You've heard it a thousand times -- exercise is good for you. And now that you are caring for a family member, perhaps someone who is elderly or chronically ill, you're being told that they should be exercising too. And you may be thinking: It's hard enough to make time for my own exercise, how will I ever get "Mom" to exercise too?
When Karen, a mother of four children and nine grandchildren, found herself as the primary caregiver for her mother Joy, it took some time to shift her focus from her kids to her mother. Joy had always been extremely independent and healthy, but at 84 she had a stroke which left her with limited mobility on her right side. While she still had a positive outlook on life, she couldn't do certain daily activities, such as cooking, driving and laundry. Her balance was greatly affected, and after standing for any length of time, she became shaky and had to sit down. She often relied on a walker.
Joy received home care from VNSNY for several weeks after the stroke. Nurses and home health aides helped her and Karen learn many skills for managing life at home, such as dressing, bathing safely and grooming with limited right-side mobility. Her physical therapist stressed that daily exercise would help Joy continue improving her coordination, and it would also stave off other chronic conditions. Karen listened to the advice, believing that any exercise her mother did would help her, but anytime she tried to get her mother to do the prescribed exercises, Joy resisted. She hadn't exercised when she was younger, and felt particularly loathe to start now, at the weakest time in her life. "Mom felt uncoordinated, especially on her right side, couldn't stand for long periods, and was afraid of falling or hurting herself. Plus, she tired easily now, and the last thing she wanted was to be told to get up and exercise," stated Joy.
For those in their 70s, 80s or 90s, regular exercise may be a new concept. They did not grow up hearing about the many benefits of a regular fitness routine, and it could take some coaxing and some creative planning to get them to partake. As a family caregiver, you may be in the best position to help your family member start an exercise program. But it's natural to feel reluctant to be given "one more thing to do," particularly if you're facing resistance from the person for whom you're caring.
Is this a battle worth fighting? Most health professionals believe it is. According to the U.S. Surgeon General's Report on Physical Activity and Health, exercising regularly can help prevent or delay many diseases and disabilities, and exercise is also an effective treatment for chronic conditions one may already have, such as arthritis, heart disease, diabetes, high blood pressure, balance problems, and difficulty walking. In addition to these physical benefits, regular exercise can help the elderly with psychological symptoms, such as stress and depression. i
Studies also suggest that exercise can improve or maintain our ability to think as we age. According to an April 18, 2012 article in The New York Times Magazine, in just the past few months scientists have discovered that exercise appears to enhance cognitive flexibility and prevent shrinkage in the brain over time. According to the article, a limited number of studies in the past several years have found cognitive benefits among older people who lifted weights for a year; exercise seems to slow or reverse the brain's physical decay, much as it does with muscles.ii
Nina David is a yoga therapist who works with seniors at the VNSNY CHOICE Adult Day Center in Queens. She has experienced firsthand the resistance many seniors show to exercise, especially when they are already feeling physically weak. Her number one piece of advice for caregivers is not to make a big deal about exercise. "Start with small sessions and whenever possible, do them with your family member," Nina advises. "For example, teach your family member to take deep breaths, and breathe along with them. Deep breathing is good for the muscles of the upper body and this kind of synchronized breathing helps establish a connection between caregiver and care recipient."
According to the National Institute on Aging, there are four main types of exercise, and seniors need some of each:
- Endurance activities -- like walking, swimming, or riding a bike -- which build "staying power" and improve the health of the heart and circulatory system;
- Strengthening exercises, which build muscle tissue and reduce age-related muscle loss;
- Stretching exercises to keep the body limber and flexible; and
- Balance exercises to reduce the chances of a fall.
According to Ms. David, many seniors -- particularly those with conditions who require home care -- are not fit enough to start a program of biking or swimming. "It is very important to check with your physician before starting any exercise program," she warns, but once you have the okay from your doctor, any kind of physical activity will have benefits. Stretching arms overhead, flexing and rotating ankles, and lifting knees holding onto a chair can be a way to start. "Even if a person wants to remain seated, they can get their heart pumping," she states:
We tell them to sit in a straight-backed chair with their feet flat on the floor and start lifting the knees. First start with tiptoe-ing, then move to simulated walking, and progress to simulated running as the person gets stronger. Pumping arms at the same time will really get the heart rate up, and just a few minutes per day of this will build aerobic capacity.
Ms. David suggests that caregivers manage their expectations and remember that it is important to start slowly and congratulate even the smallest successes. "Over time your family member will begin to feel stronger and may even experience some of the endorphin rush that comes with physical activity."
On the advice of Ms. David, Karen worked with Joy to do some seated leg lifts, deep breathing, and arm movements with one-pound weights. After a month, they purchased a recumbent stationery bicycle for their family room, and Joy started pedaling each day. "She started very slow and is still only up to pedaling 10 minutes at a stretch," says Karen, "but Mom doesn't resist as much and does some biking almost every day. Even I get on it occasionally!" Karen laughs.
For more tips on how to get a family member to enjoy the benefits of exercise, visit the VNSNY "A Day in the Life" blog series at http://blogs.vnsny.org/2012/04/09/dementia-and-exercise/.
For more by Kathryn Haslanger, click here.
For more on caregiving, click here.