Beyond “Just Walk More”– Cardio for the Older Adult

For the older adult, common cardiovascular exercise advice is to just perform activities like walking or biking. This is a great start for sedentary individuals, but for those who want to play sports, be fit and perform at a higher level, this isn’t enough.

A commonly used measure of cardiovascular health and performance is VO2 Max, which is a measure of a person’s ability to take in oxygen and deliver it to working tissues (i.e. skeletal muscle during exercise). A person with a higher VO2 Max is able to take in more oxygen and deliver it to their muscles which means:

 1. They can better perform short bursts of high intensity activity. For example, when sprinting during soccer, an athlete with a higher VO2 Max can better create energy to support that sprint.

2. They can perform longer duration activities with an increased intensity. For example, if a runner increases their VO2 Max, they should be able run 1 mile at a faster pace, since they can create more energy to sustain that longer duration activity. 

Like strength, VO2 Max starts to decrease around 40 years of age (1). However, research shows that athletes who maintain high training intensities experience smaller decreases in VO2 Max compared to those who decrease their training intensity (1). This means that with age, performing high intensity cardiovascular exercise is vital to maintain high levels of cardiovascular fitness. Another benefit of high intensity training, is that it recruits more type II muscle fibers and helps maintain muscle mass, both of which tend to decrease with age (1).

So where does one start with cardiovascular training?

The first step is in developing a strong aerobic base with moderate intensity training for longer intervals. Moderate intensity, steady state cardio helps build the aerobic energy base that supports recovery from higher intensity training. For older adults, the minimum recommended intensity is about 75-80% of one’s age predicted maximum heart rate (calculated as 220-age). Another way to roughly estimate this, is to perform exercise at an intensity where one can still talk, but not sing (also known as the “Talk Test”) (2). As far as duration, the Center for Disease Control (CDC)’s “Physical Activity Guidelines for Americans”, recommends 150-300 minutes of moderate intensity exercise weekly (3). This includes a range of activities such as walking, swimming, dance, or cycling. A sample program could be starting with 30 minutes, 5 days per week and increasing your total weekly duration by 10% (about 15 minutes) until reaching 300 minutes per week. Note that these recommendations serve not only as a base for higher intensity training, but also promote cardiovascular health (3).

After several weeks of lower intensity aerobic exercise, then we can start with high intensity interval training (HIIT). While a completely sedentary individual will see an increase in VO2 Max with low intensity training, more active individuals will need to incorporate high intensity training to further improve their VO2 Max. Typically, this intensity range is defined as 80-95% of age predicted max heart rate (4). Another estimation method is to perform an exercise with sufficient intensity that you can only say a few words at a time (3).

Many HIIT protocols exist, however my preferred is as follows:

  • 5 minutes of low intensity warmup
  • 60 seconds of high intensity work, followed by 60 seconds of low intensity work. This would be repeated 6-10 times.
  • 5 minutes of low intensity cool down

As for exercise selection, HIIT is ideally performed with activities that:

  1. Require little skill to perform well
  2. Have minimal eccentric muscle loading, which produce more muscle soreness and fatigue*
  3. Can be easily increased/decreased in intensity

Thus activities like an assault bike, stationary bike, or rower are ideal for HIIT. While many popular fitness programs use bodyweight exercises such as burpees and other jumping exercises, I don’t recommend these for HIIT, unless they are the only option one has. These movements are not bad, per se, but they require some degree of skill to perform well, have higher eccentric muscle loading demands, and the intensity of them cannot be easily adjusted.

So to summarize here is a sample training program to improve cardiovascular health and performance in the older adult:

 Moderate Intensity TrainingHigh Intensity Interval Training
Intensity via Heart Rate75-80% of max heart rate80-95% of max heart rate
Intensity via Talk TestCan talk, but not singCan only say a few words at a time
Warm Up/Cool DownNone needed5 min warmup, 5 min cool down
Duration30-60 min per session, for a total of 150-300 min per week60:60 sec, work: rest interval, repeated 6-10 times
Frequency5-7x/week1-2x/week
Example Recommended ActivitiesWalking, cycling, rowing, light dance, swimming, ellipticalCycling, rowing, elliptical

Much like with strength training, the exact program varies by the medical history, needs, wants, abilities and response of each person.

*An eccentric muscle contraction is the part of a movement where the muscle is stopping motion, whereas a concentric muscle contraction is when the muscle is creating motion. For example, during a squat, the lowering down portion of the movement is the eccentric phase and the rising up part is the concentric phase. Exercises like biking, mostly involve concentric muscle contractions since your limbs primarily encounter resistance when they contract to create motion e.g. when your foot is on a bike pedal, you don’t have to control/stop the motion, you only experience resistance when you actively push the pedal.

References:

  1. Foster, C., Wright, G., Battista, R. A., & Porcari, J. P. (2007). Training in the aging athlete. Current sports medicine reports6(3), 200–206. https://doi.org/10.1007/s11932-007-0029-4
  2. https://www.acsm.org/docs/default-source/files-for-resource-library/exercise-intensity-infographic.pdf?sfvrsn=f467c793_2
  3. https://health.gov/sites/default/files/2019-10/PAG_ExecutiveSummary.pdf
  4. Roy, Brad A. Ph.D., FACSM, FACHE High-Intensity Interval Training, ACSM’s Health & Fitness Journal: May/June 2013 – Volume 17 – Issue 3 – p 3 doi: 10.1249/FIT.0b013e31828cb21c

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: