An FP's guide to exercise counseling for older adults.

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Date: Sept. 2022
From: Journal of Family Practice(Vol. 71, Issue 7)
Publisher: Jobson Medical Information LLC
Document Type: Report
Length: 2,905 words
Lexile Measure: 1830L

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At what intensity and frequency should older patients exercise? This review offers guidance and resources to help you get your patients moving.

The health benefits of maintaining a physically active lifestyle are vast and irrefutable. (1) Physical activity is an important modifiable behavior demonstrated to reduce the risk for many chronic diseases while improving physical function (TABLE 1 (2)). (3) Physical inactivity increases with age, making older adults (ages > 65 years) the least active age group and the group at greatest risk for inactivity-related health consequences. (4-6) Engaging in a physically active lifestyle is especially important for older adults to maintain independence, (7) quality of life, (8) and the ability to perform activities of daily living. (3,9)

Prescribe physical activity for older adults

The 2018 Physical Activity Guidelines for Americans recommend that all healthy adults (including healthy older adults) ideally should perform muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on 2 or more days per week and either (a) 150 to 300 minutes per week of moderate-intensity aerobic physical activity, (b) 75 to 150 minutes per week of vigorous-intensity aerobic physical activity, or (c) an equivalent combination, if possible (TABLE 2 (2)). (3) It is recommended that older adults specifically follow a multicomponent physical activity program that includes balance training, as well as aerobic and muscle-strengthening activities. (3) Unfortunately, nearly 80% of older adults do not meet the recommended guidelines for aerobic or muscle-strengthening exercise. (3)

Identify barriers to exercise

Older adults report several barriers that limit physical activity. Some of the most commonly reported barriers include a lack of motivation, low self-efficacy for being active, physical limitations due to health conditions, inconvenient physical activity locations, boredom with physical activity, and lack of guidance from professionals. (10-12) Physical activity programs designed for older adults should specifically target these barriers for maximum effectiveness.

Clinicians also face potential barriers for promoting physical activity among older adults. Screening patients for physical inactivity can be a challenge, given the robust number of clinical preventive services and conversations that are already recommended for older adults. Additionally, screening for physical activity is not a reimbursable service. In July, the US Preventive Services Task Force (USPSTF) reaffirmed its 2017 recommendation to individualize the decision to offer or refer adults without obesity, hypertension, dyslipidemia, or abnormal blood glucose levels or diabetes to behavioral counseling to promote a healthy diet and physical activity (Grade C rating). (13)

Treat physical activity as a vital sign

The Exercise is Medicine (EIM) model is based on the principle that physical activity should be treated as a vital sign and discussed during all health care visits. Health care professionals have a unique opportunity to promote physical activity, since more than 80% of US adults see a physician annually. Evidence also suggests clinician advice is associated with patients' healthy lifestyle behaviors. (14,15)

EIM is a global health initiative that was established in 2007 and is managed by the American College of Sports Medicine (ACSM). The primary objective...

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Gale Document Number: GALE|A722030326