Exercise and Physical Activity for Older Adults

Wojtek J. Chodzko-Zajko, Ph.D., FACSM; David N. Proctor, Ph.D., FACSM; Maria A. Fiatarone Singh, M.D.; Christopher T. Minson, Ph.D., FACSM; Claudio R. Nigg, Ph.D.; George J. Salem, Ph.D., FACSM; James S. Skinner, Ph.D., FACSM

Disclosures

March 01, 2010

In This Article

Abstract and Introduction

Abstract

The purpose of this Position Stand is to provide an overview of issues critical to understanding the importance of exercise and physical activity in older adult populations. The Position Stand is divided into three sections: Section 1 briefly reviews the structural and functional changes that characterize normal human aging, Section 2 considers the extent to which exercise and physical activity can influence the aging process, and Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. Although no amount of physical activity can stop the biological aging process, there is evidence that regular exercise can minimize the physiological effects of an otherwise sedentary lifestyle and increase active life expectancy by limiting the development and progression of chronic disease and disabling conditions. There is also emerging evidence for significant psychological and cognitive benefits accruing from regular exercise participation by older adults. Ideally, exercise prescription for older adults should include aerobic exercise, muscle strengthening exercises, and flexibility exercises. The evidence reviewed in this Position Stand is generally consistent with prior American College of Sports Medicine statements on the types and amounts of physical activity recommended for older adults as well as the recently published 2008 Physical Activity Guidelines for Americans. All older adults should engage in regular physical activity and avoid an inactive lifestyle.

Introduction

In the decade since the publication of the first edition of the American College of Sports Medicine (ACSM) Position Stand "Exercise and Physical Activity for Older Adults," a significant amount of new evidence has accumulated regarding the benefits of regular exercise and physical activity for older adults. In addition to new evidence regarding the importance of exercise and physical activity for healthy older adults, there is now a growing body of knowledge supporting the prescription of exercise and physical activity for older adults with chronic diseases and disabilities. In 2007, ACSM, in conjunction with the American Heart Association (AHA), published physical activity and public health recommendations for older adults (see Table 1 for a summary of these recommendations).[167] Furthermore, the College has now developed best practice guidelines with respect to exercise program structure, behavioral recommendations, and risk management strategies for exercise in older adult populations.[46] Recently, the Department of Health and Human Services published for the first time national physical activity guidelines. The 2008 Physical Activity Guidelines for Americans[50] affirms that regular physical activity reduces the risk of many adverse health outcomes. The guidelines state that all adults should avoid inactivity, that some physical activity is better than none, and that adults who participate in any amount of physical activity gain some health benefits. However, the guidelines emphasize that for most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration. The guidelines stress that if older adults cannot do 150 min of moderate-intensity aerobic activity per week because of chronic conditions, they should be as physically active as their abilities and conditions allow.

This revision of the ACSM Position Stand "Exercise and Physical Activity for Older Adults" updates and expands the earlier Position Stand and provides an overview of issues critical to exercise and physical activity in older adults. The Position Stand is divided into three sections: Section 1 briefly reviews some of the structural and functional changes that characterize normal human aging. Section 2 considers the extent to which exercise and/or physical activity can influence the aging process through its impact on physiological function and through its impact on the development and progression of chronic disease and disabling conditions. Section 3 summarizes the benefits of both long-term exercise and physical activity and shorter-duration exercise programs on health and functional capacity. The benefits are summarized primarily for the two exercise modalities for which the most data are available: 1) aerobic exercise and 2) resistance exercise. However, information about the known benefits of balance and flexibility exercise is included whenever sufficient data exist. This section concludes with a discussion of the benefits of exercise and physical activity for psychological health and well-being.

Definition of Terms. Throughout the review, the Institute of Medicine's definitions of physical activity and exercise and related concepts are adopted, where physical activity refers to body movement that is produced by the contraction of skeletal muscles and that increases energy expenditure. Exercise refers to planned, structured, and repetitive movement to improve or maintain one or more components of physical fitness. Throughout the Position Stand, evidence about the impact of exercise training is considered for several dimensions of exercise: aerobic exercise training (AET) refers to exercises in which the body's large muscles move in a rhythmic manner for sustained periods; resistance exercise training (RET) is exercise that causes muscles to work or hold against an applied force or weight; flexibility exercise refers to activities designed to preserve or extend range of motion (ROM) around a joint; and balance training refers to a combination of activities designed to increase lower body strength and reduce the likelihood of falling. Participation in exercise and the accumulation of physical activity have been shown to result in improvements in Physical fitness, which is operationally defined as a state of well-being with a low risk of premature health problems and energy to participate in a variety of physical activities. Sedentary living is defined as a way of living or lifestyle that requires minimal physical activity and that encourages inactivity through limited choices, disincentives, and/or structural or financial barriers. There is no consensus in the aging literature regarding when old age begins and no specific guidelines about the minimum age of participants in studies that examine the various aspects of the aging process. The recently published ACSM/AHA physical activity and public health recommendations[167] for older adults suggest that, in most cases, "old age" guidelines apply to individuals aged 65 yr or older, but they can also be relevant for adults aged 50-64 yr with clinically significant chronic conditions or functional limitations that affect movement ability, fitness, or physical activity. Consistent with this logic, in the present review, most literatures cited are from studies of individuals aged 65 yr and older; however, occasionally, studies of younger persons are included when appropriate.

Process. In 2005, the writing group was convened by the American College of Sports Medicine and charged with updating the existing ACSM Position Stand on exercise for older adults. The panel members had expertise in public health, behavioral science, epidemiology, exercise science, medicine, and gerontology. The panel initially reviewed the existing ACSM Position Stand and developed an outline for the revised statement. Panel members next wrote background papers addressing components of the proposed Position Stand, using their judgment to develop a strategy for locating and analyzing relevant evidence. The panelists relied as appropriate on both original publications and earlier reviews of evidence, without repeating them. Because of the breadth and diversity of topics covered in the Position Stand and the ACSM requirement that Position Stands be no longer than 30 pages and include no more than 300 citations, the panel was not able to undertake a systematic review of all of the published evidence of the benefits of physical activity in the older population. Rather, the Position Stand presents a critical and informed synthesis of the major published work relevant to exercise and physical activity for older adults.

Strength of Evidence. In accordance with ACSM Position Stand guidelines, throughout this Position Stand, we have attempted to summarize the strength of the available scientific evidence underlying the relationships observed in the various subsections of the review. An Agency for Health Care Research and Quality (AHRQ) report notes that no single approach is ideally suited for assessing the strength of scientific evidence particularly in cases where evidence is drawn from a variety of methodologies.[260] The AHRQ report notes that significant challenges arise when evaluating the strength of evidence in a body of knowledge comprising of combinations of observational and randomized clinical trial (RCT) data as frequently occurs in aging research. The AHRQ consensus report notes that although many experts would agree that RCTs help to ameliorate problems related to selection bias, others note that epidemiological studies with larger aggregate samples or with samples that examine diverse participants in a variety of settings can also enhance the strength of scientific evidence. Consistent with this approach, in this Position Stand, the writing group adopted a taxonomy in which both RCT and observational data were considered important when rating the strength of available evidence into one of four levels. In each case, the writing group collectively evaluated the strength of the published evidence in accordance with the following criteria:

  1. Evidence Level A. Overwhelming evidence from RCTs and/or observational studies, which provides a consistent pattern of findings on the basis of substantial data.

  2. Evidence Level B. Strong evidence from a combination of RCT and/or observational studies but with some studies showing results that are inconsistent with the overall conclusion.

  3. Evidence Level C. Generally positive or suggestive evidence from a smaller number of observational studies and/or uncontrolled or nonrandomized trials.

  4. Evidence Level D. Panel consensus judgment that the strength of the evidence is insufficient to place it in categories A through C.

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