Although regular physical activity has many beneficial health-related effects for the elderly, inappropriate or excessive exercise has been known to exaggerate or be associated with risk of cardiovascular events. Therefore, appropriate initial health screening, including medical evaluation and risk stratification, is vital to ensure or increase exercise safety.
In the elderly, medical evaluation needs to focus on identifying the coronary risk factors or signs suggestive of cardiovascular disease, since coronary artery disease has been demonstrated to be the most common cause responsible for cardiovascular events during physical activity in the elderly. It is noteworthy that variability of physical fitness is high in the elderly and cardiovascular risk during exercise is greater in subjects with lower physical fitness. In risk stratification, there-fore, pre-assessment of physical fitness in addition to routine medical evaluation is pivotal.
Exercise prescription must be based on risk stratification and/or complicating cardiovascular disease severity. Low-level exercise, for example, 40% of VO₂max is recommended for high-risk subjects such as those with two or more coronary risk factors, suggestive cardiovascular disease, lower physical fitness, or flail order adults. Since most subjects have reported at least one prodromal symptom within one week of sudden death, it is very important to check the physical condition before exercise on each day. Although various arrhythmias are likely to be responsible for cardiac events during exercise, their complete prediction is seldom possible. Therefore, monitoring EGG during exercise contributes greatly to exercise safety.
Further investigation is required for improvement of exercise safety for the elderly.

The number of sudden deaths occurring during bathing in Japan has recently exceeded 10, 000 people and the 80% of these have occurred to the elderly. Although some guidelines for safe bathing are available, bathing-related accidents have still not declined. The purpose of this study is to use a questionnaire to survey the daily bathing habits of middle-aged and elderly people.
Method: For the subjects of this study, 77 middle-aged and elderly persons attending a healthful exercise class were given a questionnaire survey, and of these 10 persons were recruited at random and their daily bathing habits at home were studied. Results: The questionnaire survey revealed that almost all of the middle-aged and elderly people had unsafe bathing habits. In addition, a comparison of the questionnaire and the home habits study showed much discrepancy between the perceived and measured body and room temperatures before, during, and after bathing. Conclusion: Almost all middle-aged or elderly people had unsafe bathing habits.

To investigate a relationship between gender differences in recovery from skeletal muscle fatigue and muscle oxygenation, we examined whether there is a difference in oxygen supply and consumption of the working muscles after intermittent handgrip exercise between young males and females using near-infrared spectroscopy (NIRS). Healthy young subjects (25.8±3.9 years ; males, n=10 ; females, n=10) repeated static maximal voluntary contractions (MVC) with a handgrip for 5 seconds followed by 5 seconds rest for a period of 4 minutes in Study 1. The MVC force was measured before, each minute during the handgrip exercise, and 2, 5, and 10 minutes following the exercise. In Study 2, the selected 10 subjects (males, n=5 ; females, n=5) performed the same exercise and their total- and deoxy- hemoglobin/myoglobin level was measured using the venous occlusion NIRS method; and O₂ supply index (OSI) and O₂ consumption index (OCI) calculated before and after the exercise. In Study 1, females exhibited higher %MVC force at the end of the exercise and during the recovery period than males (p<0.05). In Study 2, the %OSI was significantly lower in females than in males at 5 and 10 minutes in the recovery period (p<0.05), but no significant differences were detected in %OCI. Furthermore, %MVC of the recovery period correlated with %OCI of the recovery period in females (r=0.724, p=0.015), but not in males. These findings suggest that female working muscles can convert consumed oxygen more effectively after an intermittent handgrip exercise, and therefore, be able to recover muscle force faster.

We used near-infrared spectroscopy (NIRS) to study noninvasively the effects of aging on changes in muscle oxygenation during steady bicycle exercise. For the study, 6 healthy young males and 13 healthy elderly male volunteers were recruited. To evaluate the physical fitness level and to determine exercise intensity, the ventilatory threshold (VT) was first measured. As a result, elderly subjects were divided into two groups according to O₂ uptake at VT (Elderly-H ; 936.0±26.4, Elderly-L ; 695.3±29.9, Young ; 790.0±51.19 ml) . Secondly we measured muscle oxygenation by NIRS at rest and during exercise at relative work intensities of VT ; 20%, 40%, 60%, 80% and 100%. In all cases muscle oxygenation at rest and during exercise was expressed as a relative value from 100% oxygenation (oxygen capacity) established by thigh occlusion (ischemia) . All subjects showed progressive deoxygenation with increasing intensity. There were no differences between the three groups in muscle oxygenation during exercise at relative work intensity of VT. These data suggest that aging and physical fitness level have no effect on muscle oxygenation below relative work intensity of VT.

The effect of daily physical activity on oxidative stress is still an unknown issue, especially in middle-aged and elderly individuals. In this study, we examined the relationships of oxidative stress and antioxidant capacity with daily physical activity, taking into consideration the dietary antioxidant vitamin intake (vitamin B₂, C and E) of middle-aged and elderly people (66.0±7.0 years, n= 21; 10 males and 11 females, including 5 male trained runners) . Daily physical activity was measured using both a calorie counter and a questionnaire over a period of two weeks. The plasma concentration of thiobarbituric acid reactive substance ( [TBARS] ) and both oxidized and reduced glutathione concentrations ( [GSSG] and [GSH] ) in whole blood were determined in blood samples obtained at rest and immediately after two periods of acute exercise: maximal cycle ergometric exercise and steady state cycle exercise at 80% of ventilatory threshold (VT) for 30 minutes. At a given statistically controlled dietary antioxidant vitamin intake level (vitamin B₂, C and E), the amount of daily physical activity was associated with neither [TBARS], [GSH] and the ratio of [GSSG] / [GSH] at rest, nor changes in levels of these substances after both exercise tests. These data suggest that the amount of daily physical activity may have little influence on oxidative stress or antioxidant capacity at rest and after acute cycle ergometric exercise. Further investigation would be necessary to clarify how much volume or intensity of physical activity induces increased oxidative stress, from the aspect of habitual physical training and nutrition.

Resistance exercise in the elderly and patients with a cardiovascular disorder has been thought to have a high cardiovascular risk, because it has the tendency to cause an excessive rise in blood pressure and induce serious arrhythmia. But recently, resistance exercise has been introduced into physical therapy because the safety of such exercise has been confirmed in subjects without a cardiovascular disorder.
The purpose of this study was to investigate the safety of lower extremity resistance exercise in middle-aged or elderly subjects with hypertension and receiving medical treatment (n=24), and those without hypertension (n=40), by measuring cardiovascular response during resistance exercise of different loads (40% and 60% 1 RM), and usefulness of respiratory guidance during such exercise.
As a result, there was no difference in diastolic blood pressure between those with and without hypertension ; but systolic blood pressure and rate pressure product both at rest and during exercise were significantly greater in patients with hypertension. However, neither group showed symptoms of angina, ischemic signs in ECG, or serious arrhythmia ; and there was no difference in the frequency of excessive rise in blood pressure between the groups (2 subjects with hypertension and 1 subject without hypertension) . Blood pressure during exercise was significantly lowered by respiratory guidance.
These results show that it is important to measure blood pressure during exercise before resistance exercise training regardless of the presence of hypertension, although an excessive rise in blood pressure occurred in only a few subjects. Furthermore, it is important to exhale slowly and not hold one's breath during exercise.

Arterial compliance progressively decreases with aging. This aging-induced reduction of arterial compliance causes an increase of systolic blood pressure (SBP), whereas regular exercise increases arterial compliance. We hypothesized that an increase in daily physical activity (DPA) produces a beneficial effect on systemic arterial compliance (SAC ; an index of central arterial compliance) and this phenomenon could decrease SBP in the elderly. We investigated the relationship among DPA, SAC, SBP, diastolic blood pressure (DBP), and some other risk factors for cardiovascular and/or cerebrovascular events (total cholesterol, HDL-cholesterol, and HOMA-R) cross-sectionally in 127 elderly persons (42 male, 85 female : aged 74±4 years) . The DPA was estimated by expended calories using an accelerometer. The SAC was calculated from a finger pulse pressure waveform recorded by using PORTAPRES ; and stroke volume obtained from the same pressure waveform based on the volume-clump method. The analyses demonstrated that SBP was directly and decreasingly affected by SAC, and that DPA had an increasing effect on SAC. Furthermore, SBP was directly and increasingly affected by DBP, and DBP was directly and decreasingly affected by both SAC and DPA. Therefore, it is considered that DPA may have suppressive effects on the rise of SBP through the indirect effects of changing SAC and DBP. These findings suggest that an increase in DPA could improve the age-induced reduction of arterial compliance and rise of SBP in elderly humans.

The purpose of this research was to study the effects of exercise program participation on the personal factors of exercise adherence promotion in the middle-aged and elderly by comparing a group and individual exercise program. The personal factors for promoting exercise adherence, the four domains (i, e. initiative attitude, achievement satisfaction, self-recognition, and intrinsic motivation), were hypothesized. Two groups of middle-aged and elderly subjects, who volunteered to participate in different 6-month exercise programs, were examined. Group 1, 33 subjects (aged 67.7 ±4.3 years : mean±SD), participated in a program consisting of an individual exercise program (combination of endurance and resistance exercise, e. g. cycling exercise, dumbbell and machine exercise, once a week) and group exercise program (e, g. dance and ball game, once a week) . Group 2, 27 subjects (aged 65.2±4.Ovears), participated in the same individual exercise program twice a week. After the 6-month exercise program, significant improvements in group 1 were found in the selfassessment of activity score of the initiative attitude domain, the achievement satisfaction score including enjoyment, achievement and satisfaction, and the self-recognition score representing competence. In group 2, the mastery score in the intrinsic motivation domain was reduced, and the curiosity score in the same domain and the achievement score in the achievement satisfaction domain tended to decrease. These results show that a group program might have a more significant effect on the personal factors hypothesized to promote exercise adherence in this study. Hut there should be follow-up study on the subjects to determine the effectiveness of the program over the long term.

High-sensitivity C-reactive protein (CRP) is a novel risk factor for coronary artery disease. It is well known that body weight loss is effective in reducing serum CRP concentration ; however, the effect of exercise training on serum CRP concentration has not been fully elucidated. The purpose of this study was to examine the effect of a 24-week exercise training program on serum CRP concentration in 169 healthy middle-aged and elderly subjects (65.9±6.4 years). Each subject underwent baseline testing (peak oxygen uptake, daily physical activity, body weight, and serum CRP levels), and repeated these tests on completion of the training program. The subjects were classified into 2 groups based on initial CRP levels : normal<1.0 mg/L, n=139, and high≥1.0mg/L, n=30. On completion of the program, both daily physical activity and peak oxygen uptake increased significantly (+33.9±72.4%, p<0.0001, +5.4±14.7%, p=0.014, respectively). However, body weight did not change significantly. In addition, CRP levels of the entire group did not change significantly. However, CRP levels significantly decreased among the high baseline CRP group (from 1.82±0.81 mg/L to 0.98±0.59 mg/L, p<0.0001). It was concluded that serum CRP levels are reduced without body weight loss in response to exercise training in healthy middle-aged and elderly subjects with high initial CRP levels.