Physical Activity Initiatives with Older Adults Physical Activity Initiatives with Older Adults A...

Physical Activity Physical Activity Initiatives with Initiatives with

Older AdultsOlder Adults

A Canadian Perspective

Whistler, B.C.

December 10, 2001

Our Challenges

“It is surely a great criticism of our profession that we have not organized a critical summary, by specialty of sub-specialty, adapted periodically, of all relevant randomized controlled trials.”

• Archie Cochrane

Our Challenges

Clear Lake Agreement by Federal, Provincial, & Territorial Ministers responsible for fitness, active living, recreation set a joint target to reduce physical inactivity in Canadians by 10% from 1998-2003

Active Old Age

Director General of the World Health Organization described gains in life expectancy as one of humanity’s greatest achievements

Living a full life to reach a healthy, happy and active old age is our aspiration

Between Friends

Not Aging but Saging …Wise Beyond Your Years

It might not affect you now, but it will.

Growing older is inevitable.

Dignity, Respect, Independence and Control

The importance of older people being able to maintain control and autonomy in their lives must not be lost

Definition of Older Adult

Self-defining (Active Living Coalition for Older Adults)

Varies depending upon initiative 50-55+ for many initiatives (Physical Activity

Guide)

Aging Population - Facts

Being physically active reduces the risk of heart disease, fall and injuries, obesity, high blood pressure, adult-onset diabetes, osteoporosis, stroke, depression, colon cancer and premature death

One-third of older adults face an increased risk of loss of mobility and functional capacity, thereby decreasing their functional independence

Aging Population Facts

1 in 10 Canadians is an older adult This number will double by 2021 The greatest health risk for older adults is

sedentary living (WHO, 1997) Among adults 55 + only 34% of men and 29% of

women are physically active Among adults 74+ only 29% of men and 19% of

women are physically active

The Older Adult Audience

50% of seniors report physical activity of 15 min. or more at least 12/month

Almost 2/3 of those aged 80+report needing no help with daily tasks

Only 16% of older adults use the Internet Once online Canadian seniors use the

Internet on average 12 hours weekly

The Older Adult Audience

1/3 of Canadian seniors live in rural areas and small towns, the rest in urban areas

93% of seniors live in private households 20% of Canadians 65+ have post-secondary

diploma or degree 60% did not finish high school Considerable number have difficulty with

reading

By 2041….

46% have a disability but for most part continue to enjoy and active lifestyle in their communities

For those born in 1998 life expectancy increased to 92 for men and 100 for women

By 2041 number of Canadians over 80 will quadruple

Why Older Adults are not as Physically Active

Accessibility Safety Security Support Motivational issues

– Must be addressed to encourage, support and ensure that opportunities exist that facilitate involvement in Active Living

Aging and Communication

Visual acuity Hearing acuity Agility & Mobility Social/emotional changes

Barriers to Reaching Older Adults

Physical changes of aging Stereotypes, outdated assumptions about older

adults lifestyles, interests, capabilities Communication materials and media not suited to

audience

Initiatives

Physical Activity Guide for Older Adults– -individuals & leaders, practitioners

Moving through the Years – A Blueprint for Action for Active Living and Older Adults– Policy, decision makers

Evidence Based Clinical Guidelines for Osteoporosis– Physicians (Specialists/ GP,FP), Other Allied Health

Professionals

Canada’s Physical Activity Guide for Older Adults

The Guide and the accompanying handbook are the Canadian standard for physical activity and older adults

Based on prototype of Physical Activity Guide for Canadians and Canada’s Food Guide

Bilingual (French & English)


Developed over 3 years Done in partnership with the Active Living

Coalition for Older Adults (ALCOA), Canadian Society for Exercise Physiology and Health Canada

Launched in May 1999 Multi-disciplinary national advisory committee

which included older adults Focus testing with both older adults and health

professionals in urban and rural settings


Guide and Handbook underwent numerous reviews by a group of scientific experts

Guide and handbook used by leaders, health providers and program delivers

Guide includes tips to getting started, how much activity is enough, health benefits, and examples of endurance, flexibility, strength and balance activities to choose from

Launched in conjunction with the “Blueprint for Action”

Canada’s Physical Activity Guide for Older Adults Challenges

Retain scientific validity Retaining balance between consumer wants &

needs and what science says Marketing of message had to be simple, realistic,

believeable, and inspiring Attaining the outcomes & benefits while making

goal attractive & attainable Carry a message to audience that was clear and

user friendly

Canada’s Physical Activity Guide for Older Adults Challenges

Simple Messages: Age is no barrier Be Active, Your Way, Every Day for Life Every little bit helps, but more is better Add it up principle Moderate physical activity most days for 30-60

minutes Choice of activities from each of three activity

groups:– Endurance, Flexibility, Strength & Balance

Canada’s Physical Activity Guide for older adults

Science based facts (benefits/risks) Why do this and what is in it for you Variety & Safety concerns (start where you can) Overcoming barriers Pull out Guide to put on refrigerator Sample calendar/planning sheet Stories/Real people (not cartoons) Next steps planner

Canada’s Physical Activity Guide for older adults - Barriers

I feel too tired to get started I don’t want to exercise? I’ve worked hard all my

life, not its time to relax I have arthritis or stiff joints? I have osteoporosis? I have concerns about my heart? I’m afraid that

physical activity will do more harm than good

Canada’s Physical Activity Guide for older adults - Barriers

I don’t have much time…so which activity is best?

I am unsteady on my feet? I am afraid to go out in winter?

What’s Different

Size of print Benefits right up front Real people Practical user friendly suggestions Talk about barriers (tell it like it is) Safety Refers individuals to their physician or health

professional

What’s Different

Lots of white space Bold headings Clear Language Stories of real people

Key Learning from the Guide

Senior friendliness is an attitude based on considering seniors’ needs and respecting seniors’ contributions

Physicians are credible influencers of individual’s health behaviours for older adults

Design communication with your clients not for them.


An excellent example of how consensus statements and research can be translated into simple clear messaging for the target audience


Outcomes– Over 50 National organizations endorsed the

Guide– Over 2 million copies have been printed and

distributed

College of Family PhysiciansKey Influencers

Adopted a Physical Activity and Health Strategy Developed a unique video on active ageing Physicians learn more about barriers to PA Describes new counseling & training tools New Practice-based Small Group Learning

Module on PA & older adults For info email [email protected]

mailto:[email protected]

Moving Through The Years:A Blueprint for Action

Goal to update 1991 original Blueprint Fondation en Adaptation Motrice, ALCOA and

Health Canada conducted survey in 22 communities across Canada and over 20 NGO’s

Over 450 individuals consulted (over half of whom were older adults)

Launched in 1999 in International Year of Older Persons


A national framework for plan of action Provides a collective direction for current and

future initiatives A tool for planned change ALCOA asked to serve as the keeper of the

Blueprint to ensure its uptake Serves as a base for ALCOA’s goals and

objectives

Active Living Coalition for Older Adults

In 1993 three older adult national bodies came together (National Walking Campaign, Secretariat for Fitness for the Third Age, The Older Adult Active Living Association)

Became Active Living Coalition for Older Adults (ALCOA)

Mandate to bring together national organizations & researchers working with older Canadians in Active Living


Nine Guiding Principles based on the vision of : An active society where all older Canadians are

leading active lifestyles thereby contributing to their physical and overall well-being.


Principle 1– It is recognized that active living is essential

for daily living and a cornerstone of health and a quality of life.


Principle 2:– There is a need for more positive attitudes

toward aging, with realistic images that depict older adults as respected, valued, and physically active members of society.


Principle 3:– Older adults should be encouraged to

participate in decision-making and leadership positions, in all phases of program/service development and delivery.


Principle 5:– Issues, needs and interests of older adults in

their community need to be identified, and accessible, affordable active living activities and programs designed to meet these needs.


Principle 6:– While it is recognized that both aging and

learning are a life-long process, it is appreciated that for some, pre-retirement years may be a key time to re-focus on active living and well-being.


Principle 7:– Canada is a society for all ages: Programs and

services should be developed which accommodate older adults’ choice to be with others.


Principle 8:– There is a need to identify, support, and share

research priorities that apply to active living and aging.


Principle 9:– There is a need for education and promotion of

the health benefits of active living as a way of life for older adults

Areas of emphasis for active living and older adults

Increase public awareness about the benefits of active living

Develop competent leaders in active living who can meet the needs & interests of older adults

Ensure resources and social supports needed to be active are in place

Strengthen delivery systems and improve levels of cooperation, coordination, and communication among organizations

Areas of emphasis for active living and older adults

Encourage and enable older adults to advocate for the right to a quality of life that includes physical activity

Identify, support, and share research priorities and results on aging and active living

Continually monitor and evaluate programs, services and outcomes to ensure that active living needs, interests, and concerns of older adults are met

Blueprint Implementation Summit

In 1999 Blueprint implementation Summit held Over 50 national and provincial organizations

attended along with other stakeholders Resulted in five priority areas:

– Leadership Development– Shared Research in Plain Language– Marketing and Communications– Influencing Policy– Coordination and Capacity Building

Leadership Development

ALCOA providing strategic leadership Develop a network of community presenters to

conduct workshops with older adults Develop strong delivery system at the community

level through the members of ALCOA Presenting to seniors groups and organizations to

promote the Guide and the Blueprint and to highlight local opportunities in each community to be active

Communicating Research in Plain Language

ALCOA Research Update Launched May 2001 Goal to interpret current leading edge research

into user friendly, plan language format Included in Research Update is a special Active

Living Tips sheet for older adults Copies available

Marketing & Communications

Includes ALCOA’s website, newsletter, electronic listserv, national spokesperson and a framework for affecting change

Provides an opportunity to share information, network, learn and reach older adults with consistent active living messages

Influencing Policy

ALCOA partners with key member groups and stakeholders

ALCOA to develop information to members of parliament/policy and decision makers to influence and promote the priority of active living opportunities for older adults

Capacity Building

Increase and strengthen ALCOA’s membership Involve older adults in all planning & decision

making Bring together multidisciplinary professionals,

volunteers and older adults to share information and resources

To foster a broader collaborative network Holds national forums, Mark your calendars for

Forum Regina Saskatchewan May 9-12, 2002

Intended Outcomes of these Efforts by ALCOA

Results of these efforts is to increase the opportunities for and the possibility of healthy aging by all Canadians

Osteoporosis Society of CanadaDefinition of Osteoporosis

What is osteoporosis?– A disease characterized by low bone mass and

micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risks.

Thinning of bone that leads to higher risk of fracture.

Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines

Prevalence of Osteoporosis– Major health problem in Canada and other

industrialized countries– Affects up to 1 in 4 Canadian women over 50– Affects 1 in 8 men over 50( and increasing)– As many as 2 million Canadians at risk over

their lifetime


Why should we be concerned about osteoporosis?– Hip fractures strongly related to osteoporosis

• 20% lead to subsequent premature mortality

– Vertebral fractures dramatically affect quality of life

– Often decrease in personal freedom– Annual cost of treatment $1 billion in Canada– Canada’s population is aging– Frequency of osteoporosis will rise as well


Our goal…– To prevent fracture through proven preventive

measures and effective therapies


Why do we need guidelines? Distill a large body of medical knowledge into a

convenient, readily useable format Primary purpose is to educate and create

awareness– Difficult for physicians to keep up with the

latest advances


Why Guidelines? To keep up to date in Internal Medicine

physicians need to read 17 articles a day, 365 days a year

They don’t Nor does anyone else


Why Guidelines? Physicians need evidence about

– The accuracy of diagnostic tests,– The power of prognostic markers,– The comparative efficacy and safety of interventions, etc

Need evidence about 5 times for every in-patient (and twice for every 3 out-patients)

Properly structured guidelines are an invaluable resource to the busy clinician


1996 Guidelines Project were consensus-based guidelines– A narrative view– Scan through arbitrarily selected documents

and pick out what seems to address questions– Quicker to create


Consensus-based Guidelines– Very susceptible to bias– Subjective evaluation of literature, opinion– No criterion for inclusion of investigation or to

the grading of quality– Often, exalted individuals keep up the least with

current literature and advances– Experts are often less able to produce objective

reviews of the literature in their area than non-experts


What is evidence-based evidence? It is the conscientious, explicit and judicious use

of current best evidence in making decisions about the care of individuals (patients)


Evidence-based medicine is the integration of:– Individual clinical expertise– Best available external clinical evidence from

systematic research and– Individual’s (Patient) values and expectations


Total abstracts caught and searched by the committee:

Grand Sum: 89,804 Exercise and Fall Prevention: 11,713 Nutrition: 16,058


Abstracts selected for formal review:– Grand Sum: 6941– Exercise and Fall Prevention: 1293

The scope

To this date, no review has ever been published that is more comprehensive

We have searched high and low for every possible citation

Evidence Based Danger

Systematic bias– A few therapies have much good evidence– Often can be reflective of funds to prove

effectiveness– May be at the expense of other areas without the

financial wherewithal

Danger of “without substantial evidence” to it being thought to be “without substantial value”

Physical Activity and Osteoporosis

Physical activity is not a standardized intervention

Variation in type, frequency and intensity and varies in site-specificity

Moreso that any other intervention compliance is a major issue

Potential for good and for harm

Physical Activity and Osteoporosis

As yet there is no clear insight into type, frequency or intensity is important for bone health

Or how this might change for different ages with different levels of bone mass

Some recent evidence that repetitious loading and unloading may work well

Goals

To prevent fractures:– a) Through improving bone mass– b) Through fall prevention

Effect of Exercise as Lifestyle

In children, exercise plus calcium (& Vit D) makes better bones

Lifelong exercisers have better bones then sedentary people (& fewer fractures)

Over-exercising can lead to bone loss in both men and women

Body weight changes might be important: weight gain above the waist is good, its loss is not good

Interim Expert Opinion

If you have been an exerciser all your life, stick with it

High activity level throughout adult life may be protective and lead to fewer fractures in old age


In people with osteoporosis: If exercise has any role to play in reducing bone

loss it is secondary to pharmaceutical treatment Osteoporosis exercise programs are of value and

should be available to patients


In Elderly Fallers: Strengthening and balance exercises, and where

relevant, multi-factorial interventions, based on individual assessment, will reduce falling risks

• Dr. Richard Crilly, Scientific Advisory Council. OSC

Implementation of Evidence Based Guidelines

Partnerships with allied organizations– College of Family Physicians– Other Health Charities– Corporate Health Sector– Other medical specialties

Web-site Nation wide forums with case study approach and

opportunity to dialogue with experts Translate into user friendly language Publish in Canadian Medical Association Journal

Implementation

New evidence often takes a long time to be implemented

Established practices persist even if they have been proven ineffective or harmful

Outcomes

Family physicians and non-specialists able to quickly establish the best, evidence-based care for a particular patient– Considering the patient’s individual characteristics

Guidelines for the prevention of osteoporosis– Policy changes for governments– Forms foundation for all Society public and

professional information– Credible source of osteoporosis information in

Canada i.e. media

Summary CommentsPlain Language Checklist

Use concrete examples to illustrate ideas or concepts

Present ideas with illustrations or diagrams Highlight main ideas and important information

with headings, point form and boldface type

Summary CommentsPlain Language Check List

Use familiar words, conversational personal tone Proceed logically, most important ideas first Use action verbs and active construction Favour short words and sentences Use short paragraphs

Promotion & Marketing Checklist

Research and consult guidelines about tailoring messages for older consumers

Focus-test your materials with older adults Recognize in your marketing plan that this is not

a single homogeneous group Test a marketing plan and materials with several

groups of older consumers (include a range of ages and literacy levels)

Promotion and Marketing Checklist

Use older persons or models in your promotional materials

Present positive images of people who are healthy, happy and representative of OA diversity of culture, language, health status, geographic location, income level, etc.

Active Living & Older AdultsNext Steps in Education

Continue increasing awareness & education about the benefits and importance of active living

Promote a consistent message Decrease fears about physical activity Advocacy efforts for policy changes Strengthen partnerships so that health

professionals and organizations at all levels promote the active living message

Active Living for Older AdultsNext steps in Programming

Create specialized programs for each stage of the older adult continuum

Incorporate a variety of programming Include all components of fitness Incorporate progression Include social components Address environmental and accessibility issues Develop community wide plans

Active Living for Older Adults Next steps in Research

Continue research into physical activity and older adults

Increase investigation of psychosocial aspects

Translate research into clear language

Active Living for Older AdultsNext steps in Empowerment

Older adults take responsibility for their own health and to take an active role in program planning and delivery

Encourage and support role models and leadership

Foster and promote a change in attitude

Active Living for Older AdultsNext steps in Empowerment

Older adults the fastest growing group on Internet users

Internet expands the world of seniors Powerful tool for maintaining health and well-

being New form of intergenerational communication Encourage older adults to get online Build senior friendly websites

This is a prime opportunity for governments, individuals and organizations to make a positive

impact on the health of all Canadians

Physical activity, especially for older adults, is overlooked as an effective and essential part of health promotion strategy

Active Living is a long-term, low-cost preventative approach

The Ultimate Goal

Prolong the independence of older Canadians and add life to years

When Physical Activity has a prominent place in the Cochrane Collaboration we will know we have been successful.

Thank you / Merci

For more information:

Physical Activity Guide: 1-888-334-9769– www.paguide.com

ALCOA: www.alcoa.ca 1-888-549-9799 Osteoporosis Society of Canada

– www.osteoporosis.ca

http://www.alcoa.ca/

http://www.osteoporosis.ca/

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