Most conversations around physical activity are frequently centred around— and limited to— the younger, able-bodied generation. A group that is often neglected and ignored is that of senior citizens, especially those above the 65+ age bracket.
Exercise combined with a healthy diet is essential for cognitive and physical functioning, but due to lack of awareness, the elderly population in Pakistan often live a sedentary lifestyle.
This got me thinking: Are there any specific exercises that the elderly population should be doing to strengthen their bodies? What can they do to be physically able, even fit, in old age? How do their dietary habits affect their movement?
To answer my queries, I first reach out to one of the most highly-recommended physiotherapists in Karachi, Dr Rabbia of the Physical Wellness Centre in Karachi, who gets right to the heart of the issue and says that Pakistan has two types of families; one that pushes their older members to work (e.g. home chores) and be active, and the other that restricts their older members from physical work, lest they injure themselves.
She urges everyone to be like the former.
A holistic view of 'wellness' in old age
Though Dr Rabbia is aware of the social and cultural need to take care of guardians in old age, she stresses that a sedentary lifestyle for the elderly actually increases their risk of injury.
“They’re underutilising their muscles, consequently, stiffening their bodies and restricting their range of motion.”
She suggests that their routine include “a 30-min walk, twice a week — anything that challenges them in their day-to-day lives without exerting themselves too much.”
However, she specifies that weight training for the older community is not something she would recommend.
“I've heard of chair yoga here [in Karachi], there's water aerobics and gardening is a great activity,” Dr Rabbia continues, “the key focus should be on functional movement rather than exercise-specific, for instance reaching for items on high-up shelves or playing with children will require them to move in all planes involuntarily.”
Perhaps the most important aspect of physical activity for seniors according to her is that it “not only makes them independent but stimulates them cognitively, refreshes their mindset, betters their behavioural activity and helps with their balance and stability.”
“It strengthens their muscles allowing them to do regular chores with ease as their biggest fear of falling, tripping, slipping comes from having to perform everyday tasks,” she emphasises. “They feel a sense of mental relaxation that comes from that independence — that they can do their chores themselves.”
The physiotherapist also highlights the importance of water intake. “Old people often deal with muscle stiffness and cramping because they drink less water out of fear of making multiple trips to the bathroom but that results in a loss of muscle capacity. I always prescribe high water intake to my senior clients.”
“Movement is integral in regaining control over your body"
Given the small pool of certified fitness instructors in the city who work with the elderly, I was recommended Saman Ali, a yogi who teaches seniors chair yoga.
In her practice, she employs “a combination of cardio, restorative, strength building and mobility work.”
She says, “All the years of neglect of exercise leaves them not just physically challenged but also often unaware of how their bodies work and which of their muscles to engage to get a particular result.”
Personally, she recommends restorative and meditative exercises so elders can tap into their inner self mentally and physically for inner peace and comfort. “Yin is a great way to increase mobility, a lack of which is a common cause of discomfort for seniors,” Saman advises.
There’s more to it than just attending exercise classes, she says. “Movement is integral in regaining control over your body. Two to four hours in my class are not enough to notice change in self unless they have the patience to wait for years. Stretching and conscious engagement of muscles must be exercised routinely to feel the changes.”
"The best form of movement for the elderly is one which is fun for them"
Another instructor who trains a large clientele of seniors is Mantahaa Tareen, a Lifestyle and Wellness Coach based in Karachi.
“I have trained clients in the same age group who suffer from depression, joint issues, osteoporosis, sciatica, arthritis and in 85-90% of the cases, I have seen their conditions improve through exercise,” says the fitness instructor.
“The aches and pains don’t necessarily go away but they no longer impinge on the client’s functional abilities.”
In her opinion, the best form of movement for the elderly is one which is fun for them — and that doesn’t necessarily translate to exercise.
She also touches upon a point usually overlooked in older women: exercise to treat menopause.
The average age at which women hit menopause is 51 but its symptoms can last for years. A quick online search shows that women in postmenopausal stages are at an increased risk of health conditions like osteoporosis and heart disease, they suffer from emotional side effects, especially depression, they gain weight around their abdominal area and lose their sex drive.
Her approach towards clients who’ve hit menopause sometimes involves supplements but mainly revolves around “improved nutrition and diet” along with “low-intensity interval training.”
She says, “They feel better, they look better and they feel younger.”
It's important to do it right
However, Mantahaa warns that too much cardiovascular activity can result in injuries and saggy skin. On the other hand, “strength training helps improve bone health, mental health, muscle health and the immune system.”
She reiterates that a person’s mental and physical state are intrinsically linked and exercise can elevate both states simultaneously.
But before heading to a trainer, “always get blood tests done, seek your doctor’s approval and get a physical assessment before taking up any form of exercise.”
Additionally, senior clients should have their blood pressure checked and recorded before each class, says Mantahaa.
The one thing all three place emphasis on is the need for a healthier and active lifestyle during a young age to maintain good physical health in old age.
Like Saman aptly puts it, “Exercise is not only important for those who are above 65+ age bracket, it is important for all ages starting as young as six months. It is just that lack of mobility and strength is more evident with seniors.”
Point to learn, encourage the elderly in your homes to do their own chores, to get moving and find activities to do inside and outside the house. Help them help themselves.