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Most clinicians are no doubt familiar with the mental and physical benefits of regular exercise. And most patients are as well.
According to a survey by AARP, the majority of member respondents know regular exercise is good for them. Still, <20% of U.S. adults >64 years get the surgeon general's recommended amount of physical activity (i.e., 30 cumulative minutes of moderate activity most days).1
Fortunately, physicians can help motivate senior patients—including those with health conditions such as diabetes—to get active through a number of means.
"Physicians can make a huge impact by bringing up the subject during [an] office visit," says Colin Milner, who heads the International Council on Active Aging, a senior fitness association. "Research shows that patients do listen to their doctors' advice. The challenge is to address the issue of physical activity in the right way with older patients."
Senior fitness experts and researchers offer the following useful tips for influencing patients in their 60s and beyond to commit to more daily exercise.
• Teach patients that all movement counts.
"Encouraging [seniors] to simply take more steps throughout the day is often a better strategy than prescribing formal exercise," says Sheri Colberg, PhD, associate professor of exercise science at Old Dominion University in Norfolk, Va.
A recent 6-week study at University of Tennessee in Knoxville is a good
illustration. It included a group of 58 age-matched sedentary women equipped
with pedometers. Researchers asked half the participants to take 
10,000
steps/day and instructed the other half to take a brisk 30-minute walk most
days of the week. On average, the women in the daily steps group took about
25% more steps/day than those given the formal 30-minute walking prescription
and also were more likely to adhere to the
program.2
"We need to change people's perceptions of what constitutes exercise and talk to them about the real health benefits of just moving around more any way they can," Colberg says, providing examples such as using the stairs and parking farther from building entrances. "Those little spurts add up to meaningful benefits." And once seniors start moving, she says, they're more willing to gradually progress toward the moderate-level activity they need.
• Know your audience.
"The key to penetrating the hearts and minds of older adults is to speak their language," Milner says.
The AARP member survey found that the way in which physicians talked to older patients about exercise may have impacted responses. For instance, seniors responded positively to concepts, such as becoming "physically active," that suggest a wide range of activities. But they associated words like "exercise" and "staying fit" with something difficult or unpleasant.
"It also helps to remember your patient's mindset at this age," Milner says. In pre-retirement, older adults have experienced health changes and are starting to think about battling the aging process. In retirement, people are more focused on disease prevention and management and on maintaining their independence and functionality, he says.
"Asking about [patients'] health concerns at this stage of life can be a great conversation starter about how activity can improve their quality of life," Milner says. "Every patient in this age group wants that."
A good follow-up question: What has to occur for you to start getting more active?
"That always gets people thinking and recognizing any roadblocks they may need to clear out of their way," Milner says.
• Personalize exercise benefits. "Seniors often don't value exercise until they understand what they specifically have to gain from it," says Shannon Mihalko, associate professor of health and exercise science at Wake Forest University in Winston-Salem, N.C.
For their research, Mihalko's team focused on three independent-living communities offering an introductory physical activity session.3 Half of 79 residents with a mean age of 81 years received a flyer announcing the class. The other half were recruited for simple physical performance tests to assess balance, gait speed, and lower body strength. After getting feedback on their results, these residents also received the flyers. Researchers found that >50% of the residents who received the physical performance feedback attended the class, whereas just 12% who had received only the advertisement attended.
"If you can personalize the importance of exercise and show a patient how adding more activity could be specifically relevant to him or her, that patient is much more likely to buy into it," Mihalko says.
• Encourage fun.
Linking movement with favorite leisure-time activities also can strengthen commitment, experts say. "Helping patients find activities they enjoy and having negotiated activity goals helps them feel they're a partner in the plan instead of someone being told what to do," according to Mihalko.
For people who like socializing, physicians can recommend more walk-around outings with friends or even getting a dog that requires daily walks. For physically able people who enjoy reading or watching TV, riding a stationary bike or walking on a treadmill can turn a sedentary pastime into an active one. Low-impact sports such as golf and swimming, or even yard work and gardening, may also encourage activity.
• Use referral sources.
"Physicians can't be expected to be a one-stop resource for
everything patients need to successfully add exercise to their lives,"
Milner says. "Having a team and printed materials you can refer people
to for more in-depth assistance and information is a big help" (see
"FYI"). 
Exercise May Benefit Bottom Line, Too
Growing evidence suggests exercise may help reduce health care costs for older patients with diabetes.
In a study published in the January 2007 issue of Diabetes Care, seniors with diabetes who participated more often in a community-based physical activity program during 1 year had significantly lower total health care costs compared with seniors who attended fewer or no classes.1
The retrospective cohort study, led by researchers at University of Washington in Seattle, included >500 patients >65 years of age with diabetes enrolled in a large staff-model HMO. The researchers matched 163 study group patients with 3 control patients each, based on age, health risk, various comorbid conditions, glycated hemoglobin (A1C) levels, and baseline health care use and cost variables.
The researchers followed the study group's 12-month participation in an elective Enhanced Fitness Program involving three free weekly activity classes at >30 community-based sites in the Seattle/Puget Sound area. During the classes, certified fitness instructors led typically sedentary older adults through a 5-minute warm-up, 20–25 minutes of moderate-intensity aerobics, 20 minutes of resistance strength training, and 10 minutes of flexibility and balance training. Enrolled patients could attend as many free class sessions as they chose during the 12 months.
Enrollees who attended at least one exercise session a week showed statistically significant cost savings. They had 41% lower total health care costs compared with those attending less than one session per week and with controls.
Although the researchers did not analyze participants' use of health services, they suggest exercise may positively affect cardiometabolic risk factor control and rate of hospital admissions for acute hyperglycemic and cardiovascular complications.
Previous research also points to such cost savings and lower use of health care services among sedentary adults >50 years of age who engage in regular moderate physical activity, the researchers report. But they advise further study to clarify cost benefits for older patients with diabetes.
"We were not privy to other physical activities that the older adults may have been engaged in outside of the class," says lead author Huong Nguyen, PhD, RN. "So we clearly need more research in this area to better understand the relationships between exercise and its impact on clinical outcomes and health service use and costs for this older diabetic population.
"It's an area that's ripe for study," she continues, "since most patients want to know the minimum amount of exercise needed to achieve positive outcomes."
Footnotes
The International Council on Active Aging offers a searchable Facility Locator service and downloadable resource materials, co-sponsored by the American Academy of Family Physicians. To locate fitness facilities suited to older patients of varying abilities, visit www.icaa.cc.
The National Academy of Athletic Trainers can help identify certified athletic trainers qualified to serve as "physician extenders." These medically trained professionals can evaluate senior patients who want to become more active and will develop and monitor individualized exercise goals and plans with physician guidance. To learn more, go to www.nata.org/publications/brochures/phyextender.pdf.
References
2. Hultquist CN, Albright C, Thompson DL: Comparison of walking recommendations in previously inactive women. Med Sci Sports Exerc 37:676–683, 2005.
3. Mihalko SL, Wickley KL, Sharpe BL: Promoting physical activity in independent living communities. Med Sci Sports Exerc 38: 112–115, 2006.
1. Nguyen HQ, Ackerman RT, Berke EM, et al.: Impact of a
managed-Medicare physical activity benefit on health care utilization and
costs in older adults with diabetes. Diabetes Care 30: 43–48, 2007.
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