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?

National Falls Prevention Awareness Day is observed on the first day of fall (today!) to increase public awareness and promote activities to reduce falls among older adults. This year's awareness day is themed "Standing Together to Prevent Falls," and 46 states are planning to participate. National Falls Prevention Awareness Day is just one example of the tremendous work over 70 professional organizations, including APTA, federal agencies, and 42 state falls prevention coalitions have done through the Falls Free Initiative.

According to the Centers for Disease Control and Prevention (CDC), one-third of older adults fall at least once each year. Falls are the leading cause of fatal injury and nonfatal trauma-related hospital admissions among older adults. Muscle weakness, balance impairments, and walking difficulties are among the leading risk factors for falls among older adults. Fortunately, various types of exercise can lessen the impact of these factors and reduce one's chances of falling.

The US Preventive Services Task Force recently supported exercise or physical therapy and Vitamin D supplementation to prevent falls among community-dwelling older adults. These recommendations are also supportive of those proposed by the American Geriatrics Society, which recommends balance, walking, and strength training to reduce falls risk.

The Physical Activity Guidelines for Americans (PAG) also recommend balance training at least 3 times per week for older adults at increased risk for falls. This is in addition to the general recommendation for a minimum of 150 minutes of moderate-intensity or 75 minutes of vigourous-intensity aerobic exercise per week and 2 days per week of strength training.

Balance training should be challenging and progressive in difficulty (such as reducing base of support and/or increasing movement in multiple directions). Group or individual programs that combine balance and strengthening exercises, such as tai chi, have been proven to effectively reduce falls among older adults.

Evidence-based balance exercise programs can be offered in any number of settings. It is also acknowledged that a variety of other healthy aging programs can be strategically offered within facilities to promote and sustain behavior change, address intermediate risk factors or barriers, or serve as entry programs for referral to more targeted fall prevention programming. Many of these programs are already found within communities supported by the US Administration on Community Living. Research supports a minimum of 50 hours of exercise, over a minumum of 12 weeks (6 months is best) to affect balance and falls, so physical therapists need to partner with agencies that can help to augment or supplement our plans of care.

There are many examples of successful partnerships among community agencies and exercise professionals to offer evidence-based and best-practice programs that deliver the recommended type and amount of exercise. Community agencies are also in a strategic position to offer assistance with marketing, recruiting participants, and providing activity space. Potential partners include senior centers, older adult housing, churches, fitness and wellness centers, and nutrition sites.

APTA provides website resources on falls prevention to its members and promotes the Falls Prevention Awareness Day through its e-newsletter. Other awareness and planning resources are also available from the National Coalition on Aging Center for Healthy Aging. How can your organization and members join together to help your communities' older adults improve balance and reduce falls?

Guest bloggers: Lori Schrodt, PT, PhD, Chair of the Health Promotion & Wellness Special Interest Group, Section of Geriatrics, American Physical Therapy Association; (Bonita) Lynn Beattie, PT, MP, MHA, Vice President, Injury Prevention Lead, Falls Free Initiative; Center for Healthy Aging; National Council on Aging; and physical therapist students from Western Carolina University, Andrea Cahoon, Sherrie Flory, Anna King, Caitlin Laemmle, Kenneth Richards, and Monica Vargas.

What makes a healthy community? One answer is contained in the physical spaces and services that enable older adults to engage in healthy behaviors. Bike paths, walking trails, outdoor fitness spaces, meditation areas and labyrinths are just a few examples of infrastructure that can inspire and engage older populations. Another example can be found in upgraded senior centers providing spaces for community gardens and offering numerous educational campaigns and incentives to help lead their population towards a healthier life across the lifespan.

The second answer lies in the catchphrase of "personal responsibility." For a community to be healthy, the people living in that community need to take action. Here are 10 tips that can help you inform your older consumers about ways in which they can lead a healthier life, thus creating a healthy community. Here we go...

1. Expectations: If they have been following a healthy lifestyle up until now, simply tell them to keep going. If they need to make changes, help them to anticipate succeeding, not failing - and don't let age be a barrier. Research has shown that thinking positively about getting older can extend their life by as much as 7.5 years.

2. Enthusiasm: Few people are thrilled with every aspect of their lives, but many have at least one area - family, friends, work, avocation - that they feel good about. Identify an activity or connection that sparks their enthusiasm, and make it their lifeline; try to get them to extend that enthusiasm to other areas of their life.

3. Energy: Having the energy and motivation they need to age well are hallmarks of healthy living. If they are fatigued all the time, don't let apathy and lethargy drag them down; suggest they get a checkup to try to determine the cause and the solution.

4. Eating: Eating a balanced diet and attaining/maintaining a normal weight are keys to physical and mental health; if they need to lose weight or make changes in their diet, keep their expectations high - they can do it!

5. Exercise: Staying physically active fuels the body and mind. If they are already exercising regularly, encourage them to keep it up. It they are just getting started, help them to understand their skill level, get them to set goals and progress at their own pace, and get them to be consistent.

6. Engagement: Volunteers have higher levels of well-being and life satisfaction than those who don't volunteer; volunteering and other forms of civic and social engagement can play an important role in the maintenance of good health later in life. Get them involved in the community.

7. Emotions: Everyone feels down at times, but full-blown depression is a major cause of disability. If they are feeling out of sorts for two weeks or more, talk with their doctor or have them take an online screening test. In many instances, simply exercising and eating right can change their mood.

8. Education: Lifelong learning is important to living an independent and fulfilling life. Suggest your customers start now to learn a new area of knowledge or physical activity. It's good for the brain.

9. Effort: Changing expectations and embarking on new behaviors takes energy and effort, but the results for your customer will be well worth it.

10. Enjoyment: A healthy life generally is a joyous one. Suggest ways in which your customers can savor the process of being or becoming active, engaged, and truly alive.

How will you use this information to help build a healthier community in your town or city?