Promoting exercise for older adults.

This special issue is an exceptional grouping of some useful review articles and pilot studies addressing physical activity in older adults. Specifically addressed aremeasurement challenges and solutions and innovative ways nurse practitioners (NPs) can implement physical activity programs in real-world settings. This work is particularly timely given the relatively recent passage of new health promotion guidelines associatedwith ‘‘Welcome toMedicare’’ (Centers for Medicare and Medicaid Services, 2006), Pay for Performance, and the Health Plan Employer Data and Information Set (HEDIS), as well as the American College of Sports Medicine and the American Heart Association 2007 Guidelines for physical activity for older adults (Nelson et al., 2007). These programs provide reimbursement, regulatory guidelines, and incentives for providers to discuss health promotion activities such as physical activity with patients and encourage adherence to current guidelines. Unfortunately, most healthcare providers do not encourage physical activity or take time to discuss the benefits of such activities (Dauenhauer, Podgorski, & Karuza, 2006; Kerse, Elley, Robinson, & Arroll, 2005). Based on observations of 423 video-taped physician–patient encounters (Ory et al., 2006), only 39% were found to include a discussion about physical activity. Approximately 50% of providers report that they do not prescribe physical activity for older adults (Dauenhauer et al.). Patient recollections of the frequency of physician recommendations related to physical activity are somewhat higher ranging from 50% to 62% (Balde et al., 2003; Hirvensalo, Heikkinen, Lintunen, & Rantanen, 2005). In addition, 10%of older patients reported that they received warnings against participating in physical activity and 34% reported receiving both recommendations for and warnings against physical activity (Hirvensalo et al.). Tompkins and colleagues specifically address the health promotion care practices of a sample of NPs. Their findings indicated that NPs do a better job of promoting physical activity than their physician colleagues. Participants included 398 NPs, who averaged 11 years in practice (SD = 7.9) and worked in a variety of practice areas. In a givenweek, about half (48%) of the NPs counseledmore than 50% of their patients for exercise. The majority of participants (84%) reported that exercise counseling was as valuable an intervention as prescribed medication. These findings are quite encouraging in terms of the behavior of NP providers with regard to promoting physical activity among older adults. There are still, however, 50% of NPs who are not actively engaged in this type of health promotion. Prior research has noted that generally healthcare providers (physicians, NPs, and physician assistants) believe in the benefits of physical activity, but they have insufficient knowledge of what to recommend with regard to beginning a physical activity program (Dauenhauer et al., 2006). This group of focused articles can help to fill the void in knowledge experienced by healthcare providers with regard to how to evaluate and prescribe physical activity for older adults. To lay the foundation, the review article by Yeom and colleagues provides the critical evidence to support why exercise should be encouraged when working with older adults. In addition, their review identifies specifically for the reader the types of exercise and exercise programs that aremost likely to be beneficial for the older individual. The review indicates that exercise interventions as simple as walking programs,whether individual or groupbased,will result in improved mobility among older adults as long as they continue for at least 12 weeks. Yeom and colleagues also highlight the ongoing challenges NPs are likely to face when trying to engage older adults in exercise. Challenges addressed include such things as cultural differences and acceptance and motivation and adherence over time. To further help NPs who are motivated and willing to recommend exercise to their older patients but are uncertain of what to prescribe, I recommend exploring the Exercise Assessment and Screening for You (EASY) available online at www.easyforyou.info. This screening tool can be used by providers to screen older adults for what will be a safe exercise program for them based on underlying physical problems. The recommended exercise programs have all been reviewed and endorsed by national organizations and institutions such as the National Institute ofAging.All the recommendedprograms can be easily printed and given to the patient prior to leaving the office. The pilot work of others (Alpert et al., Dorgo et al., and Resnick et al.) in this issue provides additional examples of innovative interventions to engage older adults in physical activity. Alpert’s team describes a pilot study of a 15-week dance class for community-dwelling older adults. The results indicated that participation in the classes did not improve cognition or mood but the dance class did have a significant impact on balance among those who