assisted living
Never Too Old to Exercise
A personal training program can improve the
physical and mental state of your residents.
by Robert Van Dyk, MHA
DON’T TELL THE RESIDENTS in my nursing homes and assisted living residences they are too old to exercise. They may be too busy or tired to exercise, but never too old. Tufts University, Boston, Mass., proved this when it conducted a study involving frail nursing home residents up to age 96.1
The purpose of the eight-week study was to determine the benefits of strength training in the frail elderly. The results showed that high-resistance weight training led to significant gains in muscle strength, muscle size and functional mobility. Harvard University published a subsequent paper that studied 16 clinically diagnosed depressed seniors. After 12 weeks of strength training, 14 of the 16 subjects no longer met the criteria for clinical depression.2
ELEMENTS OF PERSONAL TRAINING
Three years ago, I began to work with a personal trainer to help me lose weight and fight off Mother Nature’s way of reminding me that I can’t play tennis the way I did when I was 20 years old. During our first meeting, my trainer discussed and assessed my present physical condition, short- and long-term goals, and established a customized exercise program. I began working out three times a week and started to see rewarding results after a couple of months. Overall, I felt physically stronger and mentally healthier. 
As I got to know Dan, my trainer, I learned he had graduated at the top of his class in exercise physiology and enjoyed working with the elderly. He offered to give an exercise class at one of our nursing homes. After Dan’s third visit, it became very clear that he loved the residents and they loved exercising with him. In fact, Dan’s exercise class became the No. 1 activity for both men and women.
As time passed we began to recognize that each resident had varying energy levels, physical limitations and attention spans. Although this popular exercise class was a fun activity, there was no one set of exercises that actually improved each individual’s specific functional capabilities. Each resident needed an individualized exercise program to meet his or her unique needs and goals.
STARTING UP
Dan and I discussed offering one-on-one training to the residents with our medical director and nursing staff. We decided that if we were going to offer this service, we should develop a baseline of data on the physical capabilities of each resident enrolled in the program and monitor any progress or changes in their physical condition. Dan decided to collect data points that were similar to the data recorded in the Tufts University study:
* arm revolutions using arm ergometer
* leg revolutions using leg ergometer
* repetitions of leg extensions, bicep curls and shoulder front raises.
He chose these indicators because of their importance in developing key muscle groups that may aid in improving upper- and lower-body strength and balance. The goal of the program was to enhance physical capabilities, such as increased muscle strength and flexibility (ROM), as well as improved balance, cardiovascular functions, posture and bone density. We hoped to achieve the following outcomes: improved walking ability, fall prevention, prevention of loss of physical function and improved emotional well-being.
RESULTS
We found marked improvement in all areas for all residents after monitoring for 12 weeks. Not all residents had the same outcome, but all had surpassed our highest expectations. Figures 1-3 summarize our results. Although we shouldn’t have been, we were surprised to find that our results mirrored the studies conducted by Tufts and Harvard.
Not only were our paper results rewarding, but the feedback from residents, families and staff confirmed we were doing the right thing. We actually watched some residents progress from using a wheelchair to a walker, a walker to a cane and others walking without assistance.
A number of our residents had previously been receiving physical therapy under Medicare. When Medicare benefits stopped because there was “no rehab potential,” we continued with our exercise physiologist (personal trainer). Within a short period of time, we saw marked improvements in the conditions and functions Medicare felt were unachievable. Much to our surprise, we found the personal training program provided an unexpected benefit: Residents whom Medicare assessed to be too weak to benefit from physical therapy were now able to qualify for Medicare, as the exercise program helped build their cardiovascular and muscle strength. This helped to build a relationship between our trainers and physical therapists, who initially were concerned about the trainers taking clients or duplicating services.
The feedback from residents, families and staff has been extremely positive. The wife of one our residents remarked, “About two-and-a-half years ago, my husband was diagnosed with Parkinson’s disease. He lost strength and balance and regressed to the point where he was hardly able to walk. For the past year and a half he has engaged in an exercise program with Dan. His walking ability and mental alertness has shown great improvement. I cannot stress the important role that this exercise program has played in his life.”
Another resident’s daughter says her mother can now walk to the dining room without assistance, improving her entire mental outlook. Also, it appears that regular exercise increases blood circulation, opening up some of the blocked arteries that come from aging. Although we cannot prove this scientifically, the anecdo-
tal evidence seems to support the
concept.
The program results were so overwhelming, we added it at another nursing home and now employ two full-time personal trainers for 160 residents. Dan Muilenburg, our original trainer, no longer has time for me and now devotes all of his time to the frail aged. Last August, with our help and blessing, Dan started his own company, Quantum Senior Fitness, where he employs five trainers and is contracting with a growing number of nursing facilities, assisted living residences and senior housing communities. From my perspective as an owner and operator in senior health and housing, it takes more than just putting a trainer in your home to experience similar results. I believe the success experienced by my residents came from the relationships Dan and his team developed with them, in addition to making the new program fun for residents and easy for facility staff.
PPS IMPLICATIONS
What we are now experiencing in our nursing homes, and the results Dan and Quantum are having with all of their clients, is a direction the long-term care industry must closely scrutinize. As we enter a new era under PPS and consolidated billing, exercise physiology may sandwich itself effectively and efficiently on both sides of the Medicare physical therapy process.
So who says you’re too old to exercise? If my frail 96-year-old residents are improving their quality of life, you can too. Just think: Grandma has her own personal trainer! *
References
1. Fiatarone M, Marks E, Ryan N, Mcredity C, Lipsitz L, Evans W. High-intensity strength training in nonagenarians. JAMA 1990; 263:3029-3034.
2. Singh N, Clements K, Fiatarone M. A randomized controlled trial of progressive resistance training in depressed elders. J Gerontol A biol Sci Mod Sci 1997; S2(1):M27-3.
Robert Van Dyk is president and CEO of Van Dyk Health Care Inc., Ridgewood, N.J. He can be reached at (201) 689-7999.
Dan Muilenberg, president of Quantum
Senior Fitness, can be reached at (201)
445-7552.
Table 1
The average number of revolutions performed prior to entering the exercise program, and then 6 weeks and 12 weeks after.
Table 2
The average number of revolutions performed prior to entering the exercise program, and then 6 weeks and 12 weeks after.
Table 3
The average time in seconds it took to walk from one point to another prior to entering the exercise program, and then 6 weeks and 12 weeks after.
tables/courtesy Robert Van Dyk, MHA
Related Internet Sites
California Accreditation of
Residential Elder Services
http://www.elder.org/ca-home.htm
The American Geriatrics Society
http://www.americangeriatrics.org/
Administration on Aging
http://www.aoa.dhhs.gov/
50 Plus Fitness Association
http://www.50plus.org/pages/
directory.htm
