Diet Plus Exercise in Older Adults
As we age our metabolism begins to slow down and gradual weight gain usually follows. In addition, people tend to be less active after they retire. With this extra weight, older adults have increased risk for diabetes, heart disease and joint problems. A recent study, published in the Journal of Applied Physiology, involved participants who were 60 – 75 years of age, overweight and sedentary. The study subjects were divided into three groups for weight loss: exercise only, diet only, and exercise plus diet. The exercise group used the stationary bike or walked but did not change their diet. The diet group reduced their caloric intake to achieve a 10% weight loss over four months. The third group combined daily exercise with a sensible diet. The exercise only group used more fat stores but burned fewer calories while exercising as their bodies grew accustomed to the workout. The diet only group had weight loss resulting from a loss of both muscle and fat. The exercise plus diet group lost weight but most of it came from fat stores. Older people tend to lose muscle and bone mass due to inactivity and normal aging. Dieting without daily exercise produced a loss of muscle mass which is undesirable. Not only with older adults, but with all my clients, I emphasize the importance of exercise together with diet for the best overall health results. You should warn anyone that starts exercising after being totally sedentary that significant weight loss may not occur in the first few weeks because they are toning muscle (which is heavy) while they are losing fat mass. Instead of measuring success only with a scale, try measuring upper arms, thighs, waist and hips to show them how many inches they have lost. This keeps them motivated even when they see little change in the scale.
My most recent challenge is Mrs. D. A widow of 34 years, she is an adorable 79 year old, at 4 feet, 11 inches tall, with a weight of 294 lb; her BMI is 59.4 with a majority of her weight is at her mid-section and lower extremities. Simple daily activities are difficult for her and she has trouble with almost every common movement, from rolling over in bed to getting out of a chair. She cannot walk more than 10 to 12 steps without becoming short of breath and often has to sit down to recover.
Moreover, Mrs. D has not been able to flex at her waist because of her weight and lacked the fine motor grasp and arm strength necessary to put on her stockings. Because of her decreased knee and hip range of motion, Mrs. D also cannot raise or physically lift her legs.
I worry about her constantly and although she quite sweet, she tends to disregard my advice and her food choices show it. I work closely with an OT here who also shares my concerns.
Just thought I'd share when I saw your post. Any suggestions?
I understand how difficult it is to encourage our older folks to change their habits- eating or exercise for that matter- I have had better luck when I counsel them to cut the portion - not give up- their favorite foods. Does your facility with the help of OT and PT have a fun chair group exercise opportunity? I am also of the opinion that we only do the type of physical activity we enjoy with any consistency. We also have the consideration of Patient Rights - It makes it quite difficult sometimes to limit the intake of those who are mentally competent and able to choose for themselves. I know you give excellent advice and convey your concerns, but it is really up to Mrs. D to decide to change.