An FP’s guide to exercise counseling for older adults
At what intensity and frequency should older patients exercise? This review offers guidance and resources to help you get your patients moving.
PRACTICE RECOMMENDATIONS
› Encourage older adults to engage in at least 150 minutes of moderate-intensity aerobic physical activity throughout the week, OR at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week, OR an equivalent combination of moderate- and vigorous-intensity activity. A
› Recommend older adults perform muscle-strengthening activities involving major muscle groups on 2 or more days per week. A
› Encourage older adults to be as physically active as possible, even when their health conditions and abilities prevent them from reaching their minimum levels of physical activity. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Time. The 2018 Physical Activity Guidelines for Americans recommend a specific duration of physical activity throughout the week; however, as with frequency, it is important to remember that duration of exercise is individualized (TABLE 22). Older adults should be as physically active as their abilities and comorbidities allow, and in the setting of frailty, numerous comorbidities, and/or a sedentary lifestyle, it is reasonable to initiate exercise recommendations with shorter durations.
Type of exercise. As noted in the 2018 Physical Activity Guidelines for Americans, recommendations for older adults include multiple types of exercise. In addition to these general exercise recommendations, exercise prescriptions can be individualized to target specific comorbidities (TABLE 22). Weight-bearing, bone-strengthening exercises can benefit patients with disorders of low bone density and possibly those with osteoarthritis.3,23 Patients at increased risk for falls should focus on balance-training options that strengthen the muscles of the back, abdomen, and legs, such as tai chi.3,23 Patients with cardiovascular risk can benefit from moderate- to high-intensity aerobic exercise (although exercise should be performed below anginal threshold in patients with known cardiovascular disease). Patients with type 2 diabetes achieve improved glycemic control when engaging in combined moderate-intensity aerobic exercise and resistance training.7,23
Referral to a physical therapist or sport and exercise medicine specialist can always be considered, particularly for patients with significant neurologic disorders, disability secondary to traumatic injury, or health conditions.3
An improved quality of life. Incorporating physical activity into older adults’ lives can enhance their quality of life. Family physicians are well positioned to counsel older adults on the importance and benefits of exercise and to help them overcome the barriers or resistance to undertaking a change in behavior. Guidelines, recommendations, patient history, and resources provide the support needed to prescribe individualized exercise plans for this distinct population.
CORRESPONDENCE
Scott T. Larson, MD, 200 Hawkins Drive, Iowa City, IA, 52242; scott-larson@uiowa.edu
