Older people have much to gain from being physically active, given the potential benefits to mental and physical health and wellbeing (Bauman 2004). Older people are also more prone to adverse effects from medication: physical activity offers a useful, cost effective alternative to drug management in older people, reducing the need for medication. Recent national surveys show that the current physical activity status of older Australians leaves scope for improvement (Bauman 1997; Armstrong, Bauman et al. 2000). Only 43% of those aged 60 to 75 are sufficiently active to achieve health benefits (Armstrong, Bauman et al. 2000). Given their high level of absolute risk for mortality and a range of health problems, sedentary older people have the potential to benefit more than any other sector of the population from physical activity uptake and maintenance.
Physical activity can prevent the onset of chronic conditions and ameliorate the impact of chronic conditions. The current consensus is for a combination of moderate aerobic, strength, balance and flexibility exercises for older people (King, Pruitt et al. 2000) to decrease the impact of age related decline. The evidence for the benefits of exercise extends to frail older people (Fiatarone, O Neill et al. 1994) both in the community and in residential aged care settings. For epidemiological evidence and that obtained from effectiveness studies to reach and impact on the health of older Australians, evidence needs to be translated into policies and practice.
The current national physical activity guidelines (Department of Health and Aged Care 1999) are intended for all Australians. Whilst they are generally relevant to older people, their non-specific nature means that there have been some reservations about their application to older people, from both consumers and health care providers. The Australian Government has responded by commissioning a review and the development of physical activity recommendations for older people. This work has been undertaken by the National Ageing Research Institute. These recommendations will complement the adult guidelines and those produced for other population sub-groups: children and young people (Trost 2005). With a range of health promotion and physical activity campaigns currently being rolled out at a national and state level, development of tailored recommendations is timely. Recommendations on physical activity for older Australians have the potential to optimise the uptake and maintenance of a range of evidence based physical activity programs currently available and to identify programs that may need further development and implementation for particular sub-groups of older people, especially those with complex comorbidities.
This document and the associated Recommendations will support the Australian Government Department of Health and Ageing in promoting the health of a growing sector of the population, to optimise the overall health of the nation. The work accords with the Australian Government’s Healthy Ageing Strategy, the Be Active Australia: A Health Sector Framework for Action 2005-2010, the ‘Better Health For All Australians’ package recently announced by the Council of Australian Governments (February 2006) and a range of population health and chronic disease prevention and management frameworks or national action agendas, such as that of the National Obesity Taskforce (Department of Health and Ageing 2005). The recommendations will contribute to the evidence base for the National Health Priority Areas and the National Research Priority Area of Promoting and maintaining good health.
This document addresses physical activity for older people at three levels: individual, societal and structural. The evidence to date suggests that key elements at each level are:
- Individual : health status and disability, negative and positive beliefs e.g. perceptions of available time. Maintenance of physical activity needs strategies to sustain motivation and participation;
- Societal : addressing isolation, role models, community attitudes. Maintenance of physical activity needs strategies to provide social support;
- Structural : access to information and venues and tailored, safe options for all individuals and groups. Maintenance of physical activity needs strategies to promote enjoyable, affordable and accessible activities.
The methodology for producing this discussion paper and recommendations for physical activity in older people consisted of four main components:
- Scoping: A framework for the development of the paper and recommendations was produced for discussion by the expert advisory group and subsequently refined;
- Literature review: The evidence was reviewed using approved national guidelines and a discussion document produced for consideration;
- Formulation of recommendations: A series of recommendations were outlined, incorporating guidance relevant to sub-populations of older people and specific stakeholder groups involved in implementation.These were reviewed by the expert advisory group;
- Refinement: The documents were refined in line with the feedback received from the expert advisory group. The refinement process also involved widespread national consultation, and focus groups with older people.
Top of page
The recommendationsThe recommendations reflect the heterogeneity of the older population in terms of physical capacity, activity patterns and cultural diversity. The rationale and purpose underlying each recommendation are explained (see recommendation section of this document).
Recommendation 1Older people should do some form of physical activity, no matter what their age, weight, health problems or abilities.
Recommendation 2Older people should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility.
Recommendation 3Older people should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days.
Recommendation 4Older people who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up the amount, type and frequency of activity.
Recommendation 5Older people who have enjoyed a lifetime of vigorous physical activity should continue to participate at this level in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to.
A broad range of physical activity options can improve health outcomes for older people, both in the short and medium-term. Endurance and strength training activities can be used to prevent and treat congestive heart failure, depression, diabetes, osteoporosis and other conditions affecting older people. Progressive resistance training can slow and even reverse age and disease-related loss of muscle mass and function, and activities involving balance can improve stability and reduce risk of falls.
In frail older people, even small gains in physical activity performance might have a significant effect on their functional performance and quality of life. Residential care programs must be feasible, acceptable to staff and residents, and be evaluated using relevant outcomes of function and quality of life. In all settings, those providing physical activity programs for older people should have adequate training and understanding of the specific needs and differences in physical activity for older people.
Very little research in physical activity for older people has investigated issues of effectiveness, implementation, or adherence in important population sub-groups such as Aboriginal and Torres Strait Islanders, and older people from Culturally and Linguistically Diverse Backgrounds. There is a need to ensure the recommendations and implementation strategies are culturally appropriate.
How much physical activity, how often and for how long?The recommendation of 30 minutes of moderate activity on most, if not all days of the week is relevant for older adults. Activity in any form is beneficial for older people. There is not yet sufficient evidence to allow us to advise on the ‘best’ intensity or duration of physical activity to adopt to accumulate the recommended amount of daily physical activity. That is, we do not know whether it is preferable to do more intense activity for shorter bouts or less intense activity for longer bouts in order to expend our weekly ‘dose’ of energy. More research is needed to establish optimal doses of physical activity for older people to achieve comprehensive health benefits, using studies that draw upon a broader range of older people and incorporating close monitoring of compliance rates.
Older people are generally aware of the health benefits of physical activity. However, knowledge alone is often not sufficient to motivate a person to adopt and maintain physical activity behaviour. Interventions incorporating the principles of behaviour change are needed, both to maximise the reach of physical activity promotion initiatives and programs across the older community and to minimise attrition once people begin to be physically active. Programs that include some behavioural techniques and have a community extension or connection are more likely to result in sustained increases in activity. Activity that is assisted by social support and woven into daily activities increases the likelihood of sustained behaviour and associated health benefits. To support older individuals in making behavioural change, modifications to their social and physical environment are needed. Strategies to address negative micro, meso and macro-cultural attitudes toward the concept of physical activity in older people are required. The physical environment will require adaptation to enable safe and enjoyable physical activity options to be readily accessible to all older Australians.
ConclusionPhysical activity provides a range of health benefits for older Australians. Physical activity programs - particularly for the frail old - need to provide not only facilities that are safe, accessible and appropriate, but also a supportive environment to optimise program adherence. The evidence overviewed in this document will assist capacity building for organisations and practitioners to conduct physical activity promotion amongst older people. The focus upon the translation of evidence into practice will engender optimal population health impact.
Top of page