In 2015, Helping Hand aged care centres implemented an innovative, 12-week exercise program. They wanted to see if it could improve cognitive and functional abilities in older adults with significant memory loss or dementia.
The Exercise Physiology in Aged Care Project, led by exercise physiologist Alison Penington, prescribes individually tailored activities to match the skill levels and personal preferences of residents.
Gaynor Parfitt, associate professor in exercise and sports psychology at the University of South Australia, has been evaluating the program and says, “we’ve really been very positively blown away by the impact that the exercise has had.”
Listening to staff interviews, Parfitt said one worker was laughing as she described finding a “stand-assist” resident – who could not stand or walk unassisted – standing up and walking in her room. “She said afterwards, it’s that sort of OMG, I never expected to see that happen.”
Initially, some were sceptical about doing exercise with this population, who are 86 years old on average and “severely declined”. But Parfitt says, “overwhelmingly it’s dispelled the idea that these people are just on one downward trajectory”.
Staff reported improvements in residents’ behaviour, socialisation, communication and alertness. Even language started coming back. Residents became more communicative and started using fuller sentences.
They started socialising and smiling more, as they did some exercises together like passing a medicine ball around.
Family members described being able to hold conversations, and the exercises gave them a point of conversation – or even something they could engage in with them. One man who visits his wife, for instance, started doing the exercises as well.
Because the activities improved their mobility, dressing residents became easier, and they became more independent in activities of daily living, like brushing their hair or teeth.
The exercise physiologists who ran the program prescribe physical activities that individuals find fun and can achieve within their own limits.
“One of the reasons that people tend to stop being active,” Parfitt says, “is because of the fear of falling.” It’s important that they feel safe, and individually targeted activities can overcome this limitation to being active.
Moving beyond aged care, Helping Hand is developing a walking trails program for community dwelling adults that can be adapted to different skill levels; for instance with different trail lengths and difficulties and places for people to sit down and catch their breath.
The key message is to get up and move a bit more than what people are doing.
And the capability of patients who are thought to be severely incapacitated is more than staff believed was possible. “So it’s now actually challenging them to spend more time encouraging them to walk,” Parfitt reports.
This environmental transformation reveals the ripple effects of the program. “It’s changed how people perceived how life can be,” says Parfitt, “and I think that’s quite marked.”
Jane is 52 years old. She suffers chronic neck pain and impaired mobility, resulting from an occupational violence attack. But she needs to continue her activities in the domestic domain and understands the importance of staying active despite the pain.
This is not easy. Although Jane’s house was designed for her ageing parents, the surrounding footpaths are dangerous, and she has already tripped a couple of times. Jane is also a quiet person who enjoys intimate social interactions in the comfort of her own home.
John is a socially and mentally active 44-year old who admits to mildly excessive alcohol consumption and periods of depression. He stays physically active to keep fit and get around.
With an aversion to driving, cycling is his preferred mode of transport. He hopes his physical health will allow him to continue. John lives close to a natural enjoyment which facilitates outdoor physical activities.
As Jane and John age, mobility will become an increasingly important theme in their lives. Their independence will count on it.
A comprehensive survey of long-term studies covering 12.6 million older adults found that mobility improved quality of life and body function capacity and reduced medical expenditure.
Grocery shopping, housework, gardening, visiting friends and family, personal hygiene, going to appointments are things we take for granted. But impaired mobility and chronic conditions in aging can have a significant impact on these daily activities.
“Life space”, the space within which people move in their daily lives, impacts mobility – people who have restricted life space tend to be less mobile.
Walking is an activity that can easily be included in a daily routine as a form of transport to increase life space, thereby enhancing mobility and health.
John and Jane both identify Tai Chi as an activity that they could enjoy in 25 years. It is low impact, and as a bonus includes meditation and breathing for mental relaxation.
Global public health policies increasingly target healthy aging. To this end, a lifestyle index was developed to identify key factors related to aging well.
Core components of the index are vigorous and moderate physical activity, consuming fruit and vegetables, regular meals, plenty of fluids, and psychosocial factors – social engagement, networking and life satisfaction.
There is an interactive element to these. For instance, eating well reduces risk of overweight and chronic disease, both of which restrict mobility. Being socially active, like John, will enhance opportunities to be active.
In turn, higher mobility will enable greater engagement in social networks and activities.
Active aging policies could support people like Jane to be mobile by improving sidewalks and providing walking trails.
More broadly, policies across multiple sectors will empower older adults to remain independent, active community members – characteristic of a healthy, humane society.