If you didn't exercise between the ages of 30 and 60, don't expect 70 to be a walk in the park.

That is according to visiting World Confederation for Physical Therapy president Dr. Marilyn Moffat, who was on the Island to give three days of workshops to members of the Bermuda Physiotherapy Association.

Dr. Moffat focused primarily on exercise for the aging adult, and how to test older people for things like aerobic capacity, strength and posture.

"I would say that work with the aging population is my real love at this point," said Dr. Moffat. "I love the challenge of keeping someone really well into their 80s and 90s and hopefully over that," she said.

"There is no doubt all of our body systems decline from the age of 30 on," she said. "We are on the downhill slope if we don't do any exercise. If we don't do anything from age 30 to 60, and it is downhill those years, it will only get worse from 60 to 90, or however long you live."

Dr. Moffat, a professor of physical therapy at New York University, co-author of 'Age-defying Fitness' and also has a private practice, said every facet of an older person's life (and probably a younger person's life also) can be improved through exercise.

Exercise improves the function of the heart, lungs, and urinary tract system and it also helps with muscular skeletal problems, balance, co-ordination and agility. "Bottom line, exercise is the answer," Dr. Moffat said. But she said unfortunately, most people aged over 60, do not exercise.

"It is something that is a real challenge for us as physiotherapists," she said. "We need to get the word out, and begin to motivate people to exercise. We should get out into community centres and do the education.

"We need to have older people realise that you can start exercising and have fun doing it, as long as it is under the appropriate guidance."

She said most aging adults who have never exercised are afraid to start. "Often times if they do start in a fitness centre they do too much too fast and they get sore." Dr. Moffat said elderly people starting an exercise regime should think about consulting a physiotherapist.

In addition, Dr. Moffat said people should tackle fitness from several different perspectives.

"You can't do just resistance and strength training," she said. "You also have to look at posture, flexibility and balance."

In addition to her work with the elderly, Dr. Moffat has spent a lifetime improving physiotherapy itself.

"At the World Confederation of Physical Therapy we are attempting to set up standards of practice and education, and attempting to encourage research into physiotherapy," said Dr. Moffat. "We are also trying to raise the profile of physical therapists around the world and to tackle the problems that physios face in many countries."

These problems include unfair regulations and lack of direct access to a physiotherapist.

"In some places, if you have a problem with your back, hip or knee, in some countries you can't come to me directly. You have to go to a physician for a referral. Sometimes it is for regulatory or legal reasons, and in other cases it has to do with insurance."

She said in the United States about 90 percent of what physiotherapists do should require no referral. She said that most physicians were not trained in physiotherapy and were therefore ill-equipped to judge if someone needed physiotherapy.

"It is somewhat ludicrous to think of someone prescribing something for us when they have no training," she said.

The World Confederation is also working to set up standards of practice around the world. "Our view is that every physiotherapist should have a minimum of a four year university degree in physiotherapy. That's a degree, and not a diploma."

Dr. Moffat has a masters degree in physical therapy from New York University and a doctoral degree in health education, also from New York University. She is yoga trained and Pilates mat certified.

But she said people have to be careful of seeing people for physical therapy who are not actually physical therapists.

"One of the things that concerns me a lot is when you see people going to personal trainers and yoga practitioners who attempt to treat problems which they have absolutely no training.

"Physiotherapists are the exercise experts when it comes to prescribing exercise for anyone with any type of physical problem or condition.

"It should not be someone who has no training or understanding of pathophysiology trying to do those things. I have a private practice and I have a lot of clients from fitness centres and personal trainers who have pushed them too hard, or done things that were inappropriate, and then they get them in trouble. That is unfortunate, and it just shouldn't happen."

But she said she was the first one to send her clients back to fitness centres and other exercise practitioners, but under advice and guidance.

She has received a number of awards including the 2004 Mary McMillan Lecture Award from the American Physical Therapy Association, the American Physical Therapy Association Section on Geriatrics President's Award in 2008, and also a tourism certificate of appreciation from the State of Israel, for her work with the Israeli Physiotherapy Society, among many, many other awards. She has even won an award with her own name on it. In 2003 she won the Marilyn Moffat Leadership Award from the American Physical Therapy Association in Washington, DC and in 2005 the Marilyn Moffat Chair in Physical Therapy was announced at New York University. She originally started her career in physical education, but after a year of teaching highschool, she found she hated it.

"I had a physiology professor who was also a physical therapist," Dr. Moffat said. "He suggested I volunteer at a rehabilitation hospital in New York State."

After the work in the rehabilitation she was hooked, and has been in physiotherapy for more than 40 years.