Gentle exercises for older, frail people

Exercise can boost both the duration and quality of your life, especially if you start when you’re young and keep at it. But as people age, heart disease or other health problems sometimes derail exercise routines. The resulting loss of muscle and endurance often contributes to frailty, which affects about a quarter of people after age 85 but can also occur at younger ages (see “What is frailty?”).

Because frailty often develops gradually, it can be overlooked. “It’s usually a family member who notices that the person is looking a little less steady or walking more slowly than usual,” says Darlene Harrier, a physical therapist at Harvard-affiliated Beth Israel Deaconess Medical Center.

What is frailty?Clinicians use the term “frail” to describe people ages 65 and older with age-related physical decline that leaves them vulnerable to injuries and other health problems. Although we usually think of frail people as being thin, people who are overweight or obese also can be frail. In fact, overweight frail people may be even weaker than their slimmer counterparts because their muscle has been replaced with fat, and they have extra weight to move around.According to one widely accepted definition, you are considered frail if you meet three of the following criteria:You have lost 10 or more pounds in the past year without trying.You have trouble standing without assistance or have a weak grip.You walk slowly; it takes you more than six or seven seconds to walk 15 feet.You feel exhausted often and can’t get going three or more days most weeks.You aren’t very active; household chores and activities you once did for fun feel too challenging.

Realistic options

But if you — or your spouse, partner, or parent — is frail, don’t assume there’s nothing you can do about it. For people who’ve had a heart attack or heart procedure, cardiac rehabilitation might be an option. However, this supervised exercise and lifestyle program involves hourlong sessions several times a week for several months. As such, it probably isn’t realistic for people who are frail.

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Instead, consider working with a physical therapist, who can provide safe, personalized exercise coaching to help people regain strength and mobility. “Primary care doctors and geriatricians are often happy to refer their patients to physical therapists,” says Harrier. They want to keep them as independent as possible and minimize their risk of falling, she adds. During a session, physical therapists can check a person’s heart rate, breathing rate, blood pressure, and oxygen saturation at rest and then after a short period of exercise. “We want to make sure you’re exercising at an appropriate level,” says Harrier.

Heart disease and frailty

Expert guidance and monitoring is particularly important for people with cardiovascular problems. Coronary artery disease may limit exercise capacity, leading to chest pain or shortness of breath even at low levels of effort among those who are frail. Other cardiac conditions such as a narrowed heart valve or a heart rhythm disorder can leave people more vulnerable to dizziness or fainting, which increases the risk of falling. And falls are especially dangerous for people taking anti-clotting medications (which are prescribed for many heart problems) because these drugs increase the risk of bleeding.

Gentle exercise examples

Walking — even at a slow pace and with a cane or a walker, if needed — can help build stamina. Simple strength exercises can be done while sitting in a chair or even lying in bed so you don’t have to get up off the floor afterward, says Harrier. Two leg-strengthening exercises she recommends are clamshells and bridges. Clamshells are done lying on your side with your knees bent and raising and lowering only your top knee while keeping your feet together. For a bridge, lie on your back with your knees bent, then lift and hold your buttocks off the ground. You can also do mini-crunches on your back to engage your core muscles — just reach up to your bent knees with your fingertips. To build arm strength, make fists and do punches, both straight ahead and over your head, while seated in a chair.

If balance is a challenge, here’s an exercise to try. Stand with your back in a corner, with the back of a chair facing you so you’re supported on all sides. Practice standing with your feet close together, then one in front of another, and if possible, on one foot at a time.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

No one has ever seen God; but if we love one another, God lives in us and his love is made complete in us. 1 John 4:12

This is what the Lord requires of you: Do justice, love kindness, and walk humbly with your God. Micah 6:8

People will not call you Deserted anymore. They will no longer name your land Empty. Instead, you will be called One the Lord Delights In. Your land will be named Married One. That’s because the Lord will take delight in you. And your land will be married. As a young man marries a young woman, so your Builder will marry you. As a groom is happy with his bride, so your God will be full of joy over you. Isaiah 62:4

Be joyful in hope, patient in affliction, faithful in prayer. Share with the Lord’s people who are in need. Practice hospitality. Bless those who persecute you; bless and do not curse. Rejoice with those who rejoice; mourn with those who mourn. Live in harmony with one another. Romans 12:9

Let love and faithfulness never leave you; bind them around your neck, write them on the tablet of your heart. Proverbs 3:3

A cord of three strands is not easily broken. Ecclesiastes 4:9-12

Perhaps this is the moment for which you have been created. Esther 4:14

This is my commandment, that you love one another as I have loved you. John 15:12

And above all these put on love, which binds everything together in perfect harmony. Colossians 3:14

Though one may be overpowered, two can defend themselves. A cord of three strands is not quickly broken. Ecclesiastes 4:12

Be devoted to one another in love. Honor one another above yourselves. Romans 12:10

My beloved is mine and I am his; he browses among the lilies. Song of Songs 2:16

Recommended contacts for prayer request and Bible study

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