The UK physical activity guidelines for older adults and the benefits of physical activity for this age group

UK Physical Activity Guidelines UK-wide Global evidence of the health benefits Life course Recommended amount for health benefit This set of guidelines, first published in July 2011 and titled Start Active, Stay Active, is the first time England, Scotland, Wales and Northern Ireland have had the same guidelines The guidelines are based on comprehensive reviews of research evidence and take account of publications which consider the guidelines in other developed countries such as USA, Australia and Canada. These guidelines cover all age groups across the lifespan: early years (0-5 years), children and young people, adults and older adults. The government recommendations are based on prescribing a minimum level of physical activity to benefit health and focus on prevention of disease. These guidelines apply to all, irrespective of gender, race, or socio-economic status, but should be interpreted with consideration of individual physical and mental capabilities.

Why do we need guidelines for older adults? Physical activity levels are low and decline with age The benefits of regular physical activity for older adults are well known Consistent public health messaging There is a well-established trend of a decline in physical activity levels as we get older. However, being active regularly can improve physical and psychological health and is associated with the maintenance of functional activities and independence. It can also assist in reversing the decline of physical function even in later life. These guidelines provide a basis for consistent public health messaging and physical activity promotion programmes by anybody working to promote physical activity with older adults. The following slides introduce all six guidelines for older adults (aged 65+).

UK physical activity guidelines: Older Adults Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Some physical activity is better than none, and more physical activity provides greater health benefits. Physical activity levels amongst older adults are low and meeting the Chief Medical Officers guidelines provides a significant challenge for many older adults. For the majority of older adults, moving towards the recommendation provides a starting point and small increases will produce some health benefits. This guideline is simply about motivating older adults to move a little bit more.

Working towards achieving the guidelines Moving Moving More Often Moving regularly and frequently Increased benefits Meeting the guidelines Sedentary The dose response curve of physical activity in this slide demonstrates the first guideline well. Dose response refers to the concept that as physical activity levels increase, so do the health benefits. Helping older adults to reduce their sedentary behaviour and progress to moving, to moving more often and then to moving regularly and frequently will produce the greatest reduction in risk. Sedentary individuals can gain some health benefits simply by moving a little bit more. If they begin to move more often and gradually build to meet the physical activity guidelines, the health benefits experienced with increase proportionally. Increased physical activity

UK physical activity guidelines: Older adults Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more One way to approach this is to do 30 minutes on at least 5 days a week. A series of recent systematic reviews consistently identified 150 minutes of moderate intensity physical activity per week as providing substantial benefits for the prevention of over 20 chronic diseases, including coronary heart disease, stroke, type 2 diabetes, depression, dementia and loss of physical function. 150 minutes may seem like a significant challenge for some adults, but this can be achieved by accumulating multiple activity bouts of at least 10 minutes over the week. This is likely to be a more realistic way for some adults to achieve the guidelines. It is the overall volume of activity that is key to the beneficial effects of physical activity rather than the intensity or frequency.

UK physical activity guidelines: Older adults Moderate intensity activity will make older adults: feel warmer breathe harder have a faster heart beat out of breath but still able to hold a conversation. Moderate physical activity will cause older adults to become warmer, breathe harder and feel their heart beating faster than usual. They should still be able to carry on a conversation. Many older adults may feel nervous at being asked to raise their heart and breathing rate and may interpret this as an onset of a cardiac event or asthma. However, this is just a normal reaction to activity.

UK physical activity guidelines: Older adults For those who are already active at a moderate intensity, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity. Vigorous activity may not be appropriate for all older adults and should only be attempted by those who have been very active for some time and have a high level of fitness. A small percentage of older adults continue with higher intensity physical activity through regular running, swimming, cycling or competitive sports. To gain the same benefits as 150 of moderate physical activity, it only takes 75 minutes of vigorous activity. It may also bring significantly increased benefits for some fitness and health outcomes.  

UK physical activity guidelines: Older adults Older adults should also undertake physical activity to improve muscle strength on at least two days a week (in addition to the 150 minutes) Muscle strengthening activities should be included at least twice a week in addition to the 150 minutes a week. Muscle strengthening exercises help maintain functional ability and reduce the bone and muscle loss associated with ageing. Strength activities will help older adults with simple activities such as walking, climbing steps or standing from a chair.

UK physical activity guidelines: Older adults Types of strength exercises Movements against a resistance or extra weight Some everyday activities, eg, using the stairs, Tai Chi, heavy housework, gardening, lifting Participation in a class or home based programme Muscle strengthening activities that load each of the main muscle groups provide the greatest benefits. Initially, using body weight will have a strengthening effect, eg, gardening, stair climbing, hill walking or dance. As strength improves, adults should try using a heavier weight. This could be achieved by attending group classes to improve strength. It is normal for muscles to feel stiff or sore in the few days after carrying out strength activities and strength activities should not be carried out on consecutive days.

UK physical activity guidelines: Older adults Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week 33% of adults aged 65+ and 50% of those aged 80+ fall every year. Older adults can reduce this risk by doing activities to improve balance at least twice a week in addition to the recommended 150 minutes. There is good evidence that physical activity programmes which emphasise balance training, limb co-ordination and muscle strengthening activity are safe and effective in reducing the risk of falls.

UK physical activity guidelines: Older adults What counts as balance activities? Standing or moving about whilst standing and: reducing the base of support moving the centre of mass reducing upper body support. Activities that challenge balance can help reduce falls and maintain independent living. Activities that improve balance include standing or moving about and fit into one of the following categories: reducing the base of support eg, standing on one leg or going up on tip toes. movement of the centre of mass of the body eg, racket sport, dancing, Tai Chi, standing exercise classes, movement to music classes and walking on uneven ground reducing the amount of body support eg, changing from holding onto a supportive object to being unsupported.

UK physical activity guidelines: Older adults All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods. Sedentary behaviour refers to a group of behaviours that occur whilst sitting or lying down and that typically require very low energy expenditure. The Chief Medical Officers guidelines include for the first time a recommendation about reducing sedentary behaviour. Sedentary behaviour refers to a group of behaviours that occur whilst sitting or lying down and that typically require very low energy expenditure. Examples of sedentary behaviour include sitting whilst watching television, using a computer, driving a car or being a passenger.

UK physical activity guidelines: Older adults A risk factor for poor health independent of physical activity High levels of sedentary behaviour among older adults Alarming levels of sedentary behaviour in residential and nursing homes and hospitals Sedentary behaviour is an independent risk factor for poor health, meaning that even if you are active, being sedentary can be bad for your health, including a loss of muscle function, mobility and bone health. Sedentary behaviour increases with age and rises sharply from age 70 (in some cases as much as 10 hours a day). Older adults should break up long periods of sedentary time by walking around for a few minutes or performing some sit to stand exercises.

Top line messages Moving more often every day Some activity is better than none. Build up your activity gradually. Be sure to add activities that will help you be strong and steady. Limit and break up the amount of time spent sedentary. These top line messages summarise the important information included in the Chief Medical Officers’ guidelines for physical activity for older adults.

Different individuals and groups Older adults are not all the same, we need to interpret the guidelines for: The Actives - already active Older adults in transition –experiencing a decline in function Frail elderly people - very low physical or cognitive function and frailty Not all older adults are the same and there is a difference in functionality between and older adult who can still participate in vigorous activity and a frail person in a care home, regardless of their age. They can be grouped into three: The Actives - Those who are already active, either through daily walking, leading an independent life, an active job and/or who are engaging in regular recreational or sporting activity. In transition - They are said to be in transition - between independence and dependence, good health and poor health. They may be losing their muscle strength and balance and may be overweight.   Frail elderly - Those who are frail or have very low physical or cognitive function perhaps as a result of chronic disease such as arthritis, dementia, or very old age itself.

Interpreting the guidelines for older adults (65+) The Actives In Transitions Frailer, older people This resource helps to interpret the guidelines for: physical activity and health practitioners and policy makers anyone who works with older people and wants to increase their physical activity levels The aim is to help inform good practice by providing examples of how the Chief Medical Officers’ Guidelines can be interpreted according to different needs and abilities. These guidance documents are available to download. Available at www.ssehsactive.org.uk/older-adults-resources-and-publications

Benefits of physical activity Being active helps prevent and manage over 20 long term conditions as well as maintain functional capacity and independent living in old age. The following slides explain the benefits of physical activity for older adults.

Disease prevention Being active in later life has a preventative effect for: all cause mortality cardiovascular disease type 2 diabetes physical function weight gain. Evidence suggests that the preventative effect of activity on all cause mortality, cardiovascular disease and type 2 diabetes is as strong in older adults as it is for adults. Active adults have better levels of physical function compared to their lower active peers. Being active can help older adults reach and maintain a healthy weight. For obese or overweight older adults, being active can have health benefits even in the absence of weight loss.

Disease symptoms Older adults may be suffering from disease symptoms. Being active can help alleviate symptoms of some the following: joint pain caused by arthritis breathlessness for people with COPD delayed progression of osteoporosis. Many diseases manifest in older age, but some symptoms can be alleviated through physical activity. Being active can help reduce the joint pain caused by rheumatoid arthritis and knee arthritis and people with Chronic Obstructive Pulmonary Disorder can experience reduced feelings of breathlessness. Strength training can increase the rate of bone turnover and slow the rate at which bone is lost (osteopenia). This delays the progression of osteoporosis.

Functional capacity Resistance training can help improve physical function and mobility Cardiorespiratory training can offset the decline in endurance Naturally, functional capacity declines with age impacting on older adults health, wellbeing and ability to maintain independent living. This can be offset by resistance training which can improve factors such as walking speed and time to stand from a chair. Examples of resistance training can be movement against a resistance or additional weight, this can include bodyweight through climbing the stairs, doing the gardening. Cardiorespiratory training includes anything that raises an individuals heart beat and causes them to breathe harder. It will reduce the rate of decline in endurance and help reduce feelings of breathlessness and fatigue.

Fall prevention Approximately 33% of adults aged 65+ fall each year Major cause of injury Regular physical activity helps maintain balance Specific postural stability exercise are beneficial to unstable individuals Approximately 33% of older adults fall each year, increasing to 50% in adults over 80 years. Balance impairment is a key risk factor for falls, which can be improved by regular physical activity. For more unstable older adults, specific postural stability exercise may be beneficial.

Circulation Among frail older adults, physical activity and movement that promote circulation will assist in reducing certain complications including: deep vein thrombosis gravitational oedema contractures pressure sores Physical activity promotes blood circulation which will assist in reducing the following complications: deep vein thrombosis - a blood clot in one of the deep veins – usually in the calf or thigh gravitational oedema - swelling of the feet and lower legs caused by accumulation of fluid contractures - thickening of the joint tissues leading to deformity pressure sores – also known as bedsores develop when pressure is applied on the skin over a long period of time usually among people who are confined to bed or sitting for prolonged periods of time.

Mental wellbeing Being active in later life can help promote good mental health including: better perception of mental wellbeing increased self-esteem better ability to cope with stress reducing symptoms of depression and anxiety better quality and quantity of sleep.

Risks and benefits Engaging in physical activity carries very low health and safety risks for most older adults In contrast, the risks of poor health as a result of inactivity are very high. If older adults are encouraged to begin at their own pace and make gradual increases in duration, frequency and intensity over a period of time, physical activity carries very low health and safety risks for most older adults. The risks associated with inactivity are very high.

Evidence briefing Further information on the health benefits of being active in later life can be found in this evidence briefing. To download please visit www.ssehsactive.org.uk This evidence briefing providing a summary of the evidence on physical activity and older adults.