Tuesday, January 20, 2015

The Way Forward: Exercising for Life


Exercise has always been important. But today, it's critical in the health and well-being of older adults. 


Gladys Chelte started exercising after retirement. The incentive to finally start and stick with it came from watching her husband’s health decline. “After my husband and I retired, his health problems got progressively worse. I decided I needed to do something to keep in better shape so we could stay in our home. I started an exercise plan. I knew I had to at least try.”

Finding the motivation to embrace fitness paid off for Chelte. “By the time I am done exercising—even if I really didn’t want to—I feel so much better and it just lifts my spirit,” she says. 


Seventy-year-old Connie Balcom is an ACE (American Council on Fitness) certified senior fitness instructor. Her impetus to prioritize exercise and to teach came from her father’s premature death. “He was the kind of guy who always meant to make time for exercise--but didn’t” she says.

Balcom knew she wanted to teach people like her dad who hadn’t exercised in quite some time, didn’t know what exercise meant, and just never got around to it. “A lot of us haven’t exercised since we were kids, but exercise is really the key to independence
and better health,” she says.

The Experts

As a nation, we began researching exercise and promoting fitness through group sports to young people in the 1950s. The 1970s saw a push for cardiovascular workouts through activities like basketball, running, and aerobics programs. Messaging of the 1980s and 1990s centered on activities like walking and dancing as options for moderate-intensity workouts (U.S. Department of Health and Human Services et al. 2012). Now, as those children and adolescents of the 1950s who received the first public message about the benefits of exercise are retiring and settling into their golden years, we know so much more. 

Today, we know that even light to moderate exercise is enormously beneficial for health and independence. In this age of information, the most advanced studies on health and cost benefits of fitness are readily available. Whether looking to the World Health Organization, the Centers for Disease Control and Prevention (CDC), National Institute of Health, American Cancer Society, Alzheimer’s Association, or the AARP, the data consistently boils down into one message: exercise is undeniably good for you. According
to the CDC, “Regular physical activity is one of the most important things a person can do to stay healthy (CDC 2009).”

Yet, only one-third of all aging Americans exercise (Jacobsen et al. 2011).

Research shows that regular exercise helps manage chronic disease like Type-2 diabetes, cancer, stroke, heart disease, osteoporosis, arthritis, and dementia. It reduces medical costs, fights depression, and prevents illness. Exercise impacts healing and recovery and can be used as a tool to extend treatment benefits and stop the revolving door to hospital readmission (CDC 2009).



The Continuum of Care: The Care Provider

Michael J. Foley, M.D., a general surgeon with the Affinity Medical Group in Oshkosh, Wisconsin, says that we cannot ignore the fact that the majority of Americans do not exercise on their own because “those are the people we see again and again in the
health care system.”

“The relationship between fitness and health is undeniable. Individuals who stay active and exercise after they retire stay out of the hospital, have fewer illnesses, and live in their homes longer,” he notes.

As the Affordable Care Act (ACA) switches to a system that pays based on quality of care or value from one that previously rewarded for volume, Dr. Foley sees the opportunity for the entire continuum of care to use tools like exercise for better health outcomes, to
extend treatment benefits, and to stop the revolving door to hospital readmission.

Dr. Foley points to what has been learned about exercise in relationship to dementia and Alzheimer’s as evidence.

• In 2008, the University of Washington’ s Dr. John Medina wrote in his book, Brain Rules, that you can cut your lifetime risk of Alzheimer’s by 50 percent and your risk of general dementia by 60 percent with regular exercise (Medina 2008).

• An April 2013 Finnish study found that thirty minutes of exercise in the home each day can result in 50 percent fewer falls, less hospitalization, and reduced medical costs for someone already living with Alzheimer’s or general dementia (Pitkala et al. 2013).

• A July 2013 study undertaken at the University of Maryland concluded that exercise may be the best medicine for Alzheimer’s because “no study has shown that a drug can do what we showed is possible with exercise (Smith et al. 2013).

 “We can’t just look to pills or surgery to make people better in every situation,” says Foley. “The time has come to deliver exercise as a part of care. We don’t need more research. We need application across every level.”

On the Continuum: The Physical Therapist

Sara Bryan, rehab director for Orthopedics at Gentiva Health Services in Minneapolis/Saint Paul, Minnesota, is a true believer in exercise. Like Dr. Foley, Bryan has a growing concern that the continuum of care does not currently put enough emphasis on exercise as a key factor in wellness. “When benefits end and we leave the home, exercise usually stops, and health fails again. There is a gap in care that we need to address as a system.

“Complying with exercise and activity as part of a lifestyle change is necessary for long-term success, to keep these patients from going back into the hospital, or from having another fall,” Bryan says. As a solution, she is looking for stronger partnerships with providers, home care, and the family. They need to be a part of ensuring that tools are used and the plan is followed.”

The Continuum of Care: Home Care

Home care is undergoing major transformations largely because of licensing, the ACA, dementia, and Alzheimer’s, and the overall growth in the aging population. It is also starting to deliver exercise as a part of care. 


Right at Home has embarked on a nationwide pilot project to determine best practices for adding fitness to its care offerings. ComForcare recently completed a fitness pilot and is adding exercise as one of its tools available in its dementia care program. Visiting Angels
is rolling out an extensive dementia care program this summer to all of its franchises and will incorporate fitness as one of its main tenets.

Bonnie Reid, Director of Program Development for Visiting Angels Home Care, is putting together that dementia care program for the entire corporation. She designed her program to include fitness because “you can’t just have a dementia care program that helps the brain but ignores the body. Our clients are whole people. The research about dementia and exercise is real. It is a great way we can help our clients and their families and be a stronger partner with others in care.”

Some individual business owners are moving faster than their corporations by adding fitness to their care services. SYNERGY HomeCare franchise owner Brian McDonald knows that the home care industry can be a bigger partner in wellness, and he knows his clients will benefit.

“The basic premise of in-home care is to help people remain independent and spend their golden years in their own homes. In-home care has a unique opportunity to help people stay active. This is not about going to a gym or raising barbells over your head. This is about staying active,” McDonald says.

The Way Forward

Dr. Foley tells his patients, “The possibility for up to a 30 percent improvement in longevity or your ability to care for yourself when you are active is real. You can start exercising when you are sixty, sixty-five, seventy, seventy-five—whatever it takes to keep you active and where you want to be in your life.” When asked about patients who do not exercise, Dr. Foley says, “I tell my patients that they don’t have to be out there running 5Ks or marathons, lifting heavy weights at a gym, or being a body builder. They just need get their engine running, move consistently and often, and keep those muscles and bones strong.”

He emphasizes that all of us should be working toward the same goal of improved quality of life, and exercise has to be part of the equation. Advisors and other professionals who work with older adults are in a position to advise their clients on the merits of exercise,
and encourage them to begin an exercise program. •CSA 



Beth Commers has spent most of her career in college athletics, education, government,
and politics. As co-owner of FOG LLC (For Our Grandparents) she worked with a team of experts to create the Independence Home Fitness Curriculum to help older adults re-engage with fitness. Contact her at bethcommers@fog-llc.com or visit www.forourgrandparents.com. 


The Way Forward: Exercising for Life was recently published in the Summer 2014 edition of the CSA Journal.


Blog posting provided by Society of Certified Senior Advisors