Exercise for Older Adults
With ever changing restrictions and uncertainty associated with COVID-19, it is easy to spend greater periods of the day at home being inactive. For Australians aged 65 years and older, the physical activity and exercise guidelines recommend 30 minutes of moderate intensity exercise on most, preferably all days of the week (Australia Department of Health, 2021). Despite the well documented risk factors associated with increase periods of sedentary behaviour including type II diabetes and cardiovascular disease, only 25% of older adults meet these guidelines (Australia Institute of Health and Welfare, 2018).
Klempel et al. (2021) reviewed 25 studies to determine the effectiveness of chair-based exercise on physical function in older adults. Participants aged 50 years or older with or without health conditions were included. The exercise protocols ranged from 2 to 72 weeks with an average of 12 weeks for most studies. The frequency of exercise varied between 2 and 14 sessions per week with each session lasting between 15 to 110 minutes.
The results of this review suggest that chair-based exercises significantly improved upper limb function via handgrip strength and 30 second arm curl test and lower limb function via the 30 second sit to stand test.
Moreover, considering that an increase in age has been associated with an increase in falls (Peel, 2011), exercises for the older population should aim to reduce the risk of falling. Sherrington et al. (2017) reviewed 88 studies and determined that exercise programs with balance components may reduce the rate of falls in older adults. These exercise programs were implemented for at least 3 hours per week and has shown to reduce the overall rate of falls by 39% in community dwelling older adults (Sherrington et al., 2017). This review also provided nine recommendations to reduce falls risk including:
Include exercises that aim to challenge balance in a safe manner. Examples of these are:
Decrease base of support (e.g. standing with both feet closer together, standing on one leg).
Moving centre of gravity in standing (e.g. reaching for objects outside of arm’s length, step ups, weight shifting from one leg to another).
Decrease reliance on arms for support (e.g. one arm instead of two, using one finger instead of the whole hand).
Perform at least 3 hours of exercise each week.
Exercise participation should be ongoing to maintain benefits.
Fall prevention exercises should be targeted to all older individuals regardless of falls risk.
Fall prevention exercises can be performed in group or individual settings.
Walking can be included in addition to balance and strength exercises, but it is not recommended for individuals who are high falls risk.
Strength training can be included.
To address other potential risk factors to falls, physiotherapists should involve other members of the multidisciplinary team.
Exercise programs as the sole intervention may prevent falls in individuals with cognitive impairments and Parkinson’s disease.
Overall, chair-based exercises allow for a safe and minimalistic approach to improve strength in older adults. However, given that the different studies in the review utilise different patient demographics and exercises, it is unclear which specific exercises are best for which population. Furthermore, fall prevention and balance exercises should be included in exercise programs for all older individuals, regardless of falls risk. It is therefore recommended that exercise programs for older adults be tailored to the individual’s health status and functional ability incorporating exercises emphasising range of motion, strength and balance.
By Jarrad Jansz, physio student at Exercise Thought.
References
Australia Department of Health. (2021). For older Australians (65 years and over). Retrieved from https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-older-australians-65-years-and-over
Australia Institute of Health and Welfare. (2018). Physical activity across the life stages. Retrieved from https://www.aihw.gov.au/reports/physical-activity/physical-activity-across-the-life-stages/contents/summary
Klempel, N., Blackburn, N. E., McMullan, I. L., Wilson, J. J., Smith, L., Cunningham, C., ... & Tully, M. A. (2021). The effect of chair-based exercise on physical function in older adults: A systematic review and meta-analysis. International journal of environmental research and public health, 18(4), 1902.
Peel, N. M. (2011). Epidemiology of falls in older age. Canadian Journal on Aging/La Revue canadienne du vieillissement, 30(1), 7-19.
Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., ... & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British journal of sports medicine, 51(24), 1750-1758.