The importance of exercise to service users in care and nursing homes

The Journal of Physiology. Older people who are inactive or sedentary for any period of time can rapidly lose muscle mass and mobility. Researchers have been able to document for the first time how the same period of inactivity has a greater and more severe impact on the muscle power of the lower limbs of the elderly than young people, which is essential for movements like climbing the stairs. The disuse of muscles due to a sedentary lifestyle or short periods of inactivity caused by hospitalisation can dramatically enhance the decline in muscle mass, metabolic health and functional capacity. This loss of muscle power caused by disuse can be especially detrimental in the elderly. The research, conducted by the University of Udine in conjunction with the University of Padova, involved studying the impact of complete inactivity in a group of elderly subjects that were bedridden in a hospital environment for 2 weeks, and their results were compared with young subjects. In the elderly subjects, there was a difference in single muscle fibre response to disuse, a more pronounced loss of muscle mass and a change in how muscle contraction is controlled by the nervous system compared to young individuals. Furthermore, the recovery phase was more difficult in the elderly group. Carlo Reggiani, the lead investigator on the project commented on the findings: “While clinical and epidemiological data on inactivity in the elderly are abundant, experiments on disuse and inactivity are seldom performed in elderly for several reasons. The results obtained are relevant not only to understand the inactivity-dependent enhancement of the decline (in muscle mass, metabolic health and functional capacity) but also to design new rehabilitation protocols where timing and intensity of the sessions are optimized.” It is not uncommon for service users in care homes to sit for long periods of time, and in some cases because of ill health can be confined to their beds. As the aforementioned report shows inactivity and lack of exercise can have serious consequences for service user’s health and wellbeing and ultimately their quality of life.

The value of physical activity Further evidence of the importance of an exercise program for service users comes from a taskforce report, under the auspices of The International Association of Gerontology and Geriatrics. Its recommendations on physical exercise concludes that beside activities of daily living dependency service users in social care services face other important medical challenges. Dementia care, behavioral and psychological symptoms of dementia falls, pain, the use of potentially harmful drugs (e.g., antipsychotics), and mood (particularly depression), and quality of life are often recognized by staff and experts as crucial issues for the care of service users. Exercise training has the potential to improve many of the above-mentioned issues. Recent studies also suggest that exercise is of benefit for the mobility and physical function of people with dementia. One of the key challenges for staff is to maintain service users’ functional ability, which is made up of subjects’ intrinsic capacity and environmental characteristics and the ability to cope with their functional limitations for as long as possible. Overall physical activity has been shown to protect against activities of daily living disability. Experts in care home research and clinical care, with the support of the International Association of Gerontology and Geriatrics and the World Health Organization, have already recognized the importance of exercise for the quality of care of people who live in care homes. Scientific evidence has shown that exercise training, i.e. a subset of physical activity that is planned, structured, repetitive, and purposeful, being generally used to improve/maintain physical and functional capacities, has been found to have positive effects on the ability to perform activities of daily living.

Motivation Motivation and pleasure are the key aspects to take into account when attempting to increase overall activity levels of service users. To increase service users’ motivation, it is important to build awareness of the importance of replacing sedentary time with physically demanding activities, even if those activities are of light-intensity (e.g. walking slowly). Staff should attempt to promote service users’ physical engagement during social and daily life activities. Building awareness should target both the service users themselves as well as staff, other healthcare professionals (including the primary care physician), service users’ family, and policy makers.

Proposed recommendations to increase overall activity levels According to the International Association of Gerontology and Geriatrics, when considering the crucial importance of enhancing the overall levels of activity in the daily life of service users, the manager should consider: 1) To adopt strategies for breaking the sedentary time of service users. Establishing short breaks (2-5 minutes) twice or three times a day is probably feasible in a care home setting. 2) To systematically use simple strategies to stimulate service users to move: walking to the lunch/dining hall rather than using wheelchairs for people who are able to ambulate, and organizing events that require service users going out from their rooms. 3) To avoid chemical and physical restraints as much as possible since they result in bed and chair-rest. 4) To optimize the utilization of the architecture and equipment in order to promote mobility. 5) Staff, should organise group activities that are motivating and pleasant, for example promoting chair exercises and dancing where appropriate. 6) To use innovative solutions, such as using animal interventions and new technologies, in order to increase service users’ motivation and pleasure and, then, overall activity levels. Animal interventions have been shown to be effective in increasing physical activity in institutionalized older adults. 7) The use of robots which have been shown to decrease feelings of loneliness and improve participation in activities.

Summary The importance of exercise to service users in care and nursing is now supported by numerous health advisory studies worldwide. Managers of care and nursing homes should ensure that assessment of service user’s physical activity and a program of appropriate physical exercise forms part of the service user’s person centred care plan. Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy