Implementing a physical activity program: It's not only fun, it's cost-effective. (Feature Article).

Most health and exercise experts agree that physical activity is important at any age. Consistent physical activity is especially important to maintain functionality and avoid degenerative aging. However, many long-term care facilities neglect to include physical activity as an essential component of their resident activity programs.

During this era of tight budget margins and reduced third-party reimbursements, it may seem infeasible to add another component to the resident activity program. However, the inclusion of physical activity need not be expensive. In fact, a consistent physical activity program might result in lower costs because of a stronger, healthier, and abler resident population. The following are low-cost options to consider when implementing a physical activity program in your facility.

Involve the Staff Physical Therapist

A staff physical therapist or his/her aide might schedule a regular 30-minute group exercise session for all interested residents around individual skilled rehabilitation sessions. The group exercise session gives residents an opportunity not only to exercise their joints and muscles, but to socialize with their peers. This also will give residents who may not be eligible for physical therapy benefits an opportunity to add a physical activity component to their daily regimen.

At the National Lutheran Home for the Aged, a CCRC located in Rockville, Maryland, the staff physical therapist, Judy Singh, provides a 20-minute exercise class three mornings a week. Participating residents gather in the physical therapy studio, where they socialize until class begins, which is for many residents the key motivation to attend class. Singh has created a party-like ambience that continues to attract participants. Playful music fills the room with cheer, while tasty treats on a table nearby keep the residents energized throughout the session. Class participation is a must in this studio. Residents are asked to count in various languages as they perform their exercises. The exercises are quite simple, requiring minimal equipment and coordination. Exercises include squeezing stress balls while alternating them between hands, marching while in a seated position, clapping, and performing biceps curls. Ankle weights are added both to ankles and arms to increase exercise intensity. The physical therapy studio also is available at other times for those residents who prefer individualized exercise.

Got a Pool?

Many long-term care facilities have indoor swimming pools. Physical activity inside a pool with a water temperature of 86[degrees] F may help to alleviate arthritic pains. Aerobic and strength-building water exercises are low-impact and do not add stress to the bones and joints. To teach this type of exercise, an instructor should be certified in group water-exercise instruction.

No pool at your facility? The fitness industry increasingly provides group water-exercise classes to seniors within the community. Inquire at your local YMCA/YWCAs and private gyms to see if they would be willing to provide senior water-exercise classes for your residents during off-peak hours.

Chair Aerobics

Chair aerobics can be scheduled in an activity or day room in your facility. Arrange chairs in several wide rows or in one big circle. Then add great music and a cheerful, outgoing instructor, and this session will become very popular. Again, the instructor should be certified in group exercise and possess the knowledge and skills necessary to teach a senior fitness class. Aerobic, flexibility, and strength building exercises can be done while seated or in a standing position with one hand holding the chair for balance. To add a resistance element for strength building, purchase elastic bands. Elastic bands and exercise instructors do not necessarily entail a large investment but, if necessary, residents might be charged a minimal fee, such as $3 per class, to reduce the cost to the facility.

Chair aerobics also can be adapted to the capabilities of the cognitively impaired. Simple exercises can be performed with residents on dementia/Alzheimer's units. When I served as an activity aide in an Alzheimer's unit, residents were arranged in a circle to engage in a game of volleyball or catch with lightweight balls of varying colors, sizes, and textures. Such games provided amusement as well as movement to residents with an otherwise sedentary lifestyle.

Walking Routes

This option may be the simplest and lowest-cost physical activity to implement. Design a walking route inside your facility or on your campus. Use way finding signs to direct walkers along the path. Incorporate distance measurements, such as meters, on the signage, thus providing residents with a yardstick to self-monitor their improvement as endurance and strength levels increase. Add rest stops along the path to alleviate any tired feet and allow residents to replenish fluids. To add a social milieu, establish walking groups that meet on a designated schedule.

At the National Lutheran Home for the Aged, a sidewalk circumscribing the entire facility provides residents with a scenic walking path. Park benches are conveniently situated along this path, giving residents a place to recuperate and enjoy the natural environment. Furthermore, doors on opposing sides of the facility can be accessed by any resident unable to complete the path. This walking route gives residents a much-desired outdoor exercise option.

Dance Parties

Most seniors, if not all, enjoy the nostalgia of listening to music from their generation. Many still enjoy dancing to their favorite tunes. Dancing provides great aerobic activity. As an activity aide, I often danced with the residents on my unit. Those who were not mobile remained seated, clapping and laughing with delight. Regular dance engagements give residents opportunities for joyful physical activity.

Gardening

An old hobby for many, gardening combines physical activity and the opportunity to reminisce about previous gardening experiences. Informal and personal, this activity invites residents who are leery of any type of formalized exercise program to participate. Most facilities provide elevated flowerbeds that allow residents to stand or sit while working. Tools always should be available in the flowerbeds to encourage residents to garden on their own.

In the Alzheimer's unit of a 100-bed skilled nursing facility I worked at, a secured outdoor patio provided residents an occasion to garden outdoors. Residents entered the patio through the dining room. A central flowerbed filled with tools gave both mobile and chairbound residents access to physical activity. For an Alzheimer's unit, this option was beneficial to wanderers who embraced the purpose that the gardening activity provided.

Senior Olympics 

To emphasize your administration's support for physical activity, an annual Senior Olympics Day can be scheduled. Such an event will arouse spirits of enthusiasm, competition, and camaraderie. Individuals and teams of residents can preregister for listed events and use the preceding months to improve and perfect their skills. Emphasizing fun instead of competition will encourage participation from more residents. Group sports might include volleyball using a beach ball or bowling with a waffle ball. Individual events might include a walking race or indoor golf. The list of potential events is endless. Be creative. Most importantly, everyone who participates should receive an award.

Although physical activity is important, safety must be the first priority. Each participating resident's primary care physician must submit a medical clearance for aerobic, flexibility, and strength building exercise. The physician also might submit an exercise prescription describing the type of exercise, duration, intensity, and frequency appropriate for that particular resident. Those residents who have been cleared medically for physical activity should be encouraged to participate consistently in exercise sessions.

Participation in a physical activity program will enhance residents' quality of life. Symptoms of depression should decrease, while independence may increase as endurance and muscular strength improve. Incorporating a physical activity program in your facility is a win-win situation. Residents benefit from a higher quality of life, while the facility lowers its costs by caring for a healthier and more independent population.

Aisha Mansour, MHSA, is a licensed NHA and an Aerobics and Fitness Association of America-certified primary aerobic instructor based in Wauwatosa, Wisconsin. For information, phone [phone].

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