Exercise in the Elderly

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Condition: Exercise is physical activity that is performed to become stronger and healthier. A physical medicine and rehabilitation (PM&R) physician is the ideal professional to evaluate and council the older adults for exercise.

Background: The benefits of exercise and physical activities include improving brain health, weight management, reducing disease, strengthening your bones and muscles, and improving your ability to do everyday activities. United States Department of Health and Human Services recommends at least 150 minutes a week of moderate intensity aerobic activities and at least two days week muscle strengthening activities. However, only 16% of individuals aged 65-74 years follow this guideline. As baby boomer generation age, promotion of physical activities and exercise is important to reduce the disease burden related to sedentary lifestyle in our society. 

Risk Factors: Obesity, mobility challenges, low confidence, and disease burden impact an individual’s ability to maintain physical activity levels during aging. Osteoarthritis, heart and lung diseases are common challenges that affect older adults participating in an exercise program. These conditions along with decreased mobility can place older individuals at risk of further deterioration in function and increase disease burden.

History and Symptoms: Details of current level of activity and exercise are asked during office visit for proper counseling regarding exercise. Older patients often over-report their activity levels, while a detailed medical history often reveals a sedentary lifestyle. Clinicians focus on activity limiting factors including pain in specific joints or area, muscle tightness, reduced range of motions, walking or balance difficulty, and shortness of breath, or chest pain.

Physical Exam: Physical examination include heart, lung, limb circulation, back and other joints for range of motion, stability, and tenderness, walking pattern, and balance. Any significant findings will alert clinicians of potential injuries that may arise with increase in physical activity.

Diagnostic Process: Functional assessment includes walking and balance, vision, and risk of falls. Exercise stress testing is recommended in some instances. The use of fitness-tracking devices to objectively monitor exercise is beneficial and provides motivation for some patients.

Rehab Management: Patients should receive counseling about precautions during exercise which include fall prevention, monitoring heart rate and subjective perception of how hard the exercise is, and giving rest periods between exercises. PM&R physicians are well equipped with knowledge and skills of assessing older adults and can prescribe exercises based on specific needs and limitations of older adults. PM&R Physicians can address musculoskeletal and neuromuscular concerns following increased physical activity and adjust the level of activities. Exercise-related cardiopulmonary symptoms should be reported for further evaluation by a primary care provider or cardiologist. The role of a PM&R physician is to address the function of the patient as a whole, design a comprehensive patient centered treatment plan to maximize independence and mobility.

Other Resources for Patients and Families: Patient education regarding safety (fall prevention, temperature regulation, hydration, and nutrition) is important. Encouraging family members to participate in the exercise program with the older relative may improve participation.


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