Osteoarthritis Osteoarthritis (OA) is characterized by pain and joint space narrowing (Vincent & Vincent, 2012). More than 60 million Americans currently suffer from OA (Vincent & Vincent, 2012). Patients with OA in weight-bearing joints, such as the knees and the hips, may have previously self-limited their exercise due to pain, but exercise is critical for older adults with OA. Quadriceps weakness contributes to an increase in symptoms, including pain and impaired proprioception in patients with hip and knee OA, making resistive exercise an important but sometimes difficult undertaking for this population (Alnahdi et al., 2012; Nguyen et al., 2016). Both aerobic and resistive exercise are known to decrease pain and increase function and mobility in older adults with OA and have been adopted as a core recommendation for adults with OA (Bennell et al., 2016; McAlindon et al., 2014). This means that exercise is generally recommended for all individuals with OA, but modifications may be needed in an exercise program for those who are experiencing pain associated with OA (Vincent & Vincent, 2012). A slower progression of exercise may be necessary for these older adults, and only one variable at a time should be changed for resistance exercise (i.e., frequency, resistance, or duration). For example, when progressing a leg press for someone with OA, the practitioner should either increase the weight or the repetitions, but not both, in the same training session. If joint pain is elicited as a result of the progression, the practitioner can determine which variable increased the joint pain. Exercise should elicit only mild pain in the joint (less than 3 on a numeric scale of 10) or be modified to decrease pain (Vincent & Vincent, 2012). While ideally exercise should not cause any joint pain, many individuals with OA experience joint pain with daily physical activity and may experience some joint pain with exercise. When a joint is acutely inflamed, making weight- bearing exercises difficult, isometric strength training may be a beneficial form of resistance exercise. Performing isometric strength training will minimize the impact of movement but still allow for resistance training during times of acute inflammation. Dementia Dementia is a progressive neurodegenerative disorder characterized by deficits of memory loss, motor planning, language, and executive functioning (Ho et al., 2020). As age increases, so does the prevalence of dementia. Alzheimer’s disease accounts for 60% to 80% or all dementias and is typically a late onset disease, after age 65 (Liguori & American College of Sports Medicine, 2020). Exercise may result in decreased depression in those with dementia and help associated muscles loss along with decreased gait speed and functional ability (Ho et al., 2020). Several systematic reviews have also found that aerobic exercise results in improved physical function in older adults with dementia (Forbes et al., 2015; Ho et al., 2020; Kumar et al., 2022). Research into the effects of exercise on mobility and function in those with dementia is sparse, but literature syntheses consistently demonstrate that physical exercise (both aerobic and resistive) lead to improvements in mobility, functional cognitive performance, and physical functioning in older adults with dementia, though aerobic exercise has been found to be slightly more effective (de Castro Cezar et al., 2021; Forbes et al., 2013, 2015; Kumar et al., 2022; Pitkala et al., 2013). However, older adults with dementia present several unique challenges related to prescribing exercise. Those with advanced dementia traditionally have low compliance with exercise programs and require additional motivation and/or supervision. Individuals with dementia may have increased difficulty adhering to exercise programs due to avolition or confusion due to motor coordination deficits and bradyphrenia (Peabody, 2013). Activities also have to be functional and relevant to the client due to reduced abstract reasoning ability. Therefore, it would be beneficial to demonstrate or model exercises for the client in a functional and relevant way (e.g., kicking a ball rather than sitting and extending a leg without a functional task) and to give the
Isometric exercises are valuable because they produce low intra- articular pressures and can be done without increasing joint pain (Folland et al., 2005). However, strength is improved only at the angle at which the muscle is trained. Therefore, isometrics will need to be performed at multiple joint angles. It is generally recommended that the isometric strengthening exercise be performed every 10 to 30 degrees to cover the joint’s entire range of motion (Folland et al., 2005). The isometric contraction should be held for four to six seconds, and 8 to 10 repetitions at each joint angle should be performed (Folland et al., 2005). Reduced weight-bearing exercises such as pool walking, swimming, and biking may provide beneficial aerobic exercise during times of acute exacerbation. Tai chi has also been shown to decrease knee pain and to improve physical function and stiffness, and it may be a good resistance exercise option for those who are suffering from symptoms associated with OA (Brismee et al., 2007). Joint pain associated with exercise should decrease within 24 hours. If joint pain is significantly worse 24 hours after the exercise session, the activity may need to be modified at the following sessions to allow pain to decrease, and the program should be carefully modified to reduce joint pain. Reductions in the weight, duration, or types of exercise may be necessary to alleviate joint pain. The exercise session should not induce changes in the patient’s gait (Vincent & Vincent, 2012). If the exercise increases joint pain to the point that the patient is limping or altering their gait pattern, then the exercise should be modified or reduced to avoid the gait alterations. All patients suffering from symptoms associated with OA should be educated about the need for both aerobic and resistive exercise and encouraged to participate in both types of training. Short bouts of frequent aerobic activity may also help individuals in this population meet the target goal of 150–300 minutes of moderate activity per week (Liguori & American College of Sports Medicine, 2020). With some minor modifications, older adults with OA should be able to get the exercise they need through participation in both aerobic and resistive exercise. client a longer time to process and respond to requests to copy the demonstrated exercise (Peabody, 2013). Use function rather than free weights to elicit physical movements from clients. Clients have more consistent and safe isolated muscle movements if they are related to tasks that are familiar in motor praxis. Supervised and guided participation in exercise is critical to ensure compliance from clients who have dementia due to some of the aforementioned deficits. One study found that those with Alzheimer’s disease completed on average only 33 out of 88 exercise sessions, with one-fifth of participants completely dropping out of their exercise program over a one-year period (Rolland et al., 2007). This dropout rate demonstrates the difficulty that may be experienced when prescribing an exercise program for older adults with dementia without such supervision/guidance. Additionally, older adults with dementia, particularly those with advanced dementia, may require additional cueing to complete an exercise safely and due to poor body mechanics may not be able to exercise safely without supervision. For this reason, family members and/or caregivers may need to be educated about how to assist with an exercise program (Teri et al., 2003). Exercises may need to be adapted to be performed at home or in another familiar and comfortable environment outside of the clinic or gym to reduce distractions for those with dementia (Teri et al., 2003). Finding activities that older adults with dementia routinely enjoyed in the past may also help improve adherence to an exercise program. For those with advanced dementia, a simple walking program may be an effective way to safely encourage aerobic exercise. Group exercise has also been successfully done in long-term care settings (Toots et al., 2016). For those who become easily agitated, short bouts of activity or one-on-one exercise sessions may be needed and ideally should be implemented when
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