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It s too bloody late for me Physical activity and older people

Overview. Update on evidencePSA Targets and themesTargeting and priorities Activity recommendationsThe BHF National Centre at Loughborough UniversityNo, it's not too b****y late for me !. New evidence. DiabetesCancersObesityCognitive functioningPrevention of dementiaFalls preventionAll l

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It s too bloody late for me Physical activity and older people

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    1. Its too bloody late for me ! Physical activity and older people Bob Laventure BHF National Centre for Physical Activity and Health Loughborough University Bassetlaw Partnership for Health November 2007

    2. Overview Update on evidence PSA Targets and themes Targeting and priorities Activity recommendations The BHF National Centre at Loughborough University No, its not too b****y late for me !

    3. New evidence Diabetes Cancers Obesity Cognitive functioning Prevention of dementia Falls prevention All linked to lifestyle Just how much more do we need ? www.bhfactive.org.uk

    4. Older evidence mental health have we forgotten ? Reduction in stress, anxiety and depression Improvement in overall psychological well-being Improvements in cognitive function Improvements in self-esteem and self-worth Increased contact with friends, community and reduction in isolation and loneliness Increased prevalence and most frequently reported by participants across the age range (UK Enquiry into Mental Health of Older People (NIMH and Age Concern 2006) Psychological benefits The psychological benefits of physical activity are also well established and have been identified as: Reduction in stress and anxiety Reduction in depression Improvement in overall psychological well-being Improvements in cognitive function Improvements in self-esteem and self-worth A reduction in isolation and loneliness Many of these effects are also apparent among those taking up physical activity at a later age.Psychological benefits The psychological benefits of physical activity are also well established and have been identified as: Reduction in stress and anxiety Reduction in depression Improvement in overall psychological well-being Improvements in cognitive function Improvements in self-esteem and self-worth A reduction in isolation and loneliness Many of these effects are also apparent among those taking up physical activity at a later age.

    5. Evidence of effectiveness Brief interventions (NICE 2006/7) Public health interventions (BHF NC 2007, NICE 2007) Multi level interventions ecological health promotion

    6. Evidence of effectiveness From a critical review of 29 physical activity interventions: Increased activity levels over a longer period of time 18 months (75%) Group/class-based and home-based activity were effective Tailored to individual needs Cognitive-behavioural strategies and goal-setting Telephone support and continued contact More likely than young adults (King et al, 1998) Evidence of effectiveness A recent critical review of 29 physical activity interventions targeting older adults by King et al (1998), reported: Higher physical activity participation rates among older adults relative to younger people. (This included frequency of participation as well as the duration of the intervention.) Several studies reported satisfactory longer-term class or group participation rates, extending up to three years in at least one case. Both group and class-based activities as well as home-based activity were found to be effective. Interventions tailored to individual needs were found to be more effective. The use of cognitive-behavioural strategies and goal-setting increased effectiveness. Telephone support and continued contact with participants also increased effectiveness.Evidence of effectiveness A recent critical review of 29 physical activity interventions targeting older adults by King et al (1998), reported: Higher physical activity participation rates among older adults relative to younger people. (This included frequency of participation as well as the duration of the intervention.) Several studies reported satisfactory longer-term class or group participation rates, extending up to three years in at least one case. Both group and class-based activities as well as home-based activity were found to be effective. Interventions tailored to individual needs were found to be more effective. The use of cognitive-behavioural strategies and goal-setting increased effectiveness. Telephone support and continued contact with participants also increased effectiveness.

    7. Policy drivers, PSA Targets and themes PSA 17 Tackle poverty and promote greater independence and well being in Later Life PSA 18 Promote better health and well-being for all PSA 19 Ensure better care for all PSA 21 Build more cohesive, empowered and active communities PSA 23 Make communities safer

    8. PSA 17 - Independence and well being in later life Indicators 1 2 - employment and pensions Indicator 3 - healthy life expectancy at age 65 Indicator 4 - Satisfaction with home and neighbourhood Indicator 5 - Support to live independently at home

    9. PSA 18 - Better health and well-being for all Indicator 1 - All age all cause mortality rate Indicator 2 AAACM (spearhead areas) Indicator 4 people to supported to live independently

    10. PSA 18 - Better health and well-being for all All age all cause mortality indicators/measures reducing the mortality rate by 2010 for cancer by at least 20 per cent in people under 75, with a reduction in the inequalities gap by at least 6 per cent; reducing the mortality rate by 2010 for heart disease, stroke and related diseases by at least 40 per cent in people under 75, with a reduction in the inequalities gap by at least 40 per cent National stroke strategy

    11. PSA 19 - Ensure better care for all Patient services and waiting times Indicator 5 - Long term conditions (preventative care and self care self management)

    12. PSA 21 - More cohesive active communities Indicator 5 Thriving communities strong emphasis on 3rd sector and volunteering Indicator 6 - % participation in culture or sport (beware of measures !)

    13. PSA 23 - Make communities safer A pre-requisite for older peoples mobility, independence, confidence to travel, get out and about and participate in their community

    14. PSA targets Distinguish between Those with direct association with Physical activity Those by inference/contribution e.g. stronger communities Support from other frameworks e.g. NSFs

    15. LIFE STAGES IN ACTIVITY all older people but a change in focus Entering Old Age disease prevention recreation and social activity Transitional Phase reduce disability maintain mobility and independence Activity in the later years occupational activities maintain autonomy and dignity

    16. Priority groups and conditions Who should we be targeting ? Boomers Older men The transitional phase between independence and frailty and especially people isolated at home People over 85 People with dementia

    17. Boomers Prevention - Evidence on impact of an active lifestyle is increasing New generation, new ideas, new challenges Busier than ever, we are competing for their time, counter-attractions We need to be innovative and provide high quality experiences

    18. Older men Inequality in health Men die younger Different disease patterns Do not use health services Are services designed or appropriate for men ?

    19. People isolated at home Poor mental health, significant isolation and loneliness Downward spiral of functional decline and loss of independence Circle of Life (contact with friends, neighbours and community) diminishes Inactivity is life limiting

    20. People over the age of 85 The new generation Small proportion in nursing and care. Most at home Increased prevalence of disease and frailty We have low expectations of them Fear and skills factor

    21. People with dementia Prevalence set to increase (Im by 2025) Not all in advanced years and 2/3 live at home D is accompanied by depression, anxiety and increased risk of falls Impact on carers National Dementia strategy next year New skills and ways of working required

    22. People with dementia Costs of care = CHD, Stroke and cancers together in UK (17b) IN USA someone under 65 develops D every 79 seconds By 2030 costs in USA will = total medicare budget The New Cancer ? Fear and ignorance Prevalence is increasing, cure not in sight, delayed onset by 5 years would halve deaths

    23. New guidelines BHF National Centre for Physical Activity and Health How much is physical activity is enough and how do we communicate this ? What works in practice ? www.bhfactive.org.uk

    24. Effective health promotion for older people and physical activity What works ? Ecological models that recognise multilevel components e.g. Population wide interventions Community interventions and programmes 1 to 1 interventions (Whitehead 1999, Sallis et al 1999, CDC 2000)

    25. New activity Active for Later Life resource updated and now available online as website BHF Campaign 30 Mins. a Day, Any Way, Policy calls for the 50 65 population Fit for Life Plan - (motivating the older person)

    26. Activity recommendations 30 mins moderate intensity on 5 or more days a week Strength, flexibility, balance and coordination are vital (2 x per week) CMO 2005, BHF NC 2007, AHA & ACSM 2007 Different for obesity and weight loss Different for falls prevention and management

    27. Activity recommendations Distinguishing between Authoritative Guidelines Professional understanding (PA and non specialist) Public education (clear and accurate messages)

    28. Its too b****y late for me ! Fiatarone et al (1990) strength training among nono-generians Campbell et al 75+ (fallers) Prevalence of depression and anxiety amongst oldest old Older people respond to training in the same way as young people So detrained that gains are greater Quick wins

    29. The good news ! - Improvements in fitness and functional capacity Balance - Static 8 weeks +, dynamic 8 weeks Muscle strength (8 - 12 weeks) Gait (8 weeks) Muscle power (12 weeks) Postural Hypotension (24 weeks) Transfer (24 weeks) Endurance (26 weeks) Bone strength 1 year for femur and lumbar spine (Skelton 1999)

    30. Thank you for listening ! bob.laventure@ntlworld.com www.bhfactive.org.uk

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