Older Ladies Gently Exercising

Evidence shows that exercise improves physical performance in community-dwelling older adults. But does that mean we should be prescribing exercise to help ward off frailty? YKC’s Dave Duffy shares his view.

Earlier this year, an article was published in the Lancet which asked: ‘Is there enough evidence to prescribe exercise to older adults living in residential care?’. It’s an interesting piece, and it makes some extremely valid points.


Raising the profile of musculoskeletal failure

Everybody’s aware of heart failure. We’ve all heard of kidney failure and respiratory failure. Yet nobody really talks about musculoskeletal failure. Essentially, that’s what happens when a (typically) older adult falls and breaks their hip or damages their knee. When you reach your 80s or 90s your bones and muscles simply don’t work as efficiently as they once did. The same is true for most parts of your body, from eyes to kidneys to respiratory system.

Unlike other conditions however, we tend not to speak of musculoskeletal failure as a condition. We tend to say “X has had another fall,” which always sounds a little like it’s the individual’s fault for not picking their feet up and being more careful. You wouldn’t use the same sort of language to describe someone who was having trouble breathing. This attitude towards musculoskeletal failure has contributed to its low profile relative to other conditions.

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The value of exercise

As the Lancet article notes, “Evidence from randomised clinical trials shows that exercise improves physical performance in community-dwelling older adults.” Exercise pushes back against the march of time. You can’t stop musculoskeletal failure, but you can slow its progression through regular exercise and activity designed to protect muscle tone, strength and endurance.

Putting load through your knee joint, for example, helps to promote bone health and keep the joint serviceable. When it comes to muscle mass and bone density, it really is a case of ‘use it or lose it’.

While all of that sounds reasonable, there’s an obvious problem. Older adults living in residential care are more likely to be physically weaker and frailer than their peers not living in care. They may not be inclined to exercise, and they may not have the physical ability to perform the exercises even if they wanted to, especially when starting out on a new exercise programme.

It’s for that reason that the authors of the Lancet article posed the question. If we know that musculoskeletal failure has a perception problem, and we know the benefits to musculoskeletal health of regular exercise, and we also know that those in residential care are less likely to engage in exercise to protect their musculoskeletal health, should we be prescribing it?


Should we prescribe exercise?

Prescription may help to change the way musculoskeletal failure is perceived. It may give it greater prominence. It may help unlock tailored, personalised exercise programmes which would be of far greater benefit to care home residents that the current, often one-size-fits-all approach. It may help keep frailty at bay.

But I’m concerned about that word ‘prescribe’. I’m concerned about the meaning that’s loaded into that word, and the optics of an approach which medicalises exercise and adds an almost compulsory element.

There is, of course, real benefit in encouraging people to retain their muscle mass and bone density. I am entirely in favour of daily, personalised routines to help protect against musculoskeletal failure. The issue is how we achieve that goal. I believe we should do it through making gentle exercise a natural, consensual part of every day, so we encourage rather than ‘force’.

If knee pain has left you struggling to maintain a healthy, active life, contact us or phone us on 03453 052 579.

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Dave Duffy

Dave Duffy

Private appointments weekly at The Duchy Hospital Harrogate & Nuffield Hospital Leeds

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Amanda Hardy
The Duchy Hospital Harrogate
07889 485 579

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Nuffield Leeds
07930 585 744


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