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Active for Later Life Making the case for physical activity and older people.

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Presentation on theme: "Active for Later Life Making the case for physical activity and older people."— Presentation transcript:

1 Active for Later Life Making the case for physical activity and older people

2 What do we mean by ‘older people’? The benefits of physical activity for older people How active are older people? How active should older people be? Can we help to change matters? What helps older people to become active? Older people and physical activity – strategic connections

3 What do we mean by ‘older people’?

4 “We all age, but we all age differently” Not a homogeneous group Traditionally defined as those aged over 50 Significant variations in health and functional capacity Improvements in health and longevity Self-identification often most important What do we mean by ‘older people’?

5 Hierarchy of physical function (World Health Organization, 1997) Physically fit Physically unfit Physically unfit frail Healthy Unhealthy independent Unhealthy dependent Group 1 Group 2 Group 3

6 What do we mean by ‘older people’? Hierarchy of physical function (Adapted from Spirduso, 1995) Physical function Physically elite Physically fit Physically independent Physically frail Physically dependent Disability

7 What do we mean by ‘older people’? National Service Framework for Older People Entering old age Transitional phase Frail older people (Department of Health, 2001a)

8 What do we mean by ‘older people’? Older people and physical activity Entering old age Making Activity Choices To promote and extend healthy active life and compress morbidity Transitional phase Increasing the Circle of Life To maintain independence and reduce long-term dependency Frail older people Moving in the Later Years To maintain independence and improve quality of life

9 The benefits of physical activity for older people

10 Increasing evidence in relation to: Disease prevention and management, psychosocial benefits and complications of immobility Maintaining independence, improving the quality of life, and ‘successful ageing’ Opportunities for significant savings to health and social care services Benefits can be achieved by healthy older people as well as the frail and very old.

11 The benefits of physical activity for older people Prevention and management of disease Coronary heart disease Stroke Increased blood pressure Late onset (Type 2) diabetes Osteoporosis Colon cancer Weight control Reduction in accidental falls Effects apparent even among those taking up activity at a later age.

12 The benefits of physical activity for older people Psychological benefits Reduction in stress and anxiety Reduction in depression Improvement in overall psychological well-being Improvements in cognitive function Improvements in self-esteem and self-worth Reduction in isolation and loneliness Effects apparent even among those taking up activity at a later age.

13 The benefits of physical activity for older people Reducing the complications of immobility Deep vein thrombosis Gravitational oedema Intermittent claudication Contractures Pressure sores Faecal impaction Effects apparent even among those taking up activity at a later age. Movement can be passive and aided.

14 The benefits of physical activity for older people Maintenance of social networks Continued independent living Improved quality of sleep Sustained performance of ‘activities of daily living’ Effects apparent even among those taking up activity at a later age. Improvements in independence, quality of life and successful ageing

15 The benefits of physical activity for older people Potential social benefits Enhanced social integration Formation of new friendships Widening of social networks Role maintenance and new role acquisition Empowerment Enhanced inter-generational activity Positive images of older people Maintenance of caring skills Reduced health and social care costs

16 The benefits of physical activity for older people Reduction in health and social care costs Accidental fractures among women (£1.8 billion) CHD and stroke (£1.6 billion for health care alone) Diabetes (5% of NHS resources) Obesity (£2.5 billion) Poor mental health (£32 billion)

17 The benefits of physical activity for older people Changing the focus of physical activity promotion Disease prevention Maintenance of independence Age

18 How active are older people? Levels of physical activity, fitness and functional capacity

19 How active are older people? Regular physical activity among MEN aged 50+, England % participating at least five times a week Age 0% 20% 40% 60% 80% (Skelton, Young et al, 1999)  5 kcal/min including brisk/fast walks  2 miles  4 kcal/min including all walks  2 miles  4 kcal/min plus all walks  1 mile

20 How active are older people? Regular physical activity among WOMEN aged 50+, England % participating at least five times a week Age 0% 20% 40% 60% 80%  5 kcal/min including brisk/fast walks  2 miles  4 kcal/min including all walks  2 miles  4 kcal/min plus all walks  1 mile (Skelton, Young et al, 1999)

21 How active are older people? Regular physical activity among minority ethnic groups aged 55+, England Those participating in activity 5 x 30 minutes a week African-Caribbean Indian Pakistani Bangladeshi Chinese 20% 22% 15% 7% 13% 14% 2% 6% 1% 14% Men Women (Erens et al, 2001)

22 How active are older people? Levels of sedentary behaviour among MEN aged 50+, England % participating less than once a week Age 0% 20% 40% 60% 80% (Skelton, Young et al, 1999)  5 kcal/min including brisk/fast walks  2 miles  4 kcal/min including all walks  2 miles  4 kcal/min plus all walks  1 mile

23 How active are older people? Levels of sedentary behaviour among WOMEN aged 50+, England % participating less than once a week Age 0% 20% 40% 60% 80% (Skelton, Young et al, 1999)  5 kcal/min including brisk/fast walks  2 miles  4 kcal/min including all walks  2 miles  4 kcal/min plus all walks  1 mile

24 How active are older people? Levels of sedentary behaviour among minority ethnic groups aged 55+, England Those participating less than once a week African-Caribbean Indian Pakistani Bangladeshi Chinese 57% 67% 73% 85% 68% 59% 78% 85% 92% 64% Men Women (Erens et al, 2001)

25 How active are older people? Participation in walking among MEN aged 70+, England % able to walk for different periods of time and length of walk, without discomfort Age 0% 20% 40% 60% 80% min 15, < 30 min 5, < 15 min < 5 min 100% 1 / 4 mile or more (Skelton, Young et al, 1999)

26 How active are older people? Participation in walking among WOMEN aged 70+, England % able to walk for different periods of time and length of walk, without discomfort Age 0% 20% 40% 60% 80% min 15, < 30 min 5, < 15 min < 5 min 100% 1 / 4 mile or more (Skelton, Young et al, 1999)

27 How active are older people? Older people living in care and residential settings 86% of women and 78% of men in care homes are sedentary. Sedentary behaviour in care homes is double that in private households (at age 65+). Half of all men and women in local authority residential homes never or very occasionally take trips outside the home. (Department of Health, 2002b)

28 How active are older people? Thresholds for quality of life Exercise performance Age Adapted from Young (1986) ‘Threshold’ value necessary for performance of an everyday task Physically active Physically inactive

29 How active are older people? Aerobic capacity in MEN and WOMEN aged (mean ± 2sd) Maximum oxygen uptake (ml/kg/min) (Skelton, Young et al, 1999) Age VO 2 max to walk comfortably at 3mph Men Women

30 How active are older people? Knee extension strength in MEN and WOMEN aged (mean ± 2sd) Isometric knee extension strength (N/kg) (Skelton, Young et al, 1999) Age Strength to be confident of rising from low chair without using one’s arms Men Women

31 How active are older people? Shoulder flexibility in MEN and WOMEN aged 50+ (mean ± 2sd) Shoulder abduction (degrees) (Skelton, Young et al, 1999) Age Requirement to wash hair without difficulty Men Women

32 How active are older people? Functional capacity Even healthy older people lose functional capacity. Muscle strength ‘lost’ at 1%-2% per year Muscle power ‘lost’ at 3%-4% per year Aerobic capacity ‘lost’ at 1% per year Bone density ‘lost’ at 1% in men and 2%-3% in women after menopause Flexibility and balance Proprioception and kinesthetic awareness Co-ordination and reaction Thermo-regulation Sedentary behaviour increases loss of performance. (Skelton and Dinan, 1999)

33 How active are older people? Functional decline and frailty (Spirduso, 1995) DiseaseDisuse Time Human frailty

34 How active are older people? Inactivity-related disease? Disuse rather than disease? One week’s bed rest reduces: – strength by up to 20% – spine bone mineral content by 1%. Nursing home residents spend 80%-90% of their time seated or lying down – leading to inactivity-related disability. Those who are less active and weaker will enter nursing homes earlier than those who maintain their fitness.

35 How active are older people? Physical activity is disappearing from everyday life Labour-saving devices Transport patterns Concerns over safety in public spaces Sport as entertainment The impact of information technology Leading to an increase in sedentary and physically less demanding lifestyles

36 How active should older people be? Current recommendations

37 How active should older people be? Recommendations for all adults “30 minutes of moderate physical activity, on at least five occasions a week.” (Department of Health, 1999b) Activities like brisk walking, cycling, swimming, dancing and gardening are good options.

38 How active should older people be? Working towards the recommended levels Those who cannot achieve the recommended 30 minutes should build towards that target, e.g. 2 x 15 minutes and smaller bouts of activity on a regular basis. Even the smallest amounts will bring some benefit, e.g. walking to the post box on the corner of the street or to the bottom of the garden.

39 How active should older people be? Physical activity for the older person should also include: muscle strength and endurance (resistance) exercises for all major muscle groups balance exercises flexibility (stretching) (American College of Sports Medicine, 1998)

40 How active should older people be? Physical activity opportunities for older people Continued or renewed sports participation and active recreation as well as fitness, exercise and dance activities and groups ‘Active Living’ including walking, cycling, swimming and gardening Playing with grandchildren, posting a letter, walking in shopping centres Chair-based activities Assisted corridor and ward walking, or activities in the bath and at bedtime

41 Can we help to change matters? Evidence of effectiveness and successful interventions

42 Can we help to change matters? Evidence of effectiveness From a critical review of 29 physical activity interventions: Increased activity levels over a longer period of time Group/class-based and home-based activity were effective Tailored to individual needs Cognitive-behavioural strategies and goal-setting Telephone support and continued contact (King et al, 1998)

43 Can we help to change matters? Evidence of effectiveness Strength – Fiatarone et al, 1990 Functional capacity – Skelton et al, 1995 Bone density – Rutherford, 1999 Depression – Blumenthal et al, 1999 Blood pressure – Young et al, 1999 Mental health – Fox, 1999 Cardiac rehabilitation – Jolliffe et al, 2001

44 Can we help to change matters? Evidence of effectiveness – falls prevention FICSIT Trials: Province et al, 1995 Tinetti et al, 1996 Wolf et al, 1996 Campbell et al, 1997 PROFET: Close et al, 1998 Gardner et al, 2000 FaME: Skelton, 2001 Day et al, 2002

45 Can we help to change matters? Evidence of effectiveness – duration vs outcome Gait (8 weeks) Balance (Static 8 weeks + Dynamic 8 weeks) Muscle strength (8-12 weeks) Muscle power (12 weeks) Endurance (26 weeks) Transfer (6 months) Postural hypotension (24 weeks) Bone strength (1 year for femur and lumbar spine) (Skelton and McLaughlin, 1996)

46 Can we help to change matters? Promoting physical activity through primary health care Physical activity advice/counselling can increase physical activity. King et al, 1995 Riddoch et al, 1998 PAL: Goldstein et al, 1999 Eakin, 2001

47 Can we help to change matters? Home-based programmes Improve health and function in older people living in the community Some studies show higher rates of adherence to prescribed exercise compared with group activities. Telephone-based counselling improves participation and adherence. Improvements in muscle strength and functional capacity. (Atienza, 2001)

48 Can we help to change matters? Community-based physical activity programmes Reviews King et al, 1998; Stewart, 2001 Interventions CHAMPS: Stewart, 2001 GALM: Stevens et al, 1999 On the Move: Cassady et al, 1999 Dunn et al, 1999 There is a need for differentiation.

49 Can we help to change matters? Best practice for promoting physical activity with older people Use of a health educator and extended consultation time Agreement of problem areas Goals agreed by both older person and professional Identification and recognition of social and environmental barriers Tailored action plan Choice and range of accessible local activities Supplementary educational materials Systematic follow-up and support over time

50 What helps older people to become active? Barriers, beliefs, attitudes and motivation

51 What helps older people to become active? Barriers to activity Intrinsic barriers Those that relate to the beliefs, motives and experiences of the individual, e.g. previous experiences at school, concerns about over- exertion, or perceptions of physical activity. Extrinsic barriers Those that relate to the broader physical activity environment, e.g. skills and attitudes of others, the types of opportunities available, access and safety.

52 What helps older people to become active? Previous experiences Opportunities in school Activity not associated with fitness and health Armed forces Limited experiences of sport All aspects of life were more physically demanding

53 What helps older people to become active? Older people’s sources of beliefs The media (radio, TV, magazines, newspapers) Workplace, leaflets ‘Common sense’ Personal experiences (and experiences of others) Medical and health professionals (Finch, 1997)

54 What helps older people to become active? Beliefs about activity It’s good for you. It’s common sense. General health benefits Specific health benefits e.g. weight control, mental well-being, specific conditions Maintenance of function Onset of ageing (Finch, 1997)

55 What helps older people to become active? Moderation “at our age” “You can overdo it.” Gentler activities are more suitable. It depends on the individual. Fears over breathlessness and increased heart rate. (Finch, 1997)

56 What helps older people to become active? Beliefs – exceptions to the positive view The health ‘lottery’ A fashion for exercise nowadays “You need to be fit to do physical activity.” Too late to start Dangers when you stop “It can become an obsession.” (Finch, 1997)

57 What helps older people to become active? Overcoming barriers The association between physical activity and exercise and sport Frequency Intensity Old age is a time to slow down. Reassurance and education (Finch, 1997)

58 What helps older people to become active? Beliefs about activity – the underlying motivators To maintain suppleness and agility, and control weight ‘Feeling better’ Enjoyment Prevent future illness Manage existing health problems To keep going, be independent (live longer rare) Adventure/challenge, new learning (Finch, 1997)

59 What helps older people to become active? Overcoming concerns about being active “I don’t think I should start at my age.” “I’m worried I might hurt something.” “I have to take it easy at my age.” “My aches and pains will get worse.” “Can I do exercise with my blood pressure?” Health concerns need the advice of a GP.

60 What helps older people to become active? ‘Triggers’ and life events Wanting to play with grandchildren Physiological signs of ageing Retirement, children leaving home Onset of ailment or illness Moving home Bereavement Maintaining independence (Finch, 1997)

61 What helps older people to become active? Extrinsic barriers Skills and attitudes of others, e.g. exercise instructors, GPs, leisure/recreation managers Appropriate programming Accessible opportunities (transport) Safe activity environments (parks, well-lit streets) Positive images of older people

62 What helps older people to become active? A different ‘spin’ on fitness Strength to lift household objects Flexibility to wash hair, tie shoes Balance and agility to climb stairs Co-ordination and dexterity to open a door with a key Speed to cross the road at pedestrian traffic lights Muscular endurance to walk to the shops

63 Older people and physical activity: Strategic connections

64 Strategic connections National Service Framework for Older People Standard 8 The promotion of health and active life in old age Increasing physical activity Improved nutrition and diet Immunisation and management of influenza Other areas of health promotion e.g. smoking cessation

65 Strategic connections National Service Framework for Older People Standard 1 Age discrimination Standard 5 Stroke Standard 6 Falls Standard 7 Mental health

66 Strategic connections National Service Frameworks Preventative aspects of: NSF for Coronary Heart Disease NSF for Mental Health NSF for Diabetes NHS Cancer Plan National osteoporosis strategy

67 Strategic connections Other strategic connections Successful ageing and ‘Ageing Well’ Independent living Cultural strategies and sports development e.g. Active Communities Neighbourhood regeneration and renewal Human transport Lifelong learning

68 Active for Later Life – Summary Physical activity can contribute significantly towards successful ageing. Although physical activity can confer a wide range of benefits, the majority of older people remain inactive. Even modest amounts of activity can be beneficial. There are many opportunities to enable older people to become Active in Later Life.


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