1. 關節炎 arthritis
Prevention: possibly through weight control
• Treatment: yes
• Effective modality: AET, RET, aquatic ex
– Low impact
– Adequate volume to achieve healthy weight
Cancer
• Prevention: yes
• Treatment: yes, for QOL, wasting,
lymph edema, psychological function, breast
ca survival
• Effective modality: AET, RET
COPD
• Prevention: no
• Treatment: yes, for extrapulmonary benefit
• Effective modality: AET, RET
– RET is more tolerable in severe dis,
complementary effects in combined
modality
– Ex with bronchodilator use
– Use O2 during ex if needed
Cognitive impairment
• Prevention: yes
• Treatment: yes
• Effective modality: AET, RET
– Mechanism unknown
–Need supervision in dementia
Hypertension
• Prevention: yes
• Treatment: yes
• Effective modality: AET, RET
– Large change in those reduce weight
– Small reduction in both SBP & DBP
Osteoporosis
• Prevention: yes
• Treatment: yes
• Effective modality: AET, RET, balance training,
high-impact ex
– Weight bearing, high-impact, high-velocity
(jump)
– RET effect is local around contracted muscles
– Balance training to prevent fall
Peripheral vascular disease
• Prevention: yes
• Treatment: yes
• Effective modality: AET, RET
– Systemic vascular effect
– Ex volume to the limits of pain tolerance to
improve claudication
– RET is less robust
Benefits of AET in older adult
• Aerobic ex capacity (A): sufficient AE intensity
(>60% of pretraining VO2max), freq, and
length (>3 d/wk for >16 wk) increase VO2max
in healthy middle & old aged adults
• CV effects (A): >3 mo of mod-intensity AE
elicits CV adaptations in healthy middle & old
aged adults, at rest & acute dynamic ex
• Body composition (A/B): mod-intensity AET
reduce body fat in obese middle & old aged
adults, no effect on FFM
• Metabolic effect (B): AET can enhance
glycemic control, augment postprandial lipids
clearance, and utilize fat during submax ex
• Bone health (B): AET can counteract agerelated decline in BMD in post-menopausal ˖
• Muscle strength can be increased after RET(A)
• Muscle quality is increased after RET(B). similar between older and younger, male and female
• Muscle endurance can be improved by mod- or high-intensity RET, not low-intensity (C).
• Body composition (B/C): FFM increased. FM decreased with mod- or high-intensity RET
• High-intensity RET improved BMD relative to sedentary control(B)
• Metabolic and endocrine effects (B/C): the evidence is mixed.
Benefits of balance training in older adult
• (C): Multimodal ex, including stength and balance ex, and Tai-chi 太極拳 have been shown to be effective in reducing the risk of non-injurious and sometimes injurious falls in populations who are at elevated risk of falling.
Benefits of stretching and flexibility
training in older adult
(D) there is some evidence that flexibility can be increased in the major joints by ROM ex; however, how much and what types of ROM ex are most effective have not been established.
運動處方
FOTT-Pro
= frequency, intensity, time, type, proression.
種類
- AET aerobic exercise training: jog, stair climb, brisk walk, bicycle, swim
- Resistance exercise training RET: weight lift, theraband, weight training.
- Flexibility exercise: stretch
- balance impact exercise: sprinting, single-leg stance
特異性
有氧運動
- 中等強度 for 30-60 min on 5d/wk, 或vigorous-intensity 激烈強度 20-30 min on 3d/wk (1A).
- 10 point scale (sitting 0, all-out 10)
~ mod: 5/6 , noticeable increase in HR and Breath.
~ vig: 7/8 , large increase in HR and breath
- Routine light-intensiry ADL or mod-intensity activity < 10 min are not included.
- Walking, stationary bike, aquatics (NWB no weight bearing).
- define aerobic intensity by fitness, instead of absolute term (eg, MET).
~~ 50-85% of O2 uptake reserve
~~5-8/10 of perceived effort 自覺運動強度
~~~ correlated but not linearly
~~A period of supervised exercise may help them learn the desired level of effort
肌力訓練
Muscle-strengthening activity
• Maintain or increase muscular strength and
endurance >2d/wk (IIaA)
• At least 1 set of 8-10 ex using major m. on 2 or
more nonconsecutive days per wk
• 8-12rep, 1-3set, mod to high intensity
• 10-point scale (no move:0, max effort:10)
– Mod-int: 5/6, High-int: 7/8
– 40-50% 1RM -> 60-80% 1RM
• Mode: progressive wt training, wt bearing
calisthenics, stairs climbing, similar resistance ex
Greater amount of activity
• Additional health benefits & physical fitness in
higher levels of AE/RE(IA)
– If no condition preclude higher amounts of PA
• Improve fitness
• Improve management of existing dz
• Reduce risk of premature chronic condition
• Higher impact weight bearing activity for skeletal
health (IIaB)
• Higher PA for preventing weight gain (IIaB)
Flexibility activity
• 2 d/wk for >10 min/d to maintain flexibility
necessary for regular PA and daily life (IIbB)
• Major muscle and tendon with 30-60s for a static
stretch
• Stretch to the point of feeling tightness or slight
discomfort; static, not ballistic
• Perform on the day that AE or RE is performed
• Specific health benefit is unclear
– Reduce risk of ex-related inj
Balance exercise
• Balance exercise to reduce risk of falls in
community-dwelling older adults (IIaA)
• Multi-component interventions prevent fall in
community elderly
• Ex, not activity (eg.dancing) is recommended,
though PA itself could reduce falls 35-45%
• 3 times/wk? Preferred types, frequency, and
duration are unclear
• No evidence for LTC and hospital setting
整合預防性及治療性活動
• 對許多疾病而言是相同的
• 骨質酥鬆為例, 預防性運動: 有氧,阻力, 平衡, 柔軟度,
• 強調負重急高衝力活動, 例如跳躍
–Osteoporosis as example: preventive for
aerobic, resistance, balance, flexibility.
Emphasize wt bearing and high impact
activity, like jumping
• At least avoid sedentary behavior, when
chronic conditions preclude minimum
recommended activity.
– Activity limitation: assess the nature of the
activity limitation, the capability and
preferences of the person. Usually
determine the target activity level and
details of activity plan mostly in CR/PR
centers, or ex classes.
老人照護的一般原則
- 不要給太辛, 太複雜活動, 最好是老人們以前熟悉有興趣的
- 從低強度開始, 隨時保持警覺性, 適時加以調整老人們活動內容及強度
- 提供老人安全舒適的活動空間, 例如照明, 地板防滑, 行進動線, 洗手間設備等.
- 注意老人服用多種藥物的情況.
