Is exercise beneficial for Older Adults?
For our latest newsletter we have investigated whether exercise can really make a difference to older adults regardless of their physical and cognitive capabilities living in long term care. We will then briefly look at what types of exercises are appropriate for this population, and some guidelines and tips to ensure that older adults get the most benefit while remaining safe, motivated and having fun!
We have been working with older adults since 2001 and have learnt a lot about what motivates this population and have developed programmes and training courses to deliver appropriate exercise therapy.
We hope that you find this information useful.
Regards, Mark Sweeney, MSc, BSc, BSc, MIAPT. Managing Director Fit For Life
Is exercise (Physical Activity) the answer for older/elderly adults? The answer is a resounding yes with the research being unequivocal about the positive effects of exercise for all older adults both physically and mentally. Exercise or physical activity (research has shown that older adults associate negative attitude towards the word 'exercise') is effective providing that It is done properly, that it lasts for long enough and that there are no absolute contraindications to exercise (please see appendix A below) and that they continue to remain as active as possible.
New research has also shown that this is relevant for all individuals including those with Alzheimer's and related dementia with a recent study (Pitkälä et al., 2016) reporting that participants with MMSE scores of between 5 and 15 benefited most from a falls prevention exercise programme.
So we now know that exercise is beneficial but lets look a little bit more in what types and frequency of exercise or physical activity that are most effective.
How do you gauge the appropriate intensity of physical activity for older adults?
It is important to recognise that individuals in long term care may have a vast difference in their initial exercise tolerance and therefore they should be offered an opportunity to exercise at a level that challenges them.
For example, for someone who is very sedentary or has been bed bound for a period of time for them to start any form of physical activity, even just starting by standing up for 60-90s at regular intervals during the day will be of benefit.
In contrast for one of your more mobile residents they will need a different level of exercise intensity including balance and falls prevention training in order to see the benefits.
In fact by encouraging those residents with a lower exercise tolerance to start they will be initially the ones who may experience the greater the health benefit associated with an increase in physical activity (Haskell 1994).
It is important to note that age is not a barrier to the positive benefits of exercise as strength gains can be made up to 100 yrs of age as shown by a study
by Fiatrone et al., in 1990 with reported a doubling of strength in 90+yr olds.
Precautions to take before and during any physical activity with your residents/service users:
1. Consult with clients any GP/Nurse or other AHP before commencing any exercise programme
2. Never exceed a moderate level of exercise intensity (see chart below)
3. If your client feels any ‘sharp’ pain brought on by exercise stop immediately
4. If your client feels dizzy/lightheaded when standing up do not continue with standing exercises
5. If walking with a client make sure that you start off walking short distances and gradually increase distances.
What Types of Physical Activity (Exercise) should older adults be doing?
In general terms the areas that should be covered in any exercise intervention for older adults are: - Warm up and cool down: A warm up is completed at the start of an exercise session. It consists of a gradual increase in intensity in physical activity a "pulse raiser", and joint mobility exercises for 5-15 minutes. It prepares our body for the exercises to follow. A cool down and stretch is completed at the end of the exercise session. We use similar exercises to the warm up and focus on gradually decreasing exercise intensity back to resting. It allows the body to return to normal. We complete stretches for the main muscle groups. We stretch to the point of tension but not pain. New research has indicated that static stretching should not be carried out in the warm up phase by older adults (8-10mins).
- Flexibility: exercises aiming to increase or maintain the range of movement in all of our joints e.g. shoulders.
- Cardiovascular: this type of exercise works the heart and lungs to increase breathing rate and circulation and improve CV fitness.
- Strength or Resistance: this type of training is an extremely important for older adults to maintain functional ability and independence. And it helps to counteract the extremely debilitating condition sarcopenia (loss of muscle mass and function).
- Postural stability or balance training: this type of exercise should only be carried out with residents/participants that have appropriate lower limb strength i.e If a resident is unable to stand up and walk across the room they are not ready to start balance training (NB This type of exercise should only be performed by a fully trained Allied healthcare professional with experience working with older adults).
In fact in the complex area of falls prevention for older adults correctly prescribed exercise therapy is the single most effective intervention in reducing falls(Sherrington et al., 2011)!
Strategies for introducing new physical activities into your care facility
1. Try not to use the word exercise (see above) ! Use physical activity, movement to music, etc.
2. Train and educate your team about the importance and many benefits of exercise for your residents.
3. Identify a reason or goal to exercise. Some of your residents will not need any encouragement to participate in any form of activity. However, they are not normally those residents who need exercise most. So, in order for anyone to buy into participating in an exercise programme they must have a purpose or goal that they wish to achieve from participating. This may be being able to stand again without assistance or walk outside without falling etc If you can work out a goal, participation.
4. Group physical activity classes have been proven to be excellent forms of physical activity and social outlets. These classes should cover the areas mentioned above and have variety, be challenging and enjoyable and a competitive element always goes down well.
5. Hold social exercise events with teams to create a fun experience with staff and residents involved such as: Soccer penalty shoot out, Tennis using light balloons and batons, Skittle tournament between staff and clients, Relay races (supervised!!).
6. Individual exercise opportunities - Not everybody likes group environments so individual exercises should also be offered which could mean walking programmes('Walk and Talk'), using pedals or other equipment available (e.g. motomed). Some ideas that have worked really well in homes include:
· Introduce symbols in your home for staff to use for measuring walking loops/distances to help motivate clients with progress.
· Provide certificates of achievement with distances/timed walks achieved by residents.
· Create exercise stations around your home such as 'Sit to Stand ' in 30s for your residents.
7. HAVE FUN!! In order for anyone to keep interest in any activity they must be enjoying the experience so try and make sure that you always bring enthusiasm and a bit of 'craic' to whatever physical activity you are promoting!!!