Patient information: See related handout on exercise in older adults, written by the authors of this article.
Author disclosure: Nothing to disclose.
Article Sections
Few older adults in the United States achieve the minimum recommended amount of physical activity. Lack of physical activity contributes to many chronic diseases that occur in older adults, including heart disease, stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, and cancer. Lack of physical activity, combined with poor dietary habits, has also contributed to increased obesity in older persons. Regular exercise and increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity, and are proven to reduce disease and disability, and improve quality of life in older persons. In 2008, The U.S. Department of Health and Human Services released guidelines to provide information and guidance on the amount of physical activity recommended to maintain health and fitness. For substantial health benefits, the guidelines recommend that most older adults participate in at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or an equivalent combination of each per week. Older adults should also engage in strengthening activities that involve all major muscle groups at least two days a week. Those at risk of falling should add exercises that help maintain or improve balance. Generally healthy adults without chronic health conditions do not need to consult with a physician before starting an exercise regimen.
The number of older Americans is expected to double from 35 to 70 million over the next 25 years. By the year 2030, 20 percent of the U.S. population will be older than 65 years.1 Lack of physical activity contributes to many of the chronic diseases that occur in older adults, including heart disease, stroke, diabetes mellitus, lung disease, Alzheimer disease, hypertension, and cancer. Lack of physical activity, combined with poor dietary habits, has also contributed to increased obesity in this population.2 In response to these trends, the U.S. Department of Health and Human Services published the 2008 Physical Activity Guidelines for Americans to provide specific minimum guidelines for regular physical activity.3 Unlike previous recommendations, these guidelines suggest a total amount of activity per week and allow for individualized activity plans.
Clinical recommendationEvidence ratingReferencesTo promote and maintain health, older adults should participate in moderate-intensity aerobic activity for at least 30 minutes on five days of the week, or vigorous-intensity aerobic activity for at least 20 minutes on three days of the week.A15Moderate- and vigorous-intensity activity can be combined to meet the minimum recommendation for aerobic activity.B15To promote and maintain health and physical independence, older adults should perform muscle-strengthening activities on at least two days of the week.B15Participation in more than the minimum recommended amount of aerobic and muscle-strengthening activities leads to additional health benefits and higher levels of fitness.A15To reduce the risk of falls and related injuries, community-dwelling older adults with substantial risk of falling should perform exercises that maintain or improve balance.A15To maintain the flexibility necessary for regular physical activity and daily life, older adults should perform activities that maintain or increase flexibility for at least 10 minutes on at least two days of the week.B15Older adults should have a plan for obtaining sufficient physical activity that addresses each recommended type of activity.C15
Relatively few older adults in the United States achieve the minimum amount of recommended physical activity, and 28 to 34 percent of adults 65 to 74 years of age are inactive.4 The medical costs for inactive adults are substantially higher than for active adults and increase with age. This suggests that it may be possible to significantly lower health care costs by improving physical activity levels in older adults, as compared with any other age group.4
Health Benefits of Physical Activity
Regular physical activity has beneficial effects on a variety of health outcomes4 [Table 13 ]. It is a proven public health strategy that reduces disease and disability while improving quality of life in older persons.5
Strong evidenceDecreased risk of early death, heart disease, stroke, type 2 diabetes mellitus, high blood pressure, adverse blood lipid profile, metabolic syndrome, and colon and breast cancersPrevention of weight gainWeight loss, when combined with healthy dietImproved cardiorespiratory and muscular fitnessFall preventionReduced depressionImproved cognitive function [older adults]Moderate to strong evidenceImproved functional health [older adults]Reduced abdominal obesityModerate evidenceWeight maintenance after weight lossDecreased risk of hip fractureIncreased bone densityImproved sleep qualityDecreased risk of lung and endometrial cancers
MAINTAINING FUNCTION
Muscle strength decreases with age and may lead to a loss of autonomy and increased disability.6 A randomized controlled trial examining the effects of progressive weight training in 142 healthy adults 60 to 80 years of age found that long-term resistance training increased dynamic muscle strength, muscle size, and functional capacity.6
PROTECTING THE MIND
Physically active adults have a lower risk of depression and cognitive decline than inactive adults.3 In a study of 1,740 persons 65 years and older without a diagnosis of dementia at baseline, those who exercised at least three times a week were much less likely than nonexercisers to develop dementia or Alzheimer disease.7 Additionally, participating in an activity, especially regular physical exercise, appears to decrease the risk of delirium in hospitalized older patients. In a study of 779 newly hospitalized patients 70 years and older without dementia, regular exercise lowered the risk of delirium by 24 percent.8
DECREASING THE RISK OF MEDICAL CONDITIONS
Regular exercise and increased aerobic fitness are associated with a decrease in all-cause mortality and morbidity in older adults.9,10 The benefits are greatest among the most active persons, but are also evident with moderate activity.9 In one study, life expectancy was increased even in persons who did not begin exercising regularly until 75 years of age.11
Strong scientific evidence shows that physical activity helps maintain a healthy body weight and lowers the risk of obesity.3 Physically active persons also have a significantly lower risk of colon and breast cancers compared with inactive persons.3
It is estimated that approximately 2.3 million adults in the United States have atrial fibrillation. By the year 2050, it is projected that this number will increase to more than 5.6 million adults, and more than 50 percent of those affected will be 80 years or older.12 In one study of 5,446 adults with an average age of 73 years, the incidence of atrial fibrillation was inversely proportional to how often a person walked. For example, persons who walked five to 11 blocks weekly had a 22 percent lower risk of atrial fibrillation than those who walked fewer than five blocks weekly. The risk was 44 percent lower for those who walked 60 or more blocks weekly.12
The cardiac risk of inactive persons is comparable with that of smokers.4 Adults who are regularly active have lower rates of heart disease and stroke, lower blood pressure, a lower risk of hypertension, a better lipid profile, and a higher fitness level.3
Recommended Levels of Physical Activity
Recommendations for physical activity in generally healthy older adults are summarized in Table 2.3,13 The 2008 Physical Activity Guidelines for Americans does not recommend consultation with a physician before starting an exercise plan in persons without diagnosed chronic health conditions or symptoms, such as chest pain or pressure, dizziness, and joint pain.3