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?
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
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
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
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
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.