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Importance of physical activity for the geriatric population

According to the CDC, 54 million adults are over the age of 65 and that number is expected to increase to 71 million by 2030. Among the aging population comes a multitude of medical conditions and comorbidities that lead to disability and thus decreased function and independence. Physical activity is the common deterrent to combat the consequences of not only disease but a sedentary lifestyle that puts many older adults at risk for falls and increasing mortality.¹ The challenge is encouraging older adults to participate in exercise and maintain an active lifestyle. A common barrier to exercise regardless of age is lack of time to engage in physical activity.² Therefore, the ultimate goal as physical therapists and other healthcare and exercise providers is to determine the most effective, safe, and meaningful experience to benefit our geriatrics patients.

What is HIIT?

High Intensity Interval Training (HIIT) is a low volume exercise program characterized by vigorous intervals of physical activity at 80-95% of an individuals’ HRmax, interspersed by either passive or active recovery periods at low to moderate intensity. Completely customizable by activity, intensity, duration, and pattern of recovery, HIIT is a favorable choice when it comes to a low volume workout that yields effective results in physiological adaptations in skeletal muscle and cardiorespiratory performance similar and often superior to “matched-work” endurance exercise.³

Benefits of HIIT in Geriatric Population

Improvements in body composition (BMI and fat mass), cardiovascular health (resting HR and BP)⁴, and aerobic capacity (VO₂max)⁵ are among the many health benefits seen as a result of implementing HIIT in the geriatric population. Participation in at least an 8-week HIIT program at 2x/week may demonstrate a sustained beneficial effect in maintaining a reduction in fat mass and functional performance (6-minute walk test and chair stand test) up to 4-weeks of detraining more so than exercising at moderate intensity, either interval or continuous.⁴ Additionally, HIIT does not tend to lead to compensations in daily physical activity and total energy expenditure levels in older adults, meaning that exercising at vigorous intensities is not likely to negatively affect the ability to perform activities of daily living and decrease energy levels related to cost of living.⁵ Interestingly, HIIT did not hinder nor seem to increase risk of falls in older adults exercising at higher intensities.⁶ A supervised HIIT program in the geriatric population has been shown to be feasible, safe, and demonstrate high adherence.⁶

How can I implement HIIT for my geriatrics patients?

Meaningfulness matters when designing any exercise program for patients of any age. The Generation 100 Study conducted a long term analysis of exercise patterns in older adults (age: 70-77) following either a moderate or high intensity exercise regimen for one year.⁷ For the geriatric population, exercising 2-3 times per week at high intensities is most common and seemingly most effective, according to both controlled and uncontrolled research.^4-7 A common and easily feasible mode of exercise is walking, but cycling is also a popular choice when aiming to reach higher intensities. Exercise setting can be either indoors or outdoors depending on the preference of the patient, but most subjects partaking in HIIT preferred to exercise in a gym according to the Generation 100 Study.⁷ Other common choices of exercise utilized in HIIT were swimming and jogging. Even though women more so than men were more likely to participate in exercise with partners or friends, encouraging the geriatric patient to participate in group exercise is still important for positive social health.⁷

Example of HIIT for the Geriatric Patient

70 year old patient enjoys talking walks in the park

1. Determine HRmax: (208 - .7 x age) = 159bpm
2. Determine intensity 80 - 95% HRmax: 127 - 151bpm
3. Mode of Exercise: Walking outside
4. Frequency: 2x/week
5. Duration: 4 bouts of 4 - minutes of high intensity walking (HR between 127-159 bpm) with 4-minute recovery periods, either passive resting or active recovery (i.e. slower walking pace at less than 65%HRmax); Total Time 32minutes
6. Don’t forget warm up and cool down (10-minutes)

References
 

1. Cdc.gov. 2021. Promoting Health for Older Adults | CDC. [online] Available at: <https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-older-adults.htm> [Accessed 1 June 2021].
2. Centers for Disease Control and Prevention. 2021. Overcoming Barriers to Physical Activity. [online] Available at: <https://www.cdc.gov/physicalactivity/basics/adding-pa/barriers.html> [Accessed 1 June 2021].
3. Gibala MJ, Little JP, MacDonald MJ, Hawley JA. Physiological adaptations to low‐volume, high‐intensity interval training in health and disease. The Journal of physiology. 2012;590:1077-1084.
4. Coswig VS, Barbalho M, Raiol R, Del Vecchio FB, Ramirez-Campillo R, Gentil P. Effects of high vs moderate-intensity intermittent training on functionality, resting heart rate and blood pressure of elderly women. Journal of translational medicine. 2020;18:88-88.
5. Bruseghini P, Tam E, Calabria E, Milanese C, Capelli C, Galvani C. High Intensity Interval Training Does Not Have Compensatory Effects on Physical Activity Levels in Older Adults. Int J Environ Res Public Health. 2020;17(3):1083. Published 2020 Feb 8. doi:10.3390/ijerph17031083
6. Pires Peixoto R, Trombert V, Poncet A, et al. Feasibility and safety of high-intensity interval training for the rehabilitation of geriatric inpatients (HIITERGY) a pilot randomized study. BMC geriatrics. 2020;20:197-197.
7. Reitlo LS, Sandbakk SB, Viken H, et al. Exercise patterns in older adults instructed to follow moderate- or high-intensity exercise protocol - the generation 100 study. BMC geriatrics. 2018;18:208-208.

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