active for later life making the case for physical activity and older people

Active for Later Life

Making the case for physical activity and

older people

What do we mean by ‘older people’? The benefits of physical activity for older

people How active are older people? How active should older people be? Can we help to change matters? What helps older people to become

active? Older people and physical activity –

strategic connections

What do we mean by ‘older people’?

“We all age, but we all age differently”

Not a homogeneous group

Traditionally defined as those aged over 50

Significant variations in health and functional capacity

Improvements in health and longevity

Self-identification often most important



Hierarchy of physical function

(World Health Organization, 1997)

Physicallyfit

Physicallyunfit

Physicallyunfit frail

Healthy

Unhealthy independent

Unhealthy dependent

Group 1

Group 2

Group 3


Hierarchy of physical function

(Adapted from Spirduso, 1995)

Physicalfunction

Physicallyelite

Physicallyfit

Physicallyindependent

Physicallyfrail

Physicallydependent

Disability


National Service Framework for Older People

Entering old age

Transitional phase

Frail older people(Department of Health, 2001a)


Older people and physical activity

Entering old ageMaking Activity ChoicesTo promote and extend healthy active life and compress morbidity

Transitional phaseIncreasing the Circle of LifeTo maintain independence and reduce long-term dependency

Frail older peopleMoving in the Later YearsTo maintain independence and improve quality of life

The benefits of physical activity for older people


Increasing evidence in relation to: Disease prevention and management, psychosocial

benefits and complications of immobility Maintaining independence, improving the quality of

life, and ‘successful ageing’ Opportunities for significant savings to health and

social care services

Benefits can be achieved by healthy older people as well as the frail and very old.


Prevention and management of disease

Coronary heart disease Stroke Increased blood pressure Late onset (Type 2) diabetes Osteoporosis Colon cancer Weight control Reduction in accidental falls

Effects apparent even among those taking up activity at a later age.


Psychological benefits

Reduction in stress and anxiety Reduction in depression Improvement in overall psychological well-being Improvements in cognitive function Improvements in self-esteem and self-worth Reduction in isolation and loneliness



Reducing the complications of immobility

Deep vein thrombosis Gravitational oedema Intermittent claudication Contractures Pressure sores Faecal impaction

Effects apparent even among those taking up activity at a later age. Movement can be passive and aided.


Maintenance of social networks Continued independent living Improved quality of sleep Sustained performance of ‘activities of daily living’


Improvements in independence, quality of life and successful ageing


Potential social benefits

Enhanced social integration Formation of new friendships Widening of social networks Role maintenance and new role acquisition Empowerment Enhanced inter-generational activity Positive images of older people Maintenance of caring skills Reduced health and social care costs


Reduction in health and social care costs

Accidental fractures among women (£1.8 billion) CHD and stroke (£1.6 billion for health care alone) Diabetes (5% of NHS resources) Obesity (£2.5 billion) Poor mental health (£32 billion)


Changing the focus of physical activity promotion

Disease prevention

Maintenance of independence

Age

How active are older people?

Levels of physical activity,

fitness and functional capacity


Regular physical activity amongMEN aged 50+, England

% participating at least five times a week

Age

0%

20%

40%

60%

80%

50-54 55-59 60-64 65-69 70-74 75-79 80+

(Skelton, Young et al, 1999)

5 kcal/min including brisk/fast walks 2 miles

4 kcal/min including all walks 2 miles

4 kcal/min plus all walks 1 mile


Regular physical activity amongWOMEN aged 50+, England

% participating at least five times a week

Age

0%

20%

40%

60%

80%

50-54 55-59 60-64 65-69 70-74 75-79 80+






Regular physical activity among minority ethnic groups aged 55+, England

Those participating in activity 5 x 30 minutes a week

African-Caribbean

Indian

Pakistani

Bangladeshi

Chinese

20%

22%

15%

7%

13%

14%

2%

6%

1%

14%

Men Women

(Erens et al, 2001)


Levels of sedentary behaviour among MEN aged 50+, England

% participating less than once a week

Age

0%

20%

40%

60%

80%

50-54 55-59 60-64 65-69 70-74 75-79 80+






Levels of sedentary behaviour among WOMEN aged 50+, England

% participating less than once a week

Age

0%

20%

40%

60%

80%

50-54 55-59 60-64 65-69 70-74 75-79 80+






Levels of sedentary behaviour among minority ethnic groups aged 55+, England

Those participating less than once a week

African-Caribbean

Indian

Pakistani

Bangladeshi

Chinese

57%

67%

73%

85%

68%

59%

78%

85%

92%

64%

Men Women

(Erens et al, 2001)


Participation in walking among MEN aged 70+, England

% able to walk for different periods of time and length of walk, without discomfort

Age

0%

20%

40%

60%

80%

70-74 75-79 80+ 70-74 75-79 80+

30+ min

15, < 30 min

5, < 15 min

< 5 min

100%

1/4 mile or more



Participation in walking among WOMEN aged 70+, England

% able to walk for different periods of time and length of walk, without discomfort

Age

0%

20%

40%

60%

80%

70-74 75-79 80+ 70-74 75-79 80+

30+ min

15, < 30 min

5, < 15 min

< 5 min

100%

1/4 mile or more



Older people living in care and residential settings

86% of women and 78% of men in care homes are sedentary.

Sedentary behaviour in care homes is double that in private households (at age 65+).

Half of all men and women in local authority residential homes never or very occasionally take trips outside the home.

(Department of Health, 2002b)


Thresholds for quality of life

Exercise performance

AgeAdapted from Young (1986)

‘Threshold’ value necessary for performance of an everyday task

Physically active

Physically inactive


Aerobic capacity in MEN and WOMEN aged 50-74 (mean ± 2sd)

Maximum oxygen uptake (ml/kg/min)

(Skelton, Young et al, 1999)Age

0

10

20

30

60

50-54

VO2 max to walk comfortably at 3mph

40

50

55-59 60-64 65-69 70-74 50-54 55-59 60-64 65-69 70-74

Men

Women


Knee extension strength inMEN and WOMEN aged 50-74 (mean ± 2sd)

Isometric knee extension strength (N/kg)


0

2

4

6

12

50-54

Strength to be confident of rising from low chair without using one’s arms

8

10

55-59 60-64 65-69 70-74 50-54 55-59 60-64 65-69 70-74

Men

Women


Shoulder flexibility inMEN and WOMEN aged 50+ (mean ± 2sd)

Shoulder abduction (degrees)


0

40

80

120

50-54

Requirement to wash hair without difficulty

160

200

55-59 60-64 65-69 70-74 75-79 80+ 50-54 55-59 60-64 65-69 70-74 75-79 80+

Men

Women


Functional capacity

Even healthy older people lose functional capacity. Muscle strength ‘lost’ at 1%-2% per year Muscle power ‘lost’ at 3%-4% per year Aerobic capacity ‘lost’ at 1% per year Bone density ‘lost’ at 1% in men and 2%-3% in

women after menopause Flexibility and balance Proprioception and kinesthetic awareness Co-ordination and reaction Thermo-regulation

Sedentary behaviour increases loss of performance.(Skelton and Dinan, 1999)


Functional decline and frailty

(Spirduso, 1995)

Disease Disuse

Time

Humanfrailty


Inactivity-related disease?

Disuse rather than disease? One week’s bed rest reduces:

– strength by up to 20%– spine bone mineral content by 1%.

Nursing home residents spend 80%-90% of their time seated or lying down – leading to inactivity-related disability.

Those who are less active and weaker will enter nursing homes earlier than those who maintain their fitness.


Physical activity is disappearing from everyday life

Labour-saving devices Transport patterns Concerns over safety in public spaces Sport as entertainment The impact of information technology

Leading to an increase in sedentary and physicallyless demanding lifestyles

How active should older people be?

Current recommendations


Recommendations for all adults

“30 minutes of moderate physical activity, on at least five occasions a week.”(Department of Health, 1999b)

Activities like brisk walking, cycling, swimming, dancing and gardening are good options.


Working towards the recommended levels

Those who cannot achieve the recommended 30 minutes should build towards that target, e.g. 2 x 15 minutes and smaller bouts of activity on a regular basis.

Even the smallest amounts will bring some benefit, e.g. walking to the post box on the corner of the street or to the bottom of the garden.


Physical activity for the older person should also include: muscle strength and endurance (resistance)

exercises for all major muscle groups balance exercises flexibility (stretching) (American College of Sports Medicine, 1998)


Physical activity opportunities for older people

Continued or renewed sports participation and active recreation as well as fitness, exercise and dance activities and groups

‘Active Living’ including walking, cycling, swimming and gardening

Playing with grandchildren, posting a letter, walking in shopping centres

Chair-based activities Assisted corridor and ward walking, or activities in

the bath and at bedtime

Can we help to change matters?

Evidence of effectiveness and successful interventions


Evidence of effectiveness

From a critical review of 29 physical activity interventions: Increased activity levels over a longer period of time Group/class-based and home-based activity were

effective Tailored to individual needs Cognitive-behavioural strategies and goal-setting Telephone support and continued contact(King et al, 1998)


Evidence of effectiveness

Strength – Fiatarone et al, 1990 Functional capacity – Skelton et al, 1995 Bone density – Rutherford, 1999 Depression – Blumenthal et al, 1999 Blood pressure – Young et al, 1999 Mental health – Fox, 1999 Cardiac rehabilitation – Jolliffe et al, 2001


Evidence of effectiveness – falls prevention

FICSIT Trials: Province et al, 1995 Tinetti et al, 1996 Wolf et al, 1996 Campbell et al, 1997 PROFET: Close et al, 1998 Gardner et al, 2000 FaME: Skelton, 2001 Day et al, 2002


Evidence of effectiveness – duration vs outcome

Gait (8 weeks) Balance (Static 8 weeks + Dynamic 8 weeks) Muscle strength (8-12 weeks) Muscle power (12 weeks) Endurance (26 weeks) Transfer (6 months) Postural hypotension (24 weeks) Bone strength (1 year for femur and lumbar spine) (Skelton and McLaughlin, 1996)


Promoting physical activity through primary health care

Physical activity advice/counselling can increasephysical activity.

King et al, 1995 Riddoch et al, 1998 PAL: Goldstein et al, 1999 Eakin, 2001


Home-based programmes

Improve health and function in older people living in the community

Some studies show higher rates of adherence to prescribed exercise compared with group activities.

Telephone-based counselling improves participation and adherence.

Improvements in muscle strength and functional capacity.

(Atienza, 2001)


Community-based physical activity programmes

Reviews King et al, 1998; Stewart, 2001

Interventions CHAMPS: Stewart, 2001 GALM: Stevens et al, 1999 On the Move: Cassady et al, 1999 Dunn et al, 1999

There is a need for differentiation.


Best practice for promoting physical activity with older people

Use of a health educator and extended consultation time

Agreement of problem areas Goals agreed by both older person and professional Identification and recognition of social and

environmental barriers Tailored action plan Choice and range of accessible local activities Supplementary educational materials Systematic follow-up and support over time

What helps older people to become active?

Barriers, beliefs, attitudes

and motivation


Barriers to activity

Intrinsic barriers Those that relate to the

beliefs, motives and experiences of the individual, e.g. previous experiences at school, concerns about over-exertion, or perceptions of physical activity.

Extrinsic barriers Those that relate to the

broader physical activity environment, e.g. skills and attitudes of others, the types of opportunities available, access and safety.


Previous experiences

Opportunities in school Activity not associated with fitness and health Armed forces Limited experiences of sport All aspects of life were more physically demanding


Older people’s sources of beliefs

The media (radio, TV, magazines, newspapers) Workplace, leaflets ‘Common sense’ Personal experiences (and experiences of others) Medical and health professionals(Finch, 1997)


Beliefs about activity

It’s good for you. It’s common sense. General health benefits Specific health benefits e.g. weight control, mental

well-being, specific conditions Maintenance of function Onset of ageing(Finch, 1997)


Moderation “at our age”

“You can overdo it.” Gentler activities are more suitable. It depends on the individual. Fears over breathlessness and increased heart rate. (Finch, 1997)


Beliefs – exceptions to the positive view

The health ‘lottery’ A fashion for exercise nowadays “You need to be fit to do physical activity.” Too late to start Dangers when you stop “It can become an obsession.” (Finch, 1997)


Overcoming barriers

The association between physical activity and exercise and sport

Frequency Intensity Old age is a time to slow down. Reassurance and education (Finch, 1997)


Beliefs about activity – the underlying motivators

To maintain suppleness and agility, and control weight

‘Feeling better’ Enjoyment Prevent future illness Manage existing health problems To keep going, be independent (live longer rare) Adventure/challenge, new learning (Finch, 1997)


Overcoming concerns about being active

“I don’t think I should start at my age.” “I’m worried I might hurt something.” “I have to take it easy at my age.” “My aches and pains will get worse.” “Can I do exercise with my blood pressure?”

Health concerns need the advice of a GP.


‘Triggers’ and life events

Wanting to play with grandchildren Physiological signs of ageing Retirement, children leaving home Onset of ailment or illness Moving home Bereavement Maintaining independence (Finch, 1997)


Extrinsic barriers

Skills and attitudes of others, e.g. exercise instructors, GPs, leisure/recreation managers

Appropriate programming Accessible opportunities (transport) Safe activity environments (parks, well-lit streets) Positive images of older people


A different ‘spin’ on fitness

Strength to lift household objects Flexibility to wash hair, tie shoes Balance and agility to climb stairs Co-ordination and dexterity to open a door with

a key Speed to cross the road at pedestrian traffic lights Muscular endurance to walk to the shops

Older people and physical activity: Strategic connections

Strategic connections


Standard 8

The promotion of health and active life in old age Increasing physical activity Improved nutrition and diet Immunisation and management of influenza Other areas of health promotion e.g. smoking

cessation



Standard 1 Age discrimination Standard 5 Stroke Standard 6 Falls Standard 7 Mental health


National Service Frameworks

Preventative aspects of: NSF for Coronary Heart Disease NSF for Mental Health NSF for Diabetes NHS Cancer Plan National osteoporosis strategy


Other strategic connections

Successful ageing and ‘Ageing Well’ Independent living Cultural strategies and sports development

e.g. Active Communities Neighbourhood regeneration and renewal Human transport Lifelong learning

Active for Later Life – Summary

Physical activity can contribute significantly towards successful ageing.

Although physical activity can confer a wide range of benefits, the majority of older people remain inactive.

Even modest amounts of activity can be beneficial.

There are many opportunities to enable older people to become Active in Later Life.

active for later life making the case for physical activity and older people

Documents

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activity choices

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later age

dependent disability

psychosocial benefits