What it refers to the mode of exercise being performed?

Maximum ventilatory perfusion (VQ) drops 5-15% per decade in individuals aged 20-80 years. A lifetime of dynamic exercise maintains the individual's VQ at a level higher than that expected for any given age. The rate of decline in VQ is directly related to maintenance of the physical activity level, which emphasizes the importance of physical activity.

Developing and maintaining aerobic endurance, joint flexibility, and muscle strength is important in a comprehensive exercise program, especially as people age. Elderly women and men show comparable improvement in exercise training, and adherence to training in elderly individuals is high.

Resistance training exercise alone has only a modest effect on risk factors compared with aerobic endurance training, but resistance training does aid carbohydrate metabolism through the development or maintenance of muscle mass and effects on basal metabolism. Furthermore, resistance training is recommended by most health promotion organizations for its effects on maintenance of strength, muscle mass, bone mineral density, functional capacity, and prevention and/or rehabilitation of musculoskeletal problems (eg, low back pain).

In elderly individuals, resistance training is both safe and beneficial in improving flexibility and quality of life. Persons with cardiovascular disease are usually asked to refrain from heavy lifting and forceful isometric exercises, but moderate-intensity dynamic strength training is safe and beneficial in persons at low risk.

Individuals with pulmonary disease should engage in low workloads of short duration.

Patients should exercise in frequent intervals rather than a longer duration and fewer intervals.

Supplemental oxygen is needed.

A study examined the exercise intensity when walking training was prescribed at 80% average 6MWT (6-minute walk test) speed in people with chronic obstructive pulmonary disease (COPD). According to the authors, walking exercise prescribed at 80% average 6MWT speed resulted in a high but tolerable exercise intensity that is likely to result in training benefits in most people with COPD. [28]

Exercise should be of short duration with a gradual progression to longer durations, as tolerated.

Exercises include aquatic aerobics, swimming, walking, jogging, or bicycling, among others.

Monitor blood sugar, as follows, because hypoglycemia or hyperglycemia can occur in diabetic persons during exercise.

• Before exercise: Consume a meal 1-3 hours before exercising, administer insulin at least 1 hour before exercise, and, if the blood glucose level is greater than 250 mg/dL, check urine for ketones.

• During exercise: Supplement energy (caloric) intake every 30 minutes and maintain adequate fluid replacement.

• After exercise: Monitor the glucose level, increase energy (caloric) intake for 12-24 hours following activity, and expect postexercise hypoglycemia; thus, appropriately adjust insulin dosing.

A study by Mendes et al analyzed the guidelines regarding exercise prescription for patients with type 2 diabetes and concluded that exercise prescription for individuals with type 2 diabetes should include specific information on the type, mode, duration, intensity and weekly frequency. The authors added that exercise strategies must be adapted for each individual, based on comorbidities, contraindications and realistic personal goals. [29]

Individuals who are morbidly obese should be cautious of orthopedic stresses.

They may start with non–weight-bearing exercises (eg, swimming, water aerobics, floor exercises).

These individuals should avoid high-impact aerobic activities.

Emphasize duration as tolerated and exercise frequency (sessions per week).

Emphasize premeal exercise, especially exercise in the morning before eating breakfast to mobilize fats (lipolysis).

Research on exercise during pregnancy continues to demonstrate marked benefits for the mother and fetus. [30, 31, 32, 33, 34] The type, intensity, frequency, and duration of the exercise seem to be important determinants of its beneficial effects.

Maternal benefits include improved cardiovascular function, limited weight gain and fat retention, easier and less complicated labor, quick recovery, and improved fitness. A small study involving Hispanic women, the largest minority group in the United States with the highest birth rates, evaluated physical activity before and in early pregnancy. The results corroborated data from previous studies that suggest physical activity in early pregnancy decreases the risk of pregnancy-related hypertensive disorders. [35]

Fetal benefits may include decreased growth of the fat organ, improved stress tolerance, and advanced neurobehavioral maturation.

Offspring are leaner at age 5 years and have a slightly better neurodevelopmental outcome. Postpubertal effects are still unknown.

In the absence of medical contraindications, women should be encouraged to maintain their prepregnancy activity level. In general, activity should be individualized (exercise prescription), depending on previous activity levels.

Available outcome data suggest that a healthy woman may begin or maintain a regular exercise regimen during pregnancy, with benefit and without adversely affecting the course and outcome of the pregnancy. Data also suggest that the clear difference between theoretic concern and observed outcome is best explained by the hypothesis that the physiologic adaptations to exercise and to pregnancy are complementary and fetoprotective.

Although an upper level of safe performance is not established, otherwise healthy mothers-to-be appear to obtain the benefits of a regular exercise regimen without undue risk to the embryo and fetus. The exact regimen can be flexible and individualized (exercise prescription), provided that both the exercise and the pregnancy are monitored.

The American College of Obstetricians and Gynecologists (ACOG) recommends that a thorough clinical evaluation be performed before an exercise program is prescribed, to ensure that the patient does not have any medical contraindications. In general, ACOG supports aerobic and strength-conditioning exercises for healthy women with uncomplicated pregnancies. [36]

Exercise is an essential part of treatment for patients with osteoporosis. Just as regular workouts build muscle, these activities also maintain and may even increase bone strength. By strengthening the muscles and bones and improving balance, exercise can reduce the risk of falls and resulting fractures.

Exercise works well with medications that increase bone density and strength.

Exercise, medication, and proper diet, including an absorbable source of calcium, phosphorus, boron, and other bone-building minerals, are more effective in combating osteoporosis than any one treatment alone.

Weight-bearing exercises and resistance training benefit bones and muscles as well as help improve general health.

Weight-bearing exercise

For most people who have osteoporosis, brisk walking is ideal. Walking can be performed anywhere, requires no special equipment, and carries minimal risk of injury. If walking is too difficult or painful, workouts on a stationary exercise cycle are a good alternative.

Resistance training

Lifting weights or using strength-training machines strengthens bones, especially if one exercises all of the major muscle groups in the legs, arms, and trunk.

A qualified trainer, exercise specialist, or therapist is important for instructing and guiding resistance-training programs.

Joining a gym or fitness facility is a good way to begin because these facilities typically provide access to trainers who can advise on proper techniques.

Strength training is a slow process, so it should be started at a low level and should be gradually built up over several months. For each exercise, select weights or set the machine so the muscle being trained becomes fatigued after 10-15 repetitions. As muscles strengthen, gradually add more weight. The weight should not be increased more than 10% per week because larger increases can increase the risk of injury.

The following are tips for trouble-free exercise:

• Lift and lower weights slowly to maximize muscle strength and to minimize the risk of injury.

• Perform resistance workouts on any given muscle group every second or third day. This gives your body a chance to recover.

• Avoid exercise that puts excessive stress on the bones, such as running or high-impact aerobics. Rowing is appropriate if proper form is used and the rowing machine provides a way to maintain continuous inertia with the use of a flywheel.

• Stiffness is normal the morning after exercise. If pain continues for most of the following day, joints become swollen, or a limp develops, stop the program until comfortable again and reduce the weight and number of repetitions by 25-50%. If bone, joint, or muscle pain is severe, call the doctor.

• If a particular area of the body feels sore right after exercise, apply ice for 10-15 minutes. Wrap ice in a towel or plastic bag or just hold a cold canned or bottled beverage on the spot.

• Vary the routine to make it more interesting. For example, if the strength-building program involves 12 separate exercises, complete 6 in one session and the other 6 in the next session.