▶
successful aging
SMART_READER_LITE
LIVE PREVIEW

SUCCESSFUL AGING: EXERCISE IN THE OLDER ADULT Aaron Vaughan, MD - - PowerPoint PPT Presentation

May 31, 2023 538 likes •1.12k views

SUCCESSFUL AGING: EXERCISE IN THE OLDER ADULT Aaron Vaughan, MD MAHEC Sports Medicine Director Primary Care Sports Medicine Asheville Orthopaedic Associates Sports Medicine Director Mission Health 12 January 2018 DISCLOSURES I have no

slide-1
SLIDE 1

SUCCESSFUL AGING:

EXERCISE IN THE OLDER ADULT

Aaron Vaughan, MD MAHEC Sports Medicine Director Primary Care Sports Medicine Asheville Orthopaedic Associates Sports Medicine Director Mission Health 12 January 2018

slide-2
SLIDE 2

DISCLOSURES

  • I have no pertinent disclosures
slide-3
SLIDE 3

“We don’t stop playing because we grow old; we grow old because we stop playing.”

  • George Bernard Shaw
slide-4
SLIDE 4

“GETTING OLD”

slide-5
SLIDE 5

WE ARE ALL ATHLETES

slide-6
SLIDE 6

OBJECTIVES:

  • Review normal aging physiology
  • Exercise Prescription
  • Common Ailments and Associated Treatments
  • Art of Diagnosis: Diagnostic Ultrasound Demonstration
slide-7
SLIDE 7

CASE REVIEW

  • 75 yo male tripped on carpet while at home and fell on hip.

Unable to walk

slide-8
SLIDE 8

HIP FRACTURES

slide-9
SLIDE 9

HIP FRACTURES

slide-10
SLIDE 10

“OLDER ADULT”

  • 65+ or 50-64 (with clinically significant chronic conditions and
  • r functional limitation)- ACSM
slide-11
SLIDE 11

WHAT IS “EXERCISE”

  • Lifestyle choices
  • Organized sports
  • Unstructured play
  • Household and

Occupational tasks

slide-12
SLIDE 12

WHY IS IT IMPORTANT

  • Top 10 Chronic Conditions
  • Arthritis
  • Hypertension
  • Hearing Impairment
  • Heart Disease
  • Cataracts
  • Orthopedic

Impairment

  • Chronic sinusitis
  • Diabetes
  • Visual Impairment
  • Varicose Veins
slide-13
SLIDE 13

EXERCISE AND AGING PHYSIOLOGY

slide-14
SLIDE 14

PHYSIOLOGIC CHANGES WITH AGING

  • Decreased
  • Muscle mass
  • Muscle strength
  • Muscle power
  • Muscle endurance
  • Muscle contraction velocity
  • Muscle mitochondrial

function

  • Muscle oxidative enzyme

capacity

  • Maximal and submaximal

aerobic capacity

  • Cardiac contractility
  • Maximal heart rate
  • Stroke volume and cardiac output
  • Nerve conduction velocity
  • Balance
  • Proprioception
  • Gait velocity
  • Gait stability
  • Insulin sensitivity
  • Glucose tolerance
  • Immune function
  • Bone mass/strength/density
  • Collagen cross-linkage, thinning

cartilage, tissue elasticity

slide-15
SLIDE 15

PHYSIOLOGIC CHANGES WITH AGING (CONT)

  • Increased
  • Systolic blood

pressure

  • Diastolic blood

pressure

  • Visceral fat mass
  • Total body fat
slide-16
SLIDE 16

AGING AND AEROBIC CAPACITY

  • Peak between 15-30
  • Declines with age
  • Approximately 10% per decade after age

25-30

  • Anaerobic threshold: occurs at lower work rates
slide-17
SLIDE 17

AGE-RELATED DECLINE: NORMAL

slide-18
SLIDE 18

AGE-RELATED DECLINE (CONT)

  • Sedentary people lose large amounts of muscle mass (20-40%)
  • 6% per decade loss of Lean Body

Mass (LBM)

  • Aerobic activity not sufficient to stop this loss
  • Balance and flexibility training contributes to exercise capacity
slide-19
SLIDE 19

BENEFITS OF EXERCISE

slide-20
SLIDE 20

BODY COMPOSITION

  • Increased muscle

mass

  • Walking isn’t enough
  • Progressive

resistance training

  • DM prevention?
  • Falls and fractures
  • Decreases in total body

adipose tissue

slide-21
SLIDE 21

PULMONARY

  • Training attenuates decline in lung capacity
  • Improve exercise tolerance
slide-22
SLIDE 22

MENTAL HEALTH

  • Lower prevalence and incidence of

depressive symptoms

  • Reversal of cognitive loss?
slide-23
SLIDE 23

CHRONIC DISEASE MANAGEMENT

slide-24
SLIDE 24

DIABETES/OSTEOPOROSIS

  • Insulin Resistance
  • Improves insulin sensitivity
  • Osteoporosis prevention and treatment
  • Stabilization or increase in bone density with resistive or weight

bearing exercise

slide-25
SLIDE 25

HIGH CHOLESTEROL/HTN

  • Exercise = improved profiles
  • Lower pressures in active individuals
  • 5-10 mmHg
  • Greater training effect in those with mild to moderate

hypertension

slide-26
SLIDE 26

CVD/PVD

  • Exercise training beneficial in PVD
  • Reduced claudication pain
  • Greater walking distance
  • Improved functional endpoints
slide-27
SLIDE 27

ARTHRITIS/CANCER

  • Improved functional status
  • Faster gait
  • Less pain
  • Less medication use
  • Potential protective benefits with
  • Breast Cancer
  • Colon Cancer
slide-28
SLIDE 28

EXERCISE PRESCRIPTION

slide-29
SLIDE 29

ACSM GUIDELINES

  • Exercise 3-5 days each week
  • Warm up 5-10 minutes before aerobic activity
  • Maintain intensity for 30-45 minutes
  • Heart Rate Goals are variable
  • Gradually decrease intensity of workout, then stretch to cool

down during last 5-10 minutes

  • If weight loss is goal, 30 minutes five days a week
slide-30
SLIDE 30

EXERCISE PRESCRIPTION

  • Modes
  • General activities
  • Aerobic
  • Resistance
  • Flexibility
  • Balance
  • Mode governed by:
  • Duration
  • Frequency
  • Intensity
slide-31
SLIDE 31

CONTRAINDICATIONS

  • Relative
  • Acute illness
  • Undiagnosed chest pain
  • Uncontrolled diabetes
  • Uncontrolled hypertension
  • Uncontrolled asthma
  • Uncontrolled CHF
  • Musculoskeletal problems
  • Weight loss and falls
  • Absolute
  • Inoperable Aortic

Aneurysm

  • Cerebral aneurysm
  • Malignant ventricular

arrhythmia

  • Critical aortic stenosis
  • End-stage CHF
  • Terminal illness
  • Behavioral problems
slide-32
SLIDE 32

EXERCISE STRESS TEST

  • High Risk Individual
  • Generally no indication for individual planning mild to

moderate exercise

slide-33
SLIDE 33

RISK FACTORS (CONT)

  • Medications
  • Hypertension
  • Beta Blockers
  • RAA system
  • Diuretics
  • Pain
  • NSAIDs
  • Diabetes
  • Hypoglycemics
slide-34
SLIDE 34

OTHER IMPAIRMENTS

  • Vision/hearing
  • Adaptive devices
  • Environmental issues
slide-35
SLIDE 35

COMMON AILMENTS

slide-36
SLIDE 36

WHAT WE SEE

  • Neck Pain
  • Conditions:
  • Neck Arthritis
  • Cervical Stenosis
  • Muscle Spasm
  • Chronic Headaches
  • Disc Problems
  • Pinched Nerves
  • Compression

Fractures

slide-37
SLIDE 37

WHAT WE SEE

  • Low Back Pain
  • Conditions:
  • Arthritis
  • Spinal Stenosis
  • Muscle Spasm
  • Disc Herniation
  • Pinched Nerves
  • Compression

Fractures

slide-38
SLIDE 38

WHAT WE SEE

  • Shoulder Pain
  • Conditions:
  • Shoulder Arthritis
  • Rotator Cuff Tears
  • Tendonitis
  • Bursitis
  • Shoulder Weakness
  • Shoulder Fractures
slide-39
SLIDE 39

WHAT WE SEE

  • Elbow Pain
  • Conditions:
  • Arthritis
  • Tennis Elbow
  • Golfer’s Elbow
  • Tendonitis
  • Bursitis
  • Elbow

Fractures

slide-40
SLIDE 40

WHAT WE SEE

  • Wrist/Hand Pain
  • Conditions:
  • Wrist/Hand Arthritis
  • Finger/Thumb Arthritis
  • Wrist/Hand Tendonitis
  • Carpal Tunnel
  • Trigger Finger
  • Carpal Tunnel Syndrome
  • Dupuytren’s Contracture
  • Hand/Wrist Fractures
slide-41
SLIDE 41

WHAT WE SEE

  • Hip Pain
  • Conditions
  • Hip Arthritis
  • Hip Fractures
  • Hip Tendonitis
  • Hip Bursitis
  • SI Joint Pain
slide-42
SLIDE 42

WHAT WE SEE

  • Knee Pain
  • Conditions:
  • Knee Arthritis
  • Knee Tendonitis
  • Knee Bursitis
  • Baker’s Cyst
  • Knee Swelling
slide-43
SLIDE 43

WHAT WE SEE

  • Ankle/Foot Pain
  • Conditions:
  • Ankle/Foot Arthritis
  • Achilles Tendonitis
  • Plantar Fasciitis
  • Ankle/Foot Fractures
  • Bunions
  • Arch Pain
slide-44
SLIDE 44

HOW WE SEE IT

slide-45
SLIDE 45

HOW WE SEE IT

  • Imaging
slide-46
SLIDE 46

HOW WE FIX IT

  • Rehabilitation
slide-47
SLIDE 47

HOW WE FIX IT

  • Bracing
  • Elbow
  • Hand/Wrist
  • Knee
  • Ankle
slide-48
SLIDE 48

HOW WE FIX IT

  • Medications
  • Pain
  • Anti-inflammatories
  • Anti-spasm
  • Homeopathics
slide-49
SLIDE 49

HOW WE FIX IT

  • Procedures
slide-50
SLIDE 50

SUMMARY

  • We are all athletes
  • Exercise is essential (and fun!)
  • With aging comes physiologic challenges
  • Benefits are far reaching
  • Few reasons not to exercise
  • If you have questions, Ask
  • Know who to ask
slide-51
SLIDE 51

THE ART OF DIAGNOSIS: DIAGNOSTIC ULTRASOUND

slide-52
SLIDE 52

DIAGN GNOSI OSIS

What we see first

DIAGNOSTIC ULTRASOUND

slide-53
SLIDE 53

WITH ULTRASOUND

DIAGNOSTIC ULTRASOUND

slide-54
SLIDE 54

Diagnosis Treatment

  • Bone
  • Fracture/Fracture healing
  • Ex: Fracture classification
  • Tendon
  • Tendon partial or full thickness

tearing

  • Tendonitis/Tendinopathy
  • Ex: Achilles rupture %
  • Ligament
  • Ligament Disruption
  • Ex: UCL disruption of elbow
  • Muscle
  • Muscle tearing
  • Ex: Hamstring tears
  • Injections
  • Joint
  • Knee
  • Hip
  • Shoulder
  • SI
  • Small Joint
  • Tendon Sheath
  • RTC
  • Tennis Elbow
  • Bursa
  • Subacromial
  • Pes Anserine
  • Greater Trochanter
  • Nerve
  • Carpal Tunnel
  • Morton’s Neuroma
  • Cubital Tunnel

DIAGNOSTIC ULTRASOUND

slide-55
SLIDE 55

DEMONSTRATION

slide-56
SLIDE 56

AAR AARON ON VAUGHAN, UGHAN, MD MD

AARO RON.VAU N.VAUGHAN@MAH GHAN@MAHEC.NET EC.NET AVAUG AUGHAN HAN@ASHEV @ASHEVIL ILLEOR EORTH THO.COM O.COM 828-767-9693