Welcome back! Our next podcast series is focused on clinical programs and effective patient interventions. In this episode, exercise prescription is reviewed with strategies on how to develop and measure programs to improve strength and aerobic condition.

Here are the American College of Sports Medicine recommendations for exercise prescriptions for older adults discussed during this episode:

Summary of ACSM/AHA physical activity recommendations for older adults.
The current consensus recommendations of the ACSM and AHA with respect to the frequency, intensity, and duration of exercise and physical activity for older adults are summarized below. The ACSM/AHA Physical Activity Recommendations are generally consistent with the 2008 DHHS Physical Activity Guidelines for Americans, which also recommend 150 min/wk of physical activity for health benefits. However, the DHHS Guidelines note that additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration. The DHHS Physical Activity Guidelines stress that if older adults cannot do 150 min of moderate-intensity aerobic activity/wk because of chronic conditions, they should be as physically active as their abilities and conditions allow.

Endurance exercise for older adults:
FREQUENCY: For moderate-intensity activities, accumulate at least 30 or up to 60 (for greater benefit) min/d in bouts of at
least 10 min each to total 150–300 min/wk, at least 20–30 min/day or more of vigorous-intensity activities to total 75–150 min/wk, an equivalent combination of moderate and vigorous activity.

INTENSITY: On a scale of 0 to 10 for level of physical exertion, 5 to 6 for moderate-intensity and 7 to 8 for vigorous intensity.
DURATION: For moderate-intensity activities, accumulate at least 30 min/day in bouts of at least 10 min each or at least 20 min/d of continuous activity for vigorous-intensity activities.
TYPE: Any modality that does not impose excessive orthopedic stress; walking is the most common type of activity.
Aquatic exercise and stationary cycle exercise may be advantageous for those with limited tolerance for weight bearing activity.

Resistance exercise for older adults:
FREQUENCY: At least 2 days/wk.
INTENSITY: Between moderate- (5–6) and vigorous- (7–8) intensity on a scale of 0 to 10.
TYPE: Progressive weight training program or weight bearing calisthenics (8–10 exercises involving the major muscle groups of 8–12 repetitions each), stair climbing, and other strengthening activities that use the major muscle groups.

Flexibility exercise for older adults:
FREQUENCY: At least 2 days/wk.
INTENSITY: Moderate (5–6) intensity on a scale of 0 to 10.
TYPE: Any activities that maintain or increase flexibility using sustained stretches for each major muscle group and static rather than ballistic movements.

Balance exercise for frequent fallers or individuals with mobility problems:
ACSM/AHA Guidelines currently recommend balance exercise for individuals who are frequent fallers or for individuals with mobility problems. Because of a lack of adequate research evidence, there are currently no specific recommendations regarding specific frequency, intensity, or type of balance exercises for older adults. However, the ACSM Exercise Prescription Guidelines recommend using activities that include the following: 1) progressively difficult
postures that gradually reduce the base of support (e.g., two-legged stand, semi-tandem stand, tandem stand, one-legged stand), 2) dynamic movements that perturb the center of gravity (e.g., tandem walk, circle turns), 3) stressing postural muscle groups (e.g., heel stands, toe stands), or 4) reducing sensory input (e.g., standing with eyes closed).

The ACSM/AHA Guidelines recommend the following special considerations when prescribing exercise and physical activity for older adults. The intensity and duration of physical activity should be low at the outset for older adults who are highly deconditioned, functionally limited, or have chronic conditions that affect their ability to perform physical tasks. The progression of activities should be individual and tailored to tolerance and preference; a conservative approach may be necessary for the most deconditioned and physically limited older adults. Muscle strengthening activities and/or balance training may need to precede aerobic training activities among very frail individuals. Older adults should exceed the recommended minimum amounts of physical activity if they desire to improve their fitness. If chronic conditions preclude activity at the recommended minimum amount, older adults should perform physical activities as tolerated so as to avoid being sedentary.