to go. Remember the aging person has limited energy and cognitive abilities, such as focusing and concentration. A comprehensive program could be broken up into small segments which could be done daily for short periods. The patient will achieve maximum benefits over a 6-8 week training program.(17). Plyometrics will benefit the Type II muscle fibres, in-creasing strength and speed to lower limb muscles, im-prove cardiorespiratory function and general body strength, balance and cognition. Plyometrics could be done on alternate days and each week the duration and intensity (height of jump), could be gradually increased. This will easily fit into their time constrain requirements. In addition, supplementing with Vitamin E which has been shown to benefits myoblast proliferation, differenti-ation, survival, membrane repair, mitochondrial efficiency, muscle mass, muscle contractile properties, muscle strength and increase exercise capacity.(18) When ade-quate protein intake and Vitamin D are added, these four factors will contribute significantly to the functional per-formance of the aging person. References 1.https://www.canada.ca/en/public-health/services/health-promotion/aging-seniors/publica-tions/publications-general-public/seniors-falls-canada-second-report.html 2.Distefano G, et al. Effects of Exercise and Aging on Skeletal Muscle. Cold Spring Harb Perspect Med . 2018 Mar 1; 8(3): a029785. 3.Sherrington C, et al. Exercise to Prevent Falls in Older Adults: An Updated Systematic Review and Meta-Analysis. Br J Sports Med. 2017 Dec; 51(24): 1750-1758. prevention in this population.(7) Other factors will contribute to the effective function of the Type II skeletal muscle fiber, such as calcium. Lack of calcium and aging affects muscle cells power output.(8) The aging person needs to be taking adequate amounts of calcium. Certain types of exercises such as jumping, help to maintain the conduction velocity, ie. the propagation of the action potential, especially in Type II mus-cle fibers.(9) For the nervous system, certain areas of the brain such as the prefrontal cortex activity levels can also contribute to the progression of falls (10) and neuromuscular control and step to step variability.(11) As well, the amount of sleep the aged person achieves each night(12), important, as this ties in to the level of melatonin released in the system. The better levels of melatonin will positively affect skeletal muscle frailty and help to improve physical exercise performance.(13). The research literature regarding fall prevention, states that a good program should address as many components as possible, and when this is done, even in a short program, will still be beneficial for fall prevention.(14) Reduced abil-ity to adapt gait, particularly under challenging conditions, may also be an important reason why older adults have an increased risk of falling.(15) Introducing variable surface patterns into the gait training, along with balance, cognitive and behavioral components, would contribute significantly to decreasing falls in the aging person.(16) Having a comprehensive multimodal program, which is short and covers all the major systems for the aging person, such as muscle training, neuromuscular co-ordination, car-diorespiratory, core and cognitive areas, seems to be the way www.Cndoctor.ca 4.Zhao R, et al. Exercise Interventions and Prevention of Fall-Related Fractures in Older People: A Meta-Analysis of Randomized Controlled Trials. Int J Epidemiol. 2017 Feb 1; 46(1): 149-161. 5.Morat M, et al, Agility Training to Integratively Promote Neuromuscular, Cognitive, Cardiovas-cular and Psychosocial Function in Healthy Older Adults: A Study Protocol of a One-Year Rand-omized-Controlled Trial. Int J Environ Res Public Health. 2020 Mar 12; 17(6): 1853. 6.Shahtahmassebi B, et al. Trunk Exercise Training Improves Muscle Size, Strength, and Function in Older Adults: A Randomized Controlled Trial. Scand J Med Sci Sports. 2019 Jul; 29(7): 980-991. 7.Wang E, et al. Impact of maximal strength training on work efficiency and muscle fiber type in the elderly: Implications for physical function and fall prevention. Exp Gerontol. 2017 May; 91:64-71. 8.Straight C, et al. Age-related reduction in single muscle fiber calcium sensitivity is associated with decreased muscle power in men and women. Exp Gerontol. 2018 Feb;102:84-92. 9.Methenitis S, et al. Muscle Fiber Conduction Velocity, Muscle Fiber Composition, and Power Performance. Med Sci Sports & Exercise. . 2016 Sept. 48(9):1761–1771. 10.Verghese J, et al. Brain activation in high-functioning older adults and falls: Prospective cohort study. Neurology. 2017 Jan 10; 88(2): 191-197. 11.\Allen J, et al. The Motor Repertoire of Older Adult Fallers May Constrain Their Response to Balance Perturbations. J Neurophysiol . 2018 Nov 1; 120(5): 2368-2378. 12.Vincent B, et al. Sleeping Time Is Associated With Functional Limitations in a National Sample of Older Americans. Aging Clin Exp Res . 2020 Mar 13. 13.Stacchiotti A, et al. Impact of Melatonin on Skeletal Muscle and Exercise. Cells. 2020 Jan 24; 9(2): 288. 14.Losa-Reyna J, et al. Effect of a short multicomponent exercise intervention focused on muscle power in frail and pre frail elderly: A pilot trial. Exp Gerontol. 2019 Jan; 115: 114-121. 15.Caetano M, et al. Executive Functioning, Concern About Falling and Quadriceps Strength Mediate the Relationship Between Impaired Gait Adaptability and Fall Risk in Older People. Gait Posture. 2018 Jan; 59: 188-192. 16.Montero-Odasso M, et al. Falls in Cognitively Impaired Older Adults: Implications for Risk Assessment And Prevention. J Am Geriatr Soc. 2018 Feb; 66(2): 367-375. 17.Donath L, et al. Exercise-Based Fall Prevention in the Elderly: What About Agility? Sports Med. 2016 Feb; 46(2): 143-9. 18.Chung E, et al. Potential Roles of Vitamin E in Age-Related Changes in Skeletal Muscle Health. Nutr Res. 2018 Jan; 49: 23-36. Photo:© Ricardo Ferrando / Adobe Stock December 2020 Chiropractic and Naturopathic Doctor 23
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