b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarship REHAB UpdateConsiderations for the Over 65 By Dr. Donald C. DeFabio PatientLEGAL Q&A CHIRO Assist and joint health of the patient will determine if they perform The baby boomers are officially senior citizens, and they want to Executive Directors Update remain active since it is directly related to quality of life. Exercisewater aerobics, recumbent bike, stationary bike, upper body is essential for our patients to hold their adjustments better,ergometer, treadmill or walk/run outside. Consistency with remain independent and avoid the chronic diseases related to acardio is the key with the current recommendation being at sedentary lifestyle. While there are specific physiologic changesleast 120 minutes per week. Cardio also improves a favorable that do occur with aging (see Chart 1 below), there are speciallipid profile, reduces pro-inflammatory cytokines and reduces considerations we need to consider when prescribing exercisesbody fat.in the over 65 group.Flexibility training is important and is also based on the findings Legislative Update Metabolic Functions that Decrease with Age of your exam. An excellent life skill is simply getting up and down from the floor, but if your patient cannot, then stretches, INSURANCE Update INSURANCE Update Maximum attainable heart rate foam roller, yoga and floor activities are obviously not a good Cardiac output recommendation. Stretches seated, standing (depending on Muscle mass TECHNIQUE Update balance), against the wall, using a massage stick, or perhaps Balance lying in bed are options. Coordination (neuromuscular efficiency) Resistance training is essential in the older adult. Studies have Connective tissue elasticity shown that men who perform resistance exercises live longer Bone Density and simply performing step up exercises on a 9 platform Exercise and lifestyle changes can have a positive impact inwill ensure your patients can use stairs. Additional resistance MedicareQ&AMedicare Update these biomarkers of aging and can positively impact the agingexercises with elastic resistance or in the gym are best kept to OUR HEALTH 1-3 sets of 8-20 repetitions with an RPE of 4-8/10 3-5 days a process in terms of balance, bone density, respiratory function,week. In the beginning the RPE is obviously lower, and as the muscle mass and flexibility. It is well established that cardio- patient develops strength and endurance, the RPE can move vascular exercise reduces the risk for cardiovascular diseasecloser to 8/10. (See Chart 2 below)by up to eight times, and The Cleveland Clinic recommends 60 minutes/day of exercise (cardio, flexibility and resistanceGeneral Exercise Parameters for the Seniorcombined) for brain health. However, if we can simply keep our patients ambulatory without assistive devices, that is aCARDIO:huge factor in maintaining both independence and a positive2-5X/week, 30-60 min, RPE 4-8/10psychosocial demeanor.FLEXIBILITY:As with all patients, before prescribing exercises to your Medi- 2-5X/week, 20-30 min, within physiologic limitscare age patients, you need to review their health history and medications. Check all medications to determine if they haveRESISTANCE:an effect on heart rate, muscular function or nerve health, since3-5X/week, 1-3 sets, 8-20 reps, RPE 4-8/10 that could affect your exercise prescriptions. Joint replacements may also affect the exercises choices. If the patient has a historyIn determining your exercise plan, you need to balance the of cardiovascular disease or if they have grade 1 hypertensionpatients goals, physiologic status, muscular, neural, joint and (135/90), take the time to have them cleared by their cardiolo- bone health and remember that tall posture is essential while gist before beginning physical rehab. The outcome assessmentexercising. Progressions need to be slow and controlled with tool for readiness for cardiovascular activity is the Par-Q and cangradual increase. Always work towards excellence in exercises be downloaded off the internet. that relate directly to life skills: squatting, walking without For your older patients who are cleared to begin exercise,assistance and single leg balance activities. Finally, remember start with low to moderate intensity using a relative perceivedthat if your patients train in a slouched, weak posture, they will exertion (RPE) of 4-6 on the Borg 10 scale. However, RPE maywalk, read, sit, stand in the same poor posture.not be accurate for the untrained individual. Monitoring heartReferences:rate (HR) and blood pressure (BP) during exercise every 10A World of Hurt, A Guide to Classifying Pain. Kolski MC, OConnor A. 2017 minutes to ensure it remains in a desirable range is important.Thomas Land, St. Louis Mo.Once the patient can synchronize their RPE and actual exertion, they can self-monitor and spread out BP and HR reading toDonald DeFabio, DC, DACBSP, DABCO, is in private practice in every 15 minutes with exercise.Berkeley Heights and is the team chiropractic physician for a local Start cardiovascular activities at 8-10 minutes building up touniversity. He conducts Relevant Rehab, and his exercise protocols 30-60 minutes 2-5 times per week. The neuromuscular efficiencycan be found on his YouTube Channel.www.njchiropractors.com I 25'