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Summaries of research on older adults are provided on these pages by topic area. Please click the links below for more information. Alternatively, additional physical activity research can be found in the Information Centre, or in other population/setting sections on the left hand side menu.
Strength and resistance training for older adults
Physical activity and health benefits
Physical activity and mobility
Exercise and healthcare costs
Effectiveness of physical activity counselling
Physical activity and retirement
Physical activity and falls among the elderly
The health benefits of physical activity for older adults
Daily activity energy expenditure and mortality among older adults
Manini, T. M., Everhart, J. E., Patel, K. V., Schoeller, D. A., Colbert, L. H., Visser, M., Tylavsky, F., Bauer, D. C., Goodpaster, B. H. & Harris, T. B. (2006). Daily activity energy expenditure and mortality among older adults. Journal of the American Medical Association, 296(2): 171-179.
The purpose of this study was to determine the association of free-living activity energy expenditure, measured using doubly labelled water coupled with resting metabolic rate, with all-cause mortality in a group of 302 high-functioning, community-dwelling older adults aged 70-82 years. Total energy expenditure was assessed over 2 weeks using doubly labelled water. Resting metabolic rate was measured using indirect calorimetry and the thermic effect of meals was estimated at 10% of total energy expenditure. Free-living activity energy expenditure was calculated as: (total energy expenditure x 0.90) – resting metabolic rate. Participants were followed up over a mean of 6.15 years (1998-2006). The main outcome measures assessed were free-living activity energy expenditure (3 tertiles: low, <521 kcal/d; middle, 521-770 kcal/d; high, >770 kcal/d) and all-cause mortality. 55 participants (18.2%) died during follow-up. The results showed that objectively measured free-living activity energy expenditure was strongly associated with lower risk of mortality in healthy older adults. An increase in free-living activity energy expenditure (287 kcal/d) was associated with a 32% lower risk of mortality after adjusting for age, sex, race, study site, weight, height, percentage of body fat, and sleep duration. Using the same adjustments, individuals in the highest tertile of free-living activity energy expenditure were at a significantly lower mortality risk compared with the lowest tertile. Absolute risk of death was 12.1% in the highest tertile of activity energy expenditure vs. 24.7% in the lowest tertile; absolute risks were similar to these for tertiles of physical activity level. The effect of free-living activity energy expenditure changed little after further adjustment for self-rated health, education, prevalent health conditions, and smoking behaviour. According to self-reports, individuals expending higher levels of free-living activity energy were more likely to be in paid work and climb stairs but self-reported high-intensity exercise, walking for exercise, walking other than for exercise, volunteering, and care giving did not differ significantly across the activity energy expenditure tertiles.
The affects of changing exercise levels on weight and age-related weight gain
Williams, P. T. & Wood, P. D. (2006). The effects of changing exercise levels on weight and age-related weight gain. International Journal of Obesity, 30(3): 543-551.
This study aimed to prospectively determine whether physical activity can prevent age-related weight gain and whether changing levels of activity affect body weight. The study consisted of 8080 male and 4871 female runners who completed two questionnaires as part of the National Runners’ Health Study. The results found that changes in running distance were inversely related to changes in men’s and women’s body mass index (BMI), waist circumferences and percent changes in body weight. A longer history of running diminished the impact of changing running distance on men’s weights. When adjusted for change in km/week, years of aging in men and years of aging in women were associated with significant increases in BMI, change in body weight and waist circumference. In conclusion the study found that age-related weight gain occurs even among the most active individuals when exercise is constant. Therefore, in theory vigorous exercise must increase significantly with age to compensate for the expected gain in weight associated with aging.
Exercise accelerates wound healing among healthy older adults: A preliminary investigation
Emery, C. F., Kiecolt-Glaser, J. K., Glaser, R., Malarkey, W. B. & Frid, D. J. (2005). Exercise accelerates wound healing among healthy older adults: A preliminary investigation. Journal of Gerontology: Medical Sciences, 60A(11): 1432-1436.
This study found that regular exercise may speed up the wound healing process in older people. The body's ability to heal wounds on the skin normally slows down with age. The study participants were 28 healthy adults, aged 55 to 77 years, none of which had exercised regularly for at least 6 months prior to the study. 13 were allocated to an experimental group, and the remaining 15 to a control group. The intervention group exercised 3 times a week for 3 months, while the control group made no changes to their physical activity habits during the same period. The exercise intervention consisted of 10 mins of warm-up floor exercises and stretching followed by 30 mins exercising on a stationary bike, then either jogging or walking briskly on a treadmill for 15 mins, then 15 minutes of strength training. All sessions ended with 5 mins cool-down exercises. All participants completed assessments of exercise endurance and stress at the beginning and end of the study to measure aerobic fitness levels from how much oxygen was consumed while exercising. Saliva samples were also taken to measure levels of cortisol, a primary stress hormone. High cortisol levels indicate that the body is under stress; prior studies have suggested that exercise is associated with lower cortisol levels. Stress levels were also measured through a Perceived Stress Scale questionnaire. Each participant received a small puncture wound to the back of the upper arm, around 1/8th of an inch across and deep. The exercise group started exercising about a month before the wound procedure, to give their bodies enough time to adapt to the programme. Each wound was photographed 3 times per week, until it was no longer visible (about 6 to 7 weeks later). The study found that the skin wounds healed, on average, in 29 days in the intervention group, compared to 39 days in the non-exercise group. Exercise endurance increased in the group that worked out, but remained the same in the non-exercise group. However, increases in cortisol levels were found in the exercise group, whereas previous research has suggested that exercise may lower levels of cortisol.
Exercise and the metabolic syndrome in older adults
Stewart, K. J., Bacher, A. C., Turner, K., Lim, J.G., Hees, P. S., Shapiro, E. P., Tayback, M. and Ouyang, P. (2005). Exercise and risk factors associated with metabolic syndrome in older adults. American Journal of Preventive Medicine, 8(1), 9-18.
Researchers found that in people aged 55 to 75 years, a moderate programme of physical exercise can significantly offset the potentially deadly mix of risk factors for heart disease and diabetes known as the metabolic syndrome. More specifically, the researchers found that exercise improved overall fitness, but the 23 percent fewer cases were more strongly linked to reductions in total and abdominal body fat and increases in muscle leanness, rather than improved fitness.
Exercise programs for older men: mode and intensity to induce the highest possible health-related benefits
Delecluse, C., Colman, V., Roelants, M., Verschueren, S., Derave, W., Ceux, T., Eijnde, B. O., Seghers, J., Pardaens, K. and Brumagne, S. (2004). Exercise programs for older men: mode and intensity to induce the highest possible health-related benefits. Preventive Medicine, 39(4), 823-833.
The health-related benefits of physical activity in older men are well established. This study goes on to look at the effectiveness of the mode and intensity of a training programme. The investigation looked at whether the combination of endurance and resistance training has supplementary health-related benefits as compared to endurance training alone. Men aged between 55 and 75 years of age were randomly assigned to one of four groups: a control group or one of three different exercise programmes. All of the exercise groups displayed significant improvements in resting heart rate, work capacity and recovery, waist girth, insulin response and knee extensor strength, however, there were no differences amongst groups. The study concludes that a 20 week endurance training programme combined with resistance training, whether it is of low or moderate intensity, is equally effective as endurance training alone. The findings suggest that for an untrained older man to gain fitness benefits, engaging in fitness training for 20 weeks is more important than the specific exercise mode or intensity.
Physical activity and older adults: a review of health benefits and the effectiveness of interventions
Taylor, A. H., Cable, N. T., Faulkner, G., Hilisdon, M., Narici, M. and Van Der Bij, A. K. (2004). Physical activity and older adults: a review of health benefits and the effectiveness of interventions. Journal of Sports Sciences, 22(8), 703-725.
Both levels of physical fitness and measures of physical activity decline with age. The extent to which this is due to the biological aging process or due to disuse is uncertain. This paper examines this issue, providing a critical review of the evidence from descriptive, efficacy and effectiveness studies concerned with physical activity and older adults. The review considers the evidence which suggests causal relationships between sedentary behaviours, physical activity programmes and cardiovascular, musculoskeletal and psycho-social health, and also independent living and health related quality of life into old age. Furthermore, the review considers the effectiveness of different types of intervention for older adults and issues relating to cost effectiveness. Lastly, the implications for future policy in terms of research, health care services, and education and training are briefly discussed. The article identifies that the potential range of health enhancing effects of physical activity across both physical and psycho-social dimensions is huge and highlights that it remains an important issue for public health.
Physical activity and the mobility of older adults
Associations of leisure-time physical activity with mobility difficulties among middle-aged and older adults
Malmberg, J. J., Miilunpalo, S. I., Pasanen, M. E., Vuori, I. M. & Oja, P. (2006). Associations of leisure-time physical activity with mobility difficulties among middle-aged and older adults. Journal of Aging and Physical Activity, 14(2): 133-153.
This prospective study investigated the associations of the amount, frequency, intensity, and type of leisure-time physical activity (LTPA) with the risk of self-reported difficulty in walking (WD) and stair climbing (SCD) over 16 years in a population-based cohort aged 40–64 years at the onset of the study. The results indicated that the risk for SCD was highest among men and women with a low amount of weekly LTPA. The risk was high also among women with weekly light LTPA compared with women with weekly vigorous LTPA. The risk for WD was highest among men who engaged in fitness activity once a week compared with men who engaged in fitness activity at least three times a week. A low amount of weekly LTPA, light LTPA twice or more a week, and LTPA for keeping fit and healthy less than three times a week are associated with future risk of mobility difficulties among middle-aged and older adults.
Physical activity and functional status in community-dwelling older women: A 14-year prospective study
Brach, J.S., FitzGerald, S., Newman, A.B., Kelsey, S., Kuller, L, VanSwearingen, J.M., and Kriska, A.M. (2003). Physical activity and functional status in community-dwelling older women: A 14-year prospective study. ARCHIVES OF INTERNAL MEDICINE, 163, 2565-2571.
One hundred and seventy women were tested over a 14-year period from 1985 to 1999. The average age of women in this study was 74 years in 1999. Physical activity levels were measured both objectively (pedometers and LSI activity monitor) and by self-report at three points (1985, 1995, and 1999). Functional status was measured by the Functional Status Questionnaire (FSQ), Physical Performance Test (PPT) and gait speed. The results showed that women who were physically active in 1995 reported better functional status in 1999 than women who were less active in 1995. Physical activity levels in 1985 were a significant predictor of gait speed in 1999. Even those who were inconsistently active had a better functional status than women who were never active. This study suggests that physical activity plays a key role in maintaining functional ability in later life.
Patel, K. V., Coppin, A. K., Manini, T. M., Lauretani, F., Bandinelli, S., Ferrucci, L. & Guralnik, J. M. (2006). Midlife physical activity and mobility in older age: The in CHIANTI Study. American Journal of Preventive Medicine, 31 (3): 217-224.
Among older adults, loss of mobility represents a critical stage in the disablement process, whereby the risk for disability is significantly increased. Physical activity is a modifiable risk factor that is associated with reduced risk of losing mobility in older adulthood; however, few studies have examined physical activity performed earlier in life in relation to mobility later in life.
In 2005 and 2006 data from 1155 adults aged 65 years and older living in the Chianti region of Italy were analysed. Participants retrospectively recalled their physical activity levels in midlife and underwent mobility testing and medical examination. Two objective mobility outcomes were examined as a function of past physical activity: the Short Physical Performance Battery (SPPB) and the ability to walk 400 meters.
Older Italian adults (mean age 74.8) who engaged in higher levels of physical activity in midlife were significantly more likely to perform better on the SPPB than individuals who were less physically active in midlife. The previously physically active men (Level II) and very physically active men (Level II) were significantly less likely to fail to complete the 400-meter walk test than the previously less active men (Level I). These associations remained after adjustment for demographic factors, medical conditions, and physiological impairments.
In conclusion, older adults who reported higher levels of physical activity in midlife had better mobility in old age than their less physically active counterparts.
The benefits of older adults participating in strength and resistance training
Strength training in older adults: An empowering intervention
Katula, J. A., Sipe, M., Rejeski, W. J. & Focht, B. C. (2006).Strength training in older adults: An empowering intervention. Medicine & Science in Sports & Exercise. 38(1): 106-111.
This study evaluated the benefits of adding a psychological empowerment intervention (PEI) to traditional strength training (TST) on social cognitive variables in community-dwelling older adults. 38 participants were randomly assigned to either a PEI or a TST intervention for 6 weeks. Before random assignment and following training, participants completed measures of self-efficacy for upper and lower body strength as well as the desire to be able to lift specific amounts of weight. Both treatments involved two sessions per week of centre-based training and one session per week of home-based training. The PEI condition also included a group-mediated intervention that was designed to increase self-efficacy for physical strength and the desire for upper and lower body strength. The results revealed that the two groups experienced differential gains in the desire for upper body strength and were marginally different in gains for upper body strength self-efficacy. On a four-point scale, the adjusted mean differences for the PEI group on the desire for upper body strength was significantly higher than the TST group, whereas the PEI group's improvement in self-efficacy for upper body strength was higher than the TST group. The results imply that empowerment-based exercise programmes may be particularly motivating for older adults by creating a more meaningful physical activity experience for them.
Strength training may be the best intervention to help prevent muscle weakness in older adults
Borst, S. E. (2004). Interventions for sarcopenia and muscle weakness in older people. Age and Aging, 33, 548-555.
In the past three major strategies have been tested fir combating the losses in muscle mass and strength than accompany aging. These strategies are testosterone replacement for men, growth hormone replacement and resistance exercise training. This review covers the risks and benefits associated with each of these three types of intervention. The review comes to the conclusions that testosterone replacement in elderly hypogonadal men produces only modest increases in muscle mass and strength, which are observed in some studies and not in others. Growth hormone replacement produces a high incidence of side effects, has not been found to increase strength and does not augment strength gains resulting from resistance training. Resistance training remains the most effective intervention for increasing muscle mass and strength in older people. Elderly people have reduced food intake and increased protein requirements, and as a result adequate nutrition is sometimes a barrier to obtaining full benefits from resistance training in this population.
Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: A 6-month randomised, controlled trial
Liu-Ambrose, T., Khan, Eng, J., Janssen, P., Lord, S. and Mckay, H. (2004). Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: A 6-month randomised, controlled trial. Journal of the American Geriatrics Society, 52(5), 657.
A recent Canadian study suggests that resistance training and agility exercises in older women with lower bone mass or osteoporosis reduces the likelihood of falling. Study co-author Dr. Karim M. Khan, of the University of British Columbia in Vancouver, says these findings show that individuals with osteoporosis should be encouraged to be active with the proper supervision, rather than to avoid physical activity due to concerns about safety. Khan and colleagues enrolled 98 women ages 75-85 for the study. The women were randomly assigned to three groups: strength training, agility training, or stretching exercises. The strength training participants used light weights and did strengthening exercises (i.e. squats) to increase muscle strength. Those in the agility group utilized dance, games and obstacle courses, with the goals of improving their coordination, balance, and reaction times. Participants in all the groups engaged in classes of 50 minutes duration twice weekly for about six months. Assessments were conducted at the study's baseline, midpoint and end. After 25 weeks of training, participants in the strength and agility training groups recorded a larger reduction in fall risk than those in the stretching group, the researchers found. Using a battery of tests, the investigators estimated that fall risk dropped by 57.3% among strength training participants and 47.5% among agility training participants. In comparison, the stretching group recorded just a 20.2% reduction. Both types of training provided benefits through improved postural stability, say the researchers. One caution: agility training had a higher fall risk than strength training for participants. The researchers conclude that resistance training may be an especially good way for older adults with osteoporosis to be active.
The effectiveness of physical activity counselling for older people
Is physical activity conselling effective for older people? A cluster randomised, controlled trial in primary care.
Kerse, N., Raina Elley, C., Robinson, E. & Arroll, B. (2005). Is physical activity counseling effective for older people? A cluster randomized, controlled trial in primary care. Journal of the American Geriatrics Society,53(11): 1951-1957.
According to the results of this randomised controlled study in New Zealand, providing older people with tailored physical activity advice in an approach called the ’Green Prescription‘ programme may be an effective way to help them increase their exercise levels. About three percent of New Zealanders each year currently receive a Green Prescription from their doctor. The authors investigated the effectiveness of physical activity counselling among 270 sedentary patients, aged 65 years or older. The study also included 117 doctors in the Waikato region of New Zealand. The intervention group were assigned to a Green Prescription physical activity intervention group, in which doctors provided individualised exercise recommendations based on age, medical condition, capability and everyday activities, and faxed those recommendations to trained exercise specialists. The participants then received follow-up telephone calls from the specialists over a three-month period, in addition to quarterly written material and newsletters. The control group were assigned to usual care from their physicians. The authors found that the participants assigned to the Green Prescription group reported spending about 40 additional minutes per week engaged in leisure time moderate and vigorous activity after the year-long follow-up, compared with those in the usual care group. The Green Prescription group also expended nearly three more kilocalories per kilogram of body weight each week than their peers. Participants in the Green Prescription intervention also showed improvements in measures of vitality and general health, and experienced fewer hospitalisations than those in the comparison group.
Randonmized controlled trial of physical activity counselling for older primary care patients
Pinto, B. M., Goldstein, M. G., Ashba, J., Sciamanna, C. N. & Jette, A. (2005). Randomized controlled trial of physical activity counseling for older primary care patients. American Journal Of Preventive Medicine, 29(4), 247-255.
Research has shown that regular physical activity reduces the risk for chronic diseases among older adults. Older adults are likely to be seen by primary care clinicians who can play an important role in promoting physical activity among their patients. This randomised controlled trial compared the effects of brief advice to exercise from a clinician supplemented by telephone-based counselling by health educators (extended advice) to brief advice from a clinician alone (brief advice). A total of 100 primary care patients (63.2% female, mean age 68.5 years) participated in the trial. The extended-advice intervention consisted of clinician advice plus exercise counselling via the telephone provided by health educators, and the brief advice condition consisted of clinician advice alone. Both interventions focused on promoting moderate-intensity physical activity. Self-reported physical activity, using the 7-Day Physical Activity Recall instrument and objective activity monitoring using Biotrainers were assessed at baseline, and at 3 and 6 months. Participants in the extended-advice group reported significantly greater participation in moderate-intensity physical activity than the brief-advice group at 3 months and 6 months. Objective activity monitoring also showed significantly increased physical activity among extended-advice versus brief advice participants at both time points. The results indicate that clinician advice with follow-up counselling can more effectively promote adoption of moderate-intensity physical activity among older, primary care patients, compared to brief advice alone.
Work retirement and physical activity levels
Work retirement and physical activity: cross-sectional analyses from the Whitehall II study
Mein, G. K., Shipley, M. J., Hillsdon, M., Ellison, G. T. and Marmot, M. G. (2005). Work, retirement and physical activity: cross-sectional analyses from the Whitehall II study. European Journal of Public Health, 15(3), 317-322.
The study looked at the relationship between work, retirement and physical activity through cross-sectional analyses of data from self-completed questionnaires by 6224 civil servants aged 45–69 years participating in phase 5 of the Whitehall II longitudinal study.
The results indicated that there appeared to be a dose–response relationship between hours worked and the prevalence of physical activity. A lower prevalence of individuals achieving the recommended physical activity levels occurred amongst participants working full time ( 30 h/week), higher prevalence rates occurred amongst those working part time (<30 h/week), and the highest rates amongst participants who were retired. The findings suggest that full-time work is associated with lower rates of recommended physical activity levels in this cohort of middle-aged white-collar office workers. Lower grade occupations are also less likely to meet the recommended physical activity levels. The frequency of different types of physical activity is associated with different occupational grades, with more sport and gardening being done by the higher occupational grades.
The impact of physical activity on healthcare costs
Community Exercise Program Use and Changes in Healthcare Costs for Older Adults
Ackerman, R., Cheadle, A., Sandhu, N., Madsen, L., Wagner, E. and LeGerfo, J. (2003). Community Exercise Program Use and Changes in Healthcare Costs for Older Adults. American Journal of Preventive Medicine, 25(3), 232-237.
The Lifetime Fitness Program (LFP) in western Washington State is a group-based exercise programme offered to community-dwelling older adults through local senior centres in the Seattle/Puget Sound area. The authors compared primary healthcare costs over a two-year period between a group of Group Health Cooperative enrolees who participated in the LFP and controls. Average annual costs for participants was $301 lower than controls and the adjusted risk of hospitalisation was 4.9% lower among participants than controls. Participants who attended one or more days per week had annual total healthcare costs 21% lower than controls.
Changes in physical activity and short-term changes in health care charges: A prospective cohort of older adults
Martinson, B., Crain, L., Pronk, N., O’Connar, P. and Maciosek, M. (2003). Changes in physical activity and short-term changes in health care charges: A prospective cohort study of older adults. Preventive Medicine, 37, 319-326.
A random sample of approximately 2,400 older adults enrolled in a Minnesota health plan, were monitored over a three-year period to determine the influence of physical activity on health care charges. Results indicate that
adults aged 50 and older who initiate a physically active way of life have significantly lower short-term health costs compared to those who remain inactive.
Physical activity and falls among the elderly
Older persons afraid of falling reduce physical activity to prevent outdoor falls
Wijlhuizen, G.J., Jong, R. and Hopman-Rock, M. (2007) Older persons afraid of falling reduce physical activity to prevent outdoor falls. Preventive Medicince 44: 260-264
The fear of falling down is high among adults older than 65 years, it could therefore be assumed that this fear will restrict older adults outdoor physical activity levels. The aim of this study was to test this theory against actual outdoor falls according to the Task Difficulty Homeostasis Theory. The study was conducted in three communities in the Netherlands and included 1752 randomly selected adults over 65 years. The participants completed a questionnaire at baseline which asked about personal characteristics, general health, how often they were afraid of falling outdoors and how often they walked or cycled outside for at least 30 minutes during the winter and summer months. The participants also received a monthly phone call for ten months to ask if they had fallen the previous month. It was found that 22% of the adults reported fear of falling down outside their home of which 3% did actually fall during the ten month follow-up. Those who had a higher fear of falling were less physically active than those with a lower fear. This study suggests that people with a high fear of falling outside restrict their physical activity to reduce their risk of falling. To help prevent older adults falling the authors of this study believe that older people should first build up their physical abilities in a safe environment before increasing physical activity outside.
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