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


J Am Board Fam Med. 2002;15(3) 

In This Article

Exercise Environments for Frail Elders

Limited equipment and exercise space are often-cited reasons for not exercising by some patients, both old and young. Other common barriers include competing time demands from other activities (which frequently can involve caring for another, frailer adult), lack of a safe place to exercise, self-consciousness about physical appearance, fear of injury, and the lack of a partner. Many issues cited by older adults were classified as external factors in a British study examining lifestyle changes.[52] Participants at the start of the study were asked to list perceived barriers that prevented them from adopting an exercise routine. These barriers were then classified as either internal factors, issues relating to their own feelings or attitudes, or external barriers such as those cited above. In the follow-up survey, the older adults who made the greatest changes in incorporating routine exercise into their lives were those who had reported external factors as barriers. The implication from this and other studies is that it is easier for older adults to overcome environmental barriers than to overcome will power barriers to exercise.[53]

When responding to environmental barriers raised by patients, it is important that physicians advocate adapting the exercise to the setting and the time of day the older adult wants to exercise. There will be frail elders who have the requisite mobility, financial resources, and motivation to go to an exercise facility, and gyms and athletic clubs are required by law to accommodate the physical limitations of their membership. For most frail elders, however, exercise needs to take place in the home, senior center, place of worship, or institutional living setting. The latter includes both traditional skilled nursing homes and assisted living or other congregate housing. Many assisted and communal living facilities have dedicated common spaces for exercise activities and have made great efforts to integrate exercise into their residents' daily routine. Physician advocacy can support these efforts and promote accommodation of a variety of exercises. A key element of organized exercise classes is the opportunity for socialization, which is considered to be important for older patients to sustain exercise participation.[54]


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