Chapter 5: Active Older Adults
Regular physical activity is essential for healthy aging. Adults aged
65 years and older gain substantial health benefits from regular physical
activity, and these benefits continue to occur throughout their lives.
Promoting physical activity for older adults is especially important because
this population is the least physically active of any age group.
Older adults are a varied group. Most, but not all, have one or more
chronic conditions, and these conditions vary in type and severity. All have
experienced a loss of physical fitness with age, some more than others. This
diversity means that some older adults can run several miles, while others
struggle to walk several blocks.
This chapter provides guidance about physical activity for adults aged
65 years and older. The chapter focuses on physical activity beyond baseline
activity. The Guidelines seek to help older adults select types and amounts of
physical activity appropriate for their abilities. The Guidelines for older
adults are also appropriate for adults younger than age 65 who have chronic
conditions and those with a low level of fitness.
For adults aged 65 and older who are fit and have no limiting chronic
conditions, the guidance in this chapter is essentially the same as that
provided in Chapter 4Active Adults.
Explaining the Guidelines
Like the Guidelines for other adults, those for older adults mainly
focus on two types of activity: aerobic and muscle-strengthening. In addition,
these Guidelines discuss the addition of balance training for
older adults at risk of falls. Each type provides important health benefits, as
explained in Chapter 2Physical Activity Has Many Health Benefits.
People doing aerobic activities move large muscles in a rhythmic manner
for a sustained period. Brisk walking, jogging, biking, dancing, and swimming
are all examples of aerobic activities. This type of activity is also called
Aerobic activity makes a person's heart beat more rapidly to meet
the demands of the body's movement.
Over time, regular aerobic activity makes the heart and cardiovascular
system stronger and fitter.
When putting the Guidelines into action, it's important to
consider the total amount of activity, as well as how often to be active, for
how long, and at what intensity.
Key Guidelines for Older Adults
The following Guidelines are the same for adults and older
- All older adults should avoid inactivity. Some physical activity is
better than none, and older adults who participate in any amount of physical
activity gain some health benefits.
- For substantial health benefits, older adults should do at least
150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75
minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical
activity, or an equivalent combination of moderate- and vigorous-intensity
aerobic activity. Aerobic activity should be performed in episodes of at least
10 minutes, and preferably, it should be spread throughout the week.
- For additional and more extensive health benefits, older adults
should increase their aerobic physical activity to 300 minutes (5 hours) a week
of moderate-intensity, or 150 minutes a week of vigorous-intensity aerobic
physical activity, or an equivalent combination of moderate- and
vigorous-intensity activity. Additional health benefits are gained by engaging
in physical activity beyond this amount.
- Older adults should also do muscle-strengthening activities that
are moderate or high intensity and involve all major muscle groups on 2 or more
days a week, as these activities provide additional health benefits.
The following Guidelines are just for older
- When older adults cannot do 150 minutes of moderate-intensity
aerobic activity a week because of chronic conditions, they should be as
physically active as their abilities and conditions allow.
- Older adults should do exercises that maintain or improve balance
if they are at risk of falling.
- Older adults should determine their level of effort for physical
activity relative to their level of fitness.
- Older adults with chronic conditions should understand whether and
how their conditions affect their ability to do regular physical activity
How much total activity a week?
Older adults should
aim to do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity
physical activity a week, or an equivalent amount (75 minutes or 1 hour and 15
minutes) of vigorous-intensity activity. Older adults can also do an equivalent
amount of activity by combining moderate- and vigorous–intensity
activity. As is true for younger people, greater amounts of physical activity
provide additional and more extensive health benefits to people aged 65 years
No matter what its purposewalking the dog, taking a dance or
exercise class, or bicycling to the storeaerobic activity of all types
counts toward the Guidelines.
How many days a week and for how long?
physical activity should be spread throughout the week. Research studies
consistently show that activity performed on at least 3 days a week produces
health benefits. Spreading physical activity across at least 3 days a week may
help to reduce the risk of injury and avoid excessive fatigue.
Episodes of aerobic activity count toward meeting the Guidelines if
they last at least 10 minutes and are performed at moderate or vigorous
intensity. These episodes can be divided throughout the day or week. For
example, a person who takes a brisk 15-minute walk twice a day on every day of
the week would easily meet the minimum Guideline for aerobic activity.
Examples of Aerobic and Muscle-Strengthening Physical Activities for
Older Adults. The intensity of these activities can be either relatively
moderate or relatively vigorous, depending on an older adult's level of
- Water aerobics
- Aerobic exercise classes
- Bicycle riding (stationary or on a path)
- Some activities of gardening, such as raking and pushing a lawn
- Golf (without a cart)
- Exercises using exercise bands, weight machines, hand-held
- Calisthenic exercises (body weight provides resistance to
- Digging, lifting, and carrying as part of gardening
- Carrying groceries
- Some yoga exercises
- Some Tai chi exercises
Older adults can meet the Guidelines
by doing relatively moderate-intensity activity, relatively
vigorous–intensity activity, or a combination of both. Time spent in
light activity (such as light housework) and sedentary activities (such as
watching TV) do not count.
The relative intensity of aerobic activity is related to a
person's level of cardiorespiratory fitness.
- Moderate-intensity activity requires a medium level
of effort. On a scale of 0 to 10, where sitting is 0 and the greatest effort
possible is 10, moderate-intensity activity is a 5 or 6 and produces noticeable
increases in breathing rate and heart rate.
- Vigorous-intensity activity is a 7 or 8 on this
scale and produces large increases in a person's breathing and heart rate.
A general rule of thumb is that 2 minutes of moderate–intensity
activity count the same as 1 minute of vigorous-intensity activity. For
example, 30 minutes of moderate-intensity activity a week is roughly same as 15
minutes of vigorous-intensity activity.
At least 2 days a week, older adults should do
muscle–strengthening activities that involve all the major muscle groups.
These are the muscles of the legs, hips, chest, back, abdomen, shoulders, and
Muscle-strengthening activities make muscles do more work than they are
accustomed to during activities of daily life. Examples of muscle-strengthening
activities include lifting weights, working with resistance bands, doing
calisthenics using body weight for resistance (such as push-ups, pull-ups, and
sit-ups), climbing stairs, carrying heavy loads, and heavy gardening.
Muscle-strengthening activities count if they involve a moderate to
high level of intensity, or effort, and work the major muscle groups of the
body. Whatever the reason for doing it, any muscle-strengthening activity
counts toward meeting the Guidelines. For example, muscle-strengthening
activity done as part of a therapy or rehabilitation program can count.
No specific amount of time is recommended for muscle strengthening, but
muscle-strengthening exercises should be performed to the point at which it
would be difficult to do another repetition without help. When resistance
training is used to enhance muscle strength, one set of 8 to 12 repetitions of
each exercise is effective, although two or three sets may be more effective.
Development of muscle strength and endurance is progressive over time. This
means that gradual increases in the amount of weight or the days per week of
exercise will result in stronger muscles.
Balance Activities for Older Adults at Risk of Falls
Older adults are at increased risk of falls if they have had falls in
the recent past or have trouble walking. In older adults at increased risk of
falls, strong evidence shows that regular physical activity is safe and reduces
the risk of falls. Reduction in falls is seen for participants in programs that
include balance and moderate-intensity muscle-strengthening activities for 90
minutes (1 hour and 30 minutes) a week plus moderate-intensity walking for
about 1 hour a week. Preferably, older adults at risk of falls should do
balance training 3 or more days a week and do standardized exercises from a
program demonstrated to reduce falls. Examples of these exercises include
backward walking, sideways walking, heel walking, toe walking, and standing
from a sitting position. The exercises can increase in difficulty by
progressing from holding onto a stable support (like furniture) while doing the
exercises to doing them without support. It's not known whether different
combinations of type, amount, or frequency of activity can reduce falls to a
greater degree. Tai chi exercises also may help prevent falls.
Meeting the Guidelines
Older adults have many ways to live an active lifestyle that meets the
Guidelines. Many factors influence decisions to be active, such as personal
goals, current physical activity habits, and health and safety considerations.
Healthy older adults generally do not need to consult a health-care
provider before becoming physically active. However, health-care providers can
help people attain and maintain regular physical activity by providing advice
on appropriate types of activities and ways to progress at a safe and steady
Adults with chronic conditions should talk with their health-care
provider to determine whether their conditions limit their ability to do
regular physical activity in any way. Such a conversation should also help
people learn about appropriate types and amounts of physical activity.
Inactive Older Adults
Older adults should increase their amount of physical activity
gradually. It can take months for those with a low level of fitness to
gradually meet their activity goals. To reduce injury risk, inactive or
insufficiently active adults should avoid vigorous aerobic activity at first.
Rather, they should gradually increase the number of days a week and duration
of moderate-intensity aerobic activity. Adults with a very low level of fitness
can start out with episodes of activity less than 10 minutes and slowly
increase the minutes of light-intensity aerobic activity, such as
Older adults who are inactive or who don't yet meet the Guidelines
should aim for at least 150 minutes a week of relatively moderate-intensity
physical activity. Getting at least 30 minutes of relatively
moderate–intensity physical activity on 5 or more days each week is a
reasonable way to meet these Guidelines. Doing muscle-strengthening activity on
2 or 3 nonconsecutive days each week is also an acceptable and appropriate goal
for many older adults.
Active Older Adults
Older adults who are already active and meet the Guidelines can gain
additional and more extensive health benefits by moving beyond the 150 minutes
a week minimum to 300 or more minutes a week of relatively moderate-intensity
aerobic activity. Muscle–strengthening activities should also be done at
least 2 days a week.
Older Adults With Chronic Conditions
Older adults who have chronic conditions that prevent them from doing
the equivalent of 150 minutes of moderate-intensity aerobic activity a week
should set physical activity goals that meet their abilities. They should talk
with their health-care provider about setting physical activity goals. They
should avoid an inactive lifestyle. Even 60 minutes (1 hour) a week of
moderate-intensity aerobic activity provides some health benefits.
Doing a Variety of Activities, Including Walking
Older adults have many ways to live an active lifestyle that meets the
In working toward meeting the Guidelines, older adults are encouraged
to do a variety of activities. This approach can make activity more enjoyable
and may reduce the risk of overuse injury.
Older adults also should strongly consider walking as one good way to
get aerobic activity. Many studies show that walking has health benefits, and
it has a low risk of injury. It can be done year-round and in many settings.
Physical Activity for Older Adults Who Have Functional Limitations
When a person has lost some ability to do a task of everyday life, such
as climbing stairs, the person has a functional limitation. In older adults
with existing functional limitations, scientific evidence indicates that
regular physical activity is safe and helps improve functional ability.
Resuming Activity After an Illness or Injury
Older adults may have to take a break from regular physical activity
because of illness or injury, such as the flu or a muscle strain. If these
interruptions occur, older adults should resume activity at a lower level and
gradually work back up to their former level of activity.
Flexibility, Warm-up, and Cool-down
Older adults should maintain the flexibility necessary for regular
physical activity and activities of daily life. When done properly, stretching
activities increase flexibility. Although these activities alone have no known
health benefits and have not been demonstrated to reduce risk of
activity-related injuries, they are an appropriate component of a physical
activity program. However, time spent doing flexibility activities by
themselves does not count toward meeting aerobic or muscle-strengthening
Research studies of effective exercise programs typically include
warm-up and cool-down activities. Warm-up and cool-down activities before and
after physical activity can also be included as part of a personal program. A
warm-up before moderate- or vigorous-intensity aerobic activity allows a
gradual increase in heart rate and breathing at the start of the episode of
activity. A cool-down after activity allows a gradual decrease at the end of
the episode. Time spent doing warm-up and cool-down may count toward meeting
the aerobic activity Guidelines if the activity is at least moderate intensity
(for example, walking briskly to warm-up for a jog). A warm-up for
muscle-strengthening activity commonly involves doing exercises with less
weight than during the strengthening activity.
Physical Activity in a Weight-Control Plan
The amount of physical activity necessary to successfully maintain a
healthy body weight depends on caloric intake and varies considerably among
older adults. To achieve and maintain a healthy body weight, older adults
should first do the equivalent of 150 minutes of moderate-intensity aerobic
activity each week. If necessary, older adults should increase their weekly
minutes of aerobic physical activity gradually over time and decrease caloric
intake to a point where they can achieve energy balance and a healthy weight.
Some older adults will need a higher level of physical activity than
others to maintain a healthy body weight. Some may need more than the
equivalent of 300 minutes (5 hours) a week of moderate-intensity activity. It
is possible to achieve this level of activity by gradually increasing activity
Older adults who are capable of relatively vigorous–intensity
activity and need a high level of physical activity to maintain a healthy
weight should consider some relatively vigorous-intensity activity as a means
of weight control. This approach is more time-efficient than doing only
moderate-intensity activity. However, high levels of activity are not feasible
for many older adults. These adults should achieve a level of physical activity
that is sustainable and safe. If further weight loss is needed, these older
adults should achieve energy balance by regulating caloric intake.
It is important to remember that all activities "count" for
energy balance. Active choices, such as taking the stairs rather than the
elevator or adding short episodes of walking to the day, are examples of
activities that can be helpful in weight control.
Getting and Staying Active: Real-Life Examples
The following examples show how different people with different living
circumstances and levels of fitness can meet the Guidelines for older adults.
Mary: A 75-Year-Old Woman Living Independently in Her Own Home
Mary gets the equivalent of 180 minutes (3 hours) of moderate-intensity
aerobic activity each week, plus muscle-strengthening activity 3 days a week.
- She participates regularly in an exercise class at her local senior
center. The class meets Mondays, Wednesdays, and Fridays. It includes 30
minutes of aerobic dance, which she can do at moderate intensity, as well as 20
minutes of strength training, a 5-minute warm-up, a 5-minute
cool-down, and some stretching exercises.
- On most Sundays, she visits her favorite park and walks a loop trail
with several friends, which takes them about 45 minutes. The trail is hilly, so
about 30 minutes of the walk is moderate-intensity walking for her, and about
15 minutes is vigorous intensity (the 15 minutes of vigorous intensity counts
as 30 minutes of moderate-intensity walking).
- She adds at least an additional 30 minutes of walking each week in
different ways. For example, she walks her grandson to school, she walks to her
friends' homes, or she walks at the mall during shopping trips.
Manuel: An 85-Year-Old Man Living in an Assisted-Living Facility
Manuel, who has problems with falls, gets about 70 minutes (1 hour and
10 minutes) of aerobic activity each week and has an individualized
strength-training program. He cannot do 150 minutes of moderate intensity
physical activity because of his chronic conditions, but he is being as
physically active as his condition allows.
- To reduce the risk of falls, a physical therapist has prescribed an
individualized exercise program. This program includes 3 days a week (30
minutes each session) of strength- and balance-training exercises. Manueluses
ankle weights for lower body muscle strengthening exercises and does a series
of balance exercises. He does this program with the assistance of a residential
- Manuel's residence includes a garden with walking paths and
benches. He has gradually increased his physical activity to walking about 10
minutes each day. On some days he can walk more than on others, but he tries to
walk a little every day. The plan is for him to sustain this level of activity
for several weeks.
- After he builds strength and his balance improves, Manuel will
consider increasing his level of activity and joining an exercise class
specially designed to reduce the risk of falls in older people.
Anthony: A 65-Year-Old Man Living in a Retirement Community
Anthony has been active and fit all his life. He does 180 minutes of
relatively vigorous-intensity activity each week, plus muscle-strengthening
activities on 3 days.
- Six days a week, Anthony gets up early and runs 3 miles, which takes
about 30 minutes.
- With help from staff at his community's fitness facility,
Anthony designed a weight-lifting program using weight machines. He does this
program on 3 days.
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