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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. 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:
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:
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. 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:
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 exercises—using free weights (barbells and dumbbells) or machines with adjustable tensions—using 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. 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. 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.
Getting Started 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 short—7 to 10 minutes when first starting out—and 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.
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