Move It or Lose It

If we had a dime for every time we’ve told an older adult the importance of exercise and fitness to maintain function … In our evidence-based world, there are more data than ever to support the benefits of exercise.

Benefits of Regular Physical Activity

Regular physical activity provides the following benefits:

• it reduces the risk of developing chronic diseases such as heart disease;
• it improves chronic illness such as high blood pressure, diabetes, obesity, and high cholesterol;
• it improves the ability to function and stay independent in the face of caregiving challenges; and
• it improves nighttime sleep patterns.

How Much Is Enough?

Older adults should engage in at least 30 minutes of moderate physical activity five times per week. Ten-minute bursts of increased intensity, which can include any effort that involves sustained activity, are helpful.

What Should Exercise Target?

Activities should focus on strength, balance, and flexibility.

* New data show that water exercise can improve bone density.

Dr. Laird’s Top Six Exercises for Older Adults

• Walking (as important as all the other exercises combined)
• Swimming
• Tai chi, yoga
• Weights
• Chair exercises
• Treadmills, NuStep, cardio machines, etc.

Does It Work?

Healthy People 2020 guidelines were created after a review of large amounts of detailed research on the impact of physical fitness on overall health and function. Interesting findings include the following:

• Substantial health benefits occur with a moderate amount of activity (ie, at least 30 minutes of brisk walking) on five or more days of the week.
• Brief episodes of physical activity, such as 10 minutes at a time, can be beneficial if repeated.
• Sedentary individuals can begin with brief episodes and gradually increase the duration or intensity of activity.
• Older adults can benefit further from activities aimed at building or maintaining muscle strength and balance.
• A recent review of individually tailored programs for elderly people demonstrated that programs to build muscle strength, improve balance, and promote walking significantly reduced falls in older persons.
• Experts recommend that older adults should participate at least two days per week in strength training activities, such as workouts with weights, to improve and maintain muscular strength and endurance.
• Older adults should also perform physical activities such as tai chi, water exercise, and yoga that enhance and maintain flexibility and balance.
• Women in the exercise group engaged in four 30- to 40-minute sessions of aerobic exercise, such as brisk walking. Participants spent five hours per week in physical activity by the study’s end. They completed brief daily logs including activity type, intensity, and duration that were mailed monthly to project staff. The exercise group showed significant improvements in stress-induced blood pressure levels and sleep quality compared with the women who received nutrition counseling.

Before Starting Exercise Routines

Prior to the start of a new exercise routine, encourage older adults to complete the following:

• Discuss exercise plans with their physicians.
• Consider the kinds of physical activities they enjoy such as walking, swimming, tennis, dancing, or gardening.
• Determine the time of day and the place where the type of activity would work best.
• Evaluate the exercise programs available at local senior centers. Local malls often have walking clubs and provide a place to exercise in inclement weather.
• Maintain realistic expectations.
• Progress slowly. For example, begin with a short walk around the yard before progressing to a walk around the block.
• Be aware of any discomfort or signs of overexertion and consult a physician if this occurs.

Other Tips for Success

Other activities or routines help older adults adhere to exercise goals, including the following:

• Journal the workout. Watching the miles or minutes add up is a great motivator.
• Window shopping. Take a few laps past favorite stores prior to shopping.
• Reward yourself. Celebrate exercise success with a favorite movie or a new handbag.
• Use home equipment/DVDs for walking programs or Sit and Be Fit PBS program.
• Find a walking buddy. Exercising with a partner reduces the likelihood individuals will stop exercising.
• Use a pedometer to count steps; 7,000 to 10,000 per day is advised.

The following resources offer guidance on safe exercise for older adults:

• Healthy People 2020: www.healthypeople.gov/2020/topics-objectives/topic/older-adults
• The National Institute on Aging’s Go4Life program: http://go4life.nia.nih.gov/
• Centers for Disease Control and Prevention physical activity guidelines for older adults: www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html

Handout for Patients

Aging Successfully: Move It or Lose It!

“I’ve fallen and I can’t get up.” Sadly, this phrase is known all too well. The number of falls, injuries, and fall-related deaths that occur every day is distressing. Each year in the United States, more than one-third of community-dwelling adults aged 65 and older experience falls, according to the Centers for Disease Control and Prevention. Approximately 20% to 30% of falls result in moderate to severe injuries that impair elders’ mobility, reduce their ability to maintain independence, and frequently lead to early death.

In more than 90% of elders whose hip fractures have been caused by falls, 25% die within six months to one year after the fall. Adults aged 75 and older account for nearly 85% of fall fatalities. While older adults may think about this risk as it relates to a loved one, they should realize that caregivers are at risk as well.

What accounts for this increased risk of falls in older adults? A number of changes combine to create an increased risk of falling. Muscle mass decreases, and the efficiency of nerves, especially sensory nerves that detect how soft or hard the ground is, declines, leading to decreased muscle strength and performance particularly when quick movements are necessary. Both men and women lose bone density. The resulting changes to the anatomy of the spine, foot, and joints can alter gait and contribute to unsteadiness while walking. Cardiovascular efficiency at rest is reasonably preserved as we age, but maximal ability when stressed is decreased so we become more susceptible to changes in circulation and dizziness with change of position as in getting up quickly. Vision and hearing changes can limit information the brain needs to adjust properly to the surrounding environment.

How can you avoid this decline? It’s important to remember that if you move it, you won’t lose it. Research has clearly shown that you can improvement your level of physical fitness well into your 90s. Regular exercise is one of the most important ways to reduce fall risk because it builds strength and helps you feel better, both physically and mentally. Thirty minutes per day on at least five days per week of moderate exercise (moderate means you can have a conversation while doing the exercise) is ideal.

Yoga, tai chi, and other exercises focused on improving balance and coordination are most helpful, but any exercise increasing strength, endurance, and flexibility provides improved physical function for balance and coordination. Walking is the universal exercise and walking in a pool or other water-based exercises are effective as well.

What if I am unsteady while walking or afraid of falling? Initially, you should see your primary care provider for a full evaluation. In addition to the effects of aging, there are other causes for falls, including medications that can increase fall risk. Next, don’t be afraid to use a cane or walker if necessary for balance and security. It is critical to stay active. But you need to avoid injury. Elders should use handrails on stairs for guidance and support. Wearing rubber soled, low-heeled shoes that support feet and are not slippery adds to the security of walking with reduced fall risk.

Talk to your doctor before starting any new exercise programs, and keep the intensity low but frequent. Don’t forget, you really do have to “move it or lose it.”

— Rosemary Laird, MD, MHSA, AGSF, is a geriatrician, medical director of the Health First Aging Institute, and past president of the Florida Geriatrics Society. She is a coauthor of Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One With Memory Loss.