Goal settingMotivational interviewingSelf-monitoring

Physical activity in older age: how much is enough?

By Anne Tiedemann, The University of Sydney, Australia

“Lack of activity destroys the good condition of every human being while movement and methodical physical exercise save it and preserve it”… Plato, 400 BC.

It’s long been known that making physical activity a regular habit is important for health and wellbeing. But health promotion messages often target children and young people, with less focus on the importance of physical activity in people aged 65 years and over. However, older age is a crucial time for making activity part of every day.

The WHO Global recommendations on physical activity for health recommend that people aged 65+ years should do at least 150 minutes of moderate-intensity physical activity, or at least 75 minutes of vigorous-intensity physical activity, or an equivalent combination of moderate- and vigorous-intensity activity throughout the week. It also recommends that older adults perform physical activity to enhance balance and prevent falls on 3 or more days per week, and take part in muscle-strengthening activities at least twice weekly. Despite clear recommendations about the amount of physical activity associated with health gains, around one third of the world’s population is physically inactive, with older people being the most inactive. 

It’s important to note that doing something is better than nothing, even if people can’t quite manage the amount recommended by guidelines. Physical activity can include a range of activity types, from structured exercise classes, to active transport, to gardening and home maintenance. Starting small and building up the amount and intensity of activity and choosing something enjoyable are the best ways to start.  For those who are already participating in more vigorous activities such as running, rowing, or cycling, ageing is no reason to stop if a person’s health allows it. 

Falls are also a common issue in older age, with around 1 in 3 people aged 65 + falling each year. Falls often have lasting, devastating consequences for an older person and their family, and can result in an older person moving into residential aged care. Falls are not inevitable, and can be prevented with regular exercise that challenges balance, such as tandem walking or repeated sit-to-stand exercises.

Older people face particular barriers to being more physically active – these can be financial, physical, social or practical. Some older adults find electronic gadgets that track daily physical activity useful for reminding and motivating them to be more active. 

Some people require a more supported approach to stay on track and reach their physical activity goals. Health coaching is a person-centred approach that commonly includes motivational interviewing techniques and solution-focused goal setting as strategies for promoting behaviour change. A recent systematic review of the effect of health coaching on physical activity among people aged 60+ demonstrated significant improvements in physical activity with this approach.

Goal setting is another strategy that promotes physical activity behaviour change. Goals encourage people to create a sense of urgency and motivation to invest time and energy to make the desired change. To maximise effectiveness, goals should be self-directed and meet S.M.A.R.T  criteria: Specific, Measurable, Attainable, Relevant and Timely.

The social benefits of physical activity participation are often particularly important to older people. There are many options for people who prefer to exercise in organised groups. Many local councils organise free walking groups – these are a way of keeping active in a fun and sociable way. Or for a bit more of a challenge, Parkrun is a free, weekly 5km timed running (or walking) event in more than 1,700 locations across the globe.

At any age the message around physical activity is simple- be as active as you can, in as many ways as possible, as often as you can. Doing something is better than doing nothing, and every little bit counts towards better health.

Practical recommendations

  1. Make physical activity a  part of every prevention/ treatment plan in order to maximise health and wellbeing.
  2. Help patients to see movement as an opportunity to boost health rather than an inconvenience, for example suggest taking the stairs rather than the lift or walking to the shops rather than driving, where possible.
  3. Older adults who are new to physical activity should be encouraged to choose something they enjoy and start with small amounts and build up the duration and intensity over time.
  4. Exercise performed in a standing position that specifically challenges balance is the most effective for reducing the risk of falls in older age.
  5. Recommend goal setting, activity trackers and/or health coaching to assist older people to increase and maintain physical activity participation.

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