and progressive resistance training should include one or two sets of eight to 10 repetitions (McDermott & Mernitz, 2006). Pain status may also dictate the exercise plan and patients severely limited by pain should consult a physician before initiating an exercise program (McDermott & Mernitz, 2006). Peripheral arterial disease Patients with peripheral arterial disease are at a high risk of cardiovascular disease and should have an exercise stress test prior to beginning an exercise program (McDermott & Mernitz, 2006). Many patients with peripheral arterial disease Pulmonary disease For patients with pulmonary disease, the minimal frequency goal should be three to five days per week and those with impaired functional capacity may benefit most from daily exercise (McDermott & Mernitz, 2006). Patients should initially exercise intermittently for 10 to 30 minutes per session and then progress to 20 to 30 minutes of continuous exercise (McDermott
Contraindications to exercise for patients with osteoporosis include: ● Avoiding explosive movements and high-impact loading (jumping, jogging) as well as dynamic abdominal exercises with excessive trunk flexion and twisting (sit-ups, golf swing, bending while picking up objects). (McDermott & Mernitz, 2006)
are extremely deconditioned, which must be considered when beginning a new exercise program (McDermott & Mernitz, 2006).
& Mernitz, 2006). Patients may be taught to use a heart rate or dyspnea scale to assess intensity (McDermott & Mernitz, 2006). Progressive resistance training with an emphasis on shoulder girdle and inspiratory and upper extremity muscles is important (McDermott & Mernitz, 2006).
SAMPLE EXERCISES FOR THE ELDERLY POPULATION
● Side arm raises. ● Elbow extensions (triceps). ● Chair dips. ● Seated rows with resistance bands. Lower body exercises
The following exercises are appropriate for the elderly population: ● Guidelines: Incorporate all types of exercise, including endurance, strength, balance and flexibility. ● Strength exercises should target both upper and lower body. ● Utilize weights or resistance bands. ● Start with light weight and progress as tolerated. Upper body exercises: ● Wrist curls. ● Arm/bicep curls. The five A’s to support behavior change In order to make lifestyle changes, patients must commit to the change and perform steps to move them into a consistent routine. As a health-care provider, either a physical or occupational therapist, it is important to support patients in this journey toward better health. The five A’s – Assess, Advise, Agree, Assist and Arrange – were designed to encourage behavioral changes. Health-care providers must first assess a patient to determine their current fitness and their willingness to begin a new program. You can administer questionnaires Conclusion Aging causes natural changes in the body which can lead to risk of falls, reduced activity levels, illness, disease and mortality. Evidence shows that exercise can decrease the risk of multiple co-morbidities and lead to a better quality of life in the aging population. It is important that all adults exercise in order to counter the effects of aging. It doesn’t matter how old a person is, the effects of exercise can impact their body in a positive way. It is important for physical and occupational therapists to References American College of Sports Medicine Position Stand. (1998). Exercise and physical activity for older adults. Med Sci Sports Exerc. 30 (6):992-1008. Cadore, E. L., Pinto, R. S., Bottaro, M., Izquierdo, M. (2014). Strength and endurance training prescription in healthy and frail elderly. Aging and Disease. 5 (3):183-195. Campbell, A. J., Robertson, M. C., Gardener, M. M., Norton, R. N., Tilyard, M. W. & Buchner, D. M. (1997). Randomized controlled trial of a general practice programme of home-based exercise to prevent falls in elderly women. BMJ. 315 :1065. Elsawy, B & Higgins, K. E. (2010). Physical activity guidelines for older adults. Am Fam Physician. 81 (1):55-59, 60-62. Evans, A. & Meredith, C. (1989). Exercise and nutrition in the elderly. In: Munro, H. N., Danford, D. E., eds. Nutrition, aging and the elderly. New York. Plenum Press , 89-128. Franzke, B. et al. (2015). The impact of six months strength training, nutritional supplementation or cognitive training on DNA damage in institutionalized elderly. Mutagenesis, 30 :147-153. Ishigaki, E. Y., Ramos, L. G., Carvalho, E. S., Lunardi, A. C. (2014). Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: A systematic review. Braz J Phys Ther. 18 (2): 111-118. Kawanabe, K., Kawashima, A., Sashimoto, I., Takeda, T., Sato, Y. & Iwamoto, J. (2007). Effect of whole-body vibration exercise and muscle strengthening, balance, and walking exercises on walking ability in the elderly. Keio J Med. 56 (1):28-33. Krist, L., Dimeo, F., Keil, T. (2013). Can progressive resistance training twice a week improve mobility, muscle strength, and quality of life in very elderly nursing-home residents with impaired mobility? A pilot study. Clinical Interventions in Aging. 8 :443-448. Langlois, F., Vu, T. T. M., Chasse, K., Dupuis, G., Kergoat, M. J. & Bherer, L. (2012). Benefits of physical exercise training on cognition and quality of life in frail older adults. Journals of Gerontology Series B; Psychological Sciences and Social Sciences. 68 (3): 400-404. Larson, E. B. (1991). Exercise, functional decline and frailty. J Am Geriatr Soc. 39 :635-6.
● Back leg raises (hip extension). ● Knee curls (hamstring curls). ● Leg straightening exercises (knee extensions). ● Toe stands (heel raises). (NIH Senior Health)
to assess a patient’s readiness to change. The patient and the therapist should collaborate to determine short- and long-term fitness goals. The therapist should advise a patient on how to begin a program and utilize the appropriate level of support. The patient and therapist should agree upon the goals. The therapist should assist the patient in obtaining goals and then help the patient to arrange activities that will allow them to continue carrying out their fitness plan (McDermott & Mernitz, 2006). understand the normal effects aging has on the body in order to understand how exercise can positively impact their patients. It is important to tailor exercise programs to the patient’s individual needs based upon their overall health and whether there is presence of chronic illness or disease. No matter a person’s level, they can always incorporate an appropriate exercise program. Aging can’t be avoided, and exercise is important way to minimize the effects of this natural process. Leland, N. E., Elliott, S. J., O’Malley, L. & Murphy, S. L. (2012). Occupational therapy in fall prevention: current evidence and future directions. American Journal of Occupational Therapy. 66 :149-160. Li, F. et al. (2013). Implementing an evidence-based fall prevention program in an outpatient clinical setting. J Am Geriatr Soc. 61 : 2142-2149. Mangione, K. K., Miller, A. H. & Naughton, I. V. (2016). Cochrane Review: Improving physical function and performance with progressive resistance training in older adults. Oxford Academic. 90 (12): 1711-1715. McDermott, A. Y. & Mernitz, H. (2006). Exercise and older patients: Prescribing guidelines. Am Fam Physician. 74 :437-44. National Senior Health: Exercise: Exercises to try . http://nihseniorhealth.gov/ exerciseandphysicalactivityexercisestotry/strengthexercise/01.htm. Topic Last Reviewed: January 2015. Accessed 05/20/2018. Owen, A. & Croucher, L. (2000). Effect of an exercise programme for elderly patients with heart failure. European Journal of Heart Failure, 2 :65-70. Periera, M. P. & Goncalves, M. (2012). Proprioceptive neuromuscular facilitation improves balance and knee extensor strength in older fallers. International Scholarly Research Network . Volume 2012, Article ID 402612, 7 pages doi:10.5402/2012/402612. Pollock, M. L., Franklin, B. A., Balady, G. J., et al. (2000). AHA science advisory. Resistance exercise in individuals with and without cardiovascular disease: Benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention. Council on Clinical Cardiology. American Heart Association; position paper endorsed by the American College of Sports Medicine. Circulation. 101 (7): 828-833. Rhodes, E. C., Martin, A. D., Taunton, J. E., Donnelly, M., Warren, J. & Elliot, J. (2000). Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women. Br J Sports Med. 34 :18-22.
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