Barbara Resnick, PhD, CRNP, FAAN, FAANP


Topics in Advanced Practice Nursing eJournal. 2001;1(1) 

In This Article

Exercise Benefits and Recommendations

Exercise can certainly be viewed as a source of primary prevention, and consistently has been noted to benefit the older adult. There is increasing evidence to suggest that habitual aerobic exercise, such as walking, cycling, circuit weight training, swimming, and jogging, can improve strength and aerobic capacity.[39,40]

Aerobic exercise is defined as physical activity that primarily stimulates mitochondrial oxidative metabolism. Aerobic exercise can also prevent and help manage diseases such as osteoporosis, coronary artery disease, and noninsulin-dependent diabetes mellitus.[41] It can also decrease the risk of falling,[42] reduce physical disability,[43] improve sleep,[44] enhance mood and general well-being,[45,46] provide added physiologic reserve, and slow development of disability.[47]

The physiologic effects of aerobic exercise training include:


  • Cardiovascular improvements

    • decreased heart rate, blood pressure, sympathetic discharge, and peripheral vascular resistance

    • increased stroke volume at any given work level[48]

  • Overall increase in maximum aerobic capacity (VO2 Max, or the amount of oxygen consumed by the body)[49]

  • More efficient use of oxygen by skeletal muscles, thus decreasing myocardial oxygen requirements[50]

  • Increase in brain serotonin synthesis[51]


To achieve the benefits of exercise, training should begin at low levels and gradually increase to the training zone, or target heart rate (THR). The THR is 60% to 80% of the individual's maximal heart rate (MHR), which is 220 minus the age.


Exertion within the training zone of 60% to 80% of the MHR for 20 to 40 minutes 3 times per week for several weeks is needed for conditioning. Evidence of conditioning can be measured by:


  • VO2 Max (maximum amount of oxygen consumption in the body);

  • Individual's ability to achieve and sustain THR during exercise; or

  • Improvement in function and timed performance.


The extent of screening necessary before an older patient starts an exercise program depends on the individual's health status. The American College of Sports Medicine


recommends that individuals be categorized as:


  • Low-risk: Healthy with no more than 1 risk factor for coronary heart disease (high blood cholesterol, high blood pressure, diabetes, cigarette smoking, obesity, sedentary lifestyle).

  • Higher-risk: Patients with 2 or more risk factors for coronary heart disease. (This category is further divided into 2 groups -- patients with symptoms, such as chest pain or shortness of breath, or those without symptoms)

  • Chronic disease: Patients with chronic diseases such as heart, lung, or metabolic disease.


Once the prospective exerciser's risk level has been categorized, the provider can decide whether a complete medical evaluation and/or stress testing is needed before starting an exercise program ( Table 3 ).

All practitioners working with older adults should recommend regular exercise and establish a method of motivating older adults to exercise. Table 4 outlines the WALC intervention, which can be used to help sedentary older adults initiate and adhere to a regular exercise program.[31]

Follow-up visits with the practitioner should focus on adherence to the exercise plan, and the patient should be given positive reinforcement for any exercise activity. The positive outcomes of regular exercise, both physical and psychological, have a major influence on helping older adults to adhere to exercise programs.[53] Therefore, it is important to help the older patient recognize these benefits, such as reduced blood pressure, increased muscle strength, or improved balance, and help them connect these improvements to their increased exercise activity.


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