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Physical Assessment

How to assess cardiac risk for adverse events

Because of the high incidence of heart disease in older adults and the increased risk for cardiac events, it's important that older adults are screened for potential problems during a physical activity program. The American College of Sports Medicine (ACSM) provides guidelines for exercise testing & prescription. Physical activity is generally safe for most individuals, although there are a few contraindications to exercise such as active rheumatoid arthritis, unstable cardiac disease, or recent myocardial infarction. As with any intervention, the benefits should outweigh the risks. Individuals who present with persistent musculoskeletal symptoms should be first referred to a physical or occupational therapist for evaluation before prescribing a structured physical activity program.

How to assess and document individual physical ability

There are several useful and clinically proven methods of assessing fitness levels among older adults. These assessments are used to help determine initial fitness levels, set goals, and to assess progress. It's important to choose the tests that are appropriate for the individual. These recommended assessments don't require expensive equipment or large facilities.

The Senior Fitness Test (Rikli & Jones, 2001) is suggested for office or clinical assessment of physical ability, and is particularly useful when documenting outcomes. Norms for this assessment have been established for various age groups. The test involves six different activities to assess upper and lower body strength and flexibility, as well as balance and cardiorespiratory fitness.

How to assess functional limitations

Once the above physical ability tests and/or functional limitation checklist are completed, healthcare providers can look for possible areas to improve through an individualized physical activity program

Limitation Activity Recommendation
Carrying Groceries Upper Body Strength & Balance
Getting into and out of bathtub Lower & Upper Body Strength & Balance
Walking on uneven ground Lower Body Strength, Balance

Goals should be based on the results of the physical assessment or checklist noted above. For example, "After 8 weeks of strength training, I will be able to walk up and down a flight of stairs 3 times". A physical activity log (download PDF here) is useful in motivating individuals to continue activity.

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