Exercise for Frail Elders (2003)
Authors: Elizabeth Best-Martini & Kim A. Botenhagen-Digenova
Pages: 228

Publisher: Human Kinetics Champaign, IL

Reviewed by: Karen Croteau, Ed.D. and Nancy E. Richeson, Ph.D., CTRS

The fastest growing population segment in the United States consists of persons who are 85 years of age and older (i.e., oldest – old), with most of the growth expected to occur between 2010 and 2030 (Buettner, 2000). Levels of physical activity decline with age and physical inactivity rates among our oldest citizens are alarmingly high; 33% of men and 50% of women over the age of 75 report no leisure-time activity (USDHHS, 1996). Physical inactivity, coupled with the aging of America, means many older adults are living with numerous complex and chronic health conditions, such as arthritis, diabetes, osteoporosis, and dementia (Buettner, 2000). These conditions often lead to a decrease in functional abilities causing frailty in older adults. The importance of maintaining and improving functional ability and independence is paramount for this population group and is a quality of life issue. Therefore, there is a need to provide programs for the frail older adult that focuses on functional ability to maintain independence and enhance the quality of their lives.

Exercise for Frail Elders provides a useful training manual for practitioners interested in enhancing the lives of the frail elderly and the older adult with special needs through the development of exercise programs. Part I addresses the exercise program planning process, including knowing your participants, developing a safe, effective and motivational exercise program, and leadership tips to enhance safety, effectiveness and motivation. Part II addresses exercise program implementation, with chapters on specific exercise session components and another tying each component together.

Professionals leading fitness programs for older adults need to have knowledge of the aging process and the various medical issues that older adults may have. It’s also important to realize that there is significant variation in physiologic status and in the physiological response to exercise. Therefore, individualization is a key component of any exercise program. Chapter 1 does an excellent job of addressing these issues. The user-friendly tables on common medical disorders provide the reader with specific characteristics of each disorder, exercise recommendations, and specific safety tips to note with each disorder.

Chapter 2 provides detailed information on developing an exercise program that is safe, effective and motivational. To minimize potential risk associated with exercise training, practitioners need to know the participant’s health status and their ability to participate in an exercise program. Various medical forms in the appendices provides the practitioner with convenient, ready-to-use forms, including the Physical Activity Readiness Questionnaire (PAR-Q), a medical history and risk factor questionnaire, an informed consent form and a sample medical release form. Various safety checklists are also included throughout the chapter. American College of Sports Medicine guidelines have been followed when addressing recommended frequency, intensity, duration and mode for the exercise components of aerobic fitness, resistance training and stretching. With exercise program dropout rates at 50% or higher for older adults, keeping participants motivated to continue is important. This chapter addresses the motivation topic adequately with an overview of both the physical and psychological benefits of exercise and practical discussion of setting specific and attainable goals.

The exercise leader plays a crucial role in providing a safe, effective and motivational exercise experience. Chapter 3 discusses the importance of creating a welcoming environment, promoting social support among participants, and fostering a sense of community. Also included are tips for opening and closing the class, as well as various instructional techniques for participants, including those with communication, cognitive and sensory losses.

In chapters 4 through 7, specific exercise class components are addressed: the warm-up, the aerobic segment, resistance training exercises and cool-down exercises, including stretching. General safety precautions checklists are included in each chapter, as are specific safety precautions for adults with special needs. Each chapter also addresses exercise selection, sequence, frequency, intensity, duration, variations and progression. Most useful to the practitioner are the illustrated exercises that are provided at the end of each chapter, including start/finish position and movement phase. Finally, chapter 8 integrates information provided in the previous chapters so that a complete program may be put together, scheduled appropriately and modified as needed.

There are two noticeable exclusions from the manual. The book nicely addresses the adult with special needs; the title could mention that. Also, while information on evaluation/outcome measures could amount to an entire book, a brief overview and/or reference list could have been provided.

In conclusion, this manual is a useful resource for students and practitioners interested in exercise for frail older adults and adults with special needs, including recreational therapists and exercise specialists. Step-by-step guidance in the planning and implementation of a safe, effective and motivational exercise program is provided. Useful forms, educational handouts, and exercise illustrations abound.

References:

Buettner, L. (2000). Gerontological recreation therapy: Examining the trends and making a forecast. Annual in Therapeutic Recreation, (Volume 9), 35-46.

U.S. Department of Health and Human Services. Physical activity and health: A report of the surgeon general. Washington D.C.: U.S. Government Printing Office, 1996.