Health Benefits of Exercise for Frailer Older People

Don’t mention the F**** word!

More Older People Living Longer 2004: 16% aged >65 yrs 4% aged >80 yrs 4 people working to support 1 retired 2050: 30% aged >65 yrs 11% aged >80 yrs 2 people working to support 1 retired

1-2% in functional ability p.a. –Strength –Power –Bone density –Flexibility –Endurance –Balance and co-ordination –Mobility and transfer skills Ageing affects us all….. Sedentary behaviour accelerates the loss of performance...

Activities of Daily Living….  Wash hair comfortably?  20% women & 14% of men > 50 do not have sufficient shoulder flexibility  Confident of getting out of a chair without using arms ?  25% women & 7% men aged 70 – 74 do not have sufficient leg strength  Ease of stair use?  47% women aged 70 – 74 do not have sufficient leg power  Walk comfortably at a 20 minute a mile pace?  35% men and 80% women aged 70 – 74 do not have sufficient aerobic capacity

Thigh strength in older people Men Women Knee extension strength (N/kg) Strength to be confident of rising from low chair without using arms Age (years)

Vicious Cycle of Inactivity Physical deterioration - Heart disease - High blood pressure - Aches and pains - Osteoporosis Further decrease in physical activity Social / psychological ageing - Feeling ‘old’ - ‘Acting’ one’s age - Increased stress - Anxiety, depression - Low self-esteem Increasing age Less exercise Decreased physical abilities - Increased body fat - Sagging muscles - Decreased energy

UK ’ S Sedentary Ways 40% of people aged 50 or over in the UK are sedentary 40% of people aged 50 or over in the UK are sedentary 60-85% are sedentary in ethnic minority groups 60-85% are sedentary in ethnic minority groups  Half of the sedentary over 50 ’ s and 2/3 of over 70 ’ s believe they take part in enough physical activity to keep fit.

How much exercise do you do? All stand up All stand up Sit down if you Sit down if you –Walk to or from work daily –Play sports, cycle or swim more than twice a week –Spend more than 4 hours on your feet every day

Increasing the fracture risk? No standing activity leads to active loss of bone and muscle 1 wk bed rest  strength by ~ 20% 1 wk bed rest  spine BMD by ~1% Nursing home residents spend 80-90% of their time seated or lying down

The Guidelines apply to all older people 65+ The Actives - Those who are already active, either through daily walking, an active job and/or who are engaging in regular recreational or sporting activity.. Functional decline -Those whose function is declining due to low levels of activity, too much sedentary time, and who may have lost muscle strength, and/or are overweight but otherwise remain reasonably healthy. 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. Interpretation

Achieving the guidelines Moving Moving More Often Moving regularly and frequently Sedentary Meeting the guidelines Increased physical activity Increased benefits

17 Older adults – Moderate intensity – accumulating 150 minutes per week OLDER ADULTS (65 + ) Older adults should aim to be active daily. Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2 ½ hrs) of moderate intensity activity in bouts of 10 minutes or more. Over a week, activity should add up to at least 150 minutes (2 ½ hrs) of moderate intensity activity in bouts of 10 minutes or more. For those who are already regularly active at moderate intensity comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous activity. For those who are already regularly active at moderate intensity comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous activity. CMO, Start Active Stay Active, 2011

Older Adults – Sedentary, Strength and Balance All Older adults should minimise the amount of time spent being sedentary (sitting) for extended periods. All Older adults should minimise the amount of time spent being sedentary (sitting) for extended periods. Older adults should also undertake physical activity to improve muscle strength on at least two days a week. Older adults should also undertake physical activity to improve muscle strength on at least two days a week. Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week. Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week. CMO, Start Active Stay Active, 2011

Too frail to benefit? Dose response curve The lower the baseline level of physical activity, the greater the health benefit associated with an increase in physical activity. Exercise can be adapted for any medical condition The lower the baseline level of physical activity, the greater the health benefit associated with an increase in physical activity. Exercise can be adapted for any medical condition (Haskell 1994) (Haskell 1994)

Benefits of Exercise Prevention of : disease Coronary Heart Disease, Osteoporosis, Obesity, Stroke, Depression, Type 2 Diabetes, Hypertension, Colon Cancer, disability Arthritis, Intermittent claudication, Angina, Sleep, low back pain complications of Constipation, Deep vein thrombosis, Oedema, immobility Pressure sores immobility Pressure sores isolation Socialisation, Self-efficacy, Confidence dependence Functional ability, Falls, Autonomy, Dignity, Caring skills

Benefits of Regular Exercise IMPROVES OR MAINTAINS Good posture & body image Good posture & body image Intake of nutrients and immunity to infection Intake of nutrients and immunity to infection Cerebral function, mood, memory Cerebral function, mood, memory Sleep pattern and duration Sleep pattern and duration Social contacts, play Social contacts, play INDEPENDENCE AND QUALITY OF LIFE DEPENDENCE AND ISOLATION REDUCES OR PREVENTS Likelihood of falls and fractures Likelihood of falls and fractures Breathlessness, Obesity Breathlessness, Obesity Constipation, incontinence, urinary urgency Constipation, incontinence, urinary urgency Anxiety, Depression, Stress Anxiety, Depression, Stress

“Man does not cease to play because he grows old. Man grows old because he ceases to play” George Bernard Shaw If I ’ d known I was going to live this long, I ’ d have taken better care of myself Dubey Blake