Physical Activity in Older Adults

Original Editor - Caroline Greenwood

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

Introduction

Physical activity (PA) in older people is critically important in the prevention of disease, maintenance of independence, and improvement of quality of life. Despite the obvious benefits to older people from being active, for example, preventing falls, remaining independent, reducing isolation, and maintaining social ties in order to improve mental health, women and men become less active as they age across all WHO regions.

• Regular physical activity (PA) has the potential to provide substantial health advantages to individuals across all age groups. It is important to note that for PA does not diminish in later stages of life. In fact, there is mounting evidence suggesting that engaging in PA can prolong the duration of active independent living, decrease disability, and enhance the overall quality of life for older individuals.
• The significant increase in the global aging population has presented new challenges in promoting the health of older individuals. It is crucial to not only extend their lifespan but also enhance the "quality" of their extended years. Encouraging older people to increase their level of physical activity is one effective approach to achieve this goal.

What is Ageing?

Aging is an inevitable process that manifests differently in each individual. The rate at which aging occurs and the specific areas of the body that are affected can vary greatly from person to person. Initially, the signs of aging may be subtle and have minimal impact on a person's daily life. However, as time goes on, these changes accumulate and eventually impact all systems within the body. It is important to note that the aging process encompasses both biological and psychosocial changes.

• Psychosocial changes occur as individuals navigate through different roles in society. They often adapt their goals and priorities, which can make it challenging for some older individuals to accept the need for assistance or to recognize the importance of self-care. This can lead to feelings of sadness and frustration. Consequently, older individuals often require additional motivation and support.
• Biologically changes occur at a molecular and cellular level, resulting in a decline in physiological reserve and an increased susceptibility to various diseases. Even in individuals who maintain a healthy and active lifestyle, there is a gradual decline in strength, endurance, bone density, and flexibility, typically at a rate of approximately 10% per decade. Muscle power, in particular, diminishes at a faster rate of about 30% per decade. These changes can significantly impact a person's overall level of functioning.

The physical functioning of older individuals has been the subject of a recent study utilising the International Classification of Functioning, Disability, and Health (ICF) framework. The findings revealed a significant decline in muscle strength, including hip abductors and knee extensors, as well as various aspects of physical performance such as walking capacity, speed, mobility, sit-to-stand performance, upper extremity function, and balance performance after one year. However, there were no notable changes observed 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. 
• 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

It is widely known that exercise offers numerous health benefits, which applies to adults of all age groups. A systematic review and meta-analyses conducted among older adults living in Japanese communities have revealed that sarcopenia is prevalent, with an overall rate of 9.9% (9.8% among men and 10.1% among women). This information is valuable in addressing the prevention of sarcopenia within the older community.

Engaging in resistance training can enhance strength and potentially reverse or delay the decline in muscle mass and strength that typically occurs with aging. Additionally, aerobic exercise can improve endurance by increasing capillary density, as well as levels of mitochondria and enzymes in skeletal muscles. These combined effects can assist older adults in maintaining their ability to participate in activities of daily living (ADLs) and, consequently, preserve their independence. A randomised controlled trial has demonstrated that an Augmented Prescribed Exercise Program (APEP) produces better outcomes for frail older medical patients in acute settings compared to usual care. This suggests that this intervention is valuable for enhancing the well-being of medically vulnerable inpatients.

Regular physical activity can also aid in decreasing the likelihood of various non-communicable illnesses. Studies have demonstrated that exercise can:

• Lower the risk of coronary heart disease, stroke, specific forms of cancer, and diabetes.
• Prevent post-menopausal osteoporosis and consequently decrease the risk of osteoporotic fractures.
• Decrease the complications of immobility.
• Decrease the likelihood of accidental falls.
• Enhance mental/cognitive function, decrease stress/anxiety, and boost self-esteem.

Why exercise is important for older adults

Physical activity for older people

Regular physical activity from a young age can play a crucial role in preventing various diseases. Additionally, consistent movement and activity can alleviate the discomfort and impairment linked to these conditions. Notably, the advantages of engaging in physical activity can still be experienced even if one begins practicing later in life. Research has indicated that older adults who regularly participate in physical activity exhibit enhanced:

1. Balance

2. Strength

3. Coordination and motor control

4. Flexibility

What Exercise is Appropriate for Older Adults?

The exercise regimen and level of intensity will vary based on the individual's capabilities. Physical activity options for older adults are diverse and include activities like walking, swimming, stretching, dancing, gardening, hiking, cycling, or participating in organized exercise sessions. However, there are specific factors to consider when recommending physical activity for older adults:

• The intensity of aerobic activities should be adjusted according to the older adult's aerobic fitness level.
• It is recommended to engage in activities that maintain or enhance flexibility.
• Balance exercises are beneficial for older adults who are at risk of falling.
• Older adults with medical conditions or disabilities that may impact their ability to be physically active should consult with a doctor for guidance

It is crucial to acknowledge that some older individuals may have limited range of motion, reduced muscular strength and mass, or stiff joints due to disabilities. In such cases, manual handling and passive exercises can be utilised to maintain their well-being, while also encouraging active exercises.

Clinical Guidelines

The current international recommendations for physical activity in adults vary slightly across different countries.

• In Australia, it is recommended that individuals aged 65 years and over engage in at least 30 minutes of moderate-intensity physical activity on most, if not all, days. If starting with 30 minutes seems challenging, one can begin with just 10 minutes once or twice a day and gradually increase the duration over time. Incorporating different types of activities throughout the week is also encouraged, while minimising sedentary behaviour..
• In Canada, the recommendation is to aim for at least 30 minutes of moderate-intensity physical activity on most, if not all, days. Similarly, in the United States, it is advised that all adults accumulate a minimum of 30 minutes of at least moderate-intensity physical activity on most, if not all, days of the week..
• In the United Kingdom, the guideline suggests that adults should strive for a total of at least 30 minutes of at least moderate-intensity physical activity on five or more days of the week for general health benefits.

It is important to note that these recommendations serve as a guideline and individuals should consult with healthcare professionals for personalised advice based on their specific circumstances.

Falls Prevention

Approximately 30% of adults over the age of 65 experience at least one fall each year. Studies have shown that exercise is an effective way to decrease the number of falls and injuries resulting from falls. This exercise regimen can be done at home or in a center, either individually or in a group setting. It should include a combination of balance, gait training, and strength training. The exercises should be challenging but safe, achieved by reducing the participant's base of support, shifting their centre of gravity, or removing hand support. Ideally, individuals should aim to complete at least 3 hours of exercise per week to achieve the greatest reduction in the risk of falls.

Physical Activity in Dementia

• According to studies , patients with dementia or mild cognitive impairments experience improved cognitive scores after 6 to 12 months of exercise compared to sedentary controls.
• Telomere length serves as a marker for biological aging, and shorter telomeres are linked to various geriatric diseases such as cancer, dementia, osteoporosis, and mortality. Recent systematic reviews and meta-analyses of randomised controlled trials indicate that exercise has a positive impact on telomere length compared to usual care or inactivity. Among these, aerobic exercise performed at moderate intensity for a duration of six months or longer proves to be the most effective in slowing down the rate of telomere shortening.

• Meta-analyses of RCTs focusing on aerobic exercise in healthy adults have also shown significant improvements in cognitive scores. These findings lead to the conclusion that physical exercise may also help mitigate cognitive decline by reducing cerebrovascular risk, including the contribution of small vessel disease to dementia.
• In 2018, a study came to a different conclusion regarding the effects of exercise on people with dementia. The Dementia and Physical Activity trial studied 494 people with dementia, with a 2:1 random allocation to exercise versus control. The study found that people with dementia who were assigned to a year of vigorous exercise had a worse mean score on the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-cog) than those who kept to their usual routines. The study also found that a four-month aerobic and strengthening exercise program did not slow cognitive decline in people with mild to moderate dementia, and there is a possibility that the intervention could worsen cognition.
• However, a randomised control trial suggests that home-based exercise and nutrition strategies have a positive outcome on the frailty score and physical performance in pre-frail or frail older adults.
• Another single-blind randomised clinical trial evaluating the effects of usual care and early structured exercise intervention on 370 elderly hospitalized patients showed improvement in muscle power output of lower limbs at submaximal loads and maximal muscle strength.
• A systematic review shows the advantages of brain health with exercise training in older adults due to the changes in brain structure and function.
• Additionally, another systematic review suggests that e-health strategies are effective in enhancing physical activity in older patients.

Designing an Exercise Program

The World Health Organization (WHO) has released specific guidelines in 2020 for individuals over the age of 65, recommending a combination of aerobic exercise and strength training.

• For optimal health benefits, adults and older adults should engage in at least 150-300 minutes of moderate-intensity aerobic physical activity or 75-150 minutes of vigorous-intensity aerobic physical activity per week.;
• Additionally, muscle-strengthening activities involving all major muscle groups should be performed at moderate or greater intensity on 2 or more days per week
• For older adults, multicomponent physical activity emphasising functional balance and strength training should be done on 3 or more days per week to enhance functional capacity and prevent falls. To maintain bone and muscle strength, strength training should be done 2 to 3 days per week with a day of rest between workouts, and the intensity of the workout should be gradually increased.

1. For older individuals, it is recommended to engage in aerobic exercise for at least 30 minutes a day, on most days of the week. This can include activities such as walking, swimming, water exercises, and stationary cycling. Research has shown that a treadmill-walking program can have a positive impact on the postural balance of older adults living in institutions..
2. To maintain bone and muscle strength, it is important to engage in strength training. Gradually increasing the intensity (weight) of the workout can help to further strengthen muscles and bones. It is recommended to engage in strength training 2 to 3 days a week, with a day of rest between workouts. When repetitions can be completed with ease and good form, it is advised to increase the weight lifted.

The specific exercise chosen will naturally differ for each individual. It is crucial to take into account medical conditions, as well as the fitness and functional level of the patients. If someone is new to exercise, it is advisable to consult their healthcare provider first and gradually increase their activity level. According to the recommendations of the World Health Organization (WHO), exercise should encompass both aerobic and strength training, while also incorporating elements of balance and flexibility. There are various options available, such as hiking, walking, swimming, going to the gym, dancing, practicing tai chi, or engaging in chair exercises. It is important to find an activity that brings enjoyment and can be sustained independently by each person.

A qualitative study conducted on older individuals participating in an evidence-based exercise intervention sheds light on how they perceive their relationship with their therapists and how this relationship can impact their motivation for exercise. The study emphasizes the significance of a "Therapeutic Alliance" in therapy, highlighting the importance of relational knowledge and competence in effectively transferring professional knowledge during therapy sessions. These findings are particularly valuable for therapists working in clinical practice, especially those who work with vulnerable populations.

How to Promote Positive Health Message

The WHO 2020 guidelines reiterate the importance of engaging in some form of physical activity, emphasizing that increased physical activity leads to better health outcomes. Additionally, the guidelines recommend reducing sedentary behaviours.

To effectively engage older adults, it is crucial to present the message in the right manner. Research has shown that gain-framed messages, which highlight the benefits of a specific behaviour, are more likely to promote preventive actions compared to loss-framed messages. For instance, a message like "regular exercise can aid in weight loss" would be more impactful than "not exercising regularly can result in weight gain."

Here are some links to healthy living campaign:

• On your feet-Workers across Britain unite together and participate in a variety of fun and simple activities to #SitLess and #MoveMore

Related pages

• Age and Exercise
• Falls in the elderly