Cross-promoted from the NCHPAD News: Volume 12, Issue 1

Written by: Carol Kutik, Director of Fitness & Health Promotion at the Lakeshore Foundation

Never! Even if you have had an inactive lifestyle, research suggests that you are never too old to benefit from exercise. The National Institutes of Health (NIH) report that even moderate physical activity can improve the health of older adults who are frail, or who have diseases that accompany age. A substantial number of research studies confirming the many benefits of regular physical activity for older adults helped the U.S. government to report in its 2008 Physical Activity Guidelines for Americans that, compared to less active people, more active people have lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, metabolic syndrome, colon cancer, breast cancer, and depression. The Guidelines add that “regular physical activity is essential for healthy aging.” Note the word essential, as opposed to the word suggested.

Despite the known benefits of physical activity, the NIH reports that rates are low among older people. Only about 30 percent of adults between age 45 and 64, 25 percent between age 65 and 74 years, and 11 percent age 85 and older engage in regular physical activity. Physical activity rates for older adults with physical disabilities are even lower. According to a study by the Centers for Disease Control and Prevention regarding adults age 50 and over, approximately 70 percent of those with disabilities do not participate in recommended amounts of physical activity, as compared to 60 percent of those without disabilities.

As older individuals become less active, they begin to lose their ability to perform standard daily living activities and become discouraged and reluctant to exercise, fearful that it will be too strenuous and cause them harm. All too often, decreased levels of both physical function and independence are accepted as natural consequences of aging, leading older adults to believe that exercise is not “for them” and perpetuating the downward spiral. Research from the NIH shows that the opposite is true – that exercise is safe for people of all age groups, and that older adults hurt their health far more by not exercising than exercising.

The following types of exercise are recommended for seniors who want to stay healthy and independent:

• Strength exercises build muscles and increase metabolism (which helps with weight control). Strength exercises can be performed by using machines, free weights, working with resistance bands, using your own body weight (push-ups, pull-ups, sit-ups, etc.), heavy gardening, yoga and other methods.
• Endurance exercises improve the ability of your heart and lungs to work efficiently. Any activity that increases heart rate and breathing will help build endurance. Try walking, pushing, swimming, cycling or raking leaves!
• Stretching exercises keep joints and muscles limber, which can give you more freedom of movement. Special attention is important for joints that are particularly tight.
• Balance exercises can help avoid falling, as well as build strength and postural awareness.

The following steps will help guide you in your new exercise routine:

• First, make a commitment to yourself. Keep in mind that research tells us it takes most people 21 days to develop a new habit. Get out your calendar and plan those first 21 days – the rest will follow!
• Start out slowly, especially if you have been inactive for a long time, and set realistic short-term goals. Seek the advice of a fitness professional who is experienced in working with older adults. If you are computer savvy, use the internet to find exercises that you enjoy. Explore NCHPAD’s multitude of exercise programs. Check out EASY (www.easyforyou.info), a website developed to help older adults identify the physical activity programs most suited to their personal needs, preferences, and health conditions.
• Use your own body awareness as your guide. Pay attention to how you feel before, during, and after exercise, and adjust your pace as needed. Keep in mind that it will take you a while to know when it’s just right, but trust me, when you experience that awesome feeling you will be hooked!
• Reward yourself along the way as you reach small goals to keep the habit.

What do we know about physical activity among older adults?

For starters, physical activity is a powerful means to help prevent age-related loss of function, reduce the risk of chronic disease, improve mental and physical health, and support quality of life.

Older adults who exercise can:

• Reduce their risk of heart disease, some cancers, hypertension, high cholesterol and obesity;
  
• Mediate hypertension, diabetes and depression;
  
• Lower their risk of falls and injury;
  
• And improve their sleep.

The American College of Sports Medicine (ACSM) recommends that older adults get 150 minutes of moderate-intensity cardiovascular exercise per week. Recommended activities include strength-training, neuromotor exercise, functional training to improve balance, and flexibility excerise.

In general, strength training is important not only for fall prevention, fat metabolism, and bone health, but for the ability to perform daily activities such as lifting groceries. Cardiovascular conditioning reduces the risk of heart disease, improves endurance, and elevates mood. Improvements in flexibility aid regular activities like reaching, and ease certain conditions like arthritis. Improvements in balance help prevent falls and improve performance in sports and games.

Walking is the primary recommended activity, since it is inexpensive and simple. Only 12% of adults age 65 to 74 years old do strength training, but this is also an equally encouraged activity.

Aging is such a personal process that levels of physical fitness and function can not be recommended by chronological age. Some people in their '70s and '80s run marathons, while others are confined to wheelchairs. The prescription for physical actiivty must account for individual levels of function as well as the biological process of aging.

While the value of physical activity for older adults is well-documented,the number of older adults who exercise remains small. There is an unhealthy trend toward obesity in the older population, which is a future health problem. Other reports show that physical activity is more prevalent among white Americans than among ethnic groups or people of color.

Survey after survey finds that older adults know about the benefits of exercise, yet few take action. How do we change this?

The National Physical Activity Plan (NPAP) is clearly a positive step forward, as it is filled with solid research and recommendations. However, like older adults themselves, we need to move from recognizing that physical activity is important to actually making change happen.

Making an Impact

How do we make an impact? How do we get organizations and individuals to embrace exercise? How do we fulfill the visions of the National Physical Activity Plan?

Maybe the answer lies within an August 27, 2012 New York Times article by Jane Brody. In the article, entitled, "Changing our Tunes on Exercise," Brody interviews Michelle L. Segar, a research investigator at the Institute for Research on Women and Gender at the University of Michigan. Brody writes that "based on studies of what motivates people to adopt and sustain physical activity, Dr. Segar is urging that experts stop framing moderate exercise as a medical prescription that requires 150 minutes of aerobic effort each week. Instead, public health officials must begin to address 'the emotional hooks that make it essential for people to fit it into their hectic lives.'"

"Immediate rewards are more motivating than distant ones," says Segar. "Feeling happy and less stressed is more motivating than not getting heart disease or cancer, maybe, someday in the future."

How can we benefit from this information? According to Brody, "stop thinking about future health, weight loss, and body image as motivators for exercise. Instead, experts recommend a strategy marketers use to sell products: portray physical activity as a way to enhance current well-being and happiness."

What do you think? Is this a promising strategy? And how will you use it to increase the physical activity level of your older consumer?

The American Physical Therapy Association Section on Geriatrics held a 3-day conference in July 2010 on the campus of the University of Indianapolis to promote the application of research on benefits of exercise for older adults into clinical practice. Both the content format and the unique meeting planning create a model that may be useful to other organizations planning an education offering on the value of physical activity.

The conference, Exercise and Physical Activity in Aging Conference (ExPAAC): Blending Research and Practice, was hosted by the University of Indianapolis Center for Aging & Community and Krannert School of Physical Therapy, and drew 350 participants. Presentation topics included the effects of PA and exercise on health and aging, how to affect behavioral change, and evidence-based prescription for older adults. Our goals for the conference were to: 1) make available current research about PA and exercise from middle through older adulthood; 2) translate research into evidence based practice; 3) identify barriers to translation of research into evidence based practice; 4) promote best practices in physical therapist practice; and 5) evaluate public policies that influence the capacity of physical therapists to provide services. Speakers included national and international researchers Jack Guralnik, MD, PhD, MPH; Pamela Duncan, PT, PhD, FAPTA, FAHA; Alexandre Kalache, MSc, MD, PhD, FRCPH; James Rimmer, PhD; Thomas Prochaska, PhD; Barbara Resnik, PhD, RN, CRNP, FAAN, FAANP; and Luigi Ferrucci, MD, PhD.

Session topics included national and international physical activity initiatives, effects of physical activity and exercise on components of health and aging, determinants of behavior change, and evidence based practice exercise for optimizing function. We also held an evening poster presentation session to highlight case reports, research studies, special interest reports, and theory reports. Some participants wished to attend ExPAAC but felt they needed a review in geriatrics, so we offered a one-day pre-conference course that enabled these participants to maximize their experience. The closing keynote speech was delivered by Dr. James Canton, PhD, renowned author and advisor from the Institute for Global Futures.

Holding the conference at the university allowed us to have many great opportunities for networking and discussion - both formal and informal - at mealtimes in the campus cafeteria, during breaks on the outdoor commons, and at several special social events planned for conference attendees. Attendees stayed in the nearby Holiday Inn or in the dormitories on campus, which had the advantages of lower hotel and meeting site costs. An additional benefit was that conference participants were invited to attend exercise classes and to use campus recreational facilities during their free time.

For those who were unable to attend ExPAAC, we made sure that all of the sessions could be purchased through the APTA Learning Center at (click on "Courses" and search for ExPAAC). The PowerPoint presentations and the commentary of the experts during their ExPAAC presentations were included. Each session features multiple choice question examinations for the purposes of CEU credit.

Because of ExPAAC's overwhelming success, the Section on Geriatrics is considering an "ExPAAC II" in the next 5-10 years. We hope that a model such as ours will be as successful for you as it was for us...

Written by guest bloggers: Ellen Milner, PT, PhD; David M. Morris, PT, PhD