Physical activity and exercise for health and well being of older people

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Physical inactivity has been identified as the fourth leading risk factor for global mortality (6% of deaths globally). With the exponential growth in the older population, increasing physical activity and exercise in older people has been identified as a key target, by the World Health Organisation (WHO) Active Ageing Framework (2002), to reduce the global burden of non-communicable disease.

2012 is the European Year of Active Ageing and Solidarity Between Generations and an associated programme of events is taking place across Europe. Active ageing means growing older in good health, independent in daily life, and as a full member of society. However, it is known that health declines with age and active ageing involves empowering individuals through knowledge relating to the impacts of lifestyle choices on health and well being. 2012 also heralds the London Olympics, with a highlight on sporting excellence, and the 8th World Congress on Active Ageing, in Glasgow, UK, providing a platform to ensure the legacy of a more active population reaches even the oldest population.

The WHO Global Recommendations on Physical Activity for Health (2010) recommends that adults aged 65 years and above undertake at least 150 minutes of moderate-intensity aerobic physical activity or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week. Aerobic activity can be accumulated in bouts of at least 10 minutes. They also recommend that older adults perform strengthening activities at least twice a week, activities that improve balance at least three times a week, and minimise the time they spend in sedentary postures (sitting and lying down).

Physical activity is any bodily movement produced by skeletal muscles that requires energy expenditure and includes activities carried out as part of normal daily life such as walking, climbing stairs, gardening and leisure activities such as dancing and swimming. Exercise is a sub-set of physical activity that is planned, structured, and repetitive and includes exercise classes and weight training. Exercise therapy is considered an important component of rehabilitation programmes for older people with the aims of: reducing pain; improving, joint stability, functional ability, muscle strength and endurance, and aerobic capacity; and preventing bone loss and fractures, and improving or maintaining quality of life.

This special collection brings together a selection of Cochrane Reviews assessing the benefits of physical activity and exercise on the health and well being of older people, such as impacts on physical function, muscle strength, balance and bone health, and cognitive function and sleep. The physical activity and exercise programmes included in these reviews range from leisure activities and simple home exercise programmes to intensive and supervised clinically based programmes.

The Cochrane Reviews highlighted in this special collection have been prepared by authors and editors from a diverse range of Cochrane Review Groups including the Bone, Joint and Muscle Trauma Group, the Dementia and Cognitive Improvement Group, the Developmental, Psychosocial and Learning Problems Group, and the Musculoskeletal Group.

Physical activity programmes

Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment

Physical activity is beneficial for healthy ageing. It may also help maintain good cognitive function in older age. Aerobic activity improves cardiovascular fitness, but it is not known whether this sort of fitness is necessary for improved cognitive function. Studies in which activity, fitness and cognition are reported in the same individuals could help to resolve this question. This review assesses the effectiveness of physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment.

Physical activity programs for persons with dementia

There is some evidence that physical activity delays the onset of dementia in healthy older adults and slows down cognitive decline to prevent the onset of cognitive disability. Studies using animal models suggest that physical activity has the potential to attenuate the pathophysiology of dementia. 'Physical activity' refers to 'usual care plus physical activity'. This review assesses whether physical activity programs, compared with usual care, maintain or improve cognition, function, behaviour, depression, and mortality in older persons with dementia, whether the programs have an indirect positive impact on family caregivers' health, quality of life, and mortality, and whether they reduce the use of healthcare services in older persons with dementia and their family caregiver.

Home versus center based physical activity programs in older adults

Physical inactivity is a leading cause of preventable death and morbidity in developed countries. In addition physical activity can potentially be an effective treatment for various medical conditions such as cardiovascular disease or osteoarthritis. Many types of physical activity programs exist, ranging from simple home exercise programs, to intense highly supervised hospital (center) based programs. This review assesses the effectiveness of 'home based' versus 'center based' physical activity programs on the health of older adults.

Exercise programmes

Exercise for improving balance in older people

In older adults, diminished balance is associated with reduced physical functioning and an increased risk of falling. This review examines the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care.

Exercise for preventing and treating osteoporosis in postmenopausal women

Osteoporosis is a condition resulting in an increased risk of skeletal fractures due to a reduction in the density of bone tissue. Treatment of osteoporosis typically involves the use of pharmacological agents. In general it is thought that disuse (prolonged periods of inactivity) and unloading of the skeleton promotes reduced bone mass, whereas mechanical loading through exercise increases bone mass. This review examines the effectiveness of exercise interventions in preventing bone loss and fractures in postmenopausal women.

Progressive resistance strength training for improving physical function in older adults

Muscle weakness in old age is associated with physical function decline, and progressive resistance strength training exercises are designed to increase strength. This review assesses the effects of progressive resistance strength training on older people, including adverse effects.

Physical exercise for sleep problems in adults aged 60+

The prevalence of sleep problems in adulthood increases with age. While not all sleep changes are pathological in later life, severe disturbances may lead to depression, cognitive impairments, deterioration of quality of life, significant stresses for carers and increased healthcare costs. The most common treatments for sleep disorders (particularly insomnia) are pharmacological. Non-drug interventions have been suggested to have a slower effect than pharmacological methods, but they don’t have the risk of drug-related tolerance or dependency. Physical exercise, taken regularly, could promote relaxation and raise core body temperature in ways that are beneficial to initiating and maintaining sleep. This review assesses the efficacy of physical exercise amongst older adults (aged 60 and above).

Exercise for acutely hospitalised older medical patients

Functional decline (deterioration in physical or cognitive function) among older adults during hospitalisation is common, but the role of exercise in preventing these deconditioning effects is unclear. This review assesses the effect of exercise interventions for acutely hospitalised older medical patients on functional status, adverse events and hospital outcomes.

Acknowledgements: Tracey Howe, Professor of Rehabilitation Sciences, Glasgow Caledonian University, Director of External relations and partnerships at Glasgow City of Science, and Editor of the Cochrane Musculoskeletal Review Group, and Dawn Skelton, Professor of Ageing and Health, Glasgow Caledonian University, and Chair of the 8th World Congress on Active Ageing, for drafting the text.

Image credit: Mauro Fermariello/Science Photo Library, P960/0706

Date published: 16 May 2012

Contact: Cochrane Editorial Unit (editorial-unit@cochrane.org)

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