Physical activity in later life: an exercise in common sense

1. Physical activity in later life: an exercise in common sense Marion E T McMurdo Professor of Ageing and Health University of Dundee Scotland Annual NICE Knowledge Exchange 24th May 2012

2. Key messages • It is never “just your age” • Modest amounts of physical activity are good for health • Common sense urgently needed regarding safety

3. Old age is the age at which most of the medical profession start to lose interest in you Marion McMurdo Old age begins and middle age ends the day your descendants outnumber your friends Ogden Nash

4. Lifelong trajectory of health and disease • Genetics • Chance • Social environment • Lifestyle

5. Physical activity Movement of the body by the skeletal muscles that results in energy being expended

6. Exercise Physical activity that is planned, structured, and repetitive done with aim of improving or maintaining physical fitness

7. The condition of exercise is not a mere variant of the condition of rest, it is the essence of the machine Sir John Barcroft 1926

8. Active like a hunter gatherer • Most human history, man lived as a hunter gatherer – a physically demanding life • Our exercise needs remain same as our ancestors • Technology has eliminated physical work • Sedentary lifestyles ‘normal’ • Inactivity-induced epidemics Archer and Blair. Prog Cardiovasc Dis 2011;53:387-396.

9. Physical activity, age and physical disability Age/motor disability/knee pain ¯ Activities Muscle Weakness Ready fatigue/poor endurance Further restriction of activities Decreased muscle strength Further disability Adapted from Nair SK. Mayo Clin Proc 2000;75:S14-S18

10. Regular physical activity Protective against • Heart disease • Diabetes • Some cancers • Mild depression • Dementia and Alzheimer’s disease Larson EB et al. Ann Intern Med 2006;144:73-81

12. Deterrents to physical activity • Survey of 409 people aged 65-84 years • “Cannot” • “Will not” • “Should not” Crombie et al. Age Ageing 2004;33:287-92

13. Deterrents to physical activity • Confusion! • Collective amnesia! • Fear!

14. Exercise recommendations for healthy older adults • Activity of moderate intensity 30 minutes, 5 days per week (150 mins per week) • Bouts as short as 10 minutes • Muscle strengthening 2 days per week • Flexibility exercises • ‘More better’ Nelson et al. Med Sci Sports Exerc 2007;39:1435-1445

16. Activity and risk of heart disease Longitudinal follow-up of 39,000 older women • Light-to-moderate physical activity associated with reduction in risk of heart disease • At least 60 minutes walking per week predicted lower risk Lee I-Min JAMA 2001;285:1447-54

17. “Just get out the door!” • Study 1002 women aged >65 years • Walking ≥8 city blocks per week, twice as likely to still be mobile than those walking less Simonsick EM et a. JAGS 2005;53(2):198-203.

18. Relationship between health benefits and physical activity Kesaniemi et al. Med Sci Sports Exerc 2011;22:73-107 Nigam et a. Lancet 2011; 378: 1202 – 1208.

19. Safety of physical activity in old age • Risks of inactivity are high • Avoid sudden unaccustomed vigorous exercise at all ages • Moderate intensity – low risk • Stay within own level of comfort, • start slow, build up gradually Liu and Latham. Cochrane Database Rev 2009 Jul 8;(3): CD002759

20. University of Dundee’s seniors exercise classes: a not-for-profit organisation

21. More than 600,000 hours of event-free seniors exercise time • Founded by Dorothy Dobson in 1986 • Classes UK wide • No exclusions, no screening, no disclosures, no disclaimers www.dorothydobsonsover60s.com

22. Determinants of physical activity • Encouragement and enjoyment • Confidence in ability to be active and safety • Low to moderate intensity • Goal setting and planning McMurdo MET. Exercise in old age: time to unwrap the cotton wool. Br J Sports Med 1999;33:295-296.

23. Key messages • It is never “just your age” • Modest amounts of physical activity are good for health • Common sense urgently required regarding safety