PHYSICAL ACTIVITY FOR AGEING SUCCESSFULLY

1. PHYSICAL ACTIVITY FOR AGEING SUCCESSFULLY J. Manuel González Aramendi PhD Virgen del Pilar Medical Centre San Sebastian - Euskadi - Spain aramendi@infonegocio.com

2. Health is, itself, an opportunity, for everyone and the community where we live WHO 2000

3. Older People - Facts People aged 60 and over: 600 million in 2000 1,2 billion in 2025 2 billion in 2050 Senior citizens living in developing countries: 33 % world population in 2000 75 % “ “ in 2025 In developed world, aged 80+ are the fastest growing group. In very old age, the ratio of women/men is 2:1. (WHO: Towards Policy for Health and Ageing)

4. Longevity is, probably, the best measure of physical life quality. It is a precious offer that science makes to humanity: the present of life, no less. Carl Sagan

5. Life Expectancy Life expectancy is a beautiful result of public health, mainly because of vacciness, sanitation and health education. Global life expectancy at birth is growing: In 1955 was 48 years In 1975 was 59 years In 1995 was 65 years

6. The spanish Basque Country Present Population and Expectations The Wind’s Comb E. Chillida Year Population 1981 2.141.809 2000 2.069.000 2005 2.048.700 2010 2.039.100 (Source: Eustat - Basque Government): Life expectancy was 35 years in 1900. In 2000 it was 82 years for women and 74 years for men. Population older than 60 years is 25%. It is, probably, one of the oldest countries in the world.

7. To sustain: • health • movility • independence • In other words... • To delay: • illness • disability • dependence Objectives for Older People A challenge for individuals, families and community

8. Increase life expectancy Decrease disability Challenge 90 years 80 years 81 years 65 years Disability-free Disability-free In 2000 In 2025

9. Ageing Successfully What is successfully ageing ? To sustain a smile is probably an evidence of successful ageing. For that, we must take care of our body and our spirit, and live together with the rest of persons and beings in a unique biosphere.

10. The Determinants of Active Ageing

11. Risk Factors Non communicable diseases, mainly cardiovascular disease, cancer and diabetes, account 77% of global deaths in developing countries, and 85 % of global burden of disease in low and middle income countries. These diseases share few and preventable risk factors: • Physical inactivity • Unhealthy diets • Tobacco

12. Physical Activity and Healthy Ageing Physical activity has been present in 99% of our existence on the Earth. Now, over 65% of world population is not physically active. Around the world, the inactivity is more prevalent in urban areas, mainly in poor communities.

13. Physical Activity in the Basque Country 1 2 3 4 1: innactive 2: moderadelly active 3: active 4: very active This situation is similar in other developed countries

15. Benefits of Regular Physical Activity Prevention of diseases: Coronary Heart Disease Stroke Hypertension Colon cancer Brest cancer Osteoporosis Obesity Type II diabetes

16. Benefits of Regular Physical Activity Prevention of disability: Arthritis Intermittent claudication Low back pain Sleep disturbances

17. Benefits of Regular Physical Activity Prevention of dependence and isolation: Functional ability Falls Autonomy Socialisation

18. Components of Fitness • “Visibles” • cardiorespiratory fitness • muscular strength-endurance • flexibility • body composition • balance and coordination • “No-visibles” • metabolics: • blood glucose and lipids • blood pressure • bone density.

19. Flexibility The range of motion of articulations is afected by aging of joints, muscles and connective tissue. Flexibility exercises should be incorporated into the overall fitness program. These exercises should stretch the major muscle groups. Recomended exercises: yoga, supervised classes of aerobics, walking and strength exercises. Good tolerance: don’t give up.

20. Muscular Strength and Resistance • Aging is associated with a muscular mass loss, due to both • ageing process and lack of muscular activity. Consequently • muscular strength decline with age, with important effects • in the functional capacity : • Increased risk of falls • Reduced capacity for walking • Strength - Resistance training should be an integral part of • adult fitness program, of a sufficient intensity to maintain • or enhance strength, muscular endurance, and fat-free mass.

21. Aerobic Power Maximal oxygen consumption (VO2max) declines 10% per decade after age 25. But, if physical activity levels are kept constant, the decline is only about 5% per decade. When VO2max is lower than ± 1L/min (±14 ml/kg/ min), daily normal activities are not possible without fatigue. Then, the quality of life becomes deteriorated.

22. Cardiovascular Function Maximum heart rate, stroke volume and cardiac output decrese as we age. It is unclear how much decrease is due to aging alone and how much to decreased activity.

23. Bone density Aging is associated with a loss of bone mineral and bone matrix. These changes affect to 25% of older people, and lead to greater risk of fractures, mainly in post-menopausal women. In theses, the major contributing factors are: estrogen deficiency, low calcium intake and physical inactivity.

24. Diabetes In the elderly person, diabetes type II stems from cellular resistance to insulin by decresed number or sensitivity of insulin receptors. Diabetes is asociated with increased cardiovascular risk . Physical activity and the avoidance of obesity are important preventive measures. In secondary prevention, regular physical activity helps to normalize both glucose tolerance and tissue insulin sensitivity. Improvements are observed as little as 30 minutes of exercise at moderate intensity.

25. Other chronic diseases Peripheral vascular disease: treadmill training has been shown to improve walking distance and claudication (pain on walking). Chronic lung disease:improvements in the distance walked and quality of life have been reported after walking, supervised treadmill and exercise reconditioning. Chronic arthritis:walking and home joint mobility exercises are successful for improvement in arthritis symptoms. Well done, PA will not worsen pre-existing arthritic conditions.

26. How much exercise?

27. How much exercise for the frail and very old? Strength exercises: Aim: to improve strength, balance and muscle coordination. Progressive resistance training of the major muscle groups 2-3 days per week with 2-3 sets of each exercise. Aerobic exercises: Moderate intensity aerobic training like walking, ergometry or water exercises, reaching first a target frequency (three days per week), then duration (at least 20 min per session), and finally, appropriate intensity (40-60% heart rate reserve). Stretching, warming up and cooling downfor older adults should be longer and more gradual than in younger adults.

28. Prior to beginning Men over 40 and women over 50should obtain advice from a doctor before starting any vigorous activity. Persons with symptoms suggestive of coronary, pulmonary or metabolic disease should have a physician supervised maximum exercise test prior to start a vigorous exercise program. In addition, exercise tests measure the heart's exercise capacity, and the aerobic and anaerobic muscular capacity.

29. Psychological functioning It is well established that physical activity and psychological function in the older adult are related.Improved well-being, self-efficiency and quality of life have been reported in several studies. The improved psychological function is obtained by physicalactivity per se and by the concomitant social contact that it leads.

30. Economic benefits The regular practice of appropriate physical activity can bring economic benefits in terms of reduced health care costs and increased productivity, mainly. Two examples: Canada: The expected savings from achieving the 2003 target of increasing the physically active population by 10%: $5 billion in cost for medical care. (CFLRI-Health Canada) USA: Potential cost savings can be as much as $29 billion in 1987 (@ $50 billion in 1998). (Colditz GA.Med Sci Sports Exer; 31suppl, 1999)

31. Conclusions Substantial health benefits occur with a moderate amount of activity on most, if not all, days of the week. Additional health benefits can be gained through greater amounts of physical activity, Anyway, even small amountsof physical activity are healthier than a sedentary lifestyle.

32. Scientits have yet to discover the philosopher’s stone that will confer immortality. However, the ability of regular exercise to reduce biological age by 10 to 20 years is no mean miracle. Indeed, I know of no other therapy that could achieve comparable results. Roy J. Shephard

33. Suggested lectures Zumaia • ACSM Fitness Book • ACSM Guidelines for Exercise Testing and Prescription • Active Living. Health Promotion (HPR) - WHO • Aerobic Fitness and Health - Roy J. Shephard • Aging, Physical Activity and Health - Roy J. Shephard • Health and Ageing. A Discussion Paper- WHO • Healthy Ageing and Physical Activity - NSW-HEALTH • Older People & Physical Activity - Dawn Skelton