Prescribing Exercise for Frail Elders

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

J Am Board Fam Med. 2002;15(3)

Methods

A detailed literature search of multiple databases was conducted using key words such as "exercise benefits," "exercise motivation," "lifestyle modification," and "frail elderly." The results were summarized, and then reviewed for clinical relevancy and practical implementation with a group of practicing clinicians caring for frail older adults in multiple settings.

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Cite this: Prescribing Exercise for Frail Elders - Medscape - May 01, 2002.

Table 1. Common Medical Limitations for Exercise by Frail Elders
Limitation	Recommended Management
Heart disease	Electronic heart rate monitoring (by self or supervisor)
	Clearly established initial goals (eg, mobility over fitness)
	Availability of nitrates
Chronic respiratory condition	Oximetry monitoring
Chronic respiratory condition	Adequate oxygen tubing length, comfortable mask or cannula
Cognitive impairment	Supervision of mobility
Cognitive impairment	Limited concurrent sensory input during exercise
Diabetes	Consistent use of insulin injection sites
	Pre- and post-exercise home glucose monitoring
	Availability of hypoglycemic corrective measures
Osteoarthritis	Strength training along functional planes of motion, (avoiding rotational stresses)
	Reduce weight-bearing loads
	Pre- and post-exercise hot or cold packs to affected joints
Sensory impairment	Consistent use of adaptive devices before start of exercise
	Center movement around a fixed reference or support point
	Low-frequency musical impulses for rhythmic exercise

Table 2. Linking Potential Exercise Modes with Relevant Functional Limitations for Frail Elders
Functional Limitation	Precautions and Exercise Modes
Basic activities of daily living
Mobility and transferring
Walker use	Chair arms available for seated resistance training
	Ensuring secure match between walker tips and floor surface for walking
Wheelchair use	Truncal and upper body motion and resistance training
Dressing and bathing
Shoulder range of motion restricted	Pre-exercise local heat and active stretching
Truncal motion limited	Seated, non-weight-bearing rotational motion
Continence and toileting	Prompted voiding before and after exercise
	Bladder-strengthening exercise (eg, Kegel exercises)
	Vaginal weights for enhanced pubococcygeal muscle tone
	Prompted fluids during and after exercise session
Instrumental activities of daily living
Communication	Proactive postexercise interview and assessment
Medication management	Time dosing of selected agents (eg, diuretic medications)
Transportation	In-home mobility and strengthening options
Shopping and housekeeping	Simple footwear and loose clothing requirements

Table 3. Components of an Exercise Prescription for Frail Elders
Exercise Component	Examples
Intent: this exercise program will help my...	Circulation problems, heart condition, breathing condition, diabetic glucose control, arthritis, etc
Exercise type (mode): I agree to start this type of exercise	Strengthening arm and leg muscles
	Walking
	Balance practices
	Stretching neck and back muscles, etc
Dose (endurance): I agree to try this amount of exercise	10 minutes each session, I breath comfortably from my mouth, my heart rate reaches about ___ beats per minute, my oxygen saturation level is at ___
Frequency: I agree to try to do this exercise this often	Every morning at breakfast, every time my aide comes, before my nightly dessert, before my bath, during my favorite radio or TV show, etc

Table 4. Ways to Encourage and Reinforce Exercise for Frail Elderly Patients
Recommendation	Example
Make it fun	Add music and movement to exercise environment
Make it fun	Link exercise to other pleasurable or positive events, eg, favorite radio or television show, pre-bath activity
Make it social	Promote exercise in groups whenever possible; if not possible, create virtual groups using videotapes
Make it social	Seek out an exercise partner for mutual support and encouragement
Make it sustainable	Advocate for affordable exercise modes
Make it sustainable	Advocate for brief, dedicated time period(s) for exercise daily
Make it a priority	Explicitly validate exercise as a prescribed health intervention
Make it a priority	Enlist reinforcement from other health care providers and from family or caregivers

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