Screening for and Prescribing Exercise for Older Adults

Barbara Resnick, PhD, CRNP, FAAN, FAANP, Professor, University of Maryland School of Nursing, Baltimore, MD, USA.
Marcia G. Ory, PhD, MPH, Professor, Social and Behavioral Health; Director, Active for Life National Program Office, School of Rural Public Health, The Texas A & M University System, College Station, TX, USA.
Michael E. Rogers, PhD, CSCS, FACSM, Associate Professor, Department of Kinesiology and Sport Studies, Center for Physical Activity and Aging, Wichita State University, Wichita, Kansas, USA.
Phillip Page, MS, PT, ATC, CSCS, Manager, Clinical Education & Research, The Hygenic Corporation, Akron, OH, USA.
Roseann M. Lyle, PhD, Purdue University, Department of Health and Kinesiology, West Lafayette, IN, USA.
Cody Sipe, MS, Program Director, A.H. Ismail Center, Purdue University, West Lafayette, IN, USA.
Wojtek Chodzko-Zajko, PhD, Professor, Department Head of Kinesiology, University of Illinois at Urbana-Champaign, Urbana, IL, USA.
Terry L. Bazzarre, PhD, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ, USA.

Physical activity helps to maintain function, health, and overall quality of life for older adults. It is challenging, however, for health care providers and others who work with older adults to know what type of activity to encourage older adults to engage in, and how to motivate them to initiate and adhere to physical activity and exercise over time. The purpose of this piece is to provide an overview of physical activity for older adults and provide the resources needed to evaluate older adults and help them establish safe and appropriate physical activity programs, as well as providing motivational interventions that will eliminate the barriers to exercise and optimize the benefits.
Key words: exercise, screening, motivation, self-efficacy, outcome expectations.

Introduction
A substantial body of scientific evidence indicates regular physical activity can bring dramatic health benefits to people of all ages and abilities, with these benefits extending over the life course.^1-13 Physical activity offers one of the greatest opportunities to extend years of active independent life, reduce disability, and improve the quality of life for mid-life and older persons.^14-17 Older adults who engage in regular physical activity are more likely to have better health, as evidenced by research findings in many specific physical and mental health domains (Table 1). Despite these clear benefits, the majority of older adults do not engage in regular physical activity18 and prescribing physical activity and/or specific exercise programs is not yet routine clinical practice.^18,19 To optimize physical activity among older adults, we recommend a three-step process. The first step is the screening process prior to starting an exercise program, the second is the prescriptive process, and the third is motivating the individual to initiate and adhere to the exercise program prescribed.

Screening Prior to Prescribing an Exercise Program
Ideally, the purpose of screening is to: (1) minimize injury or other serious adverse events (e.g., musculoskeletal trauma, falls, or cardiovascular events) while allowing the individual to achieve the maximum benefit from physical activity;²⁰ (2) identify medical problems so that exercise programs are appropriately modified for safety and optimal benefit;²¹ and (3) identify functional impairments that the activity program will address.²² Screening of older adults prior to starting an exercise program continues to be a controversial issue,²³ and beliefs about the benefits and disadvantages of screening vary across and within both patients and provider groups.²¹ While many guidelines or protocols still strongly recommend “seeing your doctor first,”²⁴ a recent American College of Sports Medicine²⁵ best practices statement endorses the perspective that medical clearance should not be required prior to encouraging older individuals to begin a light-intensity activity program. In addition,