It may come as a shock, especially given the amount of free time we have in lockdown and the amazing number of people we see outside exercising currently (we are always supporters of people doing exercise no matter the conditions!), but only around half of all adults and just a quarter of

people aged over 65 years meet the minimum recommended activity levels needed to maintain health.

A study by Sport England back in 2006 found that Older people felt the best way to increase participation would be to keep costs low, make sessions enjoyable, be reassured about the safety of activities and the opportunities to be physically active could be better advertised (raise

awareness of local exercise classes).  I want this blog to focus on helping you to understand the benefits of exercise for older people and how they hugely outweigh the risks associated with exercise in older people.

Lets start by looking at some facts here.  We are all hopefully familiar with the term ‘life expectancy’ and data shows that our average life expectancy is increasing year on year.  However, are you familiar with the term ‘healthy life years’?  This refers to the number of years lived in ‘good health’.  Now it Is important to know the definition of ‘health’….

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Healthy life years therefore refers to the number of years lived in ‘good health’.  The worrying statistic here though is that as our life expectancy increases over the years, our number of years lived in ‘good health’ is actually decreasing! For instance, as of 2015, in the UK the mean life expectancy for women at birth in 2008 was 81.8 and in men it was 77.7 years and by 2013 this had increased to 82.9 for women and 79.2 years for men.  Over this same time period, the mean healthy life expectancy had changed little, or even decreased: for women in 2008 it was 66.3 and in men it was 65 years, but by 2013 it had fallen to 64.8 in women and 64.4 years in men.  That’s something to hopefully make us all sit up and take note.

When it comes to things that result in poor health, the list is pretty big. Musculoskeletal disorders are the most common chronic, disabling conditions, affecting 14 % of people aged over 65 years. These are followed by heart and circulatory conditions affecting 10 %; respiratory conditions affecting 6 %; endocrine or metabolic conditions affecting 6 % and mental disorders affecting 4 % of people aged over 65 years. Incidence of these chronic diseases more than doubles in the 10 years that follow retirement. Of people aged over 75 years, 30 % report chronic musculoskeletal conditions; 32 % report heart and circulatory conditions and 13 % report endocrine or metabolic conditions.

The statistics don’t stop there either, sedentary people aged 50 years and older had twice the risk of death compared with those who had the highest level of physical activity after adjusting for a range of risk factors

However, it is never too late to start exercising.  Studies have regularly shown that even for those who were relatively sedentary through middle age, it is never too late because beginning a new exercise regimen in old age leads to significant improvements to health and cognition.  Achieving[150 min/week moderate-intensity aerobic exercise, such as walking or other moderate intensity aerobics-type activities, is associated with at least 30 % lower risk of morbidity, mortality and functional dependence compared with being inactive.  Walking 5–7 days per week was associated with 50–80 % lower risk of mobility impairments and increases longevity by around 4 years and disability-free life expectancy by around two years. There is also evidence that sedentary people will benefit from regular short activity periods of as little as 1 min or 10 min bouts to break-up periods of sitting or lying.

Although vigorous activities are not advisable for sedentary older people, master’s athletes can train and compete in very high intensity sports, with the risks of adverse events during competition being similar to those of younger adults.  Older people who maintained regular jogging postponed disability by almost 9 years and had three times lower risk of death compared to those who had never been a member of a running club. The risk of developing cardiovascular disease is also lower in those completing regular vigorous compared with moderate intensity exercise. Thus, there appears to be a dose–response relationship to indicate that higher intensity activities bring greater health benefits, but it is important to note that older people must be suitably adapted to participate in the higher intensity activities, so this relationship might reflect the overall exercise history.

Whilst there are many beliefs surrounding physical activity in the older population and how this may be dangerous, it based on no factual information and mis-led societal beliefs.  I know I am one for trying to change beliefs but let’s take a look at some of the facts.  An aerobic exercise intervention aiming for 60 min intense cycling/walking/running/rowing exercise 6 days per week over 12 months for previously sedentary men aged 40–75 years found no increased risk of injury or adverse event. In the non-exercise control group, 27 % experienced an injury compared with 28 % in the exercise group.

Furthermore, you will often hear people state that they couldn’t run a marathon as they would have a heart attack!  Obviously this is most likely tongue in cheek but scientists have actually tested the probability of this happening across the whole running population and concluded that you have a 0.0005% chance of suffering a heart attack during a marathon, regardless of age!  That is the equivalent to around five incidents per one-million runners.  I won’t give you the stats on this but compare that risk to death caused from driving your car and tell me which is more dangerous!

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Frailty in Older Age

The topic of frailty is a very interesting one too.  One of the easiest ways to assess if you or loved ones are suffering from frailty is the sit to stand test.  To perform this test, the person completes 5 chair-rises.  The maximum score of 12 is easily achieved by healthy older people, while a score less than 8 indicates sarcopenia and frailty. Thus, a score of between 8 and 11 indicates the moderate physical impairments associated with sarcopenia (low muscle mass) and ‘prefrailty’.

Reviews of the literature have led to the recommendations that frail older people should perform moderate intensity leg-strengthening exercises and functional training, including walking, chair rising, balancing and game-like activities, two to three times per week with sessions lasting around 45 min. This is in line with the suggestion that combined resistance and endurance training may be more beneficial than any of these exercise types individually for improving functional mobility, walking, balance, reducing falls risk and risk of developing metabolic and cardiovascular disease among older people with moderate deficits or frailty.

Furthermore, in frail older people, 12 month combined training (aerobic, strength, balance and flexibility) was more effective than conventional aerobic training alone at improving general activity levels and functional mobility and reduced risk of mobility disability by around 30 %.

To conclude here, physical activity and exercise in older people is nothing but beneficial.  Obviously those who have under-lying health issues need to seek guidance from a trained healthcare professional but guidance has often suggested that a simple questionnaire is sufficient to determine eligibility.  All allied healthcare professionals are trained to offer guidance and advice on what you should and shouldn’t be doing.  If you know someone who can relate to the information above then share it with them and lets start the beginning of a new belief structure where exercise is at the forefront of everyone’s mind so they can lead a healthier and hopefully happier life.