Physiotherapy for Healthy Aging

The world’s population is aging. The number of adults over age 65 is expected to double in the next 20 years. In 2012, almost one in seven Canadians were aged 65 years or older; by 2030, nearly one in four Canadians will be a senior. Increased life expectancy is a key factor contributing to the aging of the population; thus, promotion of health span and healthy aging is a global priority. Kaeberlein¹ defined health span as the period of life spent in good health, free from chronic diseases and the disabilities of aging.¹ The World Health Organization (WHO) has defined healthy aging as “the process of developing and maintaining the functional ability that enables wellbeing in older age.”²

Regular physical activity is the most effective behavioural strategy for increasing health span and promoting healthy aging. The Conference Board of Canada³ has estimated that the number of older adults receiving physiotherapy (PT) care will double from 1.5 million in 2014 to 3.0 million by 2035. According to the Canadian Institute for Health Information, more than 26,000 physiotherapists; 90% are providing direct care.⁴ Physiotherapists are trained to manage complex health conditions across the lifespan and are embedded in a variety of settings in the public and private sectors.⁵ Physical activity promotion and healthy aging are in the curriculum of entry-to-practice PT programmes across Canada; hence, physiotherapists are in an ideal position to promote health span and healthy aging.

Traditionally, physiotherapists work with older adults after an injury (e.g., fall-related hip fracture) or event (e.g., stroke). However, for our profession to significantly contribute to the healthy aging agenda, we need to leverage our expertise in movement and exercise prescription, as well as counselling skills, to support our clients across the health continuum to be physically active in their daily lives. In short, we must integrate physical activity promotion into our practice with older individuals to prevent chronic conditions that impact their functional ability, quality of life, and well-being.

Physical Activity: A Key Ingredient in Healthy Aging

Physical activity is a critical strategy in increasing health span because it can effectively prevent chronic non-communicable diseases such as diabetes, cardiovascular disease, and dementia.^6,7 WHO has defined physical activity as “any bodily movement produced by skeletal muscles that requires energy expenditure.”⁸ Exercise is a subtype of physical activity that has specific parameters and is done with the intention of improving or maintaining physical or health outcomes. Reducing physical inactivity by 25% could prevent 1 million cases of dementia annually worldwide.⁹ Further, physical activity is a first-line secondary prevention strategy in osteoarthritis,^10–12 which affects 33% of men and 40% of women over age 65 in Canada.¹³ Yet nearly a third of adults in developed countries are physically inactive.^14,15

Physical activity is a widely recognized and promoted strategy for healthy aging. It specifically improves both cognitive health and mobility, intrinsic functions that are essential for functional ability and robust indicators of overall health.¹⁶

Falls prevention is an area in which physiotherapists have played a key role in promoting healthy aging. Ample evidence indicates that the Otago Exercise Program, a home-based strength and balance exercise training programme that physiotherapists can deliver, is effective in the primary and secondary prevention of falls.^17–19 Physiotherapists are best suited to deliver this programme as many older adults who fall have multiple comorbidities, and physiotherapists have the expertise to adapt the programme to individual needs. Physiotherapists also play a critical role in screening individuals who are at risk for falls and mobility disability using simple clinical assessments such as usual gait speed, timed up-and-go test, and 30-s chair stand; the Healthy Aging: Seniors’ Mobility Toolkit for Physiotherapists offers a physiotherapy-specific framework for the assessment of mobility and identification of modifiable factors responsive to physiotherapy interventions.²⁰

In contrast, both the profession and our clients underappreciate the value of physiotherapy for the promotion of cognitive health and the prevention of cognitive impairment.²¹ Evidence shows that an active lifestyle reduces the risk of cognitive impairment and dementia,^22–24 and targeted exercise training promotes cognitive function, brain structure, and brain function in older adults.^25–28 Notably, many modes of exercise physiotherapists prescribe to improve mobility and prevent falls (e.g., walking, functional exercises, balance training, strength training) also promote cognitive and brain outcomes in older adults. These evidence demonstrate the role physiotherapists have in the promotion of healthy aging.

Leading the Healthy Aging Agenda

Moving forward, we can start by revisiting the concept of rehabilitation in physiotherapy practice. WHO has defined rehabilitation as a process aimed at enabling people with disability to reach and maintain their optimal functional level.²⁹ Central to this concept is a time-limited process that ends when treatment goals are reached.³⁰ Traditionally, rehabilitation has been conceptualized as either remedial or adaptive. Remedial rehabilitation focuses on restoring capacity (e.g., improving muscle strength) or retraining lost skills (e.g., self-care, work skills). Adaptive rehabilitation aims to compensate for lost or absent capacity and focuses on providing assistive equipment or altering the environment to optimize the performance of a task or activity.²⁹ These definitions, however, fall short when the rehabilitation concept is applied to promoting healthy aging.

Within the current concept of rehabilitation, a client sees a physiotherapist until the client reaches treatment goals, at which time the client is discharged from PT. Visits resume only when the client experiences the next health episode. This model leaves no room for physiotherapists to monitor and refine clients’ exercise recommendations and physical activity plan to promote mobility or cognitive health over time. Hence, the current concept of rehabilitation limits its benefits in promoting healthy aging across the continuum.

It is our profession’s time to advance the practice and science of promoting healthy aging by reshaping the current concept of rehabilitation into a model in which clients receive support to maximize their health over the lifespan. Unless we take on the role as a leader, the health professions, clients, and society will continue to underappreciate the value physiotherapists offer seniors to keep them safe and independent.