Physical activity in later life: an exercise in common sense Marion E T McMurdo Professor of Ageing and Health University of Dundee Scotland Annual NICE Knowledge Exchange 24 th May 2012

Key messages It is never “just your age” Modest amounts of physical activity are good for health Common sense urgently needed regarding safety

Old age is the age at which most of the medical profession start to lose interest in you Marion McMurdo Old age begins and middle age ends the day your descendants outnumber your friends Ogden Nash

Lifelong trajectory of health and disease Genetics Chance Social environment Lifestyle

Physical activity Movement of the body by the skeletal muscles that results in energy being expended

Exercise Physical activity that is planned, structured, and repetitive done with aim of improving or maintaining physical fitness

The condition of exercise is not a mere variant of the condition of rest, it is the essence of the machine Sir John Barcroft 1926

Active like a hunter gatherer Most human history, man lived as a hunter gatherer – a physically demanding life Our exercise needs remain same as our ancestors Technology has eliminated physical work Sedentary lifestyles ‘normal’ Inactivity-induced epidemics Archer and Blair. Prog Cardiovasc Dis 2011;53:

Age/motor disability/knee pain Muscle Weakness Decreased muscle strength  Activities Ready fatigue/poor endurance Further restriction of activities Further disability Physical activity, age and physical disability Adapted from Nair SK. Mayo Clin Proc 2000;75:S14-S18

Regular physical activity Protective against Heart disease Diabetes Some cancers Mild depression Dementia and Alzheimer’s disease Larson EB et al. Ann Intern Med 2006;144:73-81

Deterrents to physical activity Survey of 409 people aged years “Cannot” “Will not” “Should not” Crombie et al. Age Ageing 2004;33:287-92

Deterrents to physical activity Confusion! Collective amnesia! Fear!

Exercise recommendations for healthy older adults Activity of moderate intensity 30 minutes, 5 days per week (150 mins per week) Bouts as short as 10 minutes Muscle strengthening 2 days per week Flexibility exercises ‘More better’ Nelson et al. Med Sci Sports Exerc 2007;39:

Activity and risk of heart disease Longitudinal follow-up of 39,000 older women Light-to-moderate physical activity associated with reduction in risk of heart disease At least 60 minutes walking per week predicted lower risk Lee I-Min JAMA 2001;285:

“Just get out the door!” Study 1002 women aged >65 years Walking ≥8 city blocks per week, twice as likely to still be mobile than those walking less Simonsick EM et a. JAGS 2005;53(2):

Relationship between health benefits and physical activity Kesaniemi et al. Med Sci Sports Exerc 2011;22: Nigam et a. Lancet 2011; 378: 1202 – 1208.

Risks of inactivity are high Avoid sudden unaccustomed vigorous exercise at all ages Moderate intensity – low risk Stay within own level of comfort, start slow, build up gradually Liu and Latham. Cochrane Database Rev 2009 Jul 8;(3): CD Safety of physical activity in old age

University of Dundee’s seniors exercise classes: a not-for-profit organisation

Founded by Dorothy Dobson in 1986 Classes UK wide No exclusions, no screening, no disclosures, no disclaimers More than 600,000 hours of event-free seniors exercise time

Determinants of physical activity Encouragement and enjoyment Confidence in ability to be active and safety Low to moderate intensity Goal setting and planning McMurdo MET. Exercise in old age: time to unwrap the cotton wool. Br J Sports Med 1999;33:

Key messages It is never “just your age” Modest amounts of physical activity are good for health Common sense urgently required regarding safety