Encourage older adults to develop exercise regimens suited to their abilities and medical conditions.
The benefits of regular exercise for people of all ages have been well established. Regular exercise is associated with a decreased chance of death disability from pathologies such as cardiovascular disease, diabetes, arthritis, cancer, and pulmonary disease. It is also associated with positive psychological benefits such as decreased depression and improved quality of life. Nevertheless, inactivity continues to be a major public health concern, with many people failing to exercise as recommended. But what are the current exercise recommendations for older adults?
The American College of Sports Medicine (ACSM) Position Stand has long been the gold standard for exercise recommendations. In 2007, the ACSM and the American Heart Association (AHA) released updated physical activity guidelines for older adults. In late 2008, the federal government, through Health and Human Services (HHS), published comprehensive Physical Activity Guidelines for Americans. In January 2009, the National Institute on Aging (NIA) released the updated version of Exercise & Physical Activity. And in July 2009, the ACSM released its new Position Stand on Exercise and Physical Activity for Older Adults. Although the three entities provide overlapping and similar recommendations, there are slight differences in terminology and exercise categories.
The first terms requiring clarification are the most important ones. Although used interchangeably, there is a difference between physical activity and exercise. Physical activity is defined as any bodily movement produced by the skeletal muscles resulting in energy expenditure that exceeds resting energy expenditure. Exerciseis considered a subcategory of physical activity and is defined as planned, structured, and repetitive body movements that are performed to improve or maintain one or more components of physical activity.
In other words, physical activity is activity that gets a person moving, such as walking to the mailbox, taking the stairs instead of the elevator, or gardening, whereas exercise includes activities such as weight training, tai chi, and aerobics classes. Physical activity and exercise are both important for health and fitness. While the ACSM, HHS, and the NIA use physical activity in the titles of their recommendations, by definition they are referring to exercise.
How Much Exercise Is Enough?
The amount and type of exercise in which older adults should participate each week differs based on a number of factors, including age and special conditions such as disabilities and chronic medical or health conditions. For all individuals, some activity is better than none.
The recommendation for older adults is 150 minutes of exercise per week (as opposed to specifying 30 minutes of moderate-intensity exercise five days per week). New research shows there is a therapeutic effect in moderate-intensity endurance exercise in as little as 10 minutes. Exercising less than 10 minutes at a time does not seem to provide the desired heart and lung benefits. When broken down into at least 10-minute segments, 150 minutes is only (approximately) 20 minutes per day, seven days per week; 30 minutes per day for five days per week; or 50 minutes per day for three days per week. Performing 10-minute exercise periods spread throughout the week is often more appealing to older adults because it seems easier to accomplish.
What Type of Exercise Is Best?
The new recommendations speak not only to how much exercise older adults need but also what type of exercise is needed. There are four different categories of exercise, and participation in all four types is necessary for full health benefits. The first two categories, endurance or aerobics and strength training or weight lifting, are the ones with which most people are familiar. The second two categories, while not new to the field of exercise, are relatively new in that they fall into a separate category with specific recommendations. These are balance and stretching or flexibility. The key to fitness is to do all four of the major types of exercise regularly and increase the level of intensity over time.
With the previously stated goal of a minimum of 150 minutes of exercise per week, it is recommended that older adults strive to increase from the minimum goal of 10 minutes of aerobic increments to longer stretches as well as increasing over time the weekly number of minutes from 150 to 300. Examples of endurance exercises are walking, jogging, dancing, and playing tennis.
Strength-training or weight-lifting exercises should be performed two to three days per week with a rest day between sessions. This rest day doesn’t mean to forgo the other types of exercises, just strength training. Strength-training activities should include exercises for all major muscle groups (shoulders, arms, chest, abdomen, back, hips, and legs). If an elder chooses to strength train on a daily basis, he or she must alternate the muscle groups to allow for a rest day. Examples of strength-training exercises include lifting or pushing free weights, pulling resistance bands, and using strength-training equipment at a fitness center or gym.
Some balance exercises build up leg muscles, while other exercises focus on stability. Balance exercises, therefore, fall into two categories. Strengthening exercises must be performed two or more days per week (but not on any two days in a row), whereas stability exercises can—and in some cases should—be performed daily. Balance exercises include strength exercises for the lower body such as back and side leg raises and toe stands as well as stability exercises such as heel-to-toe walking and the stork pose (standing on one foot with arms held out to the side.)
Stretching exercises improve flexibility but do not improve endurance or strength. Despite this, it is suggested that older adults perform stretching exercises after they have completed endurance and strength exercises. If they do only stretching/flexibility exercises, they must warm up first with gentle movements or slow walking. Stretching exercises can be performed daily and include shoulder, upper arm, calf, and thigh stretches.
For many the hardest part of exercising is getting started, but thinking about fitness goals in 10-minute segments doesn’t seem as daunting to older adults. For some it is helpful to make it part of their daily routines. For example, after putting the coffee on to brew, they could do 10 minutes of exercise and then have breakfast. In senior housing with congregate meals, have a 10-minute sitersize (aerobics while seated) session before lunch. If elders are working in offices that have periodic breaks, they could partner with some colleagues and make an appointment for a 10-minute walk during the afternoon break.
Using workout routines and other training materials designed specifically for older adults will also help encourage exercise. One such program, produced by the University of Arkansas Division of Agriculture (www.uaex.edu), is Fit in 10, a research-based program that includes a full-length exercise DVD with 10-minute segments for each of the four categories of exercise as well as accompanying facts sheets with the matching 10-minute exercise routines.
Thinking of exercise in shorter bouts makes it easier to find time to fit exercise into older adults’ daily routines. Understanding the new recommendations of accumulating fifteen 10-minute segments of exercise throughout the week should entice more older adults to exercise as recommended.