Exercises, when designed as “games”, will increase its attractiveness and participation of elderly. From the viewpoint of physiotherapy, even simple game like “Paper, Scissors, Stone” can be a form of mobilisation exercise for the finger joints and a training of the hand grip power.

A. Design and Implementation of an Exercise Game

Point 1: Consider elderly persons’ interests and health conditions

• Group elderly persons with similar abilities and interest together

Point 2: Set the objectives of the games clearly

• For examples: Decide whether the objective is to increase their mobility, improve team spirit or stimulate their cognitive function, and plan the program accordingly

Point 3: Consider time factors, venue, equipment, expected attendance and manpower

• For outdoor activities, weather, transportation as well as the equipment should be considered. For instance, whether the location can be reached by coach and whether the equipment is portable
• Start with the easy game first and progress gradually. Avoid over-competitiveness and emphasise the enjoyment of the process

Point 4: Add in fun element, for example

• Use some handy and simple tools such as balls, beanbags, rubber bands and colour bands
• Help those elderly persons with visual problems by using larger font size and pictures with vivid colours. Use more pictures or photos to facilitate understanding
• Make use of festival spirit; for example: use lantern and moon cakes for decoration or name of the game during Mid-Autumn Festival
• Invite elderly persons and their family members to take turn to demonstrate and participate

B. Examples of “Exercise and Game”

“Exercise and Game” (1) upper limbs exercise:

Participant:

• 16 to 20 independent elderly persons

Objective:

• To plan a game that could improve mobility of upper limbs

Arrangement:

• Use a small ball, tennis ball or bean bag, lead by one carer; invite the elderly persons and their family members to join and assist

Exercise and Game:

• Split the group into two queues
• The elderly person can hold firmly onto stable handrails or furniture while passing the ball overhead to the person behind
• The game can be continued in a reverse direction using another hand

Analysis:

• This game can improve mobility of the shoulder joint, stretch the elbow and forearm as well as strengthen the hand grip power
• This can also help to improve eye-hand coordination and team spirit

“Exercise and Game” (2) lower limbs exercise:

Participant:

• 6 to 8 frail elderly persons who need walking aids or walk with assistance from others

Objective:

• To plan a game that could improve mobility of the lower limbs

Arrangement:

• Use a medium size ball and about 1 to 2 pounds in weight, led by one carer
• Ensure the venue is spacious enough to accommodate stable armchairs arranged in a circle

Exercise and Game:

• The elderly persons sit in a circle, the carer put the ball in the centre and ask the elderly persons to kick the ball towards each other

Analysis:

• This game can improve mobility of lower limb joints, including knees movement and ankle control
• It improves leg muscle strength and hence improves balance
• If it is played for 10 minutes or more, it is a low intensity aerobic physical activity

C. Other Points to Note

Point 1: Recommended Intensity

• Regarding aerobic exercise, start with lower intensity and shorter duration; slowly progress to moderate-intensity which leads to slight increase in breathing rate and still able to talk; such exercise including other aerobic physical activity is recommended to be performed for at least 150-300 minutes per week.
• Regarding strengthening exercise, start from light-intensity and slowly progress to moderate-intensity for 2 or more times per week

(Remarks:
Physical activity --- Any bodily movement produced by skeletal muscles that requires energy expenditure.
Exercise --- A subcategory of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective.)

Point 2: Exercise and Game Safety

Apart from the general principles of exercise safety (Please refer to the “Exercise Safety” and “Tips about Planning Physical Activities Programme for Elderly People” under the website of Elderly Health Service of the Department of Health for more details) the following should be observed:

• Elderly should be advised to exercise within their capacity, they should stop and seek medical advice if they feel unwell
• Equipment should be cleansed and disinfected properly after use
• Start with a slower pace and smaller range of movements, then increase gradually; finish by slowing the pace gradually as a cool-down
• For elderly persons with chronic diseases such as dementia and stroke, consult healthcare professionals on their special needs