Benefits of Physical Activity in Older Age - Literature review Example

Gerontology: Benefits of physical activity in older age. Ageing is a natural part of life. The process of ageing is affected by genetic makeup, the environment in which the person lives and how he has lived his life. Ageing is a slow but dynamic process which includes many internal and external influences. It is a lifelong process that varies in rate for each individual. During ageing most organs decline in their capacity to function and to maintain homeostasis. The average life span is getting longer with increased advances in medical technology, but even though people are living longer it is not so obvious whether they are living stronger. Mees (2003) reported that in the United States “each year, musculoskeletal conditions and injuries account for about 102.3 million visits to physician offices, 10.2 million hospital outpatient visits, 25 million emergency department visits, 3 million hospitalizations, and 7.5 million procedures, and they cost an estimated $300 billion”. She goes to report that “ people in their 50s notice more aches and pains after performing the same activities that were painless in their 40s, and those in their 60s can't do as much as they did in their 50s”. Because the ageing process is multidirectional and multidimensional, in examining the effect of physical activity on the process we must examine the many aspects of health that are affected as one gets older, the different types of physical activity that can be beneficial, and how can elderly people be more motivated to engage in physical activity to help them in the ageing process. Even if there is no disease present there are so many other effects on the body of ageing. Coronary artery disease, hypertension, congestive heart failure, type 2 diabetes mellitus, osteoarthritis, osteoporosis, and cognitive disorders are some of the disorders that become more prevalent as people age. Brennan (2002) describes some of the normal physiological changes that occur in the body during ageing as “changes in the cardiovascular system include decreased elasticity in blood vessel walls, increases in blood pressure, and myocardial hypertrophy resulting in decreased end-diastolic filling and cardiac output; pulmonary effects include loss of tissue elasticity as well as a gradual decline in the number of alveolar sacs”. In addition he says that “as humans age, they experience neuronal cell loss, decreases in reaction time, decreases in overall balance, and decreases in nerve conduction velocities. Aging decreases estrogen, androgen, and growth hormone levels. Rates of depression increase with age, while motivation decreases, leading to a decrement in daily function and increased hospital mortality”. However the most noticeable changes in the body are in the musculoskeletal system. Body mass decreases while fat content increases, the motion in the joints diminish and the muscle strength and endurance decrease. Bone density loss is another concern, especially in women. Muscle strength decreases rapidly after age 50 and is more rapid in women especially around the time of menopause. Mazzeo et al (1988) also describe the changes in muscles as humans age. They report a study that “indicates that 40% of the female population aged 55-64 yr, 45% of women aged 65-74 yr, and 65% of women aged 75-84 yr were unable to lift 4.5 kg.”. They discuss the important results of loss of muscle strength in older people. One of the significant effects is on walking speed which of course affects the everyday life of the elder person. As the walking becomes affected the individual becomes more and more sedentary. As less energy is expended the basal metabolic rate decreases. Other more specific effects of muscle changes are described by Buckwalter (1997). The changes vary from one individual to the next and do not always lead to malfunction. However he states that “Between the ages of 30 and 80, mean strength of back, arm, and leg muscles drops as much as 60%, largely reflecting a progressive loss of muscle mass at an average rate of 4% per decade from 25 to 50, and 10% per decade thereafter .” Some of the consequences of the vulnerability of ageing muscles are that “protracted healing extends the period of immobility due to the pain of injury; if this period is long enough, normal strength may never return, and newly weakened muscle will be more vulnerable to further injury. Once set in motion, this vicious cycle is very difficult to interrupt”. (Buckwalter, 1997). Age-related changes in joint structures also affect individuals. As the cartilage, ligaments and synovium in the joints change with age the joints become stiff, have limited range of motion and become more vulnerable to injury. This also affects mobility. These changes in soft tissue- muscles and joints and ligaments make the older person more prone to injury as they increase the risk of falls and of fractures. This can also account for much of the soreness that older people feel after exercising. All these difficulties often tend to cause the elder person to become more and more sedentary. Yet sedentary life has its disadvantageous. According to Petrella (1999), “sedentary living is an independent risk factor for cardiovascular disease; it doubles the risk of cardiovascular disease compared with that of active patients. Sedentary life imparts a risk similar in magnitude to that of smoking 20 cigarettes a day, an elevated cholesterol level, or mild hypertension.” Sedentary living also has negative effects on the person’s mental and psychological well-being and other aspects of life. According to Buckwalter (1997), ” financial status and quality of life decline along with the ability to work and participate in leisure activities. Self-image suffers, sleep quality deteriorates, and mood may be lowered. In time, reduced capacity for exercise can compromise the health of diverse organ systems, increasing the risk of heart disease, stroke, diabetes, and colon cancer. If it progresses unchecked, decreased mobility undermines the capacity for activities of daily living: the ability to feed and clothe oneself, attend to personal hygiene, and perform such routine tasks as shopping for groceries. Besides promoting mental deterioration and cardiovascular disease, the loss of mobility is a significant cause of loss of independence among the elderly”. Benefits of physical activity. There is no doubt that physical activity is important and has many benefits for the ageing process. The role of physical activity in the ageing process has been explored in many different ways. The effects of physical activity on the various age-related changes in the body have been reported in the literature, including the effects on cardiovascular fitness, muscle strength, diseases, respiratory capacity, cognitive disorders and even psychological functioning. Various types of physical activities have been examined in particular aerobic training and strength training among others. Andrews (2001) sums up the benefits of physical activity when he says “The most substantial body of evidence for achieving healthy active ageing relates to the beneficial effects of regular exercise. Increased physical activity is associated with a reduced incidence of coronary heart disease, hypertension, non-insulin dependent diabetes mellitus, colon cancer, and depression and anxiety In addition, increased physical activity increases bone mineral content, reduces the risk of osteoporotic fractures, helps to maintain appropriate body weight, and increases longevity”. National Center for Chronic Disease Prevention and Health Promotion (n.d) offers a list of benefits of physical activity. This list includes Helps maintain the ability to live independently and reduces the risk of falling and fracturing bones. Reduces the risk of dying from coronary heart disease and of developing high blood pressure, colon cancer, and diabetes. Can help reduce blood pressure in some people with hypertension. Helps people with chronic, disabling conditions improve their stamina and muscle strength. Reduces symptoms of anxiety and depression and fosters improvements in mood and feelings of well-being. Helps maintain healthy bones, muscles, and joints. Helps control joint swelling and pain associated with arthritis. Some of the beneficial effects of exercise reported by Mees (2003) are "regular exercise slows atherosclerosis and controls hypertension, exercise may have more direct effects by raising the blood pressure and, thus, cerebral perfusion, although for most seniors, the changes are probably small and short-lived, good blood flow lowers blood pressure and may reduce Alzheimer's dementia and slow memory loss, gait training and exercise training improve symptoms and endurance and can reduce some of the side effects of Parkinson's disease medications, and those who have established disease can obtain moderate functional gains from various types of aerobic exercise—walking, cycling, or aqua-fit classes." She describes the benefits of physical activity in hip fractures, arthritis and cognitive dysfunction. According to her in the 1970s bed rest was the treatment for hip fractures. Instead, today hip replacement is common and movement is encouraged. Additional benefits of exercise instead of bed rest are that “disuse issues are eliminated or lessened, and pneumonia, pressure sores, and death are not inevitable outcomes. People who would have been bedridden 30 years ago now have total joint replacements that keep them moving and maintaining strength and independence”. Regular exercise is beneficial in breaking the arthritis cycle. Although moving the joint to keep it flexible and strong might be a bit painful, patients are willing to deal with the small amount of pain as they know that in the long run it helps in controlling the arthritis. Although regular exercise has not been absolutely proven to slow cognitive dysfunction, physical exercise is still recommended in addition to brain exercises such as math, puzzles and brain teasers. “The human body generally responds well to physical exercise and substantial improvements may be anticipated in heart and lung function, muscular strength and endurance, flexibility and one's ability to respond to stimuli”.(Center for Physical Activity in Ageing, n.d.). The Center lists some of the benefits derived from physical activity to include increased muscle strength, bone strength and joint range of motion and flexibility, increased ability to perform physical work. The benefits to the physiology include improved glucose regulation and decreased blood pressure. In addition psychological benefits include an improved sense of well being and less anxiety. Brennan (2002) looked at the benefits of exercise on several aspects of ageing. He reports that “Regular aerobic exercise will also increase levels of high-density lipoprotein (HDL) and decrease levels of low-density lipoprotein (LDL), both of which are advantageous for those who have other cardiovascular risk factors”. Physical exercise has also been shown to increase the ability to regulate glucose and help in the fight against diabetes. Depression is a common issue for the elderly. As a means of combating depression Brennan indicates that “studies suggest that regular exercise helps reduce the risk of becoming depressed and decreases the symptoms in elderly patients who are already clinically depressed. Promoting exercise may also improve socialization with other elderly people who choose to exercise together”. He also discusses the effects of exercise on osteoarthritic pain and reports “The Fitness and Arthritis in Seniors Trial (FAST) demonstrated a decrease in pain and increased daily functioning among more than 400 patients older than age 60 with significant osteoarthritis. No increase in overall injuries was observed in patients who exercised. In addition, resistance training markedly increases lower-extremity strength, gait speed, and the ability to climb stairs”. And finally the benefit of exercise in reducing the number of falls is pointed out as significant. Benefits of exercise on the heart have also been described by Lee and Paffenbarger (2001). They believe that physical activity may have a direct effect on the heart. There are many ways that physical activity helps to reduce the risk of developing heart problems. Physical activity increases oxygen supply and decreases oxygen demand and improves myocardial contractions. This results in lower heart rate and blood pressure at rest. Physical activity also increases the diameter of the blood vessels in the heart. The other factors that physical activity affects are “high levels of physical activity are associated with lower systolic and diastolic blood pressures, elevated levels of high-density lipoproteins, perhaps low levels of low-density lipoproteins, and increased insulin sensitivity and glucose tolerance” (Lee and Paffenbarger, 2001). Finally physical activity helps to prevent over weight which is a risk factor in heart disease. Connected to heart risks are other metabolic diseases that are affected by the ageing process and have been shown to benefit from physical activity. Petrella (1999) has been an active researcher in this area. He believes that there is a strong association between aging and type 2 diabetes that may be caused in part by increasing levels of inactivity. He states however that “exercise in patients with diabetes promotes cardiovascular fitness and increased insulin sensitivity (lowering of plasma glucose) and may lower the dosage of oral hypoglycemic drugs required. Furthermore, lifestyle interventions including regular exercise may be effective in preventing the development of type 2 diabetes”. Exercise can also help in improving pain control, strength, flexibility and endurance in patients with osteoarthritis. Although there have been some debate about the benefits of exercise in older patients with osteoarthritis, Petrella (1999) reports some studies that have been useful- “recent studies also support the use of exercise in the management of osteoarthritis, specifically of the knee. Exercise that strengthens the quadriceps muscle and has an aerobic training component has been shown to be effective in reducing pain and improving function in a small cohort study. A large, randomized, multicenter study by Ettinger et al. showed that older patients who engaged in resistance or aerobic exercise had better pain control and functional outcomes at 18 months than patients who only attended an educational program.” And “in another study involving 172 older patients with osteoarthritis of the knee, a colleague and I observed that exercise lessened knee pain and improved activities of daily living”. The physical areas benefitting from physical activity as people age are body shape, bone strength, muscular strength, skeletal flexibility, motor fitness and metabolic fitness. But the physical is not the only areas that are affected by ageing and benefit from physical activity. The additional areas that benefit from physical activity are cognitive function, mental health and social adjustment. (WHO, 1998). The benefits of physical activity are summed up thus- “The research results indicate that as well as increasing muscle capacity, physical activity can help to improve stamina, balance, joint mobility, flexibility, agility, walking speed and overall physical coordination. Physical activity also has favorable effects on metabolism, the regulation of blood pressure, and the prevention of excessive weight gain. Furthermore, there is epidemiological evidence that regular vigorous exercise is related to a decreased risk of cardiovascular diseases, osteoporosis, diabetes and some forms of cancer” (WHO, 1998). This paper details the importance of activity in preventing diabetes. Two factors that are related to ageing and are associated with Type 11 diabetes, which usually occurs after the age of 40, are obesity and glucose tolerance which deteriorates with increasing age. Regular moderate exercise appears to reduce the risk of developing Type 11 diabetes by improving the metabolism of glucose. Although there has not been a lot of research on the connection between exercise and mental health, especially in the elderly, there is some indication of an indirect relationship between the two. The aspects of mental health that have been shown to improve with physical activity include reducing depression and anxiety, and improving tolerance of stress and self-esteem. The link between physical activity and depression has been only a correlation and not causal so far. It is suggested “that physical activity may reduce depression through a cognitive rather than a social mechanism, meaning that elderly people who can cope independently with physical activities by virtue of an exercise program, for instance, will see their self-esteem and confidence increase, which in turn may also contribute to reducing depression” (WHO, 1999). Similarly, physical activity has suggested as the best remedy for stress and aerobic exercises for anxiety. Research has been done on Finland to study the effects of exercise on mental and psychological functioning. The study (Ruuskanen and Ruopilla, (1995) was a part of an interdisciplinary gerontological research program, the Evergreen Project and was conducted among elderly residents in the city of Jyvaskyla, central Finland. Some of their results were: “Intensive practice of physical exercise was related to better self-rated health, a lower occurrence of depressive symptoms and self-rated meaningfulness of life. Men practicing physical exercise intensively are more likely to avoid depressive symptoms than inactive men”. Kallinen (2005) carried out an extensive research study in Finland to examine the effects of prolonged physical training on cardiovascular fitness in 66-85-year-old women, the predictive value of exercise-test status and results, including exercise capacity for survival in 75-year-old men and women, and the effects of an endurance and strength training program in women aged 76 to 78 years. This study found a significant association between high exercise capacity and low mortality among the elderly, both men and women. This effect on low mortality could be connected to protection from disease which comes from the beneficial effects of exercise on blood lipids, blood pressure, glucose metabolism, vascular function, autonomic tone, blood coagulation and inflammation, as reported in other studies. Recommended physical activity for elderly. The most common type of exercise recommended for the elderly is walking. Calisthenics is also safe. More vigorous exercises such as cross-country skiing, cycling and swimming are not as popular or sometimes safe for older people. Many also use utility exercises such as gardening and doing jobs around the house to help with mobility. In addition to these, aerobics and strength- training are commonly recommended. In a recent study involving 25 healthy older men and women who underwent six months of twice weekly resistance training the genetic fingerprinting of ageing and muscle strength were measured. “Results showed that in the older adults, there was a decline in mitochondrial function with age. However, exercise resulted in a remarkable reversal of the genetic fingerprint back to levels similar to those seen in the younger adults. The study also measured muscle strength. Before exercise training, the older adults were 59% weaker than the younger adults, but after the training the strength of the older adults improved by about 50%, such that they were only 38% weaker than the young adults” (Buck Institute for Age Research, 2008). The six month resistance training was done on standard gym equipment for twice-weekly sessions of one hour. The benefits of aerobics have been reported by several researchers. Buckwalter (1997) reports that “one study of healthy patients aged 60 to 70 years found that VO2 max increased by 30%, on average, with 6 months of aerobic exercise. In another, a 9- to 12-month program of walking or running for 45 minutes 4 days per week produced a mean increase of 24% in aerobic capacity”. Brennan (2002) also states that “regular aerobic exercise will also increase levels of high-density lipoprotein (HDL) and decrease levels of low-density lipoprotein (LDL), both of which are advantageous for those who have other cardiovascular risk factors”. WHO (1999) recommend .” that regular aerobic exercise of at least 30 minutes’ duration three or more times a week offers potential benefits to those elderly people with glucose intolerance or overt diabetes”. Walking is suggested as the most natural and everyday form of movement. Some of the reasons for recommending walking include that it is convenient and can be included in any routine; it is year-round and self-reinforcing, no special skills or equipment are required, it uses the large muscles and helps with cardiovascular and respiratory functions and walking with someone else helps with socialization (WHO, 1999). “The most dramatic exercise benefits have been achieved with strength training”. Buckwalter (1997). He reported several studies that showed improved strength and performance as a result of strength training. One study he reported showed that a 12-week resistance training program doubled knee extensor strength and tripled flexor strength in older men. Another study used 86 – 96 year old nursing home residents in 8 weeks of high-intensity exercise. Quadriceps strength increased during the program. Additional gains included significant functional improvements, increase in gait speed and even no longer needing the cane to walk. Caution must be taken however in strength training. Patients must begin with light loads and progress slowly. For those who have access gym equipment can be used, but ankle weights and plastic-coated dumb-bells can be substituted. Other recommendations include “For some patients, standard aerobic exercise with a stationary cross-country ski machine or stationary exercise bicycle will provide adequate resistance as well as endurance training. Walking in knee-high or waist-high water in a swimming pool can also provide effective resistance” (Buckwalter, 1997). The National Osteoporosis Foundation recommends regular weight-bearing activities 45 to 60 minutes four times per week. In addition they offer some helpful tips which include strengthening muscles such as the back and abdominal to reduce the risk of fractures and aquatic exercises that condition muscles. Proper nutrition should also accompany any physical activity and training. (Brennan, 2002) Petrella (1999) supports the benefits of strength training and cautions when he states that “It is important to include both range-of-motion and strength exercises. Strength training should include isotonic resistance (i.e., lifting weights) or isometric exercise (i.e., muscle contraction without joint movement). Non-weight-bearing exercise such as water aerobics, swimming, chair exercises, and cycling are good modes, but positions that will lead to joint deformity, such as tight grips, should be avoided”. And especially for women prone to osteoporosis he suggests “weight-bearing activity, which will also improve muscle mass and strength. For prevention, moderate-intensity exercises such as low-impact aerobics and vigorous walking are suitable. Jumping or jarring movements should be avoided. In addition, some movements may place undue stress on a vulnerable joint or bone and should not be done at all; these include standing on one leg and excessive flexion and extension of the spine”. In recommending exercise for the ageing some factors must be considered in order to make it safe for them and not to exacerbate physical conditions. Three important factors are discussed by the Center for Physical Activity in Ageing (n.d). These are the intensity, the duration and the frequency. The intensity should be guided by the heart rate or in some cases by paying attention to the body. Mild fatigue should be the feeling after a bout of exercise. An optimum duration of exercise is 30 minutes a day, with an optimum frequency of 3 to 5 sessions per week. However benefits can be derived from shorter periods less frequently. It is important however for exercise to be on-going and not just a passing fad. Motivating and supporting elderly in physical activity. Despite all the evidence to show the benefits of physical activity on ageing, it has not been always easy to motivate and encourage older people to maintain a routine of physical activity. It may be necessary to convince them to adopt a more mobile life style. They may need to have pointed out to them that age is not an obstacle to being physically active and that they will enjoy a better life if they are less sedentary. Sometimes simple alternatives can be helpful such as climbing the stairs instead of taking the lift, walking to the store instead of taking the bus or car. The idea of training may be too much for them also. Making exercise a fun and sociable activity is more attractive. Reasons for this have been examined with a view to motivating more elderly persons to engage in physical activity to help maintain mobility and strength. Crombie et al ((2004) conducted a study in Sweden to gain insights into the factors preventing the elderly from exercising. The study included 409 randomly select4ed older people, aged 65-84. A questionnaire was developed to measure their level of physical activity including light and heavy housework, light and heavy gardening, and leisure time activity. The study found that many older people do not engage in leisure time physical activity. Most were clear about benefits about physical activity and thought they were doing enough Some of the factors identified as deterring the elderly from taking part in leisure time physical activity included- physical symptoms, e.g. painful joints, shortness of breath (patients need guidance on interpretation and management of these symptoms), reluctance to go out and safety, lack of transportation and depression. The authors offer the following suggestions to increase involvement in physical activity - health education campaigns to highlight non-physical benefits, e.g. socializing, easily accessible facilities and programs for fun in daytime. There is one hypothesis that suggests that senior citizens who were actively involved in sport at earlier stages of the life cycle are more likely to be physically active elderly persons than those who had no active exposure to sport previously. Their participation in social life also accompanies their involvement in physical activities. Other deterrents suggested by Vanreusel et al ((1983) are a lack of role models promoting the image of physically active ageing people and ageism or the pressure from the rest of society to act ‘their age’. In their study these authors interviewed 80 men and women in Belgium to describe patterns of involvement in physical activities and determine some of the social deterrents of involvement. Most of the activities that the sample was involved in were walking and cycling, with some swimming, gymnastics and local folk games. From their study they offered many useful suggestions. First was having positive role models promoting physical activities, e.g. a grandmother in a gym suit. Existing sports clubs and community recreation programs should provide programs and opportunities for elderly members and in selecting physical activities for senior citizens individual activities should be performed in the sociable climate of a group. The National Center for Chronic Disease Prevention and Health Promotion (n.d) also agree that community –based activities should be offered for senior citizens. these suggestions for communities to encourage the elderly to take part in physical activities. Among their suggestions is not only organizing such activity programs but also the providing of transport for older adults to parks and other facilities that offer such activity programs. References. Andrews, Gary R. "Care of older people. Promoting health and function in an ageing population." BMJ Vol.322 (2001): 728-729. Brennan, Fred H. "Exercise prescriptions for active seniors. A team approach for maximizing adherence." The Physician and Sportsmedicine Vol.30. Issue2February 2002 10 Oct 2008 . Buck Institute for Age Research. "Exercise Reverses Aging In Human Skeletal Muscle." Science Daily 23 May 2007. 8 October 2008 . Buckwalter, Joseph A. "Decreased mobility in the elderly: the exercise antidote." The Physician and Sportsmedicine Vol. 25.Issue9September 1997 10 Oct 2008 . Center for physical activity in ageing, "The benefits of exercise." 10 Oct 2008 . Crombie, Iain K.,Linda Irvine, Brian Williams, Allison R. McGinnis, Peter W. Slane, Elizabeth M.Alder, Marian E.T. McMundo. "Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents." Age and Ageing Vol.33 (2004): 287-292. Kalinin, M."Cardiovascular benefits and potential hazards of physical exercise in elderly people." Journal of Sports Science and Medicine 4 Suppl.7 (2005): 1-51. Lee, I Min, and Paffenbarger, Ralph S. "Preventing coronary heart disease. The role of physical activity." The Physician and Sportsmedicine Vol. 29 Issue 2February 2001 10 Oct 2008 . Mazzeo, Robert S., Peter Cavanaugh, William J.Evans, Maria Fiatarone, James Hagberg, Edward McAuley, Jill Startzell. "Exercise and Physical activity for older adults." Medicine and Science in Sports and Exercise Vol. 30(1998): Mees, Patricia D."Key to the Fountain of Youth. Physically Active for life." The Physician and Sportmedicine Vol.13.Issue 12December 2003 10 Oct 2008 National Center for Chronic Disease Prevention and Health Promotion, "Physical activity and health. Older adults." 10 Oct 2008 . Petrella, Robert J. "Exercise for older patients with chronic disease.” The Physician and Sportsmedicine Vol.27 Issue11October 1999 10 Oct 2008 . Ruuskanen, J.M., I. Ruopilla. "Physical activity and psychological well-being among people aged 65-84 years." Age and Ageing Vol.24(1995): 292-296. Vanreusel, Bart, Roland Ronson, Hilde De Meyer. "Some patterns of participation in physical activities among elderly people." International Review For the Sociology of Sport Vol. 18(1983): 103-114. World Health Organization, "Growing old staying well. Ageing and physical activities in everyday life."WHO Ageing and Health Programs. WHO/HPB/A4E. 1998. Read More