|Exercise Programs: An Important Therapeutic
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
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
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
- 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
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
- lessen the degree of disability for seniors
- increase muscular strength and endurance which deteriorates
- 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
- 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
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
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
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
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