09 October 2020
When it comes to optimising the health outcomes for ageing adults, prevention is the key, writes APC’s Exercise Physiologist Kimberley Hobson.
With a high percentage of our population ageing, it is imperative that we start developing a strong commitment to improving not only the physical health of these individuals, but also the overall psychosocial health of our elderly population. Evidence strongly supports the positive association between increased levels of physical activity with improved physical health, and furthermore proves exercise is the only ‘medicine’ that can positively affect multiple body systems simultaneously. So why are we not prescribing it more?
With increasing age, there is an commensurate risk of developing non-communicable chronic health conditions. The five leading risk factors for death in older adults are as a result of high blood pressure, smoking, high blood glucose, physical inactivity and obesity. With these factors all positively influenced by an increase in exercise it is time we start encouraging exercise prescription over pharmacological intervention.
Alongside the increasing incidence of these risk factors with ageing, there is also a decline in other physiological systems – a loss of muscle mass, a decline in balance ability, a reduction in muscle and bone strength and a decline in cognitive performance, all of which impact on functional independence. For older adults, extending life is an important factor, although the maintenance of functional independence and quality of life is also of high importance to reduce psychological stress on the individual and financial strain on an already stressed healthcare system.
Current trends in physical activity state that typically we decrease our structured exercise as we age, which is a significant contributor to the range of adverse health effects. In fact very few, an estimated less than 10 percent of people over 65 years of age currently achieve the recommended level of physical activity that stimulates health improvements. So a challenge lies ahead for all health professionals to increase physical activity and exercise participation in older adults.
We can all recognise the elderly will benefit from exercise for preventing chronic disease and falls, and maintaining independence and quality of life. Exercise needs to be specific and often just walking isn’t enough, so how do we know if what they are currently doing, or what we are recommending, is enough to stimulate these positive changes?
Recommendations for exercise for older adults
Aerobic exercise (any longer sustained exercise that can be maintained for longer than 10 minutes)
- Importance – improves cardiovascular health, lowers blood pressure, helps regulate blood sugar, reduces chronic pain, aids sleep, regulates weight, boosts mood, reduces risk of falls.
- Guidelines – Be active on most, preferably all, days every week. Accumulate 150 minutes (20 minutes each day, can be split into two 10-minute blocks) of moderate intensity physical activity, should notice an increase in heart rate and breathing rate. Minimise the amount of time spent in prolonged sitting; spend 10 minutes of every 30 minutes up and out of the chair.
Anaerobic exercise (activities that require quick bursts of power at a higher intensity than what is normal for the individual)
- Importance – used to promote strength, speed and power and muscle mass. Also helps metabolise fat, promotes bone growth and plays an important role in balance.
- Guidelines – Should be completed in addition to aerobic exercise two to three times a week at a moderate intensity. Can include weights, body weight and balance specific exercises.
Importance of the general practitioner
Older adults, particularly those with chronic health conditions, have relatively high rates of attendance at their physician’s offices; this puts the GP in a strong position to provide exercise-related advice.
Patients report poor compliance to exercise when they do not feel adequately supported, reporting fearing doing more harm than good. Therefore, providing generalised exercise advice is not enough. To promote long-term compliance into physiologically beneficial exercise, patients need specifics on how they should go about increasing their activity levels and what they specifically should do that is appropriate for their age, current chronic health conditions and injuries.
Giving specific physical activity advice, a plan of action and some form of follow-up, either with an exercise professional or at subsequent appointments, are important factors in facilitating the uptake and maintenance of exercise programs in older adults.
Recommendations for health professionals
- Ask what the patient is already doing – at a minimum, discuss the duration, type and intensity of exercise recommended and advise the patient to at least start walking 20 to 30 minutes per day at a moderate intensity.
- Emphasise the importance of intensity of exercise over the duration and type.
- Discuss the importance of resistance exercise for maintaining muscle strength and endurance, bone density, improved balance, managing metabolic conditions and maintaining independence at home.
- Refer your patients to the ESSA (Exercise and Sports Science Australia) website (www/essa/org.au) to find the closest exercise physiologist.
- Discuss eligibility of EPC (enhanced primary care) referral.
Individual health practitioners have an important role in discussing physical activity as medicine for older adults and starting the process of supporting these patients to become more physically active. The main challenge lies in finding an effective way to support older adults to increase their physical activity in a time-poor environment that provides enough information and emphasis on the type of exercise that allows a patient to develop habitual physical activity behaviours. Consistently reiterating the message of exercise and providing adequate referrals or support shows that we can improve the health
Kimberley Lyford is APC’s Exercise Physiologist. To refer a patient or make an appointment please contact APC