Note from Vista Healthcare – This article has been written to be general in nature, this information does not substitute information from your Doctor or relevant clinician.
Introduction
Australian Guidelines recommend that older people should engage in daily exercise or physical activity that promotes strength, balance, flexibility and fitness.
Physical Activity becomes increasingly important as we age. The primary reason is that as we age, we may develop other comorbidities or medical conditions that can lead to decreased physical activity OR some people think that being retired or elderly means one should be resting more! This is a myth.
Part of the problem
Comorbidities result in physical changes (output metrics, such as slower reactions, thus not being able to move our feet quickly to prevent ourselves from falling) and muscle wasting or atrophy, leading to reduced muscle mass and weakness.
This is often compounded by an increasingly sedentary lifestyle (less movement, more sitting). Over time, this leads to a loss in functional capacity – making some tasks of daily life difficult.
A simple approach
The best strategy: Perform Physical Activities/ Exercises as recommended by the Australian Guidelines & partner with a Physiotherapist. It is never too late to get started.
Walking Patterns Changing As We Age
Gait pattern and balance decline as we age
There are many factors that can contribute to walking pattern decline, from injuries, physical conditions, neurological conditions such as Parkinson’s, lifestyle choices, lower limb strength and so forth.
Statistically, the most apparent problem this creates is increasing the risk of falls, the number one reason elderly people are hospitalised. 1 in 3 Australian over the age of 65 experiences at least one fall per year. As such, falls prevention becomes a key service for Physiotherapists and Occupational Therapists.
Mastering our gait pattern is important! Plus, walking is great for the heart and respiratory health.
Recommendations to Manage Gait Pattern
According to the Physical Activity Guidelines, people should perform two resistance training sessions per week. One of which can be allocated to lower limb power. Strength & balance training is even more important than simply walking.
The primary muscles used for walking are the glutes, calves and quadriceps, a sit to stand is a perfect exercise that engages all these muscles. A Physiotherapist will provide a graded exercise program to develop lower limb strength.
Strong legs allow people to lift their feet high and clear obstacles and maintain an optimal walking pattern as they age.
In addition to being strong, we need to ensure we maintain a good range of movement in each joint. Being strong and flexible is a lot healthier than being strong and stiff.
According to the Australian Institute of Health and Welfare, 1/11 Australians have Osteoarthritis. One of the effects of Osteoarthritis is increased stiffness – which has a compound effect on stiffness and pain.
The Elderly Improving Strength at Home
Physiotherapists with experience serving people at their homes, are typically well-placed to prescribe exercises for that person to conduct at home. There are many excellent bodyweight exercises.
If weights are required, a person may simply use a bottle of water, a pack of rice or sandbags to make weights.
Engaging in exercises that can be done at home, within the living room, the verandah, the porch and the garden is a wonderful way to enjoy life and retain functional capacity.
Plus, there are exercise programs such as the Otago Exercise Program which are research-based for people living in community dwellings to maintain strength, flexibility and balance at home. This was developed in New Zealand, learn more about Otago here.
Motivating People Who Are Unmotivated to Exercise
There could be many reasons why an elderly person is unmotivated.
The fact the elderly become depressed is underdiagnosed, according to research. We believe the following factors contributed to demotivation:
- A lot of people live by themselves
- Chronic pain
- Fear
- People have lost loved ones
- Association between aging and end of life
One thing to acknowledge – is to really listen to that person, and put ourselves in their shoes, so we can try to understand them.
Looking at the positives.
It can be very challenging for a Physiotherapist or Occupational Therapist to encourage someone to perform physical activity.
The first thing we can do is provide a clinical explanation. For example, someone may feel like they require rest when they really need exercise.
We may start by the simplest of activities, something that is functional and of interest to them, this could relate to
- Cooking
- Gardening
- Watching TV – doing exercises in the commercials
- Participating in the community
We recommend people try to develop a great social network and community.
There are some very low-cost exercise programs run by various councils, people can try these to find out what exercises they like. They’re a great place to meet like-minded people, it’s social engagement, it’s outdoors and it’s motivating.
Another option is to explore community transport facilities. We believe that many people are unaware of this. These transport options are often very affordable and provide a great way to get around.
For middle-aged people that have never committed to regular physical activity, how should they get started?
They should meet with a Physiotherapist to structure an exercise program.
A Physiotherapist will conduct an initial assessment, in which time, they will identify the deficiencies to be improved, these often relate to a combination of:
- Strength
- Balance
- Coordination
- Flexibility
As mentioned, a Physiotherapist will determine the baseline and implement an evidence-based rehabilitation strategy.
Typically, we would ask the person to set a goal for themselves to work towards. A Physiotherapist should endeavour to empower their clients with lifelong skills for improving their physical attributes.
Answer: Consult a Physiotherapist and agree upon a gradually progressed exercise program.
Misconceptions About Physical Activity for Older People
Elderly people should rest more
The first misconception is that some elderly people believe the older they become, they should rest in proportion to their age. It’s
“I’d rather take the lift, stairs are bad for my knees”
“I’m moving into an apartment, there is too much gardening in my backyard”
Research has shown that excessive rest is associated with losing muscle strength, so functional activity will become more difficult over time. A simple activity such as getting out of a chair becomes difficult and tiring.
Additionally, a weakened state can lead to more pain – another reason people may use to stop moving. It makes sense – people do not want to expose themselves to pain or difficulty, so it becomes a vicious cycle.
The takeaway is the use it or you’ll lose it mentality.
A sound strategy for people in this situation is to perform regular, short-duration strengthening exercises as they age.
Should people exercise less as they age?
No, definitely not.
150 minutes per week or 30 minutes of moderate exercises on most days of the week is highly recommended. This can be split into chunks of 10 minutes, three times per day.
If I feel pain, should I stop exercising?
This depends on the exercise the person is performing. Put simply, it’s best to use a person’s baseline to measure against.
For example, we may be asked “Mum has been feeling ankle pain, what exercises should my elderly mother be doing that are safe? We would then reply with what exercises has your mother been doing these past few weeks?
Let’s say the mother has been walking everyday for 30 minutes, we would use this as a starting point. The next day, we may suggest the mother performs the same 30 minute walk and sing a little song to themselves.
From this point, we would build capacity, which could be done by increasing the distance or speed.
From this point, a person may also consult a Physiotherapist for pain management services and to develop pain management strategies.
Is impact bad for an elderly body? (i.e. jumping off a step)
This is quite a generic question. Generally speaking, no, impact is an important stimulus for the body to increase bone density.
Vista Healthcare are strong believers in letting elderly people do what they feel they’re capable of. If someone can punch a boxing bag, go for it.
Impact exercises can be made safer, such as using gloves, foam mats, holding onto things for support and other equipment.