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EXERCISE PHYSIOLOGY 47 Special consideration: older exercisers “This is a really interesting demographic,” Mr Douge said of older groups, “because we know that exercise is one of the best preventers of falls, but then being more active and perhaps trying new activities could increase the risk of a fall.” He says training specialists “always encourage older clients to have whatever they need around them to feel comfortable”. “Often home is a really comfortable and safe place to exercise, because usually the home is set up well to accommodate this if they don’t have access to a gym,” Mr Douge said. “The plus side of someone starting an exercise program when they’re a bit older is that you don’t have to do a lot to get the benefits.” “Not exercising alone is always a good idea, or having an emergency call button or alert button available. “The plus side of someone starting an exercise program when they’re a bit older is that you don’t have to do a lot to get the benefits. So, very simple, what we call functional exercises that replicate your day-to-day tasks – doing them with a bit more focus or a bit more intensity is ideal and usually quite safe.” be pretty comfortable – pretty easy for them to self-manage. “When it comes to more specific exercise, they might need a little bit more assessment to help them.” Role of a pharmacy assistant Mr Douge suggests pharmacy assistants can help customers in several ways with initiating exercise, such as “asking questions around their lifestyle behaviours”. “Then it might be a case of referring on to the doctor or getting in touch with an exercise physiologist,” he said. Mr Douge recommends that pharmacy assistants point to resources such as the Exercise and Sports Science Australia website for “some really basic tools that people can use” and easy tests they can administer, “so that patients can start to inform themselves”. “Or if they do have community groups that they run, getting some inclusions in that \\\\\\\[is a good option\\\\\\\],” he said. “They might just need to run some pre- screening before that happens. “There’s a pre-screening questionnaire, which is pretty simple to fill out ... that then indicates whether the person needs a bit of extra assessment from a GP or exercise physiologist before they start something. But again, we always reinforce that if they’re at all unsure, to go and get some support and guidance.” Continuing on the role of pharmacy staff in making exercise recommendations, Mr Douge says “it’s important that pharmacists and assistants feel like they should be \\\\\\\[able\\\\\\\] to ask these questions about lifestyle behaviours”. “The people who come into a pharmacy, they’re after medications, they’ve got some sort of condition they’re taking care of – often they’re chronic diseases – they’re populations that often feel the biggest barrier to exercise,” he said. “So, if they know that people are asking about it \\\\\\\[exercise\\\\\\\], it’s something that they should consider and know that it’s there and available. Sometimes a conversation starter is the most important part of removing that barrier.” Special consideration: females and exercise When it comes to the female population, some extra considerations need to be considered when talking about exercise. “That’s a really interesting topic and something that’s only just getting research behind it,” Mr Douge said. “We’ve often treated women the same as we do men when it comes to prescribing exercise and what we expect that change to be. But we do know now that women respond differently, particularly during different phases of their \\\\\\\[menstrual\\\\\\\] cycle. “It’s mostly to do with higher intensity exercise, so particularly seen in athletes. And if the pharmacy assistant is aware of the athlete and what they’re training for and how hard they’re training, it’s advisable that they ask questions around energy levels or fatigue or their cycle, if things are as expected. They’re relevant questions to ask these days.” Beyond this, and particularly in worrying cases, Mr Douge recommends referral to a “GP first” who then may refer the customer on “to an endocrinologist to assess their hormones”. “Then after that, once they’ve assessed what’s going on biologically – so, looking at blood markers and levels of hormones in the blood, how the body is responding – then you might need guidance from an exercise physiologist around modifying training and what they’re doing,” he said. “A lot of research that’s coming out now is showing that actually modifying training around your menstrual cycle, you can get better benefits from your training. You don’t have to sacrifice your function as a woman to get \\\\\\\[the benefits\\\\\\\].” RETAIL PHARMACY ASSISTANTS • MAR 2021