which older adults feel comfortable and in which they are willing to participate may be challenging, but older adults should be encouraged to participate frequently in both aerobic and resistive exercise. A list of resistance activities can be found by referring back to Table 2. The National Institute on Aging and the Growing Stronger program (a collaboration of the Centers for Disease Control and Prevention and Tufts University) both provide additional recommendations for resistance training exercises. Further information can be found in the “Resources” section. improvements outside of the rehabilitative context (Stathokostas et al., 2012). The American College of Sports Medicine currently recommends that flexibility exercises for older adults be performed at least 2 days a week for at least 10 minutes (Nelson et al., 2007). The College also recommends a general stretching routine involving major muscle groups with a 10 to 30 second static stretch and 3 to 4 repetitions per stretch. It is preferable that stretching exercises follow aerobic or resistance exercise (Nelson et al., 2007). However, given the dearth of evidence for stretching and functional outcomes, it is best to add stretching as an adjunct to resistance and aerobic exercise and not make it the main focus of a general exercise program for healthy older adults. In all cases, PTs should use their general knowledge and expertise regarding joint structure and function when evaluating and prescribing flexibility exercises in older adults. Balance exercise, like aerobic and resistance exercise, should be a lifelong habit and undertaken frequently. It is estimated that 50 hours of balance training are necessary to have an effect (Sherrington et al., 2008). This is equivalent to doing 1 hour of balance exercise twice a week for 6 months. However, the benefits of balance exercise are quickly lost when the program is stopped; in other words, balance exercise, like resistance and aerobic exercise, should become a habit and part of a daily routine of physical activity (Sherrington et al., 2011). If an individual presents with significant balance difficulties, it may also be best to undertake a balance exercise program prior to starting an aerobic or resistance training program. Studies have noted that the inclusion of a walking program may actually reduce the effectiveness of the balance exercise program for fall risk (Sherrington et al., 2011). This is most likely because those who participate in both a fall and a walking program simultaneously are sacrificing some balance time in order to participate in walking (Sherrington et al., 2011). However, the multiple benefits of both resistance and aerobic exercise should not be ignored. Once a balance exercise program has been established, the inclusion of other exercises can take place, as long as they are not at the expense of balance training (Sherrington et al., 2011). consistent exercise time or participating in a group exercise class may help in overcoming these barriers. Many older adults report that they enjoy the social aspect of exercise (Costello et al., 2011), and group exercise is a motivator to show up and continue exercise (Costello et al., 2011). A lack of access to a safe environment for exercise is another frequent concern (Costello et al., 2011; Franco et al., 2015; McPhail et al., 2014). Older adults may reside in neighborhoods with few sidewalks, unsafe conditions, or a lack of an exercise facility in close proximity to their home. 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
to result in a gain in muscle mass, it has been shown to result in improved lower extremity strength in older adults, and its slow-flowing movements may be more appealing than traditional resistance exercise for some older adults (Barbat-Artigas, Filion, Dupontgand, Karelis, & Aubertin-Leheudre, 2011; Chen, Crowley, Zhou, & Cartwright, 2012; Shen et al., 2012). In a study of 62 postmenopausal women, Barbat-Artigas and colleagues (2011) found that a 12-week tai chi program performed 3 times per week resulted in improved muscle strength, chair stand time, and single-limb stance time, indicating improved lower extremity strength and balance. Finding a resistive exercise with Flexibility exercise benefits and prescription PTs are familiar with assessing and treating general limitations in joint range of motion that occur with illness or injury. Although stretching may improve the global decrease in joint range of motion that occurs with aging (Ahmed et al., 2005), few studies have focused on the relationship between flexibility exercises and functional outcomes in older adults. Because of this lack of research, little consensus exists as to the amount and type of flexibility exercises best suited to healthy older adults (Chodzko- Zajko et al., 2009). The goal of a flexibility program for healthy older adults should be to improve the range of motion of most major joints (Stathokostas, Little, Vandervoort, & Paterson, 2012). Although some studies have demonstrated functional improvements in older adults after a general stretching program, a recent systematic review concluded that there is a lack of evidence to recommend stretching routines for functional Balance exercise benefits and prescription At least one third of older adults fall at least once a year, and falls account for at least one half of injury-related hospitalizations for older adults (Sherrington et al., 2008). Balance difficulties are a major risk factor for falls, and any well-developed exercise program should also include a balance exercise program. While a full review of fall prevention and balance exercise programs is beyond the scope of this course, brief recommendations on balance exercises will be provided. The American College of Sports Medicine recommends the use of balance exercise in older adults, but no specific recommendation is given for the frequency, intensity, or type of balance program. The inclusion of balance training in an exercise program is estimated to reduce fall risk by up to 17%, and some balance studies have demonstrated as much as a 35% reduction in falls (Sherrington et al., 2008). In order for a balance program to be effective at reducing falls, it must provide at least a moderate challenge to the participants (Sherrington, Tiedemann, Fairhall, Close, & Lord, 2011). Balance exercises should challenge participants by reducing their base of support, moving their center of gravity, and reducing the need for upper limb support. For example, individuals may practice standing while reaching. While they are reaching, they should be focused on extending their reach and gradually relying less on upper extremity support to maintain their balance. 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. Many older adults cite a lack of time as a barrier to consistent participation in an exercise program (Costello, Kafchinski, Vrazel, & Sullivan, 2011; Franco et al., 2015; McPhail, Schippers, Marshall, Waite, & Kuipers, 2014). 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 doctors’ appointments for themselves or those close to them, or ongoing volunteer commitments (Costello et al., 2011; Franco et al., 2015 ). Scheduling a
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