The ageing process brings about a change in physical ability, which differs from person to person. However, some changes happen due to a lack of activity that, in some part, can be attributed to "thoughtful" friends and relatives. As people age we feel the need to assist them in every possible way: we help them with their bags, we give them lifts everywhere, we even move them into bungalows. Unfortunately these acts of kindness could also be classed as acts of neglect in so much as we are neglecting to understand the implications of our behaviour.
It is true that as we age we become weaker as a result of a reduction in lean muscle and bone mass, a phenomenon called sarcopenia.1 Sarcopenia is the primary reason people become weaker as they grow older. This slow muscle loss occurs even in healthy individuals who engage in regular exercise, but it usually goes unnoticed for many years; the body compensates by subtly padding affected areas with extra fat. So, "while thinning bones render older women especially vulnerable to fractures, it's the unsteadiness caused by muscle wasting in the legs that leads to falls. To the extent that it makes walking, stair climbing, and getting in and out of chairs difficult, muscle loss cannot only rob ageing adults of their independence but also steer them into unhealthy, sedentary lifestyles2 As a result of sarcopenia we adjust our lifestyle to accommodate our loss of strength, which directly impacts upon our ability to function. The domino effect of this unfortunately can be compared to any machine with moving parts, if we cease to use certain pieces (muscles) they cease to operate efficiently. We will, however, never stop relatives/friends from carrying out supposed acts of kindness and why should we? We can, alternatively, attempt to educate the recipient to stay active, accepting assistance without total submission and inform the population that sometimes it is more caring to let the older generation continue to just walk up the stairs.
The loss of strength experienced through age has been directly related to the loss of balance, flexibility, gait and coordination that we realise in later life. However, research by Fiatrone and Frontera2,3,4offers evidence that it is never too late to start building up your strength: “muscle mass and strength can be regained no matter what your age and no matter what the state of your body’s musculature before starting a strength programme”. That has to be a positive message to feed to your members but if they are more spurred on by the potential negative impacts experienced without the intervention of a strength training programme you may like to pass on the information gathered by Miriam E Nelson PhD5 (author of the Strong Women series of books). From 40 years of age women lose approximately 240g of muscle per year, and gain the same in fat. By the age of 60 years women may have lost up to 5kg of muscle mass and gained 5kg in fat and by 80 years this could have doubled. Men lose about 1% of strength per year after 30 years of age, 2% after 60 and by 80 years of age have usually lost 60% of the strength they had at 30.
The solution to all of the above is simple – exercise. Of course, it may be advisable to use the more friendly word – activity. No matter what you call it, the benefits are endless for both physical and mental health. Physically active people have 20-30% reduced risk of premature death and up to 50% reduced risk of major chronic disease such as coronary heart disease, stroke, diabetes and cancer. The message is clearly not getting across, however, as six out of 10 men and seven out of 10 women are still not active enough to benefit their health 6
Benefits of exercise
- controls blood pressure, body weight and cholesterol levels.
- reduces the risks of hardening of the arteries, heart attack and stroke.
- conditions muscles, tendons, ligaments and bones which in turn helps fight osteoporosis, keeps the body more limber and stabilises joints thus reducing risk of injury.
- lowers risk of certain cancers.
- enhances quality of sleep.
- assists with stress management.
- improves digestion
- manages lower back pain, arthritis and diabetes
- increases opportunities to meet people and function independently.
- acts as an effective, safe and feasible antidepressant in older people
Every person has a different fitness level and it is important to recognise this from the very outset. There are no forms of exercise that are considered unsuitable for older people, provided the exercise is tailored towards their particular level of fitness and takes into account any health or mobility problems they may have.
If you are a total novice or experimenting with a new type of exercise, it is advisable to have a check-up with your GP prior to commencing the new programme. If you have limited mobility, it is important to prescribe a programme that keeps the upper body, heart and lungs fit. If you are very disabled and you are unsure of a suitable exercise programme it may be better to consult a physiotherapist or alternative expert to ensure that you do not leave yourself open to injury.
Walking and swimming are good types of general exercise, although any form of physical activity such as housework or gardening can increase fitness and you should be advised of this. These types of exercise, if combined with balance, strength and stretching exercises, are useful for protecting against falls and fractures. Falls are a major cause of disability and the leading cause of injury mortality in people aged over 75 years in England and Wales. Between one third and a half of people aged over 65 fall each year, 400,000 of which attend A&E in England alone.7
This older generation need not be segregated from the mainstream fitness enthusiast, but there are considerations that need to be taken into account when older adults train:
- Frequency, duration, intensity, mode, and progression; all of these factors will most probably need to be less than for a younger person.
- Medication; it is important to make sure that you are aware of the side-effects of any medication that you may be taking. For example, beta blockers – which are widely used for treatment of hypertension and coronary heart disease – can cause a modification of the heart rate of 15-60 beats per minute, depending on the dosage and the individual’s response.8
- Medical clearance requirements; as previously mentioned it is important to ensure that you have medical clearance to exercise.
- Cardiovascular concerns; CAD, hypertension, TIA, stroke, intermittent claudication. The cardiac response to exercise in a hypertensive population varies according to the level of hypertension, medication and individual differences. High intensity exercise should be discouraged to reduce the risk of cardiac difficulties. Isometric contraction exercises are shown to increase systolic and diastolic blood pressure and therefore are not the best choice for hypertensive individuals.
- Back problems.
- Arthritis; it is important to include both range-of-motion and strength exercises if you suffer with arthritis.
- Osteoporosis; research shows that in order to affect the loss of bone mineral density, exercise must be weight-bearing. For those people in the later stages of osteoporosis, exercising on one leg should be avoided completely. Consider the benefits versus risks of any vigorous movements. Avoid excessive flexion of the spine to avoid fracture or placing the internal organs in a position vulnerable from injury if you suffer from osteoporosis.
- Balance and motor control deficits.
- Sight/hearing deficits.
- Vanishing Flesh, Janet Raloff,
Science News Online, August 10, 1996.
- Fiatarone MA, O'Neill EF, Doyle N, Clements KM, Roberts SB, Kehayias JJ, Lipsitz LA and Evans WJ (1993). The Boston FICSIT study: The effects of resistance training and nutritional supplementation on physical frailty in the oldest old,
Journal of the American Geriatrics Society, 41, 333-337.
- Fiatarone MA, O'Neill EF, Ryan ND, Clements KM, Solares GR, Nelson ME, Roberts SB, Kehayias JJ, Lipsitz LA and Evans WJ, (1994). Exercise training and nutritional supplementation for physical fraility in very elderly people,
New England Journal of Medicine,330, 1769-1775.
- Frontera WR, Meredith CN, O'Reilly KD, Knuttgen HG and Evans WJ (1988), Strength conditioning in older men: Skeletal muscle hypertrophy and improved function,
Journal of Applied Physiology, 64, 1038-1044.
- Strong Women, Strong Bones: Everything You Need to Know to Prevent, Treat, and Beat Osteoporosis, Miriam Nelson, Sarah Wernick, Wendy Wray, Putnam Publishing Group (April 1, 2000).
- Summary of Intelligence on Physical Activity: Choosing Health Summaries, Department of Health (2004).
- Summary of Intelligence on Accidents: Choosing Health Summaries, Department of Health (2004).
- Wilmore JH (1988), Exercise-drug interactions in the older adult, in WW Spirduso and HM Eckert (eds),
The academy papers: Physical activity and aging(pp194-199), Human Kinetics, Champaign IL.
- Active Seniors Enjoy Life More, Fit Facts from the American Council on Exercise www.acefitness.org
- Benefits of Physical Activity on Psychological Well-being for Older Adults, Review 1, BHF National Centre for Physical Activity and Health