From the Geriatric Education and Research in Aging Sciences (GERAS) Centre for Aging Research, McMaster University, Hamilton, ON.
- Objective. To summarize the literature on improving opportunities for physical activity for residents in long-term care (LTC).
- Method. Narrative review of the literature.
- Results. Residents in LTC spend much of their time in sedentary activities such as sitting or lying in bed. Physical activity is important to help decrease the negative effects of sedentary time, such as poor mood and increased risk of death, and to improve physical function. This review identifies several strategies for promoting physical activity for LTC residents: incorporating simple strategies into daily activities, participating in group activities (eg, exercise, dance, or music therapy), using motivational strategies to encourage staff to promote activity, leveraging the physical environment, reducing physical and chemical restraints, and using innovative solutions such as robots or interactive technology.
- Conclusion. While the quality of evidence to date is limited, preliminary work suggests that the strategies identified in this article could be included as part of a multifactorial approach to increasing physical activity in LTC.
Keywords: long-term care; nursing homes; physical activity; sedentary; mobility.
The United Nations estimates that between 2013 and 2050 the population aged 60 years or older will double.1 Furthermore, the fastest growth rate will be seen in older adults over the age of 80 years.1 With this demographic shift, a growing number of older adults will require supportive housing, such as long-term care (LTC). Indeed, it is projected that the number of older adults requiring LTC will double by 2036.2
Residents in LTC are often medically complex and experience multimorbidity, cognitive impairment, and functional decline,3 making it difficult for them to engage in physical activity. LTC residents spend approximately 75% of their waking time in sedentary activities (eg, sitting, lying down, watching TV), which amounts to more than 12 hours per day.4-6 Residents with cognitive impairment are even more sedentary, spending as little as 1 minute per day in moderate physical activity and approximately 87% of their time in sedentary activities.7 Additionally, a high prevalence of use of psychotropic drugs and physical restraints contributes to high levels of physical inactivity for residents in LTC.8 Increased time spent in sedentary activities has been associated with adverse health outcomes, such as incidence of cardiovascular disease and type 2 diabetes, and mortality.9-11 Moreover, bed and chair rest are associated with muscle disuse, which can lead to functional impairment.12,13
Given the large amount of time LTC residents spend in sedentary activities and the negative consequences this has on their health, it is essential to find opportunities to engage residents in physical activity throughout the day. This article summarizes evidence about increasing opportunities for physical activity for LTC residents. Physical activity is defined as “any bodily movement produced by skeletal muscles that results in energy expenditure,” while exercise, which is a subset of physical activity, is purposefully planned, structured, and repetitive and has a goal of maintaining or improving physical fitness.14 Previous work has described exercise among LTC residents in detail,8,15,16 and thus exercise is not addressed here. Also, as a narrative review, this article provides an overview of available interventions to improve physical activity for LTC residents and does not provide comments on efficacy or an exhaustive list of potential interventions. Rather, it provides a starting point for LTC homes to consider when providing opportunities to improve physical activity for their residents.
Guidelines for Increasing Physical Activity
There are currently no published evidence-based guidelines for increasing physical activity and reducing sedentary time for residents of LTC homes. However, an international task force of experts in geriatrics, exercise, and LTC research convened in 2015 and made recommendations on this matter.8 They emphasize the importance of considering the needs of residents, family members, health care professionals, LTC staff, and policy-makers when designing strategies to promote movement in LTC.8 This will ensure that the strategies to promote movement will be realistic and sustainable. Additionally, the task force identified motivation and pleasure as key to engaging residents in physical activities, and recommended that interests and preferences should be used to guide the selection of activities.8 The following sections describe example strategies to improve physical activity for residents in LTC that LTC homes can use to help facilitate movement for their residents.