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

Disclosures

J Am Board Fam Med. 2002;15(3) 

In This Article

Prescribing Exercise for Frail Elders

The traditional elements of an exercise prescription can be applied to frail elders: mode of exercise, intensity of exercise, and frequency of exercise.[15] A fourth element -- progression -- is often included but is less important in those for whom the primary goal is not aerobic fitness. Likewise, exercise intensity might focus on establishing an upper level of endurance rather than a specific threshold.

The variety of exercise modes appropriate for frail elders depends on preserved functional skills, available resources, and perhaps most importantly, those forms of exercise that offer the most enjoyment and can be sustained. Pain-free range of motion is key to all three factors. If whole body movement is not possible initially, the patient should start with isolated upper and lower extremity movements from a stationary position. There is no compelling evidence that endurance exercises (eg, aerobic activities) are better than resistance training (eg, weights) for elderly patients, so a combination of approaches can be appropriate.

There are documented benefits from having the mode of exercise incorporate movement for balance and flexibility, both of which are major factors in fall prevention.[23] Once aerobic movement is established and becomes routine, increasing the intensity by adding various forms of resistance training can increase the strength of the involved muscle groups. Resistance training can include elastic bands of various tensile strengths, as well as the more typical metal dumbbells or plastic-formed weights filled with sand or water. Using weights in the form of hand-held drinking bottles filled with water can provide a motivation for continued hydration, which is important with outdoors exercise.

The initial frequency of an exercise routine for frail elders can be as short as 6 minutes, repeated throughout day. Whereas younger and more mobile patients might consider exercise as a single defined event, shorter and more frequent exercise periods might be more feasible for frail elders, whose schedules often allow more flexibility. Daily, specific exercise periods promote optimum sustainability, although documented benefits in frail elders have resulted from as little as 30 cumulative minutes of exercise a week. Exercise as a group activity encourages both socialization and peer reinforcement.[58]

When family physicians discuss the various modes of exercise for their frail elderly patient, it is important to address explicitly the pleasurable aspects of an exercise to help make it sustainable. Pleasure can be derived from the environment in which the exercise will be conducted (eg, access to music, companionship, etc). Exercise can be integrated into a daily routine by proactively eliminating barriers to activities of daily living (eg, having a toilet available, creating a safe walking environment). Further examples of exercise modes appear in Table 2 and in the discussion of specific disease states and functional limitations.

Table 3 provides an outline of suggested exercise prescriptions adapted for a frail elderly population. Although a written prescription of physician recommendations might reinforce adherence, it alone is unlikely to effect change without the accompanying personal involvement of the patient's own caregivers and other health care providers. Table 4 provides some guidance to support prescribing exercise.

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