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Design exercise routines to maintain mobility in elderly clients

This is an excerpt from Client-Centered Exercise Prescription 3rd Edition With Web Resource by John C. Griffin.

Functional Exercise Design

Having followed the component guidelines, the prescription process should continue with the selection of exercises that simulate the movements of everyday activities encountered by your client. This functional training involves physical activities that are designed to make tasks and activities of daily living easier, safer, and more efficient.

Older clients themselves have repeatedly stated that their goals are to maintain functional fitness and independence in their chosen daily activities. Functional training makes older adults more aware of the connection between their exercise prescription and activities or tasks they perform in their daily lives. People can make many daily tasks and recreational activities easier by performing well-designed functional exercise. Griffin (2012) identified three primary domains of function:

1. Up and down activities: lower body focus
2. Locomotor activities
3. Carry - push - reach activities: upper body and trunk focus

Table 13.6 identifies specific functional tasks that are related to these domains.

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Functional mobility involves movement patterns used in active daily living and recreation. Chapter 14 discusses this in more detail. Functional exercises, tasks, or activities allow the client to progress to a level of effective and efficient movement patterns. These should be paired with functional assessment to identify accurately the level of the client's ability to perform daily activities or more advanced recreational activities. For example, in the Senior Fitness Test, upper body flexibility is measured by the back scratch test and may reflect the ability to put on tight overhead clothes. The exercise program should include range of motion exercises for shoulder joint abduction and rotation. In another example, several researchers (Griffin 2012; Rikli and Jones 2001) have used the timed up-and-go (TUG) test to measure agility and balance, components needed for avoiding obstacles while walking quickly or hiking. Those having difficulty should include motor coordination activities involving control and speed (suited to their level).

The term functional refers to basic required activities of daily living, as well as those that allow us to engage in recreational and meaningful activities related to work or leisure and to move effectively and efficiently in our environment (Taylor and Johnson 2008). As with traditional structured exercise, functional exercise also fulfills the development of essential fitness components of strength, dynamic stability, flexibility, motor mechanics, and so on. So how do you make your exercise design more functional? Several authors refer to this outcome as "functional fitness" (Rikli and Jones 2001). Functional exercise is also designed to restore clients' confidence and ability to achieve normal speed, power, control, and balance without the risk of injury. Ultimately, we want to give the client basic and advanced exercises and activities that will encourage increased participation in lifelong active living.

Essential in the design of functional exercise is the inclusion of certain elements:

● Dynamic stabilization (some muscles working to stabilize while other muscles work to accelerate or decelerate)
● Reactive movements to help maintain postural stability (relate to one of the primary causes of falls)
● Functional range of motion (without which, stress on structures and movement compensations can occur)
● A progression of challenge mimicking the speed, power, and agility required for continued participation in many activities

It is optimal if activity and exercise become not only a part of your client's lifestyle but also an element that enhances his QOL. Most days are completed with a series of routine tasks; some of these we may enjoy (like reading a newspaper), and others are a part of maintenance, such as sweeping a floor. Our lives are also made up of events that are usually longer in duration and take a little more planning. They often involve other people and may involve transporting ourselves to a different location.

Exercise, particularly starting an exercise program, is a challenge, and approximately half of all exercise plans end in failure within 6 months. Integrating activity within patterns of living can lead to more success. The first part of the lifestyle activity plan we call the daily dose is linked to activities of daily living. The second part of the plan is social adventure.

Daily Dose

Most of us have standard routines in our daily lives, things that we need to do or want to do almost every day. This may include activities such as preparing meals, shopping, light housecleaning, computer time, and reading. Researchers call these activities of daily living (ADLs). For one reason or another, most days these activities are completed at a certain time that is convenient or habitual. These activities may not be at the top of our list in terms of QOL, but their completion often gives us a sense of satisfaction. Integration of "daily dose" exercise within our routine must be just as convenient and most often at the same time every day. Daily dose exercise is our exercise habit or routine and may be once a day or several short bouts within the day. It is the cornerstone of an active lifestyle and prepares us for the challenges that may come with our "social adventures." Take a serious look at integrating one of the following three approaches as your daily dose exercise:

1. Daily program. It could be a walk, a yoga video, a series of stretches and calisthenics, a routine from your physiotherapist as a follow-up from an injury treatment, resistance training with light weights or TheraBands, or some time on a home exercise device such as a treadmill, bicycle, or stepper.
2. Active living. You may recall from chapter 6 that active living is an enhancement of the simple activities in a daily routine, like walking to the store instead of taking the car, or climbing stairs instead of riding the elevator, active playing with the grandkids, or selecting a more vigorous chore for the day. Active living may replace a daily program on certain days or further complement exercise. However, active living is about making choices and should extend beyond an exercise routine with the potential of becoming a way of life. Table 13.7 provides a few more practical ways to integrate active living into your daily activities.
3. Daily dose routine linkages. Daily dose routine linkages are dynamic movement mini-routines that can be done at the same time as one of our activities of daily living, for example, when you are standing in the washroom about to brush your teeth. These are activities that happen every day, perhaps several times a day; and each time they do, they cue the client to do a specific daily dose routine.

Three different sample daily routine linkages are presented in the drills that follow. The first is for the lower body daily dose, the second is for the core and trunk area, and the third is for the upper body. These mini-routines are designed to improve flexibility, muscular endurance, strength, joint stability, and balance.

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Lower Body Daily Dose

This routine is linked to standing in the washroom before teeth brushing. Instruct your client to do 3 sets per day.

1. Partial squat (10 times), figure 13.9
2. Alternating hamstring curl (10 times), figure 13.10
3. Alternating side leg lift (10 times), figure 13.11
4. Knee-up hip roll (10 times), figure 13.12
5. Alternating toe (foot) lift (10 times), figure 13.13

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Partial squat.

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Alternating hamstring curls.

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Alternating side leg lift.

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Knee-up hip roll.

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Alternating toe (foot) lifts.

Social Adventure

Daily exercise is the core and the heart of a lifestyle activity plan. However, the real joy that people feel with activity may come from a different source. Apart from the plethora of research on the benefits of physical activity from a psychological or sociological perspective, it is a wonderful feeling when we share an active event with a friend or group of people - a "social adventure." For some it may be more social; for others it is the thrill of the mini-adventure. In any case, when you ski, golf, hike, curl, or bowl with someone else, you continue to create new stories of shared experiences. This is important at any stage of life; however, to feel renewed as an older adult is extremely refreshing. For some the experience may involve a change of geography, climate, and perhaps an adventurous exposure to the elements. For others it may be a game of doubles tennis with lots of laughter and time for coffee when all is done. If we can plan four or five of these events every month (a weekly social adventure), we add to the physiological benefits of the lifestyle activity plan. In some ways, the daily dose can keep us fit and mobile enough to be able to feel confident with the social adventures. For many of us, our QOL is defined in no small part by the nature and frequency of our social adventures.

Learn more about Client-Centered Exercise Prescription, Third Edition With Web Resource.

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