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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

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  1. 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

  2. DISCLOSURES • I have no pertinent disclosures

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

  4. “GETTING OLD”

  5. WE ARE ALL ATHLETES

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

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

  8. HIP FRACTURES

  9. HIP FRACTURES

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

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

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

  13. EXERCISE AND AGING PHYSIOLOGY

  14. 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

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

  16. 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

  17. AGE-RELATED DECLINE: NORMAL

  18. 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

  19. BENEFITS OF EXERCISE

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

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

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

  23. CHRONIC DISEASE MANAGEMENT

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

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

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

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

  28. EXERCISE PRESCRIPTION

  29. 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

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

  31. 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

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

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

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

  35. COMMON AILMENTS

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

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

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

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

  40. 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

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

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

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

  44. HOW WE SEE IT

  45. HOW WE SEE IT • Imaging

  46. HOW WE FIX IT • Rehabilitation

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

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

  49. HOW WE FIX IT • Procedures

  50. 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

  51. THE ART OF DIAGNOSIS: DIAGNOSTIC ULTRASOUND

  52. DIAGNOSTIC ULTRASOUND DIAGN GNOSI OSIS What we see first

  53. DIAGNOSTIC ULTRASOUND WITH ULTRASOUND

  54. 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

  55. DEMONSTRATION

  56. 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

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