Physical activity in older age: perspectives for healthy ageing and frailty

Abstract

Regular physical activity helps to improve physical and mental functions as well as reverse some effects of chronic disease to keep older people mobile and independent. Despite the highly publicised benefits of physical activity, the overwhelming majority of older people in the United Kingdom do not meet the minimum physical activity levels needed to maintain health. The sedentary lifestyles that predominate in older age results in premature onset of ill health, disease and frailty. Local authorities have a responsibility to promote physical activity amongst older people, but knowing how to stimulate regular activity at the population-level is challenging. The physiological rationale for physical activity, risks of adverse events, societal and psychological factors are discussed with a view to inform public health initiatives for the relatively healthy older person as well as those with physical frailty. The evidence shows that regular physical activity is safe for healthy and for frail older people and the risks of developing major cardiovascular and metabolic diseases, obesity, falls, cognitive impairments, osteoporosis and muscular weakness are decreased by regularly completing activities ranging from low intensity walking through to more vigorous sports and resistance exercises. Yet, participation in physical activities remains low amongst older adults, particularly those living in less affluent areas. Older people may be encouraged to increase their activities if influenced by clinicians, family or friends, keeping costs low and enjoyment high, facilitating group-based activities and raising self-efficacy for exercise.

Keywords: Exercise; Falls; Frailty; Health; Muscle; Physical activity.

Fig. 1

Schematic representation of ageing trajectories and individual exercise needs. Good physiological function is maintained until middle age and thereafter progressively deteriorates. The upper horizontal dashed line represents a theoretical point at which deterioration manifests as moderate functional deficits and above this line the general aim of physical activity is to maintain good health. The lower horizontal dashed line indicates a theoretical threshold beyond which a person suffers disability and frailty, so the aim of physical activity is to recover the deficits and improve mobility. The curved lines represent a accelerated ageing, b normal ageing and c healthy ageing. Exercise interventions should match the physical capability, rather than chronological age per se to be effective

Fig. 2

Physical Activity Participation in UK adults. With increasing age, sports participation progressively declines. Walking for health benefits or enjoyment remains fairly constant amongst young and middle-aged adults, but declines progressively into older age. Amongst those who are sedentary, more of the younger adults have a desire to increase physical activity levels compared with the middle-aged and the old. Data are from The Taking Part Survey, which interviewed >92,000 people in England between 2005 and 2009 to ask about physical activity habits (Department for Culture 2011)