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Physical activity is one of the most important and effective ways to prevent and treat certain health problems in older adults. Physical activity means that the body is using energy to move muscles. Exercise is a type of physical activity that is designed to improve fitness. Your level of physical activity influences your risk of chronic illness, loss of function, dependence, and death. A number of things influence the specific effects of physical activity, including the type of activity and how often and how long someone performs the activity.
Health Benefits of Physical Activity Regular physical exercise is the best antidote to many of the effects of aging. Major benefits from regular exercise include the following:
Studies are currently being done to show the benefits of exercise programs for increasing life expectancy and decreasing the risk of or delaying disability as long as possible. Regular physical activity has beneficial effects on most (if not all) organ systems and can prevent a broad range of health problems and diseases. For example, physical activity reduces the risks of heart disease, high blood pressure, diabetes, obesity, osteoporosis, and colon cancer. There is also much evidence that physical activity can reduce loss of muscle related to age, depression, injuries related to falls, and stroke. In addition, physical activity has been linked to a decreased risk of gall stones, sleep problems, and ability to fight off infections. Currently, investigators are studying whether inactivity might also be a risk factor for many types of cancer. Regular physical activity also decreases the risk of dying from heart disease or other causes. In some studies, inactive older adults had death rates twice as high as those of active older adults. Remember–even if a person has some health problems, exercise is still beneficial. For example, inactive, obese smokers can improve their health by increasing their physical activity, even if they continue to smoke and do not lose weight. In addition, even a little bit of exercise pays off, such as parking farther away from the grocery store and reducing the time spent sitting and watching television. You don’t have to join a gym to get healthier! Physical activity has beneficial effects in the management of many chronic conditions in older adults. Physical activity can improve symptoms of depression, with one study suggesting that strength training can improve symptoms of depression as much as medication. Regular physical activity can also improve sleep. Exercise is a vital part of the treatment of arthritis, and studies have found that exercise reduces pain without causing damage in people who have arthritis of the knee. Exercise is also useful to lower blood pressure in people with high blood pressure, to reduce falls, and to improve bone strength in people with osteoporosis (brittle bones). Numerous professional organizations have issued guidelines that recommend various types and amounts of physical activity adjusted for certain conditions such as cardiovascular disease, high cholesterol, high blood pressure, diabetes mellitus, osteoporosis, etc. In addition to these guidelines, in general, you should check with your health care provider before making a major change in your level of physical activity or starting an exercise program. Professional Organizations/Groups with Guidelines for Physical Activity Preventing loss of function and dependency Regular physical activity delays the loss of function and can keep you living independently longer. Research data show that physically active, nonsmoking women at age 65 can expect to remain functionally active for 18+ years, on average, compared with less than 13 years for similar inactive women. Higher levels of physical activity are also associated with fewer years of disability before death. Exercise in older adults decreases functional limitations and increases quality of life. Inactive older adults who have lost some function probably benefit the most from increasing their level of exercise. However, at least one study suggests that healthy older adults also can improve function from exercising regularly. What is the Right Amount of Physical Activity? Older adults are the least physically active age group in the United States. Data from the Centers for Disease Control and Prevention show that about 35% of adults 65-75 years old and 46% of adults older than 75 years are inactive or sedentary. About 40%-45% of adults are not active enough, and only about 20%-25% of older adults are moderately active. On average, the activity levels of older adults have not improved much over the past decade. Do I need to see my health care provider before increasing my physical activity? Healthy adults with no symptoms of illness do not necessarily need a medical evaluation before increasing their level of activity. However, adults with chronic illness should consult their health care provider before making any major change in their activity levels. Your health care provider can help design a physical activity plan that is best for your specific needs. Your health care provider may also recommend additional medical evaluation to minimize your risk of possible injury related to exercise. A moderate amount of physical activity has major health benefits and is recommended for all adults, regardless of age. Regular day-to-day activities may provide enough activity for older adults. For example, these activities might include walking, gardening, or performing household chores. Traveling to an exercise class is not necessary. Indeed, surveys show that most older adults do not prefer this option. However, for people who are trying to increase their level of activity, exercise classes can be useful because they provide supervision, instruction, and motivation. Again, many professional and government organizations, including the Centers for Disease Control and the American College of Sports Medicine, have recommendations for amounts of physical activity for adults. Although these recommendations vary in some specifics, nearly all agree that adults should include a total of 30 minutes of moderate physical activity in their daily routine. What is meant by "moderate" activity? Definitions of a "moderate" amount of activity differ, even among experts. A moderate amount of activity expends about 150-200 kcal (ie, calories) per day, over 30-45 minutes, on at least 5 days per week. In less technical terms, a common example of a moderate amount of activity is a brisk 30-45 minute walk, 5 days a week. Moderate activity has also been defined based on maximal heart rate. Several equations have been developed to predict maximal heart rate:
Using these definitions, moderate activity for most adults (all ages) would increase heart rate to 70% of maximal. However, a realistic, practical goal for currently inactive older adults is 30-45 minutes of activity at 55% to 69% of maximal heart rate. In fact, inactive older adults may benefit from even less exercise at lower intensity. For most older adults, exercise programs of moderate intensity that last longer are better than programs of high intensity that are short. One of the reasons for this it that the risk of injury is lower in moderate-intensity exercise, so people are better able stick with the program. Increasing activity level by running is not generally recommended for older adults (unless they have always been runners) because injuries are common. Running and other high-intensity activities carry a greater risk of both sudden cardiovascular problems and injury to bones and muscles. People are also less likely to continue this type of exercise program. What if I can’t exercise a lot? Although bouts of activity 30-45 minutes long, are recommended, several bouts as short as 10 minutes each may substitute for one 30- to 45-minute bout. Short bouts fit into daily schedules more easily. They are also often preferred by older adults who may have symptoms of conditions that limit exercise, such as arthritis pain. Even low amounts of activity have important health benefits and are better than an inactive life style. For example, in the Nurses Health Study, about 10 minutes of moderate activity a day reduced the risk of cardiovascular events by over 20%. About 22 minutes of moderate activity a day reduced the risk by about 35%. The generally recommended activity level of about 30-45 minutes a day reduced the risk by more than 50%. Also, function improved and disability lessened in exercise programs that result in only small improvements in fitness. In the Fitness, Arthritis, and Seniors Trial (FAST), 2%-4% improvements in aerobic fitness and leg strength resulted in 8%-10% improvements in functional limitations and disability. In another study of falls prevention in women 80 years and older, 90 minutes of walking per week combined with low-intensity weight training and balance training reduced falls by 50%. Some recommendations suggest that moderate activity must work up a sweat, but this advice is questionable. Whether activity causes perspiration depends on several factors, including the following:
Monitoring either heart rate or symptoms with exercise is probably a better way to guide level of exercise than working up a sweat. In group programs, an exercise leader can help older adults monitor themselves to maintain moderate levels of exercise intensity. Moderate amounts of physical activity are enough to gain important health benefits. However, gaining even more health benefits is possible with more activity. Although the best amount of activity is not known exactly, older adults who already are (or who have become) moderately active may want to increase their level of activity (within reason) to maximize health benefits. The most important thing to remembering in increasing activity is to do a mix or variety of activities that improve all aspects of fitness, including endurance, strength, balance, and flexibility. Also, remember that the total amount of exercise can be measured by the calories your body uses up. So long as the number of calories used up is about the same for less strenuous bouts of exercise that are done for a longer time as for more strenuous bouts that are done for a shorter time, the health benefits are similar. Health Benefits from Different Types of Exercise Walking and aerobic activities Walking is the core activity in most exercise plans for older adults. It is, by far, the most common and popular form of physical activity for older adults. Walking reduces the risks of death and heart disease, as well as the risk of falling. Of course, some older adults prefer other forms of aerobic activity, such as swimming, biking, dancing, and racket sports. Stretching exercises and other activities that improve flexibility are recommended for older adults. Flexibility can be increased by specific stretching exercises, by exercise programs that include stretching exercises, or by some daily activities such as walking. Current recommendations encourage stretching at the end of a bout of activity, or after gentle warm-up activities. Reducing muscle loss related to age Age-related loss of muscle is called sarcopenia. This condition contributes to functional limitations and dependence in older adults. We don’t completely understand why sarcopenia develops, but nerve damage, decreased blood supply, and injury to cells may be involved. Several studies suggest that regular physical activity among older adults can prevent much loss of muscle mass. For example, in one study of 22 active older men, their fat-free mass (a measurement of the amount of muscle tissue) did not change over 6_ years. In a Finnish study, everyday physical activities, such as household work, walking, and gardening, maintained skeletal muscle strength well enough for independent living. Isotonic resistance training is strength training using weight machines or free weights. It has been extensively studied and is recommended as a means of building muscle mass and counteracting sarcopenia. Strength training has become a standard part of many therapeutic exercise programs, including programs for heart and lung rehabilitation. It also improves function and joint symptoms of older people with arthritis. In addition, strength training can improve control of blood sugar in older adults with diabetes. As a rule, older adults benefit from strength-training programs at moderate-intensity levels. These programs typically use free weights, such as weight cuffs or dumbbells. Typically, regular training for 3-6 months can increase strength by 10-30%. In general, 2 days per week of resistance training is enough, doing, for example, 8-10 exercises 10-15 times each. Even 1 day per week has some benefits. Strength training programs also improve overall physical function, including improved balance and gait and less risk of falling. Programs are inexpensive and are run in a variety of settings, such as nursing homes, senior centers, and residences. Some older adults may want to go a step further and explore more strenuous or high-intensity resistance training. In high-intensity training, the resistance or weight is at least 70% of the maximal weight that a person can lift just once. Older adults involved in these programs can gain strength steadily for many months. Although with proper supervision, vigorous training appears safe (even for nursing home residents), it is time consuming and less practical because it requires weight machines or other major equipment. In addition, training at this level is not for everyone. It can cause low levels of muscle inflammation and, if improperly done, cause injury. Reducing osteoporosis, falls, and fractures Regular physical activity by older adults probably has some effect in slowing bone loss related to age. Resistance and high-impact exercises are probably the most beneficial for slowing bone loss but they may be associated with injury. Weight-bearing aerobic activities can also help maintain bone mass. Increasing physical activity is regarded as an effective part of programs to prevent falls. Overall, exercise improves balance and reduces the risk of falls and hip fracture. Studies also suggest that even daily activities, such as walking and climbing stairs, can reduce the risk of hip fracture. Some types of balance training, such as tai chi, can improve balance in older adults and reduce the risk of falls. Some programs include separate balance exercises, such as standing on narrow bases of support (eg, a one-leg stand). Other programs include some stretching and strengthening exercises done in a way that also improves balance (see Additional Resources for more specific exercise info). Balance exercises can increase in difficulty, with exercises becoming more difficult as balance improves. For example, ,a tandem-walk exercise (walking by putting one foot directly in front of the other) is easiest when holding onto a table. The same exercise becomes progressively harder with arms in any position, then with arms close to the body, and then with arms close to the body and holding a weight. Work with Your Health Care Provider Healthy People 2010 and the 1996 U.S. Preventive Services Task Force recommend that inactive adults should ask their doctor or other health care provider about increasing their physical activity. Counseling can have both short-term and long-term effects on increasing physical activity levels in adults. Physically active older adults are more likely to have received counseling to increase their activity, and they consistently identify physicians as a key source of advice about physical activity and exercise. Your doctor or other health care provider can help you establish an activity program that is right for you. Key things for you to work on together include:
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Published: 2/28/2005