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Staying active as you get older

I’M GETTING OLDER - WHY BOTHER WITH EXERCISE?

It is well known that exercise is good for you, but as you get older, exercise should remain an important part of a healthy lifestyle. Exercising when aged 65 and over has been linked to better long-term physical function[i],[ii] and improved cognitive function,[iii] and is linked to improved outcomes in so many diseases and conditions associated with ageing. With the emergence of ‘lifestyle medicine’, exercise can now be prescribed in a health setting to both treat disease and promote general wellness.[iv]

It is important to use exercise and physical activity as part of a well-rounded approach to lifestyle. A healthy, balanced lifestyle can be thought of in four main areas: exercise, diet, sleep and relaxation, and it is important to balance exercise with these other three concepts.[v]

This article outlines some of the clear links between exercise and disease, some ideas to help you get started and five top tips for exercising as an older adult to maximise your time and optimise lifestyle.

 

LINKS BETWEEN EXERCISE AND COMMON CONDITIONS IN OLDER ADULTS

Data published by Public Health England shows that by the age of 60, two-thirds of the population have at least one long-term condition, rising to 90% being affected by the age of 80.[vi] The following conditions are named by Age UK as having a significant prevalence in the older adult population (those aged over 60 years)[vii], and they each have convincing evidence for the benefits of physical activity:

 

CONDITION
EFFECTS OF EXERCISE

Cardiovascular disease (inc. high blood pressure, heart disease and stroke)

The association between exercise and heart disease is well established and research demonstrates a strong link between increased physical activity and reduced risk of cardiovascular disease.[viii],[ix],[x]

There are also positive links between exercise and improving outcomes following incidents such as stroke[xi] and during cardiac rehabilitation.[xii]

Dementia

Physical activity has been shown to give a positive impact on cognitive performance,[xiii] as well as reducing depression, movement problems and other behavioural symptoms associated with dementia.[xiv]

Depression

In the UK, depression is estimated to affect 22% of men and 28% of women aged 65+,[xv] and is often left undiagnosed. A collation of relevant research has shown strong evidence that tailored physical activity can reduce the severity of depression in older adults.[xvi]

Cancer

Exercise has shown benefits in multiple aspects associated with cancer, including prevention, prognosis and cancer-related fatigue.[xvii],[xviii]

Arthritis

Activity and movement is greatly beneficial for rheumatoid arthritis, both for symptom control and slowing disease progression, although there are often barriers to sustaining exercise.[xix]

Physical activity, particularly water-based, are also associated with an improvement in symptoms of osteoarthritis.[xx]

COPD (Chronic Obstructive Pulmonary Disease)

COPD is classically associated with a reduction in exercise tolerance, however aerobic, resistance and balance training prescribed as part of pulmonary rehabilitation have all shown to improve symptoms, exercise capacity and survival in people suffering with COPD.[xxi]

Falls

Falling accounts for the majority of accidents in people over 65 and has strong associations with disability and reduced survival in the long term.[xxii] Exercise-based interventions for those who are more frail and most at risk of falling have shown improved overall outcomes, both in terms of falling and general health.[xxiii],[xxiv]

 

WHAT EXERCISE SHOULD I BE DOING?

The NHS recommends that adults over 65 should do at least 150 minutes of moderate activity (such as walking or water aerobics) or 75 minutes of vigorous activity (such as jogging or fast swimming) per week.[xxv] For example, this can equate to just over 20 minutes of walking a day. Whilst keeping this in mind as a guideline, it is important to adapt your own exercise routine to your individual lifestyle and capabilities. A great model to base this around is the four target areas of exercise: flexibility, strength, balance and endurance, with each conferring different benefits[xxvi]. Endurance training can include walking, jogging, swimming, cycling and dancing! Try to find something that suits you, your ability level and that you enjoy!

 

Here are a few strength, flexibility and balance exercises to get started at home. Many of these can be adapted to be done seated where required.[xxvii]

 

Equipment: 1 stable chair (no arms), small weights (you can use food tins or bottles of water as alternatives)

Repetitions: For all of these exercises, it is best to include multiple repetitions, but remember to adapt to your own abilities. As you exercise more, you may feel that you can do more repetitions.

 

Strength
  1. Stand from sit
  • Sit squarely in the chair, feet spaced about hip-width apart and well planted on the floor, stand up slowly (aim to stand without using your arms to push yourself up; focus on using your legs)
  • As a seated alternative, sit squarely in the chair, hold on to a support to stabilise, and lift each knee up from the chair, alternating
  1. Bicep curl
  • Sitting or standing squarely, hold some light weights (food tins work as great alternatives for this one) with straight arms, palms facing forwards. Bend your elbow, bringing the weight up to your shoulder, pause for a few seconds, and slowly lower the weights back down
  1. Seated rotations
  • Sit squarely, feet well planted on the floor with your hands crossed over your chest. Keeping your hips still, turn your torso slowly from side to side, holding for a few seconds on each side. If this is very easy, you can do it whilst holding a weight or heavy book to build more strength
Flexibility
  1. Neck stretches
  • Sitting or standing squarely, stretch your neck gently by slowly turning your head to look over each shoulder in turn.  Secondly, slowly flex your head to each side, bringing your ear towards your shoulder, alternating sides
  1. Calf stretch
  • Stand up straight in front of a stable wall, place your hands on the wall for stability and step back with one foot, keeping your heel on the floor to stretch the back of your leg
  • For a seated alternative, straighten out a leg at a time and point your toes back towards yourself
  1. Lower back stretch
  • Lying flat on your back, bring one knee up to your chest (as far as you comfortably can) and hold with your hands for at least 10 seconds. Repeat with the other knee
  • For a seated alternative, sit squarely and bring each knee up to your chest and hold with your hands, alternating
Balance

With all of these, start with the support you need and work towards completing each exercise unsupported.

  1. Walking
  • Sideways: try walking sideways whilst facing forwards (like a crab), placing your feet together between steps
  • Grapevine: this is very similar to the sideways walking, but try to cross your feet over between steps
  • Heel-to-toe: walking forwards, placing each foot closely with your heel touching the toes of the other foot, as if you were measuring out the floor with your feet
  1. One leg stand
  • Stand on one leg at a time; hold for a few seconds at first and try to increase the time as your balance improves
  1. Seated balance
  • Sitting upright on a large medicine ball or ‘stability wobble cushion’ for periods of time can help strengthen your core and improve balance

 

SUMMARY – TOP 5 TIPS

  1. Remember the big picture: Exercise is an important component of a healthy and well-rounded lifestyle. Balance your activity with eating well, sleeping well and making time for relaxation
  2. Start low and slow: Particularly when trying exercises, make sure you start easy and work up at your own pace
  3. Adapt, adapt, adapt: Most exercises can be altered to suit different abilities or limitations. Whatever your situation, try to find something that works for you.
  4. Don’t underestimate balance and flexibility-based exercise: When thinking about exercise, most people immediately think about high intensity sports, but there is a plethora of health benefits from activities like yoga and pilates, particularly for older adults, that are based more on developing flexibility and balance. There are great for relieving stress too![xxviii]
  5. Try something new: The key to sustainability with exercise is enjoyment. Try a new activity or sport, try group classes or home videos. Change it up and have fun!

 

 

 

 


[i] Yorston, L., Kolt, G. and Rosenkranz, R. (2012). Physical Activity and Physical Function in Older Adults: The 45 and Up Study. Journal of the American Geriatrics Society, 60(4), pp.719-725.

 

[ii] Brovold, T., Skelton, D. and Bergland, A. (2013). Older Adults Recently Discharged from the Hospital: Effect of Aerobic Interval Exercise on Health-Related Quality of Life, Physical Fitness, and Physical Activity. Journal of the American Geriatrics Society, 61(9), pp.1580-1585.

 

[iii] Barnes, D., Santos-Modesitt, W., Poelke, G., Kramer, A., Castro, C., Middleton, L. and Yaffe, K. (2013). The Mental Activity and eXercise (MAX) Trial. JAMA Internal Medicine, 173(9), p.797.

 

[iv] Taylor, D. (2013). Physical activity is medicine for older adults: Table 1. Postgraduate Medical Journal, 90(1059), pp.26-32.

 

[v] Chatterjee, R. (2017). The Four Pillar Plan. Penguin Life.

 

[vi] Public Health England (2017). Health Profile for England - Trends in Morbidity. gov.uk, Chapter 3.

 

[vii] Melzer, D., Delgado, J., Winder, R., Masoli, J., Richards, S. and Ble, A. (2015). The Age UK almanac of disease profiles in later life. NIHR.

 

[viii] Li, J. and Siegrist, J. (2012). Physical Activity and Risk of Cardiovascular Disease—A Meta-Analysis of Prospective Cohort Studies. International Journal of Environmental Research and Public Health, 9(2), pp.391-407.

 

[ix] Sattelmair, J., Pertman, J., Ding, E., Kohl, H., Haskell, W. and Lee, I. (2011). Dose Response Between Physical Activity and Risk of Coronary Heart Disease: A Meta-Analysis. Circulation, 124(7), pp.789-795.

 

[x] Wahid, A., Manek, N., Nichols, M., Kelly, P., Foster, C., Webster, P., Kaur, A., Friedemann Smith, C., Wilkins, E., Rayner, M., Roberts, N. and Scarborough, P. (2016). Quantifying the Association Between Physical Activity and Cardiovascular Disease and Diabetes: A Systematic Review and Meta‐Analysis. Journal of the American Heart Association, 5(9), p.e002495.

 

[xi] Tang, A., Eng, J., Krassioukov, A., Madden, K., Mohammadi, A., Tsang, M. and Tsang, T. (2013). Exercise-Induced Changes in Cardiovascular Function after Stroke: A Randomized Controlled Trial. International Journal of Stroke, 9(7), pp.883-889.

 

[xii] Dibben, G., Dalal, H., Taylor, R., Doherty, P., Tang, L. and Hillsdon, M. (2018). Cardiac rehabilitation and physical activity: systematic review and meta-analysis.

 

[xiii] Kirk-Sanchez, N. and McGough, E. (2013). Physical exercise and cognitive performance in the elderly: current perspectives. Clinical Interventions in Aging, p.51.

 

[xiv] de Souto Barreto, P., Demougeot, L., Pillard, F., Lapeyre-Mestre, M. and Rolland, Y. (2015). Exercise training for managing behavioral and psychological symptoms in people with dementia: A systematic review and meta-analysis. Ageing Research Reviews, 24, pp.274-285.

 

[xv] The Information Centre (2005). Mental Health and Wellbeing. Health Survey for England - The Health of Older People.

 

[xvi] Bridle, C., Spanjers, K., Patel, S., Atherton, N. and Lamb, S. (2012). Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. British Journal of Psychiatry, 201(03), pp.180-185.

 

[xvii] Bigley, A., Spielmann, G., LaVoy, E. and Simpson, R. (2013). Can exercise-related improvements in immunity influence cancer prevention and prognosis in the elderly?. Maturitas, 76(1), pp.51-56.

 

[xviii] Sprod, L., Fernandez, I., Janelsins, M., Peppone, L., Atkins, J., Giguere, J., Block, R. and Mustian, K. (2015). Effects of yoga on cancer-related fatigue and global side-effect burden in older cancer survivors. Journal of Geriatric Oncology, 6(1), pp.8-14.

 

[xix] Veldhuijzen van Zanten, J., Rouse, P., Hale, E., Ntoumanis, N., Metsios, G., Duda, J. and Kitas, G. (2015). Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature. Sports Medicine, 45(10), pp.1401-1412.

 

[xx] Waller, B., Ogonowska-Slodownik, A., Vitor, M., Lambeck, J., Daly, D., Kujala, U. and Heinonen, A. (2014). Effect of Therapeutic Aquatic Exercise on Symptoms and Function Associated With Lower Limb Osteoarthritis: Systematic Review With Meta-Analysis. Physical Therapy, 94(10), pp.1383-1395.

 

[xxi] Reid, D., Yamabayashi, Goodridge, D., Chung, Hunt, Marciniuk, Brooks, Chen, Camp and Hoens (2012). Exercise prescription for hospitalized people with chronic obstructive pulmonary disease and comorbidities: a synthesis of systematic reviews. International Journal of Chronic Obstructive Pulmonary Disease, p.297.

 

[xxii] Gale, C., Cooper, C. and Aihie Sayer, A. (2016). Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing. Age and Ageing, 45(6), pp.789-794.

 

[xxiii] de Labra, C., Guimaraes-Pinheiro, C., Maseda, A., Lorenzo, T. and Millán-Calenti, J. (2015). Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatrics, 15(1).

 

[xxiv] Chan, W., Fai Yeung, J., Man Wong, C., Wa Lam, L., Chung, K., Hay Luk, J., Wah Lee, J. and Kin Law, A. (2015). Efficacy of Physical Exercise in Preventing Falls in Older Adults With Cognitive Impairment: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 16(2), pp.149-154.

 

[xxv] Nhs.uk. (2018). Physical activity guidelines for older adults - NHS.UK. [online] Available at: https://www.nhs.uk/live-well/exercise/physical-activity-guidelines-older-adults/ [Accessed 19 Jun. 2018].

 

[xxvi] Panton, L. and Artese, A. (2015). Types of Exercise: Flexibility, Strength, Endurance, Balance. Exercise for Aging Adults, pp.41-58.

 

[xxvii] Exercises for Older People. NHS Choices. [online] Available at: https://www.nhs.uk/Tools/Documents/NHS_ExercisesForOlderPeople.pdf [Accessed 19 Jun. 2018].

 

[xxviii] Bonura, K. and Tenenbaum, G. (2014). Effects of Yoga on Psychological Health in Older Adults. Journal of Physical Activity and Health, 11(7), pp.1334-1341.

 

Date: 17/07/2018
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