If you were to guess which demographic in society disproportionately doesn’t meet physical activity guideline recommendations, would you guess it’s adults over the age of 60? You probably would, and although that’s a little ageist, it’s not wrong. The Statistics Canada census reported that in 2015 only 13% of older adults were meeting physical activity guidelines, while the 2019 Participaction report card reported that 15% of adults over 65 met guideline recommendations (1). Objectively this is pretty bad and concerning. We know that physical inactivity is associated with a higher risk for falls, fractures, cognitive decline, and an inability to perform activities of daily living (2,3). Without question there are many reasons why the number of older adults meeting activity guidelines is so low, including social determinants of health like the built environment, financial resources, geographical limitations, and systemic inequality. However, I’m going to talk about what things look like from a patient facing health care professions perspective because, well, that’s what we do here.
This week a secondary analysis came out from De Luca et al (2021) that showed on average, chiropractors recommended exercise to adults over 65 seeking care in 29 per 100 patient encounters (4). Let me reiterate one more point, the word “recommended”. This unfortunately doesn’t mean exercise was done, or prescribed, and instead leaves us wondering what exactly was done. Now, I am both an advocate for walking, and the idea of movement snacks in general (I wrote another article here about ways small bouts of exercise are awesome), so I do believe that we can take a bunch of approaches towards incorporating exercise. I also firmly believe that when working with older adults, providing a movement-based approach checks off a lot of boxes. An important caveat here is that I’m not advising against hands on care, just that there are reasons that including some physical movement can be important for older adults. Multimorbidity is a BIG topic that I won’t talk about here but know that this is becoming fairly prevalent in our society. (For an example of a condition that is beginning to garner more attention, I gave a small talk on sarcopenia, and exercise programs for older adults. You can find that here).
So why isn’t exercise more frequently used, or why was it not more frequently used in this recent study? I don’t have the answer for that unfortunately. If we take a look at physiotherapy data, only 38-67% of physiotherapists felt confident that they had the skills to prescribe aerobic exercise and resistance training(5). If physiotherapists, who undoubtably receive more exercise training than chiropractors, do not feel prepared to prescribe exercise, broader collective issues may exist. In my small effort to moderate this issue, I’ve outlined three of my favourite exercise programs for older adults, and the papers you can find them from. For the 52 people who will read this, I hope this is helpful.
The ViviFrail program is awesome. I don’t really have another way of describing it. It’s a large international collaborative project designed for the prevention of falls and frailty, and is applicable in hospitals, in gyms, clinics, or at home. It’s been shown to help reverse frailty status post covid confinement(6), and has shown to greatly reduce falls risk, as well as improve strength and functional testing(7). ViviFrail is unique in that it has 4 sets of exercise prescriptions based on how the older adult(s) you’re working with scored on baseline testing. This allows for flexible exercise progressions to meet the individual where they’re at. The core tenets of ViViFrail are Strength, Balance, Cardiovascular, and Flexibility. I’ve provided images of the “A Level” (the baseline program) as well as the “D level” (most advanced) below. People can even move well beyond level D. Get some weights, or some bands, and let’s get those positive health benefits rolling.
2) The Keeping Strong 6 Week Beginner Strength Program
I tweeted (@BCsiernik) about this program earlier this week because of how nicely laid out it is, how simple it is, and the low time and equipment required. The website is fantastic, and includes details about the specifics of the program, as well as a collection of YouTube videos for each exercise. The program can benefit from having weights, but can also be done with items you have around the house. Without further ado, here is what the 2x per week program looks like.
For those unaware, the NEMEX-T-JR program is the foundation for the GLA:D Program. Now the research on the effects of GLA:D for knee and hip osteoarthritis are fairly extensive, so I won’t cite anything here directly because there is a lot. It turns out exercise and education provided in a social setting is enjoyable and helpful. Now, the NEMEX-T-JR program is lower body focused, and as such doesn’t include any ideas for upper body training. Which is why below you can find a bonus paper!
Bonus: The Minimal Dose Approach for Older Adults(8)
This paper is a really simple review of the minimal dose approach. The authors break things down a lot, but what they come down to is that if we had to choose 3 exercises specifically for older adults beginning with resistance training, we should choose:
1) Chest Press
2) Leg Press
3) Seated Row
Suggested supplemental exercises include adding in overhead presses, pull-downs, knee extensions, and leg curls. I would also add that you should include some balance work too, as it’s recommended in the physical activity guidelines to include balance training twice per week.
To wrap things up here, I’ve included the Canadian physical activity guidelines as a reminder. Remember, a little exercise encouragement and incorporation can go a long way when you’re working with older adults. Hopefully these can provide some ideas to get you started.
Canadian Physical Activity Guidelines
1. Statistics Canada. Accelerometer-measured moderate-to-vigorous physical activity of Canadian adults, 2007 to 2017. [cited 2021 May 2]; Available from: https://www150.statcan.gc.ca/n1/pub/82-003-x/2019008/article/00001-eng.htm
2. Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. The Lancet. 2012 Jul 21;380(9838):294–305.
3. Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016 Oct 8;388(10053):1659–724.
4. de Luca K, Hogg-Johnson S, Funabashi M, Mior S, French SD. The profile of older adults seeking chiropractic care: a secondary analysis. BMC Geriatr. 2021 Apr 23;21(1):271.
5. Barton CJ, King MG, Dascombe B, Taylor NF, de Oliveira Silva D, Holden S, et al. Many physiotherapists lack preparedness to prescribe physical activity and exercise to people with musculoskeletal pain: A multi-national survey. Phys Ther Sport. 2021 May 1;49:98–105.
6. Courel-Ibáñez J, Pallarés JG, García-Conesa S, Buendía-Romero Á, Martínez-Cava A, Izquierdo M. Supervised Exercise (Vivifrail) Protects Institutionalized Older Adults Against Severe Functional Decline After 14 Weeks of COVID Confinement. J Am Med Dir Assoc. 2021 Jan;22(1):217-219.e2.
7. Romero-García M, López-Rodríguez G, Henao-Morán S, González-Unzaga M, Galván M. Effect of a Multicomponent Exercise Program (VIVIFRAIL) on Functional Capacity in Elderly Ambulatory: A Non-Randomized Clinical Trial in Mexican Women with Dynapenia. J Nutr Health Aging. 2021 Feb 1;25(2):148–54.
8. Fisher JP, Steele J, Gentil P, Giessing J, Westcott WL. A minimal dose approach to resistance training for the older adult; the prophylactic for aging. Exp Gerontol. 2017 Dec 1;99:80–6.