John M. Heath, MD, and Marian R. Stuart, PhD

Disclosures

J Am Board Fam Med. 2002;15(3) 

In This Article

Abstract and Introduction

Background: Frail elders often have chronic illnesses, such as osteoarthritis, hypertension, diabetes, and peripheral vascular disease, for which exercise is a proven means of achieving nonpharmacologic benefits, even at advanced age. Exercise has been shown to enhance the quality of life for these elders.
Methods: A literature search of exercise literature applied to older adults and lifestyle modifications was conducted, summarized, and then reviewed with practicing colleagues.
Results and Conclusions: Exercise continues to be an underused therapeutic intervention for frail elders as a result of barriers created by patients themselves, their caregivers, and their health care providers. Family physicians can overcome these barriers by prescribing appropriate exercises and by tailoring the exercise to the functional needs and preferences of their patients. An exercise prescription for frail elders is based on a pragmatic strategy that makes therapeutic exercise both sustainable and safe. Such a strategy incorporates motivational elements and knowledge of achievable benefits.

This article reviews why exercise should be considered for frail elders both as a general lifestyle enhancement and as a targeted disease state intervention and suggests strategies for family physicians to increase the exercise activities of their patients.

Inactivity increases with aging. Although about one half of the overall population reports doing some routine exercise activities, only 30% of those aged 65 and older report any regular exercise.[1] This inactivity is in stark contrast to current recommendations of 30 minutes of activity on most days of the week.[2] Exercise encouragement was an important element of Healthy People 2000,[3] which sought to enhance public health awareness. A target goal of the initiative was that 50% of primary care providers counsel all their patients on exercise. This issue is not only important for young elders, it also applies to frail elders for whom dramatic changes in outcome measures have resulted from exercise interventions even at advanced age. These benefits include the direct measures of enhanced muscle mass, cardiovascular endurance, and bone density changes, and such indirect measures as greater mobility and safety, which are critical to functional independence.[4]

In addition to its potential for improving general measures of health, exercise can be a specific therapeutic intervention for the many accumulated chronic illness of frail elders. These diseases include osteoarthritis, diabetes, peripheral vascular diseases, coronary heart disease and congestive heart failure, obesity, and depression.[4] Targeted exercise interventions for such conditions are commonly recommended for the affected younger patient populations and should also be considered for frail elderly patients.

Although there has been a shift from viewing exercise as the purview of fit athletes and those participating in organized sports toward its use in achieving improved health and well-being for everyone, family physicians will encounter several barriers to motivating frail elders to exercise. These patients' overall level of functioning has decreased as the result of one or more chronic conditions, and exercise is seldom considered either by the older adults themselves or by their health care providers.[5] Barriers to exercise for this patient population include a lack of knowledge about the documented benefits of exercise in older patient populations, attitudes about the appropriateness of physical exercise for older adults, and environmental factors that do not encourage exercise.[6] Understanding and responding to overcome those barriers are key to mobilizing these elderly patients.[7] Family physicians then have to assess their patients' capabilities for exercise and help develop corresponding exercise regimens that their patients will be motivated to undertake.

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