Physical Activity in Older Adults
Lack of physical activity contributes to many chronic diseases that occur in older adults, including heart disease, stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, and cancer. Lack of physical activity, combined with poor dietary habits, has also contributed to increased obesity in older persons. Regular exercise and increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity, and are proven to reduce disease and disability, and improve quality of life in older persons.
For substantial health benefits, the guidelines recommend that most older adults participate in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of each per week. Older adults should also engage in strengthening activities that involve all major muscle groups at least two days a week. Those at risk of falling should add exercises that help maintain or improve balance.
Relatively few older adults in the United States achieve the minimum amount of recommended physical activity, and 28 to 34 percent of adults 65 to 74 years of age are inactive. The medical costs for inactive adults are substantially higher than for active adults and increase with age. This suggests that it may be possible to significantly lower health care costs by improving physical activity levels in older adults, as compared with any other age group.
Muscle strength decreases with age and may lead to a loss of autonomy and increased disability. A randomized controlled trial examining the effects of progressive weight training in 142 healthy adults 60 to 80 years of age found that long-term resistance training increased dynamic muscle strength, muscle size, and functional capacity.
PROTECTING THE MIND
Physically active adults have a lower risk of depression and cognitive decline than inactive adults. In a study of 1,740 persons 65 years and older without a diagnosis of dementia at baseline, those who exercised at least three times a week were much less likely than non-exercisers to develop dementia or Alzheimer disease.
DECREASING THE RISK OF MEDICAL CONDITIONS
In one study, life expectancy was increased even in persons who did not begin exercising regularly until 75 years of age. Physically active persons also have a significantly lower risk of colon and breast cancers compared with inactive persons. The cardiac risk of inactive persons is comparable with that of smokers.
Recommended Levels of Physical Activity
The 2008 Physical Activity Guidelines for Americans advises older adults to avoid inactivity while striving to be as physically active as their abilities allow. According to the American College of Sports Medicine (ACSM), aerobic and muscle-strengthening activity is critical for healthy aging.
It is important to create a plan that addresses each recommended type of activity. The plan should describe how, when, and where each activity will be performed. Additionally, the activity plan should gradually and progressively increase physical activity over time. Participating in several short periods of physical activity enables some older adults to achieve the recommended level of activity.
Patients should be encouraged to self-monitor their physical activity on a regular basis and to reevaluate their activity plan as their abilities improve or as their health status changes. Additionally, some older adults may need to increase their physical activity level and modify their diet to maintain a healthy body weight.
AEROBIC PHYSICAL ACTIVITY
Joint guidelines from the ACSM and American Heart Association recommend engaging in a variety of different types of aerobic physical activity throughout the week. The activities should last at least 10 minutes at a time and should be performed at moderate-or vigorous-intensity. Studies show that activity performed at least three days a week may reduce the risk of injury and excessive fatigue while producing health benefits.
The development of muscle strength and endurance is progressive and is important to help prevent loss of bone and muscle mass. At least two days a week, older adults should do muscle-strengthening activities (e.g., lifting weights, carrying groceries) that involve all major muscle groups. These exercises should consist of eight to 12 repetitions per activity, or should continue until it would be difficult to do another repetition without help.
Stretching activities may help maintain the flexibility necessary to continue regular physical activity. Older adults should perform activities that maintain or increase flexibility on at least two days a week for at least 10 minutes a day.
For some patients, low-impact activities (e.g., stretching exercises, swimming or other water activities) may be beneficial. Yoga and tai chi are other modalities that may promote flexibility, improve balance, and increase strength.
Before initiating an exercise program, most older adults with diagnosed chronic health conditions (e.g., diabetes, heart disease, osteoarthritis) should devise an appropriate activity plan in consultation with their physician that focuses on cardiac risk factors and physical limitations.
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