goals based on accumulated experience. The following programs, organized by target, provide basic guidelines from which to determine specific goals in a wide range of settings.
Exercise programs recommended for older individuals have been based on programs designed for the general adult population. Healthy adults have been advised by the American College of Sports Medicine (as reported by Pollock32) to train three to five days a week, with an intensity of 50 to 80 percent VO2max or maximum heart rate (HRmax) reserve. Training should be from 20 to 60 minutes (the lower the intensity, the greater the duration); longer lasting, lower intensity programs are recommended for nonathletic adults. Exercise should use large muscle groups in continuous motion (as in jogging and rhythmic aerobics) and should include resistance training of moderate intensity that is nevertheless sufficient to develop and maintain fat-free weight and bone integrity.
The great variations in fitness levels among the elderly, however, make certain precautions necessary before exercise programs are initiated: programs often need to be modified to suit the particular needs and abilities of the participants. Writing for the American College of Sports Medicine, Heath recommends that individuals who participate in supervised exercise programs complete a brief medical history and risk factor questionnaire.22 Diagnostic tolerance testing is recommended for participants with diabetes mellitus or coronary heart disease and for individuals known to be at risk for these diseases. For vigorous programs, the college advises exercise leaders to ensure that program applicants have had a physical examination by a physician within the two years previous to program initiation.22
Adaptations of exercise programs may vary considerably. In the old-old population (usually 75 years of age and older), emphasis often is placed on maintaining flexibility, strength, coordination, and balance rather than on aerobic training. However, moderate aerobic training may be included in programs for the young-old.45 Programs for the elderly are likely to require exercises of lower intensity and impact and to approach their most strenuous moments more gradually than programs designed for the general adult population.32 As a result, the diminished intensity of these exercises may call for increased frequency. The American College of Sports Medicine's recommended adaptations for older persons include exercising between five and seven days a week for periods of 20 to 40 minutes.22 Given the vast differences among elderly individuals and the dearth of