Physical Activity Intervention for Older Adults with Minimal Disabilities
Physical Activity Intervention for Older Adults with Minimal Disabilities
The number of elderly persons is projected to increase significantly over the next decade. In particular the number of persons entering the above 85 age bracket is expected to increase considerably. One of the key problems of an increasingly elderly population is the emergence of a population that is classified as having disuse syndrome or physical syndrome. The phenomena can be attributed to low physical activity. It is estimated that around 40% of elderly persons of above 70 years do not undertake any exercise (Fielding, 2007). Another 60% of individuals above the age of 75 years do not exercise. The impact of low physical activity coupled with poor diet has led to an upsurge in the number of elderly people with obesity as well as the number of people who are severely impaired (Elsawy & Higgins, 2010). The purpose of this paper is to develop a physical exercise intervention for older persons with minor disabilities so as to improve the quality of life, physical performance, daily physical activity and walking ability.
The proposed intervention will target elderly men and women receiving long term care in nursing facilities for a duration of 12 months. Eligible participants are those aged 75 years to 95 years. The intervention will target around 30 individuals who experience physical instability during their day to day activities. Only those individuals receiving level 1 care in a nursing facility will be eligible to participate in the intervention.
Description of the Proposed Program
Essentially, the intervention is multicomponent employing different exercise strategies to reduce frailty in the target population. The following table shows the exercises that are included in the multicomponent exercise program:
|First 1 to 3 months of the intervention||Chair sitting exercises||light||Light aerobic activity coupled with light stretching||Ball and a towel||Rhythmic movement of the trunk, arm and the legs according to the rhythm of the music.|
|Strength activity exercise involving both lower body and upper body exercises||Ball and a rubber band||Rhythmic movement of the foot, knees, elbow, trunk, hip and the shoulder. Upper body exercises include wrist and arm curls, raising side arms, chair dip, and doing seated rows using the resistance band. Lower body exercises include back leg raises, light exercises to straighten the legs and knee curls.|
|4th to 6 month of the intervention||Chair Sitting||Light intensity||Similar as above exercises||Same equipment||Same procedure as above although the duration will increase according to the needs and the ability of each individual.|
|Standing||Slightly moderate||Strength activities||Resistance rubber band and a chair||Stand, do half squats, tiptoe, extend ones hips and raise your knees.|
|Walking||Moderate||Aerobic activity s.||N/a||Around six minutes of moderate walking|
|7th to 12 moth of the intervention||Chair sitting||Slightly moderate||Light aerobic activity coupled with light stretching||Same as above||Similar to the intervention in the fourth to 6th month, however the intensity will increase depending on the progress of individual|
|Standing||Slightly moderate||Strength activities||Resistance rubber band and a chair||Stand, do half squats, tiptoe, extend one’s hips and raise one’sknees.|
|Balancing exercises that maybe combined with other exercises||moderate||Resistance band and a soft ball||One legged standing, sitting on the soft ball while trying to maintain a stable posture|
|Walking||moderate||Aerobic activity||none||The intensity of the aerobic activity will be increased depending on the progress of the patient. It will be prolonged for more than 6 minutes|
All exercises will start slowly with more emphasis being put on the safety of the participants. At the beginning of each session, the participants will perform slow gentle movement while still seated for around thirty minutes so as to enhance mobility of the trunk as well as the upper body and the lower body as indicated in the table above (Fielding, 2007). The intensity of the sessions is as recommended by the American College of Sports Medicine. During the first three months, all exercises will be performed using a chair. Exercises to increase flexibility will involve aerobic exercises which will be accompanied by music to enhance rhythm and will involve continuous movement of the upper body and the lower body (Chou, Hwang, & Wu, 2012)
On the other hand, strength exercises will involve the shoulder targeting the adductors, rotators and abductor muscles; the flexors and extensors on the elbow; the flexors, adductors, abductors and extensors of the hip; extensors and the flexors of the knee as well as the plantar flexors and the ankle dorsal muscles of the ankle. The intensity of the exercises will be increased depending on the progress of the participant. Self-supervised session will be similar to the expert supervised sessions (American College of Sports and Medicine, 2009).
The proposed intervention will involve an expert supervised and a self-supervised module. The expert supervised module will involve a weekly 80 minute session. Within the course of the intervention, there will be 55 expert supervised exercise sessions. The supervised sessions will involve different exercises which are geared at enhancing the strength, endurance, flexibility, physical performance as well as body awareness of the targeted individuals. Each session will be led by a certified expert. The participants will be divided into 6 subgroups each consisting of 5 participants each, with one staff member supervising each subgroup. As such, there will be a single exercise expert and 6 staff who will supervise each subgroup in a single session. Some of the equipment that will be used during the intervention includes a resistance band, a chair and a soft ball. Around 3 meters squared of space will be left for each participant.
All participants receiving level 1 care at the selected nursing facility will be chosen to participate in the intervention. However, only thirty participants will be selected. Other inclusion factors include, age of between 75 to 85 years, low levels of disability and experiences of instability to perform basic life tasks in their day to day activities. Prior to the recruitment, physical performance tests, health related quality of life, mass body index and walking ability will be assessed. Test for physical performance of the participants will encompass: a) test to determine muscle strength that will involve measuring grip strength as well as the lower limb strength: b) balancing ability of the participants measured using the time that the participants can stand using one leg while both eyes are open; c) flexibility test will involve assessing the ability of the individual to reach for items while seated; and lastly, endurance to aerobic exercises will be measured by the distance the person can walk within the 6 minutes of the exercise (Powell, Paluch, & Blair, 2011). Walking aptitude will be gauged by evaluating movement of ankle, thigh angle and walking speed. Health related quality of life will be assessed using two key scales, the Mini-Mental State Examination scale and the Instrumental Activities of Daily Living Scale.
As indicated earlier the purpose of the intervention is to increase the walking ability, health related quality of life measured as the ability to perform basic and non-strenuous everyday life activities, increased physical performance, endurance and flexibility. Additionally, it is projected that the age related deterioration among the participants will decrease significantly. Also, it is hoped that the participants will accrue physiological benefits that come with aerobic training such as increased bone density, decreased adipose tissue and lipid accumulation, increased cardiac function and improved stability and gait speed. The multicomponent exercise may also reduce the susceptibility of the participants to various chronic diseases (Elsawy & Higgins, 2010).
Evaluation of the Program
The success of the program will be evaluated by comparing the performance of the participants prior to participation and performance after participating in the intervention. Performance will be measured using physical performance tests, health related quality of life, mass body index and walking ability. Other additional measures that will be included in addition to those already discussed in the operational sections include assessing the strength of the lower limbs also known as “isometric knee extensor strength,” and level of physical activity measured using an accelerometer (Chou, Hwang, & Wu, 2012). An increase in physical activity after the program, increased quality of life and independence as well as a positive change in body mass index will signal the success of the program.
American College of Sports and Medicine. (2009). Exercise and Physical Activity for Older Adults. Washington, DC: American College of Sports and Medicine.
Chou, C. H., Hwang, C. L., & Wu, Y. T. (2012). Effect of Exercise on Physical Function, Daily Living Activities, and Quality of Life in the Frail Older Adults: A Meta-Analysis. Archives of Physical Medicine and Rehabilitation, 93(2), 237-244.
Elsawy, B., & Higgins, K. (2010). Physical Activity in Older Adults. American Family Physician, 81(1), 55-59.
Fielding, R. (2007). Physical Activity and Older Adults. In C. Suitor, & V. Kraak (Eds.), Adequacy of Evidence for Physical Activity Guidelines Development: Workshop Summary (pp. 111-123). National Academy of Sciences.
Powell, K. E., Paluch, A. E., & Blair, S. N. (2011). Physical Activity for Health: What Kind? How Much? How Intense? On Top of What? Public Health, 32(1), 349.