Physical Activity in Ageing and Falls

What is Ageing?[edit | edit source]

Aging is both a biological and psychosocial change. Psychosocial changes occur as a person’s role in society evolves, and they often also adapt their goals and motivational priorities. At a biological level, molecular and cellular damage occurs which leads to a decrease in physiological reserve and the increased risk of many diseases. Even in healthy and active people; strength, endurance, bone density, and flexibility all decline at a rate of approximately 10% per decade. Muscle power is lost faster than this, at a rate of about 30% per decade[1]. This can lead to a decrease in a person’s level of function.

We live in an aging population with the majority of people now able to expect to live in their 60’s. In 2015, 8.3% of the world’s population was older than 65, an increase of 1% from 2005[2]. Whilst this population is often seen as having poor health, this doesn’t need to be the case. Many chronic conditions and non- communicable diseases can be prevented, or progression delayed, by engaging in healthy behaviours. Despite this, studies have found that this age group spends on average 10.7 hours per day sitting, with 40% of this age group living a sedentary lifestyle[3]. It is crucial that this is addressed, and that older adults are encouraged to move. A recent study examining 1-year changes in the physical functioning of older people using the International Classification of Functioning, Disability, and Health (ICF) framework suggested a significant decrease in muscle strength (both hip abductors and knee extensors) walking capacity, speed, mobility, sit-to-stand performance, upper extremity function, and balance performance at the end of 1 year. Although there were no significant changes seen in the levels of participation in activities of daily living, activities related to balance, or physical activity[4]. Systematic review and meta-analyses findings suggest pooled prevalence rates of sarcopenia among Japanese community-dwelling older adults to be at 9.9%  overall, 9.8% (among men), and 10.1%  (among women): which provides valuable information in addressing sarcopenia prevention in the community[5]

Benefits of Exercise[edit | edit source]

As is commonly known, there are many health benefits of exercise, and this stands true for adults of all ages. Resistance training will improve strength and can reverse or delay the decline in muscle mass and strength that occurs with age. Aerobic exercise can help to improve endurance by increasing the capillary density, mitochondrial and enzyme levels in the skeletal muscles. Together this can help older adults to maintain their participation in ADLs and therefore maintain independence[6].

Exercise can also help to reduce the risk of many non-communicable diseases.

Exercise has been shown to:

  • Reduce the risk of coronary heart disease, stroke, certain types of cancers and diabetes.
  • Prevent post-menopausal osteoporosis and therefore reduce the risk of osteoporotic fractures.
  • Reduce the complications of immobility.
  • Reduce the risk of accidental falls
  • Improve mental/cognitive function, reduces stress/anxiety and improve self-confidence.[7]

What Exercises are Appropriate for Older Adults?[edit | edit source]

Clinical Guidelines[edit | edit source]

The current international recommendations for adults for physical activity include:

WHO guideline 2020

  • All adults should undertake regular physical activity;
  • Adults should do at least 150–300 min of moderate-intensity aerobic physical activity, or at least 75–150 min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week for substantial health benefits;
  • Adults should also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits.
  • Strong recommendation: Adults may increase moderate-intensity aerobic physical activity to >300 min, or do >150 min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week for additional health benefits (when not contraindicated for those with chronic conditions)[8].
  • Australia-Everyone should try to do at least 30 minutes of moderate-intensity physical activity on most days of the week[9].
  • Canada- Put together at least 30 minutes of moderate-intensity physical activity on most preferably all days[10].
  • America- All adults should accumulate a minimum of 30 minutes of at least moderate-intensity physical activity on most, if not all days of the week[11].
  • United Kingdom- For general health benefit, adults should achieve a total of at least 30 minutes a day of at least moderate-intensity physical activity on five or more days of the week[12].

Falls Prevention[edit | edit source]

Every year approximately 30% of adults older than 65 experience at least one fall[13]. According to the report, in the U.S, around 27.5% of adults aged ≥65 years reported at least one fall in the year 2018 and 10.2% reported a fall-related injury. The report suggests screening older patients for fall risk, assessing modifiable risk factors, and recommending physical therapy interventions to reduce fall risk, thereby preventing falls in older adults[14].  

In older adults, physical activity helps prevent falls and falls-related injuries and declines in bone health and functional ability. 

It is recommended that PA levels as for adults (see above) plus:

  • As part of their weekly physical activity, older adults should do varied multicomponent physical activity that emphasises functional balance and strength training at moderate or greater intensity on 3 or more days a week, to enhance functional capacity and to prevent falls.
  • Exercise has been shown to be effective in reducing the number of falls and the number of injuries from falls[8].
  • Exercise can be either home or centre-based, group or individual; but must involve a mix of balance, gait training, and strength training[13]. Exercise must be challenging, but safe. This can be achieved by reducing the participant’s base of support, getting them to move their centre-of-gravity, or by removing their hand support. Ideally, at least 3 hours of exercise must be completed each week for the greatest reduction in the risk of falls[15].

Designing an Exercise Program[edit | edit source]

WHO has published specific guidelines for Older adults (aged 65 years and older) including those with chronic conditions and those living with disability.[8]

Aerobic Exercise[edit | edit source]

Older Persons should

  • Do at least 150–300 min of moderate-intensity aerobic physical activity, or at least 75–150 min of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate-intensity and vigorous-intensity activity throughout the week for substantial health benefits[8]
  • Older persons should build up to at least 30 minutes of aerobic exercise – for example walking, swimming, water exercises, and stationary cycling – on most, if not all, days.

Strength Training[edit | edit source]

Older Persons should do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits[8].

The following regimen allows the individual to maintain bone and muscle strength. In order to continue to strengthen muscle and bone, one should steadily increase the intensity (weight) of the workout. Recommendations are:

  • Strength training 2 to 3 days a week, with a day of rest between workouts
  • When repetitions can be made in good form with ease, weight lifted should be increased[16].

The exact exercise chosen will of course vary from person to person. It is important that medical conditions are considered, as well as the patients' fitness and level of function. If exercise is new to someone, it should be first discussed with their health care provider and then a program of gradual increase should be implemented. As recommended by WHO, exercise should include both aerobic and strength training, but it should also ideally include a component of balance training and flexibility work. Options may include hiking, walking, swimming, gym, dancing, tai chi or chair exercises. It is important to find something that each person enjoys and can continue independently[9]. A retrospective analysis among community-dwelling older adults participating in a community-based falls prevention program (Otago Exercise Program) showed an improvement in individuals with younger age, with better balance and baseline physical performance, and no use of an assistive device[17]. A randomized control trial in 72 prefrail adults (65 yrs and above) with mild-to-moderate fall risk found a significant improvement in fall risk, proprioception, muscle strength, reaction time, postural sway and health-related quality of life with the Multi-system Physical Exercise (MPE) which consisted of proprioceptive, muscle strengthening, reaction time, and balance training exercises.[18] Randomised control study suggests stepping exergame training (interactive, exercise-based video gaming) improves stepping performance outcomes in older adults in older adults, which can be relevant for preventing falls[19].

PP PA 7.jpg

How to Promote a Positive Health Message[edit | edit source]

In order to successfully engage older adults, it is important to frame the message in the correct way. It has been found that gain-framed messages, i.e. messages that highlight the benefits of engaging in a particular behavior, are significantly more likely than loss-framed messages to promote prevention behavior[20]. For example, the message ‘exercising regularly can help you to lose weight’ would be more effective than the message ‘not exercising regularly can make you gain weight.

Links to Healthy Living Campaigns[edit | edit source]

References[edit | edit source]

  1. Skelton D, Young A, Walker A, Hoinville E. Physical activity in later life:Further analysis of the Allied Dunbar National Fitness Survey and Health Education Authority National Survey of Activity and Health. London: Health Education Authority; 1999
  2. Population ages 65 and above [Internet]. The World Bank. 2016 [cited 23 May 2017]. Available from: [/]
  3. British Heart Foundation. Active for Later Life. London: BHF; 2007
  4. Kahraman T, Çekok FK, Üğüt BO, Keskinoğlu P, Genç A. One-Year Change in the Physical Functioning of Older People According to the International Classification of Functioning Domains. Journal of geriatric physical therapy (2001). 2019 Mar.
  5. MAKIZAKO H, NAKAI Y, TOMIOKA K, TANIGUCHI Y. Prevalence of sarcopenia defined using the Asia Working Group for Sarcopenia criteria in Japanese community-dwelling older adults: A systematic review and meta-analysis. Physical Therapy Research. 2019 Dec 20;22(2):53-7.
  6. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults (review). Cochrane database of systematic reviews. 2009 (3)
  7. Active ageing in Victoria [Internet]. health.vic. 2017 [cited 23 May 2017]. Available from: [/]
  8. 8.0 8.1 8.2 8.3 8.4 Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020 Dec 1;54(24):1451-62.Available from: (accessed 2.12.2020)
  9. 9.0 9.1 Australia's Physical Activity and Sedentary Behavior Guidelines [Internet]. The Department of Health. 2017 [cited 23 May 2017]. Available from: - [/$File/choosehealth-brochure.pdf]
  10. Canadian Society for Exercise Physiology. Older adults- 65 & older [Internet]. Canada; 2012 p. 1. Available from: [/]
  11. National Center for Chronic Disease Prevention and Health Promotion. How much physical activity do older adults need? [Internet]. Center for disease control and prevention. 2015
  12. Department of Health. Physical activity guidelines for older adults [Internet]. National Health Service. 2011 [cited 24 May 2017]. Available from:
  13. 13.0 13.1 Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S et al. Interventions for preventing falls in older people living in the community. Cochrane database of systematic reviews. 2012 (9)
  14. Moreland B. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged≥ 65 Years—United States, 2012–2018. MMWR. Morbidity and Mortality Weekly Report. 2020;69.
  15. Sherrington C, Michaleff Z, Fairhall N, Paul S, Tiedemann A, Whitney J et al. Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British Journal of Sports Medicine [Internet]. 2016;. Available from: [/]
  16. Physical Activity and Older Adults [Internet]. World Health Organisation. 2017 [cited 23 May 2017]. Available from: [/]
  17. Scronce G, Zhang W, Smith ML, Mercer VS. Characteristics associated with improved physical performance among community-dwelling older adults in a community-based falls prevention program. International journal of environmental research and public health. 2020 Jan;17(7):2509.
  18. Chittrakul J, Siviroj P, Sungkarat S, Sapbamrer R. Multi-system physical exercise intervention for fall prevention and quality of life in pre-frail older adults: a randomized controlled trial. International journal of environmental research and public health. 2020 Jan;17(9):3102.
  19. Hauer K, Litz E, Günther-Lange M, Ball C, de Bruin ED, Werner C. Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial. European Review of Aging and Physical Activity. 2020 Dec;17(1):1-3.
  20. Gallagher K, Updegraff J. Erratum to: Health Message Framing Effects on Attitudes, Intentions, and Behaviors: A Meta-analytic Review. Annals of Behavioral Medicine. 2013;46(1):127-127