Fitness for Mobility
by Gretchen M. Ashton, CFT, SFT, SFN, SSC, NBFE,
PAC Certified Independent Consultant
The most common cause of immobility is simply - lack of activity. Move it or lose it holds true in nearly every state of human existence. Even if someone else is moving our body for us. Immobility might occur slowly with changes in habits of daily living, or suddenly because of injury or illness. Depending on the illness, changes in mobility may be inevitable, but it is always important to maintain as much movement as possible for quality of living and management of care. The longer physical independence can be maintained, the better for everyone; persons living with dementia (PLwD) and all care partners. Perhaps the primary stumbling blocks for maintaining mobility are the presence of pain, how it is treated, and the amount of supervision required to keep PLwD engaged, physically. Fortunately, the human body has built in systems that not only work together, but compensate for weaknesses, allowing us to restore, maintain, prevent loss of, and improve our physical and mental conditions. Physical movement is a holistic practice with profound benefits, especially for PLwD.
During periods of required bed rest after injury or surgery, the clearest evidence of the importance of mobility is often discovered. Studies show that muscles atrophy approximately 12 percent a week, and after three weeks as much as 50 percent of muscle strength is lost in all muscle fiber types. This strength loss occurs primarily in the muscles of the back, legs, and core that aid in healthy posture. At this point the entire body has most likely lost bone density, skin is negatively affected, and the immune system is compromised. Muscles atrophy some three times more rapidly with immobilized stroke patients, and for those with peripheral nerve injury, muscle fibers might be permanently lost to connective tissue and fat. Just think about PLwD sitting in a chair all day because they may not be able to keep themselves occupied, active, and moving. Consider the physical toll, costs, and quality of life involved in performing transfers for the immobile. What if it was possible to reduce the need for this kind of dependence? While each circumstance is unique, it is possible.
Exercise is an option for pain management instead of only medications for treating pain. First, exercise can help prevent injury and illness by sustaining a healthy body, and secondly by alleviating pain through movement of the joints, muscles, circulation of blood, and improved oxygenation for the body and brain. Exercise options may be reduced with the use of certain medications. For example, blood pressure medication can cause dizziness. Changing the timing of doses to before bed instead of in the morning reduces risks of falls during activities of daily living and certainly before an exercise session. Pain medications have a myriad of side effects, such as drowsiness, lack of coordination, and reasoning that might prohibit even going for a walk safely. Exercising in the water is a great option for PLwD that experience pain. Water is soothing, low impact, and with proper supervision is available to the mobile and immobile, in all states of brain change.
Much of the success of exercise as an aspect of care relies on awareness and communication. A recent scenario involved a physical therapist working with an elderly man with dementia at a group home. The client had fallen several months ago in the group home and had a hairline fracture in his hip. The therapist was concerned because the goal of restoring strength and mobility required the client to get out of bed. The care team was reluctant to get the client out of bed because of his injury and he complained of pain in the abdomen. The visiting medical staff had not left instructions relating to this chronic pain in the abdomen which had been going on for two months. When the client was experiencing pain in the abdomen, he did not eat or drink well and was failing to thrive. As it turned out, the client was constipated. A strong cup of black tea, apple juice, and an enema were all it took to get the elderly man moving. Exercise keeps us moving in every way.