Ageing processes

As many individuals in the cardiac rehabilitation population are 50+ years of age, it is important that the exercise prescriber takes into account the

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<35yrs 35- 45- 55- 65- 75yrs+ 44yrs 54yrs 64yrs 74yrs

Figure 4.3. Deaths from coronary heart disease (BHF, CHD Statistics, 2002).

changes that are associated with ageing and the effect these will have on exercise.

Cardiovascular Function

There is loss of VO2max by about 1% per year between the ages of 25 and 75 years (Shvartz and Reibold, 1990). This loss of functional capacity is not inevitable and appears to be closely related to reduced activity levels. The elasticity of the major blood vessels declines with age, resulting in an increase in both systolic and diastolic blood pressure. This increases peripheral resistance and in turn increases afterload (see Chapter 3), which can result in ventricular hypertrophy.

Heart Rate

Maximal HR will decline with age. This is thought to be due to a decrease in myocardial sensitivity to catecholamines and the effect of prolonged diastolic filling (ACSM, 2001). The predictive age-adjusted HR formula (see Chapter 3) does take this into consideration. Some care is required in using this formula, due to the limitation of over- or under-prescription. RPE may be more useful.

Pulmonary Function

Lung elasticity and chest cavity expansion decrease with age. Many older adults will increase their rate of breathing, rather than depth, to increase ventilation. This may result in additional work for the respiratory muscles, and many will describe symptoms of breathing discomfort during exercise. Advice on breathing control should be included where appropriate.

Bone

Women begin to lose bone at age 30, and will lose about 20% by the age of 65 and 30% by the age of 80. Men at the age of 40 onwards will lose 10 to 15% by the age of 70 and 20% by the age of 80 (ACSM, 2001). (See p. 128 on osteoporosis for exercise implications.)

Strength

Muscle function decreases approximately 25% by the age of 65 (ACSM, 2001). This decline in strength generally begins at the age of 30 and will be more marked in women than men, and will be greater in the lower limbs than the upper limbs (BACR, 2000). Therefore it is appropriate to include RE in a comprehensive exercise programme.

Joints and Flexibility

Both flexibility and range of movement will decline with age. Combined with reductions in strength, this may result in an increase likelihood of falls and may exacerbate arthritic problems. Incorporating flexibility exercises into the programme will help to reduce this risk.

Body Composition

There will be a reduction in lean body mass and an increase in body fat (American Council on Exercise, 1998). Both men and women will gain weight, and this is generally a result of an imbalance of calorie intake and energy expenditure. Changes in metabolism will also contribute to weight gain. The increased energy expenditure associated with exercise and improved muscle/fat ratio will assist weight management (Pollock, et al., 2000).

Motor Skills

Balance, reaction times and motor coordination deteriorate with age. When combined with deterioration in hearing and eyesight, these changes have been shown to increase the likelihood of falls by 35 to 40% in adults over 60 (ACSM, 2001). Participants may have difficulty hearing/seeing instructions, and this can lead to anxiety or loss of confidence. The exercise leader must consider the class environment in order to be sensitive to the specific needs of the participants. Although age deteriorates motor skills, it is important to incorporate them into CR exercise programmes to ensure practice and skill rehearsal. Balance and motor skills require practice.

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