Numerous studies have demonstrated the positive effects of exercise interventions for older people. Positive effects can be demonstrated within the framework of the World Health Organization’s International Classification of Functioning, Disability and Health model on the body structure and body function domain as well as activities and participation domain.
Many programs have been developed in response to the rising percentage of sedentary older people and the lack of appropriate physical activity levels (Etkin et al., 2006; Prohaska et al., 2006), but not all have been successful. The strength of evidence that exercise intervention has positive effects on all domains of the ICF Model can no longer be ignored, but unfortunately, the implementation of effective exercise interventions are hampered by different issues.
Here are three key components that can cause programs to flounder.
One key component is the targeted population related to the program. This component is important when implementing intervention programs in different settings. Very often, specific populations have explicitly been excluded in exercise research due to different reasons, such as the perception that they are not capable of following the instructions due to cognitive impairments or physical impairments.
In addition, researchers face the challenge of the heterogeneity of older people. For example, if a fall intervention program has been demonstrated to be effective in a community-dwelling population, it has to be investigated again in another setting, such as residential care or even a nursing home setting. The program might have to be adapted to the different settings and challenges.
Campbell & Robertson (2007) discuss some of the issues regarding the lack of implementation of effective fall interventions. One reason might be the misconception that the person is too old to participate in an exercise program. This misconception comes not only from the possible participants themselves but also peers, family members—and even general practitioners or health care professionals.
Experience from my own research underlines that misconception of older adults. The study “Standfest im Alter (Enhancing Balance),” completed in Germany, had the goal of reducing the number of falls and the rate of fallers in community-dwelling older people. The effects of three interventions on fall-related physical and psychological outcomes and falls in community-dwelling older people were investigated in this study (Freiberger et al., 2006 & 2007). One of the most startling sentences by a targeted participant was, “There must have been a mistake. I got an invitation for an exercise program, but I am already 75 years old! I am too old for that, although I am very unsteady!” Later on, during the intervention phase, one female participant told me, “If you would have told me that I would be doing balance exercises with closed eyes, I would not have believed you because I was never the very active type of person and did not have any experience in exercise. Now I am having the fun of my life!”
So we still have to deal with misconceptions that exercise interventions for older adults are not appropriate or they are too dangerous, even though enough research has been demonstrated that older people do profit through structured exercise intervention on nearly all domains of the ICF model.