1 UK Wide expert recommendations on physical activity and older people WORKSHOP – Dr D Skelton England, Wales, Scotland and NI all had PA recommendations, wording slightly different. Some old (2001), some new (2008). Experts brought together to review recent changes to US and Canadian guidelines, BASES review, expert consensus and new research…………. and draft new UK-wide recommendations Three expert groups – Young, Adults, Older Adults.

2

3 Scotland Older Adults: (age range not clearly stated) Adults should accumulate (build up) at least 30 minutes of moderate activity on most days of the week. This is also appropriate for healthy adults in later life. However, for all adults from about the age of 55, including those who are frail, three sessions a week of strength and balance exercises is also recommended. Activity programmes for frail and elderly people should focus on specific strength and balance training. This approach is more relevant than aerobic training for this group of people (page 55). The main reasons for recommending physical activity are: 1It develops and maintains strength 2It develops and maintains postural stability (‘balance’) 3It is effective in preventing and treating depression and mood disorders (page 54)

4 Who were the experts?

5 Epidemiological Evidence RCT Evidence Systematic Reviews Expert Opinion Recommendations from the Expert Groups Consultation – Meeting and Website Guidelines (based on evidence)

6 1 Technical Report to 4 Govts “Messages” local / cultural / settings Communication Strategy Social Marketing Each nation produces OWN PA Guidelines?

7 Timescales UK Experts invited in August 2009 Approx 4 teleconferences all groups Approx 4 teleconferences OA group Draft recommendations and Working Paper to BHF NCPAH by early Oct These brought to wider consultation at conference in Marlow late October Followed by WHO guidelines group meeting Web Consultation (closed Jan 2010)

8 Expert Group Remit Does the scientific evidence continue to support the current PA guidelines for the [older adult] population group? Based on the current evidence what, if any, modifications to the PA guideline should be considered? Should there be a separate guideline for older people?

9 Older People DRAFT Summary Statements 150, 5 x 30 and accumulation Strength and balance Intensity and other issues No Guideline on sedentary behaviour - due to ongoing Sedentary working group by DH No need for different guidelines by race ethnicity Scope did NOT extend to treatment of existing conditions

10 150, 5 x 30 and accumulation All older adults should achieve a total of at least 150 minutes of moderate- intensity physical activity per week. This activity should be spread across multiple days. For example 30 mins on five days of the week is one good way to achieve the guideline.  150 mins daunting “spread across the week”

11 150, 5 x 30 and accumulation For additional health benefits, older adults should increase the amount of physical activity over the target of 150 minutes a week of moderate intensity. Additional health benefits are gained by engaging in physical activity beyond this amount  Explain “levelling off” not sure of value

12 150, 5 x 30 and accumulation These physical activity guidelines apply to generally healthy older adults but can also be applied to many persons to persons with chronic diseases and age-related disabilities by tailoring to the individual needs based on physical capacity and any special health/risks issues. Not necessarily age-related

13 WIDE RANGE OF ABILITIES AND NEEDS

14 150, 5 x 30 and accumulation Physical activity can be accumulated through multiple shorter bouts of at least 10 minutes or more. (It can be appropriate for inactive older adults with low fitness to begin with bouts of less than 10 minutes However, because the evidence is incomplete on the health benefits of such bouts, older adults should gradually increase levels of physical activity so as to engage in moderate-intensity activity in bouts of 10 minutes or more) 10 mins “aerobic” activity

15 150, 5 x 30 and accumulation Older adults can benefit from undertaking the recommended levels of physical activity for the prevention of diseases affecting mental health (such as depression and dementia) and improvement in mental well being (such as mood, self perception, and sleep) Link to social activities

16 69 yr old woman, active, strength-trained 71 yr old woman, sedentary (Adapted from Sipilä & Suominen Muscle Nerve 1993;16:294) Size difference is equivalent to a 30 year old (L) and an 70 year old (R)

17 Strength and Balance All older adults should undertake physical activities to improve muscle strength at least twice a week in addition to the primary recommendation of 150 minutes, activities can include heavy gardening, dancing and need not be undertaken as gym based exercise.  Not very good / good examples!!!  Explain importance of strength

18 When do we become “fallers” instead of “trippers”? Fracture site changes with age, wrist fractures more common in younger people, hip fractures more common in older people Reaction times and gait speed slows

19 Lessons that last a lifetime

20 Exercise to Prevent Falls Exercise does help fallers in a number of ways: Reducing Falls (or injurious falls) Reducing known Risk Factors for Falls Reducing Fractures ? (or changing the site of fracture) Increasing Quality of Life & Social Activities Improving bone density Reducing Fear Reducing Institutionalisation But little known on how to stop someone becoming a faller! Gardner 2000; Skelton & Dinan 1999; NICE 2004

21 Strength and Balance Older adults at risk of falls should undertake physical activity involving balance training on two or more days per week for the prevention of falls. This should be in addition to the primary recommendation of 150 minutes, although some aerobic activities can also enhance balance (e.g. dancing), and that some movements simultaneously strengthen muscles and improve balance (e.g. Tai Chi exercise). Should be for ALL adults

22 Flexibility Older Adults should maintain and improve their flexibility through physical activities such as stretching as this can be beneficial for maintenance of mobility (no specific quantification or recommendation should be made on type, frequency, duration or total volume, as there is insufficient evidence)  Disagreements  Specify exercises  Link to functional ability …..”physical function and quality of life.”

23 Intensity and other issues Moderate intensity physical activity is relative to fitness so for some de-conditioned older adults a brisk walk will be at half the speed of a brisk walk for an older adult who has better fitness. However, both may be working at an equivalent percentage of their maximum abilities. Therefore the acknowledged lay definition of moderate intensity (slightly warmer than normal and slightly out of breath) should be applied, rather than a MET equivalent or a speed of walking. Good but too technical

24 Intensity and other issues Older adults can perform moderate- and vigorous- intensity activities throughout the week to achieve the health benefits as this represents another way of achieving the recommended target volume of activity.  “… a combination of …” Repetitive cf next one

25 Intensity and other issues Older adults can gain benefit from vigorous- intensity activity, and 75 minutes of vigorous- intensity activity can provide similar health benefits to 150 minutes of moderate-intensity activity. However, vigorous activity is inappropriate for older adults unless they have been active at the moderate intensity level for some time. Also, the risk of injury is lower with moderate-intensity activity. Long winded/complicated

26 Intensity and other issues Those individuals who are least active are at greater risk, thus, undertaking some physical activity is better than none, and older adults who participate in any amount of physical activity gain some health benefits. Older adults in particular are encouraged to gradually increase their physical activity levels over time until they reach at least the target level of activity.  Provide an age bracket Should be second statement after accumulation

27 Intensity and other issues Engaging in health promoting physical activity has very low risk for most older adults, however, in contrast the risks of poor health as a result of low levels of activity (inactivity) are very high.  Emphasise progression  Language is complicated Suggested rephrase “The risks of taking part in PA for most older adults are very low. The health risks for NOT taking part in PA are very high”

28 Intensity and other issues Physical activity has an important role in healthy weight management and body composition. Adults who are overweight or obese adults should aim to attain a healthy weight by undertaking additional amount of activity beyond the primary recommendation of 150 min/week and include a decrease in calorific intake. Unrealistic / intimidating

29 Intensity and other issues These physical activity guidelines are applicable to older adults who are already overweight or obese. Older adults who are overweight and obese who achieve the recommended target of activity (150 minutes/week or 5 x 30) can gain multiple health benefits even in the absence of reductions in body weight. Should be for ALL older adults

30 UK Wide expert recommendations on physical activity and older people Implications ? – Most likely confusion amongst professionals Most who work with older people and physical activity do not have exercise science background They do not understand basic concepts e.g. aerobic activity, strength, power, balance These may shift the balance back towards exercise away from physical activity ? Obsession with “Gentle Exercise”