There's the old story about the fool, who was banging his head with a hammer. His friend asked him why he was doing that. He replied, "It feels so good when I stop." Exercising is much like that; it feels so good when you stop. At the outset, it is important to distinguish between sports medicine and training exercise, on the one hand, contrasted with maintenance exercise on the other. Therapeutic exercise usually is focused upon restoring the function of that particular part of the body that is impaired. The activity is generally intensive and scheduled to produce the benefit over a relatively short time.

Maintenance exercise usually is associated with the continuing effort to offset the effects of long-term inactivity associated with physical disability or with an aging life style. Maintenance exercise in the aging is designed to provide continuing levels of activity in the essential muscular-skeletal groups that would normally atrophy with disuse. Natural activities such as lifting and walking, which are diminished with the onset of a quieter life style, should be replaced by a regime of exercises. These exercises need not be intensive and time consuming-- burdensome. The goal of therapeutic exercise usually is to restore normal functioning as soon as possible. Specific performance standards are set as a goal for recovery. While there is a target in therapeutic therapy, there should be none in maintenance therapy. A regime for the elderly will be deemed as successful if the person continues to perform the regime tasks instead of reaching performance level targets.

While the athlete works hard to build his capacity to perform, the elderly will be looking to offset the deterioration associated with the inactivity of ageing. The elderly should not focused upon targets of performing like in their youth. Instead, they should be encouraged to accept the less spectacular benefits of being able to engage in regular, healthful activity. They should not expect to develop the abs, pects, and biceps as pictured in the Mr. Atlas advertisements. Instead, they should be pleased with their continuing ability to manage for themselves physically. A self-sufficient old age is a happier and longer one. I have always hated having to exercise every day, but it's better than the alternative.

The big villain in ageing is atrophy of the muscles. The elderly person with a broken hip goes downhill quickly! Being forced to lay in bed for just a month can make it impossible for the person to be able to get up and walk again. Atrophy in aging is an insidious process because the individual becomes weaker until activity becomes impossible. Once disabled you can't perform the exercises to make a recovery. The answer all too often is that you can't, and death will follow prematurely from complications such as pneumonia. Instead of setting performance targets, you must substitute faith that adherence to an exercise regime is the only protection against progressive atrophy. You have to keep up the "good work" and settle for small rewards to remain active in old age. Remember this-- The harder it is to get down on the floor to do the exercises, the more important to adopt the routine. If it is a bother to go down on the mat and get up again, it's not going to get any easier later. Postponing the regime for a while, may lead to enough atrophy that its adoption will no longer be feasible.

Muscular atrophy is an insidious process that leads to disability in three ways. Most obvious, is the muscular weakness that leads to the inability to exert yourself to walk any appreciable distance. The second, a less obvious process, is the weakening of the muscles and tendons that hold the bones together at the joints. When these muscles become weak they are stretched and the end of the bone no longer articulates in its socket. Instead, it rides up on the rim of the joint and causes severe pain. This type of joint pain in the hip, knee, elbow and shoulder can lead to further disability because the pain encourages disuse, resulting in further atrophy. The third process is the weakening of hip and leg muscles needed to maintain balance when standing. Weakened muscles make it difficult to exert force to correct leaning too far in one direction.

A regime must be practical to enable a person to adhere to it faithfully over the years. All exercise regimes are boring. It's a pity because everybody would prefer to be watching TV comfortably. Since a majority of the elderly fail to continue with the exercises, it is more constructive to blame the regime than the person The generally poor response of the elderly to this need for continuing exercise makes it necessary to look at the motivational factors involved. Good rapport between the person and the professional caregiver can provide a desire to please, an important motivation . However, the underlying motivation often is insufficient when compared to the many counter- motivations. The table below makes clear this imbalance in number of motivations pro and con for exercising by the elderly.

A successful regime should try to overcome eventual failure by considering these motivational factors. The exercises often are recommended by a professional, whom the elderly person respects and wants to please by conforming. Nagging about sticking to the regime can be counter-productive.

We can classify the regime into two types. First, is the activity that incorporates exercise along with pleasant social interaction with others. Such a regime makes you dependent upon a personal trainer, a group leader, or companions. Consistency and regularity in performing in a social setting makes the session subject to the availability of that person, group, or facility. Financial considerations may prove another hindrance to engaging in daily exercise. So we see that depending on others is a two-edged sword. It can provide a motivation to pursue the activities or may have the reverse effect.

When establishing a regime, keep in mind that the trainer or physical therapist usually has an interest in making you both socially and machine dependent. It is to their benefit that you join a health center and continue to operate under the oversight of a professional.

You should consider using a professional to help set up your regime but you should plan to become independent. If you have to leave the house to go to a health center, you will miss appointments for a number of reasons, and this is very unfortunate. Missed appointments are very bad because negative motivational factors listed in the chart encourage you to be inactive, and eventually terminate. There are many other reasons for missing your appointments outside the home. Financial considerations, physical weakness, sickness, lack of transport, bad weather, being busy with other matters, being out of town, or dissatisfaction with physical appearance.

The second type of regime is the independent one that you can perform alone at home . The most basic exercises, suited to the elderly, can be performed on a floor mat or even on a bed. It is important to become compulsive about your exercising. This means exercising every day without taking weekends and holidays off. Many of the common excuses for skipping days will be eliminated if you perform at home alone.

The exercises should be simple and not demanding. Once they are started, they can be continued unchanged throughout your remaining lifetime. Unlike therapeutic or cosmetic exercise they should not be exhausting or painful. Adhering to the maxim "No pains no gain" will surely lead to early termination. Exercise should be performed slowly enough to avoid fatigue. The goal is simply to use the muscles and not to train for endurance or strength.

By stretching out the time required to complete your daily cycle of exercises, you can divide the day's exercise into several sessions as aging diminishes your endurance. That way you can use the same exercises throughout your remaining years.. The basic exercises should focus on using the legs, knees, thighs, and lower back. These exercises help maintain muscles that provide vertical balance and the capacity to walk. Walking may be included in the regime because it's a simple form of exercise. It can be enhanced by swinging two-pound wrist weights while stretching those legs.

Additional exercises for the hips and lower back are important. Lower back exercises incorporate the use of arm and shoulders to provide the much-needed activity to maintain the muscles at the joints. You can use this regime when you are away from home on a holiday. I make it a rule never to miss a session. Lastly, I must confess I hate exercise-- always have. At 95 years-of- age it's so much nicer to just sit and watch TV. Each day I think of how lovely it would be to skip a session. But then I think of how, a year after going without exercise, I would be unable to get up from my chair to stumble about the house.



There are many websites that explain the various exercises. One of the best is: http://www.hphdhelp.org/exercise.htm. This link explains three of the four exercises I use regularly. My fourth exercise is rising from a seated position in a chair, to a standing position. If you have made up your mind to start (and continue) exercising, then you have made a good decision. If you just can't be bothered then you have made an important decision too! Good Luck to you!