Welcome back to Spine IQ’s Back Blog! Last week we reviewed how to incorporate one of the most effective interventions in treating low back pain: cost-effective group exercise! This week we want to discuss into one of the most common patient populations that seek chiropractic care, older adults. Approximately 20% of adults who seek chiropractic care are 65 years of age or older (1). While low back pain can be disabling in all ages, older adults are more likely to have severe low back pain and increased difficulty performing activities of daily living compared to younger adults (2,3). Additionally, only about 1 in 4 older adults meet the physical activity guidelines presented by WHO (4,5). This presents conservative clinicians with an important role in the care of older adults suffering from low back pain.

Recently, a study showed that clinicians recommended exercise to older adults seeking care in 29 out of 100 patient encounters (1). One of the common barriers that clinicians report for prescribing exercise to their patients is lack of confidence (6). That’s okay, we are here to help! We hope that this blog will help you become more confident in your ability to safely and effectively prescribe exercises for your older adult patients.

One of the most successful and evidence-based programs for older adults is the ViviFrail Program . This program has been shown to be able to be implemented both in clinic and at home, which is a plus considering online/telehealth programs are starting to become more prevalent. This program is also easy to follow and your staff can be trained to deliver this program. ViviFrail has shown to improve functional status, reduce fall risk and even reduce frailty post-COVID confinement. It also incorporates similar exercises that we have previously discussed on SpineIQ’s blogs as being effective for treatment of low back pain (8,9). The program involves 4 different “levels” of exercises that a person falls into depending on their baseline testing.

Baseline testing:

There are 7 tests that determine which “level” a patient should start at, they include:

  1. Balance test
  2. Walking speed test over 4 meters
  3. Test of getting up from a chair
  4. Fall risk test
  5. Timed up and go
  6. Walking speed test
  7. Moderate cognitive deterioration

The baseline testing can be completed in under 15 minutes and detailed description of each test is available for free on their website.

Exercises for older adults:

After completing the baseline testing, the patient will fall, no pun intended, into one of the 4 “levels”. They range from:

Level 1 exercises:

  • Walking
  • Squeeze a ball
  • Lift a bottle
  • Extend your legs using a ballasted ankle brace
  • Get up from a chair with help
  • Walk with your feet in line
  • Stretch your arms

Level 4 exercises:

  • Walking
  • Twist a towel
  • Lift a bottle
  • Get up from a chair
  • Up and down stairs
  • Walk while touching a balloon
  • Walk in a figure of 8
  • Stretch your arms
  • Stretch your legs

You can find detailed descriptions of reps and sets for all of the exercises and levels on their website. Hopefully, these will allow you to feel confident that you are doing a proper assessment and using an evidence-based intervention that has been proven to be effective for older adults. If you don’t like ViviFrail, there are other programs that have also been shown to be effective. For example, “The Keeping Strong 6 week Beginner Strength Program” is minimal equipment required and low time commitment intervention. It is designed to be performed just 2x/week and can be done without equipment. The program is laid out with videos included on their website showing the exercises for free. SpineIQ’s BackFacks for older adults also has some excellent exercises and advice for older adult patients to begin to self manage. We hope that this blog and resources will help you feel more confident to incorporate exercise for older adults seeking care in your clinics! Stay tuned for next week’s blog where we dive into how to incorporate walking programs in your clinic!



  1. de Luca K, Hogg-Johnson S, Funabashi M, Mior S, French SD. The profile of older adults seeking chiropractic care: a secondary analysis. BMC Geriatr. 2021 Apr 23;21(1):271.
  2. Hicks GE, Gaines JM, Shardell M, Simonsick EM. Associations of back and leg pain with health status and functional capacity of older adults: Findings from the retirement community back pain study. Arthritis Care Res. 2008;59(9):1306–13.
  3. Tamcan O, Mannion AF, Eisenring C, Horisberger B, Elfering A, Müller U. The course of chronic and recurrent low back pain in the general population. PAIN. 2010 Sep;150(3):451–7.
  4. Elsawy B, Higgins KE. Physical activity guidelines for older adults. Am Fam Physician. 2010 Jan 1;81(1):55–9.
  5. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451–62.
  6. Barton CJ, King MG, Dascombe B, Taylor NF, de Oliveira Silva D, Holden S, et al. Many physiotherapists lack preparedness to prescribe physical activity and exercise to people with musculoskeletal pain: A multi-national survey. Phys Ther Sport Off J Assoc Chart Physiother Sports Med. 2021 May;49:98–105.
  7. Courel-Ibáñez J, Pallarés JG, García-Conesa S, Buendía-Romero Á, Martínez-Cava A, Izquierdo M. Supervised Exercise (Vivifrail) Protects Institutionalized Older Adults Against Severe Functional Decline After 14 Weeks of COVID Confinement. J Am Med Dir Assoc. 2021 Jan;22(1):217-219.e2.
  8. Kjaer P, Kongsted A, Ris I, Abbott A, Rasmussen CDN, Roos EM, et al. GLA:D® Back group-based patient education integrated with exercises to support self-management of back pain – development, theories and scientific evidence -. BMC Musculoskelet Disord. 2018 Nov 29;19(1):418.
  9. O’Keeffe M, Hayes A, McCreesh K, Purtill H, O’Sullivan K. Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis. Br J Sports Med. 2017 Jan;51(2):126–32.