Exercise for special populations

Older population

 The fact that the world is getting older requires special recommendations for men and women aged 65 years and older. Besides the general recommendations for adults that also apply to this population, specific guidelines for elderly includes several unique points. First of all, as part of their regular weekly physical activity, older adults should have multicomponent activities of balance training (along with aerobic and muscle-strengthening activities). This might include several simple and effective exercises such as:

  1. Single-leg stance
  2. Walking heel to toe
  3. Foot taps
  4. Back leg raises
  5. Side leg raise
  6. Toe lifts
  7. Over-the-shoulder walks
  8. Standing marches
  9. Shoulder rolls

 

However, before commencing any exercise program, older adults should check their level of effort for physical activity relative to their level of health-related physical fitness. Elderly with chronic conditions should consult a medical doctor for a specific advice whether and how their conditions affect their ability to do regular physical activity safely. If older men or women cannot do a recommended amount of moderate-intensity aerobic activity because of chronic conditions, they should be as physically active as their abilities and conditions allow (EU Physical Activity Guidelines, 2008; Physical Activity Guidelines to Americans, 2015; WHO, 2020). Few tips for health-enhancing physical activity in elderly are depicted in Figure 24 and Figure 25.

Exercise for special populations

Figure 24 | Few tips for exercise in elderly

Figure 25 | Examples of exercise in elderly

Adults with disabilities

Adults with chronic conditions or disabilities, who are able to do so, should do at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity (EU Physical Activity Guidelines, 2008; Physical Activity Guidelines to Americans, 2015). Preferably, aerobic activities should be spread throughout the week. Muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups should be conducted on 2 or more days a week, as these activities provide additional health benefits for adults with chronic conditions or disabilities. When this is not achievable, adults with chronic conditions or disabilities should engage in regular physical activity according to their abilities and should avoid inactivity. Depression, low self-efficacy, lack of exercise enjoyment, and negative outcome expectations are common psychosocial barriers that limits physical activity in people with disabilities (Rimmer and co-workers, 2004), along with poor social support from family, caregivers, peers and healthcare providers (Rosenberg and co- workers, 2011). To tackle these barriers, many steps should be encountered, including the following:

  1. Individually tailored physical activity interventions
  2. Scheduling exercise when a person feeling the most energetic
  3. Start slowly based on each person abilities and fitness level
  4. Finding fitness professionals who can provide specific physical activity options
  5. Adapting technological gadgets to deliver personalized, in-home, interactive interventions
  6. Soliciting the help of health care providers and target agencies
  7. Interacting with the target population at support groups and doctor’s offices
  8. Include fall prevention education that focuses on strength, balance, and gait training

 

Several aerobic physical activities might be a preferable choice for people with disabilities due    to simple implementation, acceptable safety and feasible benefits (Figure 26). This could be complemented by a muscle-strengthening activities, including working with resistance bands or adapted yoga.

 

Adults with disabilities

Figure 26 | Aerobic physical activities for adults with chronic conditions or disabilities

Socially disadvantaged groups

Other sensible groups, including socially disprivileged populations (e.g. migrants, unemployed), should also be supported to enjoy regular physical activity to advance health. However, these  groups face unique challenges to engaging in physical activity, including less access to facilities, a perceptions of lack of safety, less time to engage in recreational activities, lower levels of education (e.g. lack of knowledge about health and health-promoting behaviors), and higher levels of stress (Mendoza-Vasconez and co-workers, 2016). Physical activity interventions that are designed with a broad range of benefits in mind, not just obesity prevention, should be trialed (Craike and co- workers, 2018).

The WHO Regional Office for Europe carried out a project to support and further enhance evidence and networking on guidance on promoting physical activity in socially disadvantaged groups, with a focus on the role of healthy environments (WHO, 2013). Learning how to overcome the challenges of physical activity promotion in socially disadvantaged groups, and how to meet the needs of underserved populations is a necessary first step in achieving health equity through physical activity promotion. Successful strategies to recruit these populations to be physically active may include:

  1. Addressing safety concerns
  2. Building partnerships with community health centers
  3. Using social marketing campaigns
  4. Hiring physical activity promotion staff that reflect the participants’ cultural background
  5. Facilitating attendance by providing free transportation or coupons
  6. Adapting technological innovations for physical activity promotion
  7. Flexible scheduling

Socially disadvantaged groups

Several patterns are recently reported as effective in promoting physical activity in socially disadvantaged groups ((Craike and co-workers, 2018) (Figure 27). Other factors that were associated with higher effectiveness were the involvement of the community in the design and implementation of interventions; developing community infrastructure (e.g., through sustainable partnerships) to sustain effective interventions; interventions delivered through personal contact; and tailored interventions.

Figure 27 | Patterns for an effective promotion of physical activity in socially disadvantaged groups