Q: What types of exercises are recommended for healthy older adults? Is a walking program sufficient for improved health? Are there any benefits for resistance training during this phase of life?
A:“Older adults” typically refers to anyone age 65 years or older, but it is important to realize that this age group includes a wide range of fitness and health. Unfortunately, age-related physiological changes result in declines in functional capacity that can impact activities of daily living (5) (see examples of physiological changes in Box 1). In addition, physical activity levels, both aerobic and muscular, decline across the life span (Fig. 1) (4). Thus, the aging process includes factors related to the passage of time (primary aging) and effects caused by lifestyle behaviors and chronic disease (secondary aging) (5). Genetic influences are another potential factor, with potential interactions with both age-associated declines and secondary aging (5).
One of the goals related to exercise throughout the life span is “healthy aging,” which means minimizing the impact of chronic conditions (e.g., heart disease, stroke, diabetes mellitus) on day-to-day life. Individuals with higher fitness during midlife often experience a delayed onset of chronic conditions. Specifically, higher midlife fitness was related to a lower burden of chronic diseases within the last 5 years of life (11). Strength and aerobic-based training can improve functional fitness (8). Thus, a complete exercise program is important throughout the life span (1).
Support for a comprehensive exercise program for older adults can be found in the 2007 American Heart Association and American College of Sports Medicine (ACSM) recommendations (9) as well as the 2008 Physical Activity Guidelines for Americans (10). These publications have been pivotal in supporting the many benefits of exercise for health and reflect the growing scientific knowledge base related to exercise in older adults. Highlights from each of these documents, relating to older adults, are included in Table 1. Overall, these recommendations are quite similar and include a focus on aerobic activity and muscular fitness, along with balance training for older adults at risk of falling (9,10).
In 2009, ACSM released a position stand “Exercise and Physical Activity for Older Adults” (5) (replacing a previous position stand published in 1998). The position stand can be found at http://www.acsm.org/access-public-information/position-stands. Although reviewing the list of physiological changes in Box 1 may seem disheartening, the position stand provides three evidence statements that should encourage physically active older adults (5):
- 1. “Healthy older adults are able to engage in acute aerobic or resistance exercise and experience positive adaptations to exercise training.”
- ○ Examples of potential positive adaptations caused by aerobic training: increases V˙O2max, reduces rise in blood pressure during exercise, reduces total body fat, counteracts age-related declines bone mineral density in postmenopausal women
- ○ Examples of positive adaptations possibly caused by resistance training: increases muscular strength and power, improves muscular endurance, increases fat-free mass and decreases fat mass, preserves or improves bone mineral density
- 2. “Regular physical activity can favorably influence a broad range of physiological systems and may be a lifestyle factor that discriminates between those individuals who have and have not experienced successful aging.”
- 3. “Regular physical activity reduces the risk of developing a large number of chronic diseases and conditions and is valuable in the treatment of numerous diseases.”
As is evident from these conclusions, as well as the benefits highlighted in Box 2 (a contrast to the list in Box 1), “successful aging” is promoted with a regular exercise program including both aerobic and resistance training.
In addition, a comprehensive exercise program typically includes flexibility exercises and balance training (2), which more recently was expanded to neuromotor exercise training (7) as covered in a previous “Wouldn’t You Like to Know” article in the 2012 November/December issue (3). Putting all the pieces of an exercise program together may seem overwhelming. An example of a program for healthy older adults that are just starting an exercise program is found in Table 2 (1). Many excellent (and free) resources related to exercise and older adults also are available (Box 3).
Knowing what to recommend is an important step, but fitness professionals also must be aware of factors that may challenge adherence. Barriers to exercise for older currently nonactive adults have some common themes, including lack of time, potential for injury, self-discipline, motivation, boredom, and intimidation (6). When asked to describe an ideal physical activity program, older adults cite ease of access and knowledgeable staff as important factors (6). Fitness professionals, therefore, are pivotal in helping provide safe and effective programs for older adults.
Given the many benefits, developing a comprehensive exercise program is a valuable tool in the quest for successful aging. A comprehensive exercise program includes cardiorespiratory (aerobic) exercise, resistance training, flexibility and neuromotor exercise training (7). Older adults unable to meet minimum recommendations because of chronic health conditions should try to be as active as abilities and conditions allow (1,10).
1. American College of Sports Medicine. ACSM’s Complete Guide to Fitness & Health
. Bushman BA, editor. Champaign: Human Kinetics; 2011. 396 p.
2. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2010. 380 p.
3. Bushman BA. Wouldn’t you like to know? Neuromotor exercise training. ACSM’s Health Fitness J. 2012; 16 (6): 4–7.
4. Centers for Disease Control and Prevention/National Center for Health Statistics/Office of Analysis and Epidemiology. Health, United States, 2011
; [cited 2012 Oct 3]. Available from http://www.cdc.gov/nchs/hus.htm
5. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al.. American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009; 41 (7): 1510–30.
6. Costello E, Kafchinski M, Vrazel J, Sullivan P. Motivators, barriers, and beliefs regarding physical activity in an older adult population. J Geriatr Phys Ther. 2011; 34: 138–47.
7. Garber CE, Blissmer B, Deschenes MR, et al.. American College of Sports Medicine Position Stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc. 2011; 43 (7): 1334–59.
8. Martins RA, Coelho E, Silva MJ, Pindus DM, Cumming SP, Teixeira AM, Verissimo MT. Effects of strength and aerobic-based training on functional fitness, mood and the relationship between fatness and mood in older adults. J Sports Med Phys Fitness. 2011; 51: 489–96.
9. Nelson ME, Rejeski WJ, Blair SN, et al.. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007; 39 (8): 1435–45.
10. U.S. Department of Health and Human Services Web site [Internet]. 2008 Physical Activity Guidelines for Americans
. 2008. Atlanta (GA): USDHHS; [cited 2011 Aug 2]. Available from: http://www.health.gov/paguidelines
11. Willis BL, Gao A, Leonard D, Defina LF, Berry JD. Midlife fitness and the development of chronic conditions in later life. Arch Int Med
. Published online August 27, 2012; [cited 2012 Sept 24]. Available from: www.archinternmed.com