As they age, adults lose significant amounts of flexibility and strength, which can lead to limited overall mobility. In many cases, these losses are not, as some might think, an inevitable aspect of the aging process; instead, they are often a result of inactivity.
The big question, though, is not necessarily why these losses occurred (illness, injury, etc.), but how to reverse them and thereby improve the quality of your life. Fortunately, research has shown that stretching and exercise can produce the same percentage of improvement in range of motion (ROM ) or flexibility in elderly people age 63 to 88 as they do in younger people age 15 to 19. So it is never too late to start!
Increased activity causes changes in many of the body's systems, however, including the heart rate, breathing patterns, circulation, and metabolism. It is, therefore, very important to discuss any planned changes in your diet and activity with your primary healthcare provider before starting a new program.
Most individuals cannot and do not want to exercise hard; they do, however, want to feel better and to have more energy for their activities of daily living (AD Ls). The more fit you are, the more capable your body is of delivering adequate blood and oxygen to your organs (heart, lungs, brain, etc.) to sustain higher levels of physical and mental activity. The balancing act is to gradually progress your movement- related activities (such as exercise) without exhausting yourself to the point that you can't perform your AD Ls.
Measuring Improvement
Exercise specialists use the parameters of Frequency (how often), Intensity (how strenuous), and Duration (how long) to measure an individual's improvement in exercise and activity capability. These parameters will work for you too. Progressing an activity means:
-
Doing it more often (walking to the mailbox two times a week, then three, etc.)
-
Doing it at a higher intensity level (when bringing groceries in from the car, carrying two small bags, then two medium bags, etc.) OR
-
Doing it for a longer period of time (standing and folding one full load of laundry, then two, etc.).
To keep from overstressing your body's systems when progressing an activity, it is never a good idea to increase more than one of these parameters at a time. Though frequency and duration are relatively easy to monitor, measuring intensity is another matter and how you decide to do it will depend on your individual preference.
Heart Rate
One way to measure the intensity with which you are doing an activity is through monitoring your heart rate (in beats per minute). You can know your heart rate by taking it manually at the radial artery on the thumb side of your inner wrist or with a portable heart rate monitor, which is available at most fitness/sports stores. The maximum heart rate (MHR ) of an individual can be estimated mathematically by subtracting his or her age from 220 [220 – person's age = MHR ]. For example, the estimated MHR of a 65-year-old would be 155 beats per minute [220 – 65 = 155]. The changes in your actual heart rate (beats per minute) during the various times you do an activity will help you determine your progress. As you improve your activity tolerance, you should be able to do the same activity with a lower heart rate.
Rating Perceived Exertion
An easy and practical method for monitoring intensity of activity is with a rating perceived exertion (RPE ) scale. Through this method, individuals can check how they are feeling at any given moment. The Modified Borg Scale provides a set of numerical values that are assigned to levels of exertion. At the end of, or at any time during, an activity, you can determine your intensity level by matching it to one of the numbers or exertion levels on the scale. As your fitness improves, you should be able to do the same activity with a lower exertion score.
MODIFIED BORG SCALE |
|
Numerical Rating |
Exertion Description |
0 |
Nothing |
0.5 |
Very, very easy |
1 |
Very easy |
2 |
Somewhateasy |
3 |
Moderate |
4 |
Somewhat hard |
5 |
Hard |
6 |
|
7 |
Very Hard |
8 |
|
9 |
|
10 |
Very, very hard |
Source: Borg, G. (1982). “Psychological Bases of Perceived Exertion,” Medicine & Science in Sports & Exercise, 14:377-387.
The Talk Test
The talk test is an excellent method of monitoring activity intensity in individuals who have a low level of activity tolerance or who are just starting a conditioning program. These individuals should be able to breathe comfortably throughout the duration of the activity with a slight increase in respiration (breathing) rate. Breathlessness and difficulty stringing two or three words together in conversation indicates that you are exceeding your activity threshold and should slow down or rest. Again, as conditioning improves, you should be able to perform the same activity without becoming breathless.
You may have noticed that I have not talked about specific exercise programs. For many deconditioned individuals, the household activities mentioned in the preceding paragraphs can be “exercise” enough and may be more valuable to their quality of life. There are plenty of options for increasing activity tolerance in the performance of AD Ls and then progressing on to a walking program, arm exercises, aerobics performed in a chair, or a gym membership.
Energy Conservation
Now, let's talk about energy conservation and rest. Rest means preserving and maintaining energy for specific mental and physical activities. Energy conservation includes task simplification, such as separating a job like doing laundry into two or three manageable activities (sorting, moving to washer/dryer/folding area, folding/hanging, putting away) with rest periods in between that allow you to complete the original job without it exhausting you.
Organization is an important aspect of energy conservation. Once you come downstairs in the morning, you don't want to be running up and down the stairs for medications, a sweater, your television guide, or the portable phone. Try to plan ahead for your immediate needs. Make a list of errands and shopping and see what you can combine or what you can split up into more manageable tasks.
When you are resting or relaxing in the day, you don't have to be lying down sleeping. You can also perform diversionary activities, such as knitting, reading, doing crossword puzzles, or playing solitaire. Rest intervals as short as four or five minutes allow muscles to relax and facilitate the restoration of energy stores. Consequences of inadequate rest are muscle fatigue and central nervous system fatigue as the brain sends weaker impulses in order to protect the body.
Striking a Balance
One of the most important aspects of balancing activity progression and energy conservation so that you'll be physically fit AND have the energy do the things you want and need to do is planning.
If you work too hard on activity progression at the wrong time, you may be too tired to do the other things you need to do. If you try to conserve your energy too much, you won't get in the exercise you need. If you have a pretty good idea of your plan for the day, however, you'll know when you need to conserve energy and when there is a good opportunity to work on your activity progression.
If you have a wheelchair, for example, you could use it early in the day to maintain your energy stores for the evening when you might want to go out wearing your more energy-intensive prosthesis. Learn how to perform AD Ls, such as making a bed or emptying the dishwasher, from your wheelchair. If you are a bilateral lower-limb amputee, you might even want to make up your bed while you are sitting on it instead of getting up, putting on your prostheses, and then walking around the bed as you make it up. You'll save a lot of energy this way for doing things later. It doesn't make sense to exhaust yourself walking around the mall all day in your prostheses and then expect to have a birthday dinner with your grandchild and stay awake for the latenight news. You might want to use a wheelchair during your mall trip and then wear your prostheses to the birthday dinner. Think about it. There are probably a lot of ways you can find to exercise AND take advantage of the principle of energy conservation in your own life. It's all about keeping your body fit AND having the energy to do all of the things you want and need to do. Make a choice; choose to do both.
About the Author
Anne F. Street, MSPT, Prosthetist, CPI, STS,
received her Bachelor's Degree in Sociology
and Education and her Master's Degree in
Physical Therapy. She is also a certified Pilates
instructor, has a certification as a strength training
specialist, and recently completed the California
State University at Dominguez Hills' Prosthetics Program. She is
practicing in Melbourne, Florida, at Brevard Prosthetics, Inc.
