The recommendation for senior citizens is similar to the updated recommendation for the younger adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult’s aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls.
In addition, senior citizens should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.
The recommendations for senior citizens (age 65 and older) also apply to adults age 50-64 with chronic conditions or physical functional limitations (e.g. arthritis) that affect movement ability or physical fitness.
The reports says healthy adults under age 65 need moderate-intensity aerobic physical activity for at least 30 minutes on five days each week or vigorous-intensity aerobic physical activity for at least 20 minutes on three days each week, according to updated physical activity guidelines.
It also recommends they will benefit from performing activities that maintain or increase muscular strength and endurance for at least two days each week. It is recommended that 8-10 exercises using the major muscle groups be performed on two non-consecutive days. To maximize strength development, a resistance (weight) should be used for 8-12 repetitions of each exercise resulting in willful fatigue.
Recommendations are less vigorous for senior citizens.
Although the author’s note in the report for the elderly that “regular physical activity, including aerobic activity and muscle-strengthening activity, is essential for healthy aging.”
Below is a summary of the recommendations for senior citizens, which the report says “can reduce the risk of chronic disease, premature mortality, functional limitations, and disability.”
Summary of physical activity recommendations for older adults – 2007.
1. To promote and maintain good health, older adults should maintain a physically active lifestyle.
2. They should perform moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic activity for a minimum of 20 min on three days each week.
Moderate-intensity aerobic activity involves a moderate level of effort relative to an individual’s aerobic fitness. On a 10-point scale, where sitting is 0 and all-out effort is 10, moderate-intensity activity is a 5 or 6 and produces noticeable increases in heart rate and breathing. On the same scale, vigorous-intensity activity is a 7 or 8 and produces large increases in heart rate and breathing.
For example, given the heterogeneity of fitness levels in older adults, for some older adults a moderate-intensity walk is a slow walk, and for others it is a brisk walk.
3. Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation.
These moderate- or vigorous intensity activities are in addition to the light intensity activities frequently performed during daily life (e.g., self care, washing dishes) or moderate-intensity activities lasting 10 min or less (e.g., taking out trash, walking to parking lot at store or office).
4. In addition, at least twice each week older adults should perform muscle strengthening activities using the major muscles of the body that maintain or increase muscular strength and endurance.
It is recommended that 8–10 exercises be performed on at least two nonconsecutive days per week using the major muscle groups. To maximize strength development, a resistance (weight) should be used that allows 10–15 repetitions for each exercise. The level of effort for muscle-strengthening activities should be moderate to high.
5. Because of the dose-response relationship between physical activity and health, older persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities, or prevent unhealthy weight gain will likely benefit by exceeding the minimum recommended amount of physical activity.
6. To maintain the flexibility necessary for regular physical activity and daily life, older adults should perform activities that maintain or increase flexibility on at least two days each week for at least 10 min each day.
7. To reduce risk of injury from falls, community-dwelling older adults with substantial risk of falls should perform exercises that maintain or improve balance.
8. Older adults with one or more medical conditions for which physical activity is therapeutic should perform physical activity in a manner that effectively and safely treats the condition(s).
9. Older adults should have a plan for obtaining sufficient physical activity that addresses each recommended type of activity.
Those with chronic conditions for which activity is therapeutic should have a single plan that integrates prevention and treatment.
For older adults who are not active at recommended levels, plans should include a gradual (or stepwise) approach to increase physical activity over time. Many months of activity at less than recommended levels is appropriate for some older adults (e.g., those with low fitness) as they increase activity in a stepwise manner.
Older adults should also be encouraged to self-monitor their physical activity on a regular basis and to reevaluate plans as their abilities improve or as their health status changes.
Need for an activity plan.
The recommendations for senior citizens put particular emphasis on an activity plan that identifies the levels of physical activity the achieve and describes how the person intends to meet them.
“It is recommended that older adults with chronic conditions develop an activity plan in consultation with a health care provider so that the plan adequately takes into account therapeutic and risk management issues related to chronic conditions,” according to the report.
The continued:
“The plan should be tailored according to chronic conditions and activity limitations, risk for falls, individual abilities and fitness, strategies for minimizing risks of activity, strategies for increasing activity gradually over time (if the person is not active at recommended levels), behavioral strategies for adhering to regular physical activity, and individual preferences.
“Healthy, asymptomatic older adults without chronic conditions should also develop an activity plan, preferably in consultation with a health care provider or fitness professional, so as to take advantage of expertise and resources on physical activity and injury prevention.
“This recommendation reframes the common advice to consult a health care provider before starting to increase physical activity. Health provider consultation regarding physical activity should occur regardless of whether an adult currently plans to increase physical activity, as it is part of the ongoing process of promoting physical activity that should occur in geriatric medicine.
This recommendation is consistent with a recently developed quality of care measure for older adults that measures whether older adults discuss physical activity with a health care provider at least once a year.”
Some other highlights include:
Areas of Emphasis in Promoting Physical Activity in Older Adults
With sufficient skill, experience, fitness, and training, older adults can achieve high levels of physical activity. The promotion of physical activity in older adults should avoid ageism that discourages older adults from reaching their potential. At the same time, it is difficult or impossible for some older adults to attain high levels of activity. Several areas should be emphasized in promoting physical activity in older adults as described below.
Reducing sedentary behavior.
There is substantial evidence that older adults who do less activity than recommended still achieve some health benefits. Such evidence is consistent with the scientific consensus for a continuous dose-response relationship between physical activity and health benefits (30). For example, lower risks of cardiovascular disease have been observed with just 45–75 min of walking per week (40).
Increasing moderate activity and giving less emphasis to attaining high levels of activity.
Realistic goals for aerobic activity will commonly be in the range of 30–60 min of moderate-intensity activity a day, as illustrated by the Health Canada recommendation for older adults (26) (Table 1).
Vigorous activity has higher risk of injury and lower adherence (20). Age-related loss of fitness, chronic diseases, and functional limitations act as barriers to attaining high levels of activity. Vigorous activity and/or high levels of activity are appropriate for selected older adults with sufficient fitness, experience, and motivation.
Taking a gradual or stepwise approach.
The standard advice to increase physical activity gradually over time is highly appropriate and particularly important for older adults. This advice minimizes risk of overuse injury, makes increasing activity more pleasant, and allows positive reinforcement for small steps that lead to attainment of intermediate goals. It can be appropriate for older adults to spend a long time at one step (e.g., attending exercise classes two or three days a week) so as to gain experience, fitness, and self-confidence. Very deconditioned older adults may need to exercise initially at less effort than a ‘‘5’’ on a 10-point scale and may need to perform activity in multiple bouts (Q10 min) rather than in a single continuous bout (20).
In addition, activity plans need to be reevaluated when there are changes in health status.
Performing muscle-strengthening activity and engaging in all recommended types of activity.
Muscle-strengthening activity is particularly important in older adults, given its role in preventing age-related loss of muscle mass (60), bone (44), and its beneficial effects on functional limitations (30,31,35,55,60). Currently, only about 12% of older adults perform muscle-strengthening activities at least twice a week (63).
Sustaining emphasis on individual-level and community-level approaches. As with younger adults, promotion of physical activity in older adults relies upon both individual and community approaches that are evidence-based and reflect theory and research on behavior change.
For example, the Task Force on Community Preventive Services has recommended or strongly recommended several community-level interventions as effective in promoting physical activity, such as interventions to increase access to places of physical activity combined with informational outreach (29).
Using risk management strategies to prevent injury.
Chronic conditions increase risk of activity-related adverse events, e.g., heart disease increases risk of sudden death and osteoporosis increases risk of activity-related fractures. Activity-related musculoskeletal injuries act as a major barrier to regular physical activity. While these considerations lead to more emphasis on risk management, there is insufficient research on effective strategies to prevent injuries. Risk management strategies mainly reflect clinical experience, expert opinion, and legal liability concerns.
Evidence that risk management strategies can be effective comes from the observation that published exercise studies routinely implement risk management and serious adverse events in these studies are rare. However, research studies presumably exclude adults at high risk of injury.
Conclusion
“Virtually all older adults should be physically active,” conclude the authors.
“An older adult with a medical condition for which activity is therapeutic should perform physical activity in a manner that treats the condition. In addition, an older adult with medical conditions should engage in physical activity in the manner that reduces risk of developing other chronic diseases as described above.
“Given the breadth and strength of the evidence, physical activity should be one of the highest priorities for preventing and treating disease and disablement in older adults. Effective interventions to promote physical activity in older adults deserve wide implementation.”
The papers have been published jointly in Medicine & Science in Sports and Exercise®, ACSM’s official journal and Circulation, a journal of the American Heart Association. For more information or additional details on the physical activity guidelines, please visit www.americanheart.org/fitness.
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1 comment:
Well said.
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