This article incorporates some of the latest available data on the benefits of
exercise in the elderly. The authors’ methods are sound and frequently innovative.
Even so, research methods in this field are not yet as sophisticated as in
areas such as stroke and neurotrauma. Most studies use only local samples, often
drawn by convenience. The Western world would no doubt benefit from a more
unified and balanced approach to exercise research in this rapidly growing patient
population. Interfacility databases, similar to those for brain and spinal cord
injury, could be used to create study populations that are more indicative of the
population of elders as a whole, permitting the drawing of stronger conclusions.
Furthermore, few studies focus on disabled elders. Because the incidence of
stroke, cardiac dysfunction, and related impairments is high in these patients,
wider study of this population would be beneficial.
Although this article focuses on individual types of exercise and their contributions
to patient health, any exercise program for a senior will incorporate
aspects of them all. The program must be tailored to the individual needs of
the patient, based on physical examination and laboratory and diagnostic data.
(See case study in Box 2.)
The American College of Sports Medicine, while acknowledging that severely
deconditioned older adults may prefer to begin with a low-intensity program such
as twice weekly PRT, advises that frequency and intensity be increased to achieve
an overall moderate-to-heavy-intensity goal. This principle holds especially true
for endurance exercise, which is the best demonstrated by research to have a
positive impact on health [57].
The community physician will undoubtedly encounter questions about
whether exercise is safe for a deconditioned elder. Taking into account the
aforementioned data, most physiatrists would advocate that the question be recast
as one of whether an elder is safe remaining sedentary. A comprehensive overexercise