Health and Economic Benefits of Exercise Programs for Seniors
The role of regular strength and conditioning exercises for seniors has been studied by many different groups and for many different reasons. The senior demographic under consideration includes individuals who are 50 years old and older, unless otherwise specified.
Seniors who exercised were once considered somewhat of an anomaly; after all, we tend to think of our golden years as a time of rest and relaxation, not necessarily a time to seek out physical stress, engage in strength and conditioning, or want to “go for the burn.” Yet, it turns out that there are a number of health benefits associated with regular physical activity,1 as well as economic advantages at both the individual level and the societal level.2
This article will explore the potential benefits of exercise on achieving optimal functional status, cardiovascular (CV) health, fall prevention, and cognitive function, which will in turn, prompt a reduction in prescription medication use, 30-day readmission rates, and social isolation.
Aging and Impairment/Disability
Before we examine some of the health benefits that regular physical activity might bring to the aging public’s ability to function, a good place to start is consideration of the age-related changes that advancing time can bring to the human condition. Even in the absence of discernable disease, both structural and functional deterioration occurs in all our physiological systems.3
Declines in maximal aerobic capacity (VO2max) and skeletal muscle mass (sarcopenia) are examples of age-related losses that can significantly impair physical independence and are representative of physiological aging.4 Both of these measures are determinants of exercise tolerance and functional abilities.5,6 There is evidence to suggest that baseline values for VO2max and sarcopenia are predictive of future disability,7,8 chronic disease,9 and death.10,11
The aging process is also associated with changes in anthropometry; specifically, there is a shift in body composition with advancing age that may lead to a greater proportion of body fat to lean body mass. This change in body composition has implications for both metabolic and CV health in terms of disease risks.12,13 As the aging body gradually takes on a greater percentage of body fat to lean muscle, the most significant change is a reduction in metabolic capacity to burn calories, which may manifest in weight gain.
As well, there is often a selective loss of fast-twitch, white muscle fibers. This matters since white fibers are the glycolytic units responsible for powerful anaerobic and explosive-type movements as opposed to the slow-twitch, red fibers that are more oxidative and facilitate longer (endurance-type) activities. Preferential muscle fiber loss, specifically type 2a and 2b white fibers, occurs in certain pathologies, such as Parkinson’s disease and hemiparesis secondary to cerebrovascular events or stroke.
Movement specialists who create exercise programs for these challenged populations need to keep the physiological changes in muscle fibers in mind when formulating effective exercise programs. Whether caused by aging or disease, a selective muscle fiber population decay that is also consistent with clinical observations suggests that strength loss is actually not the main problem: in many cases it is lack of muscle power, or the patient’s inability to generate forces fast enough to accomplish a task or activity of daily living (ADL). The muscle parameter that needs attention is not peak force generation, but rather peak torque at the right time (sequence) and within a specified duration of time. Exercise programs that focus on eccentric movements and higher-velocity muscle actions have been shown to be beneficial.14
Other aging-related functional deficit observations that can be improved through exercise include joint mobility, muscle flexibility and endurance, balance deficits, cardiac and hemodynamic functions, oxygen extraction, gas exchange/ventilation, cognitive declines, walking kinematics, stair climbing ability, lactate thresholds, and bone density—most of which adversely impact height and weight—and therefore body mass index or body weight.15
Economic Benefits of Exercise for Seniors
Recent research shows that in terms of predicting an anticipated escalation in health problems, health care costs, and 30-day all-cause hospital readmission in Medicare patients, functional impairment is a critical predictor to understand and consider monitoring.16
Severe functional impairment is defined as a person needing help in at least 2 ADLs. Thus, there is an important predictor of outcomes, both health and economic, in functional status; yet Medicare does not mandate measuring this factor in acute care patients discharged from skilled nursing facilities (SNFs) or hospitals. According to data presented at the Society of Hospital Medicine 2014 annual meeting [preceding publication], Medicare would save billions of dollars annually if the policy were changed to recognize the value of functional impairment as an important predictor of outcomes.17
The irony is that hospitals and SNFs already have the mechanism in place to assess functional status, which is typically performed by physical therapists (PTs) and occupational therapists (OTs). Since PTs and OTs routinely assess functional status in acute rehabilitation facilities, nursing homes, and the outpatient sector, the system to collect and analyze the data already exists and is ready to be tapped. Only the policy directive is missing.
In another cost comparison study, the total cost of care after hospital discharge was the primary outcome assessed through Medicare claims (adjusted for inflation).18 The authors also adjusted for age, gender, race, marital status, income, education, number of morbidities (Elixhauser index), and number of hospitalizations in the previous year. They found a linear relationship between functional level and cost at 1 year that ranged from $21,263 for those with no functional impairment to $39,705 for patients with severe impairment (needing assistance with 2 or more ADLs).18 An assessment of the data reflected a $221 billion difference in cost between patients with no impairment and those with severe impairment.18
Exercise and CV Health
The process of aging is known to affect the CV system in many ways. In the heart, there is myocyte loss with a concomitant increase in fibroblasts and collagen deposition, leading to decreased ventricular compliance.19 In the vessel walls, there is stiffening and thickening that occurs due to collagen deposition, loss of elastin, and hypertrophy of the smooth muscle cells.19 In addition, there is endothelial dysfunction caused by nitric oxide─mediated relaxation.