Exercises for Older People

While there is no consensus on the definition of older individuals, most developed countries have accepted the age of 65 as an older person. It is well known that our population is getting older. Today most people can expect to live into their 60’s and beyond and are enjoying better health in their later years than previous generations.

Health care professionals should aim to encourage healthy aging, which the WHO defines as:

“The process of developing and maintaining the functional ability that enables well-being in older age. This functional ability is determined by the intrinsic capacity of the individual (ie the combination of all the individual’s physical and mental – including psychosocial – capacities), the environments he or she inhabits (understood in the broadest sense and including physical, social and policy environments), and the interaction between these.”

• VO₂ max will decrease and almost every system will experience functional deterioration. Exercise can help prevent some of the decline in function seen with ageing.
• Despite this, older individuals are known to decrease both the volume and intensity of physical activity they participate in with age.
• It is important to educate patients on the benefits of exercise for their health, but also to manage expectations as some deterioration in function is inevitable, especially for those with chronic disease and multi-morbidities.

Resistance Exercise

• Skelton et al (1994) reported that, after age 65: the loss of muscle mass is at a rate of 1.5% per year and the loss of power is at a rate of 3.5% per year. Sarcopenia often results in a reduced ability to perform activities of daily living, however we know that functional benefits can be reaped from strength training in older people, including those with Sarcopenia.

Flexibility

As with all populations it is advisable to recommend a range of activities for senior citizens to engage with. Evidence suggests that older populations prefer low impact low intensity activities such as Yoga, tai chi, gardening, walking and golf.

Education forms a large part of any exercise prescription. It is important to let older people know that although ageing is inevitable, it is not too late to reap significant health benefits from an active lifestyle. Physical activity is known to positively affect several chronic disease risk factors. Older patients should be encouraged to take an active role in their exercise prescription and self-monitor their activity levels.

Tips for Prescribing Exercise to Older Populations

• For those who are unable to meet guidelines, emphasize the fact that any activity is better than none, even if that starts with change as simple as breaking up periods of sedentary behaviour.
• Begin with low intensity and duration, even below recommendations, for older adults who are frail, deconditioned, functionally limited or have chronic health conditions.
• Many older people suffer from arthritic conditions. If this is relevant to your patient consider exercise which avoids orthopaedic stress.
• It is worth noting that a warm-up and cool-down are especially important for older individuals since their cardiovascular response to exercise may be delayed or blunted.
• Exercise prescriptions need to be dynamic for this population who may suffer from lapses in ability. A flexible prescription should allow for periods of lower activity without the patient feeling like they have “failed” or “aren’t able to keep up”.
• Emphasizing the relevance of exercise to the person’s age or condition may help to motivate. Older people often consider exercise to be something that is no longer relevant or achievable for them. This is not the case.
• Give concrete age-relevant advice. To communicate health messages in an effective way relate the exercise prescription and supporting evidence to their age group, e.g. ‘This type of exercise is especially important/effective for people of your age and has been shown to help …’
• Emphasize the positive rather than the negative.
• Be aware that changes in medication and nutrition can also greatly affect a person’s ability to exercise.