8:38 a.m., Nov. 10, 2010----In the Tuscan region of Italy, an area about the size of Idaho, more than 6,000 older adults with mild to severe physical disabilities exercise regularly through an initiative called the Adapted Physical Activity (APA) program.

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Targeted to stroke survivors and people with lower back pain and Parkinson's disease, the program includes men and women ranging in age from 55 to 75 and encompasses 37 organizations, 74 gyms, and nine pools. Participants typically travel about a mile to get to class.

On Wednesday, Nov. 4, APA founder Francesco Benvenuti shared his perspective on exercise and aging with healthcare providers and health sciences faculty in a talk delivered at Christiana Care's John H. Ammon Medical Education Center and video-conferenced to the University of Delaware.

Benvenuti is director of the Department of Rehabilitation and Frailties at AUS 11, a local health authority in Tuscany.

He described a common pathway of disease, where impairments, functional limitations, disability, and sedentary lifestyle form a continuous loop. Changing just one of those variables -- sedentary lifestyle -- can lead to positive changes in all of the others.

Exercise, he said, is key to not only improved physical and functional outcomes but also better mood and quality of life.

“Whatever exercise you do is better than none,” Benvenuti said. “Lifestyle is my credo. We can't dictate anyone else's lifestyle, but we can create widespread, socially acceptable, and easy access to opportunities for people to improve their own lifestyles.”

Through the Tuscan project, Benvenuti has identified a number of elements that are key to the success of community exercise programs.

Classes must be continuous throughout the year, targeted to improving participants' functional status, activated by physicians, and coordinated and controlled for quality and safety.

It's also important that they be inexpensive and that participants cover the cost. APA classes cost two euros each, about the same as a brioche and a latte or the equivalent of an American fast-food breakfast.

“Our goal is to sustain participation,” Benvenuti said. “To be sustainable, a successful program must be embraced by the community.” He told the story of a flower shop owner who regularly locks the door and posts a sign telling her customers that she is off to an exercise class. No one questions the temporary closure of the store, he said.

Benvenuti's talk was part of an extended visit to Delaware as a guest of Ingrid Pretzer-Aboff, assistant professor in UD's School of Nursing. He spent a week touring facilities and observing programs at senior centers, hospitals, rehabilitation units, and academic institutions.

“The visit was a great success,” said Pretzer-Aboff, who has collaborated with Benvenuti for several years and leads a collaborative research project with Beebe Medical Center in Lewes, Del., to evaluate the effects of a community exercise class for Parkinson's disease patients and stroke survivors.

“Many people who heard Dr. Benvenuti speak across the state realize that they need to start, or re-start, exercising. As a result of his talk, we have been receiving inquiries from people regarding what exercises would be helpful for them. We as healthcare providers are already encouraging and educating people about exercise -- what we need to do now is ensure relevant, accessible and economically responsible options.”

Darcy Reisman, assistant professor in UD's Department of Physical Therapy and a co-investigator on the Beebe project, agrees.

“Programs like the APA are absolutely necessary in our healthcare system,” she said. “Italy has an advantage in being a 'walking' culture, where exercise facilities are located within the community. So we have some barriers here, but we have to figure out ways to overcome them. What we have now is a revolving door, where people come in for treatment, show some improvement, are discharged, and then come back for more therapy when their condition worsens. This is not cost-effective, and it's not beneficial to patients.”

Article by Diane Kukich
Photo by Kathy Atkinson