The Centers for Disease Control and Prevention and the American Academy of Sports Medicine, in their 2008 recommendations for physical activity to achieve health benefits, recommend a minimum of 150 minutes of moderate-intense exercise per week.1,2 Although this amount seems relatively small, 70% or more of older adults do not engage in the recommended leisure-time physical activity with individuals of increasing age being less likely to participate in any regular leisure-time physical activity.3 Given the growing proportion of older adults and the benefits of physical activity and exercise, there is a critical need to create and promote opportunities for older adults to achieve the physical activity and exercise needed for health benefits. However, barriers to exercise and physical activity participation, either perceived or actual, increase with aging.4,5 Opportunities for physical participation and engagement must be sensitive to the needs of older adults with chronic diseases such as stroke, Parkinson disease, and arthritis.
Rehabilitation professionals, such as physical therapists and physical therapists' assistants, can be ideal individuals to deliver community-based exercise programs for aging adults. Rehabilitation professionals possess content knowledge of aging and the role exercise plays in addressing the inherent challenges of aging. Rehabilitation professionals are typically adept at adapting specific exercises to differing abilities and can teach participants with pain key adaptations that may promote exercise adherence. In fact, of the 7 examples of prevention and wellness activities listed in the Guide to Physical Therapist practice, 4 describe various kinds of exercise programs.6
This issue of Topics in Geriatric Rehabilitation describes the scope of community-based exercise programs available for older adults. In the first article, I describe the process and procedures for developing community exercise programs. I also list several national, evidence-based programs that can be contacted for more information. The intent of the article is to stimulate ideas for creating a community-based exercise program and to communicate the feasibility of developing a program.
Belza and colleagues, in the second article, discuss the highly acclaimed Enhance Fitness program, now more than 15 years old, that was awarded Best Practice in Health Promotion by National Council on the Aging/Health Promotion Institute. The program currently has more than 400 sites throughout the United States serving more than 7000 older adults. Enhance Fitness is built on sound, evidence-based principles of health promotion; demonstrating effects in the areas of social functioning, depression, and physical function.
An example of a community-based exercise program for special populations is described in the third article by Eng. Fitness and Mobility Exercise is a program aimed at promoting physical function after stroke. Eng provides instructions on how to duplicate the program through an online manual at no charge: a great service to health professionals.
In the third article, Simons describes the legal issues facing the physical therapist who embarks into fitness-type activities. While her legal opinion and expertise primarily deal with physical therapists, by extension other rehabilitation professionals can learn from the examples and issues she describes.
Page, in the fourth article, discusses a falls-risk management program, Standing Strong. The exercise and education program for older adults at risk of falls was developed by national leaders in exercise and aging and currently reaches more than 500 older adults nationally.
In the last article, Rabbia discusses the role of dance in community exercise programs. As a dancer and physical therapist, Rabbia helped to develop a local class for individuals with Parkinson disease in concert with then-physical therapist students. The article is an example of parlaying one's interests and expertise into a community-effort that benefits a specific group of individuals.
There is great satisfaction in developing and delivering community exercise classes. I have developed several classes that have served different needs. First, recognizing a need to reduce fall risk in residents of a retirement center and a need to promote interaction and engagement between “well” older adults and physical therapist students; I developed a twice-weekly class run on a semester system and assisted by several students who serve as exercise helpers. This class has spawned similar classes started by these former students in their own communities. A strengthening class called Steady Steps addresses a need of older adults who were previously inactive but have chronic diseases. Steady Steps, now in its fourth year, is run out of a large nursing home and outpatient center by physical therapists. The program has a large and faithful following with demonstrated outcomes in improved well-being and physical activity. Finally, in collaboration with Syracuse City Parks and Recreation and several health care and educational organizations, an adult fitness program, Syracuse FIT!, was developed to provide free opportunities for individuals to improve their strength and fitness levels. This 2-times/week program is delivered outdoors in the City's parks. Instructors are recruited from primarily physical therapist and physical therapist assistant programs and trained in best practices of effective delivery of community exercise programs.7,8 Through these examples and the excellent articles in this issue, I hope you recognize that all that is needed to begin your own program is the knowledge contained in this issue and the desire to make a difference in older adults' lives.
Dale Avers, PT, DPT, PhD
1. Centers for Disease Control, Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Physical activity for everyone: Guidelines: Older adults. http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html
. Accessed April 4, 2010.
2. American College of Sport Medicine, ed. ACSM's Guidlines for Exercise Testing and Prescription. 8th ed. Baltimore, MD: American College of Sports Medicine; 2010.
3. Center for Disease Control. Prevalence of physical activity, including lifestyle activities among adults—United States, 2000-2001. MMWR. 2003; 52(32):764–769.
4. Bopp M, Fallon E. Community-based interventions to promote increased physical activity: Appl Health Econ Health Policy. 2008; 6(4):173–187.
5. Crombie IK, Irvine L, Williams B, et al., Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents. Age Ageing. 2004; 33(3):287–292.
6. American Physical Therapy Association. Guide to physical therapist practice. Phys Ther. 1997; 77:1163–1650.
7. Cress ME, Buchner DM, Prohaska T, et al., Best practice for physical activity programs and behavior couseling in older adult populations. J Aging Phys Act. 2005; 13(1):61–74.
8. Center for Healthy Aging. Recruiting and retaining effective instructors for physical activity programs. Washington, DC: The National Council on Aging; Spring 2005; Issue 3.