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Physician tool kit: questions your patients are likely to ask about exercising |
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Here are some questions about physical activity the ICAA recommends you discuss with your older patients:
This simple, yet promising, intervention is just one of many that primary care practices can include. Other practices could be patient goalsetting, written exercise prescriptions, individually tailored physical activity regimens, and mailed or telephone follow-up. Top Answers 1. Can I
exercise?
Although the
benefits of physical activity increase with more frequent or more
intense activity, substantial benefits are evident even for those
who report only moderate levels of activity—i.e. washing a
car for 60 minutes, raking leaves for 30 minutes, or brisk walking
or swimming for 20 minutes. All the benefits of physical activity
are especially important for older men and women, since they are
more likely to develop chronic diseases and are more likely to have
conditions such as arthritis that can affect their physical function.
Research studies
have demonstrated these benefits in both middle-aged and older persons,
and in men and women.
Self-assessment tools
Choosing
appropriate footwear
Educational articles
2. What kind of exercise can I do? Cardiovascular According to the Agency for Healthcare Research and Quality and the Centers for Disease Control, substantial health benefits occur with a moderate amount of activity (e.g., at least 30 minutes of brisk walking) on 5 or more days of the week. Additional health benefits can be gained through longer duration of physical activity or more vigorous activity. Brief episodes of physical activity, such as 10 minutes at a time, can be beneficial if repeated. Previously sedentary older adults who begin physical activity programs should start with short intervals of moderate physical activity (5-10 minutes) and gradually build up to the desired amount. Top Strength Older persons can benefit further from activities aimed at building or maintaining muscle strength and balance. A recent review of individually tailored programs for elderly people demonstrated that programs to build muscle strength, improve balance, and promote walking significantly reduced falls in older persons (Gillespie, Gillespie, Robinson et al., 2002). Experts recommend that older adults should participate at least 2 days a week in strength training activities that improve and maintain muscular strength and endurance. Older adults should also perform physical activities that enhance and maintain flexibility. However, older adults are sensitive to the effects of physical activity, and even small amounts of activity are healthier than a sedentary lifestyle. Stretching According to the National Institute on Aging, stretching exercises gives older adults more freedom of movement to do the things they need to do and the things they like to do. Stretching exercises alone can improve flexibility, but will not improve endurance or strength. Physician tools
Strength
programs
Cardiovascular
programs
Stretching
and balance exercises
Top
3. How often can I do this type of exercise? Cardiovascular According to the Agency for Healthcare Research and Quality and the Centers for Disease Control, substantial health benefits occur with a moderate amount of activity on 5 or more days of the week. Brief episodes of physical activity, such as 10 minutes at a time, can be beneficial if repeated. Strength training The National Institute on Aging suggests older adults do strength exercises for all their major muscle groups at least twice a week. Patients should not do strength exercises of the same muscle group on any 2 days in a row. Depending on their condition, individuals might need to start out using as little as 1 or 2 pounds of weight, or no weight at all. The tissues that bind the structures of the body together need to adapt to strength exercises. A minimum of
weight should be used in the first week, then gradually increased.
Starting out with weights that are too heavy can cause injuries.
When doing a
strength exercise, people should do 8-15 repetitions in a row, wait
a minute, then do another set of 8-15 repetitions of the same exercise.
Multiple sets may provide greater benefits if time allows. It should feel
somewhere between hard and very hard (15-17 on the Borg scale) for
someone to lift or push the weight. It should not feel very, very
hard. If patients can't lift or push a weight 8 times in a row,
they should reduce the amount of weight. If you can lift a weight
more than 15 times in a row, they should increase the amount of
weight.
4. How intensely can I do this exercise? Cardiovascular According to the Centers for Disease Control and Prevention, sedentary persons can begin with brief episodes and gradually increase the duration or intensity of activity. Higher intensity activities require less time spent. Lower intensity activities require more time spent. Starting at
a lower level of effort and increasing gradually is especially important
if those who have been inactive for a long time. It may take months
to go from a very long-standing sedentary lifestyle to doing some
of the activities suggested in this section.
Moderate-intensity
activities
Vigorous-intensity
activities
It should feel somewhere between hard and very hard (15-17 on the Borg scale) for someone to lift or push the weight. It should not feel very, very hard. If patients can't lift or push a weight 8 times in a row, they should reduce the amount of weight. If you can lift a weight more than 15 times in a row, they should increase the amount of weight. Stretching Stretching should never hurt. It may feel slightly uncomfortable, but not painful. Older adults should try to stretch farther, but not so far that it hurts. Physician tools
5. How long should I exercise for? Cardiovascular According to the Agency for Healthcare Research and Quality and the Centers for Disease Control, substantial health benefits occur with a moderate amount of activity (e.g., at least 30 minutes of brisk walking) on 5 or more days of the week. Additional health benefits can be gained through longer duration of physical activity or more vigorous activity. Brief episodes of physical activity, such as 10 minutes at a time, can be beneficial if repeated. Sedentary persons can begin with brief episodes and gradually increase the duration or intensity of activity. Strength training The National Institute on Aging suggests older adults do strength exercises for all their major muscle groups at least twice a week. Stretching Stretching exercise 3-5 times at each session. Individuals
should slowly stretch into the desired position, as far as possible
without pain, and hold for 10-30 seconds. They should relax, then
repeat, trying to stretch farther. 6. How do I know when to progress? Cardiovascular The National Institute on Aging recommends progress once you build up the amount of time they spend doing endurance activities, then build up the difficulty of their activities later. Example: The individuals should gradually increase their time to 30 minutes over several days to weeks (or even months, depending on their condition) by walking longer distances, then start walking up steeper hills or walking more briskly. Strength training After the first week or so of strength training, older adults should start doing each exercise with weights they can lift at least 10 times with only moderate difficulty. (If a given exercise seems too difficult—if they cannot do at least eight repetitions—then the weight they are are using is too heavy and they need to scale back.) After two weeks
of strength training, individuals should reassess the difficulty
of each exercise with their current level of weights. They may start
doing the overhead press with one-pound dumbbells, for example.
By the end of the second week, they exercise may feel too easy—that
is, they can easily lift the one-pound dumbbell through the full
range of motion and in proper form more than 12 times. They should
now step up their weights to two-or three-pound dumbbells and see
how the exercise feels at the new weight level. 7. Do I need any type of test beforehand? Most older adults, regardless of age or condition, will do just fine in increasing their physical activity. According to the National Institute on Aging, you should get tested if you display any of the following:
8. Should my exercise program be supervised or unsupervised? According to the National Institute on Aging, most older people can exercise just fine on their own, without advice from a fitness instructor. Some have special needs and may want to consult a professional. Instructors who aren't trained to work specifically with older adults might not be aware of their needs. For example, they might not know that certain conditions or medications can change older people's heart rates or that people with osteoporosis risk spine fractures if they do some types of forward-bending exercises incorrectly. Older adults who consult a fitness professional should ask for their credentials. Instructors who are qualified to work with older people should have no problem sharing their credentials with them. Also individuals should ask about expense. Costs vary, and insurance plans differ as to what kinds of services they will cover. Physician tools Tracking
your progress 9. Can you refer me to a qualified facility? The ICAA age-friendly
fitness and wellness facility locator and patient referral program
was designed to address this issue. The ICAA program offers older
adults a variety of settings within organizations that are better
suited to meet their needs. To find a ICAA
age-friendly facility near you, click here. The site goes live
October 1, 2004.
10. Are you familiar with guidelines for exercise from the CDC or ACSM? Physician tools
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