Physiotherapy for Older Adults: Maintaining Mobility and Independence

As we grow older, maintaining our mobility and independence becomes increasingly important. There’s a lot that can start to work against us with age - including greater joint stiffness, poorer coordination, reduced bone density and muscle strength, to name a few. These factors impair a person’s mobility and balance, and put them at risk of falls, broken bones and other issues that can take away from their independence. The real impact of a reduction in mobility is often much greater - with the ability to meet our exercise guidelines being associated with reductions in the risk of cardiovascular problems, diabetes, and many other conditions and illnesses.

Physiotherapy plays a crucial role in supporting older adults in optimising their mobility and preventing events like falls and falls-related injuries.[1][2] This is done by evaluating a person’s functional capacity at a specific point in time, and directly addressing the issues contributing to mobility problems as well as providing targeted interventions. Physiotherapy also helps you stay more comfortable throughout your older years, helping reduce daily pain levels to optimise a person’s quality of life.

How Does Physiotherapy Promote Independence?

• Assessing and addressing mobility: physiotherapists assess an individual's mobility and identify areas of concern. Through targeted exercises, balance training, and advice on gait techniques inside and outside the home, they help improve strength, coordination, and stability, enabling older adults to move with greater confidence and reduce the risk of falls.

• Assistive device training: physiotherapists can also educate older adults on the proper use of assistive devices such as canes and walkers. They can help ensure a proper fit, teach safe techniques, and provide guidance on navigating different environments, thereby promoting independence in daily activities.

• Pain management: both chronic and acute pain can significantly affect a person’s mobility and independence. This is where physiotherapy interventions, such as hands-on manual therapy, mobilisation, rehabilitative exercises and other therapies can help reduce pain, enhance joint mobility, and help restore some function, enabling older adults to engage in more of the activities they enjoy.

• Conditioning and strength training: by developing tailored exercise training programs, physiotherapists can help older adults improve their strength, endurance, and overall fitness - regardless of their starting capacity. This can enable them to perform a greater range of daily tasks independently (and maintain this capacity for longer), as well as participate in recreational activities to support their overall well-being.

What Are The Benefits Of Physiotherapy For Older Adults?

• Improved mobility and functional independence: a ten-year follow-up study found that physiotherapy interventions such as exercises, manual therapy, and gait training can enhance mobility and promote independence in completing activities of daily living.[3]

• Pain reduction and management: physiotherapy techniques like therapeutic exercises, treatment modalities (e.g., heat, cold, electrical stimulation), and manual therapy are shown to help alleviate pain in older adults.[4]

• Fall prevention and balance improvement: targeted physiotherapy programs are shown to be able to reduce the risk of falls and improve balance and postural stability in older adults.[5]

• Enhanced cardiovascular health: the aerobic exercises prescribed by physiotherapists can improve cardiovascular fitness, reduce the risk of cardiovascular diseases, and enhance overall heart health in older adults.[6]

• Management of chronic conditions: physiotherapy interventions, including exercise, education, and self-management strategies, can effectively manage chronic conditions such as arthritis, chronic obstructive pulmonary disease (COPD), and diabetes in older adults.[7]

• Improved respiratory function: physiotherapy interventions, including breathing exercises, chest physiotherapy, and pulmonary rehabilitation, can enhance respiratory function and improve lung capacity in older adults.[8]

• Better cognitive function: being able to complete regular physical exercise when supported by your physio has been found to be one of the best things an older person can do to help reduce the risk of dementia.[9]

• Improved sleep: being able to stay mobile and active is shown to improve sleep quality in all populations, including older adults. Sufficient sleep is also an important factor in improving overall mental and physical health.[10]

What's The Best Way To Stay Active In Our Later Years?

According to numerous studies and evidence-based guidelines, a combination of aerobic exercise, strength training, balance training, and flexibility exercises has been found to be the most beneficial for older adults. Aerobic exercises, such as brisk walking, cycling, or swimming, have been shown to improve cardiovascular fitness, reduce the risk of chronic diseases, enhance mood, and aid in weight management. These activities should be performed for a moderate intensity level, aiming for at least 150 minutes per week.

In addition to aerobic exercise, strength training is also greatly beneficial for older adults. This is something that will be assigned on a case-by-case basis depending on your current level of strength and capability, but may involve using resistance bands or even free weights to target major muscle groups. Strength training has been shown to increase muscle mass, strength, and bone density, reducing the risk of sarcopenia, osteoporosis, and falls. It is recommended to perform strength training exercises two or more days per week, targeting all major muscle groups with a focus on proper form and gradually increasing resistance over time. This is something that a physiotherapist can work with you on to ensure it feels gradual and natural, making it safe and effective for older adults, as opposed to overwhelming.

Balance training is also a great asset for older adults, helping to improve stability and reduce the risk of falls. Balance exercises, such as standing on one leg supported or supported side leg raises, help improve proprioception and postural control. These exercises can be incorporated into daily routines and should be performed regularly to enhance balance and prevent falls.

Perhaps the most important takeaway is that with older adults often being at risk of a decline in strength and balance, it’s always important to ensure the exercises you’re doing to help maintain your mobility and independence are prescribed and approved by a physiotherapist who has performed a comprehensive assessment and knows your unique physical circumstances - and any limitations or vulnerabilities.

References

1.  https://www.nature.com/articles/nrendo.2010.70
2.  https://www.sciencedirect.com/science/article/pii/S1836955315000120
3.  Jette, D. U., & Branch, L. G. (1992). A ten-year follow-up of a home exercise program for the elderly. JAMA, 263(20), 3029-3034.
4.  Hadi, M., Rostami, M., & Abdoli, B. (2019). The effectiveness of physiotherapy interventions on pain in elderly with knee osteoarthritis: a systematic review and meta-analysis. Medical Journal of the Islamic Republic of Iran, 33, 88.
5.  Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J. C., & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine, 51(24), 1750-1758.
6.  Sacco, I. C. N., Bacellar, S., Diniz, L. R., Faloppa, F., & Fukuda, T. Y. (2012). Aerobic exercise capacity and heart rate recovery among Brazilian older adults. Journal of Aging and Physical Activity, 20(4), 403-414.
7.  Deyle, G. D., Henderson, N. E., Matekel, R. L., Ryder, M. G., Garber, M. B., & Allison, S. C. (2000). Effectiveness of manual physical therapy and exercise in osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal Medicine, 132(3), 173-181.
8.  Nyberg, A., Lindström, B., & Rickenlund, A. (2017). Effects of physical exercise on lung capacity and muscle strength in older individuals with and without COPD - a systematic review. Clinical Physiology and Functional Imaging, 37(6), 537-546
9. https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/physical-exercise
10. Youngstedt, S. D. (2005). Effects of exercise on sleep. Clinics in Sports Medicine, 24(2), 355-365.