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NCGG Home Exercise Program for Older People (NCGG-HEPOP) 2020

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Version 1.2
National Center for Geriatrics and Gerontology
Basic Exercise and Activities for Older People

 

Preface

With the advent of the COVID-19 pandemic, concerns have been raised that the number of older individuals who have become inactive in their daily lives and have reduced mental and physical functions may increase as people refrain from spending time outdoors. In addition, the provision of medical services, including rehabilitation, has become more difficult. To help older people live as healthily as possible under such circumstances, the National Center for Geriatrics and Gerontology (NCGG) has published a guide to activities at home, the Home Exercise Program for Older People (NCGG-HEPOP) 2020. The purpose of this guide is to introduce an easy-to-understand menu of exercises and activities that can be practiced at home according to each individual function, so that physical and mental functions do not inadvertently deteriorate. At the same time, this guide introduces appropriate nutrition. We hope that you will find this guide useful and that you will continue to live a healthy life.

Contents

  1. Background and overview
  2. HEPOP flowchart
  3. Precautions and guidance for use
  4. Various kinds of exercise and activity packages
  5. Exercise intensity and physical activity
  6. Conclusion
  7. Contact us

 1. Background and overview

Due to the recent COVID-19 pandemic and other circumstances, times arise when individuals have no choice but to reduce our social interaction. Avoiding the “three Cs” of closed spaces, crowded places, and close-contact settings is very important to protect life, but if a situation of remaining isolated and disconnected from society continues for a long time, the risk of various adverse effects on both body and mind is high. Particularly for older individuals, there is concern about the progression of frailty, in which a small amount of stress can lead to major deteriorations in health (Fig. 1).
 

This is a conceptual diagram of frailty.Even in healthy people,when they are exposed to various external stresses with aging, their physiological reserve and independence decrease, and they progress to pre-frailty and frailty. If you do not take any action, your function will gradually become impaired and need long-term care. Once in a state of required long-term care, it is difficult to return to a robust state.

Figure 1.  Conceptual diagram of frailty: cited from Frailty Hand Book Hidenori Arai Edit., (LIFE SCIENCE CO., LTD. 2016 pp 3)

The risk of walking difficulties, falls and fractures, cognitive declines, and development of new diseases increases with frailty, so avoiding an inactive lifestyle and maintaining good health are important. To avoid the falling dominoes of mental and physical functions that have been maintained up to now (Fig. 2), performing as much exercise and activities as possible at home is crucial.

This figure is the frailty dominoes. Losing social ties is the first entry point to frailty. It leads to reduced life space, decreased mental and oral function, malnutrition, and impaired physical function. Be careful not to let such dominoes fall.

Figure 2. The Frailty Dominoes By courtesy of Prof. Katsuya Iijima, Institute of Gerontology, The University of Tokyo

The HEPOP 2020 guide to activities at home, basic exercise and activities for older individuals was created to support people refraining from going out or who are restricted from social activities so that they can safely engage in appropriate activities to prevent the deterioration of mental and physical functions while at home. In addition to presenting various types of exercises and activities, a flowchart can be used to determine which menus are most appropriate. We hope that this guide will help you to maintain your physical and mental functions and to continue living a safe and secure life.

2. HEPOP flowchart

First, answer Questions (1) to (3), and follow the flow indicated by the arrows to find the right exercise and activity package for you. In some cases, such as when the answer is “Yes” to both (1) and (3), more than one appropriate package may be selected for each answer.

This is the HEPOP flowchart. Answering simple questions will help you choose the appropriate activity or exercise package for you. The questions are as follows: 1. Do you think you walk slower than before?  2. Have you lost 2~3 kg or more in weight in the past 6 months?  3. Are you worried about forgetting things these days? When you answer (Yes) to 1, either or both of the following two questions are (Yes) will result in (Balance Improvement Package), and (Strengthening package) if both are (No). The two questions are as follows: 6. Have you experienced a fall in the past year? 7. Do you have a fear of falling while walking? When you answer (Yes) to 2, either or both of the following two questions are (Yes) will result in (Feeding and swallowing improvement Package), and (Nutrition improvement package) if both are (No). The two questions are as follows: 4. Do you have difficulty eating tough foods compared to 6 months ago? 5. Do you find yourself choking on tea or soup? When you answer (Yes) to 3, then (Cogni-Package) will be selected. And if all 1, 2 3 to (No), then (Inactivity Prevention Package) will be selected. Please consult with a doctor if your family or friends have pointed out your memory loss, e.g., (You ask the same question over and over again), or if you have fallen more than once.

Citation:
5-item self-report questionnaire for frailty (Yamada M, Arai H; J Am Med Dir Assoc. 2015 Nov 1;16(11):1002.e7-11), 
The questionnaire for elderly in the later stage of life /  Kihon Checklist (Japan Ministry of Health, Labour and Welfare)

Answer the flowchart questions once a month or so, or when your physical and mental condition changes, and choose those exercises and activities that you think are more suitable for you at that time. You do not have to worry about perfection. It is more meaningful to challenge yourself to exercise and engage in activities every day, so do not overexert yourself and perform activities at your own pace. If you have more than one package, check the contents of all the packages and start with the one you are most interested in. Before moving on to the exercise/activity menu of the package, check the "Precautions and Instructions for Use" and "Exercise Intensity" from the next page.

3. Precautions and guidance for use

First, the following basic measures should be taken to prevent infection.

The following is a list of notes about wearing a mask.

While taking these preventive measures, start exercising and engaging in activities by paying attention to the following points.

Notes on exercise and activities 

Pre-workout preparation

If you have any of the following diseases or symptoms, consult with your physician about your health condition and medications, and decide whether to use HEPOP 2020 or perform other exercises and activities under the guidance of your physician.

People who need to be careful about exercise and activity

4. Various exercise and activity packages

  1. Balance Improvement Package(PDF:2742KB)This link will open in a new window.
  2. Strengthening Package(PDF:1823KB)This link will open in a new window.
  3. Feeding and Swallowing Improvement Package(PDF:877KB)This link will open in a new window.
  4. Nutrition Improvement Package(PDF:3512KB)This link will open in a new window.
  5. Inactivity Prevention Package(PDF:2127KB)This link will open in a new window.
  6. Cogni-Package(PDF:5318KB)This link will open in a new window.

5. Exercise intensity, physical activity level

There is a guideline for the time and frequency of exercise and activities, but actions should be performed within the range of "easy" to "somewhat tough" according to your physical and mental condition. We recommend more than 20 minutes of exercise or activity. Exercises and activities should be performed for at least 20 minutes and up to 1 hour consecutively.

This table shows the target pulse rate during exercise in each age group. When the resting pulse rate is 60 beats, the target pulse rate per minute during exercise is 111 at 65 years old, 109 at 70 years old, 107 at 75 years old, 106 at 80 years old, 104 at 85 years old, and 102 at 90 years old. When the resting pulse rate is 70 beats, the target pulse rate per minute during exercise is 116 at 65 years old, 114 at 70 years old, 112 at 75 years old, 111 at 80 years old, 109 at 85 years old, and 107 at 90 years old. When the resting pulse rate is 80 beats, the target pulse rate per minute during exercise is 121 at 65 years old, 119 at 70 years old, 117 at 75 years old, 116 at 80 years old, 114 at 85 years old, and 112 at 90 years old.

Table 1. Target pulse rate during exercise in each age group

The effect of the intensity of the exercise on the body can also be determined by the pulse (pulse rate). Adjust the time and frequency of exercise and activities based on the target pulse rate during exercise for each age group in Table 1 (e.g., if you are 70 years old and your resting pulse rate is 60 beats/minute, your target pulse rate during exercise is 109 beats/minute).

The strength of the movement (intensity) is expressed in METs. This shows how many times the energy is expended by the exercise or activity when the resting state is 1. Not only special exercises and activities, but also daily life and household chores can lead to exercise. Referring to the Mets table in Table 2, reflect on the intensity of your daily exercises and activities.

In addition to checking the intensity of your exercise, you can also use the Exercise (Ex) unit to calculate your own physical activity. Ex is a number of hours on the METs (except for activities under 3 METs). For example, 20 minutes of normal walking on level ground = 3.0 METs × 20/60 minutes = 1.0 Ex, 30 minutes of bicycling = 4.0 METs × 30/60 minutes = 2.0 Ex. We recommend a minimum of 10–23 Ex of physical activity each week to keep you healthy. As much as possible, we would like you to engage in more than 3 METs of exercise and physical activity to maintain and improve the amount of physical activity, but there are also exercises and activities that can be performed while lying or sitting down, when mental and physical functions are not so good. It is important to avoid being bedridden or sedentary as much as possible, and any kind of exercise or activity is good, so moving your body continuously every day is important.

This is a table of METs for Physical Activities published in 2011. For example, washing dishes while standing is an activity of 1.8 METs. Fishing while standing is the same level of activity. Walking on the ground at normal speed is an activity of 3 METs. Pilates and bowling are the same level of activity. Swimming is an activity of 6 METs and jogging is of 7 METs. These are high activity exercises.

Table 2. The 2011 Compendium of Physical Activities: METs

6. Conclusions

This guide focused on exercise, cognitive function, and nutrition, and introduced a variety of menus to help seniors with reduced opportunities to go out to instead undertake activities safely at home. Older people are vulnerable to infections and restrictions on social life, and it is important to be aware that frailty can easily progress, and to improve the resilience of the body and mind through appropriate sleep, nutrition, and exercise. In addition, it is important to take measures against infection, and to participate in outdoor activities to promote the activation of vitamin D in the sunshine and to regulate the rhythm of the mind and body. We hope that all of you will maintain your mental and physical health as much as possible while using this guide in your daily life, and that you will continue to play as active a role in society as you have in the past.

7. Contact information

If you have any questions about HEPOP 2020 or require more information, please contact us at the following email address: rehab@ncgg.go.jp
We are unable to respond to inquiries over the telephone. Please note that we may not be able to respond immediately to all inquiries and may need some time to reply to you.

The NCGG-HEPOP 2020 Committee

logoNational Center for Geriatrics and Gerontology

Aiko Osawa(Chairperson), Izumi Kondo, Shosuke Satake, Shuji Kawashima, Kenichi Ozaki, Hiroyuki Shimada, Kaori Kinoshita, Naoki Itoh, Masanori Tanimoto, Ikue Ueda, Koki Kawamura, Kenichiro Maki, Masaki Kamiya, Kenji Sato, Shota Suzumura, Yukiko Kojima, Rise Murata, Mayumi Wada, Yukihiko Washimi, Hidenori Arai

logoKinjo University

Shinichiro Maeshima