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Introduction

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We don’t stop playing because we grow old; we grow old because we stop playing.

George Bernard Shaw

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Increasing numbers of older people perform regular physical activity that ranges from recreational walking and swimming or lawn bowls, to vigorous and/or competitive activity. The Veterans or Masters sports movements have grown rapidly and now provide competition at local, national, and international levels for an increasing number of older athletes. Variability in health and functional status among those of a similar age makes defining “older” by chronology difficult.

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PRACTICE PEARL

The American College of Sports Medicine and the American Heart Association use 65+ or 50–64 with clinically significant chronic conditions and/or functional limitation to define the “older” person.1

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While the cut-off point is relatively arbitrary, a prominent characteristic of relevance to older people and exercise is functional limitation. Physical limitations often prevent older people from engaging in vigorous high-intensity aerobic training.1, 2 Health benefits are apparent with less intense forms of exercise and virtually all older adults are recommended to be physically active.2

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This chapter focuses on:

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  • successful aging with the evidence for the considerable physiological and psychological benefits of exercise in the older person

  • how to minimize certain risks associated with exercise for older people

  • the potential interactions between medications commonly used by the elderly and exercise.

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Exercise program prescription for older people is discussed in Chapter 60.

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Successful aging

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Physical activity benefits all body organs as well as the psyche.36 Observational studies suggest that exercise and physical activity levels may have an important role in successful aging.

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Definitions of “successful aging” vary among studies. Elements include longevity, as well as survival free of chronic disease, impaired physical and cognitive functioning, and incident disability.79

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Midlife physical activity levels are inversely associated with survival and overall health status into old age.8, 9 Other important health outcomes that impact on independence in old age (such as functional status and disability) are also linked with physical activity.1013

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Among older adults at risk for disability, exercise interventions improve physical performance and measures of mobility disability,14 and benefits are sustained beyond the intervention period.15 These findings raise the possibility that exercise even at moderate levels (in particular, avoiding sedentary behavior) may prevent or delay disability and improve survival into older age. Achieving meaningful health benefits for older adults may require a less intense exercise stimulus compared with the general population.12

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The cardiovascular system

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The most dramatic benefits of exercise are on the cardiovascular system.16, 17 Exercise interventions in older people with coronary heart disease are associated with decreased morbidity, mortality, and symptoms, and reduced cardiac rehospitalizations....

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