2008 – Page 38 – The Sport Journal

Exercise Testing and Prescription for the Senior Population

Submitted by: Jon YeanSub Lim, CSCS, USSA Doctoral Student

Introduction

Today, the average of life expectancy has gone up in the United States (U.S.) and is expected to increase even more in the future. The U.S. Bureau of Census (1994) predicted there will be more than 40 million people over 65 years old in the year 2010. The growth in the senior population of the U.S. is a similar trend throughout the world. Consequently, the health, fitness and well-being of the senior population are of increasing concern in today’s society.

Aging is a normal biological process in human beings involving the gradual alteration of body structure, function, and tolerance to environmental stress. From approximately age 30, effectiveness of various physiological functions begins a subtle decline that becomes more obvious around age 55-60. However, physiological aging does not occur at the same rate throughout the population. At the present, it is difficult to distinguish reasons of decline in physiological functions. The reasons could be from advancing age, deconditioning from physical inactivity, disease, or any combination of them (ACSM, 1995).

There is a biological and a chronological age. Biological age focuses on senescent changes in biological and physiological processes, whereas chronological age focuses on elements of calendar time. An individual who is 70 years of age may have a biological age of 45, based on his/her health and fitness status. Biological age may be reduced by regularly participating in a well-designed physical fitness program. Nakurma, et al. (1989) found that active elderly men who followed a regular exercise program were able to significantly lower their biological age with improvement in functional capacity and maximal aerobic power. This may explain that normal aging processes account only for a portion of the loss of physiological function; physical inactivity accounts for greatest amount of the loss with age (Poehlman et al., 1991). This loss from physical inactivity is avoidable through adequate and regular exercise.

The benefits of physical activity for older individuals are well documented. It improves cardiorespiratory function, reduces risk factors for coronary artery disease, and most importantly enhances of the ability to perform daily activities (Blair, 1993; Huhn, 1993). There is no clear evidence that exercise will improve longevity, but there is little doubt that it improves the quality of life in old age. It maintains endurance, strength, and joint mobility while it reduces the incidence and severity of hypertension, osteoporosis, obesity, and diabetes mellitus. The purpose of this paper is to provide general guidelines of effective and safe exercise testing and prescription for the senior adult population. The physiological changes accompanying advancing age which influence exercise should be considered in the design of effective and safe exercise programs for the senior population.

Physiological Changes With Aging
The study of physiological changes with aging come from data collected from different cross-sectional and longitudinal studies (Table 1). It is crucial to have knowledge of the physiological changes of aging in order to have a safe and effective exercise program for older individuals. With advancing age, there are gradual decreases in basal metabolic rate (BMR), bone density, maximum oxygen consumption (VO2 max), muscle mass, muscle strength, and range of motion (ROM).

Table 1
Effects of Exercise Training and Aging

Variables

Aging

Exercise Training

Resting heart rate

Little or no change

Decreases

Maximal cardiac output

Decreases

Increases

Resting & exercise blood pressure

Increases

Decreases

Maximal oxygen uptake

Decreases

Increases

HDL

Decreases

Increases

Reaction time

Decreases

Increases

Muscular strength

Decreases

Increases

Muscle endurance

Decreases

Increases

Bone mass

Decreases

Increases

Flexibility

Decreases

Increases

Fat-free body mass

Decreases

Increases

Precent body fat

Increases

Decreases

Clucose tolerance

Decreases

Increases

Recover time

Increases

Decreases

(ACMS Guidelines for Exercising and Prescription, 1995)

The benefits associated with exercise are well documented showing the enhancement of the ability to perform daily activities in old age (Table 1). Most of the physiological changes of aging can be improved with regular exercise training.
Exercise Testing
The American College of Sports Medicine (ACSM) recommends that older individuals should obtain a medical clearance from their physician prior to maximal exercise testing and before their participation in vigorous exercise. In addition, health screening of the participant should be conducted in order to optimize safety during exercise testing and participation to develop an individualized, safe and effective exercise prescription.

After the completed health screening, the participant should have a pre-exercise evaluation which will provide a baseline measure of body composition, cardiovascular endurance, flexibility, and muscle strength. The protocols for testing older individuals need to be modified for any special needs they may have. The ACSM provided factors to be considered when selecting an exercise testing protocol for older individuals (Table 2).

Table 2 Factors to Be Considered When Selecting an Exercise Testing Protocal for Older Adults
Characteristic	•	Suggested Test Modification
Low VO2 max	•	Start at low intensity (2-3 METs)
More time to attain a steady state	•	Long warm-up (>3 min), small increments in work rate (0.5-1.0 MET per stage), longer stages
Increase fatigability	•	Reduce total test time (ideally 8-12)
Increase need to monitor ECG, blood pressure, and heart rate	•	Cycle ergometer preferred
Poor balance	•	Cycle ergometer preferred
Poor ambulatory ability	•	Increase treadmill grade rather than speed
Poor neuromuscular coordination	•	Increase amount of practice, may require more than one test
(ACSM Guidelines for Exercise Testing and Prescription, 1995, p.230)

These baseline measures are very useful in the development of exercise prescription and educating participants in physical fitness and their individual status.

Exercise Prescription
The American College of Sports Medicine (1991) recommends the goals for exercise in the senior population should be to maintain functional capacity for independent living, reduce risk factors for heart disease, retard the progression of chronic disease, promote psychological well-being, and provide opportunities for social interaction.

Although many of the general principles of exercise prescription are the same for individuals of all ages, special care must be given when setting up a fitness program for older individuals. Exercise programs for older individuals should be tailored to combine endurance, muscle strength, and flexibility to promote the quality of their life. The general exercise prescription guidelines for the senior population are developed from the ACSM guidelines (1995).

Mode

The mode of exercise for the older population should be activities with low-impact on their joints. The activities include walking, stationary cycling, water exercise, swimming, or machine-based stair climbing. The activity needs to be accessible, convenient, and enjoyable to the participant.

Duration

The duration of an exercise program should start with short periods and gradually progress in length. During the initial stage, it may be difficult for some old adults with physiologic limitations to perform exercise for 20 minutes. It will be possible for them to perform exercise in shorter sessions of five to 10 minutes repeated several times throughout the day. In addition to the duration of the exercise program itself, elderly people need additional warm-up and cool down time, perhaps as much as 10 minutes or more.

Intensity

The intensity of the exercise program must start out low since elderly people are more prone to exercise-related injuries. Because low intensity exercise is associated with a lower risk for injury, it should be encouraged in the elderly population. Exercise intensity should be sufficient to overload the cardiovascular, pulmonary, and musculoskeletal systems without overstraining them. The recommended intensity by the ACSM for older adults is 50 to 70% of heart rate reserve (1995). The intensity level of exercise should be regularly monitored by heart rate, or rating of perceived exertion (Borg, 1982).

Frequency

Generally, the frequency of exercise programs recommended is three to five days per week (ACSM, 1995). Emphasis on more frequent activity (five to seven days per week) may be made with seniors if they exercise very low intensity with short duration. This recommended increase in frequency has physiological relevance for the maintenance of endurance capacity as well as flexibility. In addition, the greater frequency may enhance compliance and lead to a greater probability of the subject assimilating physical activity in the daily routine.

Progression

Progression should be conservative and gradual for older individuals. The initial stage, usually four to six weeks, should include low intensity exercise to permit adaptation with minimal risk for injury. Elderly subjects may need a longer period of adjustment before exercising at higher intensity levels. It is better to increase exercise duration initially rather than intensity in order to avoid injury and ensure safety. Progression in an exercise program should be based on how well the individual is responding to the current regimen, the medical and health limitations of the individual, and individual goals. Exercise programs should be reviewed on a regular basis to ensure they are meeting the needs of the participant.

References

American College of Sports Medicine. (1991). Guidelines for Exercise Testing and Prescription (4th ed). Baltimore: Williams & Wilkins.

American College of Sports Medicine. (1995). Guidelines for Exercise Testing and Prescription (5th ed). Baltimore: Williams & Wilkins.

Blair, S. (1993). Physical activity, physical fitness, and health. Res Quart Exerc Sport 64: 365-376.

Borg, G. (1982). Psychophysical bases of perceived exertion. Medicine & Science in Sports & Exercise, 14, 377-381.

Hyhn, R. (1993). Cardiac rehabilitation in the cost containment environment. Cardiopul Phs Ther J 4: 4-8.

Nakamura E., Moritani T., & Kanetake, A. (1989). Biological age versus physical fitness age, Eur J Appl Physiol 58: 778-785.

Poehlman, E., McAuliffe, T., Van Houten, D., & Danforth, E. (1991). Influence of age and endurance training on metabolic rate and hormones in healthy men, Am J Physiol 159: 66-72.

U.S. Bureau of Census. (1994). Statistical Abstract of United States

U.S. Sports Academy2013-11-27T19:05:43-06:00February 11th, 2008|Contemporary Sports Issues, Sports Exercise Science, Sports Studies and Sports Psychology|Comments Off

Alabama High School Soccer Undergoes Eligibility Rule Changes

Submitted by: Dr. Joe Manjone, Dean of Student Services, Continuing Education & Distance Learning, USSA

Changes in the penalties for Alabama High School soccer players receiving misconducts have had very little effect on the numbers and types of cards issued during the 1997 and 1998 Alabama high school soccer seasons (note: high soccer is a spring sport in Alabama). Although ineligibility penalties for yellow cards were eliminated, there was a slight increase in the number of yellow cards issued per game in 1997, but the number of yellow cards issued per game in 1998 was almost equivalent to 1996. At the same time, revised red card (includes red/yellow cards) penalties seemed to have very little effect on the number of. red cards (ejections) issued per game.

During the 1996 spring season and for several years prior, penalties for Alabama high school soccer players receiving misconducts were as follows: the first accumulation of three yellow cards – ineligible for the next game; the second accumulation of three yellow cards – ineligible for the next two games; the third accumulation of three yellow cards – ineligible for the remainder of the season; the first red card – ineligible for the next game; the second red card – ineligible for the next two games; and the third red card – ineligible for the remainder of the season.

For the 1997 and 1998 seasons, soccer eligibility rules regarding a misconduct were changed to conform to the rules in effect for other high school sports. All penalties for yellow cards were eliminated. The red card (or red/yellow) penalties are as follows: a player’s first red card – the principal at the player’s school receives a warning from the Alabama High School Athletic Association (AHSAA); a second red card – the player is ineligible for the next game; and a third red card – the player is ineligible for the remainder of the season.

Prior to 1997, misconduct card totals had to be kept by each team, and the coach was responsible for enforcing the penalty. With the new rules, the referee who gives the ejection must submit a report to the AHSAA, and the AHSAA is responsible for informing the school and seeing that the penalty is enforced.

In 1996, 649 game reports were sent by the head referee in each contest to this writer. In these 649 games, there were 545 yellow cards and 104 red cards given out. This resulted in an average of .84 yellow cards and .16 red cards per game.

In 1997, 513 game reports were submitted. In these 513 games, there were 486 yellow cards and 71 red cards awarded, resulting in an average of .95 yellow cards and .14 red cards for game.

In 1998, 747 game reports were submitted. In these 747 games, there were 612 yellow cards and 113 red cards. This resulted in an average of .82 yellow cards and .15 red cards for game.

As reported above, except for a slight increase in the number of yellow cards given in 1997, the change in the penalties given to players who receive red and yellow cards has had little effect on the average number of red and yellow cards given per game. Although there has been little change in the average number of cards given, there has been considerable criticism about the revised penalties from Alabama referees about the penalty changes.

In giving their opinion about the revised changes to the penalties for players receiving yellow and red cards, the following are some of the statements that were expressed:

1 “The penalty for yellow cards was too harsh under the old system, so I often refrained from giving out a yellow card.”

2 “Giving out a red card means that I will have to take the time to submit a report that will be sent to the school principal, who may then penalize the whole team. It makes me now reconsider if a red card is really necessary.”

3 “Recently, the overtime period for a tie game was changed from two ten-minute regular time and two five-minute sudden victory overtime periods to two ten-minute sudden victory overtime periods. This decrease in game time could have had an effect on the number of cards awarded per game.”

4 “If officials would have turned in game reports for all the games played, the results might have been different.”

5 “The changes were good, because schools do a good job in taking action against players who are ejected from games”

What are your feelings concerning player eligibility penalties for red and/ or yellow cards? Please let this writer know. E-mail: Joeman@USSA-SPORT.USSA.edu

Editor’s Comments: Dr. Joe Manjone is the Alabama State High School Association Soccer rules interpreter. He is also the region V soccer officials’ representative for the National Intercollegiate Soccer Officials’ Association. He is a National High School soccer clinician, and has been officiating high school soccer since 1959.

U.S. Sports Academy2013-11-27T19:07:18-06:00February 11th, 2008|Contemporary Sports Issues, Sports Coaching, Sports Facilities, Sports History, Sports Management|Comments Off

Portable Defibrillators Protect Fans, Players at High School Athletic Events

Submitted by: Linda Del Monte, R.N., Medtronic Physio-Control

In big cities, sports arenas are among the top five places where sudden cardiac arrest (SCA) occurs-but what about towns that don’t have major league stadiums? If little league or the varsity squad is the only game in town, that’s where the people will go, and that’s where SCA will happen.

SCA is one of the most common causes of death in the US, claiming about 325,000 lives each year. Until relatively recently, treatment for SCA-an electrical shock known as defibrillation-was usually administered either in a hospital or by emergency medical service (EMS) personnel. Innovative communities are looking for ways to improve access to defibrillation. They are equipping firefighters, police-and now high school coaches and athletic trainers-with automated external defibrillators (AEDs), allowing them to provide critical treatment before EMS arrives. The leading seller in the field is the LIFEPAK® 500 AED, manufactured by Medtronic Physio-Control of Redmond, Wash.

Unlike the models of defibrillators intended for use by paramedics, nurses and doctors, AEDs do not require extensive medical knowledge to understand or operate. The expertise needed to analyze the heart’s electrical function is programmed into the device, enabling trained professionals to respond to cardiac emergencies. For more information about Medtronic Physio-Control, visit the company’s website at http://www.physiocontrol.com.

U.S. Sports Academy2017-11-02T13:56:01-05:00February 11th, 2008|Contemporary Sports Issues, Sports Studies and Sports Psychology|Comments Off

Youth Risk Behavior Surveillance Systems Survey

Submitted by: Center for Disease Control

36.4% of high school students
smoked cigarettes during the past month, while 16.7% smoked cigarettes
on 20 or more days during the past month, and 9.3% used smokeless
tobacco.

Only 29.3% of high school students
ate five or more servings of fruits and vegetables during the
past day. 4.5% took laxatives or vomited to lose weight during
the past month. 4.9% had taken diet pills to lose weight during
the past month.

63.8% of high school students
did vigorous physical activity three or more days during the
past week. 20.4% did moderate physical activity five or more
days during the past week. 48.8% were enrolled in physical education
class. 27.4% attended physical education class daily.
–Center for Disease Control, based on a survey by the 1997 Youth
Risk Behavior Surveillance Systems survey.

U.S. Sports Academy2017-12-11T11:27:54-06:00February 11th, 2008|Contemporary Sports Issues, Sports Studies and Sports Psychology|Comments Off

International Physical Fitness Test

Submitted by: United States Sports Academy in cooperation with the General Organization of Youth and Sport (State of Bahrain)

FOREWARD

The United States Sports Academy, in cooperation with the Supreme Council for Youth and Sport, presents the Arab world with its own International Physical Fitness Test Manual based on norms collected and processed on Arab youth, ages 9 to 19. This fitness test is one of the few developed outside the Western world and is believed to be the only such test battery that measures the basic components of all physical activity, i.e. speed, strength, suppleness, and stamina.

This test was introduced to 199 physical education teachers by Dr. Thomas P. Rosandich on 15 January 1977 in Manama. This test was initially developed by the International Committee for Physical Fitness Testing in Tokyo in 1964 at which time Dr. Rosandich served that committee as its first secretary.

On January 16, this two-day test battery, made up of the 50-meter sprint, standing long jump, grip strength, 1000-meter run, 30-second sit-up, pull-up, 10-meter shuttle run, and trunk flexion, was administered to 500 boys of the Manama Secondary School. The test was coordinated by Dr. Bob Grueninger, Director of Fitness and Research and administered by him and Dr. Bob Ford, Dr. Lawrence Bestmann, Vic Godfrey, James Kampen, Bruce Mitchell, and Larry Nosse, along with their counterparts, the inspectors and teachers of the Ministry of Education.

The Academy faculty and its counterparts eventually tested over 20,000 boys and girls, but not before the components of the test were re-evaluated and modified to better reflect the environment in which it was delivered. The initial test information was presented by Dr. Rosandich and Dr. Grueninger at the First Middle East Sports Science Symposium (MESS I) in April of 1977. The physical performance tables were developed in coordination with the Academy team in Bahrain and the Chairman of Fitness and Research at the Academy’s home office in Mobile, Alabama, then located on the campus of the University of South Alabama. Instrumental in developing these tables were two computer experts, Dr. George Uhlig and Dr. Bill Gilley, both members of the Academy’s National Faculty.

During MESS II, in April of 1978, the Academy did a special study to evaluate the I.C.P.F.T. battery for possible revision. The Academy coaching team in Bahrain was joined by Dr. Richard Berger, Temple University, and Dr. Bob Stauffer, United States Military Academy, both members of the Untied States Sports Academy’s National Faculty. This combined team tested the Bahrain Defense Force personnel and reached the following conclusions, which in essence are reflected in this test manual.

1. The test battery was changed from a two-day test battery to a one-day battery for purposes of efficiency and because the test administered over two days in the heat of the Middle East impacted severely upon the individual students and their second-day performances.

2. The test battery was reduced from eight components to five components that reflected effectively those components needed in sport and eliminated costly equipment such as the hand dynamometer, that often malfunctioned in field testing.

The test battery is as follows:

1. 50-meter test, relative power, speed
2. Pull-up, relative strength, strength
3. 10-meter shuttle run, relative power, speed and suppleness
4. Back throw, absolute power, speed and suppleness
5. 1,000-meter run, aerobic/anaerobic capacity, stamina

The above test was coordinated by Dr. Grueninger and Dr. Gary Hunter with over 20,000 Bahraini children tested. The results of this test are found in this manual and were presented for the first time internationally by Dr. Rosandich during the Asian Games in Bangkok, Thailand, in December of 1978. Subsequently, the test battery was adopted in more than 21 nations. Since the initial presentation, the test has been modified by replacing the pull-up with the flexed-arm hang based on data collected in neighboring Saudi Arabia.

During MESS III, in April of 1979, the leadership of the International Committee for Physical Fitness Research, including the organization’s president, Dr. Ladislav Novak, and members, Dr. Leonard Larson (USA), Dr. Roy Shepherd (Canada), and Dr. Ishiko (Japan), attended the symposium, as observers of Bahrain’s leadership role in physical fitness, research and sport medicine. Bahrain, under the leadership of the Supreme Council for Youth and Sport, developed not only the finest sport medicine and research centers found in the Middle East but also programs reflecting research, such as this Physical Fitness Test Manual. Thus, the I.C.P.F.T. named Bahrain its research center for the Middle East. Subsequently, the Arab Sport Medicine Council moved its headquarters from Tunisia to Bahrain, which is yet another indication of Bahrain’s leadership in fitness and research.

The Academy has been privileged to work with the Supreme Council for Youth and Sport — now known as the General Organization of Youth and Sport — and its many constituencies, e.g. the Ministry of Education, the Ministry of Health, the Ministry of Interior, and the Ministry of Defense, in the development of this International Physical Fitness Test, which in fact is a major contribution to the world of sport education.

U.S. Sports Academy2016-10-14T15:04:38-05:00February 11th, 2008|Sports Exercise Science, Sports History, Sports Management, Sports Studies and Sports Psychology|Comments Off