Although no amount of exercise can stop the natural aging process there is evidence that regular exercise can reduce the physiological effects of an otherwise sedentary lifestyle and promote life increased active sleep by limiting the incidence and progression of chronic disease and disabling conditions. There is also emerging evidence of significant cognitive and psychological benefits from regular physical activity for older adults.
Ideally, exercise prescriptions for older adults should include aerobic exercise, muscle-strengthening exercises, and flexibility exercises. 
Despite advances in prevention guidelines and treatment, cardiovascular disease remains a prevalent problem in all populations, including the elderly. The top risk factors include hypercholesterolemia, high blood pressure, diabetes, obesity and smoking. exacerbated by lack of exercise The harmful effects of these risk factors have been shown to reduce mortality when exercise is included in everyday life. Specifically, physical inactivity is directly linked to obesity, while also playing a role in the development of diabetes and high blood pressure. 
The good news is that there is evidence that physical activity has many benefits. Regular physical activity reduces the risk of chronic disease, increases life expectancy , and increases productivity in muscle function (strength and power) . Multimodal movement has A beneficial effect on the rate of falls was reported . A randomized controlled trial demonstrated that a home-based exercise and nutrition strategy had a positive effect on frailty scores and physical performance in pre-frail or frail older adults .
Several studies including large systematic reviews have studied the effects of exercise in the older adult to improve muscle strength aerobic capacity (VO2max) and functional outcomes. Guidelines for prescribing exercise medication for the older adult are well established . These guidelines recommend endurance training resistance exercises and balance exercises.
There is no consensus in the literature on the age range that defines an older or older adult. In general guidelines suggest that those 65 years or older can be considered older adults.
Very old and frail elderly people develop sarcopenia (weakening of skeletal muscle) due to one or a combination of malnutrition management injury and the effects of aging[ 10].Muscle weakness that accompanies aging has been associated with an increased risk of falls and fractures in these older individually. Research has shown that older adults with sarcopenia aged 80 years or older are three times more likely to fall within two years compared to older adults without sarcopenia. 12] Studies show that frail older men and women retain the ability to adapt to resistance exercise training with significant and clinically relevant muscle development and increased muscle strength.
The results of a systematic review and meta-analysis showed that the combined prevalence of sarcopenia in community-dwelling elderly in Japan was 9.9%, with an overall rate of 9.8% (men) and 10.1% (women): this is an important way to address sarcopenia prevention in the elderly Provides valuable information to the community .
Strength training or progressive resistance training (PRT) is generally defined as training in which the resistance to muscle-generating force is gradually increased over time . The maximum weight or resistance that a person can lift or move to perform an action is defined as One repetition maximum (1 RM). Prescription for repeat RMs varies based on prior experience with PRT and comorbidities. A recommendation (level IIA evidence)  from the American College of Sports Medicine and the American Heart Association recommends 8-10 exercises Perform two or more discrete sessions per week using major muscle groups. The guidelines also recommend 10-15 repetitions of weights against resistance at an intensity of 5 or 6 on a 10-point scale .
Increased muscle hypertrophy and strength, as well as body composition, hormonal, and neurologic changes positively affect daily activities and functional independence in older adults. A study shows that even people in their 90s can Muscle strength and related function improved after an 8-week strength training program . Strength training is also of great benefit in protecting older adults from injury, as falls are associated with hip weakness, poor balance and Poses sway. 
A noteworthy study also showed less pain after PRT in patients with osteoarthritis (6 trials, 503 participants, SMD -0.30 95% CI -0.48 to -0.13) .
Aerobic exercise occurs in the presence of oxygen and involves the aerobic metabolism of glucose. This exercise is less intense and lasts longer than strength training. The decline in maximal aerobic capacity occurs throughout ages at an accelerated rate in adulthood .
However older individuals show an increase in the oxidative capacity of skeletal muscle (VO2max) after PRT. Skeletal muscle glycogen stores in r adults are initially lower than those of young adults but increase significantly with exercise. Skeletal muscle aging adults enhance capillaries in terms of increased mitochondrial enzyme levels and the ability of capillaries to remove oxygen from the blood. These skeletal muscle changes contribute to increased Vo2max in trained older subjects
Although both older men and women respond to endurance training with increases in VO2max, the mechanism of adaptation differs. In older men, two-thirds of the increase in VO2max is due to increased cardiac output and one-third is due to a wider VO2 difference. In other words in older women, VO2max increases similarly with training but without changes in left ventricular systolic performance and diastolic-filling dynamics. Thus the increase in VO2max in older women is due to peripheral adaptations resulting in increased V02 content differences. Extrinsic changes include increased bone marrow lymphocyte and mitochondrial marker enzymese activity.g. citrate synthase synthesis.
Over time, individuals lose mobility in a joint-specific manner . Research has shown that, in general, shoulder and trunk mobility is reduced, while elbow and knee range of motion is preserved to a greater extent . At the same time, older adults adopt certain movement patterns and postures as they age Due to habitual injury or disability. Often, these movement patterns and learned postures result in persistently shortened or lengthened positions of muscles and other soft tissues. Persistent changes in the length of this muscle and other soft tissues (such as fascia and ligaments) lead to a decrease in power generation capacity. Stretching promotes the adaptation of shortened muscles to longer positions, resulting in better posture and movement patterns and muscle strength. Muscles held in a shortened position appear to have a skewed muscle spindle This can lead to active and passive resistance to increased length, which can lead to muscle imbalances and even painful movement patterns during exercise.
Compared with other components of exercise prescription, flexibility has been studied relatively less , and there is little consensus on the optimal parameters in flexibility prescription .
- Slow static stretching is recommended to stretch collagenous tissue as a soft tissue substance.
- The ACSM recommends at least generally not two days a week at moderate intensity ie. strength 5–6 on a scale of 0 to 10. The ACSM recommends sustained stretching for each major muscle group and static rather than ballistic movements .
- Muscle stretching of less than 45 seconds can be used in pre-exercise programs with no significant decrease in force capacity or speed type tasks.
- The ACSM recommends that flexibility stretches should follow rather than precede tasks that require muscle strength or speed.
- Research has shown that older adults are ambivalent about the importance of flexibility training to their functional capacity, although frail older adults have been shown to improve on a range of functional measures, such as functional extension and sitting .
- In general, PNF stretching appears to be more effective in improving flexibility outcomes (but not necessarily functional outcome measures) than non-PNF techniques .
Studies have reported beneficial effects on the rate of falls after multimodal exercise . The Otago Exercise Program (OEP) is also a comprehensive exercise program that includes elements such as balance. This is a 6-month to 1-year home-based exercise regime, Physiotherapists for home exercises, such as balance exercises for older adults. For a more in-depth discussion of exercise prescription in the context of falls, see the Falls Physiopedia page.
Water sports are useful for those who cannot bear the stress of land-based sports. Not only does water provide the resistance necessary to exercise muscles and joints, but it also provides a low-impact environment, which is beneficial for older adults with arthritis and joint pain, which can contribute to a person’s perception of well-being . Water-based physical therapy has been shown to achieve similar results to land-based therapies .
There are many studies describing the evidence and protocols for hydrotherapy or hydrotherapy. In a randomized controlled trial of 73 older women with osteoarthritis, a six-week hydrotherapy intervention reduced pain and enhanced muscle function . Similar results were also found in other studies  and short-term improvement in rheumatoid arthritis .
See the Hydrotherapy page in Physiopedia for information on the theory and application of hydrotherapy in physical therapy.
Plyometric movements attempt to use the stretch reflex of the muscle spindles and the elastic energy stored in the stretched muscle to enhance the immediate mutual contraction of that muscle. These exercises are designed to improve speed strength and explosiveness.
Plyometrics usually involve an eccentric (lengthening) contraction followed by a concentric (shortening) contraction of the same muscle. Plyometric training aims to improve a muscle’s ballistic ability, the ability to increase a muscle’s explosive power shrink.
There is no consensus in the current literature on specific parameters or guidelines for incorporating plyometric training , and it has been suggested that plyometric training be incorporated into an exercise program only after a foundation of strength and flexibility has been achieved . Given the general decline in strength and flexibility in older adults, plyometric training should only be introduced to individuals who demonstrate strength and flexibility performing tasks that are plyometric in nature.
There is strong evidence that as individuals age, the amount and intensity of physical activity decreases and the incidence of chronic disease increases . However, there is also evidence that this decline can be reversed, especially in previously sedentary individuals . Increase For older adults whose disuse atrophy limits activities of daily living, strength and mass may be important steps in maintaining independent daily functional activities. Regular physical activity has long been an important piece of advice for people with many chronic diseases Associated with old age . These include non-insulin-dependent diabetes, high blood pressure, heart disease, and osteoporosis. Incorporating aerobic and resistance exercise training into the lifestyle of older adults can have a considerable impact on functional capacity Physiological reserve and independence .
Risks of Exercise
The side effects of exercise are an issue that clinicians should always keep in mind, especially in more frail populations such as the elderly. Side effects include musculoskeletal impairment such as joint pain or muscle soreness, loss of function, cardiovascular events and even death.
Serious cases are rare. The most serious but not uncommon of these is sudden death, defined as death occurring during actual work or within 1 hour thereafter. Although the reported rate of sudden death varies from 4 to 56 times that of chance the absolute risk is low: one heart attack deaths per 396000 hours of running or one death per 15000 to 18000 exercises per year.
Limited data are available on the risks of injury associated with physical activity in older adults such as walking and gardening. Injuries sustained by participants in structured exercise programs resulting primarily from overuse are relatively common. The ankle is the most exposed joint to be injured. Age and obesity do not appear to be causal factors in current analyses. There is no good research on non-traumatic musculoskeletal injuries related to pedaling or gardening
Fear that the exercise may trigger osteoporosis or exacerbate a pre-existing condition has kept some older adults from participating in an exercise program and can has prevented health professionals from recommending it.
However, the ACSM recommends that the following factors be considered when prescribing exercise for older adults: The intensity and duration of exercise should be low at baseline for older adults with severe functional impairment or chronic conditions that affect their abilities do physical activities. The development of activities should be individualized and tailored to tolerance and preference; a more conservative approach may be needed for older adults with the worst conditions and physical challenges. Muscle-strengthening activities and/or balance training may be required first aerobic training activities in very lean individuals. Older adults need to exceed the recommended minimum amount of physical activity if they want to improve their fitness. When chronic conditions prevent activity at the minimum recommended levels, older adults should be physically active activities as permitted in order not to settle down.
- ↑ Jump up to:1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS. Exercise and Physical Activity for Older Adults. Medicine & Science in Sports & exercise: Official Journal of the American College of Sports Medicine. Med Sci Sports Exerc. 2009. 41 (7): 1510-1530. Available from https://www.bewegenismedicijn.nl/files/downloads/acsm_position_stand_exercise_and_physical_activity_for_older_adults.pdf. Accessed 25 June 2018.
- ↑ Patel PN, Zwibel H. Physiology, exercise. InStatPearls [Internet] 2019 May 5. StatPearls Publishing. Available from:https://www.ncbi.nlm.nih.gov/books/NBK482280/ (last accessed 8.1.2020)
- ↑ Jump up to:3.0 3.1 Cress ME, Buchner DM, Questad KA, Esselman PC, deLateur BJ, Schwartz RS. Exercise: Effects on physical functional performance in independent older adults. J Gerontol A Biol Sci Med Sci.1999. Vol. 54A, (5): M242-M248. Available at: https://academic.oup.com/biomedgerontology/article/54/5/M242/548272. Accessed 26 June 2018.
- ↑ Jump up to:4.0 4.1 Baker MK, Atlantis A, Fiatarone Singh MA. Multi-modal exercise programs for older adults. Age Ageing. 2007. Volume 36 (4): 375–381. Available at: https://academic.oup.com/ageing/article/36/4/375/40634. Accessed 26 June 2018.
- ↑ Hsieh TJ, Su SC, Chen CW, Kang YW, Hu MH, Hsu LL, Wu SY, Chen L, Chang HY, Chuang SY, Pan WH. Individualized home-based exercise and nutrition interventions improve frailty in older adults: a randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2019 Dec 1;16(1):119.
- ↑ Jump up to:6.0 6.1 6.2 6.3 6.4 6.5 Liu C, Latham NK. Progressive resistance strength training for improving physical function in older adults (Cochrane review). Cochrane Database Syst Rev 2009; (3): CD002759.
- ↑ Jump up to:7.0 7.1 7.2 Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Castaneda-Sceppa C. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007. 116(9), 1094-1105. Available from https://scholarcommons.sc.edu/cgi/viewcontent.cgi?referer=https://www.google.com.au/&httpsredir=1&article=1361&context=sph_epidemiology_biostatistics_facpub. Accessed 26 June 2018.
- ↑ Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther. 2012 Feb; 7(1): 109–119. Accessed 24 September 2018.
- ↑ Maria Antoinette Fiatarone Singh. Exercise comes of age: rationale and recommendations for a geriatric exercise prescription. J Gerontol A Biol Sci Med Sc. 2002 57; 5: M262-M282. Accessed 24 September 2018.
- ↑ Walston JD. Sarcopenia in older adults. Curr Opin Rheumatol. 2012; 24(6): 623–627. Accessed 20 September 2018.
- ↑ Landi F, Liperoti R, Russo A, Giovannini S, Tosato M, Capoluongo E, Bernabei R, Onder G. Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study. Clin Nutr. 2012 Oct;31(5):652-8. Accessed 20 September 2018.
- ↑ http://growingstronger.nutrition.tufts.edu/growing_stronger.pdf
- ↑ Makizako H, Nakai Y, Tomioka K, Taniguchi Y. Prevalence of sarcopenia defined using the Asia Working Group for Sarcopenia criteria in Japanese community-dwelling older adults: A systematic review and meta-analysis. Physical Therapy Research. 2019 Dec 20;22(2):53-7.
- ↑ Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz, LA, Evans WJ. High-intensity strength training in nonagenarians effects on skeletal muscle. JAMA. 1990;263(22):3029-3034.
- ↑ Jump up to:15.0 15.1 Avers DA, PT, MSEd Vice President of Academic Affairs Rocky Mountain University of Health Professions. Geriatric Physical Therapy. Los Angeles, California.
- ↑ Fleg JL. Aerobic exercise in the elderly: a key to successful aging. Discovery Medicine [Internet]. 2012. Available at: http://www.discoverymedicine.com/Jerome-L-Fleg/2012/03/26/aerobic-exercise-in-the-elderly-a-key-to-successful-aging/. Accessed 26 June 2018.
- ↑ Cartee GD. Influence of age on skeletal muscle glucose transport and glycogen metabolism. Med Sci Sports Exerc. 1994 May;26(5):577-85.
- ↑ Spina RJ, Ogawa T, Kohrt WM, Martin WH, Holloszy JO, Ehsani AA. Differences in cardiovascular adaptations to endurance exercise training between older men and women. J Appl Physiol. 1993 Aug;75(2):849-55.
- ↑ Jump up to:19.0 19.1 19.2 Medeiros HB de O, Araújo DSMS de, Araújo CGS de. Age-related mobility loss is joint-specific: an analysis from 6,000 Flexitest results. Age. 2013;35(6):2399-2407. Accessed 23 September 2018.
- ↑ Jump up to:20.0 20.1 20.2 20.3 Stathokostas L, Little RMD, Vandervoort AA, Paterson DH. Flexibility training and functional ability in older adults: a systematic review. Journal of Aging Research, vol. 2012, Article ID 306818, 30 pages, 2012. Accessed 23 September 2018.
- ↑ Mooventhan A, Nivethitha L. Scientific evidence-based effects of hydrotherapy on various systems of the body. N Am J Med Sci. 2014; 6(5): 199–209. Accessed 25 September 2018.
- ↑ Carere A, Orr R. The impact of hydrotherapy on a patient’s perceived well-being: a critical review of the literature, Phys Ther Rev. 2016; 21 (2): 91-101.
- ↑ Zivi I, Maffia S, Ferrari V, Zarucchi A, Molatore K, Maestri R, Frazzitta G. Effectiveness of aquatic versus land physiotherapy in the treatment of peripheral neuropathies: a randomized controlled trial. Clin Rehabil. 2018; 32 (5): 663–670. Accessed 25 September 2018.
- ↑ Dias JM, Cisneros L, Dias R, Fritsch C, Gomes W, Pereira L, Santos ML, Ferreira PH. Hydrotherapy improves pain and function in older women with knee osteoarthritis: a randomized controlled trial. Braz J Phys Ther. 2017; 21(6): 449–456. Accessed 25 September 2018.
- ↑ Silva LE, Valim V, Pessanha APC, Oliveira LM, Myamoto S, Jones A, Natour J. Hydrotherapy versus conventional land-based exercise for the management of patients with osteoarthritis of the knee: a randomized clinical trial, Phys Ther. 2008; 88(1): 12–21. Accessed 25 September 2018.
- ↑ Foley A, Halbert J, Hewitt T. Does hydrotherapy improve strength and physical function in patients with osteoarthritis—a randomised controlled trial comparing a gym based and a hydrotherapy based strengthening programme. Ann Rheum Dis 2003 ;62:1162-1167. Accessed 25 September 2018.
- ↑ Al-Qubaeissy KY, Fatoye FA, Goodwin PC, Yohannes AM. The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review. Musculoskeletal Care. Published online 16 July 2012. Accessed 25 September 2018.
- ↑ Jump up to:28.0 28.1 Davies G, Riemann BL, Manske R. Current concepts of plyometric exercise. Int J Sports Phys Ther. 2015 Nov; 10(6): 760–786. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637913/. Accessed 26 June 2018.
- ↑ Johnson RJ. Sudden death during exercise. Postgrad Med1992;92:195-206.