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Regular exercise physiotherapy · Home visits across Hong Kong

Physiotherapy for Rehabilitation and Regular Exercise

Telling a parent to walk more may not be enough. Research and the WHO 2020 guidelines both show that, to keep function and prevent falls, older people need multicomponent exercise that balances aerobic activity, strength and balance, and a single activity such as walking is not enough. A registered physiotherapist visits the older person’s familiar home, assesses fitness and fall risk, and designs an exercise prescription that is safe, gradual and done with correct technique.

  • Registered physiotherapists in Hong Kong
  • Home visits across Hong Kong
  • 1 hour $1,000 · 1.5 hours $1,300
  • Exercise prescription · fall prevention

Designing suitable exercise for the older person’s needs

Regular exercise is one of the methods with the most evidence for keeping fitness, preventing functional decline and slowing ageing, and it is especially important for older people and people with chronic conditions. More exercise is not always better, and neither is harder exercise. Only when both the dose and the type are right can exercise target fewer falls, prevent sarcopenia and protect heart and brain health. The data below, from pooled analyses of randomised controlled trials, show how clear the benefit of “doing the right exercise” is:

↓ 23%
Exercise lowers the overall fall rate in older people
RaR 0.77; Cochrane pooled result of many randomised controlled trials (Sherrington et al., 2019)
↓ 24%
Balance and functional exercise lowers the fall rate
RaR 0.76; the type of exercise with the best effect for preventing falls (Sherrington et al., 2019)
↓ 31%
Tai chi lowers the fall rate
IRR 0.69; low-impact balance exercise that suits Chinese customs (Huang et al., 2017)
↓ 55%
Multicomponent exercise improves frailty
Pooled from 18 randomised controlled trials covering 3,457 older people (BMC Geriatrics, 2024)

These data show that improving physical condition effectively takes more than walking a lot. It needs multicomponent exercise that includes enough balance and strength training. The physiotherapist designs a suitable exercise prescription for the older person’s situation, to help the older person reach a training effect.

What the WHO 2020 guidelines recommend for older people

The World Health Organization (WHO) physical activity guidelines published in 2020 give clear recommendations for adults aged 65 or above. As well as the hours of aerobic exercise, the guidelines strongly recommend multicomponent exercise that emphasises functional balance and strength on at least 3 days a week, to maintain everyday function and prevent falls. A complete exercise prescription includes the four elements below:

Aerobic exercise150–300 minutes a week at moderate intensity (such as brisk walking or swimming), or 75–150 minutes at vigorous intensity; it can be done in blocks. Moderate intensity is roughly “able to talk but slightly out of breath”.
Strength trainingAt least 2 days a week covering the major muscle groups, using resistance bands, dumbbells or body weight; the key component against sarcopenia.
Balance and functional trainingAt least 3 days a week (a particular emphasis of the WHO for older people), such as single-leg standing, heel-to-toe walking and tai chi; the core of fall prevention.
Flexibility trainingStretching the major muscle groups on 2–3 days a week, holding each stretch for 20–30 seconds without pain; keeps joint range of movement, and works better after exercise.

The WHO also states that “some activity is better than none”. Even if an older person cannot reach the recommended amount of exercise for the time being because of physical condition, starting with a small amount and continuing to practise still helps health. In daily life, older people should also try to reduce long periods of sitting without moving.

Benefits of regular exercise for the body

A well-designed exercise prescription does much more than general “keeping fit”. For older people and people with chronic conditions, the benefits supported by medical evidence include:

Bones, muscles and balance

  • Counter sarcopenia: resistance training significantly improves grip strength, leg strength and walking speed, and keeps independence
  • Prevent falls: balance and functional exercise lowers the fall rate by about 24%, and tai chi by about 31%
  • Reverse frailty: multicomponent exercise can lower the risk of frailty in older people by about 55%
  • Maintain bone and joints: weight-bearing and activity help to keep bone density and improve joint mobility

Heart, lungs, brain and general health

  • Protect the cardiovascular system: helps to improve blood pressure, blood lipids and circulation, and supports cardiovascular health
  • Offset the risk of sitting: about 60–75 minutes of moderate exercise a day almost cancels the mortality risk of long periods of sitting (Ekelund et al., 2016)
  • Chronic conditions need movement even more: in people with chronic conditions, going from “inactive” to “slightly active” brings the clearest fall in mortality risk (Geidl et al., 2020)
  • Good for the brain: aerobic plus resistance exercise helps to improve cognitive function in adults over 50 (Northey et al., 2018)

The first home assessment and drawing up the exercise prescription

Every older person differs in fitness, rehabilitation goals and health, so the exercise prescription has to start from a detailed assessment and then be adjusted as progress is made. The process is as follows:

  1. 1
    WhatsApp or phone consultation
    We first learn about the older person’s health, record of long-term conditions, mobility and personal goals, and give initial advice and a fee quote.
  2. 2
    First home assessment
    At the home visit we test the older person’s strength, balance, walking speed, flexibility and cardiorespiratory endurance, and check the home environment to assess the risk of falls.
  3. 3
    Individual exercise prescription
    Following the WHO guidelines, we combine suitable amounts of aerobic, strength, balance and flexibility training, and set the starting exercise intensity and stage goals.
  4. 4
    Guidance and supervision at home
    In the older person’s own home, training uses chairs, walls, water bottles and resistance bands. The therapist makes sure the movements are correct and increases the amount of exercise gradually when it is safe.
  5. 5
    Regular review and progression
    Objective measures such as the 1-minute sit-to-stand test and the 6-minute walk test are used to follow the older person’s progress, and the exercise prescription is adjusted according to performance.

Types of exercise for older people

All of the exercises below are fairly safe and suit the home or the community. How well they work depends on how the items are combined and how the dose is adjusted for each person’s ability:

Aerobic and strength training

  • Walking: the simplest to do; start at 10 minutes and build up, wear suitable sports shoes and choose a flat, safe route
  • Water exercise: buoyancy reduces the load on joints and suits people with arthritis, while water resistance also gives strength training
  • Sit-to-stand training: standing up from a stable chair and sitting down again strengthens the thighs; progress by crossing the arms or using a lower chair
  • Resistance bands, calf raises, side steps: strengthen the arms, calves and hips; hold on for stability and add resistance gradually

Balance and mind-body exercise

  • Single-leg standing: hold on to something stable and lift one foot, holding for 10–30 seconds; progress by using the hands less
  • Heel-to-toe walking: walk along a line with the heel of one foot touching the toes of the other, with a handrail or a helper nearby
  • Tai chi: low-impact and culturally familiar, with evidence that it clearly improves balance and reduces falls, and it suits people with joint problems
  • Chair yoga and dancing: improve flexibility and balance and combine cognitive and social benefits, which makes them enjoyable and easy to keep up

When practising balance movements, there must be stable furniture or a handrail within reach, and ideally a family member nearby. Beginners should start with simple movements. If chest pain or pressure, severe breathlessness, dizziness, an abnormal heartbeat or great tiredness occurs during exercise, stop exercising at once and seek medical attention.

Features of home physiotherapy

For the same exercise, how it is carried out often decides how well it works. The core of a good exercise prescription is an individual dose and close guidance on posture, and this is the greatest value of home physiotherapy:

Exercise prescription made for the individual
The physiotherapist visits to assess the older person’s strength, balance, gait, cardiorespiratory function and fall risk, and designs exercise according to the older person’s actual ability and goals, and does not give everyone the same exercise menu.
Correct technique, safe progression
The therapist demonstrates and corrects movements on the spot to make sure posture is correct, and raises the intensity and difficulty safely as the older person’s ability improves, which reduces the risk of injury or overdoing it.
Using household objects makes it easier to keep going
The older person can use chairs, walls, water bottles and resistance bands at home and practise in a familiar environment. Once the technique is learned, the older person can practise alone every day, and it is easier to fit exercise into daily life.
Fall prevention at the same time, and family guidance too
During training the therapist also finds and improves the places in the home where falls are likely, and teaches family members the correct way to support and watch over the older person, to help build a long-term exercise habit.

Frequently asked questions

How much exercise should an older person do each week?
The World Health Organization (WHO) 2020 guidelines recommend that older adults do 150–300 minutes of moderate-intensity aerobic activity a week (or 75–150 minutes of vigorous activity), together with strength training for the major muscle groups on at least 2 days a week. The guidelines also strongly recommend multicomponent exercise that combines “functional balance plus strength” on at least 3 days a week, to maintain everyday function and prevent falls. Even if fitness is not yet up to this level, remember that some activity is better than none, and any amount of exercise benefits the body.
Why is walking more not enough?
Walking is aerobic exercise. It benefits the heart and lungs but lacks strength and balance training. The WHO 2020 guidelines strongly recommend that older adults do “multicomponent exercise” on at least 3 days a week, with particular emphasis on functional balance and strength training. To prevent falls and keep independence, what counts is leg strength, core stability and balance reactions, and ordinary daily walking is not enough to build them. The physiotherapist’s role is to combine aerobic, strength, balance and flexibility training into a complete exercise prescription according to the older person’s physical condition.
Can exercise really reduce falls?
Yes, and there is good medical evidence for it. A Cochrane analysis pooling many randomised controlled trials found that exercise lowers the fall rate by about 23% (RaR 0.77). Balance and functional exercise has the clearest effect, lowering the fall rate by about 24% (RaR 0.76). Low-impact exercise such as tai chi also lowers the fall rate by about 31% (IRR 0.69). The key is that the exercise must include enough balance and lower-limb strength training, and be designed for each person’s fall risk.
Is exercise still suitable if sarcopenia or frailty has already started?
It is not only suitable, it is more urgently needed. Resistance training significantly raises grip strength, leg strength and walking speed. Research also shows that multicomponent exercise lowers the risk of frailty in older people by about 55%. The most important thing is that the physiotherapist sets the starting intensity according to the patient’s ability at the time, progresses step by step and guides posture, so that it is safe and effective. If the older person does not move at all out of fear of falling, bodily function declines faster.
How big a problem is sitting for long periods?
The health risk of prolonged sitting should not be overlooked. A pooled analysis of more than 1 million people found that people who sit more than 8 hours a day and do little exercise have about a 59% higher risk of death (HR 1.59). About 60–75 minutes of moderate-intensity exercise a day, however, almost cancels the extra risk from sitting. Besides building a habit of regular exercise, it is therefore also important to reduce long unbroken periods of sitting in daily life and to get up and move about more.
Is it necessary to consult a professional before starting exercise?
Older people with chronic conditions, or at high risk of falls, should first have a physiotherapist assess physical function and fall risk before starting exercise. The physiotherapist then draws up an individual, gradual exercise prescription and supervises posture, which is both safer and more effective. International guidelines (such as NICE) also stress that strength and balance training for older people should be prescribed and followed up individually by trained professionals, and a single exercise pattern should not be applied to everyone.
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Related physiotherapy topics

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.

References

  1. Sherrington, C., Fairhall, N. J., Wallbank, G. K., et al. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (1), CD012424. DOI
  2. Bull, F. C., Al-Ansari, S. S., Biddle, S., et al. (2020). World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine, 54(24), 1451–1462. DOI
  3. Huang, Z. G., Feng, Y. H., Li, Y. H., & Lv, C. S. (2017). Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open, 7(2), e013661. DOI
  4. Chen, N., He, X., Feng, Y., et al. (2021). Effects of resistance training in healthy older people with sarcopenia: a systematic review and meta-analysis of randomized controlled trials. European Review of Aging and Physical Activity, 18, 23. DOI
  5. Lu, J., Wang, J., Wang, X., et al. (2024). Impact of multicomponent exercise and nutritional supplement interventions for improving physical frailty in community-dwelling older adults: a systematic review and meta-analysis. BMC Geriatrics, 24, 945. DOI
  6. Liu, C. J., & Latham, N. K. (2009). Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews, (3), CD002759. DOI
  7. Northey, J. M., Cherbuin, N., Pumpa, K. L., Smee, D. J., & Rattray, B. (2018). Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. British Journal of Sports Medicine, 52(3), 154–160. DOI
  8. Ekelund, U., Steene-Johannessen, J., Brown, W. J., et al. (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet, 388(10051), 1302–1310. DOI
  9. Geidl, W., Schlesinger, S., Mino, E., et al. (2020). Dose–response relationship between physical activity and mortality in adults with noncommunicable diseases: a systematic review and meta-analysis of prospective observational studies. International Journal of Behavioral Nutrition and Physical Activity, 17, 109. DOI