Focused Review
Benefits of exercise for community-dwelling older adults 1

https://doi.org/10.1016/j.apmr.2004.03.010Get rights and content

Abstract

Bean JF, Vora A, Frontera WR. Benefits of exercise for community-dwelling older adults. Arch Phys Med Rehabil 2004;85(Suppl 3):S31–42.

This focused review highlights the benefits of exercise and physical activity for community-dwelling older adults. It is part of the study guide on geriatric rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the benefits of physical activity and exercise for older adults with regard to morbidity, mortality, and disability. It discusses the appropriate preexercise screening and evaluation procedures for older adults contemplating exercise. Last, it reviews the current literature on the benefits of varying modes of exercise to modify the most prevalent chronic medical conditions of late life, including arthritis, heart disease, diabetes, stroke, pulmonary disease, and osteoporosis.

Overall article objective

To summarize the current knowledge regarding the therapeutic benefits of exercise for community-dwelling older adults.

Section snippets

Outcomes influenced by exercise

To discuss the benefits of exercise for older adults, it is important to understand the varied rehabilitation outcomes that exercise can influence. These include medical outcomes, such as morbidity and mortality, disablement outcomes, such as function and disability, and psychobehavioral outcomes, including self-efficacy and QOL. In this review, we focus primarily on medical and disablement outcomes but mention psychobehavioral outcomes when pertinent. Although medical outcomes are generally

Changes associated with aging

Much of the original research on exercise interventions in older adults was directed at reversing age-associated physiologic impairments such as reduced aerobic capacity6, 7 and muscle weakness.8, 9 This approach was based on the recognition that physiologic changes associated with aging were very similar to those seen with physical inactivity and that are, in many cases, reversible with exercise. Most rehabilitation professionals are familiar with the common physiologic changes associated with

Physical activity’s relation to mortality, morbidity, and disability

Physical activity and fitness are directly linked to improvements in mortality, morbidity, and disability. From an epidemiologic perspective, the benefits of exercise are often characterized by measuring physical activity or physical fitness. Physical activity represents an optional behavior, and physical fitness represents an achieved condition resulting from increased physical activity. Both are well acknowledged for impacting positively on mortality.16, 17 A graded, inverse relationship

Effects of various exercise modes

Initial exercise research was predicated on the assumption that improvements in physiologic impairments would lead to enhanced functional performance and amelioration of disability. Therefore, early studies that used forms of endurance training or resistance training evaluated physiologic outcomes. They showed improvements with regard to endurance, aerobic power, balance, strength, muscle cross-sectional area, and fiber-type distribution. As studies expanded to evaluate functional outcomes,

Screening older adults for exercise

It is well accepted that all older adults, regardless of their underlying medical conditions, should receive a medical screening before they begin an exercise program.26, 54, 55, 56, 57 Screening examinations should serve a number of purposes, including (1) screening individuals for safety in performing exercise, (2) identifying medical problems that would require modification of the exercise prescription, and (3) identifying impairments and limitations that the exercise program will target.

In

Prevalence of chronic diseases

Although the causes of functional loss and disability among older adults are commonly multifactorial, certain chronic diseases are the most prevalent contributors. The 5 most common chronic illnesses among older adults are arthritis, CVD, diabetes, respiratory disease, and stroke.62, 63 Specifically, arthritis affects over 60% of women and 50% of men 70 years or older.62 CVD, including hypertension and heart disease, is present in 40% and 31% of all women and men aged at or over the age of 65

Osteoporosis, falls, and balance

Exercise is an important component of treatment in the maintenance of bone mass and prevention of fractures in late life. Cross-sectional analyses have shown that adults who are physically active throughout life have a higher bone density than their sedentary counterparts.112, 113 In a study of postmenopausal women, comparing sedentary older women with age-matched controls who had run an average of more than 20 miles a week since menopause, Nelson et al114 showed that, when normalized for body

Conclusions

Exercise has therapeutic benefits for almost all community-dwelling older adults, especially those suffering from the most prevalent chronic illnesses. Its benefits include reductions in morbidity and mortality, and enhanced physiologic capacity, leading to improvements in overall functioning. Many questions have yet to be answered about the effects of exercise in ameliorating disability and the best mode, intensity, and duration of exercise for treating the most common chronic conditions of

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