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February 1, 2010

Exercise as Medicine
By Jennifer Van Pelt, MA
For The Record
Vol. 22 No. 2 P. 24

Fitness programs offer boomers preventive qualities against disease, as well as socialization opportunities.

The baby boomer generation—those born between 1946 and 1964 during the post-World War II baby boom—are creating a boom themselves in fitness trends and exercise program participation. According to U.S. Census data, there are currently more than 78 million baby boomers, and 58 million will still be alive in 2030. Such numbers indicate that current trends in older adult fitness driven by boomers will continue to evolve.
While the size of the boomer population contributes to older adult fitness trends, recently published studies reporting the health and cost benefits of regular exercise for older adults are also spurring the development of new programs by care providers and reimbursement for exercise activities offered by insurance companies. And new technologies are providing new options to make older adult exercise both fun and functional.

Exercise as Medicine
“There are many trends occurring in older adult fitness; however, probably the most significant one is the repackaging of exercise as a disease solution,” says Colin Milner, CEO of the International Council on Active Aging (ICAA). Viewing exercise as medicine, as a tool to not only manage but also to prevent the health issues elders face, is becoming a commonplace way to promote regular exercise. The ICAA believes health plans will continue to pay for prevention because the fear of rising healthcare costs has forced health insurance companies to investigate the dollar value of exercise for prevention.

“Many eyes opened when HealthPartners Research Foundation announced their study that showed adults aged 50-plus years who started exercising just 90 minutes a week saved, on average, $2,200 per year in medical costs,” Milner says. According to Tricia Grayson, director of communications for Healthways’ SilverSneakers Fitness Program, Medicare claims costs in this study for SilverSneakers members were 30% lower than for nonparticipants.

Another study recently released by the Centers for Disease Control and Prevention (CDC) reported that Medicare recipients who participated for two years in the SilverSneakers health club exercise program had significantly lower healthcare costs overall, and older adults who visited health clubs at least twice per week had $1,252 less in healthcare costs than those who visited less than once per week. Combining those cost savings with baby boomers’ knowledge of the benefits of physical activity, health insurers take notice, Milner says.

In another nationwide study of more than 9,000 SilverSneakers members, 41% of members with diabetes reported having improved health after one or more years of participation and 46% reported improved body weight. High-risk sedentary behavior was reduced by 59% with SilverSneakers participation, Grayson notes.

Approximately 600,000 older adults participate in the SilverSneakers program, the nation’s leading exercise program designed exclusively for older adults, and it may be the most studied of the older adult fitness programs. Recent studies indicate that the program’s participants utilize preventive care more often, are admitted to the hospital less often, and have lower overall healthcare costs. Older adults with diabetes who participate in the program are also admitted to the hospital less often, have lower inpatient care costs, and see significant reductions in their overall healthcare costs after only one year of program participation. And greater participation in SilverSneakers has been associated with a significantly lower risk of depression. The program offers both discounted gym memberships and classes for strength, cardiovascular, and flexibility training.

Organized Exercise Programs
Group fitness classes such as those offered through SilverSneakers are extremely popular among active older adults and, in many health clubs, they have the highest levels of participation on the overall class schedules, often attracting more participants than classes geared toward younger exercisers. An AARP survey of adults aged 50 and older found that strength training was the most popular exercise activity (31%), followed by aerobics (22%). Other popular activities identified in the survey include walking, dancing, yoga, golf, and water activities. Many of these exercises are offered to older adults in group fitness settings at health clubs or community centers, and it is the group setting that keeps older adults coming back. “Probably the greatest benefit to organized exercise programs is having a date with a group, a person, or an organization that keeps people committed,” Milner says. In addition, he says, there is the added benefit of social interaction, which increases participation levels and long-term retention.

“Organized programs such as group exercise give older adults the opportunity to be in a social setting with others of similar age or skill sets and can be very rewarding and motivating,” says Deborah Redder, national fitness program director for SilverSneakers. While there are no specific physiological benefits to exercising in a group setting vs. an individual program, enjoyable social opportunities can provide the motivation to exercise that results in higher participation levels.

“Organized programs make a lot of sense. I know personally of three individuals who all tried on their own to establish and maintain a fitness program but just couldn’t do it. The three of them banded together to form a small group, and they made a commitment to meet three times a week to exercise. They have been successful and continue to do this on a regular basis. Having support from others seems almost critical to keep one on the right track,” says Jim Warren, president of Lifelong Fitness Alliance based in Redwood City, Calif., a research-oriented nonprofit organization advocating lifelong wellness.

Group exercise classes, such as water exercise, gentle yoga, tai chi, and low-impact aerobics, are well attended, and older adult personal training is also on the rise, according to Janie Clark, MA, president of the American Senior Fitness Association, an author on older adult fitness, and the coauthor of national and international guidelines for preparing older adult fitness professionals. Resistance, circuit, and balance training especially are trending upward, she says. Balance training is important for older adults to prevent falls, which often result in serious medical complications.

“The most important fitness class I teach is the balance class. Before this class was added to the schedule, the residents at Fox Hill had never practiced balance and still would probably not be today if not for this class,” says Anthony Absalon, a kinesiologist and fitness specialist at Fox Hill Club and Residences, an older adult community in Bethesda, Md. In addition to teaching classes, he also trains older adult residents using resistance equipment and free weights. Organized exercise programs, such as group fitness and personal training, are ideal for older adults, he says. “As these seniors were growing up, exercise was not highly regarded as it is today. Many of them do not know how to devise their own workout routine,” he says.

Older but Able
Older adult exercise was once limited to chair exercises and other slower paced activities. But baby boomers are changing the way fitness professionals see older adults and their physical capabilities. “Many trainers used to be reluctant to have older adults perform challenging exercises for fear of dangerously elevating their blood pressure or straining the heart. Fitness programs were sometimes so overly cautious as to be inadequate,” says Clark.

For example, a few years ago, active independent living seniors might be prescribed or have available only seated, range-of-motion exercises, despite their capability to do much more. Now, Clark says, trainers are more effectively designing fitness programming because they are better educated regarding medical clearance, preexercise functional fitness appraisal, older adult physical training guidelines, and appropriate modifications and adaptations.

Baby boomers appear to discount age as a limiting factor for participation in more vigorous exercise and in newer, “hipper” activities popular among active younger counterparts. Warren has encountered some more unusual and what he refers to as “offbeat” activities increasing among older adult exercisers, such as kettlebells for strength training and Zumba dance classes. Interestingly, both of these activities have recently become popular among younger exercisers.

Baby boomers have also enthusiastically adopted technology as part of their fitness regimens. Technology is being applied to boost the benefits of exercise for older adults and represents another trend in older adult fitness. “Technology as a motivator for exercise is another area that is experiencing growth in research and usage,” Milner observes. Research shows that using technology, from simple automated telephone reminders and motivational e-mails to computerized games and exercise equipment, can increase retention and participation in exercise programs, he says.

According to Redder, a new and growing trend is Web-based fitness assessment and program recommendations for older adults who increasingly use the Internet as a source of information. Many of these technologies can be used at home, in senior centers, and in assisted living communities. For example, elders can complete Web-based fitness assessments online at home, in conjunction with personal trainers at health clubs, or at older adult community fitness centers.

Technology—ranging from simple pedometers to state-of-the-art computerized gaming systems—seems to inspire activity. Studies show that wearing a pedometer to keep track of an individual’s steps can increase daily walking, even in elders who were previously sedentary.

Initially expected to be popular with younger generations, the Nintendo Wii has unexpectedly scored a hit with the older generations. The Wii has inspired not only exercise but also socializing opportunities. Community centers for older adults offer Wii bowling, tennis, and golf for fun and friendly competition. Grandparents can play games with their grandkids without leaving the house. For a few hundred dollars, facilities can hold regular bowling, tennis, and golf tournaments for residents in existing activity rooms without travel or weather concerns.

Exercise equipment has also evolved from basic weight machines to computerized technology—the CYBEX Trazer combines virtual reality with movement to encourage exercise that improves balance. Its unique technology engages muscle and mental skills. Because its use can aid in fall prevention, the new exercise technology earned an ICAA Innovative Equipment Award, says Milner.

At Fox Hill, Absalon helps residents train on exercise machines that can be programmed to track individual progress. Residents receive keys that plug into the exercise machines, recording their resistance and repetitions. “These machines are great for this population because this key system shows the residents what resistance and how many repetitions they did the last time they were on the machine, so they will only be exercising with weight that is appropriate for them,” Absalon explains. The system also allows him to assess individual progress and tailor exercise recommendations accordingly. “Because the machines are so sensitive and work on air resistance instead of metal weights, older adults can finely calibrate their workouts and ensure that they are working muscles that are critical for balance and stability,” he says.

Promoting Elder Fitness
It is important for older adults to understand that although exercising regularly throughout life is critical, it is never too late to start, says Absalon. For elders beginning exercise routines, motivation and encouragement are critical, along with an introduction to simple exercises and a gradual increase in difficulty. Choosing activities individuals may have enjoyed at an earlier age, such as swimming, dancing, or golf, may help with motivation. “As with anything, if it is enjoyable, they are much more likely to continue,” Warren emphasizes.

Absalon believes another important motivator, especially for elders in their late 60s and 70s, is to link exercise with performing activities of daily living, such as doing laundry, cooking, climbing stairs, and getting dressed. Explaining that exercises are geared toward making their lives easier by improving their ability to complete routine tasks keeps them coming back for more, he says. For example, Redder says biceps curls can be associated with picking up a grandchild and hand/finger/wrist exercises with driving and personal grooming.

Professionals working with older adults should consider each individual’s preferences, including the types of exercise activities he or she will enjoy and pursue regularly. “Professionals working with older adults should explore their clients’ abilities, interests, likes, and dislikes. One person may enjoy the stimulation of equipment workouts in the gym. Another may prefer the camaraderie and choreography of group exercise to music. Professionals can provide invaluable direction by rejecting the one-size-fits-all approach and, instead, embracing the goal of helping older adults identify and pursue physical activities that fit them personally,” Clark says.

— Jennifer Van Pelt, MA, is a freelance writer based in Reading, Pa.


Engaging Mind and Body
Older adult facilities have increased what Colin Milner, CEO of the International Council on Active Aging, calls “in-the-moment” programming. Adapting the environment and activity schedules to enable older adults to connect with themselves—to nurture the mind and spirit, as well as exercise the body—is another new trend for older adults. Programming may include meditation classes, sunrise yoga or tai chi, and nature walks. Environmental settings may include labyrinths, healing gardens, and quiet rooms for meditation.

Such interest in older adults’ mind-body-spirit connection has followed a larger overall trend in holistic wellness and mind-body exercise. “While many baby boomers may dream about competitive sports, weekend warrior events, or the ‘make-it-burn’ exercise regimen, the baby boomer generation as a whole is moving toward a more conservative, healthful approach to regain or maintain fitness levels that will produce real wellness results,” says Deborah Redder of SilverSneakers. Engaging in activities such as yoga and meditation that stimulate the mind and spirit, as well as the body, is part of this wellness movement among older adults.



Elder Fitness Trends
Vic Arellano, MS, currently oversees the senior wellness division of Alliance Rehab Inc, an Oak Brook, Ill.-based company that provides senior living facilities with customized rehabilitation and fitness solutions. He notes the following trends in older adult fitness programming at Alliance Rehab client facilities:

• multidimensional wellness programming;

• programs to address management of chronic health conditions;

• evidence- and outcome-based programs;

• programs that address cultural diversity and bilingual learning;

• less emphasis on fitness and longevity and more emphasis on lifestyle choices and quality of life;

• nontraditional exercise options, such as yoga, tai chi, and meditation;

• the development of wellness centers rather than fitness centers; and

• elder care communities partnering with hospitals, therapy companies, and wellness consultants on space planning, staffing, and programming.

“Baby boomers are setting these trends which go beyond traditional fitness programs and instead emphasize purposeful activities that enhance quality of life and support lifestyle choices,” Arellano says. Alliance Rehab operates evidence-based programs that minimize safety risks associated with injuries and medical complications often found in less structured older adult programs. Additionally, it has developed elder wellness best practices that guide safe and effective participation of elders of all ages and fitness levels. The company uses a proprietary Web-based fitness outcome measurement system to capture and report data from the thousands of older adults in their wellness programs. The data are then used to validate the quantitative and qualitative benefits to participants and sponsoring organizations, Arellano says.

Alliance Rehab also provides exercise guidelines to address chronic health conditions, including arthritis, diabetes, osteoporosis, dementia, lung disease, and urinary incontinence. Some of its Active Aging exercise programs include balance and fall prevention, senior box-ercise, golf conditioning workshops, and mindful movement. “These programs address the most debilitating factors of functional decline and rising healthcare costs while at the same time meeting the interests of active seniors,” Arellano says.

Also important is the training and expertise of staff working with older adults. Training and certification curriculum is conducted in conjunction with a local university and addresses the physiological and psychosocial aspects of aging, marketing and communication skills needed for older adults, and techniques necessary for dealing with elders with special needs. Since the fastest growing age segment in America is the 65-and-older age group, Arellano says, the wellness industry serving elders is in a good position for growth, and the demand exists for professionals who understand the needs and wants of aging adults.