SUCCESSFUL AGING: EXERCISE IN THE OLDER ADULT Aaron Vaughan, MD - PowerPoint PPT Presentation

SUCCESSFUL AGING: EXERCISE IN THE OLDER ADULT Aaron Vaughan, MD MAHEC Sports Medicine Director Primary Care Sports Medicine Asheville Orthopaedic Associates Sports Medicine Director Mission Health 12 January 2018

DISCLOSURES • I have no pertinent disclosures

“We don’t stop playing because we grow old; we grow old because we stop playing.” -George Bernard Shaw

“GETTING OLD”

WE ARE ALL ATHLETES

OBJECTIVES: • Review normal aging physiology • Exercise Prescription • Common Ailments and Associated Treatments • Art of Diagnosis: Diagnostic Ultrasound Demonstration

CASE REVIEW • 75 yo male tripped on carpet while at home and fell on hip. Unable to walk

HIP FRACTURES

HIP FRACTURES

“OLDER ADULT” • 65+ or 50-64 (with clinically significant chronic conditions and or functional limitation)- ACSM

WHAT IS “EXERCISE” • Lifestyle choices • Organized sports • Unstructured play • Household and Occupational tasks

WHY IS IT IMPORTANT • Top 10 Chronic Conditions • Arthritis • Hypertension • Hearing Impairment • Heart Disease • Cataracts • Orthopedic Impairment • Chronic sinusitis • Diabetes • Visual Impairment • Varicose Veins

EXERCISE AND AGING PHYSIOLOGY

PHYSIOLOGIC CHANGES WITH AGING • Decreased • Maximal heart rate • Muscle mass • Stroke volume and cardiac output • Muscle strength • Nerve conduction velocity • Balance • Muscle power • Proprioception • Muscle endurance • Gait velocity • Muscle contraction velocity • Gait stability • Muscle mitochondrial • Insulin sensitivity function • Glucose tolerance • Muscle oxidative enzyme capacity • Immune function • Bone mass/strength/density • Maximal and submaximal • Collagen cross-linkage, thinning aerobic capacity cartilage, tissue elasticity • Cardiac contractility

PHYSIOLOGIC CHANGES WITH AGING (CONT) • Increased • Systolic blood pressure • Diastolic blood pressure • Visceral fat mass • Total body fat

AGING AND AEROBIC CAPACITY • Peak between 15-30 • Declines with age • Approximately 10% per decade after age 25-30 • Anaerobic threshold: occurs at lower work rates

AGE-RELATED DECLINE: NORMAL

AGE-RELATED DECLINE (CONT) • Sedentary people lose large amounts of muscle mass (20-40%) • 6% per decade loss of Lean Body Mass (LBM) • Aerobic activity not sufficient to stop this loss • Balance and flexibility training contributes to exercise capacity

BENEFITS OF EXERCISE

BODY COMPOSITION • Increased muscle mass • Walking isn’t enough • Progressive resistance training • DM prevention? • Falls and fractures • Decreases in total body adipose tissue

PULMONARY • Training attenuates decline in lung capacity • Improve exercise tolerance

MENTAL HEALTH • Lower prevalence and incidence of depressive symptoms • Reversal of cognitive loss?

CHRONIC DISEASE MANAGEMENT

DIABETES/OSTEOPOROSIS • Insulin Resistance • Improves insulin sensitivity • Osteoporosis prevention and treatment • Stabilization or increase in bone density with resistive or weight bearing exercise

HIGH CHOLESTEROL/HTN • Exercise = improved profiles • Lower pressures in active individuals • 5-10 mmHg • Greater training effect in those with mild to moderate hypertension

CVD/PVD • Exercise training beneficial in PVD • Reduced claudication pain • Greater walking distance • Improved functional endpoints

ARTHRITIS/CANCER • Improved functional status • Faster gait • Less pain • Less medication use • Potential protective benefits with • Breast Cancer • Colon Cancer

EXERCISE PRESCRIPTION

ACSM GUIDELINES • Exercise 3-5 days each week • Warm up 5-10 minutes before aerobic activity • Maintain intensity for 30-45 minutes • Heart Rate Goals are variable • Gradually decrease intensity of workout, then stretch to cool down during last 5-10 minutes • If weight loss is goal, 30 minutes five days a week

EXERCISE PRESCRIPTION • Modes • Mode governed by: • General activities • Duration • Aerobic • Frequency • Resistance • Intensity • Flexibility • Balance

CONTRAINDICATIONS • Absolute • Relative • Inoperable Aortic • Acute illness Aneurysm • Undiagnosed chest pain • Cerebral aneurysm • Malignant ventricular • Uncontrolled diabetes arrhythmia • Uncontrolled hypertension • Critical aortic stenosis • Uncontrolled asthma • End-stage CHF • Terminal illness • Uncontrolled CHF • Behavioral problems • Musculoskeletal problems • Weight loss and falls

EXERCISE STRESS TEST • High Risk Individual • Generally no indication for individual planning mild to moderate exercise

RISK FACTORS (CONT) • Medications • Hypertension • Beta Blockers • RAA system • Diuretics • Pain • NSAIDs • Diabetes • Hypoglycemics

OTHER IMPAIRMENTS • Vision/hearing • Adaptive devices • Environmental issues

COMMON AILMENTS

WHAT WE SEE • Neck Pain • Conditions: • Neck Arthritis • Cervical Stenosis • Muscle Spasm • Chronic Headaches • Disc Problems • Pinched Nerves • Compression Fractures

WHAT WE SEE • Low Back Pain Conditions: • • Arthritis • Spinal Stenosis • Muscle Spasm • Disc Herniation • Pinched Nerves • Compression Fractures

WHAT WE SEE • Shoulder Pain • Conditions: • Shoulder Arthritis • Rotator Cuff Tears • Tendonitis • Bursitis • Shoulder Weakness • Shoulder Fractures

WHAT WE SEE • Elbow Pain Conditions: • • Arthritis • Tennis Elbow • Golfer’s Elbow • Tendonitis • Bursitis • Elbow Fractures

WHAT WE SEE • Wrist/Hand Pain • Conditions: • Wrist/Hand Arthritis • Finger/Thumb Arthritis • Wrist/Hand Tendonitis • Carpal Tunnel • Trigger Finger • Carpal Tunnel Syndrome • Dupuytren’s Contracture • Hand/Wrist Fractures

WHAT WE SEE • Hip Pain • Conditions • Hip Arthritis • Hip Fractures • Hip Tendonitis • Hip Bursitis • SI Joint Pain

WHAT WE SEE • Knee Pain • Conditions: • Knee Arthritis • Knee Tendonitis • Knee Bursitis • Baker’s Cyst • Knee Swelling

WHAT WE SEE • Ankle/Foot Pain • Conditions: • Ankle/Foot Arthritis • Achilles Tendonitis • Plantar Fasciitis • Ankle/Foot Fractures • Bunions • Arch Pain

HOW WE SEE IT

HOW WE SEE IT • Imaging

HOW WE FIX IT • Rehabilitation

HOW WE FIX IT • Bracing • Elbow • Hand/Wrist • Knee • Ankle

HOW WE FIX IT • Medications • Pain • Anti-inflammatories • Anti-spasm • Homeopathics

HOW WE FIX IT • Procedures

SUMMARY • We are all athletes • Exercise is essential (and fun!) • With aging comes physiologic challenges • Benefits are far reaching • Few reasons not to exercise • If you have questions, Ask • Know who to ask

THE ART OF DIAGNOSIS: DIAGNOSTIC ULTRASOUND

DIAGNOSTIC ULTRASOUND DIAGN GNOSI OSIS What we see first

DIAGNOSTIC ULTRASOUND WITH ULTRASOUND

DIAGNOSTIC ULTRASOUND Diagnosis Treatment Injections • • Bone • Joint Fracture/Fracture healing • • Knee Ex: Fracture classification • • Hip Shoulder • Tendon • SI • • Tendon partial or full thickness • Small Joint tearing • Tendon Sheath Tendonitis/Tendinopathy • • RTC • Ex: Achilles rupture % Tennis Elbow • Bursa • • Ligament • Subacromial Ligament Disruption • • Pes Anserine • Ex: UCL disruption of elbow • Greater Trochanter Nerve • • Muscle Carpal Tunnel • Muscle tearing • • Morton’s Neuroma Ex: Hamstring tears • • Cubital Tunnel

DEMONSTRATION

AAR AARON ON VAUGHAN, UGHAN, MD MD AARO RON.VAU N.VAUGHAN@MAH GHAN@MAHEC.NET EC.NET AVAUG AUGHAN HAN@ASHEV @ASHEVIL ILLEOR EORTH THO.COM O.COM 828-767-9693