Physical activity in later life: an exercise in common sense

Marion E T McMurdoProfessor of Ageing and Health

University of DundeeScotland

Annual NICE Knowledge Exchange 24th May 2012

Key messages

• It is never “just your age”• Modest amounts of physical activity are good

for health• Common sense urgently needed regarding

safety

Old age is the age at which most of the medical profession start to lose interest in you

Marion McMurdo

Old age begins and middle age ends the day your descendants outnumber your friends

Ogden Nash

Lifelong trajectory of health and diseaseG en eti csC h an ceSo cial en viro n m en t

L if e s t y le

Physical activity

Movement of the body by the skeletal muscles that results in energy being expended

Exercise

Physical activity that is planned, structured, and repetitive done with aim of improving or maintaining physical fitness

The condition of exercise is not a mere variant of the condition of rest, it is the essence of the machine

Sir John Barcroft 1926

Active like a hunter gatherer

• Most human history, man lived as a hunter gatherer – a physically demanding life

• Our exercise needs remain same as our ancestors

• Technology has eliminated physical work • Sedentary lifestyles ‘normal’• Inactivity-induced epidemics

Archer and Blair. Prog Cardiovasc Dis 2011;53:387-396.

Age/motor disability/knee pain

Age/motor disability/knee pain

Muscle WeaknessMuscle Weakness

Decreased muscle strength

Decreased muscle strength

ActivitiesActivities

Ready fatigue/poor endurance

Ready fatigue/poor enduranceFurther

restriction of activities

Further restriction

of activities

Further disabilityFurther

disability

Physical activity, age and physical disability

Adapted from Nair SK. Mayo Clin Proc 2000;75:S14-S18

Regular physical activity

Protective against• Heart disease• Diabetes• Some cancers• Mild depression• Dementia and

Alzheimer’s disease

Larson EB et al. Ann Intern Med 2006;144:73-81

Deterrents to physical activity

• Survey of 409 people aged 65-84 years

• “Cannot” • “Will not” • “Should not”

Crombie et al. Age Ageing 2004;33:287-92

Deterrents to physical activity

• Confusion!

• Collective amnesia!

• Fear!

Exercise recommendations for healthy older adults

• Activity of moderate intensity 30 minutes, 5 days per week (150 mins per week)

• Bouts as short as 10 minutes• Muscle strengthening 2 days per week• Flexibility exercises• ‘More better’

Nelson et al. Med Sci Sports Exerc 2007;39:1435-1445

Activity and risk of heart disease

Longitudinal follow-up of 39,000 older women• Light-to-moderate physical activity associated

with reduction in risk of heart disease• At least 60 minutes walking per week

predicted lower riskLee I-Min JAMA 2001;285:1447-

54

“Just get out the door!”

• Study 1002 women aged >65 years

• Walking ≥8 city blocks per week, twice as likely to still be mobile than those walking less

Simonsick EM et a. JAGS 2005;53(2):198-203.

Hea

lth B

enef

it

Baseline activ ity statusLow H igh

Sedentary

D oseR esponseC urve

A =

M oderate lyactive

B =

ActiveC =

Relationship between health benefits and physical activity

Kesaniemi et al. Med Sci Sports Exerc 2011;22:73-107Nigam et a. Lancet 2011; 378: 1202 – 1208.

• Risks of inactivity are high• Avoid sudden unaccustomed vigorous exercise

at all ages• Moderate intensity – low risk• Stay within own level of comfort, start slow, build up gradually

Liu and Latham. Cochrane Database Rev 2009 Jul 8;(3): CD002759

Safety of physical activity in old age

University of Dundee’s seniors exercise classes: a not-for-profit organisation

• Founded by Dorothy Dobson in 1986

• Classes UK wide• No exclusions, no

screening, no disclosures, no disclaimers

More than 600,000 hours of event-free seniors exercise time

www.dorothydobsonsover60s.com

Determinants of physical activity

• Encouragement and enjoyment

• Confidence in ability to be active and safety

• Low to moderate intensity

• Goal setting and planning

McMurdo MET. Exercise in old age: time to unwrap the cotton wool. Br J Sports Med 1999;33:295-296.

Key messages

•It is never “just your age”•Modest amounts of physical activity are good for health•Common sense urgently required regarding safety