Recently, the American Physical Therapy Association released their “ Choosing Wisely ” recommendations for patients and physicians regarding Physical Therapy treatment. As I discussed in an earlier post this year, the “ Choosing Wisely ” initiative was launched by the American Board of Internal Medicine in an effort to fuel discussion about the rising cost of health care, minimize ineffective medical treatment, and empower patients. There has been quite a bit of buzz about the first of the five recommendations, which encourages the use of an active, exercise-based treatment plan rather than one centered around the use of passive physical agents (heat, cold, ultrasound, and electrical stimulation). While I wholeheartedly agree with this recommendation, and understand why it generated such media attention, I want to focus on the APTA’s second recommendation, which states:
“Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals.” (www.apta.org)
Simply stated, this recommendation says: Don’t assume your older patients can’t tolerate exercise! When appropriate, older adults can reap great benefits from exercises and activities that challenge them. I had a great reminder of this idea recently in my clinic, when I met a new client who had been experiencing low back pain related to lumbar stenosis (a condition in which the nerves of the low back are compressed, causing pain). This client, a woman in her mid-70’s, had been trying to come in for treatment for much of the summer, but due to a variety of schedule conflicts and travel plans, our meeting was delayed. When we finally sat down in my office for our first session, she noted that about a week prior, her pain had resolved. When I asked how she found relief, she replied, “I went hiking!” It seems that during a trip to the southwest, she had the opportunity to go on daily hikes with trusted family and friends. She exercised more than she had in quite some time, and with greater intensity. She was amazed to find that the more she moved, the better she felt. Testing the theory, she continued to go on daily brisk walks after returning home, and was surprised to find that the pain stayed away.
I have to admit, I would likely not have prescribed an activity like hiking for any of my older adult clients. In fact, when she relayed her experience to me, alarm bells sounded in my head – “that’s dangerous,” my voice of caution yelled, “she could have been hurt!” Of course, we must proceed with caution when prescribing exercise to anyone, including older adults – the second part of the APTA’s guideline above highlights the importance of matching the intensity of exercise to the individual’s ability (and for the record, this post is not intended to prescribe strenuous hiking to everyone with low back pain!). It is equally important, however, not to under-estimate what the individual’s ability is. Our bodies do not automatically lose the ability to move, and the need for movement, as we get older. Part of our job as PTs is to safely encourage movement as a means to gain better health, find relief from pain, and create longevity. I’m grateful to be reminded of this important idea, both by the APTA, and by my fabulous hiking client.