AGING

1) Introduction
Throughout our entire lives, we might have wondered why our bodies change and grow. We
might have also wondered why we stop growing at a certain point and our body starts
deteriorating eventually leading to our expiration (death). What exactly is the cause of this
deterioration and eventual expiration and how we can we “stop” it? Well, the answer to this is
simple. Aging. And no, even with the recent scientific progressions, it cannot be “stopped.”

Aging is associated with changes in dynamic biological, physiological, environmental,

psychological, behavioral, and social processes. Some age-related changes are benign, such as
graying hair. Others result in declines in function of the senses and activities of daily life and
increased susceptibility to and frequency of disease, frailty, or disability. In fact, advancing age
is the major risk factor for a number of chronic diseases in humans.

Studies from the basic biology of aging using laboratory animals — and now extended to human
populations — have led to the emergence of theories to explain aging. While there is no single
“key” to explain aging, these studies have demonstrated that the rate of aging can be slowed,
suggesting that targeting aging will coincidentally slow the appearance and/or reduce the
burden of numerous diseases and increase health span (the portion of life spent in good
health). Aging in its biological definition, is the time-related deterioration of the physiological
functions necessary for survival and reproduction. More specifically, aging is caused by
biological processes such as but are not limited to oxidative stress, glycation, telomere
shortening, side reactions, mutations, aggregation of proteins, etc. In other words, it is the
progressive damage to these structures and functions that we perceive and characterize as
aging.

Aging is not, in and of itself, a disease. However, aging is the major risk factor for developing
many major chronic diseases. Furthermore, many diseases appear to accelerate the aging
process — which is manifested as declines in functionality and reduced quality of life.

Extensive researches have been conducted in trying to find ways to slow down or prevent the
aging process entirely. Although all sorts of scientific studies have been done on stem cells,
telomeres, gene mutations and other biological factors have been done, all have yet to propose
the definitive solution for ending cellular deterioration failure of the metabolic processes which
are associated with the aging process.

Then what exactly can we do till this scientific venture comes to an end and we start talking
about aging as a disease that can be cured?

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Successful aging is specified as a multi-domain concept that comprises and transcends good
health, and is made up of a wide spectrum of biopsychosocial factors; for example, Rowe and
Kahn previously defined successful aging as not suffering from chronic diseases, having optimal
social engagement and mental health, as well as a lack of physical disability. It has been posited
that this type of a multi-domain approach of assessing aging status, rather than focusing on risk
factors for individual health outcomes, such as disability or functioning could be more useful

Researches again have shown that the most natural and effective ways to slow down the
process and aid in living a lustrous and healthy life include dietary control and balance, adjusted
sleep schedules, skin and body care, meditation and stress-free environments and most
importantly physical activity – a factor we will be discussing in this paper.

Numerous studies have found that physical activity decreases the risk of many chronic diseases
and increases longevity. However, the association between physical activity and successful
aging (determined as a multidimensional concept) has shown heterogeneity across studies.
Some studies have shown either a lack of or a weak independent association between physical
activity and successful aging; however, other cohort studies as well as systematic reviews have
shown that higher levels of physical activity (based on frequency of participation or energy
expenditure in a range of household, leisure, or exercise activity) was associated with aging
successfully.

“…But how much exercise is enough? Organizations such as the Centers for Disease Control and
Prevention suggest 30 to 60 minutes of moderate to vigorous walking on most days but benefits
start with even less activity. The risk of all sorts of disease, but especially diabetes and
cardiovascular disease, is reduced by about one-half in people who follow exercise guidelines,
and active people can live about five years longer on average than inactive people. So, there’s
no need to sign up for a marathon to reap the benefits of exercise. Will exercise help even
people who are overweight or obese? The short answer is yes. In the last 20 or so years,
research has shown that being active is especially important if patients are overweight or obese
and can limit the risk of diseases such as diabetes and hypertension that are seen more
frequently in this population. More importantly, high levels of physical activity seem to blunt the
negative effects of many risk factors. In other words, conditions such as high cholesterol, high
blood pressure, and diabetes are harmful but not as significantly so in the most physically active
people. It’s important to exercise not only the body but also the brain. Probably the most
exciting findings about exercise and aging in the last five to 10 years center on what exercising
the body does to the brain. Exercise helps keep brain cells healthy, keeps the blood vessels
delivering plenty of oxygen to the brain, enhances the connections between brain cells, and may
even help grow new brain cells. We all fear developing Alzheimer’s disease as we get older, but
it turns out that about 50% of the risk of Alzheimer’s is linked to the five key behaviors
previously mentioned plus hypertension and diabetes.” (Joyner, 2021)

— Michael J. Joyner, MD, is a physician and medical researcher at the Mayo Clinic in Rochester,
Minnesota, with interest in exercise physiology and aging. He also blogs on his website
at www.drmichaeljoyner.com
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 2) Signs and Symptoms of Aging
The following are examples of how aging affects some of our major body systems. 

Cells, organs and tissues: 

 Cells become less able to divide 

 The telomeres—the ends of the chromosomes inside every cell—gradually get shorter
until, finally, they get so short that the cell dies 
 Waste products accumulate  
 Connective tissue between the cells becomes stiffer 
 The maximum functional capacity of many organs decreases

Heart and blood vessels:

 The wall of the heart gets thicker 

 Heart muscle become less efficient (working harder to pump the same amount of
blood) 
 The aorta (the body's main artery) becomes thicker, stiffer, and less flexible 
 Many of the body's arteries, including arteries supplying blood to the heart and brain,
slowly develop atherosclerosis, although the condition never becomes severe in some
people
Vital signs:

 It is harder for the body to control its temperature 

 Heart rate takes longer to return to normal after exercise
Bones, muscles, joints:

 Bones become thinner and less strong 

 Joints become stiffer and less flexible 
 The cartilage and bone in joints starts to weaken 
 Muscle tissue becomes less bulky and less strong
Digestive system:

 The movement of food through the digestive system becomes slower 

 The stomach, liver, pancreas, and small intestine make smaller amounts of digestive
juices
Brain and nervous system:

 The number of nerve cells in the brain and spinal cord decreases.  
 The number of connections between nerve cells decreases 
 Abnormal structures, known as plaques and tangles, may form in the brain.
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Eyes and Ears:

 The retinas get thinner, the irises get stiffer 

 The lenses become less clear 
 The walls of the ear canal get thinner 
 The eardrums get thicker
Skin, nails, and hair:

 Skin gets thinner and becomes less elastic 

 Sweat glands produce less sweat 
 Nails grow more slowly 
 Hairs get gray and some no longer grow

Symptoms

We each age at different rates, and to different degrees, and yet we experience many common
effects of aging. Some common signs and symptoms of aging include:

 Increased susceptibility to infection 

 Greater risk of heat stroke or hypothermia 
 Slight decrease in height as the bones of our spines get thinner and lose some height 
 Bones break more easily 
 Joint changes, ranging from minor stiffness to severe arthritis 
 Stooped posture 
 Slowed and limited movement 
 Decrease in overall energy 
 Constipation 
 Urinary incontinence 
 Slight slowing of thought, memory, and thinking (however, delirium, dementia, and
severe memory loss are NOT a normal part of aging) 
 Reduced reflexes and coordination and difficulty with balance 
 Decrease in visual acuity 
 Diminished peripheral vision 
 Wrinkling and sagging skin 

Weight loss, after age 55 in men and after age 65 in women, in part due to loss of muscle
tissue. 

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 3) Indications of Exercise in aging
It is clear that aging is inevitable, but the best defense we have to counter its drivers is exercise.
Exercise can’t reverse aging, but there is a clear evidence that it can activate the machinery
necessary for DNA repair.

Exercise can lengthen telomeres

Telomeres are the caps on the ends of DNA strands, similar to the caps on shoelaces.
Their length decreases with aging, and this contributes to cell senescence, meaning the
cells can no longer divide.

Telomere length is connected to certain chronic conditions, especially high blood

pressure, stroke and heart disease.

Several studies have found that higher levels of physical activity are related to longer
telomere lengths in some people, compared to those who are sedentary. This seems to
be especially true in older people. However, it’s still not clear whether that relationship
is causal, and it’s likely that multiple processes affect telomere length. But in general,
longer telomeres are believed to be a plus for reducing risk of age-related diseases.

Exercise also helps to live a healthier and longer life. Although the risk for developing
Alzheimer’s disease, cardiovascular disease, Type 2 diabetes, cancer or other conditions of
aging may not substantially increase until middle age or later, the underlying biology for those
conditions is in motion early in life. Not only genetics but also life style greatly determine that
trajectory. Choosing an active lifestyle and exercising on a regular basis throughout life can
influence the likelihood of a disease. since these factors, lifestyle and genetics, can have an
impact at any point, it is never too late to improve way of life.

Exercise not only improves heart and lung health, researches show that even modest physical
activity is good for the brain, bones, muscles and mood. Numerous studies have found that
lifelong exercise may

 keep people healthier for longer;

 delay the onset of 40 chronic conditions or diseases;
 stave off cognitive decline;
 reduce the risk of falls;
 alleviate depression, stress and anxiety;
 and may even help people live longer

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People who added about 60 minutes of mild exercise or 30 minutes of moderate exercise per
week had increased levels of heart-healthy HDL, significant decreases in harmful triglycerides,
improved levels of LDL cholesterol and lower total cholesterol levels.

physical activity is important at every age. Research on the effects of exercise on nursing-home
residents found improvements in their physical and cognitive abilities as well as on their mental
health.

4) Contraindications of exercise in Aging

A contraindication is a specific situation or procedure, in our case exercise, which should not be
prescribed because it may be harmful to the person.

There are two types of contraindications:

Relative contraindication: means that caution should be used when two drugs or
procedures are used together. People with relative contraindication can exercise, but
usually at lower intensity and more structured circumstances.

Absolute contraindication: means that event causes a life-threatening situation, so the

procedure must be avoided.

In this topic we are going to discuss about the contraindications exercise have in the context of
aging. It is obvious that exercise is very helpful in improving health and avoiding certain
complications that arise from aging and from sedentary life style. But sometimes exercise is not
prescribed and should be avoided. This is because sometimes medical conditions that arise with
aging negate exercise.

Certain diseases related with the aging process, or when elderly people have one or more of
these conditions, exercises should be avoided.

Some of the Absolute contraindications include

 Acute myocardial infarction (MI), within 2 days

 Ongoing unstable angina

 Uncontrolled cardiac arrhythmia with hemodynamic compromise

 Active endocarditis

 Symptomatic severe aortic stenosis

 Decompensated heart failure

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  Acute pulmonary embolism, pulmonary infarction, or deep vein thrombosis

 Acute myocarditis or pericarditis

 Acute aortic dissection

 Physical disability that precludes safe and adequate exercise

Some of the Relative contraindications include

 Known obstructive left main coronary artery stenosis

 Moderate to severe aortic stenosis with uncertain relation to symptoms

 Tachyarrhythmias with uncontrolled ventricular rates

 Acquired advanced or complete heart block

 Hypertrophic obstructive cardiomyopathy with severe resting gradient

 Recent stroke or transient ischemic attack

 Mental impairment with limited ability to safely cooperate

 Resting hypertension with systolic or diastolic blood pressures > 200/110 mmHg

 Uncorrected medical conditions, such as significant anemia , important electrolyte

imbalance (e.g. hypokalemia ), and hyperthyroidism
 Patients should be clearly told to stop exercising and seek medical attention if they
develop chest pain, light-headedness, or palpitations.

Before beginning an exercise program, older people should undergo clinical evaluation aimed
at detecting cardiac disorders and physical limitations to exercise. Routine ECG is not required
unless history and physical examination indicate otherwise. Exercise stress testing is usually
unnecessary for older people who plan to begin exercising slowly and increase intensity only
gradually. For sedentary people who plan to begin intense exercise, stress testing should be
considered if they have any of the following:

 Known coronary artery disease

 Symptoms of coronary artery disease

 ≥ 2 cardiac risk factors (eg, hypercholesterolemia , hypertension , obesity , sedentary

lifestyle, smoking , family history of early coronary artery disease)

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  Lung disease, known or suspected

 Diabetes , known or suspected

As people age Skin and muscles become thinner and bone strength may be weaker, so injuries
may take longer to heal. For people recovering from an injury, the clinical evaluation before the
start of an exercise program should assess whether they are apprehensive about the exercise
program. The evaluation should also measure the range of motion and strength of an injured
area, particularly as compared to the other side (eg, an injured knee versus the opposite,
uninjured knee). This is because exercise have adverse effect if done before full recovery.

In general, exercise should be considered as a robust adjunct to standard medical treatment

where any disease or medical condition exists. It is not a matter of one or the other and the
level of exercise will vary with the medical condition. Always consult your physician before any
exercise training

5) Precautions for exercises in aging

Follow Instructi ons

Modifying exercises for our elderly parent may be necessary to reduce the risk of strains and accidents.
However, changing the movement altogether could cause safety issues. Consult with your loved one’s doctor
when making changes to recommended workouts so you can learn which movements are suitable for your
loved one and what changes could increase the odds of an injury. With the help of a professional caregiver,
your loved one can exercise safely at home. For some families, caring for a senior loved one can be
overwhelming at times. Luckily, they can rely on professional respite care. Winnipeg, MB, Home Care
Assistance is a trusted name in respite and hourly care. Our caregivers are available around the clock to assist
seniors with bathing, transportation, medication reminders, exercise, and much more, allowing families the
time they need to focus on other important responsibilities or just take a break.

Don’t Overdo It
Although the routine your loved one takes up should be challenging, it shouldn’t be too overwhelming. If
your loved one pushes him or herself too much, he or she could pull a muscle or break a bone. Your parent
should know his or her body’s limits and try to stay within those parameters. Whenever your loved one feels
overworked, consider minimizing the exercises until he or she is ready to increase the intensity.

Wear Appropriate Gear

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Baggy pants, shoes that don’t fit, and exercise gear that’s too tight could pose safety risks. For example, if
clothing is too tight, your loved one could strain his or her muscles when moving. If his or her shoes don’t fit,
the odds of falling and breaking a bone or experiencing a head trauma could increase. Wearing appropriate
gear is necessary, whether your parent is working out at home or going on hikes, jogs, or bicycle rides
through the neighborhood

Warm Up Properly
Warming up and stretching before working out can reduce the risk of muscle soreness. During the warmup,
your loved one will raise his or her body temperature and increase blood flow to the muscles. It would also
help if your parent has a cooling-down period after exercising.

Be Aware of Surroundings
To increase safety, your parent should pay close attention to what’s going on around him or her at all times
when exercising. An older adult with vision or hearing problems should avoid working out without a family
caregiver or other healthy adult present. A caregiver can help your loved one avoid bumping into objects and
falling, which are serious safety risks associated with cognitive decline, memory problems, poor vision, and
hearing loss. There are many reasons seniors might need assistance at home. Some may require regular
mental stimulation due to an Alzheimer’s diagnosis, while others might only need part-time assistance with
exercise and basic household tasks. Home Care Assistance is a leading elder care provider. Families rely on
our expertly trained caregivers to help their senior loved ones maintain a high quality of life.

Stay Hydrated
Dehydration could cause safety issues for seniors at any time, but especially while exercising. When your
loved one fails to get enough water and other healthy fluids, he or she could experience muscle cramps,
headaches, and weakness. Your loved one should drink plenty of water when exercising to prevent dizziness
and low blood pressure. Not every senior has the same care needs, which means they don’t all need the
same type of home care service. Winnipeg families can rely on Home Care Assistance to provide
individualized care plans to meet your elderly loved one’s unique care needs. Our holistic Balanced Care
Method was designed to help seniors focus on healthy lifestyle habits such as eating nutritious foods,
exercising regularly, and maintaining strong social ties, and our Cognitive Therapeutics Method offers
mentally stimulating activities that can stave off cognitive decline and delay the onset of dementia. For
compassionate, reliable in-home care, trust the experienced professionals from Home Care Assistance. Reach
out to one of our dedicated Care Managers today at (204) 489-6000 to learn about the high quality of our in-
home care services.

Generally, the following are suggested in order to prevent some risk of the exercise

 Warm up before and cool down after exercise for five to 10 minutes. Begin exercise slowly, and
gradually increase duration and intensity.
 Pushing yourself too hard or performing repetitive activities can increase your risk of injury.

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  Pay attention to your body and stop when you're sick or in pain. If you take a break from exercise,
ease back into it again.
 Drink plenty of water or fluid replacement drinks. Wear appropriate athletic gear and protective
equipment.
 Take it easy when exercising in extreme weather.

6) Exercise prescription for aging

Regular physical activity and exercise are important for healthy aging and are beneficial for
chronic disease management. Exercise prescriptions for older adults should account for the
individual's health status and functional capacity. Any amount of exercise is better than being
sedentary, even if health status prevents a person from achieving recommended goals. For
most health outcomes, more benefits occur with physical activity performed at higher intensity,
greater frequency, or longer duration. Guidelines recommend at least 150 minutes of
moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity and at
least two days of muscle-strengthening activities per week. Key components of the prescription
include setting achievable activity goals, identifying barriers and providing potential solutions,
and providing specific recommendations on the type, frequency, and intensity of activities.
Older adults will derive distinct benefits from aerobic exercise, strength or resistance training,
flexibility or stretching exercises, and balance training. Many community resources are available
to help older adults begin a more active lifestyle.

The benefits of regular physical activity and exercise on general health and overall quality of life
in older adults are well established, and these benefits are particularly salient among patients
with chronic medical conditions such as osteoarthritis or cardiovascular disease (CVD).However,
in 2013, more than 33% of adults 65 years or older reported no leisure-time physical activities.
Only 16% of older adults met national guideline recommendations for physical activity, which
are at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-
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intensity aerobic activity and two or more days of muscle-strengthening activities per week.
Barriers to exercise include a lack of knowledge, lack of motivation, and poor health.

A combination of aerobic activity, strength training, and flexibility exercises, plus increased
general daily activity can reduce medication dependence and health care costs while
maintaining functional independence and improving quality of life in older adults. However,
patients often do not benefit fully from exercise prescriptions because they receive vague or
inappropriate instructions. Effective exercise prescriptions include recommendations on
frequency, intensity, type, time, and progression of exercise that follow disease-specific
guidelines. Changes in physical activity require multiple motivational strategies including
exercise instruction as well as goal-setting, self-monitoring, and problem-solving education.
Helping patients identify emotionally rewarding and physically appropriate activities,
contingencies, and social support will increase exercise continuation rates and facilitate
desirable health outcomes. Through patient contact and community advocacy, physicians can
promote lifestyle patterns that are essential for healthy aging.

Evidence suggests that regular physical activity provides substantial health benefits, reducing
the risk of many chronic diseases. Physical activity is associated with reduced medical costs,
especially for women, and these cost reductions become more significant with increasing age.
Current recommendations encourage activity on most or all days of the week, but only 31
percent of persons 65 to 74 years of age report regularly engaging in moderate physical activity
for 20 minutes or more three days a week; this rate drops to 20 percent by 75 years of
age. Women are more likely than men to report engaging in no physical activity. These trends
have not improved over the past decade. In addition, less than 50 percent of older adults report
that their physicians have recommended exercise.

CLINICAL RECOMMENDATIONS

 For older adults, any physical activity is better than being sedentary. Reducing sedentary
time has cardiovascular, metabolic, and functional benefits.
 Resistance training preserves muscle strength and physical functioning in older adults.
 To promote and maintain health, older adults should aim for at least 150 minutes of
moderate- intensity aerobic activity and two or more days of resistance training per
week.
 Physical activity decreases the risk of chronic diseases and enhances treatment.
 Exercise prescriptions and associated health benefits should be communicated in a way
that is meaningful to patients including keeping the language simple and checking for
understanding and agreement.

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AEROBIC AND RESISTANCE EXERCISE

Aerobic exercises have numerous cardiovascular and musculoskeletal benefits for older adults,
and resistance exercise training is the only therapy known to consistently improve muscle mass,
strength, power, and quality, as well as overall physical function in older adults. Aging is
associated with a decline in muscle strength and muscle power, which is a combination of force
and speed. These changes can be described by muscle quality, measured as the force produced
per unit of active muscle mass, which estimates the contribution from muscle mass,
neuromuscular function, and mechanical, contractile, and architectural properties of muscle.
The ACSM recommends that older adults perform the following each week: a minimum of 150
minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic
activity, and two or more nonconsecutive days of moderate-intensity strengthening activities,
with eight to 10 exercises involving the major muscle groups and eight to 12 repetitions of each
exercise. This recommendation is consistent with the 2008 HHS Physical Activity Guidelines for
Americans.

FLEXIBILITY OR STRETCHING EXERCISES

Activities such as dressing and reaching objects on a shelf. Flexibility or stretching exercises
improve joint range of motion after three to four weeks of regular stretching at two to three
times per week, but even greater gains are achieved with daily flexibility exercises. Flexibility
exercise is most effective when performed after light-to-moderate aerobic or resistance
exercise. Patients with recent joint injuries or surgery should consult with their physicians
before performing flexibility exercises to avoid worsening injuries or impairing the healing of
organs.

Balance training should be a regular part of exercise for all older adults to prevent falls,
especially in individuals at higher fall risk. Balance training involves practicing to control
movements of the body's position while standing, but with reducing base of support (e.g.,
standing on one foot). Balance training should be practiced at least two hours per week, should
be ongoing for lasting fall prevention effect, and may be group based or home based. To
minimize the risk of falling during exercise, balance training should be closely supervised at first
and begin with less challenging postures.

 Sample Exercise Prescription

Aerobic activities
For 3 days per week (frequency), walk briskly (activity, intensity) for 20
minutes (duration) each day at the local park after dinner (setting).
Flexibility training
For 3 days per week (frequency), stretch calf and thigh muscles (activity,
muscle groups) for 5 minutes each day after walking (aerobic activity).
Resistance training

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 For 2 days per week (frequency), lift 5-lb dumbbells, front arm and side arm
raises (activity, muscle groups) for 2 sets of 5 repetitions each day at home
(setting).
Weeks 3 and 4 (increase duration of aerobic activity and add more resistance
training)
Aerobic activities
For 3 days per week (frequency), walk briskly (activity, intensity) for 30
minutes (duration) each day at the local park.
Flexibility training
For 3 days per week (frequency), stretch calf and thigh muscles (activity,
muscle groups) for 5 minutes each day after walking (aerobic activity).
Resistance training
For 2 days per week (frequency), lift 5-lb dumbbells, front arm and side arm raises,
and perform wall push-ups (activity, muscle groups) for 2 sets of 10
repetitions each day.

References

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https://www.ncbi.nlm.nih.gov/books/NBK10041/

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https://www.nia.nih.gov/about/aging-strategic-directions-research/understanding-dynamics-
aging

3. Goal A: Better understand the biology of aging and its impact on the prevention,
progression, and prognosis of disease and disability. (2021). Retrieved 25 July 2021, from
https://www.nia.nih.gov/about/aging-strategic-directions-research/goal-biology-impact

4. Joyner, M. (2021). Aging and Exercise: What Does the Research Say?. Retrieved 25 July 2021,
from https://www.todaysgeriatricmedicine.com/archive/011613p34.shtml

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6. Elsawy, Bassem. 2010. Physical Activity Guidelines for Older Adults. Aafp.org. [Online] 1 1, 2010.
https://www.aafp.org/afp/2010/0101/p55.html.

7. 2021. Exercise in Older Adults - Special Subjects - MSD Manual Professional Edition. MSD
Manual Professional Edition. [Online] 2021.

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adults#v28292703.

8. Rubin, Harold. 2009. Benefits and contraindications of exercise training in the elderly.
Therubins.com. [Online] 09 14, 2009. http://www.therubins.com/geninfo/contraex.htm.

9. Exercise and aging: Can you walk away from Father Time - Harvard Health. (2021). Retrieved
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you-walk-away-from-father-time

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https://nam.edu/wpcontent/uploads/2015/06/PAandLatinos.pdf

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https://escholarship.org/content/qt42x5z4jn/qt42x5z4jn.pdf

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