Background: Current physiotherapy clinical practice in geriatrics commonly does not meet the recommendations of physical activity with going for walks the main focus. As a result, it is not enough to reduce the burden of age-related chronic disease or prevent recidivism in hospitals. In the last decade many exercise programs targeting different conditions of aging have been rolled out with much success. These programs use progressive resistance exercises and a functional movement approach, target the same muscle groups, but differ in scale (from the seated theraband leg press of the Sunbeam program to 30kg+ loaded back squats of the Onero program), use a small group intervention model, run for a long time (6/52 - a year) and involve at least 45mins of moderate to high intensity training x2/week. They meet the physical activity guidelines.
Change: We have commenced small exercise groups in private practice care. Referrals are generated by the geriatricians. We then do a physical assessment measuring hand-grip strength, gait speed, pain etc. We reassess at 3/12, 6/12, 12/12 and 18/12. Likewise, the client is reassessed by the geriatrician at 6/12. The very frail are seen in the community as 1:1 home visits. They are managed with the Sunbeam program. We teach carers how to administer the program using therabands and review at increasing intervals as improvements slow. Clients who can come to the rooms are divided into 2 groups. Both groups complete 50-60 mins of moderate-high intensity training x 2/week. For the frail group the emphasis is on strengthening and functional movements. For the more robust clients the emphasis is split between strength with barbells and kettlebells, fitness and balance. The goal is for patients to progress as able from the Sunbeam to the CrossFit style program.
Learnings: A major barrier to this model of care is cost. Poor health literacy and agism as well as unsuccessful physiotherapy experiences in the past can deter clients. Clients are often medically brittle and can fail to attend regularly either due to forgetfulness or competing medical demands and many are reliant on others for transport as they no longer drive. The best results have been gained in clients who have chronic musculoskeletal pain of a non-inflammatory nature, frailty and falls and functional decline caused by increasing muscle weakness. The program has been least effective in managing progressive cognitive disorders with apraxia or parkinsonian features of festination and freezing.