As populations continue to extend life expectancy, a concern is whether the added time comprises years of healthy life and promotes a high health-related quality of life into old age. With the average population age increasing in many countries, there is an increase in the proportion of older adults, many of whom are at risk for developing non-communicable chronic health conditions. About 80% of adults ≥60 years of age have at least one chronic condition, and 77% have at least two. Despite the known benefits of physical activity to health and physical function in aging, the proportion of older adults meeting recommended physical activity guidelines remains low. There is considerable evidence that has emerged regarding the relative benefits of exercise or combinations of physical activity. These include cardiovascular fitness, progressive resistance training, multicomponent exercise, and movement classes (Yoga, Pilates, tai-chi). These are especially important for fall-related injury prevention, and for specific physical function outcomes, such as strength, posture, gait speed, balance, and general functioning in activities of daily living. The term ‘multicomponent’ activity refers to exercise that include more than one type of physical activity, including aerobic, muscle-strengthening, and balance training.
In general, older adults are less physically active than younger adults. There is strong evidence linking physical inactivity to chronic health conditions, as well as increased physical activity to lower mortality and morbidity in older adults. The benefits of exercise have been shown to reduce the incidence of cardiovascular disease, stroke, diabetes, and some types of cancer. With regard to the South African population, there is a high prevalence of obesity, high blood sugar, and high blood pressure, that are all known side effects of physical inactivity. Therefore, it is important to develop a strong commitment to improving safe, effective, and holistic physical activity levels in older adults. This is one of our main drivers here at Virgin Active.
A significant challenge is to find effective ways to support older adults to increase their physical activity and then for them to develop habitual physical activity behaviours. Individual health practitioners, as well as exercise centres like here at Virgin Active have an important role in making recommendations around physical activity to this highly valued sector of our society.
The WHO and American College of Sports Medicine (ACSM) both have similar ‘Global Recommendations on Physical Activity for Health’, in older adults. The main message is that at least 150 min per week of moderate-intensity physical activity, combined with 2 days of strength work, is required for health benefit in older adults.
Here is a summary of the guidelines for adults (adapted from WHO’s publication Global Recommendations on Physical Activity for Health)
– Do at least 150–300 minutes of moderate-intensity aerobic physical activity OR at least 75–150 minutes of vigorous-intensity aerobic physical activity OR an equivalent combination of moderate- and vigorous-intensity activity throughout the week. Increase the times for additional health benefits.
– Do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits.
– Limit the amount of time spent being sedentary. Replacing sedentary time with physical activity of any intensity (including light intensity) provides health benefits, and
– To help reduce the detrimental effects of high levels of sedentary behaviour on health, all adults and older adults should aim to do more than the recommended levels of moderate- to vigorous-intensity physical activity.
– Adults aged 65 years and older should follow the above as well as add varied multicomponent physical activity that emphasizes functional balance and strength training at moderate or greater intensity, on 3 or more days a week, to enhance functional capacity and to prevent falls.
So what is ‘exercise’? This can often be daunting and confusing, as there are so many options and questions about what type is the most effective, or has the best benefit for one’s age? There is no correct answer for this, and sometimes finding one’s way to the exercise form that fits best can be a journey in itself. Exercise comes in various forms, summarised here:
– Cardiovascular aerobic exercise: Any type of activity that uses large muscle groups and can be maintained over a longer period of time e.g. cycling, brisk walking, swimming or dancing
– Strength training: Resistance-based strengthening requires muscles to work against a load, which is usually an external or bodyweight, that is progressively increased over the time of the program. This form often involves the support of exercise professionals, based in gymnasiums, and utilises specialist equipment.
– Balance exercises: Exercises that challenge balance and strengthen core and lower limb musculature. These are crucial in the prevention of fall-related injury and include activities such as Yoga, Tai chi, Pilates, and flexibility classes.
– Incidental physical activity: Any activity that occurs throughout the course of the day during activities of daily living. It is generally of low intensity, but can result in high energy expenditure over a prolonged time period.
Any form, or combination of the above exercise types, has the following proven physical benefits:
– Reduced morbidity and mortality
– Reduced incidence of non-communicable diseases
– Improved immune function
– Functional independence
– Fall-related injury prevention, and protection against the resulting complications
Specifically related to the current pandemic climate, immune function has become very topical, and maintaining a robust immune system is critical in staying safe and healthy. Regular exercise, especially at a low to moderate intensity, has proven benefits in optimising one’s immune function, whilst reducing the risk of viral infections in particular.
There is also evidence that regular exercise result in cognitive benefits. The effect of aerobic exercise on cognition in the older population has shown a positive effect, improving auditory attention and cognitive/thought-processing speed. There is some evidence that low to moderate impact training reduces the risk of developing cognitive impairment in older adults, and that for people who have mild cognitive deficit (e.g. dementia), exercise may in fact be a protective factor.
The ‘happy’ factor associated with exercise also needs to recognised. The endogenous release of one’s happy hormones (endorphins) during exercise, result in the post-exercise ‘high’ and general feeling of wellness and elevated mood. These effects can have profound positive effects on overall mental health.
Besides the established physical and mental benefits of exercise, it also allows for a sense of community and meeting of like-minded people. Specifically, in the older population, social engagement and exercising together with similar age groups and physical ability allows for comradery and companionship. Exercising together encourages a sense of confidence and belonging, and may even motivate the participants to maintain an exercise routine, and so the benefits keep snowballing.