Physical Activity in Older Adults

Original Editor - Bhanu Ramaswamy as part of the AGILE Project and Caroline Greenwood

Top Contributors - Kim Jackson, Wendy Walker, Admin, Vidya Acharya, Giulia Neculaes, Bhanu Ramaswamy, Lucinda hampton, Evan Thomas, Simisola Ajeyalemi, Shaimaa Eldib, Rucha Gadgil, Carina Therese Magtibay and Christina Nowak  

What is Ageing?

Ageing is both a biological and psychosocial change. Psychosocial changes occur as a person’s role in society evolves, and they often also adapt their 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. This can lead to a decrease in a person’s level of function.

We live in an ageing population with the majority people now able to expect to live into their 60’s. In 2015 8.3% of the world’s population was older than 65, an increase of 1% from 2005. Whilst this population is often seen as having poor health, this doesn’t need to be the case. Many chronic conditions and non- communicable disease can be prevented, or progression delayed, by engaging in healthy behaviours. Despite this, studies have found that this age group spend on average 10.7 hours per day sitting, with 40% of this age group living a sedentary lifestyle. It is crucial that this is addressed, and that older adults are encouraged to move.

What is physical activity and what is exercise?

Physical activity has been defined as “any bodily movement produced by skeletal muscles that results in energy expenditure”, in contrast to exercise which was defined as “Leisure time physical activity which is planned and structured, and repetitive bodily movement undertaken to improve or maintain one or more components of physical fitness”. Physical activity is an umbrella term for many activities such as exercise, sport, dancing, gardening and walking.
Regular physical activity has been shown to have important beneficial effects on physical and mental wellbeing across all age groups. There are very few medical conditions that regular exercise doesn’t help to prevent, reduce the risk of developing, or improve symptoms. This topic is core to what physiotherapists can provide, and we should be at the forefront of the field of providing activity and exercise prescription especially where a disease process is evident.

Benefits of Physical Activity (PA)

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.

For more details please see the page dedicated to the physiological Benefits of Physical Activity.

And the page Age and Exercise has more details of the impact exercise has on older people.

Many non-communicable diseases (NCDs) prevalent in older adults can benefit from participation in regular physical activity. The potential effects of exercise on the health of older adults include:

• Reduced risk of developing coronary heart disease, stroke, certain types of cancers and diabetes
• Prevention of post-menopausal osteoporosis and protection against osteoporotic fractures by reducing the risk of falls
• A reduction in accidental falls.
• A reduction in loneliness and isolation, along with a reduction in depression, which may be as effective as antidepressants.
• A reduction in the complications of immobility, such as deep vein thrombosis and pressure sores.

Being active from an early age can help prevent many diseases just as regular movement and activity can help relieve the disability and pain associated with these conditions. Importantly, the benefits of physical activity can be enjoyed even if regular practice starts late in life. It has been suggested that older adults engaged in regular physical activity demonstrate improved:

• Balance
• Strength
• Coordination and motor control
• Flexibility
• Endurance.

Consequently, physical activity can reduce falls risk, a major older age cause of disability.

Physical activity has also been shown to improve mental health and cognitive function in older adults and has been found to contribute to the management of disorders such as depression and anxiety. Active lifestyles often provide older people with regular occasions to make new friendships, maintain social networks, and interact with other people of all ages.

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Despite this, a global trend of declining physical activity participation that is associated with increasing age has been observed (Marmot et al 2003 Verbrugge et al 1996).

How active are older people?

Analysis of results from the Allied Dunbar National Fitness survey (Skelton 1990), carried out in the 1990’s, showed that around 40% of men and women aged over 50 were sedentary; however more than half the sedentary respondents thought they carried out sufficient activity to keep themselves fit. A systematic review published by Harvey and collegues found that older adults spent on average 10.7 hours a day sitting! Sedendatary behaviour is different from physical inactivity and the results indicate that we not only need to encourage older adults to exercise but need to provide education and strategies around incorporating movement into their day-to-day activities. 

Among those who were free from immobilising disease, only 30% of men and 19% women aged over 50 were frequently active. Nearly half of women aged 70-74 did not have sufficient leg power to use stairs, and 80% of women in this age group did not possess sufficient aerobic capacity to walk comfortable at a 20 minute mile pace.

What type of exercise is recommended as appropriate for older adults?

This depends upon the ability of the person. The Active for Later Life resource in the Further Reading section below describes three related and overlapping categories: Making activity choices for those entering old age; increasing the circle of life for those in the transitional phase and moving on in the later years for frailer older people. Physical activity for older adults can take many forms (e.g. walking, swimming, stretching, dancing, gardening, hiking, cycling or organised exercise sessions). However, there are several important considerations specific to the older adult population with regard to physical activity recommendations:

• Intensity of aerobic activity takes into account the older adult's aerobic fitness.
• Activities that maintain or increase flexibility are recommended.
• Balance exercises are recommended for older adults at risk of falls.
• Older adults that have medical conditions or disabilities that may affect their capacity to be physically active should seek advice from a doctor. 

Clinical Guidelines

The current international recommendations for adults for physical activity include:

• Australia-  Everyone should try to do at least 30 minutes of moderate intensity physical activity on most days of the week.
• Canada- Put together at least 30 minutes of moderate-intensity physical activity on most preferably all days.
• 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.
• 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.

Falls Prevention

Every year approximately 30% of adults older than 65 experience at least one fall. Exercise has been shown to be effective in reducing the number of falls and the number of injuries from falls. This exercise can be either home or centre based, group or individual; but must involve a mix of balance, gait training and strength training. 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 risk of falls. 

More details can be found on the Falls in the Elderly page. 

Designing an Exercise Programme

WHO has published specific guidelines for people older than 60 and recommend that both aerobic exercise and strength training should be carried out.

• Aerobic exercise- 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- 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.

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 with independently.

Implications of maintaining physical activity in older adults

The increase in the older population is anticipated mainly in developing countries. Reducing and postponing age-related disability is an essential public health measure and physical activity can play an important role in creating and sustaining well-being at all ages.

‘Move for health’ is WHO’s world health initiative and response to the fact that:

• Each year at least 1.9 million people die as a result of physical inactivity.
• At least 30 minutes of regular, moderate-intensity physical activity on 5 days per week reduces the risk of several non-communicable diseases (NCDs).
• Physical inactivity is an independent modifiable risk factor for common NCDs.

• More than 35 million people died of NCDs in 2005 - this represented 60% of all deaths worldwide.
• 80% of deaths from NCDs occur in low- and middle-income countries.
• Without action to address the causes, deaths from NCDs will increase by 17% between 2005 and 2015.

Resources

The Australian Department of Health have produced a poster with Tips & Ideas for Older Australians

The American Growing Stronger website has pages on Strength Training for Older Adults

Further Reading

WHO "Move for Health" can be accessed at: http://www.who.int/moveforhealth/en/

CSP Move for Health: A physiotherapy link with the Change4Life initiative, to encourage health and wellbeing improvement by increasing levels of physical activity:
http://www.csp.org.uk/director/public/moveforhealth.cfm

Be active, be healthy is the framework for the delivery of physical activity alongside sport for the period leading up to the London 2012 Olympics and beyond. The legacy outlines an ambition of getting 2 million more people active by 2012 and after.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094358

Fit as a Fiddle project: an Age Concern programme championing physical activity and well-being for older people. The fit as a fiddle portfolio is funded by the Big Lottery Fund as part of the Well-being programme‚ to deliver £15.1 million worth of projects across all nine English regions until 2012. http://www.ageconcern.org.uk/AgeConcern/fit-as-a-fiddle.asp

Later Life Training: aims to provide specialist, safe and effective exercise training for people working with vulnerable older populations. www.laterlifetraining.co.uk

EXTEND provides gentle exercise to music for older people and for anyone of any age with a disability. Our mission is to promote health, increase mobility and independence, improve strength, co-ordination and balance and to counteract loneliness and isolation. http://www.extend.org.uk/

Active for later life. Promoting physical activity with older people accessed at: http://www.bhfactive.org.uk/downloads/BHF_AFLL_PDF_Sec5.pdf

The Cochrane Library holds many reviews of exercise and physical activity for older people
http://www.thecochranelibrary.com/view/0/index.html 

Books:

• Best-Martini E, Bolenhagen-DiGenova K (2003). Exercise for frail elders. Illinois, Human Kinetics
• Gormley J, Hussey J (2005). Exercise therapy: Prevention and treatment of disease. Oxford, Blackwell publishing
• Morris M, Schoo A (2004). Optimizing exercise and physical activity in older people. Edinburgh, Butterworth Heinemann
• The National Blueprint report: Increasing physical activity amongst adults age 50 and over. The Journal of Aging and Physical Activity 2001, Volume 9 Supplement
• Rikli R, Jones J (2001). Senior fitness test manual. Illinois, Human Kinetics
  

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