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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?

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