Exercise Programs: An Important Therapeutic Tool

In today's media, exercise has been highly touted as an effective way to improve one's physical health. While fitness has been promoted mostly to the young, research has indicated that the elderly can also reap many benefits from an exercise program. Many nursing facilities have developed creative health and fitness programs to improve their residents' physical and emotional health.

Too often, physical frailty is seen as a fact of life for nursing home residents, with many unable to do even the simplest tasks of daily living. Body weakness can also contribute to accidents in the nursing home, with falls being a prime example. As researcher William Evans of Penn State University notes, "Many elderly are institutionalized not because of any disease or cognitive impairment, but because of muscle weakness. Their minds might be quite nimble, but their bodies are diminished." Exercise programs are being used to make these residents' bodies stronger and more flexible, helping to facilitate their independence.

Exercise is a prime example of preventative care, helping residents become better equipped to fight disease and infirmity. Indeed, because of their many health challenges, it is the elderly who can benefit the most from fitness programs. Even 2000 years ago, the Father of Medicine Hippocrates understood the necessity for keeping the body active and in shape throughout one's life. He observed:

All parts of the body which have a function, if used in moderation, and exercised in labours to which each is accustomed, become thereby healthy and well-developed, and age slowly; but if unused and left idle, they become liable to disease, defective in growth and age quickly. This is especially so with joints and ligaments if one does not use them.

Today's Elderly: Physically Unfit

Many elderly enter today's nursing homes in dire physical condition. The National Institute on Aging has recently released some revealing statistics about those elderly who are beyond the age of 75: 40 percent cannot walk two blocks, 32 percent cannot climb ten steps; 22 percent cannot lift ten pounds; 7 percent cannot walk across a small room; and 50 percent of older people who fracture hips never walk independently again and many die from complications. These statistics should ring a resounding alarm throughout the long term care community that effective fitness programs are desperately needed by residents to improve their physical health.

Misconceptions about Exercise and the Elderly

With advancing age comes an expectation of increasing frailty and a dependence upon others for the tasks of daily living. While it is true that physical debilitation is a natural part of the aging process, this debilitation can be minimized through the use of an effective health and fitness program. Common misconceptions about the elderly and fitness can include the following:

• Frail older adults are unable to exercise.
• It is unwise and unsafe for the frail elderly to begin an exercise program.
• Frail elderly gain few benefits from exercise.
• It is too difficult for most nursing homes to set up exercise programs for the frail elderly.

Many research studies have proven that even frail elderly can derive many physical and psychological benefits from well-developed fitness programs. In the future, exercise programs will play an increasingly prominent role in nursing facilities, helping curtail the debilitation that is now seen as a common reality for the elderly.

One of the mostly startling discoveries supporting this view of wellness came from a study by researchers at Harvard Medical School, published in the June 23, 1994 edition of The New England Journal of Medicine. Researchers tested the hypothesis that physical frailty is partially caused by skeletal-muscle disuse and should therefore be reduced through exercise interventions.

The study involved 100 nursing home residents, including persons with arthritis, lung disease, and dementia. One group of residents, the control group, participated in normal nursing home activities, while the other group participated in resistance training three times a week, using exercise machines to strengthen their thighs and knees.

After a ten-week period, the residents who underwent resistance training increased their muscle strength by 113 percent, increased their walking speed by 12 percent, and increased their ability to climb stairs by 28 percent. Four residents who had needed walkers to walk around the facility became able to walk with a cane. As Maria Fiatrone, MD, head researcher for the study, comments, "In other countries, older people are out there riding bikes and climbing stairs. But in this country people are keeling over out of sendentariness. It's inactivity, not exercise, that's killing us."

OBRA Mandates and Exercise Programs

Following OBRA regulations, facilities are mandated to assess the functional potential of residents, rather than focus on their disease conditions. Residents are to be assessed on an individual basis, and given interventions that maximize their remaining functional abilities.

This new way of thinking has caused nursing home caregivers to go beyond the myths and biases of exercise for the elderly. The restorative emphasis encourages staff to minimize resident dependence and maximize their functional abilities. Health and fitness programs are increasingly recognized as vital ingredients in satisfying the mandates of OBRA, in restoring functional ability, and in ultimately improving residents' quality of life.

Physiological and Functional Benefits of Exercise for the Elderly

Both research studies and the experiences of the elderly have shown that exercise produces many significant physiological benefits. Functional decline in the elderly is often the result of a sedentary lifestyle, rather than the effects of the normal aging process. According to the Office of Aging, U.S. Department of Health and Human Services, fitness programs can be effectively used to achieve the following resident goals:

• lessen the degree of disability for seniors
• increase muscular strength and endurance which deteriorates through inactivity
• improve a resident's joint flexibility and range of motion by keeping them loose and flexible
• strengthen bone mass which is weakened in the later stage by osteoporosis
• improve respiratory ability and efficiency
• relieve some of the painful symptoms of arthritis
• improve circulation and reduce high blood pressure

There are other physical benefits which have been documented in the research. Exercise has been shown to reduce the incidence of pressure sores and level of incontinence in residents. Regular physical activity can also help alleviate some of the digestive and bowel function problems that are common among the elderly.

Resistance training has increased strength in residents' knees and ankles, which can help prevent falls and reduce facility liability. Exercise helps improve the autonomic nervous system's ability to tolerate stress. It encourages healthy appetites in residents, contributing to their nutritional well-being.

Moderate exercise training has also been associated with a 20 percent increase in serum immunoglobulins, which enhances the immune system. This change is very important to the elderly, since susceptibility to illnesses greatly increases with age. A recent study by the University of Connecticut has shown that exercise can also help those individuals who suffer from sleeping difficulties.

Participating in exercise programs, residents have been able to more easily complete their activities of daily living, such as being able to eat a meal or walk to the washroom. Residents have increased energy, enabling them to become more active and better enjoy their lives. These benefits illustrate the necessity of nursing facilities to invest the time and resources needed to develop a quality health and fitness program.

Psychological Benefits of Exercise for the Elderly

Exercise programs help nursing home residents to maintain a sense of autonomy over their aging bodies. Instead of feeling like victims to the aging process, they can take control and make progressive steps towards improving their physical health. This increased sense of independence also helps to foster their self-esteem.

Cognitive abilities can also be enhanced through fitness. Improving a resident's circulation increases the amount of oxygen brought to the brain, enhancing a resident's mental alertness. As reported in the July 30, 1993 edition of the Brown University Long Term Care Quality Letter, researchers discovered that non-strenuous physical exercise can help older nursing home residents to improve their memory retrieval and visual-motor performance.

Psychological challenges such as frustration, loneliness, and hopelessness are important ones to address through programming interventions. Exercise has been shown to alleviate these problems by channeling residents' energies into healthy and productive activity. Participating in a health and fitness group helps to promote socialization and contributes to a feeling of togetherness.

One recent study of older adults found that anxiety was reduced and tension was relieved as a result of exercise. Those elderly who trained the hardest and had the greatest improvements in fitness experienced favorable changes in body image, mood, and attitudes. In increasing the delivery of oxygen to the brain, exercise has also been effective in combating resident depression.