older adults should wear appropriate eyewear prescriptions and have appropriate lighting for balance training. ● Balance is one of many risk factors that should be considered in relation to fall prevention. Other areas to be addressed include barriers and supports such as medication, comorbidities, environment, and environmental hazards. ● Proprioceptive exercises are effective for balance. diabetes or arthritis can also be found in many communities, helping to defray the cost of participation in an exercise program and also providing a social support group to encourage exercise. Older adults living in a retirement community or assisted living center also frequently have access to a community gym. Providing these resources to older adults can be a valuable tool to assist in overcoming barriers to exercise. Local senior centers often offer fitness programs, though social determinants may also need to be considered related to access to this option as well. Finally, pain-related fear may be a barrier to exercise when an older adult is afraid that exercise may cause pain during or after the exercise session. Personal encouragement and education will help to overcome these fears. den Hollander et al. (2022) showed that exposure in vivo can help alleviate fears, especially if the older adult has experienced pain, or fears experiencing pain, with exercises; this is also known as kinesiophobia (Office of Disease Prevention and Health Promotion, 2022). Regardless of the type of pain, patients can benefit from watching videos or a demonstration of the exercises as an initial exposure to acclimate to the idea (Office of Disease Prevention and Health Promotion, 2022). It may be helpful to perform several exercise sessions with the patient until they become comfortable with the exercises, know how to operate the equipment safely, and understand the intensity level they are supposed to achieve during the session. Education on the benefits of exercise as well as what to expect may be reassuring to those who are not familiar with exercise. For example, an older adult who has never participated in resistance training may find muscle soreness after an initial resistance training disconcerting or even perceive it as harmful. Providing individuals with the knowledge that muscle soreness can be expected prior to its occurrence may help them continue to participate. For cases of extreme fear, approval from a psychiatrist may be appropriate (Office of Disease Prevention and Health Promotion, 2022). intervention (summative assessment). Many functional fitness tests are available for individual populations, such as those who have suffered a stroke or heart attack, or who have multiple comorbid conditions. The functional tests presented here have been chosen because they have generally good psychometrics for use with older adults and have been used with a large variety of individuals with chronic conditions. Additionally, all the functional tests presented here are free and can be performed with minimal space and equipment, in a short period of time, which allows for easy implementation in most practice settings. progress to be documented as changes are made with improved fitness and function. 6-minute walk test The 6-minute walk (6MWT) test is a submaximal aerobic test that is used to assess functional exercise capacity (Casano & Anjum, 2021). The test measures cardiopulmonary capability with a primary test outcome of the final distance walked in 6 minutes around a 30-meter course. A great advantage of this test is it is simple to administer and well tolerated by patients (Casano & Anjum, 2021).
of wearing footwear is seen in those with the poorest balance. ● The wearing of slippers or shoes without fixation may be associated with increased risk of tripping. ● Balance training should be part of all older adults’ physical activity prescription, not just those with the highest fall risk. ● There are connections between balance and vision, specifically contrast sensitivity and stereopsis, suggesting Common barriers to exercise participation in older adults While the benefits of exercise are well known, numerous barriers to participation exist. A full review of motivations and barriers to exercise is beyond the scope of this course. However, an understanding of some of the most common barriers and strategies to overcoming them may help in developing an exercise program for older adults. Barriers that older adults report include safety, fear, health concerns, pain, fatigue, and lack of social support (Fragala et al., 2019). Many older adults cite lack of time as a barrier to consistent participation in an exercise program (Franco et al., 2015). While the perception is that many older adults are retired and therefore have ample free time to devote to exercise, many have competing priorities for their time. These may include caring for a significant other who may be ill, assisting with care for grandchildren, frequent doctor’s appointments for themselves or those close to them, or ongoing volunteer commitments (Franco et al., 2015). Scheduling a consistent exercise time, breaking exercise down into shorter durations for higher frequency, or participating in a group exercise class may help older adults overcome these barriers. A lack of access to a safe environment for exercise is another frequent concern and a social determinant of health that may need to be considered when a client lives in a city and/or doesn’t have sidewalks, access to a fitness center, or safe community access overall (Franco et al., 2015; Office of Disease Prevention and Health Promotion, 2022). All of these may present barriers to participating in a home exercise program. The cost of joining a fitness facility is also noted as a frequent concern, particularly for those who may be on a fixed income. Helping older adults develop an exercise program that is done in their home or identifying available community resources to develop a safe and economically feasible program may help to alleviate some of these concerns. Many options to reduce the cost of fitness facilities exist. Insurance programs frequently offer no-cost or low-cost memberships to fitness facilities in an effort to encourage older adults to be more active. Low-cost community programs targeting specific disease comorbidities such as Measuring change clinically Increasingly, practitioners are being asked to provide evidence of effective treatments by documenting outcomes following an intervention. Aerobic and resistance exercise both have clear physiologic and functional benefits. The use of functional fitness tests will allow for an objective measurement of both the physical and fitness functions of older adults. When used prior to starting an exercise intervention (formative assessment), these tests will allow practitioners to make objective recommendations about appropriate aerobic and resistive interventions and to document functional changes that occur after the exercise How to measure changes after aerobic exercise While aerobic fitness has traditionally been measured with a maximal VO 2 test (VO 2max ), it is not feasible to perform this test clinically in most settings. Many older adults have comorbid conditions that would require a physician to be present for a VO 2max test. The time and equipment required to perform a VO 2max test are also not readily available in most clinics. However, the 6-minute walk test, the 2-minute step test, and the gait- speed test can be quickly and easily administered in almost any setting and with any population, making these tests appropriate for most older adult populations. These tests also allow for
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