UK Physical Activity Guidelines

UK Physical Activity Guidelines
UK-wide Global evidence of the health benefits Life course Recommended amount for health benefit This set of guidelines, first published in July 2011 and titled Start Active, Stay Active, is the first time England, Scotland, Wales and Northern Ireland have had the same guidelines The guidelines are based on comprehensive reviews of research evidence and take account of publications which consider the guidelines in other developed countries such as USA, Australia and Canada. These guidelines cover all age groups across the lifespan: early years (0-5 years), children and young people, adults and older adults. The government recommendations are based on prescribing a minimum level of physical activity to benefit health and focus on prevention of disease. These guidelines apply to all, irrespective of gender, race, or socio-economic status, but should be interpreted with consideration of individual physical and mental capabilities.

Why do we need guidelines for older adults?
Physical activity levels are low and decline with age The benefits of regular physical activity for older adults are well known Consistent public health messaging There is a well-established trend of a decline in physical activity levels as we get older. However, being active regularly can improve physical and psychological health and is associated with the maintenance of functional activities and independence. It can also assist in reversing the decline of physical function even in later life. These guidelines provide a basis for consistent public health messaging and physical activity promotion programmes by anybody working to promote physical activity with older adults. The following slides introduce all six guidelines for older adults (aged 65+).

UK physical activity guidelines: Older Adults
Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Some physical activity is better than none, and more physical activity provides greater health benefits. Physical activity levels amongst older adults are low and meeting the Chief Medical Officers guidelines provides a significant challenge for many older adults. For the majority of older adults, moving towards the recommendation provides a starting point and small increases will produce some health benefits. This guideline is simply about motivating older adults to move a little bit more.

Working towards achieving the guidelines
Moving Moving More Often Moving regularly and frequently Increased benefits Meeting the guidelines The dose response curve of physical activity in this slide demonstrates the first guideline well. Dose response refers to the concept that as physical activity levels increase, so do the health benefits. Helping older adults to reduce their sedentary behaviour and progress to moving, to moving more often and then to moving regularly and frequently will produce the greatest reduction in risk. Sedentary individuals can gain some health benefits simply by moving a little bit more. If they begin to move more often and gradually build to meet the physical activity guidelines, the health benefits experienced with increase proportionally. Sedentary Increased physical activity

UK physical activity guidelines: Older adults
Older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more One way to approach this is to do 30 minutes on at least 5 days a week. A series of recent systematic reviews consistently identified 150 minutes of moderate intensity physical activity per week as providing substantial benefits for the prevention of over 20 chronic diseases, including coronary heart disease, stroke, type 2 diabetes, depression, dementia and loss of physical function. 150 minutes may seem like a significant challenge for some adults, but this can be achieved by accumulating multiple activity bouts of at least 10 minutes over the week. This is likely to be a more realistic way for some adults to achieve the guidelines. It is the overall volume of activity that is key to the beneficial effects of physical activity rather than the intensity or frequency.

Moderate intensity activity will make older adults: feel warmer breathe harder have a faster heart beat out of breath but still able to hold a conversation. Moderate physical activity will cause older adults to become warmer, breathe harder and feel their heart beating faster than usual. They should still be able to carry on a conversation. Many older adults may feel nervous at being asked to raise their heart and breathing rate and may interpret this as an onset of a cardiac event or asthma. However, this is just a normal reaction to activity.

For those who are already active at a moderate intensity, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or a combination of moderate and vigorous activity. Vigorous activity may not be appropriate for all older adults and should only be attempted by those who have been very active for some time and have a high level of fitness. A small percentage of older adults continue with higher intensity physical activity through regular running, swimming, cycling or competitive sports. To gain the same benefits as 150 of moderate physical activity, it only takes 75 minutes of vigorous activity. It may also bring significantly increased benefits for some fitness and health outcomes.

Older adults should also undertake physical activity to improve muscle strength on at least two days a week (in addition to the 150 minutes) Muscle strengthening activities should be included at least twice a week in addition to the 150 minutes a week. Muscle strengthening exercises help maintain functional ability and reduce the bone and muscle loss associated with ageing. Strength activities will help older adults with simple activities such as walking, climbing steps or standing from a chair.

Types of strength exercises Movements against a resistance or extra weight Some everyday activities, eg, using the stairs, Tai Chi, heavy housework, gardening, lifting Participation in a class or home based programme Muscle strengthening activities that load each of the main muscle groups provide the greatest benefits. Initially, using body weight will have a strengthening effect, eg, gardening, stair climbing, hill walking or dance. As strength improves, adults should try using a heavier weight. This could be achieved by attending group classes to improve strength. It is normal for muscles to feel stiff or sore in the few days after carrying out strength activities and strength activities should not be carried out on consecutive days.

Older adults at risk of falls should incorporate physical activity to improve balance and co-ordination on at least two days a week 33% of adults aged 65+ and 50% of those aged 80+ fall every year. Older adults can reduce this risk by doing activities to improve balance at least twice a week in addition to the recommended 150 minutes. There is good evidence that physical activity programmes which emphasise balance training, limb co-ordination and muscle strengthening activity are safe and effective in reducing the risk of falls.

What counts as balance activities? Standing or moving about whilst standing and: reducing the base of support moving the centre of mass reducing upper body support. Activities that challenge balance can help reduce falls and maintain independent living. Activities that improve balance include standing or moving about and fit into one of the following categories: reducing the base of support eg, standing on one leg or going up on tip toes. movement of the centre of mass of the body eg, racket sport, dancing, Tai Chi, standing exercise classes, movement to music classes and walking on uneven ground reducing the amount of body support eg, changing from holding onto a supportive object to being unsupported.

All older adults should minimise the amount of time spent being sedentary (sitting) for extended periods. Sedentary behaviour refers to a group of behaviours that occur whilst sitting or lying down and that typically require very low energy expenditure. The Chief Medical Officers guidelines include for the first time a recommendation about reducing sedentary behaviour. Sedentary behaviour refers to a group of behaviours that occur whilst sitting or lying down and that typically require very low energy expenditure. Examples of sedentary behaviour include sitting whilst watching television, using a computer, driving a car or being a passenger.

A risk factor for poor health independent of physical activity High levels of sedentary behaviour among older adults Alarming levels of sedentary behaviour in residential and nursing homes and hospitals Sedentary behaviour is an independent risk factor for poor health, meaning that even if you are active, being sedentary can be bad for your health, including a loss of muscle function, mobility and bone health. Sedentary behaviour increases with age and rises sharply from age 70 (in some cases as much as 10 hours a day). Older adults should break up long periods of sedentary time by walking around for a few minutes or performing some sit to stand exercises.

Top line messages Moving more often every day
Some activity is better than none. Build up your activity gradually. Be sure to add activities that will help you be strong and steady. Limit and break up the amount of time spent sedentary. These top line messages summarise the important information included in the Chief Medical Officers’ guidelines for physical activity for older adults.

Different individuals and groups
Older adults are not all the same, we need to interpret the guidelines for: The Actives - already active Older adults in transition –experiencing a decline in function Frail elderly people - very low physical or cognitive function and frailty Not all older adults are the same and there is a difference in functionality between and older adult who can still participate in vigorous activity and a frail person in a care home, regardless of their age. They can be grouped into three: The Actives - Those who are already active, either through daily walking, leading an independent life, an active job and/or who are engaging in regular recreational or sporting activity. In transition - They are said to be in transition - between independence and dependence, good health and poor health. They may be losing their muscle strength and balance and may be overweight. Frail elderly - Those who are frail or have very low physical or cognitive function perhaps as a result of chronic disease such as arthritis, dementia, or very old age itself.

Benefits of physical activity
Being active helps prevent and manage over 20 long term conditions as well as maintain functional capacity and independent living in old age. The following slides explain the benefits of physical activity for older adults.

Disease prevention Being active in later life has a preventative effect for: all cause mortality cardiovascular disease type 2 diabetes physical function weight gain. Evidence suggests that the preventative effect of activity on all cause mortality, cardiovascular disease and type 2 diabetes is as strong in older adults as it is for adults. Active adults have better levels of physical function compared to their lower active peers. Being active can help older adults reach and maintain a healthy weight. For obese or overweight older adults, being active can have health benefits even in the absence of weight loss.

Disease symptoms Older adults may be suffering from disease symptoms.
Being active can help alleviate symptoms of some the following: joint pain caused by arthritis breathlessness for people with COPD delayed progression of osteoporosis. Many diseases manifest in older age, but some symptoms can be alleviated through physical activity. Being active can help reduce the joint pain caused by rheumatoid arthritis and knee arthritis and people with Chronic Obstructive Pulmonary Disorder can experience reduced feelings of breathlessness. Strength training can increase the rate of bone turnover and slow the rate at which bone is lost (osteopenia). This delays the progression of osteoporosis.

Functional capacity Resistance training can help improve physical function and mobility Cardiorespiratory training can offset the decline in endurance Naturally, functional capacity declines with age impacting on older adults health, wellbeing and ability to maintain independent living. This can be offset by resistance training which can improve factors such as walking speed and time to stand from a chair. Examples of resistance training can be movement against a resistance or additional weight, this can include bodyweight through climbing the stairs, doing the gardening. Cardiorespiratory training includes anything that raises an individuals heart beat and causes them to breathe harder. It will reduce the rate of decline in endurance and help reduce feelings of breathlessness and fatigue.

Fall prevention Approximately 33% of adults aged 65+ fall each year
Major cause of injury Regular physical activity helps maintain balance Specific postural stability exercise are beneficial to unstable individuals Approximately 33% of older adults fall each year, increasing to 50% in adults over 80 years. Balance impairment is a key risk factor for falls, which can be improved by regular physical activity. For more unstable older adults, specific postural stability exercise may be beneficial.

Circulation Among frail older adults, physical activity and movement that promote circulation will assist in reducing certain complications including: deep vein thrombosis gravitational oedema contractures pressure sores Physical activity promotes blood circulation which will assist in reducing the following complications: deep vein thrombosis - a blood clot in one of the deep veins – usually in the calf or thigh gravitational oedema - swelling of the feet and lower legs caused by accumulation of fluid contractures - thickening of the joint tissues leading to deformity pressure sores – also known as bedsores develop when pressure is applied on the skin over a long period of time usually among people who are confined to bed or sitting for prolonged periods of time.

Mental wellbeing Being active in later life can help promote good mental health including: better perception of mental wellbeing increased self-esteem better ability to cope with stress reducing symptoms of depression and anxiety better quality and quantity of sleep.

Risks and benefits Engaging in physical activity carries very low health and safety risks for most older adults In contrast, the risks of poor health as a result of inactivity are very high. If older adults are encouraged to begin at their own pace and make gradual increases in duration, frequency and intensity over a period of time, physical activity carries very low health and safety risks for most older adults. The risks associated with inactivity are very high.

Physical activity levels in England
Based on the 2011 UK physical activity guidelines, in England: 47% of adults years meet the physical activity guidelines 20% of adults aged 75+ meet the physical activity guidelines. Men are more active than women Health Survey for England, 2012 This data, from the Health Survey for England, 2012 presents the proportion of adults meeting the physical activity guidelines of 150 minutes of moderate activity per week or 75 minutes of vigorous activity per week.

Physical activity levels in Scotland
Based on the 2011 UK physical activity guidelines, in Scotland: 51% of adults aged years meet the physical activity guidelines 26% of adults aged 75+ years meet the physical activity guidelines 53% of men and 56% of women are classified in the ‘low activity’ group Scottish Health Survey, 2014 This data, from the Scottish Health Survey, 2014 presents the proportion of adults meeting the physical activity guidelines of 150 minutes of moderate activity per week or 75 minutes of vigorous activity per week. Low activity refers to adults who complete less than 30 minutes of moderate activity or 15 minutes of vigorous activity per week

Physical activity levels in Wales
Based on the 2011 UK physical activity guidelines, in Wales: 56% of adults aged years meet the physical activity guidelines 35% of adults aged 75+ years meet the physical activity guidelines 40% of adults aged 65+ are classified as inactive Welsh Health Survey, 2015 This data, from the Welsh Health Survey, 2015 presents the proportion of older adults meeting the physical activity guidelines of 150 minutes of moderate activity per week or 75 minutes of vigorous activity per week. Adults are classified as inactive if they complete less than 30 minutes of moderate activity or 15 minutes of vigorous activity per week

Physical activity levels in Northern Ireland
Based on the UK physical activity guidelines in Northern Ireland: 28% of adults aged and 12% of adults aged 75+ are active for at least 150 minutes per week 6% of year olds and 1% of adults 75+ do muscle strengthening activities at least twice a week 14% of adults aged 65+ exercise to improve balance at least twice a week. Health Survey Northern Ireland 2013/14 This data, from the Health Survey Northern Ireland 2013/14 presents the proportion of adults meeting the physical activity guidelines of 150 minutes of moderate activity per week or 75 minutes of vigorous activity per week. It also asked questions about how many older adults guidelines on muscle strengthening exercise and exercises to improve balance.

Sedentary behaviour levels in the UK
In England, men aged 65+ spend 6-7 hours per day sedentary and women spend 5½-7½ hours per day sedentary. In Scotland, older adults aged 65+ spent between approximately 6½-7½ hours sedentary per day. In Northern Ireland, 61% of adults aged years and 70% of adults aged 75+ spend more than four hours per day sedentary. Sedentary behaviour refers to a group of behaviours that occur whilst sitting or lying down and that typically require very low energy expenditure.

Factors affecting physical activity
Physical activity is a complex, multi-dimensional behaviour influenced by a wide range of factors. Physical activity is a complex behaviour. A wide range of factors can influence whether or not older adults are active. These factors can operate at an individual, social and environmental level. The following slides explain what biological, demographic, psychological, social and environmental factors influence older adults ability to be active.

Factors affecting physical activity: Biological factors
Age: As adults get older, their levels of physical activity decline Gender: Men tend to be more active than women It is a well-established trend that physical activity levels decline with age. This is especially notable in older adults where physical activity levels are very low. Surveys consistently report that men are more active than women across all ages.

Factors affecting participation: Demographic factors
Older adults from the following groups tend to have lower activity levels: ethnic minority groups people who live alone lower socio-economic status lower levels of educational attainment. Several demographic factors influence physical activity. Adults from minority ethnic groups experience the greatest age related decline in physical activity. Older adults who live alone are likely to have lower activity levels than their married peers Those from a lower socioeconomic background have lower levels of activity Lower educational attainment is associated with a greater age related decline in physical activity participation.

Factors affecting participation: Psychological factors
Physical activity is positively associated with: self efficacy confidence risk perception beliefs attitudes values. Psychological markers can either facilitate or inhibit physical activity. The factors listed here are positively associated with physical activity. Therefore the greater an individual’s self-efficacy (belief in your own ability to be active), confidence, risk perception, beliefs, attitudes and values, the more likely they are to achieve higher physical activity levels.

Factors affecting participation: Psychological factors
Physical activity is negatively associated with: fear (of falling/over exertion) concern for personal safety. Older adults who experience fear of falling or over exertion while participating in activity and have a greater concern for their personal safety are less likely to be active. Overcoming these barriers may be essential to helping older adults become active.

Factors affecting participation: Social factors
Social factors that positively affect physical activity are: social support offered by significant others and health professionals social cohesion by having trust, solidarity and sharing values among neighbours. Older adults who are offered support by significant others, eg, GPs, exercise and physical activity practitioners, care givers, family and friends are more likely to be active. Older adults who trust their neighbours and share their values have higher physical activity levels.

Factors affecting participation: Environmental factors
Some environmental factors impact older adults activity levels: crime traffic safety transportation shortages proximity of destinations. Crime: Levels of crime are more likely to deter older adults from going outside than any other age group. Traffic Safety: Fear of traffic is common among older adults as they are the most likely to be involved in road traffic accidents. In addition, the time allocated by traffic lights to cross a road requires an average walking speed that is higher than what is achievable by most 70 year olds. Transportation: A shortage of transportation options prevents older adults from taking part in a range of activities. Proximity to destinations: Older adults are more likely to walk if they have somewhere interesting to go and they often report that there is a lack of physical activity opportunities and settings.

Key recommendations Successful components of physical activity interventions fall into three categories: Planning and developing physical activity initiatives Working with the individual Working in partnership with others Research has identified the common components of successful interventions to promote physical activity in older adults. These fall into these three categories: Planning and developing physical activity interventions: These slides outline the evidence-based recommendations for actions that should be taken or components that should be put into place when planning and developing physical activity initiatives for older adults. Working with the individual: These slides outline the evidence-based recommendations for actions that should be taken or components that should be put in place when working with individual older adults. Working in partnership with others: These slides will cover evidence-based recommendations for working in partnership with others to promote physical activity in older adults.

Planning and developing physical activity initiatives
Focus solely on changing physical activity levels as opposed to multiple health behaviours For example, home hazards for fall prevention Firstly, we will outline strategies for planning and developing physical activity initiatives. Evidence is limited that it is beneficial to combine physical activity interventions with other non-physical activity interventions, eg, home hazard assessments during fall prevention initiatives. Therefore, targeting activity levels has a larger effect than addressing several health behaviours.

Offer a choice of group-based activities and provide advice for activities they can do in their own time Group or centre-based activities offer social participation Group sessions that have an impact on social participation are more successful than initiatives run in the home.

Incorporate elements of behaviour change into the initiative, for example: self-monitoring personalised goal setting self-reinforcement corrective feedback. Behaviour change elements incorporated in interventions are more effective than providing health information alone. Self-monitoring shows the most consistent results for increasing physical activity levels in older adults, eg, a log book or diary to track progress. Using these four behaviour change components have been shown as effective methods for increasing physical activity levels.

Ensure opportunities are available which encourage older adults to sustain the increase in their physical activity levels Activity must be maintained to gain the benefits Determine critical elements for adherence For the benefits of physical activity to be maintained, individuals must continue to be active. It is essential to understand the individualised factors that will enable/prevent individuals to continue being active, eg, cost of activity, time commitment, accessibility, enjoyment.

Ensure activity leaders have sufficient qualifications and experience Qualified staff are most effective for supporting physical function, fall prevention and increasing mobility. Non-specialist instructors should be considered where cost is an issue. Training the public to be walk leaders as effective as professionals for walking interventions. Specialist and qualified exercise instructors are most effective for delivering physical activity programmes. Programmes focused on physical function, reducing falls and increasing mobility are more effective when using qualified instructors. NB. While this yields the best results, non-specialist instructors have been successful in increasing activity in some situations and should be considered when qualified individuals are outside of the programme budget. Walking interventions have demonstrated no difference between professionals and members of the public trained as walk leaders on physical activity levels.

Working with the individual
Encourage older adults to work towards the physical activity guidelines Some activity is better than none Set personal achievable goals In this next section, the slides outline effective strategies for working with individuals. The UK physical activity guidelines recommend that older adults should be encouraged to achieve 150 minutes of moderate intensity activity per week as well as strength training activities on two days per week. It is important that older adults understand that some activity is better than none. You should work with individuals to set realistic and achieveable goals within a realistic timescale that work towards the physical activity guidelines, eg, over the next month working towards walking two laps of the local park.

Determine with individuals the type of support most beneficial for them Level of support is a good predictor of activity Type of support may vary according to programme phase More contact time has a bigger impact Telephone calls offer valuable support Receiving support, eg, from family, friends, programme staff and other participants is a good predictor of changes in physical activity levels but older adults’ preference on who provides support may vary at different stages of a programme, eg, a qualified instructor at the initial adoption phase In general, a higher level of contact time and support have a bigger impact than those with less contact time. Telephone calls offer a valuable means of providing support.

Tailor activity information to the individual, eg, potential/actual health risks environment goals Personalised information has a positive effect on physical activity levels. Tailor information according to the: Individual’s potential/actual health risk Environment – provide information on activity opportunities within a locality, eg, local walking groups or activities Individual goals – advice on reaching goals according to ability and interests

Review participants’ progress towards their personal goals on a regular basis Realistic timetable for improvements Review yearly The benefits of a programme may not be apparent for some time, eg, improvements in mental health may not be noticed for up to six weeks. Regularly review progress and adapt goals to maintain older adults’ engagement with a programme. Research suggests that progress reviews should take place at least every year, if not more frequently.

Working in partnership with others
Collaborate with medical professionals to provide strong and consistent messages about physical activity Brief interventions from healthcare professionals are linked with increased physical activity Written prescription and verbal advice may further increase physical activity Provide training to healthcare professionals The next section provides strategies on working in partnership with others. Support from healthcare professionals has been linked to increases in physical activity, eg, a brief intervention providing information on physical activity and health Professionals are encouraged to work in partnership with healthcare professionals through Support to promote physical activity within their practice Provide training on how to approach and address the issue of physical activity with older adults Working to reach the older adults already under their clinical care.

Implications for practice - Commissioners
Impact and cost effectiveness. Multi-level interventions. Underpinned by physical activity guidelines. Specific and tailored programmes. Long term participation. Monitoring and evaluation. Ensure that programmes are based on a solid evidence-base for impact and cost effectiveness when commissioning and designing programmes for older adults. Commission multi-level interventions that include population wide, community-based and one-to-one components. Underpin programme design by the UK physical activity guidelines. Make sure programmes are targeted to specific interests, needs and abilities of older adults, both individuals and group. Commission programmes that support sustained participation in the long term – beyond 12 months. If physical activity participation ceases, the benefits will be lost. Build robust monitoring and evaluation into local programmes.

Implications for practice – policy makers
Policy measures to promote activity to older adults of all abilities and needs. Impact on physical activity participation. Engagement in policy development. Promote social cohesion and active environments. Educational opportunities for the workforce. Equal gender opportunities. Take action to promote physical activity to older adults of all ability and needs through policy measures Assess in advance the intended and unintended impact policy proposals might have on older adults’ physical activity participation. Ensure older adults are engaged in all aspects of policy development Work to promote social cohesion and environments which are safe and appropriately support physical activity in local communities. Provide educational opportunities focusing on physical activity promotion for professional groups who work with older adults, eg, carers in residential settings, practice nurses, occupational therapists. Ensure that programmes meet the needs of both men and women (as there are significant differences in motivation, interests and goals). Ensure equality of opportunities for both men and women

Implications for practice – practitioners
Review and improve knowledge. Underpin by UK physical activity guidelines. Coordinate community services. Include older adults in planning and implementing programmes. Monitoring and evaluation. Offer tailored and appropriate programmes. Work with people who can support older adults. Ensure providers are trained. Review and improve knowledge and understanding of ageing and physical activity through appropriate education, training and resources. Ensure programmes are underpinned by the UK physical activity guidelines for older adults. Develop a local coalition or alliance to ensure the coordination of community physical activity services and programmes. Ensure older adults are included in the planning and implementation of local programmes Implement robust monitoring and evaluation of local programmes. Work with ‘significant others’, eg, instructors, care givers, family members, who are positioned to support older adults to become more active. Ensure that those providing opportunities for older adults are appropriately trained to deliver experiences that are enjoyable, effective and safe.

Resources to promote physical activity in older adults

Interpreting the guidelines for older adults
Three booklets provide: an overview of the physical activity guidelines guidance on working towards the guidelines interpreting the guidelines according to functional capacity. These booklets are designed for professionals working with older adults to help them work towards achieving the physical activity guidelines. These booklets interpret the guidelines according to the functional capacity of older adults based on three key groups: The actives: already active, either through daily walking, leading an independent life, an active job and/or who are engaging in regular recreational or sporting activity Older adults in transition: between independence and dependence, good health and poor health. They may be losing their muscle strength and balance and may be overweight. Frail older adults: Those who are frail or have very low physical or cognitive function perhaps as a result of chronic disease such as arthritis, dementia or very old age. They interpret the UK physical activity guidelines by providing detail on each guideline to explain what they mean in practice with lots of practical examples. Available at

Evidence briefing Overview of evidence for physical activity and older adults including: benefits of activity current levels of physical activity factors affecting participation interventions to increase physical activity An overview of the evidence base relating to older adults and physical activity. Available at

To download this resource visit
Practice briefing Designed to give people working with older adults practical strategies to effectively promote physical activity with older adults. The briefing includes recommendations covering Planning and developing physical activity initiatives Working with the individual Working in partnership with others To download this resource visit

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