Opinion paper: Exercise for healthy aging
Introduction
According to the United Nation’s World Population Prospects: the 2019 Revision, 8% of the worldwide population is currently over 65 years of age, but this is expected to increase to about 16 % by 2050 [1]. By 2050, 25 % of the population in Europe and North America could be aged 65 or over. The change in the population age profile has several health, social and economic consequences.
In Europe, life expectancy is increasing. In member states of the Organization for Economic Co-operation and Development (OECD), the life expectancy at the age of 65 years is 20–22 years, depending on ethnic background, social situation and gender. The life expectancy of women is generally 3−4 years longer than that of men [2].
Unfortunately, longevity and illness are strongly associated. The health problems increasing with age are largely cardiovascular diseases, malignant neoplasms, type 2 diabetes, chronic respiratory problems, musculoskeletal diseases, falls, neurological and mental disorders [3]. Furthermore, the aging population also suffers from other social threats, such as the loss of the spouse and other age mates and a gradual loss of independence.
The World Health Organization (WHO) has published recommendations to counteract the declines in the physical and psychosocial capacity in older people [4]. With increasing longevity, there is only poor evidence to suggest that these extra years can be lived in good health. Based on Global Burden of Disease study, the rate of years lived with disability increased in both men (7,9%) and women (6,5%) between 1990 and 2017 [5]. Yet in population studies great interindividual diversity in health and functioning is observed in all age groups. This may be a consequence of the cumulative impacts of advantages or disadvantages in people’s lives, yet it may also be a consequence of lifestyle.
There is strong scientific evidence that regular physical activity has extensive health benefits for adults aged 65 and above (as is the case, of course, for people aged 18–64). In some cases, the evidence of health benefits is strongest in older adults because the poor outcomes related to inactivity are more common than in younger age groups [6].
Many national health agencies have published guidelines on increased physical activities and exercise in all age groups, including those over 65. They can be easily found online. Their recommendations are largely similar. This article presents some basic concepts on physical fitness and gives goals and guidelines for physical exercise for elderly people.
Section snippets
Methods
We conducted an Internet search for published national guidelines. Generally, these guidelines cannot be found in PubMed. We used search terms “exercise”, “exercise physiology”, “physical activity”, “physical training”, “aging”, “65 years+”.
We also looked for the guidelines given by various international organizations, WHO being the most important. The guidelines found are presented in the Appendix to the article. The principles of the recommendations are largely similar. We also reviewed the
Components of health-related physical fitness
Previously, fitness was commonly defined as the capacity of the person to meet the physical demands of daily life and carry out daily activities without undue fatigue. However, because of increased leisure time, changes in lifestyles have rendered this definition insufficient. Today, physical fitness is considered a measure of the body’s ability to function effectively in work and leisure activities, to stay in good health, to resist hypokinetic diseases, and to respond in emergencies.
The
Components of skill-related fitness
The above-mentioned components of health-related fitness enable one to become and stay physically healthy. In physical fitness skill-related categories also enhance one’s physical performance. Six different categories of skill-related fitness are shown below. Different testing batteries have been developed for these skills. For instance, a person is required to perform each activity as many times as possible in 30 s. A special advantage is that all these skill-related components can be trained
Changes in physical fitness with increasing age
Many physiological changes occur with aging [6,7]. During later middle age (45–64 years), women reach the menopause. The decline in physical condition generally continues but it may be accelerated by low amounts of physical activity and high amounts of sedentary behavior. In early old age (65–74 years), there may be a modest increase in physical activity, in an attempt to fill free time after retirement. By middle old age (75–85 years), many people have developed some physical disability, and
Exercise to improve health and counteract disease
Regular physical activity has many health benefits. Table 1 shows the current view on these [9]. Therefore, in appropriate situations exercise prescription has been developed to replace the writing of a chemical/drug-based prescription.
Recent extensive and updated reviews [10,11] introduce evidence‐based indications for prescribing exercise in the treatment of 26 different diseases including:
- 1
psychiatric diseases and conditions (depression, anxiety, stress, schizophrenia);
- 2
neurological diseases
Difference between physical activity and exercise
Physical activity refers to any movement of the body that uses energy. This means daily activities such as vacuum cleaning, gardening, or walking up and down the stairs. However, physical activity also includes exercise activities like running or swimming. Hence, physical activity can range from light to vigorous intensity.
Exercise refers to planned, structured, and repetitive movement with a goal of retaining or improving physical fitness. It can be personally planned and conducted, or it may
Intensity of physical training
The intensity of physical exercise can be assessed in many ways. This article attempts to be practical. The first assessment method is based on the increase in heart rate, and the second is based on estimated energy consumption.
The Finnish professor in occupational health Martti Karvonen developed in the 1950s a formula to determine a target heart rate (HR) for aerobic activity. Generally, the maximum HR a person can achieve is 220 bpm less their chronological age. In the Karvonen formula, peak
Cardiovascular training
This is definitely the most important method of exercise. The heart has to be able to circulate blood and to provide the needed oxygen and fuel to the body during sustained workloads. The well-known cardiovascular training methods have to raise the heart rate: examples are walking, jogging, cycling, rowing and swimming. In countries with severe winters, cross-country skiing and skating are very popular exercise methods. Alpine skiing, where possible, is a good training mode. In the summertime,
Education
Education of health care providers about the importance of lifelong physical activity should be included in the training and curriculum of all medical personnel. This includes international, national and local health care organizations, which should promote education in the programs of international conferences and national meetings. Medical associations and medical doctors and other health personnel should be available to assist in exercise and sporting activities to help prevent and treat the
Motivation
Research organizations should extensively publicize new findings in this area. A good example is the association of daily step count with a decrease in all-cause mortality in a population of almost 5000 persons with mean age of 57 years over a 10-year follow-up. Those who took 8000 steps a day had a 51 % lower all-cause mortality rate than those who took only 4000 steps a day [23]. In the group which took 12,000 steps a day, the mortality rate was even 65 % lower. Step intensity did not affect
Conclusion
Many national health agencies have published recommendations on the types and amounts of physical activity and exercise for adults. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Although regular exercise programs are widely promoted in health information and the mass media, recommendations are not necessarily adopted. Gynecologists meet a large number of women on a regular basis. They should be
Contributors
Risto U. Erkkola planned the paper and wrote the manuscript.
Tommi Vasankari participated in the writing and provided the figure.
Riku A. Erkkola participated in the writing and literature search.
Conflict of interest
The authors report no declarations of interest.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Provenance and peer review
This article was not commissioned and was externally peer reviewed.
Declaration of Competing Interest
The authors report no declarations of interest.
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