djustments to avoid hypoglycemia during exercise; patients with non-insulin-dependent diabetes benefit from an exercise-induced rise in insulin sensitivity that eases the uptake of glucose by muscle tissue.7-9
Medications with the potential to cause orthostatic hypotension (e.g., antihypertensives, diuretics, antidepressants, anxiolytics, sedative-hypnotics) may require downward dosage adjustments to prevent exacerbation of orthostasis caused by fluid loss during exercise (which may result in presyncope or syncope).7-9 Patients should be made aware that adequate fluid intake is essential during exercise.7-9
Medications with anabolic activity (e.g., GH, estrogen, testosterone, vitamins) have been suggested as a modality to build muscle mass in seniors with sarcopenia.7 However, studies using various hormones have shown the following: 1) mixed results with exogenous growth hormone; 2) the effect of estrogen replacement on muscle strength is limited and inconsistent; 3) testosterone replacement for men with hypogonadism, while appearing to increase muscle strength, lacks dose-response information, and adverse effects such as prostate cancer remain a concern.7
Sedative-hypnotics can potentially reduce physical performance (i.e., directly through inhibiting effects on muscles and nerves or indirectly by a reduction in activity levels) and are associated with the risk of falls.7-9 In order to improve the safety of exercise and to increase patient adherence to an exercise program, dosage reduction or discontinuation may be required.7-9
Strength Training for Seniors
Nelson and Wernick indicate that many sedentary individuals want to change; however, they do not have the accurate and practical information necessary to commence.10 In their book entitled Growing Stronger: Strength Training for Older Adults (see Resource), Seguin et al provide a highly effective program that is safe, simple, and based on the principles of strength training.7 According to the authors, worldwide laboratory research has shown that strength training not only benefits both men and women of all ages, but of all levels of fitness as well.7 Furthermore, such a program can play a role in helping to prevent and treat chronic conditions such as arthritis and osteoporosis, among others (TABLE 3).7 The program was developed at the Nutrition, Exercise Physiology and Sarcopenia Laboratory at Tufts University and includes motivational tips, safety precautions, and specific exercises. It is comprised of three phases: Part I uses an individual's own body weight to strengthen the body slowly and gently; Part II introduces dumbells and ankle weights to increase strength; and Part III adds variety so that new techniques boost strength further.7
Seguin et al note the goal of Growing Stronger: Strength Training for Older Adults is to help seniors make strength training a lifelong habit. To that end, the program is tailored to the needs of an older adult and provides step-by-step instructions on getting started, staying on track, and growing stronger and healthier as one ages.7
Strength-training exercises have the potential to make a profound difference in a senior's physical, mental, and emotional health. It can help both male and female older adults, at all fitness levels, reach toward greater strength and vitality and maintain independence. Pharmacists have the potential to make a difference in the lives of older adults by appropriately recommending the role of strength training in a plan of care and by counseling patients on safe medication use during exercise.
1. Beers MH, Jones TV, Berkwits M, et al, eds. The Merck Manual of Health & Aging. Whitehouse Station, NJ: Merck Research Laboratories; 2004:13-14, 128.
2. Beers MH, Jones TV, Berkwits M, et al, eds. The Merck Manual of Geriatrics. Whitehouse Station, NJ: Merck Research Laboratories; 2009-2010: Section 3, chapter 31; Section 7, chapter 48; Section 8, chapter 66. www.merck.com/mkgr/mmg/contents.jsp. Accessed August 10, 2010.
3. Dorland's Pocket Medical Dictionary. 28th ed. Elsevier Saunders; 2009.
4. Fried LP, Wa