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


J Am Board Fam Med. 2002;15(3) 

In This Article

Appropriateness of Exercise for Frail Elders

Health concerns were the most common barrier to regular exercise in studies examining the reasons older adults do not engage in more physical activities.[40,41] This finding underscores the importance of family physicians' promoting appropriate exercise as beneficial rather than as potentially harmful. This personal interaction between physician and patient is distinct from public health concerns for greater overall exercise participation of the population.

The older frail population is predominately female. For older frail female patients, another barrier about exercise is the attitude that women do not exercise.[42] Expectations for physical exertion for women were in transition during the mid 20th century, and the considerable gap between organized sports available to men compared with women is only now being narrowed. Widespread growth in individual fitness activities for women, such as organized aerobic classes, occurred during the late 1960s and early 1970s.[43] As studies have shown, muscle strength in women is related to physical activity in earlier life, and the greater levels of physical fitness and routine exercise enjoyed currently by aging cohorts of women will be helpful in the future.[44]

An ageist attitude that frail elders either cannot be trained or would not want to exercise is not justified. The documented gains in both strength and endurance during short-term intervention trials have repeatedly proved that those who are in their 70s and 80s can achieve benefits from physical training. In a controlled study of home-based strengthening exercises, positive outcome measures included both the expected enhanced muscular strength and increased confidence in movement.[45] Establishing a positive attitude toward physical activity for older frail elders might help then derive ultimate benefit from exercise. Most studies examining how accurately health care providers predict their frail elders' values and attitudes toward health have shown dismal results; physicians tend to underestimate their patients' sense of self-worth and preserved life meaning.[46,47]

Another important, often-cited barrier is the limited success health care providers anticipate when promoting lifestyle changes such as exercise. This expectation is partly because health promotion activities have a delayed impact in the elderly. A Finnish study examining exercise motivations for community-dwelling seniors found that health promotion was the single, most often cited reason for continuing participation in physical exercise 8 years later.[48] Even in the shorter term, physicians can effect positive change in their patient's level of physical activity. In a controlled trial, 225 sedentary adults from 17 physicians' office practices responded to a brief (3- to 5-minute) physician-delivered exercise intervention, combined with a follow-up telephone call reinforcing the exercise message, by significantly increasing their rates of walking.[49] Attitudinal research among elders outside health care settings has found that older adults see physical fitness as a way of achieving their desired functional independence.[50]

Physicians can support patients who are starting exercise efforts, and they can apply the stages of change model described below to counsel other patients who are not yet considering exercise. Such a strategy might be especially effective in overcoming attitudinal barriers when personalized exercise advocated by health professionals is supported by and consistent with the broader public health messages promoting exercise. Even the increased mobility achieved by institutionalized frail elders who have received simple exercise interventions can enhance their quality of life.[51]


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.