On a recent visit to the nursing home to see my 90-year-old mother, I brought a new blouse for her. It was wrapped and taped in tissue paper. As I handed it to her, I had to resist the temptation to rip off the paper, smooth out the blouse and hold it up for her to see.

No matter how long it takes and how much her fingers may struggle with the task, she needs to do it herself. Small-motor movements, such as manipulating a package, are more important than ever for my mother, who is now confined to a wheelchair. Using her hands and fingers as much as possible in the movements of daily living is a way to stay active.

Unfortunately, however, movement becomes a diminishing experience for many frail elderly. The older and weaker they get, the more that is done for them by others. And that can lead to a continuing deterioration in strength and function.

Frail? Exercise May Help
“Frailty is not a contraindication to exercise,” said Miriam E. Nelson, an associate professor at Tufts University in Medford, Mass., and director of its Center for Physical Fitness. This expert in bone health and nutrition for the elderly said, “Being frail is probably the major reason why people should exercise.”

Caring relatives and friends can make a difference by encouraging movement in whatever measure an elderly person can handle. Rather than only sitting and talking, or taking over tasks in an effort to be helpful, caregivers can also provide activities and exercise opportunities as a normal part of their interactions.

“You want the elderly to be functioning at as high a level as possible,” Nelson said. Typically, the elderly have become so weakened that making changes in their ability to move can go a long way. “Many of the people we’ve worked with have been able to improve 100, 200 percent in their functioning once they’ve gotten stronger,” she said.

While it’s important for elderly people who are mobile to be up walking and moving about each day, exercise routines need only be done about three times a week to make a difference. Once older people get moving regularly, Nelson said, “they become less constipated, they feel better, their mood improves, there’s a reduction in depression and improvement in sleep patterns.”

She recommends simple strengthening exercises that involve the lower body and the arms, as well as balancing exercises to minimize the risk of falls. In her books on bone health, including her latest, “Strong Women, Strong Bones” (Putnam, 2000, $23.95), Nelson gives examples of the types of exercises that can be used or adapted in working with the elderly. At her Web site, she demonstrates specific exercises — like doing a chair stand and overhead press — through animated figures.

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Of course, it’s important to check with their doctors before starting to engage the elderly in new types of movements. What you often find when you do, Nelson says, is not that there’s an underlying cardiovascular issue that restricts movement. Rather, older people may have lost the ability to get out of a chair, step into a shower, dress themselves or climb stairs because they have lost the strength to do so.

While some elderly have access to exercise programs in the community or in the facilities where they live, many do not. Caregivers can take up the slack by verifying the person’s ability to exercise, learning the motions themselves and then going through them regularly with the elderly person.

The Difference Movement Can Make
To get hard data on just what a difference movement can make to a person, for example, in a long-term care facility, Kelli Koltyn, an assistant professor at the University of Wisconsin in Madison, is undertaking a study to look at the association between physical activities, physical functioning and quality of life in older women who are no longer living at home.