For more than a year now, millions of men, women, and children have been in a state of isolation with reduced activity levels due to the COVID-19 global pandemic. Despite the availability and initial distributions of a vaccine, many older adults are still continuing to maintain isolation either by their own choice or by the guidance of family members, hospitals, skilled nursing facilities, long-term care facilities, government, etc. Those individuals who are yielding to isolation and inactivity are experiencing a devastating deconditioning effect on their bodies. Deconditioning has a particularly deleterious effect on our older population who may already be dealing with such issues as cardiovascular disease, diabetes, cancer, and even reduced mobility. Not only does the inactivity have grave consequences on the human body but also the social isolation contributes to a loss of cognitive function as well as a compromised emotional well-being. Of course, we, as rehabilitation professionals, are fully aware of the need for our patients to reduce their risk of COVID-19 infection or exposure while trying to reverse or prevent the effects of deconditioning as well as reduce the negative impacts of social isolation. Let us continue our important work for our patients. Let us help them become active again and mitigate the consequences of inactivity and isolation.

Inactivity has a direct effect on a person's general health and mortality. It is well documented that both men and women need physical activity to maintain or improve health. Not only does physical activity help in the management of long-term diseases such as diabetes and heart disease but it can also delay mortality. Regular exercise can prevent or delay onset of dementia, type 2 diabetes, depression, heart disease, and possibly dementia. We are in a prime position to impact the health and well-being of our patients. After all, they probably trust us more than most of their other health care providers. It is our solemn duty to provide education and information on maintaining health and promoting wellness. Now, more than ever, we need to carefully analyze each patient's situation, especially those who have been quarantining. We need to provide encouragement and motivation along with collaborative goal setting, followed by an individualized treatment plan tailored to each patient's personal situation. We must convince our patients to embrace long-term changes of behavior that incorporate physical activity into their daily routines.

Social isolation, another consequence of the COVID-19 pandemic, has also had a negative effect on the emotional well-being of many older (and younger) adults over the past year. We are all quite familiar with the older adult who lives in a nursing home or long-term care facility and has not been allowed to have family visit for more than a year due to health care policy guidelines. Although restrictions have been eased to allow "outdoor" visitations, the social isolation is still prominent and a dominant stressor for the older adult. Also, older adults who live at home have been complying with "stay-at-home" recommendations, thus also enduring social isolation. Individuals with fewer social contacts are at a higher risk for depression, dementia, and even premature mortality. We all agree that social isolation has detrimental effects on the health of all adults, with older adults being most affected. The rehabilitation therapist can have a positive impact on the physical and mental health of older adults while addressing social isolation.

Having considered the consequences of inactivity and social isolation for our patients during these unprecedented times, let us continue to do our jobs to the best of our ability. Let us continue to use evidence in our practice. In this "Off the Topic" issue of Topics in Geriatric Rehabilitation, we have a wide variety of evidence-based research studies from Japan, Turkey, India, United Arab Emirates, Thailand, Spain, and the United States. Let us teach our patients to become active again and minimize the consequences of inactivity and social isolation. We are all hopeful that it is time to start moving back toward a normal life as safely as we can.

-Wendy Powers James, PT

Issue Editor