Pain in its myriad forms is by far the most common complaint of patients to physicians. It is a common  elderly people  problem that we need to understand it well. In evaluating these complaints, the physician must consider the vast array of painful stimuli, including visceral sources that could cause pain in a particular area, as well as the functional anatomy and kinesiology of the region involved. Musculoskeletal pain most commonly originates in the low back, neck, or shoulder, but may radiate to adjacent areas such as a leg or arm. The history should provide answers to several questions concerning the nature of the complaint:

1. Is the pain elicited by motion or other stress of a structure either remote or proximal to the area in which pain is perceived?
2. Is there a history of symmetry or bilaterality that could suggest a systemic or otherwise diffuse process?
3. Are the symptoms produced only by activities of certain body parts or by any exertion?

Answering these questions may help determinate whether the problem is visceral or musculoskeletal in origin.

The physical examination begins when the patient first walks into the office, when he or she is less aware of being examined, and ease of movement, smoothness of gait and facial expression are readily observed. Active and passive motion of the potentially defective body part and palpation of soft tissue and bony structure is important. It is as important as a neurological examination. Using this approach to differentiate musculoskeletal pain syndromes from other more serious disorders can avoid delay in making an accurate diagnosis.

In some cases, diagnosis can be confirmed only by ruling out more serious conditions. X-Rays, electromyography, nerve conduction studies, myelography, CT scan, bone scan, blood chemistry, and other appropriate laboratory tests may then be important sources of differential diagnosis.

Groups, of course, do not have heart attacks; individuals do. What impact do stressful life situations have on individual behavior and physiology? And, conversely, what predispositions in behavior and biology will mediate the individual’s stress response? Questions about the cause of coronary heart disease and the psychosocial forces that influence its development have also been studied on an individual level.

What is the connection between precursors of heart disease and social or occupational stress? One fascinating relationship has been discovered: the same kinds of stress linked in group studies with increased incidence of heart attack risk have been found, on the individual level, to elevate levels of blood cholesterol, to raise blood pressure, and to cause people to smoke more. One group of studies related the physiological symptoms of stress to particular stressful periods in the lives of tax accountants and medical students. Marked increases in blood cholesterol were found in the accountants as April 15 deadline for filing federal tax returns approached, and significantly higher levels of cholesterol were found in the students on the day before their examinations. These studies suggest that increased work load under the pressure of a deadline may account for the physiological changes found.

The characteristic occupations of those with a high risk of heart attack offer some clues about job related stress. Many studies suggest that the jobs of high risk people generally entail a high degree of responsibility for others, comparatively high work overloads, and role conflicts, among other stresses.  The impact of a person’s occupational life has also been measured in terms of individual attitudes, such as job dissatisfaction, and ratings of job tediousness and job difficulties. These stresses correlate with coronary heart disease, independent of specific occupational categories.

The difference in the pattern of heart attack incidence between men and women has also been explained in terms of occupational stress. Black and lower class women are more likely than white middle class women to suffer from work stresses, and the increase in employment among women over the past decade parallels increases in heart attack rates among women. Apparently it is the stressful situation.

The incidence of heart attack is also high in senior citizen. Learn how to cope with this problem using Health Insurance Medicare Wikipedia.

2.       The average baby born today can expect to live to age 74.7. Increases in life expectancy at birth during the first half of this century occurred mainly because of reductions in infant mortality, and recently because of decreasing mortality from chronic diseases.

3.       Prominent aging-related concerns include the quality of life in old age, the high prevalence of chronic diseases, osteoporosis, and senile dementia among the elderly, and the financial impact.

4.       Aging refers to the normal yet irreversible biological changes that occur during the total years that a person lives. There are several theories of aging, including the “error” and “program” hypotheses. As a person ages, many changes take place in the body (summarized in the text).

5.       There is great similarity between the physiological changes that accompany aging and those that accompany inactivity. The identifying characteristics of both aging and the disuse syndrome are a decrease in cardio respiratory function, obesity, musculoskeletal fragility, and (among the inactive) premature aging.

6.       Most researchers that have evaluated the effects of aging on the cardio respiratory system have focused on work capacity, or VO_2max, VO_2max normally declines 8-10 percent per decade for both males and females after 25 years of age.

7.       Declining physical activity is probably responsible for at least half of the drop in VO_2max with age. The age-related decline in maximal heart rate may be a major factor. Even intensive training during middle-age does not appear to prevent the maximal heart rate from decreasing as one ages.

8.       The elderly can recapture decade’s worth of VO_2max with appropriate (gradual) training.

9.       The data suggest that the overall rate of loss of cardio respiratory function is similar for active and inactive people, but that at any given age the active conserve more function.

10.    Whether older people respond to physical training to the same degree as their younger counterparts is not certain. Several studies suggest the elderly can respond to physical training over an 8-20 week period in a manner expected of younger people.

11.    In general, the same basic exercise prescription principles used for younger adults can be applied for the elderly, but with greater caution and slower progression

12.    Regular physical activity can have a beneficial impact on life expectancy by reducing the life-shortening effects of the various chronic diseases. However, there is little or no evidence to support the contention that physical activity can lengthen the potential life-span (the Maximum age obtainable by a particular member of the species).

13.    Osteoporosis is characterized by decreased bone mass and increased susceptibility to fractures. The mainstays of treatment include estrogen replacement, adequate lifelong calcium intake, and appropriate exercise.

14.    Exercise helps build up bone mineral mass by inducing electric currents in the bone. Weightlessness and bed rest can cause a dramatic loss in bone mass. Cross-sectional studies show that athletes have denser bones than sedentary people. Preliminary studies show that postmenopausal women can retard bone mineral mass loss, or even increase bone density with appropriate exercise.

15.    Health habits are clearly identified as a strong factor in life expectancy. However, there is no research support for the ability of lifestyle habits to lengthen the life-span.

Incoming search terms:

• physical activity elderly
• physical activity seniors

There is good data to support the fact that humans lose bone mass rapidly when gravitational or muscular stress on the legs is reduced, as it is with weightlessness, bed rest, or spinal cord injury. A healthy person confined to bed rest for 4 to 36 weeks can lose an average of 1 percent of his bone mineral content per week. On the other hand, when gravity stress or muscle movement stress is applied to the bone, the pressure will produce an electric current (piezoelectric effect). This tends to build up te bone mineral mass.

There is also substantial data showing that athletes have a greater bone density than sedentary people. The density appears to be related to the amount of stress exerted on the bones by the particular athletic activity. Walking, running, and racket sports maintain leg and spinal bone mass more effectively than such non-weight-bearing activities as bicycling and swimming. In descending order, the athletes with the greatest bone mineral mass are weight lifters, shot-putters and discus throwers, runners, soccer players, and finally, swimmers.

Spinal BMC is significantly higher for those participating in both aerobic (>40 miles/wk running or >6 hours/wk aerobic exercise classes) and weight-bearing regimens (>6 hours/wk rigorous weight lifting) than for sedentary people or people participating only in aerobic activ­ity.

Other studies have shown that competitive mas­ters swimmers have significantly greater bone mineral content than non-athletes. People with higher VO_2max values have greater bone mass in the femoral neck, lumbar spine, and forearm. A significant relationship has been found between lifetime physical activity and bone area among postmenopausal women.Signifi­cantly higher BMC has been measured among women who maintain an active lifestyle, particularly during their pre menopause years.

Some researchers feel these differences may arise from factors of heredity and self-selection. In other words, people who tend to do well in sports competi­tion tend to have strong, dense bones to begin with. Although this may be true to a certain extent, studies comparing the active and inactive arms of tennis play­ers show differences in bones density. For example, in one study comparing the bone density of ten profes­sional tennis players with that of non-athletes, density was 15 percent higher in players’ non dominant arm and 39 percent higher in their dominant arm.

While it is well-known that gravity and muscle force exerted on the bone will increase bone size and density, and that inactivity caused by weightlessness and bed rest will lead to bone loss, there has been controversy over whether exercise can delay bone aging. Recently, however, several excellent stud­ies have provided preliminary evidence that exercise may help counter bone mineral mass loss among women

In one three-year study of 30 elderly women (mean age 81), half participated in a 40-minute program three times a week, and half engaged in no formal exercise. The sedentary control group had a bone mineral con­tent loss of 3.28 percent during the 36 months; while the physical activity group had a 2.29 percent gain.

In another study, of 3—4 years of regular exercise for 200 women ages 35-65, two-thirds exercised for 135 minutes per week, whereas one-third remained sedentary. After 3 years, bone mineral mass decreased 7.2 percent among the sedentary group, but only 3.0 percent among the exercising women.

In another study, postmenopausal women who exercised at 70-90 percent VO_2max (jogging, stair climb­ing, walking) for 50-60 min, three times weekly for 17 months, increased their lumbar bone mineral content six percent, which then fell by five percent after 13 months of no exercise; this compared to a one percent loss for a matched sedentary group.

The Surgeon General has concluded that “until better information becomes available, 3 to 4 hours of weight-bearing exercise per week is potentially benefi­cial to the skeleton and could represent a safe, low-cost method for maintaining bone mass.”

Incoming search terms:

• physical activity

Osteoporosis afflicts 15-20 million American over the age 45, each year causing an estimated 1,3 million fracture. Loss of bone mineral content (BMC) is an almost universal phenomenon with increasing age among white men and women in United States. Among those who live to be 90,32 percent of women and 17 percent of men will have suffered hip fractures, leading to death in 12-20 percent of the cases and to long term nursing home care for many of those who survive. The cost of osteoporosis is the United States has been estimated at $7-10 annually.

RISK FACTORS

Without effective preventive measures, the cost of osteoporosis is bound to increase along with the rapid increase in the number of older Americans^. Prevention is important to counter both financial burden and the limited effectiveness of treatment once the fracture has occurred.

We don’t really know why some people develop osteoporosis and other do not. Bone mineral content (BMC) varies considerably among 25 years old and 70 percent among 80 years old. Aging itself, the loss of sex hormones at menopause, and genetics all play a role. Recent studies are also showing that BMC is lower among those with no family history of osteoporosis^.

Bone is a spongy protein matrix which crystal of calsium and phosporus salts are embed. From birth until death,boe tissue is continually being formed, broken down and reformed in a process called remodelling. The cell that break down bone are called osteoclasts, and those that build bone are called osteoblasts.

Peak bone mass is achived at about age 35 for cortical bone (compact outer saft bone). And earlier for trabecular bone (spongy,internal end bone). Once peak bone mass is reached, osteoclast activity is greater than osteoblast activity, and adult begin to slowly lose bone mass.

Bone mass is aproximately 30 percent higher among men tha women an aproximately 10 percent among black sthan whites. Over their lifetimes, women lose about 35 percent of their cortical bone and ass is an important factor explaining why some develop osteoporosis and bone fractre an others do not differences in bone architecture and strusture also appear to be important.

At menopause, women normally ave an accelerater loss of bone mineral mass (2,5-5 percent per year) for several years. The result is that by the age 65,50 percent of all women have bone mineral density below the normal fracture threshold of a 20 years old woman.

Testing for osteoporosis is more widely available now, with costs ranging from $40-$300 depending on the method.

The role of dietary calcium in determining peak bone mass is uncertain^. Some studies have suggested that when calcium intake has been appropriate, a greater bone mass is developed in early adlthood, decreasing thee risk of age-reated bone loss.  When calcium intake too low early in life (probably below 500mg a day, peak bone mass) may be lower than what is considered optimal.

For example, people with a lifelong low intake of dairy products because of lactase deficiency have an increase incidence of osteoporosis American women (ages 19-50 years) average 650 mg of dietary calcium a day, men 920 mg. These amountsare close to 800 mg Recomended Dietary Allowance. In general, a lifetime of adequate calcium intake, coupled with adequate levels af serum esterogens appear to maximize bone density after menopause.

At present, studies of the effect of calcium supplementation on age-related bone loss are inconclusive. Some studies have shown that calcium supplementation can suppress bone loss, others have not. This relationship is complicated by the fact that age it self may influence both the intestinal absorption of calcium and the skeleton’s ability to utilize the calcium. Decreases in the ability of the intestine to absorb calcium may begin as early as age 30 for some or as late as age 60 for others.

There is a potential of kidney stones with excessive calcium supplementation. The rate of absorption of elderly osteoporotic women can be improved by giving vitamin D supplements. In general, the postmenopausal women most likely to benefit from calcium supplementation are those wo otherwise have low calcium intakes.

It is recommended that women at high risk for osteoporosis increase their calcium intake by consuming calcium-rich foods—which include low-fat dairy products, leafy green vegetables, and nuts and seeds. Other important lifestyle habits for decreasing the risk of osteoporosis include avoiding cigarette smoking, restricting alcohol, and engaging in regular physical activity.

At present, estrogen replacement therapy is the best known sadeguard against osteoporosis for postmenopausal women. Although tis treatment has been associated with increased risk of developing endomentrial and other cancers, many physicians believe the association is relatively weak, especially at lower doses, and prescribe estrogen in the belief that the risk of osteoporosis is much more significant.

Incoming search terms:

• benefits of vitamin D in elderly
• Black People With Osteoporosis
• osteoporotic woman
• people with osteoporosis
• osteoporosis risk factors
• vitamoin b-12 deficiency elderly exercise
• osteoporosis
• old woman osteoporosis picture
• old person fracture
• old age people with osteoporosis

This has the same statistical impact (in epidemiological research terms) of removing cancer from the United States. In practical terms, because even sedentary people burn 1000 Calories a week in physical activity, this improvement in longevity can be gain by walking or jogging 8-10 miles a week.

A summary of literature on the effect of exercise of longevity in animal showed an increase in life expectancy when exercise initiated early in life. However, when exercise has been started late in life, there has been little effect on the survival of old rats. Another study suggests that there has been an improvement in the longevity of rats who voluntarily ran one to four miles each day in activity wheels. However, the active rats did not show the true increase in life span.

Perhaps the major benefit of exercise for the elderly is that it can help improve their motility and quality of life. Exercise can contribute to vigor and vitality, and can counteract the decrease in function and other troublesome symptoms of old age.

In the Sport Medicine Insight at the end of this chapter, the relationship of other health habits such as diet to life expectancy will be reviewed. In general, regular physical activity can have a beneficial impact on life expectancy by reducing the effect of chronic disease such a heart disease, obesity and diabetes. However, there is a little or no evidence to support the connection that physical activity can lengthen the lifespan (the maximal obtainable age of a particular member of the species).

• Stress the importance of exercise for elderly patients, explaining in detail its physiological and psychological benefits.
• Obtain a complete and reliable medical history and perform a physical examination, employing exercise testing for quantification of cardiovascular and physical fitness as appropriate, before the specific exercise prescription.
• Maintain an active interest in their exercise practices with appropriate follow-up.
• Encourage all patients to establish an exercise program as a lifetime commitment in preparation for their later years.
• Walking, with gradual progression, is a most convenient and adaptable form of exercise for the elderly. Other everyday activities such as climbing stairs and gardening are encouraged.

In general, the same basic principles used for younger adults can be applied, but with greater caution and slower progression. Older people can improve their fitness, but do need more time for adaptation, along with the realization that on the average, training for younger people produces higher absolute values.

With an increasingly older population there is an urgent need for health practices that can prolong adult vigor and hopefully delay the onset and progression of chronic diseases. In an aging society, prolonging active life expectancy, not just disabled existence, is an important goal. Medicated survival by the elderly is not the goal, and exercise is one factor, along with other lifestyle habits, that can improve the quality of life.

Incoming search terms:

• exercise elderly
• exercise program form for old people
• stairs elderly
• old people doing exercise
• activities for elderly
• elderly people stair climbing
• elderly on stairs
• walking stairs seniors
• elderly people gardening
• exercising elderly people

Whether older people respond to physical training to the same degree as their younger counterparts is not certain. Several studies suggest that elderly people can respond to physical training over an 8-20 week period in a manner expected of younger subjects. For the elderly lower intensities of training can be effective in the early stages, probably because of the low initial level of fitness.

In general, aerobic capacity can be improved at nearly all ages except perhaps after age 75. Dr.Pollock of Florida State University has shown that men 49-65 years of age responded to an endurance training program (3 sessions per week, walk-jog, 30-45 minutes, for 20 weeks) with an increase of 19 percent in VO_2max   the relative values being what would be expected of younger men, with the absolute values somewhat lower.

With extreme aging, however, the ability to engage in physical exercise declines. Training the cardio respiratory system of the elderly is possible only when adequate intensity, frequency, and duration of effort is made.

The elderly are frequently divided into three approximate groupings: the young old, or those 65-74 years of age; old, or 74-87 years of age; and very old, or greater than 84 years of age. The question of whether regular cardio respiratory exercise can improve aerobic power for old to very old people has received little attention; several studies have shown that regular cardio respiratory exercise by the old to very old may have little effect on aerobic power or other metabolic parameters. At this extreme age, the aging process may dominate so powerfully that few improvements in cardio respiratory fitness are possible. In addition, health problems and a lack of motivation often prevent many people over the age of 75 from engaging in appropriate amounts of exercise.

Musculoskeletal Training

Strength seems to peak in the third decade, followed by a plateau through approximately the age of 50, followed in turn by a 20-percent loss of strength by age 65, and progressing further as age increases.” Much of this is due to the loss of muscle mass. Resistance training can result in increased strength for both elderly men and women. However, hypertrophy is decreased, and (more importantly) ability to recruit motor units is increased. Joint flexibility can also be improved when elderly people engage in appropriate range of motion exercise.

Body Composition Changes

Aging brings the accumulation of fat and a substantial loss of muscle mass. Loss of muscle mass can be as high as 10-12 percent, and can occur with no appreciable loss in overall body mass. Weight gain generally continues unchecked from age 25 to age 50. A gain in body fat of approximately 27 pounds is likely from age 20 to age 55, with a concomitant loss of 7 pounds of lean tissue. Men in their 80s can lose another 20 pounds of muscle mass, while gaining 7 pounds of body fat after age 55.

However, elderly people can have a level of body fatness similar to that of younger people if they remain consistently physically active and control food intake throughout life. In one study of 13 male and 25 female elderly people, four one-hour exercise sessions per week led to significant reductions in body fat.

Although short-term reductions in body fat are possible, however, regular exercise may not completely counter the usual age-related changes in body composition. In the study of master athletes discussed earlier in this chapter, fat weight increased an average of about 2.5 pounds during a 10-year period, while fat-free weight dropped 3-6 pounds despite heavy training. Their aerobic training (about 30 miles per week of running) did not appear to protect fat-free weight. It may be necessary to add strength training to exercise regimens of adults as they age to maintain fat-free weight.

Incoming search terms:

• elderly jog
• cardiorespiratory
• physical changes of the elderly
• elderly exercising
• physical training
• elderly cardio exercise
• respiratory elderly
• aerobic exercises for elderly
• exercises for respiratory system
• physical exercise for elderly

Some researchers have suggested that even if physical activity and body composition are kept constant, deterioration caused by the aging process itself results in a decline in VO_2max    of roughly 5 percent per decade. However, other researchers have shown that intensive training can counter the drop in VO_2max     for at least 10 years during middle age. Researchers from San Diego followed a group of active men (ages 45 to 55) for 10 years, and found no loss in VO_2max    as a result of exercising three hours per week at 86-percent capacity. It took this amount of activity, however, to counter the usual age related decrease in VO_2max. However, after 20 years of follow-up with the same group of men, despite remaining active 3 to 4 days a week, VO_2max    declined from 44.4 to 38.9 ml.kg^-1min^-1 (12 percent or 0.27  ml.kg^-1min^-1 per year).

Data from another 10-year study of 24 master track athletes showed that athletes who maintained intensive training (35 miles/week) during the 10-year period we able to maintain a VO_2max of a 54 ml.kg^-1min^-1. Athletes who remained active, but less intensively (24 miles/wk), experienced a 12.6-percent decrease in VO_2max (from 52.5 to 45.9 ml.kg^-1min^-1.) Maximal heart rate for all master athletes showed a consistent 7 beats/min drop over the 10-year follow-up period. The researchers concluded that physical training in itself does not maintain the maximal heart rate.

So in summary, although intensive exercise may forestall the drop in VO_2max  during middle age, eventually the aging process appears to dominate, and there will be a drop in VO_2max  when VO_2max  is high early in life, as is the case with former endurance athletes, even intensive training will not sustain it at the same level in later years. Within the age range of 60-65 years, data suggest that some reduction in VO_2max  is inevitable even if very intensive training is maintained.

Mavis Lindgren has run between the ages of 70 and 82 years. Despite maintaining a training regimen of 40-60 miles per week during this 12-year span, her marathon times have become progressively slower. Probably the most important factor affecting this decline is that although the quantity of training has remained the same, the intensity of her training sessions has probably diminished over time.

Incoming search terms:

• master athletes
• elderly vo2 max
• physical exercise aging