|Getting older adults to exercise requires consistency and a plan.|
Reposted with permission. Originally posted at GeriatricsForCaregivers.net
If you’ve been wondering whether it’s worth your while to encourage an older person to start exercising — or what might happen if they do stick with exercise — then I have some exciting news to share.
This week, the top-notch journal JAMA published the results of a fantastic research project: a study in which 1635 sedentary older adults (aged 70-89) were assigned to get either a structured exercise program, or a program of “successful aging” health education. The researchers called it the Lifestyle Interventions and Independence for Elders (LIFE) study.
Specifically, the researchers found that 30% of the exercisers experienced a period of major disability, compared to 35.5% of the seniors enrolled in the healthy aging education program.
This is a very encouraging finding! That said, it’s also a bit sobering to realize that even with exercise, almost 1 in 3 older adults experienced a period of limited mobility, of which half lasted 6 months or more.
In this post, I’ll share some more details on this study, because the results provide a wonderful wealth of information that can be helpful to older adults, family caregivers, and even geriatricians such as myself.
Who were the study volunteers? Whenever you read about a research study, it’s important to understand how the study volunteers compare to the older adults in *your* life. One of the many things I love about this study is that they purposefully enrolled older adults who were sedentary, and physically vulnerable. To identify vulnerable adults, the researchers looked for volunteers who could walk a quarter of a mile, but showed signs of physical weakness on a test known as the Short Physical Performance Battery.
Specific criteria for the study volunteers included:
- Age 70-89 years
- Sedentary at the start of the study, meaning less than 20 min/wk of regular exercise in the past month
- Evidence of high risk for mobility disability, based on a score of 9 or less (out of 12) on the Short Physical Performance Battery. Results on this test have previously been shown to predict future disability.
- Able to walk 400 m in less than 15 minutes, without a walker or the help of another person.
- No major cognitive impairment (i.e. no Alzheimer’s or other dementia)
Ultimately, of the 1635 older adults who completed the study, about two thirds were women. I found the list of chronic medical conditions interesting: 70% had hypertension, about 25% had diabetes, and 15% had chronic obstructive pulmonary disease.
What was the exercise intervention? The older adults assigned to exercise received a very structured and organized program of physical activity. People were ramped up toward a goal of 150 minutes/wk of walking, along with additional activities to improve strength, balance, and flexibility.
- In-person activity sessions at the study center twice a week, plus home-based activity 3-4x/week.
- Daily walking at moderate intensity, goal of 30 minutes/day
- Lower extremity strength training using ankle weights (2 sets of 10 repetitions), goal 10 minutes/day
- Balance training and large muscle flexibility exercises, goal 10 minutes/day of activity
What was the health education intervention? Half of the study volunteers participated in a health education program focused on “successful aging,” rather than the exercise program. For the first 6 months, this involved weekly workshops on various topics related to health and aging, followed by monthly sessions thereafter.
Per the study report, these topics included “ how to effectively negotiate the health care system, how to travel safely, preventive services and screenings recommended at different ages, where to go for reliable health information, nutrition, etc.” The health education sessions also included 5-10 minutes of gentle exercises.
An informational brochure on physical activity was provided at the first successful aging session, but otherwise physical activity topics weren’t included in the workshops. However, the LIFE researchers noticed that many study volunteers in the health education group began exercising during the study.
Overall, the researchers noted that the physical activity group maintained an average of 218 min/week in walking and weight training activities, whereas the health education group maintained an average of 115 min/week.
What were the results? The main outcome of interest was whether study participants developed “major mobility disability,” which the researchers defined as being unable to walk 400 meters (a quarter of a mile) unassisted, within 15 minutes. Here’s what the researchers observed over the 2.5 year follow-up period:
- Major mobility disability happened to 30% of the exercisers, versus 35.5% of the healthy aging education group.
- Persistent major mobility disability — meaning disability lasting at least 6 months — happened to 14.7% of the execisers and 19.8% of the education group
- “Serious adverse events” — usually a hospitalization — happened to 49.4% of the exercisers, and 45.7% of the health education group (a difference that was not statistically significant). The reasons for hospitalization were quite varied, and often seemed unrelated to the exercise study.
- Among the exercisers, almost 60% had to go on medical leave at least once. Half of the medical leaves lasted longer than 49 days.
- 5.1% of the exercisers died, compared to 5.9% in the health education group. (This difference was not statistically significant.)
The New York Times coverage of this study was titled “To Age Well, Walk.” It’s a good article and I agree with the media’s general conclusion, which is that a walking program is healthy and is doable, even in people who are older and start off with physical weaknesses.
That said, I think this study highlights many additional issues that family caregivers should keep in mind:
- Getting an older person to exercise requires consistency and a plan. This study didn’t test how a structured program compares to a far more common scenario, which is that either a doctor, or an adult child (or both), tell a sedentary older adult to walk more.
You can certainly ask your loved one’s doctor for a recommendation on where to find an exercise program. But in my experience, most docs will not know where to send you, unless their own healthcare system has activity program for seniors. So you might have to sleuth around a bit to find something suitable.
Once you have a plan for exercise, try to find a way to track the daily exercise, via a pedometer or other device. (Those fancy new fitness trackers might come in handy for this purpose.) Most people like being able to see their progress, although they may not bother to track it unless the tracking is easy.
- Physically vulnerable older adults are fairly likely to have a period of reduced mobility. I always tell people to hope for the best, but plan for the likely. Even with exercise, this study found that almost 1 in 3 seniors had a period of reduced walking ability. So I would recommend that all older adults and families consider what they’d do if this happened to them. Can the older person’s home be managed with a walker?
- Hospitalizations are common. Almost half of the older adults in this study experienced at least one hospital stay, over 2.5 years. So if you are caring for someone similar to these study participants, it’s a good idea to have some planning in place, in case you have to help your older loved one through an emergency or a hospital stay. What does this type of planning look like? Well we could do a whole course on that topic, but at a minimum I would say:
- Make sure you have considered who will be involved in any surrogate decision-making; it’s very common for older adults to lose the ability to make decisions during a hospitalization.
- Be prepared to tell the hospital staff what the older person’s wishes are regarding resuscitation and ICU care. The ideal of course is to have completed a good process of advance care planning, but at a minimum you should be ready to answer the hospital’s questions regarding CPR and resuscitation.
- Plan to have a family member or advocate in the hospital with your older loved one, as much as possible.
- Learn to identify and minimize common hospital problems in older adults, such as delirium, falls, risky sedatives, and restraints.
- Educate yourself about the risks of hospitalization in general. Some good resources (for people of all ages) include the tip sheets on EmpoweredPatientCoalition.org, as well as Elizabeth Bailey’s book on Hospital Checklists.
|Leslie Kernisa, MD MPH|
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