Barriers to exercising and how to overcome them

Trying to get into a regular exercise routine can be difficult for older adults as they may be deterred by aches and pains or concerned about injuries or a fall. If this is their first time exercising, they could be stuck and not know where to start.

Health concerns

Shortness of breath. If your parent is experiencing shortness of breath, it may be simply because they are out of shape, or because of a health condition. Be sure to consult their medical practitioner first to ensure that exercise can be carried out and to recommend an appropriate routine. A slow walk with friends or a gentle group-exercise class for seniors may be the best way to start, and being with others will provide reassurance that should there be a problem, someone is on hand to help.

Joint pain. Another common barrier is joint pain. Many older adults complain of joint pain when exercising, which can be because of arthritis or due to a lack of movement in joints over the years. It is important to remind them that by exercising, they may be able to reduce the pain in their joints and stiffness. Exercise can increase joint flexibility, strength in the connecting muscles, and endurance to carry on. Make sure that joints are given a chance to warm up by easing into the exericse. Joint-friendly exercises include water aerobics, swimming, and walking while wearing shoes with padded insoles. Check first with their medical practitioner, who should be able to advise on the frequency and types of exercises that are best suited for your parent’s particular condition. If your parent has flat feet or if the way they walk (their gait) is incorrect, a podiatrist may recommend orthotics to wear inside their shoes to help lift their arches, improve alignment and reduce strain on the knee joints.

Lack of energy. In some cases, your parent may report a lack of energy. This may be because they currently have a low fitness level or due to the medication that they are taking. If your parent lacks fitness, educate them on the benefits of exercising and how it can actually increase their energy levels. In some cases, exercising regularly may lead to them not needing to take medication for certain issues they faced in the past. This is not for you to decide however; only their medical professional can make a decision on the reduction of medication.

Lack of interest

The main barrier with older adults exercising is a lack of interest. Before encouraging your parent to exercise, ask them a few questions about whether they might like to improve their health and fitness, whether or not they like indoor or outdoor activities, and how long they would be able to dedicate to exercising.

Here are a few ways you can help your parent to want to exercise, using extrinsic or intrinsic motivation.

Extrinsic motivation comes from a reward. The reward can be tangible, like a gift, or intangible, such as praise from a loved one. Extrinsic motivation uses rewards or incentives to increase the chances of a desired goal being achieved. If your parent is struggling to stay motivated, try and offer them a reward for completing exercises. An example of an extrinsic motivation you may use is offering to meet them for lunch at a nearby place that requires a short walk, or having their grandchildren join in the exercises with them. If they know that a reward is tied to exercising, they may be more inclined to exercise.

Extrinsic motivation is used best when the reward won’t lose value. Offering a reward such as exercising with grandchildren or taking them to a new place that they will enjoy can be far more effective, and may motivate them more than offering a physical reward such as food or an expensive present.

Intrinsic motivation involves an internal reward that comes from the inside and is associated with the behaviour (exercising) itself. For example, completing an exercise routine with younger people could be fun; exercising with a trainer or coach may lift their confidence and increase their self-esteem; completing a swim could be satisfying; or going on a walk to a shop could help them feel more independent. Motivation to exercise may also arise from realising that they will benefit in the short term by completing the task, in the medium term by being able to participate in a greater range of activities, or in the longer term by building up their endurance, strength or flexibility. This, unlike extrinsic motivation, intrinsic motivation does not involve any obvious external rewards.

To help increase your parent’s intrinsic motivation to exercise, try reminding them that it will help them take part in more activities with family and friends, or that it could reduce the number of visits to the medical clinic or hospital. This may spark an internal interest and motivate them to want to exercise on their own accord, to achieve the desired benefits. People who are intrinsically motivated are more likely to stick with an activity and perform it well compared to those who are motivated only by an extrinsic reward.

Key areas to focus on when exercising

The three key areas to focus on are balance, cardio and strength. Below are six safe and easy exercises you may want to get your parents involved in.

Balance

Between 20% and 60% of the elderly suffer injuries from falls in any one year. Among elderly people living at home, almost half of the falls lead to injury.

Balance exercises help teach the brain to respond quickly when there is a risk of falling, and to react — without conscious thought — with the correct movements to catch or prevent the fall

Side leg raise

• For this exercise, use a chair to help with balance. Start by standing behind the chair with your feet apart. Begin by lifting your right leg up slowly to the side, keeping toes pointed outwards and back straight. Lower your leg and repeat with your left leg. Complete this movement ten times per leg, with a little rest between each exercise.

Walking heel-to-toe

• Start by placing your right foot in front of your left foot, making sure that your heel touches the tip of your toes. Continue this walk for about 20 steps. This exercise, although easy, helps improve balance and strengthens legs, which helps to prevent falls.

Cardio

About 79 to 86% of those over 80 have some form of cardiovascular disease (CVD) including hypertension (high blood pressure), coronary heart disease (CHD), heart failure and stroke. High blood pressure is one of the controllable risk factors for dementia.

Cardio or aerobic exercises may train a range of muscles, but are designed to primarily train the heart muscle. Cardiovascular fitness is the ability of the heart and lungs to supply oxygen-rich blood to muscle tissues, and the ability of the muscles to use oxygen to produce energy for physical activity.

Walking

• Walking has so many benefits for the elderly. It can help improve health, balance, and can also strengthen muscles. Walking has been linked with reducing the risk of heart disease, stroke and diabetes. If your parent hasn’t exercised in a while, encourage them to begin walking for a couple minutes each day, and slowly increase the distance until they are comfortably able to walk.

Swimming & Pool Workouts

• Swimming presents itself as an ideal exercise for seniors because the risk of injury is low (when supervised). Exercising in water works most muscle groups in the body, which makes it an ideal workout for seniors. Another benefit of a water workout is a reduced risk of falling. Swimming is gentle on joints and has been known to increase flexibility and improve muscle strength.

Strength

Older adults tend to lose muscle mass and strength over time, a phenomenon called sarcopenia. Loss of muscle strength may be exacerbated by lack of weight-bearing activity, hormonal changes, poor diet, or specific medication. A frail person who falls is more likely to suffer an injury, and the injury is likely to be worse and take longer to heal.

Strength training can not only improve muscle condition, it can also lower the risks of osteoporosis and chronic diseases such as heart disease, arthritis, and type-2 diabetes. Strength training is also said to improve sleep and reduce depression, which are two of the controllable risk factors for dementia.

Maintaining strength helps to maintain independence by being able to carry out simple daily activities such as getting up out of bed or out of a chair, showering, changing clothes, walking, cooking and performing housework.

Sit-and-stands

• Sit-and-stands help seniors maintain the ability to get in and out of chairs independently and improve leg strength and balance. Start by sitting in a chair, with feet planted on the floor at hip-distance apart. Using as little assistance as possible, engage the core and stand up, pressing weight through your feet to stand. Reverse the movement and slowly lower yourself to the seated position.

Wall push-ups

• Start by standing in front of a wall with feet shoulder-width apart. Lean forward and place the palms of your hands flat on the wall, aligned with your shoulders. Keep your feet planted on the floor and slowly bring yourself towards the wall, bending at the elbows, ending with your elbows touching the wall in line with your hands.

Fall-risk patients

Proper care needs to be taken when exercising, especially a patient with a high fall risk, or those who find balance challenging. All exercises need to be performed in ways that will reduce the risk of falling. People who are high-risk fall patients may choose to exercise in a group or while supervised.

Video assistance

If you are unable to constantly supervise your parent while they are exercising, consider conducting a video-based exercise. Having a Skype-based workout will allow you to monitor your parent while they are exercising, and should anything go wrong, you will be able to take appropriate measures to ensure that they are safe. You may consider installing a Videophone to facilitate the workouts.

Remember: Before starting any new exercise regime with your parent, consult your parent’s medical practitioner or specialist to help determine which activities are recommended, how frequently they should be performed, when to exercise relative to medication and meal times, and how to minimize risk.

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