Stretch, move, lift are trifecta

Seniors who exercise shown to have fewer injuries

WAKE FOREST -- They seem unlikely health-care revolutionaries, these 60- and 70-year-olds in constant motion for a hot half-hour in a senior center near downtown Wake Forest.

But they are healthy, living proof of an influential concept called "evidence-based disability and disease prevention." More simply, they are following a very specific routine -- cardiovascular exercise combined with weightlifting and flexibility training -- that has been tested and proven effective in improving the health of older people.

"There's a good deal of research on interventions that are proven to work," said Mary Altpeter, associate director of UNC-Chapel Hill's Institute on Aging. "Physical activity is the mother of all interventions."

It might seem common sense that exercise is good, but exercise programs are often haphazard and sometimes even dangerous to older people. Finding something that works is important because even small improvements in older people's health can save billions of dollars in health-care costs.

"From a provider perspective, in terms of how we spend money on services, being able to demonstrate benefits is very important," Altpeter said.

That's one reason why big names such as the Centers for Disease Control and Prevention, the Robert Wood Johnson Foundation and the National Council on Aging are involved in the Wake County program. Beginning last year, Raleigh-based Resources for Seniors became one of three agencies nationally to participate in a study of the program. More than 250 area seniors took part in the research, led by the University of Chicago.

"Now we can actually say that we've got proof that what we are doing is making a difference," said Miranda Strider-Allen, senior center program director for Resources for Seniors, a nonprofit group that runs Wake County senior centers.

At the Northern Wake Senior Center this week, participants worked out, line-dance style, to "Dancing Queen" and other thumping disco hits. Instructor Carol Bessette-Battle led the class in cardio exercises for the first half of the class.

"Think of the flexibility we're gaining!" she said to the class.

Proactive stance

Every year, about a quarter of a million Americans older than 65 suffer hip fractures, the most serious kind of bone fracture, the Centers for Disease Control reports. Half of them can't return home or live on their own after the injury.

According to the federal Agency for Healthcare Research and Quality, hospital charges for hip fractures amount to $6 billion a year. Reducing such injuries would save millions of dollars. Researchers have found that seniors who remain flexible are less likely to fall and break bones.

That leads to the next item on Bessette-Battle's agenda for the Wake Forest crew: 15 minutes of weightlifting and another 15 minutes of stretches to gain the strength and flexibility that are key to preventing falls. Once the person's ability level is established, each follows carefully spelled-out repetitions of specific exercises.

"We've learned that with a multicomponent approach -- flexibility, strength training and aerobic exercise -- you get the most bang for your buck," said Rachel Seymour, a University of Chicago researcher involved with the impact study.

After the session, participants said the classes made them feel healthier, and not only physically.

"I feel a lot better mentally, emotionally and physically," said Carolyn Shearon, 68, of Rolesville. "It keeps me moving."

The program has drawn people to the center because it is not the typical offering of passive programs such as bingo, Strider-Allen said.

"We love it," Bertha Salgaldo, 61, said. She started attending the class with her husband, Wilson, 60, after he retired in New York City and they moved to North Carolina.

"We wanted something to do," she said.

Reaching out

The evidence-based exercise model is expanding. One such program, called Fit and Strong, is specifically designed for people with osteoarthritis of the lower limbs. Starting next month at some Wake senior centers, the approach will offer education as well as exercises.

"They are all evaluated, and they all have measures," Altpeter said of the programs. "They have to work in a variety of settings -- with minority populations, with low-income people, with people who have cognitive impairments."

UNC nursing school professor Jean Goeppinger, a pioneer in community-based research, is working with Stanford University's Kate Lorig, director of the school's patient education research center. They are testing ways to get self-managed versions of evidence-based programs out to a wider community via e-mail and online communication.

"They know that the in-person version works," Altpeter said. "But people take in information in different ways. Some people do better with a group, where there are peers and role models." Others, she said, "are used to computers and are happy to use them."