Physical activity in older adults can decrease morbidity and mortality, reduce disability, and improve quality of life (Elsawy & Higgins, 2010). Despite these benefits, few older adults achieve the minimum recommended amount of physical activity, and 28% to 34% of older adults are fully inactive (Elsawy & Higgins). Home healthcare clinicians are in an influential position to help older adults establish a routine exercise program. Promoting physical activity assists in meeting the goals of increased independence and improved health in community dwelling patients.

The benefits of regular physical activity for older adults are great. A home exercise program can support the ability to safely walk without assistance (thus helping older adults maintain their independence), reduce the risk of falls by 40%, and reduce the risk and severity of diseases such as stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, depression, and cancer (Elsawy & Higgins, 2010). A regular exercise routine can help individuals maintain a healthy weight, restore restful sleep, reduce arthritic disability (after 16 weeks of strengthening those with osteoarthritis had less pain and more flexibility), improve blood sugar control (and possibly reduce the need for diabetes medications), keep bones strong, promote mental and cognitive health (via the release of "feel good" brain chemicals), and maintain or improve heart health (in as quickly as 6 weeks after starting the exercise program) (American Geriatrics Society [AGS], 2015). Increasing physical activity in older adults can reduce healthcare costs, which is beneficial to all (Elsawy & Higgins).

The United States Department of Health and Human Services recommends most older adults engage in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination each per week (Elsawy & Higgins, 2010). Home healthcare clinicians can educate patients to measure intensity on a 0-10 scale; with sitting being 0; and working as hard as one can at 10 on the scale (Centers for Disease Control and Prevention [CDC], 2015). Moderate-intensity activity is rated at 5-6 on the scale (the patient will be able to talk but not sing the words to their favorite song), whereas vigorous-intensity is rated at 7-8 on the scale (the patient will not be able to talk more than a few words without catching their breath) (CDC). A general rule of thumb is that 1 minute of vigorous-intensity activity is equivalent to 2 minutes of moderate-intensity activity (CDC).

Aerobic activity (also known as cardio) may be obtained by pushing a lawn mower, biking, walking, completing household chores, gardening, swimming, and the like. Older adults should engage in moderate-to-vigorous intensity for at least 10 minutes at a time, although the total exercise time can be broken down into 10 minutes or longer sessions to get the full amount of exercise per week (CDC, 2015). It is important to note that regular, adequate, weekly activity is more important than engaging in strenuous activity (Elsawy & Higgins, 2010).

In addition to aerobic activity, older adults should do muscle-strengthening activities 2 days per week (CDC, 2015). These exercises may include lifting weights, working with resistance bands, using body weight for resistance (sit-ups, push-ups), heavy gardening, and yoga (CDC). These activities should be done until the patient has a hard time completing another repetition without help (CDC). A repetition is one complete movement of an activity (like lifting a weight or doing one sit-up). A set is approximately 8 to 10 repetitions, and patients should complete at least 1 set of muscle-strengthening activities to start, with a goal of increasing to 2 or 3 sets per session (CDC).

Patients who have a high risk of falls should add exercises that help maintain or improve balance (Elsawy & Higgins, 2010). Balance exercises and moderate-intensity, muscle-strengthening activities should be done at least 3 days a week for a total of 90 minutes, in addition to moderate-intensity walking for about 1 hour a week (Elsawy & Higgins). Examples of balance exercises include walking backward or sideways, heel walking, toe walking, standing from a sitting position, and Tai Chi. These exercises should increase in difficulty as balance improves (Elsawy & Higgins).

Stretching exercises may help older adults maintain the flexibility needed to continue regular physical activity. Older adults should complete flexibility exercises at least 2 days a week for at least 10 minutes a day (Elsawy & Higgins, 2010). These exercises may include yoga or pilates types of exercises (AGS, 2015).

Home healthcare clinicians can work with the healthcare team (such as the physician and physical therapist), patient, and caregiver to help create a plan that addresses each recommended type of activity. The plan should describe how, when, and where each activity will be performed, as well as how to gradually and progressively increase the activity over time to reach the total time and intensity as recommended (or as health condition will allow) (Elsawy & Higgins, 2010). Each plan needs to be individualized to the patient's abilities. For example, patients may need to break exercises into several shorter periods of activity to achieve the recommended level of activity, especially if they have recently had an illness or have been physically inactive (Elsawy & Higgins). Additionally, some patients may need to begin with a sitting exercise routine or a light-intensity activity until they are strong or stable enough to gradually add moderate-intensity aerobic activities. For some patients, use of media (such as exercise DVDs or television programs), and/or pedometers to encourage and track walking may also help them engage in exercises on a regular basis. Home healthcare clinicians should be sure to educate and engage the caregiver so they can encourage and supervise the patient to safely complete the exercise routine. Home healthcare clinicians will need to assess the patient's progress with exercise over time and modify the plan as necessary.

Clearly, an exercise program is a key component for improved health and reduced morbidity for home healthcare patients. Home healthcare clinicians play a key role in educating and engaging patients and caregivers in an exercise routine that will be beneficial to the patient's health and well-being. Even the benefits of a simple assisted range-of-motion routine can provide an improved health status and feelings of well-being. Providing education on the benefits of a home exercise routine and utilizing the resources available, such as physical therapists and caregivers can help the patient maintain a therapeutic activity routine. An exercise routine can improve a patient's health condition and reduce utilization of healthcare resources and the number of healthcare encounters.

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