**4. Promoting physical activity for advanced older adults**

The practice of health-promoting and therapeutic physical activity, with minimal risks, is also a factor in the development of autonomy, self-esteem, and comprehensiveness of care. Such a measure can aid in sociability when adopted in therapeutic groups [41], helps in psychomotricity [42], improves cognitive performance [43], promotes the control of various cardiovascular risk factors [44], reduces the cancer risk [45], and favors lower risk of falls and fractures [46]. There is also evidence that regular physical activity can attenuate the effects of aging on the cardiovascular system [47, 48]. Therefore, it is necessary to approach interdisciplinary and create simple and reproducible and easy-expanding programs to promote physical activity for this subpopulation. These programs should consider the natural aging process and the fact that these people reach advanced ages bringing with them diseases, sequelae, cultural and environmental issues, preferences, and social conditions obtained throughout a lifetime. Exercise in the elderly is considered as promoter of quality of life with improvement of physical, social, and emotional aspects; mortality reduction, especially cardiovascular mortality; reducing the risk of cancer; and prevention of falls. There is, therefore, the need for reception, equity, attention to cultural aspects, and care for psychosocial situations, aiming for adherence and effectiveness [40].

Exercises of the most varied modalities can bring benefit to the health of the elderly, such as aerobic, resisted, or combined [48]. Smolarek et al. [49], observed that, in old women trained for 12 weeks with strength exercises, there was an improvement in both the strength of the limbs and the cognition indexes. It is possible to improve functional capacity with training even in the elderly; a systematic review showed that most studies found favorable results in physical capacity and psychological aspects in the elderly undergoing various forms of structured training [50].

Health system structure, and society in general, should be aware of the growing demands of this population on physical activity and requires clinical and complementary evaluation, where the ET is included as a tool capable of giving prognostic information, functional data, and motivation for the mobilization of the elderly because there is a high prevalence of sedentary lifestyle among the elderly, which remains unchanged for decades [28]. Exercise should be focused on the improvement of FC [1]. Managers and health professionals who work with the elderly cannot be satisfied with only accepting the nonadherence to exercise but should look for the causes of nonaccess and break these barriers [40].

#### **5. Resistance training in older adults**

The more obvious benefit of resistance training for advanced older adults is the prevention of muscular decline, which is achieved by gene and protein expression in muscle cells, with individual heterogeneity, delivering shift in the muscle fibers, muscle mass gain, force, power, mobility, and balance improvement [51]. Studies with resistance training programs (RTP) for older adults have been published in last three decades, and main results were compiled in a meta-analysis by Liu and Latham [52], with 121 studies and 6700 patients. They observed a favorable result for resistance exercise in physical function improvement in older adults. RTP is considered safe and is associated with retarding aging of muscle mass, muscle strength improvement, and reducing chronic inflammation [53]. RTP is recommended for healthy and frail individuals, with limits and technics personalization [51]. These results, achieved by neuromuscular and neuroendocrine adaptations, can help patients to improve mobility, functional capacity, performance in activities of daily living, and preserve the independence, with a dose–response effectivity relationship [54, 55]. RTP have been associated to better quality of life [56], reducing frailty symptoms [57], retarding cognitive decline [58], preventing sarcopenia and falls [59], and lowering risks of cardiovascular disease and all-cause mortality [60], with significant impact of BMI on these two major events [61]. The use of RTP can even reduce social and geographic barriers that affect elderly [62]. Cardiovascular benefits have been described, as reducing arterial stiffness [63] and blood pressure [64]. RTP can also help to improve FC in older adults, a meta-analysis with 22 studies reported that within 24-week programs, there was a 2.57 ml/kg/min mean gain in VO2max, assessed by ET [65]. In heart failure patients, RTP achieved an improvement of muscle strength, quality of life, and FC [66]. There is a recent report of FC gain in older women survivors of breast cancer, which is an important aim because quality of life and insulin resistance are associated with recidivism [67]. Even advanced pulmonary cancer patients have been trained with RTP with favorable results in quality of life and physical function [68, 69]. A systematic review observed quality of life and

survival improvements in cancer survivors with regular exercise practice, most of studies were on RTP programs [70]. In order to assist the elderly in achieving FC improvements, therefore, an interdisciplinary approach, involving various health professionals, a support team, and health managers could be very helpful [71].
