As lockdown continues, and we face another few months of life without access to our traditional gym settings, I have been inundated with questions regarding training strategies that can be implemented at home.
We all know that in order to maintain both our independence and sense of health and wellbeing, activity and exercise go hand in hand with a well-balanced diet. But as we get older, what considerations should we be making in order to keep fit and well?
The NHS states:
There's strong evidence that people who are active have a lower risk of heart disease, stroke, type 2 diabetes, some cancers, depression and dementia. If you want to stay pain-free, reduce your risk of mental illness and be able to go out and stay independent well into old age you're advised to keep moving. Recent evidence suggests that regular exercise can reduce the risk of falling in older adults.
Many older people worry about falling over, whether they have fallen or they feel less steady on their feet. As we are aware, falling over can lead to serious injury or even death. According to NHS data, nearly 100,000 older people (aged 65+) suffered hip fractures in 2017/18. Sadly the reality is that around 14 people a day in the UK die due to falls. Physiotherapy with a holistic approach is recommended in the guidelines for preventing and recovering from falls.
In the 2016 Health Survey it was found that 19% of women and 13% of men aged 16-24 were classed as inactive compared with 58% of women and 47% of men aged 75 and over:
With age, we experience many changes in hormones, nutrition, activity levels, muscle mass, bone density and many more and it’s important we understand how these can affect us.
For example, Sarcopenia is the loss of muscle mass due to ageing and alongside nutritional factors and reduced activity levels this can have an effect on balance where muscle strength is much harder to gain and the muscles become weaker. Sarcopenia is a clinical diagnosis where a doctor, nurse or physio or other health professional assess your muscle strength and walking speed and considers the risk factors for the condition. The treatment is to ensure nutritional status is good and to build muscle strength with resistance exercise.
Osteoporosis is a process that weakens bones and there is a loss of bone density where the bones are more likely to break. This can be diagnosed with a special scanning device called a DEXA like an XRAY machine. Without the scan, there is a simple calculation tool that can be used to find out if someone is at risk of not from loss of bone density and this helps doctors to know when to prescribe drugs to help protect bone strength, such as Alendronic Acid. It is really important that exercise is also used as a treatment both for preventing and after diagnosis of osteoporosis.
As with muscles, bones need exercise to remain healthy and the Royal Society for Osteoporosis
Eating and drinking can sometimes be affected with age, many people for different reasons report changes in appetite, and there are sometimes conditions that directly affect eating and digestion. Some people forget to stay hydrated or worry about drinking too much water and needing to use the bathroom as it is painful to walk or they are frightened of falling. Becoming dehydrated can be dangerous too and often leads to urine infections which increases the risk of falls, so not drinking becomes a downward spiral.
This can all be covered when speaking to a community physiotherapist who will ensure you work with your GP or continence nurse for support to provide a fully holistic approach to your care.
So, what can you do about all of this?
It is really important that everyone takes care of their fitness, strength and balance as they get older to help prevent muscle weakness, balance problems and osteoporosis.
Current guidelines ask us to achieve 30 minutes a day, five times a week of moderate-intensity exercise (getting out of breath!). This is in addition to two sessions of strengthening (using resistance like weights or a Theraband) and balance training per week. Tai Chi is also recommended for balance training to prevent falls in older people.
But what if you don’t know where to start?
Well, there are lots of resources out there and inspirational tools to help you adopt more exercise into your daily routines. For example, Physiotherapists can help set an exercise program for you that will include specific strengthening exercises, movements to help you stay fit for living daily life, balance routines and supports for aches and pains.
The benefits of enlisting the help of a physiotherapist as you get older can be multifaceted and physiotherapy services are not just restricted to hospital settings. Community physiotherapy services work with older adults in their local area. They work in people’s own homes whether that be a care home or family home, and consider their role to be much wider than just assessing muscles, nerves and bones; they work holistically and often form very close relationships with their patients, extended families and carers. They also work closely with the GP, specialist nurses and the wider team where possible.
Many people do not realise the role that physiotherapists have in the care of older people. They work with a wide range of conditions such as Osteoarthritis, Parkinson’s Disease, breathing problems such as Chronic Obstructive Pulmonary Disease (COPD) or Asthma, pelvic floor dysfunction and continence issues, musculoskeletal pain, frailty, falls, strength and balance issues and much more!
Physiotherapists can offer a comprehensive assessment of your falls or near misses at home and outdoors to really help understand what the risk factors are and can then refer to the correct specialists where needed. Sometimes people need some simple adaptations such as orthotics in their shoes to help with their balance or provide recommendations for footwear. Some people may require a little more support and exploratory tests such as an ECG from their GP to detect any problems with their heart. There are many, many factors that can contribute to the likelihood that you may experience a fall and a specialist physiotherapist’s job is to ensure you have each factor identified and addressed where possible.
Specialist community Physiotherapy services can advise on suitable exercise groups in your local community to support you to be as active and independent for as long as possible.
Age UK is a great resource for exercises for later life: You can also find out about local classes which offer suitable and importantly fun sessions where you can exercise in a group setting indoors or outdoors. Gyms, walking groups, swimming pools, hydrotherapy pools, physiotherapy departments, leaflets from your GP surgery, council websites under sports and leisure, supermarket notice boards. All should be good sources of local information for new activities to try and make a habit of. Added to the benefits of group exercise are the support and motivation they bring as well as the social benefits too.
The Chartered Society for Physiotherapy is another good resource for finding all about exercise to prevent falls with a set of six simple exercises that you can do to help keep you fit and independent.
Start being active today, the benefits are often immediate and long-lasting!
Imagine playing a complex board game where everyone is playing by their own rules, except you don’t know what the rules are or how to invent your own. That’s what life can feel like when we haven’t learnt the skill of healthy personal boundaries.
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