Monday, October 1, 2007

Physical Activity and Public Health in Older Adults: Recommendation From the American College of Sports Medicine and the American Heart Association

Title: Physical Activity and Public Health in Older Adults: Recommendation From the American College of Sports Medicine and the American Heart Association

Date Posted: 9/26/2007

Author(s): Nelson ME, Rejeski WJ, Blair SN, et al.

Citation: Circulation. 2007;116:1094-1105.

Perspective: The following are 10 points to remember about this recommendation on physical activity and public health in older adults:

1. Benefits of regular physical activity include reductions in the risk of diabetes, hypertension, cardiovascular disease (including stroke), dyslipidemia, obesity, anxiety, and depression. Physical activity is a component of clinical practice guidelines for coronary heart disease, hypertension, peripheral vascular disease, diabetes, obesity, and hyperlipidemia. Currently, older Americans are the least fit of any age group. In a study of Medicare enrollees, an estimated 14% of the men and 23% of the women were not able to walk 2-3 blocks. This age group is the fastest growing demographic segment in the United States, and has significant medical expenditures. Therefore, increasing physical activity among older adults has significant public health implications.

2. Physical activity recommendations for older adults pertain to all adults ages 65 or older, and to those ages 50-64 years with clinically significant chronic conditions and/or functional limitations. Recommendations are similar to those for adults under 65 years of age; however, intensity recommendations have been adapted to accommodate a wide range of aerobic fitness levels.

3. Physical activity recommendations include a minimum of 30 minutes/day of moderate intensity activity 5 days per week or a minimum of 20 minutes/day of vigorous activity 3 days/week. Moderate intensity activity can be completed in 10-minute intervals throughout the day. On a 10-point scale, moderate intensity is a 5-6 of perceived effort, whereas vigorous activity is a 7-8.

4. The intensity level for older adults is relative to the individual’s aerobic fitness and thus varies by person. These amounts of aerobic activity recommended should be in addition to routine daily activities such as cooking or shopping.

5. If conditions or baseline fitness do not permit the patient to achieve minimum levels of recommended physical activity, older adults should maintain regular physical activity consistent with their abilities and avoid sedentary behavior.

6. Benefits of physical activity appear to have a dose-response relationship, such that reductions in the risk of cardiovascular disease have been observed with as little as 45-75 minutes per week of walking.

7. Muscle strengthening activities are recommended at least 2 times per week and should include 8-10 exercises, which involve major muscle groups (with 10-15 repetitions). For those older adults at increased risk for falls, flexibility and balances exercises should be incorporated into these activities.

8. Physical activity has been observed to reduce risk of falls (and fall injuries) by as much a 35%-40%. Several studies have noted balance exercises to be an effective component of fall prevention.

9. An activity plan for an older adult should tailor recommendations to the person’s abilities and conditions and should include a stepwise plan for gradual increases in physical activity to achieve recommended levels of physical activity.

10. The majority of older Americans should be physically active. Both individual and community interventions are needed to support current recommendations for older adults, particularly in light of the growing number of older men and women residing in the United States.

Elizabeth A. Jackson, M.D., F.A.C.C.

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