Physical Activity in Older Adults
Original Editor - Caroline Greenwood
What is Ageing?
Ageing is both biological and psychosocial changes. 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 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. 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.
We live in an ageing population with the majority of people now are expected to live beyond 60 years. 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 diseases can be prevented or 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 be more active.
Benefits of Exercise
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 of muscle mass and strength that occurs with ageing. 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.
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
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:
- Coordination and motor control
What Exercise is Appropriate for Older Adults?
The type of exercise and intensity will depend upon the ability of the person. 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.
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
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.
Physical Activity in Dementia
A number of studies have suggested that patients with dementia or mild cognitive impairments show better cognitive scores after 6 to 12 months of exercise compared with sedentary controls. Meta-analyses of RCTs of aerobic exercise in healthy adults were also associated with significantly improved cognitive scores, concluding " physical exercise may also attenuate cognitive decline via mitigation of cerebrovascular risk, including the contribution of small vessel disease to dementia".
A new study (2018), however, comes to a different conclusion. A large, multi-centre RCT studied 494 people with dementia, with a 2:1 random allocation to exercise versus control. This Dementia and Physical Activity [DAPA] trial found that "the mean score on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog) worsened more for people with dementia who were assigned to a year of vigorous exercise than for people who kept to their usual routines."
The study states "A four month aerobic and strengthening exercise programme of moderate to high intensity added to usual care does not slow cognitive decline in people with mild to moderate dementia. The exercise improved physical fitness in the short term, but this did not translate into improvements in activities of daily living, behavioural outcomes, or health related quality of life. There is the possibility that the intervention could worsen cognition."
A randomized control trial suggests home-based exercise and nutrition strategies have a positive outcome on the frailty score and physical performance in the pre-frail or frail older adults.
Designing an Exercise Program
WHO has published specific guidelines for people older than 60 and recommended 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 .
How to Promote Positive Health Message
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, ie. Messages that highlight the benefits of engaging in a particular behaviour, are significantly more likely than loss framed messages to promote prevention behaviour. 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:
- Make your move- sit less- be active for life
- Growing stronger- strength training for older adults
- Living Longer Living Stronger
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