April 14, 1995 Number 103

Guidelines for Conducting an Exercise Program

Exercise programs are increasingly being used in Illinois Council facilities to make residents more energetic and to facilitate their independence. Research studies from Harvard and Brown Universities indicate that even the frail elderly can derive therapeutic benefits from a well-planned fitness program. These studies emphasize that functional decline in the elderly often is the result of a sedentary lifestyle, rather than the effects of the normal aging process. The following information is designed to provide helpful guidance to facilities in developing and running a goal-achieving exercise program.

Assessment of Residents' Abilities to Participate in Exercise Programs

Development of exercise programs for the elderly must be based on the resident assessment. The residents' primary physicians should first be consulted before any residents begin an exercise program. Activity staff can later utilize each resident's Minimum Data Set (MDS) to assess the following areas:

• Hearing and vision ability
• Disease diagnoses
• Ambulation abilities
• Level of independence
• Level of cognitive functioning
• Communication ability
• Medication usage
• Activity pursuit patterns

This information will help the activity director determine if a resident should participate in standing or sitting exercises, the ability of the resident to follow instructions, any physical limitations to exercising, and the resident's current level of activity. Nursing and rehab staff can also provide information on each resident's range of motion, level of strength in specific muscle groups, and flexibility of specific joints. This knowledge will determine the choice of exercises and levels of intensity and duration.

Developing Individualized Resident Goals

Staff should work together with a resident in developing individualized goals. These goals should be realistic, reflecting the resident's level of ability and allowing room for progress. Each goal should be specific, indicating the mode, frequency, intensity, and duration of the activity, such as "Jane will walk briskly through the hallway for ten minutes, three times a week." The goals should involve such physical considerations as improving range of motion, strength, and flexibility. Staff should also write goals to reflect the residents' psychological needs, such as increasing a resident's self-esteem or fostering socialization skills.

Components of an Effective Exercise Program

Exercises can be done in a group setting or individually. According to the Spring 1993 issue of The Journal of Long Term Care Administration, an ideal exercise schedule for a facility will contain each of the following components and residents can participate in any or all of these activities, depending on their level of ability:

• Warm-up or range of motion exercises
• Stretching exercises
• Muscular strengthening exercises
• Low-level aerobic exercises (for cardiovascular endurance)
• Balance and coordination exercises if the resident is ambulatory
• Cool-down exercises if an aerobic component is included
• Considering this schedule, exercise activities for the elderly generally fall into five categories.

Endurance Exercises improve residents' cardiovascular well being, increase energy and endurance, reduce stress, and decrease high blood pressure. Walking, light aerobics, and swimming are examples of this type of exercise.

Strength Training Exercises help to curtail the frailty and debilitation that is commonly seen in the elderly. Researchers have recently reported tremendous progress in residents using resistance equipment to strengthen muscle groups in their legs, which help to improve their mobility and reduce the risk of falls.

Flexibility Exercises are particularly valuable, since the aged have a tendency to lose flexibility due to their connective tissues losing elasticity. As a result, the elderly experience joint stiffness, limited range of motion, and changes in posture and gait. Arthritis also presents challenges in flexibility. Stretching and range of motion exercises can be used to reduce these impairments.

Balance Exercises address the combination of body alignment, strength, and flexibility. Balance also reflects visual, auditory, and other sensory receptors. Exercise activities, such as dance/movement programs, are an excellent way to improve a resident's ability to coordinate body movement and maintain proper balance.

Relaxation Exercises can be very helpful in reducing feelings of stress, encouraging healthy sleep patterns, and promoting feelings of comfort and security. Exercise programs should include the use of such relaxation techniques as deep breathing, meditation, and self-massaging.

According to the book Exercise and the Elderly, the benefits gained from an exercise program depend on three factors: the intensity of the workout, the duration of the workout, and the number of workouts per week. The authors recommend that workouts last at least 20 minutes per session and occur at least three times per week.

Conducting an Exercise Group

Exercise programs for elderly adults should progress slowly. Make sure that they can do the exercises at a comfortable pace. Keep in mind that they have aches and pains and may tire easily. Particularly for residents with dementia, participants may have short attention spans and may have difficulties in following directions.

Exercises should never be done rapidly or continued if there are signs of excessive breathing, flushing, or sweating. It is wiser to underestimate a resident's intensity level for exercise and gradually progress from this point. This ensures safety and provides the resident with a sense of achievement.

The staff-person who leads the exercise program sets the tone and directly affects residents' willingness to participate in the program and their achievement of goals. The program leader should always be at ease and act in a positive manner.

Touch is a wonderful motivational tool. Before the program begins, the leader should walk around the room and shake the residents' hands or pat them on the arm or shoulder and speak encouragingly. The leader's enthusiasm for the program must be infectious; if the leader is having fun, the residents will too.

During an exercise, the leader should speak distinctly and at a moderate rate of speed. Have residents with hearing impairments sit directly beside you or in front of you during the program. Or, walk over and stand next to a resident who is hard of hearing. To further facilitate hearing, close room doors and reduce other distracting noises.

Carefully watch the residents' faces for signs of comprehension. It may be helpful to state instructions twice. If possible, seat the residents in a circle during exercises. Deliver the instructions for an exercise to one side of the circle, and then paraphrase the instructions to the other side.

Marketing an Exercise Program to Residents

Getting residents to participate in an exercise program can be very challenging. Some residents may not understand the benefits of participating in an exercise program, or may not feel that they are able to participate. Staff must provide positive encouragement to residents, and teach them about the physical and psychological benefits of exercising. They must instill in them the confidence that they are able to participate.

Above all, make the exercise program fun. Residents will want to participate in an exercise program if it seems like a rewarding activity. Activity staff can foster enjoyment by projecting a positive attitude, conducting exercises at a slow and relaxed pace, and using music that reflects the tastes of the group.

Guided imagery techniques, such as having residents pretend that they are kicking their legs into the ocean water, are also effective. Residents can be motivated to complete exercises if they are put into a game-like format.

Activity staff should have the residents choose a name for their exercise group. The residents could be given t-shirts with this name imprinted on them to wear during their sessions. The residents' progress during the group should be recorded on cards which are kept in a file and could be listed on a chart in the exercise area. Staff should offer meaningful praise to residents as they reach their exercise goals, even if they are small ones.

Obtaining Staff Support for an Exercise Program

Not only do the residents need to be motivated about an exercise program, but staff members need to see the value in the program as well. Their cooperation, enthusiasm, and willingness to promote the program are vital to its success. Activity departments should conduct an in-service training session for staff which addresses the physiological and psychological benefits of exercise, staff perceptions regarding the benefits of exercise for the elderly, and specifics about the program's assessment, goals, and approaches.

By creatively planning an exercise program that represents the residents' abilities, interests, and needs, facilities can make great progress in helping residents feel better both physically and psychologically. A well designed exercise program helps residents become stronger and more active, reducing their physical decline and fostering their emotional well-being.