As a professional in the health care field, you know that physical inactivity is a nationwide problem. The Surgeon General’s Report on Physical Activity and Health tells us that 60 percent of the population doesn’t exercise on a regular basis, and 25 percent doesn’t exercise at all. That means only 15 percent of the population exercises regularly. Changing the attitude of Americans about exercise poses a challenge to us all, especially for older adults.
With the graying of the population, many more people will be in their 90s, 2000s and over the next few decades. Americans are living longer. Although many individuals will reach old age maintaining a relatively high functional capacity, many others will have to live with physical and functional restrictions. Inactivity leads to a growing decline in the efficiency of muscles. Older adults who are sedentary become unable to perform the activities of daily living. Therefore, the dramatic need to include exercise as a part of daily living for the elderly emerges.
The Abigail approach
Nestled in Hartford, Conn., on 43 acres of land, is Abigail Retirement Community. Abigail is a total life care facility that includes independent living, assisted living, adult day care, a nursing home and a wellness center.
Physical fitness and the push toward better health through exercise is what the wellness center represents. A grant from the Hartford Foundation for Public Giving, awarded in December of 1993, as well as gifts from private donors, were used to help create the center and purchase exercise equipment. Along with regular exercise programs, medical research studies pertaining to strength training, balance and walking difficulties (involving the University of Connecticut in conjunction with the Travelers Center on Aging) are conducted on site. From early morning to early afternoon the wellness center is buzzing with activity. Music tunes from the big band era can be heard upon entering the center, providing residents motivation while allowing them to reminisce about their younger days.
Two years ago, Abigail developed a supervised exercise program for older adults called “Reaching New Heights.” The program incorporates gradual strength building with cardiovascular and stretching exercises, and emphasizes the major muscle groups of the body — particularly the legs, which are important in everyday functional activities such as getting in and out of a car, bathing, stair climbing, walking and maintaining balance. Programs are supervised by an exercise physiologist and exercise prescriptions are based on current scientific research and evaluation.
More than 90 people are involved in the Reaching New Heights program, with an average age of 85 years. Participants vary from independent living and assisted living to others with less functional abilities (Alzheimer’s, Parkinson’s disease, etc.). No matter how low-functioning an individual is, no one is ever turned away; their program is just modified. One woman, who just turned 100, has been exercising at the facility for nearly two years.
Prior to joining the program, participants undergo a screening process, which includes obtaining medical clearance from their physician. Next, a consultation is arranged with an exercise physiologist to evaluate medical history, including use of medications and a variety of health conditions such as hip and knee replacements, osteoporosis, diabetes, cardiac abnormalities, macular degeneration, strokes, etc. An informed consent and release/waiver form are then signed by the participant.
The exercise physiologist measures the individual’s blood pressure, resting heart rate, weight, circumference measurements of body limbs, grip strength, reaction time (in and out of a chair) and muscular strength in the upper body and lower body using one-rep maximum (RM). Sixty percent of their RM is used to begin the strength training program. Target heart rates are based on 60 to 70 percent of their max heart rate unless they are on beta blockers or unless stated otherwise by their physician. Participants build up to 20 minutes of cardiovascular exercise and the strength training component takes about 20 to 25 minutes.
Participants are reevaluated every six months to determine progress, and each is given a sheet comparing their initial results to current data. This sheet is often shared by clients with their physician or family members to showcase their achievements and boast that, in spite of their age, they can still improve their fitness.
The classes begin with a warm up and stretches to elevate body temperature, increase blood circulation to the working muscles, prepare the body for the workout, reduce the risk of injury and prevent some of the delayed muscle soreness they may experience in a day or two. Participants then move onto eight to 10 stations of strength training equipment set up in circuit-type fashion, and finish with some cardiovascular work on the treadmill, bikes, upper-body ergometer or rowing machine. The end of the workout includes a cool down of stretches to help bring blood back to the heart and prevent pooling in the lower extremities.
Workouts consist of 45-minute sessions twice a week. Every 45 minutes a new group begins. There are eight people in a group, and every resident has an exercise card to chart their information and target heart rate zone. The exercise physiologist takes participants’ heart rate during the cardiovascular portion of the workout and assists with seat heights, charting information and weight increments. The residents perform anywhere from one to three sets of exercises with eight to 12 reps for basic strength gains.
When they feel like they can perform more than 12 reps, it’s time to increase the weight by 2.5- and then 5-pound increments. The first six months of the program is geared toward muscular strength, and cardiovascular exercise is added during the following six months.
Based on data collected to this point, residents have been able to press out more weight with their upper body, push out more weight with their legs and stand up faster than they could six months prior. Strength has improved in their upper bodies by 20 percent, lower bodies by 35 percent and reaction time by 25 percent. The program has been enthusiastically received by the residents, and is not only changing their attitudes about exercise, it is changing the way they view their own ability.
For instance, one 90-year-old female participant had trouble climbing steps when she began the program. Six months before her grandson’s wedding, she set a goal of climbing the 20 steps needed to watch the ceremony. By concentrating on the leg press and leg extension exercises (as well as some upper-body work to assist in using the railing), she was able to go beyond her goal. On the day of the wedding, she climbed the 20 steps three times!
Likewise, another woman in her 80s with significant posture problems and poor lower-body strength was able to press just 30 pounds with her legs when she began the program. At her six-month reevaluation, she was pressing 150 pounds.
Other exercise programs at Abigail include chair exercises three times a week (incorporating wooden dowels, dynabands and light dumbbells), body stretching classes, tai chi and walking programs during spring and summer months. Incentive prizes such as T-shirts, water bottles, sweatshirts, mugs, etc., are offered as motivational tools. The social aspects and camaraderie these programs offer participants are also a major factor in adherence.
A number of studies in recent years highlight the benefits of exercise and strength training for the geriatric population. These benefits include an increase in bone density, muscular strength, endurance, flexibility and lean muscle tissue, as well as a decrease in body fat, resting heart rate and blood pressure. Other improvements have been shown in balance, reaction time, sleeping patterns, and walking and stair climbing abilities. Exercise also helps to prevent the onset of frailty, cardiovascular disease, depression, diabetes and osteoporosis.
Research tells us that between the ages of 25 and 70, we lose around 30 percent of our lean muscle tissue. Strength training increases lean muscle tissue, which increases metabolism.
The benefits of exercise are endless. The results of continued studies indicate that nursing homes, retirement communities and convalescent homes may see a number of benefits if they implement strength training programs for their residents. Improved mobility strength and balance could decrease the likelihood of falls, which is the second most common cause of accidental death between the ages of 55 and 80.
Because awareness about the benefits of exercise among the elderly is on the rise, developing a comprehensive program could bring in outside business for your facility. Since the Reach New Heights Program began two years ago, Abigail has benefitted from several assisted-living facilities and other retirement communities who “bus” their residents in to take advantage of the program.
This collaborative effort is very likely reducing disability and the cost of health care as people age, and may even delay entry into a long-term care facility. Remember, it’s never too late to start an exercise and strength training program. After all, people don’t grow old; they get old by not growing