Strength and flexibility for older patients, part 1.(EXERCISE RX)

Between ages 55 and 65, your patients will lose about 15%-20% of their muscle mass unless they take action to prevent it. Even people who are fairly healthy are vulnerable to this age-related change.

In my first three columns, I'll describe a series of basic exercises aimed at the areas most crucially affected by muscle loss: the neck and shoulders, hips and lumbar spine, and knees. By improving flexibility and balance, such an exercise regimen will help avoid pain and injury, and can delay the aging process by as much as 15-20 years.

In this month's column, we'll look at a short series of stretches and strengthening exercises that older patients can use to build strength and improve flexibility in the hip and lumbar spine. (See the illustrations and instructions for patients below.)

It's not unusual to see patients in their 50s and 60s who have a reduced range of motion in their hips, which causes them to bend forward slightly when walking. Although a patient complains of pain, an x-ray or MRI may show no musculoskeletal problems because the hip stiffness may be due in part to a lack of exercise. Hip stiffness also contributes to low back pain, and the most productive exercises for stiff hips involve the hip flexor and lumbar spine muscles.

Well-functioning muscles have a major role to play in preventing pain. But for therapeutic exercises to be effective, older patients need to stretch at least 4-5 times per week. Ideally, patients should walk for 15-30 minutes before doing the exercises. Even a brief warm-up session can improve their ability to stretch by 20%-25%.

The exercises should be done on a carpeted floor or an exercise mat, although one of the stretches is done lying on a bed. Encourage patients to start slowly, doing fewer sets for the first few weeks until they get used to the movements.

Each movement should be done slowly and gradually, holding the stretched position for 12-15 seconds. Remind patients not to bounce while stretching, and emphasize that they should case into the stretching positions gradually to avoid pain.