Physical therapy offers mobility, strength benefits

Growing older comes with many challenges and benefits. An aging population must balance wisdom, life experience and personal growth with aches and pains, joint issues and overall health concerns.

“Research shows that a person in their early- to mid-70s has a much higher rate of perceived exertion, or how challenging a task feels, than a person in their early 20s for daily life activities,” said Julia Ward, a physical therapist with Kettering Health. “These activities include navigating stairs or rising from a chair. For example, the relative effort required for a 22-year-old to ascend stairs was 54% versus 78% for a 74-year-old.”

Ward, who has worked as a physical therapist for two years, said it helps to find a routine that becomes a part of the person’s lifestyle.

Ward said the American College of Sports Medicine (ACSM) recommends individuals aged 65 and older should complete aerobic exercise at moderate intensity 150 minutes a week, or 75 minutes of exercise at vigorous intensity a week, but notes that can seem daunting.

“Research shows a sedentary lifestyle negatively impacts metabolism, heart health, functional ability, and increases mortality,” she said. “So, if it’s feasible to begin with joining a friend at an exercise class for an hour a week, some exercise is better than no exercise.”

Sandy Stremel, 75, recently attended physical therapy in January at the Sports Medicine facility on Far Hills Avenue for her shoulder.

“I had a lot of arthritis and a slight tear in my rotator cuff,” Stremel said. “I was trying to lessen pain. I wanted to be able to function so I could do things.”

Stremel, of Centerville, cares for her two grandchildren and wanted to avoid surgery.

“I was having pain constantly and I have no pain right now. I can do everything I want to do, and I was able to go back to yoga. I credit that and the physical therapy for keeping me as active as I am at my age.”

Stremel is currently in physical therapy again for her hip and it is “drastically improved”.

“My main goal is to stay active and push surgery down the road,” she said. “Once you’re able to get some mobility back again, then they work on strengthening. I like that Julia gives me exercises and I can do them at home. You have to be dedicated to it.”

Stremel advises that it is important to keep moving and “PT can really help to keep your mobility and to keep yourself active.”

Ward said simple exercises to maintain strength can be performed at home, and that it is important to start small and work your way up.

Simple moves include squats (using a high-level chair to start), and standing leg kicks (bring the leg forward, backward and to the side while keeping the leg straight). As strength is gained, add resistance to keep growing stronger.

“I work with people anywhere from one to three months,” Ward said. “If your exercise is no longer a challenge, you want to progress by more repetition or stronger resistance or stretching further. You have to build a routine into your lifestyle and continue it. Staying active means mostly likely that you’re staying healthy. The body needs motion to be healthy.”

If more support is needed, then physical therapy could be helpful. Ward noted that the NeuroRehab and Balance Center on Yankee Street is specifically designed for people who have balance issues.

“See your doctor for a referral,” she said. “I see people not only for surgeries and a specific injury but also people who are de-conditioned and have overall weakness or their balance is poor. I see many people with general pain or stiffness in their back or knees, and it may not be from an injury. They are all welcome to come to physical therapy. We want to get to the bottom of what will make your life better.”

More directly from Ward

How does the body change as a person ages?

As a person ages, worsening posture can occur. Poor posture can be characterized by a forward position of the head, a slump forward in the trunk, and tightness in the front of the hips. These characteristics make extending upright to sit or stand tall much more difficult. That, in turn, affects a person’s ability to breathe and use their muscles properly, and even worsens balance and increases risk of falls.

For those with chronic conditions, such as arthritis, or mobility issues, what is your best advice for exercise: One aspect of physical therapy, and exercising in general, that I find particularly engaging is the creativity that can and should be used to tailor an exercise routine to meet the individual’s needs. A person with mobility issues for example, can create a challenging routine at home using daily activities. A movement as seemingly simple as a sit-to-stand is a great exercise that can be used to strengthen trunk and hip extensors. Arthritic joints benefit from movement as this increases the movement of nutritious synovial fluid in the joint and prevents stiffness which causes pain.

I would like to note here that there is a difference between pain and soreness. Exercises that increase pain should not be continued. However, muscle soreness for a few days after a strength work out is normal and encouraged, as it shows the person was challenged enough to build up muscle strength.

How are strength and stamina important?

As muscles age, sarcopenia can occur, which is loss of muscle strength, quality/quantity, and physical performance. It is estimated that each decade 8% of muscle mass is lost until 70, but this increases to 15% per decade after 70. Research is very clear that older adults should not under dose strength training. Intensity of strength training should fall in the 60-80% intensity with 60% intensity completing 15 repetitions for a few sets at somewhat hard perceived exertion, and 80% intensity completing 10 repetitions for a few sets at hard or very hard exertion, with form deteriorating at the last few repetitions due to fatigue. Aim to complete several days a week.

Delayed onset muscle soreness for 24-72 hours after an adequate strength work out is normal, though remember pain is not.

How are you especially tuned in to the 60+ age group?

I am blessed to work with a wide age range of patients in the outpatient orthopedic setting here at Kettering Health. I see patients who are well into their 90s. A patient may tell me they have trouble entering or exiting a car, cannot navigate the stairs safely, cannot complete specific chores, etc. Improving these activities is the most important to the patient. I especially enjoy using creativity to simulate these situations and tasks, practice and train to improve these difficult activities, and therefore improve quality of life.

What need do you see in the area for senior citizens?

Many of my older patients are not aware of the impact of posture on their day-to-day activities. They have not been taught how to properly engage core muscles and position the lower spine to lift with good form. I would recommend avoiding combining 2 or 3 of the following mechanics at one time: bending, lifting, and twisting. Complete one activity, such as lifting, and if needing to move groceries from the floor to countertop for example, use the legs to squat to lift, and turn the feet to face the counter to place groceries. Don’t bend at the low back to lift and don’t keep the feet planted to twist while lifting.

Also, poor upper back posture impairs breathing with the diaphragm and results in breathing with chest and neck muscles. This reduces oxygenation and can increase stress. I would also like to see improving balance and fall prevention interventions as higher priorities for senior citizens.

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