Physical Activity and Public Health in Older Adults: Recommendation

Abstract and Introduction

Objective: To issue a recommendation on the types and amounts of physical activity needed to improve and maintain health in older adults.
Participants: A panel of scientists with expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology.
Evidence: The expert panel reviewed existing consensus statements and relevant evidence from primary research articles and reviews of the literature.
Process: After drafting a recommendation for the older adult population and reviewing drafts of the Updated Recommendation from the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults, the panel issued a final recommendation on physical activity for older adults.
Summary: The recommendation for older adults is similar to the updated ACSM/AHA recommendation for adults, but has several important differences including: the recommended intensity of aerobic activity takes into account the older adult's aerobic fitness; activities that maintain or increase flexibility are recommended; and balance exercises are recommended for older adults at risk of falls. In addition, older adults should have an activity plan for achieving recommended physical activity that integrates preventive and therapeutic recommendations. The promotion of physical activity in older adults should emphasize moderate-intensity aerobic activity, muscle-strengthening activity, reducing sedentary behavior, and risk management.

In 1995 the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) published a preventive recommendation that "Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week".^[46] Subsequently, ACSM and the American Heart Association (AHA), in a companion paper^[25] to the present article, provide an update to this recommendation. The update is more inclusive and provides recommendations for moderate-intensity aerobic activity, vigorous-intensity aerobic activity, and muscle-strengthening activity. It states explicitly that many adults should exceed the minimum recommended amount of activity.

In considering an update of the 1995 recommendation, ACSM deemed it appropriate to issue a separate recommendation for older adults (men and women age ≥ 65 yr and adults age 50 to 64 yr with clinically significant chronic conditions and/or functional limitations). Issues naturally arise about how to apply a recommendation intended mainly for the generally healthy adult population to older adults, who commonly have chronic medical conditions, low fitness levels, and/or functional limitations. In addition, the amount of scientific information on physical activity in older adults has grown rapidly. For example, a recent meta-analysis located 66 randomized trials of resistance exercise as the sole form of exercise for older adults.^[35] Older Americans are the least physically active of any age group^[13] and generate the highest expenditures for medical care. Older Americans have been the most rapidly growing age group, yet more rapid growth in this group will occur in the next 20-30 yr when millions of baby boomers turn 65. The feasibility of attaining higher levels of physical activity in the population of older adults is encouraging in that recent trends, albeit modest, are on the upswing.^[14] It is possible that increasing levels of activity could reduce medical expenditures in this group within a year or so of the onset of behavior change.^[41]

The objectives of this article are to 1) provide a preventive recommendation on physical activity for older adults that consists of the updated ACSM/AHA recommendation for adults with additions and modifications appropriate for older adults; 2) explain and clarify the additions and modifications; and 3) discuss the promotion of physical activity in older adults so as to provide guidance about appropriate types and amounts of physical activity.

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