http://france.elsevier.com/direct/SCISPO/

Science & Sports 21 (2006) 209–213

Revue générale

Physical activity, body composition and healthy ageing ☆

Exercice, composition corporelle et vieillissement

A.J. Schuita,b

aCenter for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, The Netherlandsb Institute for Health Sciences, Faculty of Earth and Life Sciences, VU, Amsterdam, The Netherlands

Available online 22 August 2006

Abstract

Aims. – To apprehend the interest of a lifestyle adapted in order to minimize the effects of ageing.Current knowledge. – During the last century life expectancy increased rapidly in Europe as well in other affluent societies in the world.

Combined with the decline in birth rates, Europe faces an increasingly ageing population. Since ageing is associated with an increasing risk forchronic diseases, disability and cognitive decline, a sharp rise in the need for medical and social services and associated costs is to be expected.Physical activity and nutrition are both modifiable risk factors for many chronic diseases and evidence accumulates suggesting that an activelifestyle and a proper diet can also prevent the functional limitations associated with advancing age. However, data from surveys show thatphysical activity levels decline with ageing. In Europe approximately 80% of the persons 65 years and older do not engage in strenuous physicalactivity and 55% of them report not to engage in moderate activity. If the declined level of physical activity is not matched with a reduced energyintake, weight gain, particularly in the trunk is expected to occur. Abdominal obesity, also in the elderly is associated with cardiovascular disease,diabetes mellitus type 2 and cancer morbidity. On the other hand, if reduced physical activity is matched with a reduced food intake, the intake ofmicronutrients may become inadequate and will endanger the nutritional status of the elderly. Apart from inadequate intake also drug use and co-morbidity may lead to multiple micronutrient deficiencies. Therefore particularly for the elderly population a proper balanced diet is essential.

Prospects. – Public health programs should focus on the adoption of a healthy lifestyle in elderly people. There is a need for systematicallyplanned approaches addressing both food consumption patterns and physical activity. The program should be tailored to the elderly populationand make use of suitable and realistic strategies.© 2006 Elsevier SAS. All rights reserved.

Résumé

Objectifs. – Appréhender l’intérêt d’un style de vie adapté afin de minimiser les effets du vieillissement.Actualités. – Au cours du siècle dernier, l’espérance de vie s’est accrue rapidement en Europe de même que dans d’autres sociétés mondiales.

Face au déclin de la natalité, l’Europe doit assumer une augmentation de sa population âgée. Sachant que le vieillissement est associé à desrisques accrus de maladies chroniques, à un déclin des réactions cognitives, à l’incapacité et la fragilité physiques, les demandes d’interventionsmédicale et sociale ainsi que le coût financier augmentent régulièrement. L’activité physique et la nutrition sont toutes deux des facteurs quipeuvent diminuer les risques associés aux maladies cardiovasculaires, au diabète de type 2, au cancer. Les preuves s’accumulent pour démontrerqu’un style de vie physiquement actif et qu’une alimentation équilibrée limitent les restrictions fonctionnelles associées au vieillissement. Ainsi,une activité physique régulière et une alimentation appropriée sont essentielles pour maintenir le sujet âgé en bonne santé. Toutefois, les donnéesde la littérature montrent que l’activité physique décroît avec le vieillissement. En Europe, au-delà de 65 ans, 80 % des individus ne pratiquentaucune activité physique intense et 55 % de la population ne sont pas engagés dans une pratique physique même modérée. La réduction simul-tanée d’activité physique et d’un apport alimentaire induit un gain de masse pondérale, particulièrement au niveau du tronc. L’obésité abdominaleest également associée chez le sujet âgé à l’apparition de maladies cardiovasculaires, au diabète de type 1 et au cancer. Par ailleurs, un apportnutritionnel inadéquat en microéléments peut provoquer des troubles importants chez la personne âgée. Dès lors, il est essentiel que la populationâgée bénéficie d’une alimentation équilibrée.

☆ Séminaire santé, sport et innovations, Bruxelles 27 et 28 mai 2005.E-mail address: Jantine.Schuit@rivm.nl (A.J. Schuit).

0765-1597/$ - see front matter © 2006 Elsevier SAS. All rights reserved.doi:10.1016/j.scispo.2006.06.004

A.J. Schuit / Science & Sports 21 (2006) 209–213210

Perspectives. – Les programmes de santé publique devraient se focaliser sur l’adoption d’un mode de vie sain chez les seniors. Cette orienta-tion nécessite une approche planifiée, systématique, s’adressant à la fois aux apports nutritionnels et à la pratique régulière d’activités physiques.Ces programmes doivent comprendre des stratégies appropriées et réalisables vis-à-vis des besoins de la population vieillissante.© 2006 Elsevier SAS. All rights reserved.

Keywords: Ageing; Exercise; Body composition; Nutrition; Prevention

Mots clés : Vieillissement ; Exercice ; Prévention ; Composition corporelle ; Nutrition

1. Introduction

During the last century life expectancy increased rapidly inEurope as well in other affluent societies in the world (Fig. 1).Combined with the decline in birth rates, Europe faces anincreasingly ageing population. Since ageing is associatedwith an increasing risk for chronic diseases, disability and cog-nitive decline, a sharp rise in the need for medical and socialservices and associated costs is to be expected. Public healthresearch is therefore focused on identification of lifestyle fac-tors related to accelerated ageing. Both physical inactivity andpoor diet are important modifiable risk factors associated withpremature health deterioration.

2. Ageing and body composition

Ageing is associated with alterations in the body composi-tion, including a reduction in lean body mass and increase inbody fat mass. The decrease in lean body mass with ageingprimarily occurs as a result of losses in skeletal muscle mass[1]. The age-related loss in muscle mass is called ‘sarcopenia’.Loss in muscle mass reduces the basal metabolic rate and mus-cle strength, which may lead to functional limitations [2] andmay result in a lower physical activity level. Both reduction inmetabolic rate as well as a reduced physical activity level leadto a decreased energy requirement of the elderly. If the reducedenergy requirement is not matched with a reduced energyintake, weight gain, particularly in the trunk is expected tooccur [2]. Abdominal obesity, also in the elderly is associatedwith cardiovascular disease, diabetes mellitus type 2 and can-

Fig. 1. Life expectancy in Europe at birth. Source: www.nationaalkompas.nl.

cer morbidity [3]. On the other hand, if reduced physical activ-ity is matched with a reduced food intake, the intake of micro-nutrients may become inadequate and will endanger thenutritional status of the elderly. Particularly for the elderlypopulation a proper balanced diet is essential [4], because,apart from inadequate food intake, also drug use and co-morbidity may lead to multiple micronutrient deficiencies.

Hence, sufficient exercise is crucial in the elderly populationbecause, first of all, it may help to prevent elderly from becom-ing fragile by improving muscle mass and muscle strength andconsequently improve the capacity of older men and women toperform physical activity. Secondly it may prevent overweightand obesity. Some suggest that particularly strength trainingmay benefit elderly in a negative energy balance because itmay preserve or even increase muscle mass [1]. Apart fromits effect on body composition, regular physical activity hasalso been recognized as an important strategy to preventmany chronic diseases such as type 2 diabetes mellitus, coron-ary heart disease and osteoporosis [5]. This paper gives anoverview of the level of physical activity of European elderlyand presents some research in the field of physical activity andbody composition related to healthy ageing and discusses cluesfor successful interventions.

3. Physical activity in the European elderly

A European survey shows that approximately 80% of thepersons 65 years and older do not engage in strenuous physicalactivity and over 60% of them report no engagement in mod-erate activity in the past week [6] (Fig. 2). Only 15% of thesubjects 65 years and older spend more than 1 hour in the pastweek on moderate activities. However, there are some differ-ences between the European member states. The rate of thosewho reported no vigorous physical activity in the last 7 daysranged from 43% in the Netherlands to 72% in Spain. Lower

Fig. 2. Engagement in moderate physical activity in min/week by age. Source:Eurobarometer Physical activity 2003.

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than average rates of non-participation in vigorous physicalactivity in the past week were reported in Germany (45%),Luxembourg (51%), and Finland (51%). (Source: Eurobarom-eter 2003). Fig. 2 clearly shows the sharp increase in physicalinactivity between the age group 45 and 64 and the age groupof 65 years and older.

Most of our knowledge regarding age-related patterns ofchange in physical activity derives from cross-sectional studies.Also, the longitudinal effect of change in physical activity onchange in body composition has not been extensivelydescribed. There are a few exceptions. In a longitudinal Amer-ican study investigating the change in body composition over a5–12 year period, the contribution of physical activity, baselinebody weight and age was investigated [7]. In this study, weightchange was independently and inversely predicted by baselineage and baseline physical activity level. Fig. 3 presents anexample of a Dutch study that demonstrates the importanceof maintaining physical activity to prevent weight gain withageing, and particularly the impact of retirement. This figureshows the effect of retirement in subjects with a sedentaryjob versus subjects with an active job on change in bodyweight [8]. The average gain in weight in retiring men withprevious active jobs was much higher than in retiring menwith previous sedentary jobs, but also higher than in subjectsof the same age that did not retire. Average weight gain insubjects who did not retire was nevertheless 0.3 kg per year.Other examples of studies that demonstrate the importance ofphysical activity to prevent weight gain with ageing is a studyin the Health Professionals’ Follow-up study [9]. This is anobservational study among about 17,000 male health profes-sionals aged 40–75 years at baseline. In this study increasesof 25 Metabolic equivalent tasks (METs)*h/wk in vigorousphysical activity for a period of 9 year was associated with adecrease in waist circumference of 0.38 cm. An increaseof ≥ 0.5 hr/week in weight training was associated with areduction in waist of 0.91 cm. Also change in walking pacewas related to change in waist circumference over the 9 yearfollow up period.

In a recent British study [10] a relationship was foundbetween physical activity and change in body weight and fat

Fig. 3. Changes in body weight among working and retiring men withsedentary or active jobs, adjusted for age, smoking and changes in behaviour.Source Nooyens (in press).

mass over a 5.6 year follow up period in healthy men andwomen with a mean age of 54 years. However, stratifying forage, the analysis showed that in the younger middle aged group(< 54 years old), who on average gained weight during the fol-low up period, baseline physical activity energy expenditurewas inversely associated with change in fat mass, but was notassociated with change in body weight and fat free mass.Whereas, in the older age group (> 54 years old), who on aver-age were weight stable over the follow up period, baseline phy-sical activity energy expenditure was positively associated withbody weight, fat mass and fat free mass. This study therefore atleast partly supports the importance of physical activity in theprevention of weight loss and particularly muscle mass loss inolder subjects.

On the basis of these studies we may conclude that physicalactivity can play an important role in preventing the unfavour-able age related change in body fat and fat free mass in menand women.

4. Importance of physical activity to prevent nutrientdeficiencies

If energy expenditure reduces with ageing, also the need forenergy intake reduces. Fig. 4 shows Dutch data of energyintake in elderly men and women according to their physicalactivity level [11]. This picture clearly demonstrates that inac-tive subjects have a lower energy intake. Energy intake variedfrom 6.5 MJ/day in the nursing home resident group withchronic somatic disability to 8.8 MJ/day in the 4-day marchers,who participated in the annual four day long distance March inNijmegen, the Netherlands. Among women the energy intakewas significantly different between the groups.

Apart from the decrease in energy expenditure, also othercauses have been identified for a reduction in energy intakein elderly. These factors include reduction in the sensationsof taste and smell, poor dentition, the prescription of medica-tions and finally the prevalence of depression and social isola-tion.

Nutritional surveys in elderly populations indeed show alow nutrient intake. This is of particular concern among thehomebound or frail elderly as reflected by considerable invo-luntary weight loss, including net protein loss [12] leading tomuscle wasting.

Fig. 4. Energy intake of different activity groups of elderly men and women.Source: Van der Wielen, 1996.

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Van der Wielen et al (1996) also showed that the mean diet-ary intake of thiamine, riboflavin, vitamin B6 and vitamin Cwas significantly lower in nursing home residents compared toan active elderly group such as the 4-day marchers [11]. Fig. 5shows the micro nutrient intake of the female population. Formen, similar findings were presented in the paper (not shownhere) [9].

An inadequate intake of a number of nutrients has beenassociated with decreased body strength, lower resistance toinfection and poorer indicators of quality of life [12]. A lowvitamin status is associated with an increased risk of manychronic diseases such as cardiovascular diseases and dementia[13]. In addition, (involuntary) weight loss is associated withhip fractures, reduced autonomy, early institutionalization andincreased mortality risk. From 30% to 50% of institutionalizedelderly are reported to suffer from protein-energy malnutrition[14].

5. Physical inactivity and risk of chronic diseases

Apart from its effect on body composition, physical activityis a modifiable risk factors for cardiovascular diseases, diabetesmellitus type 2, osteoarthritis, some types of cancer and evi-dence accumulates suggesting that an active lifestyle and aproper diet can also prevent the functional limitations asso-ciated with advancing age [1]. In a meta-analysis it was calcu-lated that inactive subjects have a 40% increased risk of devel-oping coronary heart disease and about 80% increased risk ofdying of coronary heart disease [15]. In another meta-analysisit was concluded that physical inactivity was related to anincreased risk in stroke. Active subjects had a 20–40% lowerrisk of having a stroke than active subjects [16]. In this study itwas shown that particularly high intensity activity was protec-tive. Kelley and Goodpaster [17] concluded on the basis of areview that inactive subjects had a 50% increased risk of devel-oping diabetes mellitus type 2 compared to very active sub-jects. Part of the relationship between physical activity andthese chronic diseases are mediated by effects on biomedicalrisk factors such as blood pressure, serum cholesterol (total andHDL) and insulin resistance.

Physical activity is also related to a lower risk of breastcancer (risk reduction about 20–40%) and possibly colon can-cer, dementia and depression [3,18]. Finally, lack of physicalactivity increases the risk of disability later on in life. A pro-

Fig. 5. Proportion of elderly females receiving less than minimal requirements.Source: Van der Wielen, 1996.

spective study in older men and women showed that afteradjustment for age, BMI and lifestyle factors, a high level ofphysical activity reduced the risk of disability 10 years later byabout 50% [19].

6. Effective interventions

In the field of health promotion it has become clear thatsolely providing a health message is not sufficient in improv-ing peoples behaviour. There is a need for a systematicallyplanned and integrated approach addressing both food con-sumption patterns and physical activity to prevent both obesityand sarcopenia. Based on an extensive review [20] it was con-cluded that there is substantial evidence that community-widecampaigns are effective in increasing levels of physical activ-ity, as measured by an increase in the percentage of peopleengaging in physical activity, energy expenditure, or othermeasure of physical activity. There is also strong evidencethat social support interventions in community settings andindividually adapted physical activity programs are effectivein increasing physical activity. Finally there is strong evidencethat creation of or enhanced access to places for physical activ-ity combined with informational outreach activities is effective.Particularly these latter two approaches may be worthwhile toimplement among elderly people. This makes nursing homesor other residents for elderly potentially important settings forintervention. It is important that the environment of the elderlyis equipped in such a way that it makes it possible or more easyto regularly exercise and to eat a healthy diet.

Prevention programs should be theoretically sound andbased on solid feasibility projects. They should be tailored tothe elderly population and make use of suitable and realisticmulti media strategies. With respect to diet, strategies shouldbe focused on a balanced diet, energy density, fruit and fibre,meal frequency. With respect to physical activity emphasisshould be given to including physical activity in normal dailyactivities such as walking, household jobs, gardening, andbicycling. Some suggest that special emphasis should begiven to increasing muscle strength [1], because this willincrease both metabolic rate as well as the chance that subjectswill maintain their physical activity level. Finally, part of theintervention should be focused on creating awareness of thetargets group behaviour, because in the past, a number of inter-ventions failed because the target group was unaware of thefact that their behaviour was unhealthy. So, interventionsshould start from there.

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