Background Literature
Old age is the most common risk factor for chronic diseases. It leads to a loss in muscle strength leading to difficulties in movements and a consequent decline in physical activity. As a result, a sedentary lifestyle ensues, which increases the risk of obesity and subsequent chronic conditions like diabetes and high blood pressure. These changes result in high medical expenses for this population and a decline in the quality of life. Increasing physical activity can help this problem. When people are active, their blood pressure, glucose, body fats, and other clinical elements reduces, resulting in fewer and less severe symptoms related to their conditions. T his project proposes an inertial training program for the elderly in Oceanside who make up 13% of the regional population.
Aging results in many physiological changes. Muscle strength reduces, neuromuscular coordination and balance deteriorate, locomotive abilities decline, and the risk of falls increases. This population also suffers reduced functional efficiency and economic productivity. According to Naczk et al. (2020), 30 to 40% of seniors fall at least one time every year. These changes lead to difficulties in movement and physical inactivity. At the same time, fat accumulates in the body resulting in an increase in the Body Mass Index (BMI) beyond health values. The Center for Disease Control reported that about 42.8% of Americans aged 60 and above were obese between 2017 and 2018 (Hales et al., 2020). In Oceanside, California, the prevalence is 30%, which though lower than the national level, is still significantly high (Hales et al., 2020).
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Old age, physical inactivity, and obesity increase the risk of chronic illnesses. The National Institutes of Health (2017) reported that approximately 85% of American seniors have at least one chronic condition, and 60% at least two. Diabetes, cardiovascular diseases, and cancer are the most prevalent. With these conditions, the quality of life reduces significantly, as coping with regular daily activities becomes challenging.
Age-associated chronic conditions increase medical expenses. In America, it has led to skewed Medicare spending. Annual costs associated with chronic illnesses among seniors are high all over the country. 75% of the Medicare outlays every year are a result of the medical needs of 10% of the beneficiaries, almost all of them being chronically ill (Joyce et al., 2005). Those with chronic conditions account for 3 to 10 times more per capita medical expenditures than those with none (Joyce et al., 2005). Therefore, efforts to control Medicare costs must address the medical needs of this population.
Increasing physical activity is one of the most effective ways to solve this problem. It helps in weight management for healthier BMI, reduces the risk of chronic illnesses, as well as delays the onset and severity of symptoms (Joyce et al., 2005). When seniors are physically active, it becomes easier and cheaper to manage their chronic conditions. Their healthcare need and costs reduce, reducing the overall Medicare expenditure.
One of the most effective workouts for older people is strength-training. It can help prevent falls, improve the quality of life, and increase independence. Inertial training is one of the methods that have demonstrated good efficacy in enhancing functionality among the elderly (Naczk et al., 2020). However, it is not widely accessible or understood well for this population. It involves the use of inertial resistance coming from a specialized device to stretch weak body muscles. The exercises entail eccentric overload in short episodes, which results in a higher peak value of strength compared to regular weight training. Brzenczek-Owczarzak et al. (2013) associated these brief episodes with the high success it has among younger people. From their study, there was a substantial increase in muscle strength in seniors over short periods. Four weeks of inertial training resulted in an increase in shoulder strength from 3.5% to 21.9% ( Brzenczek-Owczarzak et al., 2013).
A similar study by Naczk et al. (2020) reported significant improvements in extensor muscle, elbow, and knee flexor, and limbs strength among seniors. After the 6-week inertial training program, function abilities, balance, gait, and confidence increased substantially. The study observed a decrease in the risk of falling, which one of the most common reasons seniors go to emergency rooms ( Naczk et al., 2020). These changes enhance safety and restore some independence, improving the quality of life.
Currently, there is limited data on the influence of inertial training chronic conditions among the elderly, especially regarding the severity of the symptoms. This project hypothesizes that this kind of training improves the overall wellbeing and reduces cases normalizes blood pressure, glucose, fats, and BMI of seniors in Oceanside due to chronic ailments. This author hopes to design an inertial training program tailored to the elderly in this region.
Contribution to Clinical Practice
Data from this project will simplify the work of nurses, particularly those dealing in homecare. It will describe a safe way to promote physical activity to reduce the risk and help manage chronic diseases among the geriatrics. With such a program, nurses will deal with fewer falls, as their clients will be safer and healthier than before. They will also suffer from fewer emergencies related to their conditions, such as heart attacks, elevated blood pressure, and blood glucose.
This project will be piloted in Pacifica Senior Living Oceanside nursing home. The subjects will be willing elderly residents diagnosed with a chronic medical condition, such as diabetes and hypertension, more than three months ago. They should not have suffered bone ligament and tendon injuries within the last two months. At the baseline, a nurse will record their vital signs, including weight, height, BMI, blood pressure, and glucose. Their lipid profile, including total cholesterol, Low-Density Lipoproteins (LDL), triglycerides, and High-Density Lipoproteins (HDL), will also be analyzed. Using the chit method, the investigator will randomly divide the participants into two groups, a training and control group. The latter will maintain their regular daily activity while the former will engage in an eight-week inertial training program.
A trained instructor will conduct inertial training three times a week; each session lasting two hours. The team will begin with a standardized warm-up by cycling on an ergometer for 10 minutes. For each exercise, participants will use a Cyklotren inertial device while sitting on a rehabilitation chair. They will train different types of muscles using weights of 10 and 20 kg under the guidance of the instructor. The loads will remain constant, but the number of cycles will increase as the training weeks progress.
The evaluation will be by tracking changes in weight, height, BMI, blood pressure, glucose, and lipid profile. For lipids, the focus will be on LDL and total cholesterol since they are the most critical markers of the condition of body fats. These assessments will happen every two weeks for all participants, both in the control and training group. A nurse will record vital signs, and a trained laboratory technologist will collect and analyze the blood for lipids and glucose. The investigator will use the results to draw charts for every participant to monitor the progress. At the end of the project, the charts will be used to track changes in the analytes and correlate them with inertial training. A reduction in BMI, blood pressure, glucose, LDL, and total cholesterol will imply that this intervention is effective in managing chronic conditions like diabetes and hypertension among seniors.
References
Brzenczek-Owczarzak, W., Naczk, M., Arlet, J., Forjasz, J., Jedrzejczak, T., & Adach, Z. (2013). Estimation of the efficacy of inertial training in older women. Journal of aging and physical activity , 21 (4), 433-443. https://doi.org/10.1123/japa.21.4.433
Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: the United States, 2017–2018. https://www.cdc.gov/nchs/products/databriefs/db360.htm#:~:text=The%20age%2Dadjusted%20prevalence%20of%20obesity%20among%20U.S.%20adults%20was,age%20group%20(Figure%201).
Joyce, G. F., Keeler, E. B., Shang, B., & Goldman, D. P. (2005). The Lifetime Burden Of Chronic Disease Among The Elderly: Reducing chronic illness in future elderly cohorts will have only modest effects on Medicare's financial stability. Health Affairs , 24 (Suppl2), W5-R18. https://dx.doi.org/10.1377%2Fhlthaff.w5.r18
Naczk, M., Marszalek, S., & Naczk, A. (2020). Inertial training improves strength, balance, and gait speed in elderly nursing home residents. Clinical interventions in aging, 15, 177. https://dx.doi.org/10.2147%2FCIA.S234299
National Institutes of Health. (2017). Supporting older patients with chronic conditions. https://www.nia.nih.gov/health/supporting-older-patients-chronic-conditions#:~:text=Your%20Older%20Patient-,Supporting%20Older%20Patients%20with%20Chronic%20Conditions,for%20Disease%20Control%20and%20Prevention.
