The Intricate Balancing Act of Physical Exercise During the COVID-19 Pandemic in Older Adults

On January 30th, 2020 — The World Health Organization set the entire world at large with their declaration proclaiming COVID-19 as an international public health emergency. For the billions of people living across the globe, life has dramatically changed. The United States of America implemented lock downs by mandating stay-at-home-orders to combat the spread of the virus. While its necessary to contain the virus, there have been many unfortunate and unintended consequences of this ‘new normal’. An immediate detrimental result of these government shutdowns has been the breakdown of structure within society’s daily routines. Specifically, with many mandated restrictions, more people have adopted a more sedentary lifestyle. Furthermore, the isolation from family and friends has created an increase in the rates of depression. With the increasing rates of unemployment, anxiety has also skyrocketed.

With the shutdown of gyms, parks, hiking trails and other facilities, people have subsequently reduced their physical activity. The limitations on facilities have greatly impacted those with underlying medical conditions who may benefit from physical activity the most. For example, the elderly person with severe arthritis who has difficulty walking and had been dependent on a public pool for physical exercise, has no other means of engaging in physical activity. With the closure of fitness stores, even obtaining exercise equipment has been challenging. Also at this time, millions of Americans are working from home. While these measures have provided immediate comfort during this challenging time, they have also created a much more sedentary lifestyle that has negatively impacted our physical well being.

The impact that COVID has made on the individual varies per person: a young, low-risk and healthy individual might not feel the strains of this ‘new normal’, as much as an older, high-risk or unhealthy patient may be currently experiencing. Recent studies have concluded that many of these high-risk, older adults admit to feeling a higher degree of fear. The fears of infection, death, and uncertainty often loom over these individuals. The resulting loss of social contacts and feelings of loneliness, depression, and helplessness are plaguing the minds of higher-risk individuals during this challenging time and further contributing to rising depression and anxiety. In addition, the loss of jobs has created financial strains which have exponentially increased rates of anxiety among the population.

This internal dilemma and mental health struggle are troubling for the older demographics of our societies. The constant struggle of balancing physical and mental wellness needs with the fear of potentially contracting COVID-19 is easily apparent. As a result, many older adults have significantly restricted their physical activity. While our higher-risk elderly populations are more prone to serious complications of the virus, the notable importance of avoiding a stationary lifestyle for their overall health cannot be ignored.

Prior to the development of the COVID-19 Pandemic, physical inactivity among older adults had been documented as the fourth highest cause for mortality worldwide and a major contributor to disability. Conversely, a sustained level of physical activity and exercise has proven to be an effective therapy for many common chronic diseases. Physical activity is essential in older individuals to at least preserve their already diminished functional reserve. Thus, continued engagement in physical activity is important for the elderly population to preserve both their physiological and psychological well-being.

My recommendations in combating this dilemma of inactivity is for healthcare leaders worldwide to get creative in promoting at-home physical activities. With the aid of technological advances, millions worldwide now have the ability to access virtual physical conditioning regimens. However, technology can present its own unique challenges for the elderly. As a community not only must we support and promote these technological advances, but we must also make them more-easily accessible and feasible for the elderly. A prime example can be noted in Tokyo, where healthcare officials found a clever way to capitalize on telehealth outreach by utilizing it to promote physical activity in Japanese elderly communities. The officials designed and implemented a telehealth program which consisted of either a video or poster that could be downloaded to one’s mobile device. For those less technologically savvy, they also provided the alternative of mailing the DVDs and posters directly to seniors’ residences. The home regimens provided included both stretching and strengthening exercises for the upper body, lower body, and core (Table 1). These actions further support the notion that providing creative and accessible means of maintaining strength and flexibility, while preserving safety and promoting autonomy and internal motivation, is paramount during this crisis for our elderly community.

Another innovative way to promote activity during this time can be done by encouraging participation in active exergames (active videogames)! Exergames are thought to be safe, easily utilized, and very enjoyable. Previous studies have shown that while exergames can safely enhance one’s physical activity and performance of daily activities, they have also been beneficial for improving postural balance and cognitive function in the elderly. The games specifically tailored towards the elderly, (e.g. Zumba, virtual ping-pong, tennis, boxing, and yoga) provide a plethora of options with a wide appeal that may accommodate a range of baseline fitness abilities. In addition to maintaining physical activity, a single 20-minute session of a Zumba exergame has been shown to significantly decrease anxiety. Exergames can also be played together with family and friends, which is an added benefit that may simultaneously help decrease the feeling of social isolation commonly experienced during quarantine.

Most community members do not have access to proper gym equipment at home, however there are many outlets that can provide creative substitutes. Many household items such as vegetables, rice, or water bottles can be substituted for weights for use in strength training. Additionally, exercises can be done using one’s own body weight. For example, squats can be done by holding onto a chair or sitting and rising from a chair. Aerobic exercises that can be done at home include walking the stairs and dancing. Balancing exercises such as tandem gait walking can also be incorporated if safe to do so.

These unprecedented times have challenged our society as a whole to seek creative avenues of promoting our overall health and wellness. Society as a whole cannot afford to weaken physical and mental measures during this COVID-19 pandemic — specifically our higher at-risk population. I strongly recommend that individuals, leaders, and healthcare providers use their platform to encourage creative and fun methods of incorporating physical activity regimen through virtual activities to promote a healthy and well-balanced lifestyle.

References

  1. Aung MN, Yuasa M, Koyanagi Y, et al. Sustainable health promotion for the seniors during COVID-19 outbreak: a lesson from Tokyo. Journal of infection in developing countries. 2020;14(4):328–331. doi:10.3855/jidc.12684.
  2. Goethals L, Barth N, Guyot J, Hupin D, Celarier T, Bongue B. Impact of Home Quarantine on Physical Activity Among Older Adults Living at Home During the COVID-19 Pandemic: Qualitative Interview Study. JMIR aging. 2020;3(1):e19007. doi:10.2196/19007.
  3. Hall G, Laddu DR, Phillips SA, Lavie CJ, Arena R. A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? Progress in cardiovascular diseases. April 2020.
  4. Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Progress in cardiovascular diseases. March 2020. doi:10.1016/j.pcad.2020.03.009.
  5. Matias T, Dominski FH, Marks DF. Human needs in COVID-19 isolation. Journal of health psychology. May 2020:1359105320925149. doi:10.1177/1359105320925149.
  6. Nyenhuis SM, Greiwe J, Zeiger JS, Nanda A, Cooke A. Exercise and Fitness in the Age of Social Distancing During the COVID-19 Pandemic. The journal of allergy and clinical immunology In practice. April 2020. doi:10.1016/j.jaip.2020.04.039.
  7. Peijie Chen, Lijuan Mao, George P. Nassis, Peter Harmer, Barbara E. Ainsworth, Fuzhong Li. Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. Journal of Sport and Health Science. 2020;9(2):103–104. doi:10.1016/j.jshs.2020.02.001.
  8. Viana RB, de Lira CAB. Exergames as Coping Strategies for Anxiety Disorders During the COVID-19 Quarantine Period. Games for health journal. May 2020. doi:10.1089/g4h.2020.0060.

Sam is a fourth year medical student at University of Maryland.

Resident and Fellow Council of the Association of Academic Physiatry (@AssocAcademicPhysiatry)

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