My elderly mother won’t do her physio exercises

It is almost never because she is being difficult. Refusal is usually specific and reasonable, and the reason is rarely the one written on the exercise sheet. For an elderly parent it may be that it hurts, or she cannot remember being shown, or she does not see the point, or it makes her feel old, or nobody is there and she is frightened of falling alone.

Each of those has a different answer, which is why “just encourage her” does not work.

Why won’t she do them?

• “I already did it.” With memory loss, this is usually true as far as she knows. Arguing about it costs you the next twenty minutes and gains nothing.
• “It hurts.” Take this literally and tell the physiotherapist. An exercise that hurts is the wrong exercise, or the right one loaded wrongly.
• “What’s the point at my age?”This is about the goal, not the exercise. Nobody is motivated by “maintaining function”. Getting to the letterbox, or to church, or down to see the grandchildren, is a different matter.
• “Not now.” Often fatigue or time of day. Most older adults are steadier and more willing mid-morning than late afternoon.
• Silence, or changing the subject. Frequently fear. Doing them alone after a fall is genuinely frightening.

What tends to work

Attach it to something that already happens. A routine she already has is worth more than a reminder. Sit-to-stands before the kettle boils. Heel raises at the sink. Walking to the letterbox after lunch. With memory loss especially, the trigger has to live in the day rather than on a list. Which means whoever writes the program has to know what her day looks like: when she gets up, what she does first, which chair she uses. That is a question for the first visit, and it does not survive a different physiotherapist turning up each week.

Make it shorter than you think. Three minutes she will actually do daily is worth more than twenty she refuses, and the program can be built up from there.

Do them alongside her rather than supervising. It stops the exercises being something that is done to her, and it is usually the change that makes the difference.

Name a goal she actually wants, rather than the one on the physiotherapist’s form. If she wants to get back to the club on Thursdays, the program should visibly be about Thursdays.

Stop calling them exercises if the word is the problem. For plenty of people it brings a gym to mind, and a memory of not keeping it up.

When memory loss is in the picture

Dementia changes the approach rather than the goal. Familiar settings, the same time each day, the same person where possible, and demonstration rather than instruction — showing beats telling once verbal memory is affected.

Expect the good days and bad days to be genuinely different, and judge the program on the month rather than on today. Dementia Australia and the Better Health Channel both have good material on activity with dementia, and they are worth reading before the next appointment.

When to stop pushing

If it is causing distress every time, the program is wrong and it needs changing rather than enforcing. A physiotherapist who hears “she hates it” and does not change anything is not doing the job. The program is meant to move when the person does.

You are her daughter or son, not her therapist. If the exercises are becoming the whole relationship, that is a reason to hand the pushing to someone else.

Why the days between visits matter so much is covered in muscle loss after 70, and our aged care page explains what a home visit involves.