How to Build an Effective & Challenging Home Exercise Program for Geriatric Patients

“Little peanuts,” is how my patient referred to the one pound dumbbells that another clinician prescribed her. The patient had nothing wrong with her upper extremities, and while amusing, this was also quite tragic.

Unfortunately, undertraining in the older adult population is widespread among therapists, despite evidence that we can and should be working our patients at a high intensity across the lifespan. The myth that all older adults are fragile and cannot withstand challenging exercise perpetuates inactivity and frailty.

Geriatric exercises should go beyond sit-to-stand transfers, walkers, and peanut-sized dumbbells. What types of exercises can our geriatric patients do? All kinds!

Functional Exercises

Functional exercises include components of functional movements such as bed mobility, transfers, and gait. Older adult patients may benefit from instruction in optimal body mechanics for functional movements due to pain, weakness and/or post-surgical precautions. These exercises encourage independence and performance within each patient’s environment.

One of my best responses from a patient came following their education on proper hand placement during a transfer. This small adjustment made the difference between getting up into the standing position on the first try versus the third. Functional exercises are a great approach to achieve buy-in from your patient due to the immediate application to their everyday life.

Below is a video from MedBridge’s HEP library that demonstrates a functional exercise:

Adaptive Movements

Adaptive movements include the use of an assistive or adaptive device such as a cane, wheelchair or walker. Exercise practice could include proper use of the device for mobility, and/or exercises performed with the device used for added stability. The selection of the appropriate assistive device for your patient’s needs is essential for proper prescription. It’s equally as important to recognize that these needs may change over time. Do not assume that your patient who needs a walker now cannot progress to unassisted ambulation. With the appropriate amount of challenge, progress is possible!

Below is a video from MedBridge’s HEP library that demonstrates an adaptive movement:

Caregiver Assisted Exercises

Caregiver assisted exercises are performed with help from the patient’s caregiver. Family members, nursing staff, restorative aides or hired companions can all serve as caregivers.

Examples of assisted exercises include range of motion exercises or functional mobility maneuvers. Thorough caregiver training by the therapist or therapist assistant is essential for appropriate follow-through. Consider providing videos or handouts with pictures, and pay special attention to the body mechanics of the caregiver!

Below is a video from MedBridge’s HEP library that demonstrates a caregiver assisted exercise:

Strengthening Exercises

Strengthening exercises target muscle mass in order to improve physical performance and/or decrease the risk for physical disability. High-intensity strength training for older adults has been supported as safe and effective in the literature since at least 1990.¹ It may be especially important for older adults to train at higher intensities to maintain independence with ADLs. Hortobagyi et al. found that it took near maximal 80% relative effort for older adults to rise from a chair as compared to 42% in younger individuals.²

Following proper medical evaluation, the American College of Sports Medicine recommends initiating strength exercises at a moderate intensity which is 60-70% one rep max effort. Direct determination of one rep max could be unsafe in the older adult population, so begin by picking a weight that the person rates as a 5-6 (moderate) on a 0-10 physical exertion scale.³

When it comes to types of strengthening exercises, the options are abundant. You could include powerlifting (front squats, back squats, deadlifting) with a barbell or dowel, floor or prone exercises, or even prescribe exercises that use five or even eight-pound weights. Do not assume that your older adult patient can not take advantage of these more challenging techniques.

Below is a video from MedBridge’s HEP library that demonstrates a strengthening exercise:

While functional, adaptive and caregiver assisted exercises may seem more intuitively “geriatric,” you can see that challenging strengthening exercises are also very appropriate and essential! Aerobic, flexibility and balance exercises are additional categories that are also not age restricted. Your evaluation should guide the greatest appropriate level of intensity for each individual patient. Expect more: not only from your geriatric patients but also from yourself!