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Fitness & Exercise for Senior Citizens
Senior Citizens Get Advice on Exercise from Heart
Association, Sports Docs
1995 recommendations updated for seniors and
younger adults
 Aug. 6, 2007 – New recommendations for the physical
activity senior citizens need to improve and maintain health were
released last week from a joint effort of the American College of Sports
Medicine (ACSM) and American Heart Association (AHA) to update the 1995
recommendations from the Centers for Disease Control and Prevention
(CDC) and ACSM. A set was also released for younger adults.
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The recommendation for senior citizens is similar
to the updated recommendation for the younger adults, but has several
important differences including: the recommended intensity of aerobic
activity takes into account the older adult’s aerobic fitness;
activities that maintain or increase flexibility are recommended; and
balance exercises are recommended for older adults at risk of falls.
In addition, senior citizens should have an
activity plan for achieving recommended physical activity that
integrates preventive and therapeutic recommendations. The promotion of
physical activity in older adults should emphasize moderate-intensity
aerobic activity, muscle-strengthening activity, reducing sedentary
behavior, and risk management.
The recommendations for senior citizens (age 65 and
older) also apply to adults age 50-64 with chronic conditions or
physical functional limitations (e.g. arthritis) that affect movement
ability or physical fitness.
The reports says healthy adults under age 65 need
moderate-intensity aerobic physical activity for at least 30 minutes on
five days each week or vigorous-intensity aerobic physical activity for
at least 20 minutes on three days each week, according to updated
physical activity guidelines.
It also recommends they will benefit from
performing activities that maintain or increase muscular strength and
endurance for at least two days each week. It is recommended that 8-10
exercises using the major muscle groups be performed on two
non-consecutive days. To maximize strength development, a resistance
(weight) should be used for 8-12 repetitions of each exercise resulting
in willful fatigue.
Recommendations are less vigorous for senior
citizens.
Although the author’s note in the report for the
elderly that “regular physical activity, including aerobic activity and
muscle-strengthening activity, is essential for healthy aging.”
Below is a summary of the recommendations for
senior citizens, which the report says “can reduce the risk of chronic
disease, premature mortality, functional limitations, and disability.”
Summary of physical activity
recommendations for older adults – 2007.
1. To promote and maintain good health,
older adults should maintain a physically active lifestyle.
2. They should perform moderate-intensity
aerobic (endurance) physical activity for a minimum of 30 min on five
days each week or vigorous-intensity aerobic activity for a minimum of
20 min on three days each week.
Moderate-intensity aerobic activity involves a
moderate level of effort relative to an individual’s aerobic fitness. On
a 10-point scale, where sitting is 0 and all-out effort is 10,
moderate-intensity activity is a 5 or 6 and produces noticeable
increases in heart rate and breathing. On the same scale,
vigorous-intensity activity is a 7 or 8 and produces large increases in
heart rate and breathing.
For example, given the heterogeneity of fitness
levels in older adults, for some older adults a moderate-intensity walk
is a slow walk, and for others it is a brisk walk.
3. Combinations of moderate- and
vigorous-intensity activity can be performed to meet this
recommendation.
These moderate- or vigorous intensity activities
are in addition to the light intensity activities frequently performed
during daily life (e.g., self care, washing dishes) or
moderate-intensity activities lasting 10 min or less (e.g., taking out
trash, walking to parking lot at store or office).
4. In addition, at least twice each week
older adults should perform muscle strengthening activities using the
major muscles of the body that maintain or increase muscular strength
and endurance.
It is recommended that 8–10 exercises be performed
on at least two nonconsecutive days per week using the major muscle
groups. To maximize strength development, a resistance (weight) should
be used that allows 10–15 repetitions for each exercise. The level of
effort for muscle-strengthening activities should be moderate to high.
5. Because of the dose-response relationship
between physical activity and health, older persons who wish to further
improve their personal fitness, reduce their risk for chronic diseases
and disabilities, or prevent unhealthy weight gain will likely benefit
by exceeding the minimum recommended amount of physical activity.
6. To maintain the flexibility necessary for
regular physical activity and daily life, older adults should perform
activities that maintain or increase flexibility on at least two days
each week for at least 10 min each day.
7. To reduce risk of injury from falls,
community-dwelling older adults with substantial risk of falls should
perform exercises that maintain or improve balance.
8. Older adults with one or more medical
conditions for which physical activity is therapeutic should perform
physical activity in a manner that effectively and safely treats the
condition(s).
9. Older adults should have a plan for
obtaining sufficient physical activity that addresses each recommended
type of activity.
Those with chronic conditions for which activity is
therapeutic should have a single plan that integrates prevention and
treatment.
For older adults who are not active at recommended
levels, plans should include a gradual (or stepwise) approach to
increase physical activity over time. Many months of activity at less
than recommended levels is appropriate for some older adults (e.g.,
those with low fitness) as they increase activity in a stepwise manner.
Older adults should also be encouraged to
self-monitor their physical activity on a regular basis and to
reevaluate plans as their abilities improve or as their health status
changes.
Need for an activity plan.
The recommendations for senior citizens put
particular emphasis on an activity plan that identifies the levels of
physical activity the achieve and describes how the person intends to
meet them.
“It is recommended that older adults with chronic
conditions develop an activity plan in consultation with a health care
provider so that the plan adequately takes into account therapeutic and
risk management issues related to chronic conditions,” according to the
report.
The continued:
“The plan should be tailored according to chronic
conditions and activity limitations, risk for falls, individual
abilities and fitness, strategies for minimizing risks of activity,
strategies for increasing activity gradually over time (if the person is
not active at recommended levels), behavioral strategies for adhering to
regular physical activity, and individual preferences.
“Healthy, asymptomatic older adults without chronic
conditions should also develop an activity plan, preferably in
consultation with a health care provider or fitness professional, so as
to take advantage of expertise and resources on physical activity and
injury prevention.
“This recommendation reframes the common advice to
consult a health care provider before starting to increase physical
activity. Health provider consultation regarding physical activity
should occur regardless of whether an adult currently plans to increase
physical activity, as it is part of the ongoing process of promoting
physical activity that should occur in geriatric medicine.
This recommendation is consistent with a recently
developed quality of care measure for older adults that measures whether
older adults discuss physical activity with a health care provider at
least once a year.”
Some other highlights include:
Areas of Emphasis in Promoting Physical Activity
in Older Adults
With sufficient skill, experience, fitness, and
training, older adults can achieve high levels of physical activity. The
promotion of physical activity in older adults should avoid ageism that
discourages older adults from reaching their potential. At the same
time, it is difficult or impossible for some older adults to attain high
levels of activity. Several areas should be emphasized in promoting
physical activity in older adults as described below.
Reducing sedentary behavior.
There is substantial evidence that older adults who
do less activity than recommended still achieve some health benefits.
Such evidence is consistent with the scientific consensus for a
continuous dose-response relationship between physical activity and
health benefits (30). For example, lower risks of cardiovascular disease
have been observed with just 45–75 min of walking per week (40).
Increasing moderate activity and giving less
emphasis to attaining high levels of activity.
Realistic goals for aerobic activity will commonly
be in the range of 30–60 min of moderate-intensity activity a day, as
illustrated by the Health Canada recommendation for older adults (26)
(Table 1).
Vigorous activity has higher risk of injury and
lower adherence (20). Age-related loss of fitness, chronic diseases, and
functional limitations act as barriers to attaining high levels of
activity. Vigorous activity and/or high levels of activity are
appropriate for selected older adults with sufficient fitness,
experience, and motivation.
Taking a gradual or stepwise approach.
The standard advice to increase physical activity
gradually over time is highly appropriate and particularly important for
older adults. This advice minimizes risk of overuse injury, makes
increasing activity more pleasant, and allows positive reinforcement for
small steps that lead to attainment of intermediate goals. It can be
appropriate for older adults to spend a long time at one step (e.g.,
attending exercise classes two or three days a week) so as to gain
experience, fitness, and self-confidence. Very deconditioned older
adults may need to exercise initially at less effort than a ‘‘5’’ on a
10-point scale and may need to perform activity in multiple bouts (Q10
min) rather than in a single continuous bout (20).
In addition, activity plans need to be reevaluated
when there are changes in health status.
Performing muscle-strengthening activity and
engaging in all recommended types of activity.
Muscle-strengthening activity is particularly
important in older adults, given its role in preventing age-related loss
of muscle mass (60), bone (44), and its beneficial effects on functional
limitations (30,31,35,55,60). Currently, only about 12% of older adults
perform muscle-strengthening activities at least twice a week (63).
Sustaining emphasis on individual-level and
community-level approaches. As with younger adults, promotion of
physical activity in older adults relies upon both individual and
community approaches that are evidence-based and reflect theory and
research on behavior change.
For example, the Task Force on Community Preventive
Services has recommended or strongly recommended several community-level
interventions as effective in promoting physical activity, such as
interventions to increase access to places of physical activity combined
with informational outreach (29).
Using risk management strategies to prevent
injury.
Chronic conditions increase risk of
activity-related adverse events, e.g., heart disease increases risk of
sudden death and osteoporosis increases risk of activity-related
fractures. Activity-related musculoskeletal injuries act as a major
barrier to regular physical activity. While these considerations lead to
more emphasis on risk management, there is insufficient research on
effective strategies to prevent injuries. Risk management strategies
mainly reflect clinical experience, expert opinion, and legal liability
concerns.
Evidence that risk management strategies can be
effective comes from the observation that published exercise studies
routinely implement risk management and serious adverse events in these
studies are rare. However, research studies presumably exclude adults at
high risk of injury.
Conclusion
“Virtually all older adults should be physically
active,” conclude the authors.
“An older adult with a medical condition for which
activity is therapeutic should perform physical activity in a manner
that treats the condition. In addition, an older adult with medical
conditions should engage in physical activity in the manner that reduces
risk of developing other chronic diseases as described above.
“Given the breadth and strength of the evidence,
physical activity should be one of the highest priorities for preventing
and treating disease and disablement in older adults. Effective
interventions to promote physical activity in older adults deserve wide
implementation.”
The papers have been published jointly in Medicine
& Science in Sports and Exercise®, ACSM’s official journal and
Circulation, a journal of the American Heart Association. For more
information or additional details on the physical activity guidelines,
please visit
www.americanheart.org/fitness.
Editor's Notes:
About the
American College of Sports Medicine
ACSM is the largest sports medicine and exercise
science organization in the world. More than 20,000 international,
national, and regional members are dedicated to advancing and
integrating scientific research to provide educational and practical
applications of exercise science and sports medicine.
About the American Heart Association
Founded in 1924, the American Heart Association
today is the nation’s oldest and largest voluntary health organization
dedicated to reducing disability and death from diseases of the heart
and stroke. These diseases, America’s No. 1 and No. 3 killers, and all
other cardiovascular diseases claim over 870,000 lives a year. In
fiscal year 2005–06 the association invested over $543 million in
research, professional and public education, advocacy and community
service programs to help all Americans live longer, healthier lives. To
learn more, call 1-800-AHA-USA1 or visit
www.americanheart.org
The authors of “Physical Activity and Public
Health: Updated Recommendation for Adults from the American College of
Sports Medicine and the American Heart Association,” are William L.
Haskell, Ph.D., FACSM (Chair); I-Min Lee, M.D., FACSM; Russell R. Pate,
Ph.D., FACSM; Kenneth E. Powell, M.D.; Steven N. Blair, P.E.D., FACSM;
Barry A. Franklin, Ph.D., FACSM; Caroline A. Macera, Ph.D., FACSM;
Gregory W. Heath, Ph.D., FACSM; Paul D. Thompson, M.D., FACSM; and
Adrian Bauman, Ph.D.
The authors of “Physical Activity and Public
Health in Older Adults: Recommendation from the American College of
Sports Medicine and the American Heart Association,” are Miriam E.
Nelson, Ph.D., FACSM; W. Jack Rejeski, Ph.D.; Steven N. Blair, P.E.D.,
FACSM; Pamela W. Duncan, Ph.D.; James O. Judge, M.D.; Abby C. King,
Ph.D., FACSM; Carol A. Macera, Ph.D., FACSM; and Carmen Castaneda-Sceppa,
M.D., Ph.D.
Choose to More
The American Heart Association’s Choose To Move
is a free 12-week program that helps busy women increase physical
activity and build healthy habits into their daily lives – without
creating new routines that take a lot of time and money. Program
registrants receive an easy, step-by-step poster for coordinating
resistance training into any fitness routine. Call 1-800-AHA-USA1 or
visit
choosetomove.org to begin the program today.
Start!
In January 2007, the American Heart Association
introduced Start!, a national campaign calling on all Americans and
their employers to create a culture of physical activity and health to
live longer, heart-healthy lives. Through active, year-round
participation in walking, Start! supports the mission of the American
Heart Association, to reduce the risk of cardiovascular disease and
stroke. To learn more, call 1-800-AHA-USA1 or visit
americanheart.org/start.
More on Exercise and Fitness from American Heart Association
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