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Beating Mobility Disability

Oct 07, 2011

A member of my family just celebrated a landmark 75th birthday! We had a nice birthday dinner to celebrate. But, it made me reflect on how things have changed over the past 5 years. When this person turned 70, she seemed full of vigor...she was active, she moved quickly, and appeared ready to live well for another 20 or 25 years.

Then, a medical problem came along that changed things. It isn’t diabetes, but it is something that has caused mobility disability. Because of the need to take steroids, this person has seen an increase in body weight and a decrease in strength. It is most evident from an outsider looking in to see how much harder it is for her to stand from a chair, walk (reaching for support whenever possible), and to go up or down stairs. The person who never sat down is now happy to watch others prepare meals, go to the store, and clean the house. She moves much more slowly and has had 1 bad fall. She has mobility disability.

As a diabetes educator, I know that this type of disability is also very present in the diabetes community. Gregg, et al. reported data from the Third National Health and Nutrition Examination Survey (NHANES III) in Diabetes Care in 2000 on community-dwelling men and women ≥60 years old. They reported that, in men and women, diabetes was associated with 2- to 3-fold increased odds of not being able to either walk ¼ mile, climb 10 steps, or do housework; a 3.6-fold increased risk of not being able to do all 3 tasks; women had slower walking speed, decreased lower extremity function, decreased balance, and an increased fall risk; and concluded that diabetes “is associated with a major burden of physical disability in older U.S. adults, and these disabilities are likely to substantially impair their quality of life.”

So, as diabetes educators, how can we help? Exercise has been shown to improve strength, power, pain, balance, walking speed, endurance, etc. Doing lower extremity strength and balance training, participating in tai chi, and simply walking can improve how people function.

If we see a person for diabetes education, and note that they are challenged with walking or doing simple tasks, we can refer them to a physical therapist or exercise physiologist, a community exercise program, a tai chi or strength and toning class, a water exercise program, or a fitness facility. It is important to guide them to a program that suits their ability (or disability). Ask around to find where other patients are going and how they are doing. Create a resource list.

Most importantly, share with the patient how exercise can improve how they move, their quality of life, and can prevent falls and worsening disability. Sometimes, improving blood glucose and A1C and prevention of a heart attack 5 or 10 years from now aren’t good enough reasons to go through the trouble of exercising routinely. But, if someone can move better, do normal activities easier, enjoy time with children/grandchildren/friends, and enjoy life more, it may be worth it to them.

How do you encourage your older patients to get more active? Any tips or resources you can share?

2 comments

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  1. Nov 07, 2011

    I see this situation repeatedly and not just in older adults but also in those with permanent work disabilities. Motivating any thing new for some of these folks is very difficult. Here are some tools I use in hopes that something will "stick". We have on ongoing Arthritis Exercise and Self Help program available in our area. The instructors are retired health professionals and they are certified by the Arthritis Foundation and use there cirriculum and materials. They ususally meet weekly and the cost is a minimum 2.00/session. I find that most people have some type of arthritis at this stage of life and respond quite well to the idea especially if they like doing things in a small group where they get individual attention and encouragement. Another item involves use of soft pilates bands which I whip out from my desk drawer. After we do a few tug-a-war moves even if they are in a wheel chair,they get the idea of "doing upper body exrcise". Also recommend table top ergometers, Sit and Be Fit videos or TV shows and pedometers. If that doesn't work I try to encourage a hobby, sort of sneak in the back door so to speak and get them to do something workthwhile that leaves a good feeling. Sometimes this makes them more receptive to other activity later on.
  2. Oct 08, 2011

    A personal favorite of mine is a program taught by the Arthritis Foundation - called 'Twinges & Hinges'. The classes are normally taught in a warm aquatic therapy pool, and many YMCA's offer these classes. Please be advised that they should be taught by Arthritis Foundation trained educators, as injuries can happen if exercises are not followed properly. It is a great way to get out and socialize, too! I personally took the training and spent time working at a YMCA teaching these classes. I highly recommend them.

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