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Modifying Programs for SubgroupsIt is difficult to provide "blanket" physical activity recommendations for all older adults. Healthcare providers should adapt physical activity prescriptions for specific populations based on their specific considerations and abilities. Obviously, different levels of ability should be taken into consideration. For example, strengthening activities should be performed standing when possible; however, persons with difficulty standing can perform the same activities sitting.FRAIL & VERY OLD ADULTS Many factors contributing to frailty can be addressed through physical activity. Strength training, in particular, offers a safe & perhaps the most beneficial intervention for the frail & very old. The ACSM recommends "all exercise programs for the frail elderly should include progressive resistance training of the major muscle groups of the upper and lower extremities and trunk". The ACSM recommends 2-3 days per week with 2-3 sets of exercises performed on each training day, including resistance activities while standing to enhance balance & muscle coordination. Strengthening & flexibility activities can be performed while sitting or in a bed. Balance training should also be incorporated under supervision, particularly for the very frail. Cardiorespiratory activities (difficult to perform in this population) should follow strength and balance training. Once the individual can tolerate weight bearing activity, moderate intensity aerobic training can begin. The ACSM (ACSM, 2000) recommends reaching a target frequency of 3 days per week for at least 20 minutes at 11-13 RPE Scale. CHRONIC DISEASE & DISABILITY Many chronic diseases can be prevented and treated with physical activity programs. The ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities (ACSM, 2003) is an excellent resource for healthcare providers. The ACSM guidelines should help healthcare providers modify physical activity programs for patients with chronic disease. Other healthcare professionals with experience in exercise may be able to modify or individualize programs specific to your patient's disease or disability, If you are uncomfortable prescribing a physical activity program for your patient, consult a specialist in rehabilitation or exercise. 
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