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Implementing physical activity for older adults

This is an excerpt from Exercise and Physical Activity for Older Adults by Danielle R. Bouchard.

By Gregory W. Heath and Danielle R. Bouchard

Even if many physical activity recommendations are published, strategies or details about how to meet them are often unknown for clients. What types or frequency is needed?How do I reach moderate intensity? How should I change my exercise program over time?These elements are discussed below.

Recommendations for Type of Physical Activity

Many older adults who seek to participate in aregular physical activity program have significant limitations (Kelley, Kelley, Hootman, & Jones, 2009). For example, physical activity programs for those with degenerative joint disease (including osteoarthritis), which is common in this age group, must be appropriately modified to ensure that participants achieve the goal of improving functional health (Cross et al., 2014; Tanaka, Ozawa, Kito, & Moriyama, 2015). An emphasis on minimal or non-weight bearing, low-impact activities, such as cycling, swimming, and chair or floor exercises, may be most appropriate (Cross et al., 2014; Tanaka et al., 2015). Activity may be contraindicated initially for individuals with restricted ability in the knees and hips, or with restricted movement to and from the floor. Most older adults are able to engage in moderate walking activities (Arnett, Laity, Agrawal, & Cress, 2008). Individualization of the mode of activity, including variation of activity and adjustments for participant bias and preference, is important.

Recommendations for Specific Frequency of Physical Activity

Physical activity guidelines place an emphasis on the accumulation of activity over the span of one week as the volume of activity (Holmes, Powell-Griner, Lethbridge-Cejku, & Heyman, 2009; Tremblay, Kho, Tricco, & Duggan, 2010). However, the primary message for older adults is to build some type of movement into each day, whether this is purposeful physical activity (e.g., active transport, home/yard maintenance, active recreation, active sport) or planned exercise. An emphasis on a frequency of physical activity among older adults from five to seven days per week may enhance and promote the maintenance of physical activity behaviors as well as maintain endurance capacity, flexibility, and strength, all of which translates into an exemplary level of functional health (Holmes et al., 2009; Tremblay et al., 2010).

Generally, no specific information on frequency for physical activities is stated in any of the current guidelines. This is because compared to the total volume of weekly physical activity, frequency (i.e., days per week), and specific mode (e.g., bike) lack evidence that a certain number of days per week is necessary to improve functional outcomes. The total volume of physical activity (e.g., 150 min per week) is that which conveys functional health and fitness and not the number of days, per se.

Recommendations for Duration of Physical Activity

Although published physical activity guidelines recommend 150 to 300 min of moderate aerobic activity per week (Holmes et al., 2009; Tremblay et al., 2010), this amount of activity can be obtained through various schedules or through the accumulation of multiple bouts of activity. However, where specific fitness or performance goals are pursued, then the specificity of the activity and a duration from 20 to 40 min of endurance activity per session is an appropriate goal for most older adults to experience significant gains in endurance capacity (Stathokostas, Jacob-Johnson, Petrella, & Paterson, 2004). However, pathophysiological limitations may indicate a need for a shorter duration (10-15 min) repeated two to three times per day. In contrast, some age-related limitations may require that the intensity of exercise be decreased and, thus, the duration increased (up to 60 min, if possible).

Recommendations for Intensity of Physical Activity

Intensity is critical due to general medical and physiological limitations that often exist among older adults (Brandon et al., 2004). For participants with chronic conditions or older adults, the percent of maximum heart rate (HRmax) or metabolic equivalent (MET) level might need to be reduced to reach moderate intensity (Kozey et al., 2010). For example, the young-old (younger than 75) person may have a peak work capacity greater than 7 METs, whereas the old-old (older than 75) person frequently has peak work capacities of less than 4 METs.Medical and physical activity status may vary significantly, and generalization of workload can be difficult. The assessment of MET levels to establish intensity after assessment of work capacity is useful, especially among those older adults who may be using prescribed medicines affecting HR. Ratings of perceived exertion (RPE) also appear to be effective in regulating intensity in older adults, especially when combined with the use of target heart rate (Shanahan et al., 2016).

Recommendations for Progression of Physical Activity

Depending on the goal of the individual, a gradual increase in the dose of physical activity in terms of duration, frequency, and intensity is most appropriate for previously sedentary or irregularly physically active older adults. The initiation of a physical activity program for previously inactive older adults might be an introductory lead time from four to six weeks. This is usually adequate for most older participants to progress from light bouts to moderate or vigorous bouts of physical activity. Another four to six weeks may be necessary to achieve a comfortable maintenance level. Individual variability in fitness and adaptation to exercise usually dictates the rate of progression.

Recommendations for Programming

It is important for older adults to successfully implement and maintain a regular routine of physical activity to ensure positive improvements and maintenance of functional health. This can be achieved through a number of options that may include supervised physical activity programming, either professionally supervised or peer-led (Bouaziz et al., 2018; Hortobagyi et al., 2015; Keadle, McKinnon, Graubard, & Troiano, 2016; Liberman, Forti, Beyer, & Bautmans, 2017; Pahor et al., 2014). The advantage of this approach is the presence of social support (a strong determinant of physical activity) and access to immediate physical activity guidance through qualified fitness professionals and health care providers (Pahor et al., 2014; Van Abbema et al., 2015).

Another option for delivery of physical activity promotion among older adults is through self-directed and self-monitored physical activity programming (Van Abbema et al., 2015). Outreach programs sponsored by global, national, and regional agencies (e.g., Health Canada, U.S. Centers for Disease Control and Prevention, World Health Organization) and community-based organizations (e.g., local parks and recreation, senior centers, hospitals, clinics, health care providers) offer many supporting materials and online coaching services that can assist an older adult in initiating and maintaining a program of regular physical activity. In addition, the use of smartphone technology allows older adults to monitor their own physical activity program, initiate physical activity prompts and cues, and connect with others as a means of social support for their individual programs.