Spring 2008

Wellness at Any Age
By Amanda-Rae Garcia, CHPD
Aging Well
Vol. 1 No. 2

Wellness has evolved to include almost every aspect that influences the quality of an individual’s life. Numerous theories surround wellness, the direct impact aging has on a person’s functional wellness, and the manner in which physical wellness paves the way for all other components of healthy and happy living.

Wellness Approaches
The traditional model for wellness may be as old as Western civilization itself. Humans have long recognized a relationship among mind, body, and spirit and the ways their interconnectivity impacts life. This is manifest in the spiritual beliefs, the desire to learn, and the interest in physical challenges that have existed in all ancient civilizations. This traditional model provided some framework for what we eventually realized healthy living should include.

But it wasn’t until the early 1950s when physician Halbert L. Dunn, MD, took his place as the “father of the wellness movement” that wellness truly began to develop shape and structure in our culture. Dunn introduced the concept of wellness, and his research has provided the foundation for advancements that enable living well today. Dunn’s research has been credited as the root of national initiatives such as Healthy People 2010. His theory includes six connected principles that best enable a person to lead a healthy balanced life.

Dunn’s Model
Emotional Principle: focuses on awareness and acceptance of one’s feelings.

Intellectual Principle: challenges the use of the mind, encouraging increased mental activity.

Physical Principle: promotes increased participation in activities despite limitations.

Social Principle: emphasizes healthy relationships, encouraging participation in both personal and group relationships.

Spiritual Principle: encourages the quest for meaning and purpose in our lives.

Vocational Principle: encourages determination and achievement of personal and occupational interests.

Since the introduction and acceptance of Dunn’s model, further expansion and exploration of living well has continued. Many health organizations have now embraced a seventh principle, the Environmental Principle, suggesting that one’s physical surroundings can affect a person’s well-being.

The key similarity between the traditional model and Dunn’s model is the multidimensional approach to wellness. Whether it involves a broad inclusion of mind, body, and spirit or a more specific connection of multiple principles, wellness is an individual map constantly being drawn by our lifestyle factors and choices.

Aging and Physical Fitness
We know that wellness includes more than physical considerations, but as we age, this aspect of living can become the most compromised. For example, if someone has difficulty breathing or has a compromised immune system, such conditions can make social settings unappealing and likely contribute to avoidance. That negative impact on social contacts undermines opportunities for social well-being and peer connection. In addition, there is an accepted lackadaisical approach to the “golden years” as we age. This type of thinking can deter people from physical activity as they age. Professionals must raise awareness among older adults about the importance of physical activity as a major component in daily living.

The aging process is likely to manifest as a decline in health over time. Many of these age-related declines can be reduced, if not eliminated, with proper and safe physical activity. Our bodies were designed to move, just as our minds were designed to think and learn—it is a move it or lose it concept. Physical activity fine-tunes our bodies for daily function by way of several interconnected health components.

Health-Related Components of Physical Fitness
How do we target the exact activities that will improve our anatomical function and improve physical response and abilities? Daily routines that include five health-related components of physical fitness achieve such results. Those components include cardiorespiratory endurance, muscular strength, muscular endurance, flexibility, and body composition. In older adults, there are more specific guidelines for how these areas of fitness can be achieved.

Cardiorespiratory Endurance
Cardiorespiratory endurance is the ability of the heart and lungs to supply oxygen and nutrients to muscles and organs during sustained physical activity. Cardiorespiratory endurance is achieved by completing activities that elevate the heart rate for a period of time. The intensity of an activity is matched to an individual’s abilities, categorized as low, moderate, or vigorous. Because abilities vary, the activities that fall into each of the categories will also vary. In older adults, functional ability rather than age should be the greatest determinant of intensity level. The minimum recommendations for aerobic activity at any age are at least 30 minutes of moderate-intensity activity five times per week or a minimum of 20 minutes of vigorous-intensity activity three times per week.

These recommendations are in addition to an individual’s regular daily activities. While this may sound like a tremendous amount, these guidelines can be further broken down and still result in health benefits. For instance, activities in 10-minute increments can still improve cardiorespiratory endurance. Modifying time-increment guidelines is especially useful for the older adult just getting started.

Muscular Strength and Muscular Endurance
Muscle strength refers to the ability of a muscle to exert force during an activity. In older adults, muscular atrophy, or loss, occurs at an increased rate. Research has shown that strength loss occurs at a rate of 12% to 14% per decade after the age of 50. After the age of 74, 28% of men and 66% of women are unable to lift 10 pounds. In other words, many older adults may not possess the physical ability to carry a grandchild.

Muscular strength differs from muscular endurance because it describes the total ability to lift, push, or pull at one time. Muscular endurance describes the continual effort and stamina available for working muscles. Both components are enhanced through similar training; the difference is in the amount of weight resistance and number of repetitions. Muscular strength is increased by using the highest safe amount of weight with few repetitions. Minimal weight resistance with a higher number of repetitions improves muscular endurance. General strength training guidelines for older adults include the following:

• minimum of two days per week on nonconsecutive days;

• eight to 10 exercises per session;

• resistance that allows 10 to 15 repetitions in muscular endurance training; and

• moderate to high level of effort—on a 10-point scale, effort level should be from 5 to 8—matched to the individual’s level of ability.

Flexibility
Flexibility is the freedom of movement around a joint, or range of movement, and is enhanced by stretching. However, it is often the most neglected type of daily activity. Muscles that are not lengthened and relaxed are susceptible to pain and injury because of muscle tightness. Older adults can combat this with simple daily stretches.

General flexibility and stretching guidelines for older adults include the following:

• flexibility activities performed on all days that aerobic or muscle-strengthening activities are performed (possible every day);

• 10 minutes of flexibility activities for major muscle groups;

• 10- to 30-second hold for a static stretch—static means to avoid bouncing; and

• three to four repetitions for each stretch.

Body Composition
Body composition refers to the relative amount of fat in the body compared with muscle and other organs. A greater percentage of fat in the body will negatively impact older adults’ health and increase the risk of developing or worsening many conditions. Therefore, body composition is a better determinant for health than knowing weight alone. In older adults, the ability to retain muscle becomes more difficult, especially in the absence of weight resistance training. This loss of muscle mass conversely causes a rise in adipose tissue or fat.

The most appropriate assessment of healthy weight as we age is body mass index (BMI), a measure of body weight related to height. This is a more practical approach than the traditional caliper pinch assessment because as we age, our skin’s elasticity is compromised, which opens a pinch assessment to validity concerns.

BMI Calculation
[Body weight (in pounds) X 703] ÷ Height (in inches)

BMI Scoring
Less than 18.5 = underweight

18.5 to 24.9 = normal weight

25 to 29.9 = overweight

More than 30 = obese

Making It Work for Older Adults
How can older adults get started? Is it ever too late? Although the variables of aging combined with the health-related components of physical fitness can seem overwhelming at first glance, it is never too late to incorporate safe, age-appropriate, and effective exercise into daily living. Older adults’ increased risk of health setbacks and expanded number of coronary risk factors emphasize the need for physician or healthcare provider approval prior to beginning. Once approval has been obtained, realistic goals and objectives, very specific to an individual’s needs, should be set. Aging continues to be a consideration, but it should not be a reason to apply the brakes. We don’t stop exercising because we get old—we get old because we stop exercising.

Putting It All Together
Dunn and the efforts of many before and after him have given us the puzzle pieces to living healthy and happy lives. We know that it takes more than physical activity to live well, but we cannot ignore the great foundation being physically fit provides us. Physical movement and activity is the starting block that propels us toward living a healthy and well-balanced lifestyle. Today’s older adults are already living longer, but with adherence to wellness initiatives, this generation of older adult can live better than any before.

— Amanda-Rae Garcia, CHPD, is the manager of wellness development for Genesis Rehabilitation Services specializing in older adult wellness programming.