Last reviewed on January 26, 2011
By Howard LeWine, M.D.
Brigham and Women's Hospital
Not only are people living longer, but a greater number of people are living healthier well into their 80's and 90's. No matter how healthy we've become, however, at some point we all have to adapt our exercise goals to our changing bodies.
Most of my columns are written for people who are able to do moderate to high intensity exercise. This month I'm directing my comments to people who need a gentler approach because they're physically weak due to advanced age or a chronic disability, such as severe arthritis.
No matter how old you are or how weak you feel, strive to keep active in some way. It's an important key to your independence.
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Activities of Daily Living
To maintain even a basic level of independence, you need to be able to perform your Activities of Daily Living, or ADLs. The ability to do so without help means that you can be alone at home for at least part of the day. ADLs include:
- Transfering from bed to chair and back
- Getting to a toilet or bedside commode
- Controlling bladder and bowel function
- Calling for help immediately when needed
There's another level of ADLs called the Instrumental Activities of Daily Living or IADLs. These are the essential activities that allow one to live alone and independently:
- Getting food and supplies into the home
- Preparing food
- Keeping the home clean
- Arranging to have finances managed
- Taking medications correctly and complying with other therapies
- Using a telephone
Exercise has the potential to improve many of the physical changes associated with frailty and disability and help a person stay independent. That's because muscle strength, general stamina, flexibility and balance can all be improved with exercise. Multiple studies show that these improvements can occur in just weeks of starting to exercise. And the people who benefit the most are those who are the most frail.
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Helping Your Joints and Bones
Regular physical activity helps preserve joint structure and function. People with either osteoarthritis or rheumatoid arthritis (the two major types of arthritis) can decrease their pain and increase their mobility with an exercise program as long as they use proper technique and pay attention to safety.
In the FAST study (Fitness And Seniors Trial), older adults with osteoarthritis were in one of three exercise groups:
- General aerobics
- Resistance training to increase muscle strength
- Range of motion exercises for the joints most involved
A group of similar patients did not receive any exercise "treatment" and remained sedentary.
The researchers looked for improvements in sense of well-being and level of disability over a period of 18 months. The seniors in each of the three exercise groups scored better than the sedentary subjects. Interestingly, the folks in all three of the exercise groups showed similar improvements on average.
When it comes to keeping bones strong and preventing bone loss (osteoporosis), the type of exercise you do matters. It must be "weight bearing" such as walking, jogging, dancing and stair climbing. Resistance exercisesusing free weights (barbells and dumbbells) or machines with adjustable tensionsusing even very modest weights or resistance may also help. To stimulate bone activity, weight bearing exercise must be combined with adequate intake of vitamin D and calcium.
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Falls in the elderly are a major cause of hospitalization and loss of independence. Maintaining muscle strength, stamina, balance and flexibility decrease the risk of falling and also decrease the risk of severe injury when a fall does occur. By far, balance training has shown the most consistent benefit for preventing falls.
Recently tai chi, an Asian practice where a series of slow movements are coordinated with deep breathing and mental focus, has become popular in Western countries. Studies suggest that tai chi may help prevent falls by improving balance, enhancing strength in the lower leg muscles, and increasing stamina.
If tai chi is not an option, there are simple home exercises you can do to decrease the risk of falls. The best approach is to combine some light resistance training, especially for the quadriceps (the muscles in the front part of the thigh), and balance exercises.
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Balance Routines To Practice at Home
Anyone who is able to stand can improve his or her balance. Try this routine if you are very weak and unsteady, preferably with another person close by as a precaution. Get behind a heavy stable chair, preferably one that is cushioned. You will be using this for support.
- Step 1: Grab the back of the chair with both hands. Slowly lift the heels of both feet, moving on to your toes. Try to raise your heels as high as you can and hold them for 1 to 2 seconds. Rest for 10 to 15 seconds. Repeat this routine 8 to 12 times, or stop sooner if you are fatigued. Once you have mastered this, move to Step 2.
- Step 2: Hold on to the back of the chair with only one hand and lift yourself onto your toes as in Step 1. Once you feel very secure balancing yourself with one hand only, try lifting the other hand an inch off the chair and see if you can still raise yourself onto your toes. Stop immediately if you feel unsteady. You can try again tomorrow.
- Step 3: Grab the back of the chair with both hands like you did in Step 1. Shift your weight to your stronger leg, then bend the knee of your weaker leg and lift your foot behind you. As long as you're able to keep your balance, try to get your foot higher than your knee. Hold for a couple of seconds and repeat 8 to 12 times. Tomorrow practice with the other leg. Once you have mastered both legs, you are ready to move to Step 4.
- Step 4: Grab the back of the chair in the middle with one hand. Raise your weaker leg as described in Step 3. Aim for the same number of repetitions. Remember to go slow and stay in control. Your muscles work harder with slower, more purposeful movements. Tomorrow switch hands and legs.
- Step 5: Hold on to the back of the chair with one or both hands. Bend the knee of your weaker leg and lift it in front of you to just below your hip. Hold it for a couple of seconds. The goal here is to keep your body and hips still as you lift the knee. As you get comfortable with this exercise, try lifting one hand off the chair and then both hands. But keep your hands close to the chair in case you feel unsteady. Repeat 8 to 12 times.
- Step 6: The last and most advanced step is marching in place behind the chair. Instead of bending and lifting the same knee multiple times, you will now alternate lifting your legs. The eventual goal is to do this without having to use your hands to support you. But always stay in back of the soft chair.
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Getting started is probably the toughest hurdle to overcome. Too often older, frail people have the wrong impression that they are past the point where exercise can do any good. In fact, the more widely held notion is that exercise will make them worse. This is clearly not the case as long as the exercise program is designed to be safe, easy at first and to progress at a reasonable pace.
Keep your exercise sessions short7 to 10 minutes when first starting outand your routines simple to build your confidence that you can do it.
Howard LeWine, M.D., is chief editor of Internet publishing, Harvard Health Publications. He is a clinical instructor of medicine at Harvard Medical School and Brigham and Women's Hospital. Dr. LeWine has been a primary care internist and teacher of internal medicine since 1978.