on-one exercise sessions may be needed. Even short bouts of activity are still beneficial to health and may be more easily implemented with some creative planning than longer durations. For example, older adults residing in nursing homes or centers for dementia care may benefit from the implementation of a routine walking program. Getting residents to walk several minutes to and from meals or activities every day can result in an accumulation of time spent exercising, leading to numerous health benefits. Music therapy or dancing programs may also provide enjoyable exercise for older adults with dementia. Studies on the effect of music therapy on older adults with dementia have demonstrated that familiar music results in an instinctive increase in activity such as toe tapping and hand clapping (Cevasco & Grant, 2003). One study found that, under certain conditions, the use of instrumental music with exercise resulted in increased participation in an exercise program by older adults with Alzheimer’s disease (Cevasco & Grant, 2003). While it may require some additional creativity and patience, exercise is critical to older adults with dementia and should be encouraged. 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 at least 150 minutes of aerobic exercise per week with the addition of regular resistance exercise 2 to 3 days a week results in improved mobility and function for older adults. While resistance training has traditionally been overlooked for older adults, we now also 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 any physical therapy practice. 3. Mrs. 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 receive medical clearance prior to starting any moderate or vigorous exercise program. 2. Mrs. 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 approximately a 5 to 6/10). 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.
average only 33 out of 88 sessions, with one fifth of participants completely dropping out of the exercise program over a 1-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. Additionally, older adults with dementia, particularly those with advanced dementia, may require additional cueing to complete an exercise safely and may not be safe to exercise without supervision. For this reason, family members or caregivers may need to be educated 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- Conclusion As the U.S. population continues to age, most PTs and PTAs 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 bed rest 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 prescribing and implementing exercise a challenge. An understanding of the anatomical and physiological changes that occur with aging and inactivity will allow PTs to correctly prescribe and implement an exercise program. While our understanding of changes that occur in the body with aging is still evolving, it now appears that many changes that occur with aging 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. Further research is necessary to Case study Mrs. RD is a retired college professor and a 75-year-old widowed female 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 5 years ago with no complications. Mrs. RD’s husband died 1 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 3 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 having increasing difficulty in moving from the ground to standing. She also reports 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. Questions 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 diagnosis of diabetes and hypertension, and she also wants to know what heart rate she should achieve during her exercise program.
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