Stephen J. Schueler, M.D.

Overview Conditions Evaluation guidelines for men guidelines for women Prevention diet exercise fitness check fitness program taking control

Elderly Health Prevention

The two most critical factors in senior health are probably diet and exercise.

Other important factors include:

General guidelines for disease prevention in seniors includes:

Elderly Health Diet

Strategies for a healthy diet in senior's include:

  • Limit your intake of fat to 30% of your total calories.
  • 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil.
  • Consume only unsaturated fats that are low in cholesterol.
  • Consume less than 300 milligrams of cholesterol a day.
  • Eat dietary fiber: whole grains are best.
  • Avoid fad diets.
  • Check with your doctor about B vitamin supplements. Some people may benefit from B vitamins.

Key Dietary Recommendations for Chronic Disease Prevention
Energy (calories)to maintain BMI < 25
Total fats< or = to 30% of total daily calories
Saturated fats< 7% of total daily calories
Polyunsaturated fats< 10% of total daily calories
Monounsaturated fats< 13% of total daily calories
Cholesterol< or = to 300 mg per day
Dietary fiber25-30 grams per day
Fiber type3:1 insoluble to soluble fiber
Sodium< or = to 1,500 mg per day
Calcium 9-24 yrs1,200-1,500 mg per day
Calcium 25-50 yrs1,000 mg per day
Calcium 51-65 yrs1,200 mg per day
Calcium >65 yrs1,500 mg per day
Vitamin D 9-50 yrs200 IU per day
Vitamin D 51-70 yrs400 IU per day
Vitamin D >70 yrs600 IU per day
Folic acid400 micrograms (ug) per day
Fruits & vegetables5-7 servings per day
Alcohol (men)< or = to 2 drinks per day
Alcohol (women)< or = to 1 drink per day

Elderly Health Exercise

Exercise is an important part of any senior's self-health strategy.

What is exercise?
Exercise is physical work that keeps the body healthy. Regular exercise has been found to prolong your life. Many people perform hard physical labor, but are not "physically fit".

What is fitness?
Fitness is a sense of well being. You feel energetic, relaxed, and strong when you are physically fit. Your body is usually trim, flexible, and coordinated. Regular exercise is an important part of physical fitness. A healthy diet and lowering stress also help you to be physically fit. Exercise can also reduce stress that allows you to be more "mentally fit".

Exercise affects your body in very complicated ways. Scientists have found that exercise is good for your body in many respects. It may help prevent and treat some illnesses, such as:

More people die from heart disease than any other illness in the United States. Doctors have found that the risk of heart disease is much lower with regular exercise. This is why exercise has become very important in the treatment of heart disease.

How will exercise make me feel?
You must perform regular exercise in order to become physically fit. As you exercise, your body adapts to (becomes used to) the work it must perform. You are then able to tolerate more strenuous activity without tiring. When it becomes a habit, you will feel stronger and more relaxed during normal activities. You will probably sleep better. The exercise may even allow you to lose weight if you follow a proper diet.

Will exercise always help treat illnesses?
Exercise may make you feel better overall, but it will not always make an illness better. For example, let us say you have emphysema (COPD) or lung disease from smoking. Regular exercise may help increase your ability to do things without tiring. You may have much more energy and strength. However, the disease does not improve, and you may not slow down the worsening of the disease.

Physical fitness is a state of mind. You will probably live a healthier lifestyle if you are motivated to be "fit". You may follow a healthy diet, lose weight, stop smoking, and reduce your use of alcohol. All of these factors make you feel better, and allow your body to tolerate an illness better. Exercise also helps your body fight infections.

What are the benefits of exercise?
There are tremendous benefits to regular exercise. Exercise can:

How does exercise help certain diseases?
For all of the following diseases, your doctor should help you plan an exercise program. Exercise has the listed effects on the following illnesses:

How do you start an exercise program?
Unfortunately, few Americans get regular exercise. You are more likely to adopt a regular exercise program if you choose activities that you enjoy. An exercise program should include:
  • Exercise 3 times a week.
  • Exercise for 20 minutes each time.
  • Increase your heart rate (pulse) when exercising. Your doctor will recommend the right number for your heart rate. He/she will also show you how to check your pulse. You may find these numbers on the Internet or in books.

You should perform exercises that are right for you. Most of the time, you should talk to your doctor. You must see your doctor before starting an exercise program if:

If you are over 65, you need to focus on balance and strength exercises first. Then, you may perform "aerobic" exercises regularly such as walking, biking or swimming.

What makes up an exercise program?
  • Type: there are a few major types of exercise:
    • Aerobic: constant exercise for a prolonged time (walking, biking, swimming)
    • Stretching: makes you more flexible
    • Weight lifting: increases muscle tone and strength
  • Intensity: how difficult (strenuous) the exercise is:
    • Usually followed by your pulse (heart rate) during the exercise
    • Your doctor should recommend a pulse that is right for you
  • Duration: how long the exercise lasts:
    • 25-45 minutes for each session
  • Sessions: what you do during the exercise time:
    • 3-5 minutes for warm-up
    • 15-40 minutes for aerobics or weight training
    • 2-5 minutes for cool-down
  • Frequency: how often you exercise:
    • Daily if you exercise less than 30 minutes or your intensity is low
    • Every other day if you exercise greater than 30 minutes or your intensity is high
  • Progression: how you increase your exercise difficulty or time
    • Start out slowly
    • Keep your pulse in the target range
    • Use a logbook to keep track of progress

What are some moderate vs high intensity activities?
Moderate Intensity ActivitiesHigh Intensity Activities
Walking briskly (3 to 4 mph)Aerobics
Toning exercisesTai-bo
Mowing lawnCycling (racing)
Golf (pulling or carrying clubs)Climbing hills
Home repairCross country skiing
Fishing, standing/castingFitness walking
Jogging (medium pace)Swimming
Swimming (medium pace)Roller skating
Cycling (< 10 mph)Tennis
Canoeing (2-4 mph)Soccer
House paintingJumping rope
CarpentryJogging or running

What are calories?
Food supplies our bodies with energy. Calories are the units we use to measure the energy that food contains. Some types of exercise tend to burn more "calories". Also, you have to exercise harder or longer to burn more calories.

How many calories are burned by certain activities?
ActivityNumber of Calories Burned
Walking (brisk)100 calories burned per mile
Jogging120 calories burned per mile
Swimming100 calories burned in 20 minutes
Bicycling (easy pace)100 calories burned in 20 minutes
Aerobic exercise to music100 calories burned in 20 minutes
Gardening (vigorous)100 calories burned in 30 minutes

What are some tips on how to exercise?
  • Always use a mat under you when doing floor exercises.
  • Always wear the right shoes for each activity. They must fit well. If they are too loose, you may suffer blisters. If they are too tight, you may injure your feet. Your socks should pad the skin and absorb sweat well.
  • Avoid exercising outdoors in very warm or very cold weather.
  • Avoid exercising right after you eat. Wait at least two hours after eating before heavy exercise.
  • Do not wear loose jewelry.
  • Drink plenty of fluids before and after exercising.
  • Keep a sugared drink nearby:
  • Exercise in a room with good air circulation. The room should be slightly cool at the start. Then you will be more comfortable when your body heats up.
  • Exercise only when feeling well.
  • Exercise with a friend.
  • Find an exercise routine, teacher, and program that you like.
  • Music may help you enjoy your workout. However, be sure that you can hear cars if you are near the road.
  • Set realistic and safe goals for yourself.
  • Take your pulse at the wrist. Do not take your pulse at the neck. Pressure on the carotid artery in the neck may make you faint.
  • Try to exercise at the same time each day so it becomes routine.
  • Wear loose, layered clothing. As you warm up, you can take off the layers.
  • Performing strenuous exercise while wearing "sweats" can be dangerous. Your body naturally tries to cool itself by sweating. Wear only enough clothing so that you are warm during the exercise.

When should you stop exercising?
You should stop exercising if you do not feel well or have any of the following:

In summary, diseases are not caused by a lack of exercise. But physical fitness will improve general health and help slow aging. Talk to your doctor about an exercise program that is right for you. Most importantly, choose an activity that you enjoy!

Elderly Health Fitness Check

Fitness is an important part of any senior's health.

Cardiovascular Fitness Evaluation
The 3-minute step test can provide important information concerning the exercise capacity of your heart and your cardiovascular fitness level. Your pulse rate during exercise is a useful guide to how much work your heart is doing. With this information you can make sure you are exercising with enough intensity to guarantee a good conditioning effect, while not pushing yourself too hard.

Before starting this test you must first answer all of the following questions:

Note: If the answer to any of the above questions is "yes", then check with your doctor before attempting the step test!

General Principles
Stop exercising immediately if you develop extreme shortness of breath, chest pain, lightheadedness, or dizziness. You can determine your pulse rate during exercise by stopping and then measuring your pulse rate for 10 seconds. Multiply this number by 6 to obtain the number of beats per minute. To perform a complete assessment of your cardiovascular fitness, you must perform the step test for a full three minutes using the technique as described below.

How to perform the 3-minute step test:
  • Find something sturdy to use as a 12-inch high step. A small bench or a securely tied stack of newspapers or magazines can be used. Do not use a stairway.
  • Facing the step, first step up with one foot, and then the other. Next, step down with one foot, then the other. Each sequence of getting up and down from the bench (with both feet) counts as one step.
  • The pace is critical.... you must make 24 full steps each minute---that's 2 every 5 seconds for a full 3 minutes!
  • After the 3 minutes has elapsed, sit down and take your pulse approximately 5 seconds after completing the step test. Compare results with the standardized charts below.

Resting Heart Rate: determine your heart rate by measuring your pulse when you first awaken or after you have been resting for at least 10 minutes.

Normal Resting Heart Rates
Age RangeAverage Beats Per Min
1 month120-130
6 months120-130
1-2 years110-120
2-3 years100-110
4-5 years95-105
6-8 years90-100
10-12 years85-95
14 years75-85

Exercise Heart Rate
Measure your pulse rate during exercise to determine how much work your heart is doing (what level of intensity you are exercising at).

Target Heart Rate Levels
Exercise Intensity LevelTarget Heart Rate
Low Intensity50 to 60% max beats per min
Weight Loss Intensity50 to 70% max beats per min
Average Intensity60 to 70% max beats per min
High Intensity70 to 80% max beats per min

Target Heart Rate Age Chart
AgeExercise Intensity Level
Low Weight LossAverageHigh

Note: If you are taking high blood pressure or heart medications that affect your pulse rate, check with your physician to determine the appropriate target heart rate for you.

During exercise your heart should be working hard enough to assure a good training effect, but not so hard as to be unsafe. During exercise you should attempt to keep your heart rate inside the ranges depicted on the target heart rate for exercise chart shown above. These values do not apply to those who are taking beta-blockers, which slow the heart rate, or those who have an artificial pacemaker.

Interpreting Pulse Rate Results of 3 Minute Step Test for Females
Excellentpulse to 79pulse to 83pulse to 87pulse to 91pulse to 94

Interpreting Pulse Rate Results of 3 Minute Step Test for Males
Excellentpulse to 74pulse to 77pulse to 79pulse to 84pulse to 89

Be sure to discuss all results and any symptoms that may arise with your physician.

Elderly Health Fitness Program

Senior's should consult a doctor before starting an exercise plan.

Guidelines on Exercise in the Elderly
The American College of Sports Medicine (ACSM) has released new guidelines regarding exercise in individuals over the age of 65. The new recommendations place greater emphasis on the total amount of time spent exercising for the elderly and for the first time, they call for flexibility training as a way to maintain joint range and fitness for adults in general. The recommendations are for 3 to 5 days per week of aerobic exercise, walking, jogging, or other different types of activities that use the major muscle groups, at moderate to moderately high levels of intensity.

The ACSM also recommends stretching of major muscle groups 2 to 3 times a week. These exercises enhance flexibility, a factor that becomes even more important with aging. Elderly adults need to focus on strength and balance training first, before working up to a moderate intensity aerobic exercise.

Neck stretches
Relax shoulders. Slowly roll head in a half circle, right ear over right shoulder, chin over chest, left ear over left shoulder. Reverse direction. Repeat 4 times.

Shoulder shrugs
Lift your shoulders toward your ears. Hold for a count of 5, and then relax. Repeat 8 times.

Deep breathing
Stand or sit up straight, shoulders relaxed. Counting to 5, slowly inhale while raising your arms to form a "V" overhead. Counting to 5 again, exhale and lower your arms. Repeat 5 times. Shake out your arms.

Hand grips
With arms straight out in front of you, stretch your fingers apart for a count of 2, then make a tight fist for a count of 2. Work up to 15 of these. Shake out your arms when you are finished.

Ankle circles
Sit on a chair or the floor with legs uncrossed. Moving your foot, make 5 circles in the air. Repeat in the other direction, and then relax. Switch feet and repeat. Shake out your feet when done.

Sample Exercises
After your warm-ups, you can begin these exercises. Start slowly, doing only a few of each. Gradually work your way up to more exercises over time. Remember to do your cool-downs after your workout.

Lateral waist bends
Stand up tall with feet shoulder-width apart. Bend to the right, bringing your right arm down the side of your body and your left arm over your head. Look straight ahead and count to 10. Slowly return to the straight-up position. Repeat the exercise, bending to the left side. Work your way up to 5 of these.

Back stretches
Lie down with your back flat on the floor. Bring your knees up to your chest and hug them with your arms. Slowly, counting to 5, bring your forehead as close to your knees as possible. Hold for 5 seconds. Roll your head back down, counting to 5. Work up to 15 of these.

Arm circles
Stand with feet shoulder-width apart, knees slightly bent. Extend arms straight out from shoulders, with fingers spread and palms down. Keep buttocks and stomach tight. Rotate your arms in circles, 10 times forward and then 10 times backward. When finished, shake out your arms. Over time, work up to 20 circles in each direction.

Arm reaches
Stand up straight, feet shoulder-width apart. Counting to 5, stretch your right arm to the ceiling while keeping your feet flat on the floor. Repeat with your left arm. Do this 10 times. When finished, shake out your arms.

Heel lifts
Stand up straight, stomach and buttocks tight, and feet shoulder-width apart. Hold on to a chair and roll up on your toes. Hold for a count of 5. Slowly roll back down to the count of 3. Work up to 10 times.

Please contact your doctor before initiating exercise

Call Back Instructions

  • If your symptoms worsen, do not improve or you develop new symptoms with exercise, please call us back for reassessment.

Elderly Health Taking Control

The successful management of any senior's health requires active participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

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