Many different physical activities can improve your health and independence. Whether you choose to do the exercises shown in this chapter or other activities that accomplish the same goals, gradually work your way up to include endurance, strength, balance, and stretching exercises.

How Hard Should I Exercise?
We cant tell you exactly how many pounds to lift or how steep a hill you should climb to reach a moderate or vigorous level of exercise, because what is easy for one person might be strenuous for another. It's different for different people.

We can, however, provide some advice based on scientific research: Listen to your body. The level of effort you feel you are putting into an activity is likely to agree with actual physical measurements. In other words, if your body tells you that the exercise you are doing is moderate, measurements of how hard your heart is working would probably show that it really is working at a moderate level. During moderate activity, for instance, you can sense that you are challenging yourself but that you arent near your limit.

Borg Category Rating Scale One way you can estimate how hard to work is by using the Borg Category Rating Scale. It was named after Gunnar Borg, the scientist who developed it. The numbers on the left of the scale don't indicate how many times or how many minutes you should do an activity; they help you describe how hard you feel you are working.

For endurance activities, you should gradually work your way up to level 13 the feeling that you are working at a somewhat hard level. Some people might feel that way when they are walking on flat ground; others might feel that way when they are jogging up a hill. Both are right. Only you know how hard your exercise feels to you.

Strength exercises are higher on the Borg scale. Gradually work your way up to level 15 to 17 hard to very hard to build muscle effectively. You can tell how hard an effort you are making by comparing it to your maximum effort. How hard does your current effort feel compared to when you are lifting the heaviest weight you can lift? Once you start exerting more than a moderate amount of effort in your muscle-building exercises, your strength is likely to increase quickly.

As your body adapts and you become more fit, you can gradually keep making your activities more challenging. You might find, for example, that walking on a flat surface used to feel like you were working at level 13 on the Borg scale, but now you have to walk up a mild hill to feel like you are working at level 13. Later, you might find that you need to walk up an even steeper slope to feel that you are working at level 13.

The Borg scale is simple to use. But if your level of effort doesnāt match the numbers you see on the Borg scale for example, if you think you are doing the exercises correctly, but you arent progressing or you are exhausted by your effort check with a fitness professional. These experts are likely to understand the science that went into developing the Borg scale, and they can teach you how to match your level of effort with the right number on the scale.

Here are some points to keep in mind as you begin increasing your activity:

If you stop exercising for several weeks and then return, start out at about half the effort you were putting into it when you stopped, then gradually build back up. Some of the effects of endurance and muscle-building exercises deteriorate within 2 weeks if these activities are cut back substantially, and benefits may disappear altogether if they arenā€™t done for 2 to 8 months.
When an exercise calls for you to bend forward, bend from the hips, not the waist. If you keep your entire back and shoulders straight as you bend forward, that will help ensure that you are bending the right way, from the hips. If you find your back or shoulders humping in any spot as you bend forward, thatā€™s a sign that you are bending incorrectly, from the waist. Bending from the waist may cause spine fractures in some people with osteoporosis.
Itā€™s possible to combine exercises. For example, regular stair-climbing sessions improve endurance and strengthen leg muscles at the same time.

How to Improve Your Endurance

Endurance exercises are any activity ā€” walking, jogging, swimming, raking ā€” that increases your heart rate and breathing for an extended period of time.

How Much, How Often

Build up your endurance gradually, starting out with as little as 5 minutes of endurance activities at a time, if you need to.
Starting out at a lower level of effort and working your way up gradually is especially important if you have been inactive for a long time. It may take months to go from a very long-standing sedentary lifestyle to doing some of the activities suggested in this section.
Your goal is to work your way up, eventually, to a moderate-to-vigorous level that increases your breathing and heart rate. It should feel somewhat hard to you (level 13 on the Borg scale).
Once you reach your goal, you can divide your exercise into sessions of no less than 10 minutes at a time, if you want to, as long as they add up to a total of a minimum of 30 minutes at the end of the day. Doing less than 10 minutes at a time wonā€™t give you the desired cardiovascular and respiratory system benefits. (The exception to this guideline is when you are just beginning to do endurance activities.)
Your goal is to build up to a minimum of 30 minutes of endurance exercise on most or all days of the week. More often is better, and every day is best.

Safety

Endurance activities should not make you breathe so hard that you cant talk. They should not cause dizziness or chest pain.
Do a little light activity before and after your endurance exercise session, to warm up and cool down (example: easy walking).
Stretch after your endurance activities, when your muscles are warm.
As you get older, your body may become less likely to trigger the urge to drink when you need water. In other words, you may need water, but you wont feel thirsty. Be sure to drink liquids when you are doing any activity that makes you lose fluid through sweat. The rule of thumb is that, by the time you notice you are thirsty, you are already somewhat dehydrated (low on fluid). This guideline is important year-round, but is especially important in hot weather, when dehydration is more likely. If your doctor has asked you to limit your fluids, be sure to check with him or her before increasing the amount of fluid you drink while exercising. Congestive heart failure and kidney disease are examples of chronic diseases that often require fluid restriction.
Older adults can be affected by heat and cold more than other adults. In extreme cases, exposure to too much heat can cause heat stroke, and exposure to very cold temperatures can lead to hypothermia (a dangerous drop in body temperature). If you are exercising outdoors, dress in layers so you can add or remove clothes as needed.
Use safety equipment to prevent injuries. For example, wear a helmet for bicycling, and wear protective equipment for activities like skiing and skating. If you walk or jog, wear stable shoes made for that purpose.

Progressing
When you are ready to progress, build up the amount of time you spend doing endurance activities first; then build up the difficulty of your activities later. Example: First, gradually increase your time to 30 minutes over several days to weeks (or even months, depending on your condition) by walking longer distances, then start walking up steeper hills or walking more briskly.

Tips on How to Gauge Your Effort
Here are some informal guidelines you can use to estimate how much effort you are putting into your endurance activities.

Talking doesnt take much effort during moderate activity. During vigorous activity, talking is difficult.
If you tend to perspire, you probably wont sweat during light activity (except on hot days). You will sweat during vigorous or sustained moderate activity.
Your muscles may get a rubbery feeling after vigorous activity, but not after moderate activity.
One doctor who specializes in exercise for older adults tells her patients this about how hard they should work during endurance activities: If you cant talk while youre exercising, its too difficult. If you can sing a song from an opera, its too easy!

Examples of Endurance Activities
Examples of activities that are moderate for the average older adult are listed below.

Moderate:

Swimming
Bicycling
Cycling on a stationary bicycle
Gardening (mowing, raking)
Walking briskly on a level surface
Mopping or scrubbing floor
Golf, without a cart
Tennis (doubles)
Volleyball
Rowing
Dancing

The following are examples of vigorous activities.

Vigorous:

Climbing stairs or hills
Shoveling snow
Brisk bicycling up hills
Tennis (singles)
Swimming laps
Cross-country skiing
Downhill skiing
Hiking
Jogging

How to Improve Your Strength

Even very small changes in muscle size can make a big difference in strength, especially in people who already have lost a lot of muscle. An increase in muscle thatā€™s not even visible to the eye can be all it takes to improve your ability to do things like get up from a chair or climb stairs.

Your muscles are active even when you are sleeping. Their cells are still doing the routine activities they need to do to stay alive. This work is called metabolism, and it uses up calories. That can help keep your weight in check, even when you are asleep!

About Strength Exercises
To do most of the following strength exercises, you need to lift or push weights, and gradually you need to increase the amount of weight you use. You can use the hand and ankle weights sold in sporting-goods stores, or you can use things like emptied milk jugs filled with sand or water, or socks filled with beans and tied shut at the ends.

There are many alternatives to the exercises shown here. For example, you can buy a resistance band (it looks like a giant rubber band, and stretching it helps build muscle) at a sporting-goods store to do other types of strength exercises. Or you can use the special strength-training equipment at a fitness center.

How Muscles Work
What makes your muscles look bigger when you flex them - when you "make a muscle" with your biceps, for example?

Muscle cells contain long strands of protein lying next to each other. When you want your muscles to move, your brain signals your nerves to stimulate them. A chemical reaction in your muscles follows, causing the long strands of protein to slide toward and over each other, shortening the length of your muscle cells. When you "make a muscle" and you see your muscle bunch up and bulge, you are actually watching it shorten as the protein strands slide over each other.

When you do challenging muscle-building exercises on a regular basis, the bundles of protein strands inside your muscle cells grow bigger.

How Much, How Often

Do strength exercises for all of your major muscle groups at least twice a week. Donā€™t do strength exercises of the same muscle group on any 2 days in a row.
Depending on your condition, you might need to start out using as little as 1 or 2 pounds of weight, or no weight at all. The tissues that bind the structures of your body together need to adapt to strength exercises.
Use a minimum of weight the first week, then gradually add weight. Starting out with weights that are too heavy can cause injuries.
Gradually add a challenging amount of weight in order to benefit from strength exercises. If you dont challenge your muscles, you wont benefit from strength exercises. (The ā€Progressing section will tell you how.)
When doing a strength exercise, do 8 to 15 repetitions in a row. Wait a minute, then do another set of 8 to 15 repetitions in a row of the same exercise. (Tip: While you are waiting, you might want to stretch the muscle you just worked or do a different strength exercise that uses a different set of muscles).
Take 3 seconds to lift or push a weight into place; hold the position for 1 second, and take another 3 seconds to lower the weight. Donā€™t let the weight drop; lowering it slowly is very important.
It should feel somewhere between hard and very hard (15 to 17 on the Borg scale) for you to lift or push the weight. It should not feel very, very hard. If you cant lift or push a weight 8 times in a row, its too heavy for you. Reduce the amount of weight. If you can lift a weight more than 15 times in a row, its too light for you. Increase the amount of weight.
Stretch after strength exercises, when your muscles are warmed up. If you stretch before strength exercises, be sure to warm up your muscles first (through light walking and arm pumping, for example).

Practice Sitting Straight
Sit or stand with your shoulders back, but not pinched, and hold this position while you take slow, deep breaths. You can do this anytime.

Safety

Don't hold your breath during strength exercises. Breathe normally. Holding your breath while straining can cause changes in blood pressure. This is especially true for people with cardiovascular disease.
If you have had a hip repair or replacement, check with your surgeon before doing lower-body exercises.
If you have had a hip replacement, don't cross your legs, and don't bend your hips farther than a 90-degree angle.
Avoid jerking or thrusting weights into position. That can cause injuries. Use smooth, steady movements.
Avoid "locking" the joints in your arms and legs in a tightly straightened position. (A tip on how to straighten your knees: Tighten your thigh muscles. This will lift your kneecaps and protect them.)
Breathe out as you lift or push, and breathe in as you relax. For example, if you are doing leg lifts, breathe out as you lift your leg, and breathe in as you lower it. This may not feel natural at first, and you probably will have to think about it as you are doing it for awhile.
Muscle soreness lasting up to a few days and slight fatigue are normal after muscle-building exercises, but exhaustion, sore joints, and unpleasant muscle pulling aren't. The latter symptoms mean you are overdoing it.
None of the exercises you do should cause pain. The range within which you move your arms and legs should never hurt.

Progressing

Gradually increasing the amount of weight you use is crucial for building strength.
When you are able to lift a weight between 8 to 15 times, you can increase the amount of weight you use at your next session.
Here is an example of how to progress gradually: Start out with a weight that you can lift only 8 times. Keep using that weight until you become strong enough to lift it 12 to 15 times. Add more weight so that, again, you can lift it only 8 times. Use this weight until you can lift it 12 to 15 times, then add more weight. Keep repeating.

Sarcopenia: A Word You Are Likely to Hear More About
We know that muscle-building exercises can improve strength in most older adults, but many questions remain about muscle loss and aging. Researchers want to know, for example, if factors other than a sedentary lifestyle contribute to muscle loss. Does age itself cause changes in the muscles of older people? Is muscle loss related to changes in hormones or nutrition? The answers to these questions may lead to ways of helping us keep our strength as we age.

In this book, we use the word "frailty" to describe the loss of muscle and strength often seen in older people, because it's a word that most people are familiar with. However, a better word to use is "sarcopenia" (pronounced sar - ko - PEEN - ya). It means not only the loss of muscle and strength but also the decreased quality of muscle tissue often seen in older adults. You are likely to hear more about sarcopenia in the future since it's a very active area of research.

Chapter Summary

Build up to all exercises and activities gradually, especially if you have been inactive for a long time.
Once you have built up to a regular schedule, include endurance, strength, balance, and stretching exercises.
If you have to stop exercising for more than a few weeks, start at half the effort when you resume, then build back up to where you were.
When bending forward, always keep back and shoulders straight to ensure that you are bending from the hips, not the waist.
If you have had a hip replacement, check with your surgeon before doing lower body exercises.

Endurance

To build stamina, you can do specific exercises, like walking or jogging, or any activity that raises your heart rate and breathing for extended periods of time.
Do at least 30 minutes of endurance activities on most or all days of the week.
If you prefer, divide your 30 minutes into shorter sessions of no less than 10 minutes each.
The more vigorous the exercise, the greater the benefits.
Warm up and cool down with a light activity, such as easy walking.
Activities shouldnā€™t make you breathe so hard you canā€™t talk. They shouldnā€™t cause dizziness or chest pain.
When you are ready to progress, first increase the amount of time, then the difficulty, of your activity.
Stretch after endurance exercises.

Strength

Do strength exercises for all your major muscle groups at least twice a week, but not for the same muscle group on any 2 days in a row.
Gradually increasing the amount of weight you use is the most important part of strength exercise.
Start with a low amount of weight (or no weight) and increase it gradually.
When you are ready to progress, first increase the number of times you do the exercise, then increase the weight at a later session.
Do an exercise 8 to 15 times; rest a minute and repeat it 8 to 15 more times.
Take 3 seconds to lift and 3 seconds to lower weights. Never jerk weights into position.
If you cant lift a weight more than 8 times, its too heavy; if you can lift it more than 15 times, its too light.
Donā€™t hold your breath while straining.
These exercises may make you sore at first, but they should never cause pain.
Stretch after strength exercises.

Balance

Add the following modifications to your regularly scheduled lower-body strength exercises: As you progress, hold onto the table or chair with one hand, then one finger, then no hands. If you are steady on your feet, progress to no hands and eyes closed. Ask someone to watch you the first few times, in case you lose your balance.
Donā€™t do extra strength exercises to add these balance modifications. Simply add the modifications to your regularly scheduled strength exercises.
Another way to improve your balance is through ā€anytime, anywhereā€¯ balance exercises. One example: Balance on one foot, then the other, while waiting for the bus. Do as often as desired.

Stretching

Stretching exercises may help keep you limber.
Stretching exercises alone will not improve endurance or strength.
Do stretching exercises after endurance and strength exercises, when your muscles are warm.
If stretching exercises are the only kind of exercise you are able to do, do them at least 3 times a week, up to every day. Always warm up your muscles first.
Do each exercise 3 to 5 times at each session.
Hold the stretched position for 10 to 30 seconds.
Total session should last 15 to 30 minutes.
Move slowly into position; never jerk into position.
Stretching may cause mild discomfort, but should not cause pain.