Physical Activity in Ageing and Falls

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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[1]. 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[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 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[3]. It is crucial that this is addressed, and that older adults are encouraged to move. 

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 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[4].

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[5]

What Exercise is appropriate for Older Adults?

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[6].
  • Canada Put together at least 30 minutes of moderate-intensity physical activity on most preferably all days[7].
  • 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[8].
  • 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[9].

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[10]. 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[11]

Designing an Exercise Program

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[12].

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[6].

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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 behavior, are significantly more likely than loss framed messages to promote prevention behavior[13]. 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:

References

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  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: [/data.worldbank.org/indicator/SP.POP.65UP.TO.ZS http://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS]
  3. British Heart Foundation. Active for Later Life. London: BHF; 2007
  4. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults (review). Cochrane database of systematic reviews. 2009 (3)
  5. Active ageing in Victoria [Internet]. health.vic. 2017 [cited 23 May 2017]. Available from: [/www2.health.vic.gov.au/ageing-and-aged-care/wellbeing-and-participation/healthy-ageing/active-ageing https://www2.health.vic.gov.au/ageing-and-aged-care/wellbeing-and-participation/healthy-ageing/active-ageing]
  6. 6.0 6.1 Australia's Physical Activity and Sedentary Behavior Guidelines [Internet]. The Department of Health. 2017 [cited 23 May 2017]. Available from: - [/www.health.gov.au/internet/main/publishing.nsf/Content/3244D38BBBEBD284CA257BF0001FA1A7/%24File/choosehealth-brochure.pdfhttp%3A//www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines http://www.health.gov.au/internet/main/publishing.nsf/Content/3244D38BBBEBD284CA257BF0001FA1A7/$File/choosehealth-brochure.pdfhttp://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#chba]
  7. Canadian Society for Exercise Physiology. Older adults- 65 & older [Internet]. Canada; 2012 p. 1. Available from: [/www.csep.ca/CMFiles/Guidelines/CSEP%20PAGuidelines%20older-adults%20en.pdf http://www.csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_older-adults_en.pdf]
  8. 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
  9. Department of Health. Physical activity guidelines for older adults [Internet]. National Health Service. 2011 [cited 24 May 2017]. Available from: https://www.nhs.uk/Livewell/fitness/Documents/older-adults-65-years.pdf
  10. 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)
  11. 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: [/bjsm.bmj.com/content/early/2016/10/04/bjsports-2016-096547 http://bjsm.bmj.com/content/early/2016/10/04/bjsports-2016-096547]
  12. Physical Activity and Older Adults [Internet]. World Health Organisation. 2017 [cited 23 May 2017]. Available from: [/www.who.int/dietphysicalactivity/factsheet%20olderadults/en/ http://www.who.int/dietphysicalactivity/factsheet_olderadults/en/]
  13. 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