April 21, 1995 Number 104

Innovative Exercise Programs for the Elderly

In developing well-planned exercise programs, many Illinois Council facilities are improving their residents' physical health, promoting their emotional well-being, and contributing to their independence and self-sufficiency. One of the biggest challenges, however in creating a results-achieving exercise program is garnering resident interest. Like anyone, residents can get easily bored doing exercises that are repetitive and seem to lack any purpose. The following information reflects creative approaches to resident fitness that are currently being implemented in nursing homes across the country. These programs not only provide residents much enjoyment, but help these residents successfully achieve many important therapeutic goals.

The "Highstepping" Fitness Program Makes Exercise Fun

The January 1993 issue of Provider magazine highlighted an exceptional fitness program called the Highstepping Fitness and Coordination Program. Taught by an exercise physiologist, the program is aimed at making physical activity a normal part of everyday nursing home life. With participants aged 85 and older, the program is designed to increase the residents' strength, flexibility, and balance, while also providing psychological enhancement and fostering resident self-esteem.

Residents are selected for the program using several assessment tools, including body composition studies, anthropometric measurements, and well-being questionnaires. Residents' exercise programs include stretching and breathing routines, balance and strength exercises in sitting and standing positions, and the use of hand and ankle weights. Classes consist of a warm-up with gentle movements, static stretches, a strength-training segment, and a cool-down relaxation stretch.

Exercise equipment including motorized treadmills, recumbent bicycles, stair climbers, and upper cycles are used to help residents achieve their fitness goals. Classes meet for one hour, three times a week. Exercises include finger-hand coordination movement, marching routines, and range-of-motion segments that reflect activities of daily living.

Open-houses, in-service presentations, and educational sessions are used to sustain resident interest. Residents also receive T-shirts and stickers as they accomplish goals. Upon completion of the first phase of the program, the participants are presented with diplomas, which are proudly displayed in their rooms. Every effort is made in the program to provide a comfortable, relaxed and fun atmosphere.

Residents participating in the program have seen dramatic improvements in their physical and emotional well-being. Before participating in the program, one resident with severe contracture had to wear a neck brace to prevent her neck muscles from tightening further and to support her head in an upright position. After three months in the program, she has gained control over her neck muscles and is able to hold her head up for the first time in many years. Her success story is but one of many from this innovative fitness program.

Tai Chi Program Promotes Balance and Reduces Stress

Gathered on the front lawn of their nursing home, residents sway and turn in flowing circular patterns. In deep concentration, they engage in synchronized movement, with their bodies postured in dance-like stances. Each movement melts smoothly into the next, providing the residents with feelings of pleasure and relaxation.

These residents are participating in a tai-chi exercise program, a 300 year old discipline from China. Embracing philosophy, psychology, meditation, physical exercise, and the martial arts, tai-chi has been proven to offer important balance, flexibility, and stress-relieving benefits to elderly adults.

As reported in the June-July 1992 issue of Modern Maturity magazine, tai chi resembles a modern-dance rehearsal without the soundtrack. Residents learn a sequence of slow, gentle movements and perform them without stopping, so one flows naturally into the next. Some participants in tai chi equate the movement sensations with pushing one's hand against the onrushing air outside of a moving car's window.

During the exercises, the participants muscles are relaxed, with their minds solely focused on completing the yoga-like movements. This meditative focusing is a wonderful relaxation technique, helping to reduce feelings of stress.

Experts believe that tai-chi exercises can dramatically improve balance and body stability in elderly adults. In a tai-chi program, participants are taught to stand so that their legs create a base of support, with their center of gravity positioned directly over the base. The body is upright, not leaning, and weight is continually transferred from one leg to another.

In improving balance, tai chi exercises can ultimately be used by facilities to significantly reduce resident falls. One elderly gentleman in a tai-chi program comments, "Four months ago I was so afraid of falling I couldn't stand up to pull on my trousers without leaning against something. But did you see how I balanced on one leg out there?" His tai chi exercise has greatly improved his balance and flexibility, helping to facilitate his independence.

Dance Programs Encourage Aerobic Exercise

Dance has always been a favorite activity of the elderly. Dance movements provide nursing home residents many important therapeutic benefits, including improved balance, enhanced cardiovascular endurance, improved muscle tone, and reduced sleeping disorders. Exercise programs that utilize dance movements can provide residents with an effective aerobic workout, while capturing their interest and enthusiasm.

In the May 1993 article on dance exercise programs in Nursing Homes magazine, the authors recommend that dances with slow tempos and very little locomotion be used for more frail residents, while faster tempos and more complex dance movements be used for more physically fit residents.

Dances that work well for nursing home residents include social dances such as the waltz, fox trot, and samba; simplified square dancing routines; as well as ethnic folk dances, which can also be used to reaffirm a resident's cultural heritage.

In teaching dance movements, instructors should begin with only the most basic steps of a dance and progress slowly to more complex movements. There should be sufficient repetition of steps to facilitate learning. As the elderly have more difficulty with body position and balance, movements requiring rapid change in motion or direction should be avoided.

The authors suggest that a dance class begin with simple movements to slowly warm up the body. Dance routines later in the program should alternate between moderate and slow tempos, with short periods of relaxation. The last dance of the class should be slow and relaxing for a cooling-down effect.

As residents may become bored with traditional exercise programs, dance offers a great way to motivate residents to do therapeutic movements and have fun. Research studies have proven that dancing is a legitimate aerobic workout for older adults which improves their physical health and fosters socialization and self-expression.

Water Walkers Exercise Program Helps Residents with Joint Pain

Some residents, due to physical limitations, are unable to participate in the traditional walking or low-impact aerobics programs currently available in some nursing homes. To allow these residents to gain the advantages of land-based exercises without stress and strain to arthritic joints, researchers at Idaho State University developed an innovative "Water Walkers" program reported in the March-April 1992 issue of Current Health Reports. The program, which is designed to take place in a pool, has the goals of increasing range of motion, promoting cardiovascular endurance, and improving muscle strength.

Participants in this program use "Water Walkers," a buoyancy device that easily attaches around the waist and allows freedom of movement without fear of drowning. With this device, residents can be immersed in the water up to the shoulder and are free to move about in the pool. Doing exercises in the water, participants are able to enjoy a full range of motion without joint strain.

Research studies have shown that aquatic exercise provides similar cardiovascular and muscoskeletal benefits for the elderly as "on the ground" aerobic exercise. Aquatherapy has been shown to increase fitness and mobility in residents with rheumatoid arthritis without exacerbating their symptoms. The warm water in the pool provides a very comforting and soothing effect on those with joint pain.

With swing music playing in the background, each 45 minute exercise session in the program begins with a warm-up period of slow deep-water jogging, followed by ten minutes of gentle stretching at the side of the pool. The next fifteen minutes involve a cardiovascular segment, with large calisthenic-like movements. The last fifteen minutes are completed in the shallow end of the pool, with participants slowly cooling down, working muscle groups essential for daily living, and doing more gentle stretching.

As a result of the program, participants receive aerobic and flexibility benefits, while minimizing movements and weight-bearing stress on muscles and joints. Illinois nursing homes could develop similar programs for residents using a community park district pool. Facilities could also have residents do some simple arm and leg movements using the facility's bathtub. Aquatic exercise provides a safe and goal-achieving exercise option for residents suffering from joint stiffness and pain.

By thinking of creative ways to make exercise fun, nursing facilities are generating much resident enthusiasm for fitness programs and are helping residents lead a higher quality of life. More and more, exercise programs are being specially designed to meet the unique needs, interests, and abilities of an elderly population.