Case study Mrs. RD is a retired college professor and a 75-year-old widow who currently lives alone in a large home. She was diagnosed with type 2 diabetes mellitus 10 years ago, and her diabetes is well controlled with the use of insulin. She also has a history of hypertension, which is currently controlled with atenolol (a beta blocker), and she had a right knee replacement five years ago with no complications. Mrs. RD’s husband died one year ago after a long illness. Mrs. RD was her husband’s primary caregiver and, as a result, has not exercised consistently in the past three years. Before her husband became ill, Mrs. RD was active, playing tennis twice a week and golfing at least weekly during the summer. She also enjoyed ballroom dancing with her husband several times a month. Currently, Mrs. RD enjoys gardening in her large back yard but reports increasing difficulty in moving from the ground to standing. She also reports that she becomes easily fatigued and out of breath from walking and is having difficulty moving up and down the stairs and standing up out of a low chair. She would like to start a fitness program again and sought the advice of her doctor, who recommended that she see a PT. Answer the following case study questions on a separate piece of paper and compare your answers with those that follow. 1. Does Mrs. RD require medical clearance from her doctor prior to starting a moderate exercise program? 2. In her first visit Mrs. RD asks what she needs to know to safely exercise with her diagnoses of diabetes and hypertension, and she also wants to know what heart rate she should achieve during her exercise program. 3. RD states that she does not want to do any resistance training because she has heard that she can get bulky muscles and that it is bad for her blood pressure. What can you say to encourage her to participate in resistance exercise? 4. How will you measure Mrs. RD’s progress before and after her exercise program? Answers 1. Yes, Mrs. RD requires medical clearance from her doctor. Due to her history of diabetes (a metabolic disorder) and her current level of inactivity, it is recommended that she Conclusion As the U.S. population continues to age, most practitioners will be working with older adults and must be familiar with the systemic changes that occur with aging and inactivity. In contrast to the past century, when bedrest was commonly prescribed, we know that exercise is critical to successful aging and that most older adults, even those with comorbid conditions, should regularly participate in both aerobic and resistive exercise. However, many of the changes that occur with aging can make recommending and implementing exercise a challenge. An understanding of the anatomical and physiological changes that occur with aging and inactivity will allow practitioners to correctly recommend and implement exercise programs. While our understanding of changes that occur in the body with aging is still evolving, it now appears that many of these changes can at least be slowed and in some cases even reversed with the implementation of exercise. Researchers are still trying to determine which changes are age related and which result from inactivity.
receive medical clearance prior to starting any moderate or vigorous exercise program. 2. RD is currently on a beta blocker that will blunt her rise in heart rate. It is important to educate her that she should not base the intensity of her workouts on her heart rate but rather on her perceived level of exertion. She should be performing her aerobic and resistive exercises at a moderate-intensity level (or a perceived exertion of approximately a 5 to 6 out of 10). She should also be checking her blood sugar before and after exercise. The insulin that she is taking puts her at risk for having a hypoglycemic episode, and she should be educated about symptoms to watch out for before and after exercise as well as the potential need for a snack prior to exercise if her blood glucose level is below 100 mg/dL. Finally, given her history of diabetes, she should make sure she has proper-fitting footwear and perform frequent foot checks to ensure she is not developing any signs of a foot ulcer. 3. The fear of becoming bulky with resistance exercise is unfounded. With the loss of muscle mass that typically occurs with aging, an increase in muscle mass would be a positive result for Mrs. RD. Education on the benefits of resistance exercise is important. Explaining that resistance exercise can help her rise from the floor and go up and down the stairs may be helpful. To address her concerns about blood pressure, you can point out that she will have clearance from her doctor prior to participating and that participation in resistance exercise can actually result in decreased blood pressure over time. Finally, it may be helpful to educate her that resistance exercise can also help in controlling her diabetes. exercise should be used. Any of the above measures in the “Measuring Change Clinically” section would be appropriate, and the best measures for the space available should be used. Given Mrs. RD’s complaints about her difficulties in getting off the floor and going up and down stairs, chair rises and the SPPB may be particularly relevant. 4. A combination of measures to examine her improvements with both aerobic and resistance Further research is necessary to determine the most effective mode, duration, and frequency of exercise for older adults, particularly those with comorbid conditions such as dementia and OA. We know that following the recommended guidelines of engaging in 150–300 minutes of aerobic and resistance exercise three or more days a week results in improved mobility and function in older adults. While resistance training has traditionally been overlooked for older adults, we now know that it is a critical component for successfully mitigating muscle and functional loss typically associated with aging. Prescribing alternative forms of exercise such as tai chi, Pilates, yoga, or downhill walking may be beneficial and warrants further research, particularly in older adults with comorbid conditions such as diabetes, OA, or dementia that make prescribing exercise particularly challenging. Despite the gaps in our understanding, it is clear that exercise is beneficial for the majority of older adults, and prescribing both aerobic and resistance exercise should be a routine part of practice.
Page 104
EliteLearning.com/Physical-Therapy
Powered by FlippingBook