With all the fad diets, infomercial exercise products, and exercise controversy, it's easy to become confused and frustrated when selecting a good exercise program. Also, as you age, your body's tolerance to certain types of exercise changes, which can cause you to avoid exercise all together. This is a concern because inactivity in the elderly has significant negative effects on the body's systems. The positive health benefits of a regular exercise program, however, far outweigh the negative, as you can see in Figure 1.

Exercises once recommended by your gym teacher or coach are unlikely to be beneficial at this stage in your life. Performing such activities can put stress on your muscles, tendons, bones, and joints, which are more prone to injury than they once were. Tissue damage, pain, and inflammation can result if you exceed your level of tolerance. Other factors, such as progressing too quickly, poorly fitting equipment, and poor technique can also cause exercise-induced injuries (Fig. 2).

Exercise prescription
Intensity, duration, and frequency are the three main variables used during the creation and progression of an exercise program. Intensity is the level of effort required to perform a particular activity, duration is defined as the length of time required to complete the activity, and frequency is how often a particular activity is performed over a specific period of time. When adjusting an established exercise program, change only 1 of these variables at a time. Failing to do so will introduce too many unaccustomed stresses and can cause tissue injury.

The rule for changing your exercise program is to increase 1 variable and decrease the other 2 variables. For example, if you lift 25 pounds during 3 sets of 15 repetitions and you want to increase the weight to 30 pounds, you should do it in 3 sets, but you should reduce your repetitions to 10. With the additional weight, muscle soreness can occur. To avoid possible injury, you should participate in this particular exercise once a week instead of twice, until the body has adapted to the changes in your program. A similar rule associated with the adjustment of a cardiovascular training program would be to increase the mileage of an established and well-tolerated distance by only 10% to 15% of your previous workout distance. The slower progression provides the body with an acclimation period to prevent excessive stress and injury.

Finally, when designing an exercise program, variety is very important for several reasons. First, the body is less likely to become accustomed to a particular mode of exercise, therefore, it will be constantly challenged to adapt through improved strength and cardiovascular gains. Second, alternating exercises that involve specific tissues or joints helps prevent repetitive stress and possible wear-and-tear injury. For example, a person who previously trained by running 5 days per week could alternate the mode of training in a 5-day cycle. The individual could run on day 1, bike on day 2, swim on day 3, use an elliptical trainer the next day, and complete the cycle with a rowing machine before beginning the sequence all over again. Another example for strength training could consist of lifting weights for the upper body 1 day, and then alternating with a lower body workout the next day.

Despite your best efforts to create a well-designed exercise program, errors do occur and injury can result. When this happens, you should follow the acronym RICE, which stands for Rest, Ice, Compression, and Elevation. Applying ice along with compression and elevation helps control swelling and helps prevent additional inflammation. Using non-steroidal anti-inflammatory drugs (NSAIDs), as prescribed by your physician or as directed on the label, also helps to decrease swelling and speed recovery.

Despite the common belief that complete rest is the key to recovery, inactivity can be nearly as detrimental as continuing with the stressful activity. During the recovery process, maintain the mobility of the involved body part, as well as the strength and flexibility of the surrounding muscles. This can be accomplished by using the sore or injured area during normal daily activities within a pain-free range of motion.

Stretching can also help prevent complications such as decreased flexibility and muscle atrophy after an injury. Continued participation in all exercises that do not stress the painful structure(s) is encouraged. For example, if pain occurs while jogging, try swimming or pool running. As symptoms resolve, a gradual return to full activity is encouraged, allowing pain to guide you in the progression back to your pre-injury exercise level. If symptoms fail to resolve following these guidelines, seek the attention of a qualified health-care professional.

Daniel Kraushaar, PT, CSCS
Columbus, Georgia