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THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 12 - DECEMBER 98


ACSM Report Stresses Strength Training for Seniors

The American College of Sports Medicine (ACSM), in issuing its first position statement (1) on aging and exercise, stresses the importance of strength training for older people. Among other recommendations, the report says that frail older people who are starting to exercise should begin with strength training before they launch an aerobic regimen.

The report, released in June at the ACSM annual meeting, endorses flexibility and balance training as well as aerobic and strength training. It offers quantitative exercise guidelines for the frail elderly but is more general in its recommendations for other older people.

Recommendations contained in this report are based on 248 research studies on exercise and aging, whereas the ACSM's general exercise recommendations (2), also released in June, are based on the body of research about exercise and general health.

"Aging is a very complex process; it involves a great many variables that interact with one another, but physical activity seems to cut across all of them and contribute to the physical and psychological well-being that defines healthy aging," said Robert S. Mazzeo, PhD, who chaired the writing group, in a statement released by the ACSM. Mazzeo is a professor in the department of kinesiology and applied physiology at the University of Colorado at Boulder.

Mazzeo says that though the paper represents the state of the art regarding exercise and aging, the field is still in its infancy and many questions have not been answered. "The major question is dose response, and there are still a lot of unknowns regarding type and amount of exercise," he told The Physician and Sportsmedicine.

According to an ACSM press release, 30 years from now more than 70 million Americans will be older than 65, and those older than 85 will be the fastest-growing group. Thus, the ACSM is focusing more attention on aging, Mazzeo says, noting that the group held a roundtable discussion in September to identify future research directions.

Exercise Conclusions

Aerobic exercise. The ACSM report recommends a regular program of aerobic activities such as walking, running, swimming, or cycling for older people because these activities are likely to be familiar, making them easier to adopt as habits. Though a moderate- to high-intensity program may be necessary to improve most cardiovascular variables and risk factors, older patients should be advised that even light- to moderate-intensity activities can reduce blood pressure and the rate of age-related deterioration in numerous physiologic functions.

Strength training. The relationship between sarcopenia—loss of muscle mass—and aging is well documented, the report states. Strength training has positive effects on insulin action, bone density, energy metabolism, and functional status. A regular strength training program can reverse sarcopenia and muscle weakness in older people. For sedentary patients, starting strength training first may enhance the ability to adapt to and perform aerobic activities.

Many older adults do not consume enough protein, and this may contribute to sarcopenia. The recommended daily intake for elderly adults is 1.0 to 1.25 g of high-quality protein per kilogram of body mass per day.

Balance training. Several studies have shown that postural stability can be improved with a wide range of interventions, but optimal frequency and intensity have not been determined. To reduce the risk of falls, an exercise program should include balance training, resistance exercise, walking, and weight transfer.

Flexibility training. Too little research has been done to permit the design of systematic programs to improve flexibility in older people. Nonetheless, the ACSM recommends exercises that have been shown to increase joint range of motion, such as walking, aerobic dance, and stretching.

Psychological benefits. Research has established a connection between physical activity and psychological function in older adults but has not elucidated the mechanisms, dose-response relationship, or timing involved. Exercise has not been shown to improve cognition. Two promising benefits are a reduction in depression and improved self-efficacy.

Exercise for the frail elderly. People in this category should undertake progressive resistance training of major muscle groups at least 2, but preferably 3, days per week, with two to three sets of each exercise, the ACSM advises. If possible, standing exercises with free weights should be included to improve balance and coordination. Balance training should be done either separately or as part of strength training. Activities should be supervised for safety and to guide progress.

Moderate-intensity aerobic training can begin after frail patients have improved their muscle strength, joint stability, and balance—the reverse of what is usually done, the ACSM says. Walking is preferred, but patients who have disabilities can improve their aerobic capacity with exercise machines or water activities. Patients should first reach a frequency target of 3 days per week before working up to a duration of at least 20 minutes, and then to an intensity of 40% to 60% of maximum heart rate reserve (or 11 to 13 on the Borg scale [somewhat hard]).

Remaining Challenges

The real importance of this document lies in its emphasis on strength training and its recognition of protein inadequacies in some older people's diets, says Thomas L. Schwenk, MD, professor and chair in the Department of Family Medicine at the University of Michigan Medical School in Ann Arbor. Many functional impairments that older patients have are caused by simple weakness rather than chronic disease, and the spontaneous activity that can result from strength increases is impressive, says Schwenk. "Elderly patients socialize more, can care for themselves, go out, and shop because of greater confidence in their strength."

He applauds the report's recognition of postural stability as an important goal of exercise, but says physicians should realize that fear of falling may be an older patient's greatest exercise obstacle. "They talk among themselves of friends who fell, had a hip fracture, went to the hospital, and died," Schwenk says.

More resources should be devoted to identifying the most effective, practical, and cost-efficient ways to counsel older patients about exercise, he says. "These recommendations support the importance of exercise but offer little guidance for how to add this preventive approach to an already overloaded medical visit that tends to emphasize the care of chronic diseases."

References

  1. Mazzeo RS, Cavanagh P, Evans WJ, et al: ACSM position stand on exercise and physical activity for older adults. Med Sci Sports Exerc 1998;30(6):991-1008
  2. Pollock ML, Gaesser GA, Butcher JD, et al: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory fitness, and flexibility in healthy adults. Med Sci Sports Exerc 1998;30(6):975-991

Lisa Schnirring
Minneapolis


School Drug Testing of Nonathletes Survives Test

For now, at least, the US Supreme Court will not bar school districts from drug-testing all students in extracurricular activities, both sports and nonsports. The court in October declined to review a federal appeals court ruling (1) that said testing does not violate students' privacy rights.

The appeal was brought by teenagers and parents from Rushville (Indiana) Consolidated High School, according to an Associated Press article (2) that appeared on the Indianapolis Star Web site. The school district's policy bars students from all extracurricular activities unless they consent to random urinalysis tests. Matthew Todd, one of the students who brought the suit, had been volunteering to videotape the school's football team when he was suspended from his work for not consenting to a drug test. Kenneth Falk, the plaintiff's lawyer, argued that the tests violate the Fourth Amendment prohibition of unreasonable search and seizure.

David L. Herbert, a practitioner in the legal aspects of sports medicine, says the Todd case was based largely on the Supreme Court's Vernonia decision (3) in 1995, which upheld the constitutionality of an Oregon school district's random drug-testing policy for student-athletes (4). Herbert is a senior partner at Herbert & Benson in Canton, Ohio. In allowing the appellate court decision to stand, he says, the Supreme Court simply extended the concepts developed in Vernonia from athletes to students who wish to participate in other extracurricular activities. Randy Aultman, a former principal in Vernonia schools, says the district randomly tests its athletes for five street drugs. Aultman is now a drug testing consultant to other school districts.

Will the Supreme Court's action prompt more school districts to institute drug-testing programs? Herbert says the decision may not motivate schools to adopt new programs, but those with existing policies might consider broadening drug testing to include other students.

John Heeney, director of educational services for the National Federation of State High School Associations (NFHS) in Kansas City, Missouri, says many schools are interested in drug testing, but high costs keep many districts from adopting policies. It costs about $10 to $20 per student to test for street drugs, and testing for performance-enhancing drugs costs from $100 to $200 per student, he says. "If it's a choice between new uniforms and drug testing, the athletic director is usually going to choose the uniforms."

The effectiveness of school drug testing is an open question, says Gregory L. Landry, MD, professor in the Department of Pediatrics at the University of Wisconsin, Madison. "Administrators are looking for ways to reduce drug abuse, but there is very little scientific evidence that drug testing is a significant deterrent," says Landry, who is past president of the American Medical Society for Sports Medicine. Drug testing might be helpful in the context of a good student assistance program, Landry says, "but I worry that drug testing does not address the biggest problem in all schools: drinking."

In September the NFHS hosted a satellite teleconference on drug testing. Several resources on the topic are available on the organization's Web site at https://www.nfhs.org/drug_testing.htm.

The NFHS position is that decisions about drug testing policies must be made by communities, says Heeney. In the Vernonia case, he says, the community had a problem with rising drug use among students, particularly athletes, and tried several prevention tactics before establishing a drug-testing policy. Starting a community dialogue on drug testing can be productive, even if no drug testing policy is adopted, he says.

References

  1. Todd v. Rush County Ind Schools, 133 F3d 984 (7th Cir 1998)
  2. Slagle M: Supreme Court lets school district continue random drug testing. The Indianapolis Star, https://StarNews.com (accessed October 6, 1998)
  3. Vernonia School District v. Acton, 115 S.Ct. 2386 (1995)
  4. Schnirring L: Drugs and high school athletes. Phys Sportsmed 1995;23(10):25-26

Lisa Schnirring
Minneapolis


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