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Published: 20 Jun, 2018

Researchers provide exercise recommendations to counter health-detrimental passivity in long-term care facilities

NEWS An international group of researchers present concrete and evidence-based recommendations for how older people in long-term care facilities can have their physical activity and exercise needs met. The recommendations are published in the Journal of American Medical Directors Association.

”Relatively recent research shows that intensive exercise is health beneficial for older people with large care needs,” says Erik Rosendahl, who is professor of Physiotherapy at Umeå University, in Sweden, and co-author of the paper. 'Long-term care facilities' (LTCF) are too often passive settings. As a group, residents are unfortunately often forgotten about, especially when it comes to those who because of disabilities need help and support to exercise. But the recommendations we have developed allow LTCF-staff to begin to change this, provided that they are also given the necessary resources.”

Erik Rosendahl

Erik Rosendahl is part of a group of world-leading researchers within this area that have developed the evidence-based recommendations for how LTCF-staff can increase physical activity and exercise for residents. The recommendations are formulated to be internationally useful and distinguish between general physical activity, which all LTCF-residents need, and personalized intensive exercise for people with extensive care- and rehabilitative needs. 

Widespread health-detrimental passivity

Physical inactivity among LTCF-residents is an international health problem. One study of physical activity in Japan found that, during six mid-day hours, when the most staff were present and residents would be expected to be most active, residents spent 60 percent of the time sitting and 20 percent lying down. Findings from a study by Umeå University researchers showed that nearly half of LTCF-residents had not been outdoors in the last two weeks, that only one in ten residents had not been outdoors more than once a week, and that half of residents had not even been outside their own ward more than once a week.

”Personnel shortage is often the biggest challenge,” says Erik Rosendahl, who recently conducted an exercise study with LTCF-residents with dementia. “In Sweden, one physiotherapist can be responsible for as many as 500 residents, which in reality means that every resident gets less than one minute of personal exercise per week. LTCF-homes with sufficient physiotherapy staff resources have better opportunities, but optimized care and rehabilitation also require increased staffing of other professionals.”

Recommendations for increased daily physical activity

Based on the notion that everyone has the right to physical activity, the recommendations hold that LTCF-staff can do a lot to facilitate this in the residents’ daily routines. Simple strategies are proposed for how to counteract sedentary conditions, with several periods of physical activity per day as the goal. Examples of proposed strategies are to:

  • encourage residents to walk to the dining hall instead of being driven in a wheelchair
  • regularly evaluate the need for drugs that reduce residents´ activity levels
  • avoid the use of physical restrains such as belted chairs
  • look at how equipment, furniture and architecture can be arranged to optimize residents’ mobility
  • organize pleasant group activities that motivate to physical activity, such as gardening, dancing and outdoor walks
  • use innovative solutions, such as new animal interventions or new technology, to stimulate physical activity

Personalized exercise programmes for residents with large care need

LTCF-residents in need of help with daily activities should have a personalized exercise programme and assistance to perform it. It is important that all residents, who are able to, have the opportunity to exercise at medium- or high intensity for 35-40 minutes, at least two times per week. However, the researchers also emphasize that it is both safe and desirable that residents who are in better physical shape exercise more regularly and for longer periods of time.

According to the recommendations, muscle strength and cardiorespiratory endurance exercises should always be part of the regimen. Flexibility and balance exercise can be included whenever possible. A medium-intensive muscle strength exercise can be 13-15 chair-rises, where the load (adjustable with for example weighted belts) is such that the person is not able to perform more repetitions without resting first.

Erik Rosendahl argues that society often has a short-sighted view of treatment and care of LTCF-residents:
”Research shows that exercise and physical activity for elderly with care needs is not only greatly beneficial of their individual health, it can also be economically beneficial for society. As people’s knowledge increases, I hope that elderly care providers also will commit the increased resources needed to meet the full needs of their residents.”

Read a digital publication of the article in JAMDA

About the publication:

Journal of the American Medical Directors Association, article: Recommendations on physical activity and exercise for older adults living in long-term care facilities: a task force report. Authors: Philipe de Souto Barreto, John E Morley, Wotjek Chodzko-Zajko, Kaisu H Pitkälä, Elizabeth Weening-Djiksterhuis, Leocadio Rodriguez-Mañas, Mario Barbagallo, Erik Rosendahl, Alan Sinclair, Francesco Landi, Mikel Izquierdo, Bruno Vellas, and Yves Rolland. DOI: 10.1016/j.jamda.2016.01.021.

For more information, please contact:

Erik Rosendahl, Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå UniversityPhone: +46 90 786 9137
Email: erik.rosendahl@umu.se
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Editor: Daniel Harju