Evidence-Based Practice Corner: Getting and Keeping Seniors Active

We all need exercise to stay healthy, no matter what our age. But maintaining activity is not easy—only one of two people who start an organized exercise program stick with it.tips-for-exercise-on-care-site

For older adults, regular physical activity can not only improve their health, but also increase their chances of remaining independent. What types of exercise are most beneficial to older adults and what behavioral strategies are most likely to keep them active are the twin focuses of PALS, Physical Activity for Life for Seniors.

PALS is an evidence-based program developed by nurses, physicians, exercise physiologists and physical therapists for sedentary adults age 60 and older who are living at home. The initial group exercise program is ten weeks long, with three sessions a week.

“We looked at the kind of exercises that older adults might need to remain independent at home,” explained Kim Gretebeck, PhD, RN, who co-developed PALS and is working with a team to adapt and implement it in various communities.  “For instance, we have exercises that encourage them to lift their arms above their head.  And that’s for opening up cupboards.  We also have exercises related to strength and flexibility. … They do stair stepping exercises.  They walk down a corridor with a weighted medicine ball. The exercises are really functional in nature, so it’s not the typical get on a treadmill.”

The PALS exercises are easily done at home, with minimal, inexpensive props like soup cans and stretch bands. That helps keep people active after the group exercise program is over.  In addition to the inertia that we’re all familiar with, older adults may have caregiving duties, physical weakness or chronic conditions that make it more difficult for them to be physically active.

That’s why PALS lays the groundwork for continued activity during the initial program. Participants set their own exercise goals and track their activity and progress. PALS even prepares people to deal with future inactivity. “We teach them a lot about relapse prevention,” said Gretebeck. “And what do you do if you relapse.  How do you get exercising again?”

Over the ten weeks following the group exercise program, participants receive follow-up calls at home, every other week.  If they say they’re having trouble meeting their exercise goals, “we talk about what the barriers are and help them try to problem solve.”

In studies, PALS participants’ physical condition improved during the group exercise program, as measured by how fast they walked and how far they were able to walk in a given amount of time.  Overwhelmingly, they maintained their improvement over the post-class follow-up period.  In fact, some participants continued to improve.

Gretebeck and her collaborators, including Dr. Jane Mahoney of the Wisconsin Institute for Healthy Aging and Community Academic Aging Research Network, are putting this proven approach to work.  They plan to offer PALS in four rural counties in central Wisconsin, and to adapt it for African American communities in Madison and Milwaukee.  The goal is to eventually go statewide, tapping into the existing network of health educators.

In each location, focus groups and community partners will provide valuable guidance. PALS recruitment and retention strategies will be targeted for different communities.  The barriers to exercise are likely to vary, as well.

For example, keeping active through walking may be less of an option in rural communities, where there may not be sidewalks or pedestrian-friendly streets. In African American communities, family caregiving duties may make it harder for older adults to find the time to exercise.

The benefit of a sustained exercise program, however, is universal. If more older adults were active for at least 30 minutes, five days a week, the impact could be profound.

Maintaining regular physical activity “is where the long term benefits are. That’s where we can keep them independent,” Kim Gretebeck stressed. Most older adults “want to live at home with their family members. And how do we keep them as healthy as possible? … Exercise is directly related to quality of life.”

–Diane Farsetta