National physical activity recommendations for older Australians: Discussion Document

Appendix 6 - Recommendations derived from previous physical activity guidelines

The National Ageing Research Institute was commissioned by The Department of Health and Ageing to review the evidence and develop physical activity recommendations for older people.

Page last updated: 01 February 2011


Table A6.1 Recommendations for physical activity for older people derived from previous physical activity guidelines

General

Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
G1Physical activity is not just for older adults in the young-old age range, who live independently. OR People of all ages, both male and female, benefit from regular physical activity (Surgeon Generals report)p9p4
G2There are four main types of exercise that help older adults gain health benefits: 1. endurance / fitness; 2. strength / resistance; 3. balance; and 4. flexibility (and various combinations of these).
G3There are some generic and some specific health benefits associated with each type of exercise for older people, and these vary between exercise type.p10
G4When starting a physical activity program, start at a level that is easily manageable, and gradually build up the amount, type or frequency.p 3p10p5
G5“Too old” and “too frail” are not of themselves reasons to prohibit physical activity for older people. In fact, there are relatively few health reasons to stop older adults from becoming more active. ALTERNATE WORDING: There are relatively few older people who are unable to undertake a physical activity program, even those with a range of co-morbidities.p15
G6Older people become sick or disabled more often from not undertaking physical activity, than from participating in a physical activity.p17
G7Physical activity can improve health outcomes for some chronic conditions (eg stroke, arthritis), so long as it is done when the condition is under control (ie not in a flare up/ acute condition).p30p4p15p22
G8Men aged over 40, or women aged over 50 should check with their doctor first if planning to commence a vigorous form of physical activity (ie – if it causes deep breathing and sweating).p16p23
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Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
G9Older people who are under a medical specialist’s care should check with their specialist / surgeon / or other medical practitioner before commencing any new physical activity (eg people with abdominal aortic aneurysm, or critical aortic stenosis), people with symptomatic CVD, diabetes or other chronic health problem.
p5
P16-17
P5&23
G10If an older person is able to sustain participation in a new physical activity program for a month and keep going after that, it s a good sign that progress is being made towards establishing a sustained change in physical activity behaviour.
p22
G11If an older person stops an established physical activity routine for several weeks, and then recommences the routine, they should start out at about half the effort they were doing prior to the break in the routine, then gradually build the routine back to its previous level.
p27
G12Older people with risk factors, and / or stable medical conditions can benefit from low intensity or light forms of physical activity
p6
G13A pre-activity evaluation is not necessary in most cases of people with stable (cardiovascular) disease who plan to undertake low to moderate physical activity. Where there is uncertainty of the safety of a new physical activity program, or for those wanting to undertake vigorous physical activity, medical review and (if required) medical investigations are recommended.
p12
G14Older people who have been inactive for some time should check with a doctor before commencing a new form of physical activity.
9
p10
G15Undertaking 30 minutes of physical activity of moderate intensity on most if not all days of the week is sufficient to achieve health benefits for older people.p 3
p 6
p2
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Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
G16Higher levels of regular physical activity by older people are associated with lower mortality and morbidity rates.p 5p7
G17Many of the benefits of physical activity diminish within several weeks if the physical activity is substantially reduced, and effects can disappear in 2-8 months if it is not resumed.p7
G18Regular physical activity can improve aspects of mental health such as depression, anxiety, mood, and improve quality of life.p8p2
G19Information about the health benefits of physical activity for older people, including those with comorbidities, should be widely available.p93p 7p6
G20Intermittent feedback about changes in health status can help sustain involvement in physical activity (eg GP blood pressure review, gym instructor remeasures 1RM)p7
G21Establishment of short and longer term goals of a physical activity program can help increase long term sustainability of participation.p8
G22Involvement of family and friends in a physical activity program can help increase long term sustainability of involvement in a physical activity program.p7
G23Opportunities should be sought to ensure consideration of healthy nutrition when an older person is involved in a physical activity program.p33p9
G24Physical activity should be considered as a health promotion approach for well older people, as well as an avenue to improve health outcomes when comorbidities are present.p94
G25Longer term health benefits require sustained engagement in physical activity over time.p2
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Strength / resistance training


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
S1Strength training physical activities increase muscle strength and body metabolism (helping to keep weight and blood sugar within normal range) and may also help prevent osteoporosis.p9
S1AWith increasing muscle strength, increased levels of spontaneous activity have been seen in both healthy, free-living older subjects and very old and frail men and women. Strength training, in addition to its positive effects on insulin action, bone density, energy metabolism, and functional status, is also an important way to increase levels of physical activity in older people.
S2Strength training physical activities should include exercises for all of the major muscle groups at least twice weekly to achieve health benefits.p32
S3When commencing a strength training physical activity, commence with a minimum of weight in the first week, and gradually over time add extra weight, to the point where performing the required amount is perceived as challenging.p32
S4When lifting weights, take 3 seconds to lift or push a weight into place, hold the position for 1 second, and another 3 seconds to lower the weight.p33
S5Each strength training physical activity routine should conclude with a gentle muscle stretching (flexibility) program.p33
S6No components of a strength related physical activity routine should cause pain. If pain is experienced, the routine should be ceased, and discussed with a medical practitioner.P11p33
C7 or S7In order to optimise health benefits, cardiorespiratory endurance activity should be supplemented by strengthening physical activity at least twice weekly.p6
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Balance training / postural control


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
B1Physical activities with a focus on balance training can improve balance abilities, and reduce falls in older people, including those with high risk of falling.p9
B2A broad-based exercise program that includes balance training, resistive exercise, walking, and weight transfer should be included as part of a multifaceted intervention to reduce the risk of falling.
B3Exercises such as walking, aerobic dance, and stretching, which have been shown to increase joint range of motion, should be included in a general exercise program for the older adult. It appears likely that many different approaches, with even short program duration, may have a beneficial effect on flexibility. The exact dose-response relationship remains to be determined, as does an understanding of the benefits in the activities of daily life that accrue from increased flexibility.
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Cardio-respiratory / fitness training


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
C1Cardio-respiratory based physical activity can result in a range of health benefits, including improved functional capacity, improved functioning of the heart muscle, improved glucose tolerance, lowered blood pressure, and increased muscle mass and reduced fat mass.p 6p4p 7
C2Start cardio-respiratory physical activity programs slowly at a low level, and gradually progress to achieve increase in breathing and heart rate. Use a minimum of 10 minute chunks to make up 30 minutes / day on most days (once you have built up).p 6p29
C3Incorporating a warm up and cool down / muscle stretching (flexibility) period before and after a cardio-respiratory physical activity program will minimise risk of injury or muscle soreness. (applies also to strengthening programs).p29
C4Using appropriate safety and protection equipment (eg well supported running shoes for walking; helmet for bicycle riding) will minimise risk of injury.p29
C5When progressing a cardio-respiratory physical activity, build up the time of the physical activity first, and then build up the difficulty of the physical activity.p29
C6To achieve optimal health benefits from cardio-respiratory forms of physical activity, they should be undertaken 4-7 days each weekp 6
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Flexibility / stretching programs


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
F1Flexibility or stretching exercises should be undertaken at the end of strengthening or cardio-respiratory physical activity routines.p45
F2Flexibility or stretching exercises can reduce the risk of injuries from physical activity participation.

Incidental physical activity


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
I1Significant health benefits can be obtained by including a moderate amount of incidental physical activity (up to 30 minutes accumulated throughout the day) on most if not all days of the week.p 4
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Condition specific recommendations


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Cardiovascular disease (recommendations taken directly from the National Heart Foundation of Australia’s guidelines).
CS1Doctors and clinicians should routinely provide brief, appropriate, written physical activity advice to people with well compensated, clinically stable cardiovascular disease (CVD).p4
CS2Survivors of a recent cardiovascular event should be offered participation in supervised# exercise rehabilitation where available and practical.p4
CS3Well compensated, clinically stable people with CVD including those with implantable cardiac devices, and congenital and valvular heart disease, should progress their physical activity over time to the recommended dose (30 minutes or more of moderate physical activity on most, if not all days of the week. The amount of activity can be accumulated in short bouts).p4
CS4People with advanced CVD or severely impaired functional capacity may have to down-regulate the recommended dose of physical activity.p4
CS5People who have recently had surgery, or angioplasty +/- stenting for CVD should take into consideration the implications of the surgery / procedure when commencing physical activity.p4
CS6Unless contraindicated, all people with peripheral vascular disease (PVD) or diabetes and survivors of stroke with sufficient residual function should progress over time to the recommended dose of physical activity (see CS3).p4
CS7Regular low to moderate exercise is safe in older people with well compensated clinically stable heart failure.P17
CS8Older people with CVD can be encouraged to do low to moderate intensity physical activity, with multiple shorter bouts daily. As they progress, the duration of bouts can increase.P18
CS9The only consistent beneficial CV response to light- to moderate-intensity exercise training in older adults is a reduction in blood pressure in older hypertensive adults.
CS10Moderate or high-intensity exercise may be required to elicit adaptations in the cardiovascular system and in cardiovascular disease risk factors. However, the initiation and maintenance of long-term light- to moderate-intensity physical activity programs in older adults may reduce the rate of age-associated deterioration in numerous physiological functions, even if they do not result in absolute increases in these measures, which, in the long-run, should benefit both quantity and quality of life.
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Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Diabetes
CS11Regular physical activity can reduce the risk of Type II diabetes (across all ages).p53
CS12In adults, the risk of Type II diabetes declines as frequency of exercise increases to 3-5 times per week.p53
Osteo-arthritis
CS13Older adults with osteo-arthritis pain should undertake a prescribed physical activity / exercise program to derive similar shorter term and longer term physical, psychological and functional benefits as observed in the general population.p810
CS14Physical activity should be an integral component of the management plan for older adults with osteo-arthritis.p810
CS15Appropriate, regular physical activity that accommodates the specific needs and circumstances of the individual older person with osteo-arthritis does not exacerbate osteo-arthritic joint symptoms or accelerate the pathological process of osteo-arthritis.p810
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Frail older people


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
FO1All exercise programs for frail older people should include progressive resistance training of the major muscle groups of the upper and lower extremities and trunk.
FO2Balance training should be incorporated into physical activity programs for frail older people, either as part of strength training or as a separate modality.
FO3Training and supervision is mandatory for safety and progression to occur.
FO4Although walking is a preferred mode because of its direct functional nature, in some individuals only arm and leg ergometry, seated stepping machines, and water exercises may be possible for a variety of disabilities, and these are suitable alternatives if available.
FO5By eliminating unnecessary barriers to optimal mobility and fitness among the oldest adults, substantial health benefits may be realized via both prevention of new disabilities as well as rehabilitation from chronic conditions.
FO6Support should be provided to facilitate access and involvement of older people with disabilities in appropriate physical activity programs.p7p7
FO7Most geriatric syndromes associated with frailty are responsive to increased levels of appropriate physical activity.
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Other recommendations for physical activity for older people not

Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
O1The selection of the most appropriate form of physical activity for older people is determined by personal preference, and the most appropriate physical activity to address identified health problems.
O2Most types of physical activity are able to be graded from a very low level through to high level, providing a basis for tailoring of a physical activity to an individual person's needs.
Providers of physical activity programs for older people / policy and planning


Number of reviewed guideline (see Table 7.1)
Rec NoRecommendation
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
P1A variety of physical activity options should be accessible, equitable and available at reasonable cost for older peoplep91
P2Physical activity programs for older people should be conducted by appropriate experience and training (see International guidelines on training, JAPA).P10
P3Environments (parks, paths, shopping centres) should be supportive of physical activity for older people. This includes issues of surfaces (paths, curbs and stairs, shops and shopping centre floors), lighting, seating, and safety.p93p93p8
P4Provision of options or choice in the types of physical activity available for an individual can increase uptake and sustained participation in physical activity.p6
P5Arbitrary chronological age cut-offs should be eliminated in research and exercise programs. Exclusions should be based on participants’ functional abilities.
P6An inter-sectoral approach is essential to the development of environments supportive of physical activity in the community.p65/100p7p8
P7Research needs to be supported to address the gaps in evidence in effective physical activity options for older people, and effective translation of new research findings undertaken to maximise uptake and sustained engagement of older people in physical activity.p93
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