Exercise as Therapy for Seniors

Q: Would exercise really help my 88-year-old mother?

A: Yes, it would. For almost every ailment your parent could have, exercise can improve his or her quality of life. At the University of Michigan medical school, students are taught that the one thing they can tell patients that would most impact their health would be to start exercising. Even though she is 88, exercise can still make a difference in the time your mother has left.

Q: What kind of exercise is most helpful?

A: Any exercise that your parent enjoys and will do regularly would be best. General guidelines are to build up to 20 to 30 minutes at least three times a week if at all possible, but depending on your parent's health status, he or she might want to consult a physician or physical therapist first.

People with arthritis or Parkinson's disease should speak with physical or occupational (helps people overcome disabilities to function in work and home environments) therapists trained in those conditions.

Your parent could:

• join a gym, where he or she can participate in fitness classes, many of which are tailored for seniors
• work out with a trainer
• exercise along with friends
• purchase an exercise or dance CD, and then exercise at home along with it
• take up activities such as gardening, vacuuming, walking or dancing, all of which could be considered exercise.

Q: How will my parent know when he has exercised too much?

A: Your parent needs to learn to listen to his or her body. If your parent is out of breath, in pain, dizzy or nauseous, then it is time to stop exercising.

Q: Is it dangerous for my parent to exercise alone?

A: That is a question for your parent's doctor to answer. But most people enjoy the exercise more if they have someone to do it with. If this is not possible, as long as the doctor says it is okay, exercising alone should be fine.

Q: Will exercise make my parent's arthritis pain worse?

A: Actually, doing the correct exercises for the specific kind of arthritis your parent has can help him or her to feel better over time.

Your parent should only exercise as much as the doctor orders, and it is best if your parent does it with a physical therapist specially trained to work with arthritis patients. Moving the joints will help reduce stiffness, which will ultimately make your parent more comfortable. If your parent exercises properly, building up gradually and also protecting swollen joints, his or her pain, fatigue and stiffness will all improve. But if your parent doesn't exercise, his or her joints can deteriorate and become so stiff that it will be difficult to move.

Q: Why is weight loss important for arthritis patients?

A: Excess weight puts more pressure on joints, causing more pain. That is why losing weight can help and is another reason why exercise -- which helps with weight control -- is important for arthritis patients.

Q: Why is exercising in a pool helpful for people with arthritis?

A: Water eases the stress on joints and makes exercising -- especially stretching and aerobics -- less painful for arthritis patients. Exercising in a pool helps relieve pain and improves the ability to move more easily. So one way you can help your parent is to facilitate getting to a pool where exercise programs for people with arthritis are offered. Make sure the water in the pool is warm enough, so your parent doesn't get chilled.

Q: My parent had a worsening of arthritis symptoms after exercising. Why?

A: In general it is good to exercise, but if your parent has pain that persists for two hours or more after exercising, then he or she has done too much and needs to cut back. After a worsening of symptoms, your parent should only do very gentle exercises that work on range of motion. Your parent can gradually progress and slowly add a few more exercises if things are going well.

Q: Are there things my parent who has arthritis should not do when exercising?

A: Your parent should avoid staying in one position that puts weight on joints and should in general move in ways that reduce stress on joints. Your parent needs to learn when to stop and rest by paying attention to his or her body and how to move while also saving energy. If your parent gets too tired when exercising, then it is time to stop.

Q: How can I help my parent who has become very weak due to chronic lung disease?

A: Your parent needs to learn how to conserve energy.

• One tip that works for many people with chronic lung disease is to rest for an hour after each meal. This gives the body time to digest the meal before using energy on something else.
• Here are other ways to conserve energy:
  • Your parent can try keeping the things he or she needs right by his or her chair, so that it isn't necessary to move too much to get them.
  • Your parent can immediately set the table with the dishes and silverware when removing them from the dishwasher -- saving the energy of putting them away in the cabinets and then removing them to set the table.
  • Your parent can put pots and pans back on the stove after washing them, to save the energy of having to bend to put them away and then to get them out again.
• If your parent lives alone, find someone else to prepare meals, shop and do chores.
• Most importantly, exercising can help tone your parent's muscles and get them to work more efficiently, helping to counteract the loss of muscle mass and strength due to inadequate oxygen. Working with his or her doctor, your parent should try to gradually build up the number of steps he or she can take.
• Some communities have lung rehabilitation programs that could be very helpful, gradually strengthening your parent and teaching him or her ways to cough and manage bronchial drainage more effectively.

Q: How can I help my parent with kidney disease?

A: Keeping weight down can be helpful in controlling blood pressure and kidney disease. So encourage your parent to exercise -- volunteer to accompany him or her, or suggest that your parent exercise with a friend, join a gym, or find a trainer. You can also encourage your parent to be active in ways he or she enjoys, such as gardening, hiking, walking or golfing.

Q: What can I do to help my parent live with heart disease?

A: Here are some things you can do:

• Encourage your family to avoid conflict with or in front of or with your parent, since stress is not good for people with heart disease.
• Try to maintain a positive atmosphere, while honestly acknowledging and not disparaging your parent's understandable anxieties.
• Encourage your parent to make whatever lifestyle changes were recommended.
  • Reinforce the doctor's advice to take up exercise, which done regularly will make the heart and lungs stronger. This will enable the cardiovascular system to send more oxygen throughout the body with each heartbeat and the pulmonary system to bring in more oxygen.
  • Avoid smoking in front of your parent if he or she is supposed to give up smoking.
  • Similarly, if your parent is supposed to follow a low-fat diet, only eat low-fat foods in his or her presence and be positive about the experience, to help reinforce behavior changes.

Q: Will my parent regain her former energy level since having a heart attack?

A: Most people -- depending on the extent of damage in the heart attack -- find that the initial level of exhaustion is temporary, and that they are then gradually able to resume an active life.

Your parent should be increasing his or her activity level each day, at the pace recommended by his or her physician. If your parent follows the doctor's instructions, and unless his or her doctor has said otherwise, you should be able to provide reassurance.

According to Jane Brody, health writer for The New York Times, the "core of cardiac rehabilitation is a progressive exercise program to increase the ability of the heart to pump oxygen- and nutrient-rich blood more effectively throughout the body. The outcome is better endurance, greater ability to enjoy life and decreased mortality."

Q: How can I convince my parent with heart disease to exercise as his doctor recommends?

A: Perhaps if you or another family member or close friend exercises along with your parent, he or she will be more likely to exercise. Encourage your parent to try it for just a week and see if he or she feels better at the end of the week. If this incentive doesn't help, perhaps you should discuss the problem with your parent's physician.

Q: My parent is anxious about having another heart attack. How can I help?

A: Anxiety is a normal response to a heart attack. Here are some suggestions taht may help:

• Encourage your parent to exercise -- only as much as his doctor recommended -- as a means of feeling less anxious.
• Many heart patients have benefited from the regular practice of relaxation techniques, which have been found to decrease anxiety, boost the immune system and also promote heart health.
• Some find physician-prescribed anti-anxiety medication helpful, either alone or in conjunction with relaxation techniques.

If your parent's anxiety persists and doesn't diminish, you should seek professional help.

Q: The doctor told my diabetic parent to exercise. Why?

A: Exercise can help diabetics in several ways. It has been shown to improve glucose tolerance -- meaning that blood sugars are controlled with less medication -- and to lower the chance of developing serious complications from the diabetes. It also helps a person deal with stress and decreases the risk of getting diabetes in the first place. Finally, weight control is an important part of diabetes treatment, and exercise helps with that.

Q: My diabetic parent has never exercised. How can I get him started?

A: If you live near your parent, offer to exercise with him. If not, encourage him to exercise with a friend or trainer, or to do things he enjoys outside, which can include:

• Walking
• Gardening
• Playing Frisbee
• Swimming
• Boating
• Playing physical games

Q: Besides helping my parent find a therapist, how can I help with the depression?

A: Here are some things you can try that may help, depending on the level of depression:

• Devise ways to get your parent out. Remind your parent of things he or she used to like doing, and plan to do one of them together. This could mean going to a sports event, having dinner together, going fishing or walking or to a movie, etc.
• Plan activities that get your parent interacting with others -- whether family or friends.
• Encourage your parent to take a class or join a gym, as either one would get him or her out of the house to a place where he or she could see the same people week after week, and could hopefully connect with some.
• See if you can encourage your parent to exercise. Exercise helps mood, as the endorphins released while exercising promote a sense of well-being -- so a daily exercise regimen could be very beneficial.
• Help your parent to find a good doctor for any medical problems and accompany him or her to appointments if possible. In this way you can provide support, raise medical concerns, and take notes on what the doctor says. If you then print out and laminate the notes, making several copies that can be left around your parent's house, this will remind your parent to follow the doctor's instructions.
• Make sure treatment for depression and for the medical problem is working. Does your parent feel comfortable with the therapist? With his or her physician? Are there side effects from the medication? Is your parent still taking the medication? Closely observe your parent and make sure the depression seems to be decreasing, not increasing.
• Many depressed people are also anxious, and for them adopting the regular practice of a relaxation technique could be helpful. In addition, treating the anxiety medically could help.

Q: How can I help my parent who has neuropathy (nerve damage) due to chemotherapy?

A: Since seniors have fewer nerve cells, and those they do have are losing their coating (causing them to transmit signals less effectively), they may be more prone to chemotherapy-induced neuropathy than others. This nerve damage usually occurs in the hands, feet, arms and legs. It can produce:

• pain
• tingling
• numbness
• a decreased sense of touch

Here are some things you can do to help:

• Encourage your parent to walk if it is not too painful, as this might increase blood circulation and reduce the neuropathy.
• Caution your parent to avoid using sharp objects, such as razor blades, knives and scissors, as due to the neuropathy it may be difficult to realize he or she is getting cut until it is serious. An electric shaver would be safer at this time.
• Check that your parent's finger and toe nails are not sharp or too long, as he or she could inadvertently get scratched.
• Avoid keeping the temperature in your parent's home very warm or cold, as either extreme could be painful.
• Purchase shirts that don't need to be buttoned, shoes that don't need to be tied, and pants that don't need to be fastened. These will make your parent's life easier and help him or her to be more independent.

Q: How can I help my parent with chemotherapy-induced hair loss?

A: If your parent is traumatized by hair loss:

• Empathize, and don't minimize. Even though this symptom is not as debilitating as, say, nausea, it is very public and distressing. Don't rush your parent into thinking about wigs and hats. Let him or her focus as long as needed on the unwished-for change.
• When your parent is ready, help find wigs, hats, eyebrows and/or eyelashes that make him or her feel more comfortable with him- or herself again. Support your parent's search for the right look. The hair loss may have reinforced your parent's sense of loss of control due to aging -- as well as due to cancer -- and feeling okay about appearance may enable your parent to feel more in control. Some websites that may be helpful are: Headcovers Unlimited and breastcancer.org.
• If your parent expresses shame or discomfort for being upset about something trivial or superficial, let him or her know that the reaction is totally understandable.
• If your parent is reluctant to be seen in public with this evidence of illness, help him or her come up with a response to use if someone comments on it.
• If your parent is depressed due to the hair loss, find someone for him or her to talk to who has experienced the same thing, and see if this helps. Some people, if they can summon the energy to do so, find that exercise improves their sense of well-being, which helps their mood and therefore helps combat depression. If this doesn't help, find a professional to treat your parent's depression.
• Suggest, but don't insist, that your parent join a cancer support group, which many patients find helpful. In some support groups members share their experiences and feelings, while in others they participate in activities like yoga or guided meditation. Support groups can be found at your local hospital, or online at: cancer.org. Find one that fits your parent's personality and preferences.
• Many people find talking with a clergy person to be helpful.

Q: Are there any approaches that can help when dealing with chronic pain?

A: Some techniques, which can be used in combination, include:

• distraction -- which can help patients focus on things other than the pain.
• hypnosis -- which can help patients focus on things other than the pain.
• physical therapy -- which can improve blood and oxygen flow to muscles, help relax the muscles, and relieve the pain.
• electrical nerve stimulation -- which may interrupt the pain pathways.
• heat -- which can relax muscles.
• cold -- which can numb muscles.
• support groups -- which can help your parent realize that he or she is not the only one experiencing pain.
• pain treatment centers -- which offer the latest treatment methods available. Different centers take different approaches. The American Chronic Pain Association has tips on finding a center that would be most suitable for your parent.
• Counseling -- which can provide support and someone to discuss the pain with.
• Exercise -- which improves blood and oxygen flow to muscles and helps them relax, thereby interrupting the pain cycle.
• Stress management -- which can help, since stress leads to muscle tensing, which causes more pain.
• Proper nutrition -- which helps your body cope with anything, including pain.
• Getting enough sleep -- which helps the body relax. People who don't sleep well tense up, increasing pain.
• Yoga -- which can help relax the muscles, but must be done carefully, so as not to aggravate the pain. It's best to get advice from a physical therapist before beginning yoga to find out what poses are safe and which aren't.
• Tai chi -- which can help relax muscles.

Q: Is there anything I can do to reduce my parent's fatigue from radiation?

A: Encourage your parent to:

• Eat lots of protein, which will help repair body tissues.
• Consume an adequate number of calories and fluids, and take a multivitamin.
• Exercise, which could help your parent feel more energetic and lift his or her spirits.

Q: How can I help my parent with depression from radiation therapy?

A: Depression during treatment is quite common, perhaps from the exhaustion that accompanies radiation, from some other side effects, or from worries about future quality of life. Here's what you can do:

• Reassure your parent that the side effects will disappear within a few weeks of ending treatment, but also tell his or her doctor about the depression. Treating the depression may help your parent's recovery from the radiation.
• If your parent can summon enough energy to exercise, it could help lift his or her spirits a bit.
• Some people benefit from joining a support group for cancer patients or those with their particular form of cancer. In some support groups members share their experiences and feelings, while in others members practice things like yoga or guided meditation. Support groups can be found at your local hospital, or online at: cancer.org. Find a group that fits your parent's personality and preferences.
• Many people find talking with a clergy person to be helpful.

Q: How can I help my parent deal with his stiff limbs due to Parkinson's?

A: It will be important for your parent to see both a physical therapist and an occupational therapist (someone trained to help people overcome disabilities to function in work and home environments) specializing in Parkinson's disease.

• The physical therapist can prescribe exercises that may reduce the stiffness.
• The occupational therapist can teach your parent ways to make normal activities easier, given his or her particular condition.
• Resistance training and aerobic exercise may improve your parent's ability to function -- which includes balance, ability to walk, and mood.
• The occupational therapist may also recommend certain adaptive devices that will enable your parent to do more.

Q: My parent has been very depressed since the Parkinson's diagnosis. How can I help?

A: Depression is a frequent reaction to the diagnosis of Parkinson's. However, it is possible that your parent will still have many years of good functioning.

If your parent refuses to exercise, treating the depression may help improve the quality of the rest of his or her life and ultimately enable your parent to more actively participate in disease management.

Q: Can anything be done for my parent's uncertain gait and mobility problems?

A: If your parent has balance problems, movement and exercise will strengthen muscles and bones and may diminish the balance problem. However, your parent will need to move carefully and safely, perhaps with the help of a walker or of an attendant -- either a family member or home care aide. Here are some suggestions:

• Talk with your parent's health care provider to learn if any exercises would help him or her. Be sure you know how to do them properly, and then guide your parent. Or, if you live far away, encourage your parent to exercise and help find someone to work with him or her to do it properly. Offering positive reinforcement for movement, while also acknowledging any pain your parent may be experiencing, can strengthen his or her determination to keep moving as much as possible.
• Ask your parent's physician to arrange for someone to show you how to help your parent get around. This person could be a physical therapist, visiting nurse, occupational therapist or social worker, who could also help you arrange for medical equipment (wheelchair or walker).
• Warn your parent not to carry bulky loads, such as laundry or garbage, as these could destabilize him or her. Find someone to do your parent's laundry and to take out the garbage.
• Have a physical therapist teach your parent how to fall safely and how to get up from a fall. Practicing these measures could help overcome fear of falling.

Q: I have heard that exercise can help stroke patients. Is this true?

A: It has been found that for people who have mini-strokes, increasing exercise very slowly over time will enhance blood flow to the brain and possibly lower the risk of a major stroke. Plus, exercises that are aerobic and strength enhancing improve the ability to perform daily tasks for stroke victims for up to six years afterwards.

Q: Is it safe for my parent to exercise after breaking a hip?

A: Actually, your parent will need to exercise in order to improve the function of his or her hip. Your parent will have to do it carefully, but exercise is critical to recovery.

Q: My parent has been depressed since breaking her hip. How can I help?

A: Elders who break their hips can feel that the situation is the beginning of the end, and that they will become increasingly frail and incapacitated.

• Empathize with your parent's feelings.
• Don't minimize the situation, but remind your parent that the disability is temporary and that he or she will gradually become more fully mobile.
• If your parent continues to feel depressed, tell the doctor and make sure the depression gets treated and starts to improve.
• Any exercise that she is able to do will help improve her mood.