How to Prescribe Exercises to Your Older Patients with Chronic Conditions

 

Do you feel intimidated by the thought of prescribing exercise recommendations to your geriatric patients with chronic conditions? If you don’t know where to begin, be sure to understand this: Any amount of exercise beats remaining sedentary. This holds true even when a patient’s health status interferes with attaining recommended goals.1 However, as healthcare professionals, we strive to provide effective, evidence-based treatment that is individualized to each patient’s needs. Frequent chronic conditions in the geriatric population such as arthritis, osteoporosis, and heart disease have specific exercise recommendations to improve physical function and symptom management.

The risk of developing arthritis increases with age, and roughly 49.6% of people 65 years or older report being diagnosed with this condition.2 The goal of exercise for individuals with arthritis is to enhance function and decrease levels of pain to improve overall mobility.3 Both land and aquatic based physical activity can increase mobility, muscular strength, joint flexibility, and reduce pain in patients with hip or knee osteoarthritis.4, 5 Starting with aquatic based activities can have a therapeutic and pain minimizing effect through reducing joint loading. As mobility is improved and pain is reduced, land-based exercises can be incorporated.5 No pool in your clinic? Educating your patients on the benefits of aquatic therapy can go a long way. Patients can use a community pool when available to increase tolerance during in-clinic interventions.            

An estimated 10 million individuals in the United States have osteoporosis, and on top of that, 34 million have low bone mass.6 Consequently, the elderly population accounts for 70% of all fractures sustained due to factors such as reduced bone density, impaired balance, and muscular weakness.7 Evidence exists regarding the benefits of resistance exercises in improving bone mineral density.8 Resistance training alone is beneficial, but try it in combination with impact-loading activities, which has been shown to have greater improvements in bone density than walking alone.8, 9 Aside from improving bone density, fall prevention is critical with these patients to minimize fracture risk. Incorporating exercises that improve muscular strength, core stability, as well as coordination and balance will help prevent future falls.10 Don’t underestimate the power of educating your patients on household fall prevention strategies such as removing trip hazards, keeping walkways well lit, and wearing comfortable shoes with good support, non-slip soles, and a broad heel.11

Heart disease continues to be the number one cause of death in the US12, and roughly 80% of those diagnosed are over the age of 65 years old.13 Both moderate- and high-intensity exercise programs are beneficial for geriatric patients with cardiac comorbidities with low risk of a cardiovascular event.14 More recently, high-intensity interval training has also been recognized as a safe alternative for older adults with heart disease.15 Exercise can also improve mental health facets including quality of life, self-confidence, and anxiety. Regular exercise has favorable effects in decreasing major risk factors for heart disease including obesity, diabetes mellitus type 2, and hypertension.16 Your geriatric patients with obesity can benefit from a combination of resistance training and moderate-intensity aerobic exercise using a treadmill or bicycle. These exercises will help maintain muscle strength and increase energy expenditure to generate caloric deficits.17 Even better, aerobic exercise has been found to improve blood glucose control, insulin resistance, and cardiorespiratory function in patients with type 2 diabetes with additional benefits when combined with resistance training.18

As you can see, regular exercise routines can benefit geriatric patients with a variety of comorbidities. You can use exercise as both a prophylaxis and treatment for common musculoskeletal and cardiovascular disorders. In general, it is recommended that healthy, older adults perform at least 150 minutes of moderate-intensity aerobic activity and two or more days of resistance training per week as tolerated.18

 

References

 

  1. Lee PG, Jackson EA, Richardson CR. Exercise Prescriptions in Older Adults. Am Fam Physician. 2017;95(7):425-432.
  2. Barbour KE, Helmick CG, Boring M, Brady TJ. Vital Signs: Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation - United States, 2013-2015. MMWR Morb Mortal Wkly Rep. 2017;66(9):246-253. Published 2017 Mar 10. doi:10.15585/mmwr.mm6609e1
  3. Gaught AM, Carneiro KA. Evidence for determining the exercise prescription in patients with osteoarthritis. Phys Sportsmed. 2013;41(1):58-65. doi:10.3810/psm.2013.02.2000
  4. Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;1:CD004376. Published 2015 Jan 9. doi:10.1002/14651858.CD004376.pub3
  5. Bartels EM, Juhl CB, Christensen R, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database Syst Rev. 2016;3:CD005523. Published 2016 Mar 23. doi:10.1002/14651858.CD005523.pub3
  6. National Osteoporosis Foundation Report Finds Patient-Centered Care Is Key Element in Delivering High-Quality, High-Value Treatment. National Osteoporosis Foundation website. https://www.nof.org/news/national-osteoporosis-foundation-report-finds-patient-centered-care-is-key-element-in-delivering-high-quality-high-value-treatment/. Published July 29, 2019. Accessed May 31, 2021.
  7. Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. 2007;22(3):465-475. doi:10.1359/jbmr.061113
  8. Bolam KA, van Uffelen JG, Taaffe DR. The effect of physical exercise on bone density in middle-aged and older men: a systematic review. Osteoporos Int. 2013;24(11):2749-2762. doi:10.1007/s00198-013-2346-1
  9. Gómez-Cabello A, Ara I, González-Agüero A, Casajús JA, Vicente-Rodríguez G. Effects of training on bone mass in older adults: a systematic review. Sports Med. 2012;42(4):301-325. doi:10.2165/11597670-000000000-00000
  10. Bone Health Special Interest Group. APTA Geriatrics website. https://geriatricspt.org/special-interest-groups/bone-health/. Accessed May 31, 2021.
  11. About Osteoporosis. International Osteoporosis Foundation website. ttps://www.osteoporosis.foundation/patients/about-osteoporosis?utm_source=Enigma&utm_medium=cpc&gclid=Cj0KCQjwktKFBhCkARIsAJeDT0jp-ffmEwSte1J_t7nQPIBq_ytOJsAn-QsCXcVjn0uXEUp2TRifDakaAnFmEALw_wcB. Accessed May 31, 2021.
  12. Deaths and Mortality. Centers for Disease Control and Prevention website. https://www.cdc.gov/nchs/fastats/deaths.htm. Updated April 9, 2021. Accessed May 31, 2021.
  13. Writing Group Members, Mozaffarian D, Benjamin EJ, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association [published correction appears in Circulation. 2016 Apr 12;133(15):e599]. Circulation. 2016;133(4):e38-e360.
  14. Rognmo Ø, Moholdt T, Bakken H, et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients. Circulation. 2012;126(12):1436-1440. doi:10.1161/CIRCULATIONAHA.112.123117
  15. Dun Y, Smith JR, Liu S, Olson TP. High-Intensity Interval Training in Cardiac Rehabilitation. Clin Geriatr Med. 2019;35(4):469-487. doi:10.1016/j.cger.2019.07.011
  16. Kaminsky LA, Arena R, Ellingsen Ø, et al. Cardiorespiratory fitness and cardiovascular disease - The past, present, and future. Prog Cardiovasc Dis. 2019;62(2):86-93. doi:10.1016/j.pcad.2019.01.002
  17. Waters DL, Ward AL, Villareal DT. Weight loss in obese adults 65years and older: a review of the controversy. Exp Gerontol. 2013;48(10):1054-1061. doi:10.1016/j.exger.2013.02.005
  18. Nomura T, Kawae T, Kataoka H, Ikeda Y. Assessment of lower extremity muscle mass, muscle strength, and exercise therapy in elderly patients with diabetes mellitus. Environ Health Prev Med. 2018;23(1):20. Published 2018 May 17. doi:10.1186/s12199-018-0710-7

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