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Physical Activity Initiatives with Older Adults

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Title: Physical Activity Initiatives with Older Adults


1
Physical Activity
Initiatives with Older Adults
  • A Canadian Perspective
  • Whistler, B.C.
  • December 10, 2001

2
Our Challenges
  • It is surely a great criticism of our profession
    that we have not organized a critical summary, by
    specialty of sub-specialty, adapted periodically,
    of all relevant randomized controlled trials.
  • Archie Cochrane

3
Our Challenges
  • Clear Lake Agreement by Federal, Provincial,
    Territorial Ministers responsible for fitness,
    active living, recreation set a joint target to
    reduce physical inactivity in Canadians by 10
    from 1998-2003

4
Active Old Age
  • Director General of the World Health Organization
    described gains in life expectancy as one of
    humanitys greatest achievements
  • Living a full life to reach a healthy, happy and
    active old age is our aspiration

5
Between Friends
6
Not Aging but Saging Wise Beyond Your Years
  • It might not affect you now, but it will.
  • Growing older is inevitable.

7
Dignity, Respect, Independence and Control
  • The importance of older people being able to
    maintain control and autonomy in their lives must
    not be lost

8
Definition of Older Adult
  • Self-defining (Active Living Coalition for Older
    Adults)
  • Varies depending upon initiative
  • 50-55 for many initiatives (Physical Activity
    Guide)

9
Aging Population - Facts
  • Being physically active reduces the risk of heart
    disease, fall and injuries, obesity, high blood
    pressure, adult-onset diabetes, osteoporosis,
    stroke, depression, colon cancer and premature
    death
  • One-third of older adults face an increased risk
    of loss of mobility and functional capacity,
    thereby decreasing their functional independence

10
Aging Population Facts
  • 1 in 10 Canadians is an older adult
  • This number will double by 2021
  • The greatest health risk for older adults is
    sedentary living (WHO, 1997)
  • Among adults 55 only 34 of men and 29 of
    women are physically active
  • Among adults 74 only 29 of men and 19 of women
    are physically active

11
The Older Adult Audience
  • 50 of seniors report physical activity of 15
    min. or more at least 12/month
  • Almost 2/3 of those aged 80report needing no
    help with daily tasks
  • Only 16 of older adults use the Internet
  • Once online Canadian seniors use the Internet on
    average 12 hours weekly

12
The Older Adult Audience
  • 1/3 of Canadian seniors live in rural areas and
    small towns, the rest in urban areas
  • 93 of seniors live in private households
  • 20 of Canadians 65 have post-secondary diploma
    or degree
  • 60 did not finish high school
  • Considerable number have difficulty with reading

13
By 2041.
  • 46 have a disability but for most part continue
    to enjoy and active lifestyle in their
    communities
  • For those born in 1998 life expectancy increased
    to 92 for men and 100 for women
  • By 2041 number of Canadians over 80 will
    quadruple

14
Why Older Adults are not as Physically Active
  • Accessibility
  • Safety
  • Security
  • Support
  • Motivational issues
  • Must be addressed to encourage, support and
    ensure that opportunities exist that facilitate
    involvement in Active Living

15
Aging and Communication
  • Visual acuity
  • Hearing acuity
  • Agility Mobility
  • Social/emotional changes

16
Barriers to Reaching Older Adults
  • Physical changes of aging
  • Stereotypes, outdated assumptions about older
    adults lifestyles, interests, capabilities
  • Communication materials and media not suited to
    audience

17
Initiatives
  • Physical Activity Guide for Older Adults
  • -individuals leaders, practitioners
  • Moving through the Years A Blueprint for Action
    for Active Living and Older Adults
  • Policy, decision makers
  • Evidence Based Clinical Guidelines for
    Osteoporosis
  • Physicians (Specialists/ GP,FP), Other Allied
    Health Professionals

18
Canadas Physical Activity Guide for Older Adults
  • The Guide and the accompanying handbook are the
    Canadian standard for physical activity and older
    adults
  • Based on prototype of Physical Activity Guide for
    Canadians and Canadas Food Guide
  • Bilingual (French English)

19
Canadas Physical Activity Guide for Older Adults
  • Developed over 3 years
  • Done in partnership with the Active Living
    Coalition for Older Adults (ALCOA), Canadian
    Society for Exercise Physiology and Health Canada
  • Launched in May 1999
  • Multi-disciplinary national advisory committee
    which included older adults
  • Focus testing with both older adults and health
    professionals in urban and rural settings

20
Canadas Physical Activity Guide for Older Adults
  • Guide and Handbook underwent numerous reviews by
    a group of scientific experts
  • Guide and handbook used by leaders, health
    providers and program delivers
  • Guide includes tips to getting started, how much
    activity is enough, health benefits, and examples
    of endurance, flexibility, strength and balance
    activities to choose from
  • Launched in conjunction with the Blueprint for
    Action

21
Canadas Physical Activity Guide for Older Adults
Challenges
  • Retain scientific validity
  • Retaining balance between consumer wants needs
    and what science says
  • Marketing of message had to be simple, realistic,
    believeable, and inspiring
  • Attaining the outcomes benefits while making
    goal attractive attainable
  • Carry a message to audience that was clear and
    user friendly

22
Canadas Physical Activity Guide for Older Adults
Challenges
  • Simple Messages Age is no barrier
  • Be Active, Your Way, Every Day for Life
  • Every little bit helps, but more is better
  • Add it up principle
  • Moderate physical activity most days for 30-60
    minutes
  • Choice of activities from each of three activity
    groups
  • Endurance, Flexibility, Strength Balance

23
Canadas Physical Activity Guide for older adults
  • Science based facts (benefits/risks)
  • Why do this and what is in it for you
  • Variety Safety concerns (start where you can)
  • Overcoming barriers
  • Pull out Guide to put on refrigerator
  • Sample calendar/planning sheet
  • Stories/Real people (not cartoons)
  • Next steps planner

24
Canadas Physical Activity Guide for older adults
- Barriers
  • I feel too tired to get started
  • I dont want to exercise? Ive worked hard all my
    life, not its time to relax
  • I have arthritis or stiff joints?
  • I have osteoporosis?
  • I have concerns about my heart? Im afraid that
    physical activity will do more harm than good

25
Canadas Physical Activity Guide for older adults
- Barriers
  • I dont have much timeso which activity is best?
  • I am unsteady on my feet?
  • I am afraid to go out in winter?

26
Whats Different
  • Size of print
  • Benefits right up front
  • Real people
  • Practical user friendly suggestions
  • Talk about barriers (tell it like it is)
  • Safety
  • Refers individuals to their physician or health
    professional

27
Whats Different
  • Lots of white space
  • Bold headings
  • Clear Language
  • Stories of real people

28
Key Learning from the Guide
  • Senior friendliness is an attitude based on
    considering seniors needs and respecting
    seniors contributions
  • Physicians are credible influencers of
    individuals health behaviours for older adults
  • Design communication with your clients not for
    them.

29
Canadas Physical Activity Guide for Older Adults
  • An excellent example of how consensus statements
    and research can be translated into simple clear
    messaging for the target audience

30
Canadas Physical Activity Guide for Older Adults
  • Outcomes
  • Over 50 National organizations endorsed the Guide
  • Over 2 million copies have been printed and
    distributed

31
College of Family PhysiciansKey Influencers
  • Adopted a Physical Activity and Health Strategy
  • Developed a unique video on active ageing
  • Physicians learn more about barriers to PA
  • Describes new counseling training tools
  • New Practice-based Small Group Learning Module on
    PA older adults
  • For info email pmaturano_at_cfpc.ca

32
Moving Through The YearsA Blueprint for Action
  • Goal to update 1991 original Blueprint
  • Fondation en Adaptation Motrice, ALCOA and Health
    Canada conducted survey in 22 communities across
    Canada and over 20 NGOs
  • Over 450 individuals consulted (over half of whom
    were older adults)
  • Launched in 1999 in International Year of Older
    Persons

33
Moving Through The YearsA Blueprint for Action
  • A national framework for plan of action
  • Provides a collective direction for current and
    future initiatives
  • A tool for planned change
  • ALCOA asked to serve as the keeper of the
    Blueprint to ensure its uptake
  • Serves as a base for ALCOAs goals and objectives

34
Active Living Coalition for Older Adults
  • In 1993 three older adult national bodies came
    together (National Walking Campaign, Secretariat
    for Fitness for the Third Age, The Older Adult
    Active Living Association)
  • Became Active Living Coalition for Older Adults
    (ALCOA)
  • Mandate to bring together national organizations
    researchers working with older Canadians in
    Active Living

35
Moving Through The YearsA Blueprint for Action
  • Nine Guiding Principles based on the vision of
  • An active society where all older Canadians are
    leading active lifestyles thereby contributing to
    their physical and overall well-being.

36
Moving Through The YearsA Blueprint for Action
  • Principle 1
  • It is recognized that active living is essential
    for daily living and a cornerstone of health and
    a quality of life.

37
Moving Through The YearsA Blueprint for Action
  • Principle 2
  • There is a need for more positive attitudes
    toward aging, with realistic images that depict
    older adults as respected, valued, and physically
    active members of society.

38
Moving Through The YearsA Blueprint for Action
  • Principle 3
  • Older adults should be encouraged to participate
    in decision-making and leadership positions, in
    all phases of program/service development and
    delivery.

39
Moving Through The YearsA Blueprint for Action
  • Principle 5
  • Issues, needs and interests of older adults in
    their community need to be identified, and
    accessible, affordable active living activities
    and programs designed to meet these needs.

40
Moving Through The YearsA Blueprint for Action
  • Principle 6
  • While it is recognized that both aging and
    learning are a life-long process, it is
    appreciated that for some, pre-retirement years
    may be a key time to re-focus on active living
    and well-being.

41
Moving Through The YearsA Blueprint for Action
  • Principle 7
  • Canada is a society for all ages Programs and
    services should be developed which accommodate
    older adults choice to be with others.

42
Moving Through The YearsA Blueprint for Action
  • Principle 8
  • There is a need to identify, support, and share
    research priorities that apply to active living
    and aging.

43
Moving Through The YearsA Blueprint for Action
  • Principle 9
  • There is a need for education and promotion of
    the health benefits of active living as a way of
    life for older adults

44
Areas of emphasis for active living and older
adults
  • Increase public awareness about the benefits of
    active living
  • Develop competent leaders in active living who
    can meet the needs interests of older adults
  • Ensure resources and social supports needed to be
    active are in place
  • Strengthen delivery systems and improve levels of
    cooperation, coordination, and communication
    among organizations

45
Areas of emphasis for active living and older
adults
  • Encourage and enable older adults to advocate for
    the right to a quality of life that includes
    physical activity
  • Identify, support, and share research priorities
    and results on aging and active living
  • Continually monitor and evaluate programs,
    services and outcomes to ensure that active
    living needs, interests, and concerns of older
    adults are met

46
Blueprint Implementation Summit
  • In 1999 Blueprint implementation Summit held
  • Over 50 national and provincial organizations
    attended along with other stakeholders
  • Resulted in five priority areas
  • Leadership Development
  • Shared Research in Plain Language
  • Marketing and Communications
  • Influencing Policy
  • Coordination and Capacity Building

47
Leadership Development
  • ALCOA providing strategic leadership
  • Develop a network of community presenters to
    conduct workshops with older adults
  • Develop strong delivery system at the community
    level through the members of ALCOA
  • Presenting to seniors groups and organizations to
    promote the Guide and the Blueprint and to
    highlight local opportunities in each community
    to be active

48
Communicating Research in Plain Language
  • ALCOA Research Update Launched May 2001
  • Goal to interpret current leading edge research
    into user friendly, plan language format
  • Included in Research Update is a special Active
    Living Tips sheet for older adults
  • Copies available

49
Marketing Communications
  • Includes ALCOAs website, newsletter, electronic
    listserv, national spokesperson and a framework
    for affecting change
  • Provides an opportunity to share information,
    network, learn and reach older adults with
    consistent active living messages

50
Influencing Policy
  • ALCOA partners with key member groups and
    stakeholders
  • ALCOA to develop information to members of
    parliament/policy and decision makers to
    influence and promote the priority of active
    living opportunities for older adults

51
Capacity Building
  • Increase and strengthen ALCOAs membership
  • Involve older adults in all planning decision
    making
  • Bring together multidisciplinary professionals,
    volunteers and older adults to share information
    and resources
  • To foster a broader collaborative network
  • Holds national forums, Mark your calendars for
    Forum Regina Saskatchewan May 9-12, 2002

52
Intended Outcomes of these Efforts by ALCOA
  • Results of these efforts is to increase the
    opportunities for and the possibility of healthy
    aging by all Canadians

53
Osteoporosis Society of CanadaDefinition of
Osteoporosis
  • What is osteoporosis?
  • A disease characterized by low bone mass and
    micro-architectural deterioration of bone tissue,
    leading to enhanced bone fragility and a
    consequent increase in fracture risks.
  • Thinning of bone that leads to higher risk of
    fracture.

54
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Prevalence of Osteoporosis
  • Major health problem in Canada and other
    industrialized countries
  • Affects up to 1 in 4 Canadian women over 50
  • Affects 1 in 8 men over 50( and increasing)
  • As many as 2 million Canadians at risk over their
    lifetime

55
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Why should we be concerned about osteoporosis?
  • Hip fractures strongly related to osteoporosis
  • 20 lead to subsequent premature mortality
  • Vertebral fractures dramatically affect quality
    of life
  • Often decrease in personal freedom
  • Annual cost of treatment ? 1 billion in Canada
  • Canadas population is aging
  • Frequency of osteoporosis will rise as well

56
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Our goal
  • To prevent fracture through proven preventive
    measures and effective therapies

57
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Why do we need guidelines?
  • Distill a large body of medical knowledge into a
    convenient, readily useable format
  • Primary purpose is to educate and create
    awareness
  • Difficult for physicians to keep up with the
    latest advances

58
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Why Guidelines?
  • To keep up to date in Internal Medicine
    physicians need to read 17 articles a day, 365
    days a year
  • They dont
  • Nor does anyone else

59
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Why Guidelines?
  • Physicians need evidence about
  • The accuracy of diagnostic tests,
  • The power of prognostic markers,
  • The comparative efficacy and safety of
    interventions, etc
  • Need evidence about 5 times for every in-patient
    (and twice for every 3 out-patients)
  • Properly structured guidelines are an invaluable
    resource to the busy clinician

60
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • 1996 Guidelines Project were consensus-based
    guidelines
  • A narrative view
  • Scan through arbitrarily selected documents and
    pick out what seems to address questions
  • Quicker to create

61
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Consensus-based Guidelines
  • Very susceptible to bias
  • Subjective evaluation of literature, opinion
  • No criterion for inclusion of investigation or to
    the grading of quality
  • Often, exalted individuals keep up the least with
    current literature and advances
  • Experts are often less able to produce objective
    reviews of the literature in their area than
    non-experts

62
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • What is evidence-based evidence?
  • It is the conscientious, explicit and judicious
    use of current best evidence in making decisions
    about the care of individuals (patients)

63
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Evidence-based medicine is the integration of
  • Individual clinical expertise
  • Best available external clinical evidence from
    systematic research and
  • Individuals (Patient) values and expectations

64
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Total abstracts caught and searched by the
    committee
  • Grand Sum 89,804
  • Exercise and Fall Prevention 11,713
  • Nutrition 16,058

65
Osteoporosis Society of CanadaEvidence-Based
Clinical Guidelines
  • Abstracts selected for formal review
  • Grand Sum 6941
  • Exercise and Fall Prevention 1293

66
The scope
  • To this date, no review has ever been published
    that is more comprehensive
  • We have searched high and low for every possible
    citation

67
Evidence Based Danger
  • Systematic bias
  • A few therapies have much good evidence
  • Often can be reflective of funds to prove
    effectiveness
  • May be at the expense of other areas without the
    financial wherewithal
  • Danger of without substantial evidence to it
    being thought to be without substantial value

68
Physical Activity and Osteoporosis
  • Physical activity is not a standardized
    intervention
  • Variation in type, frequency and intensity and
    varies in site-specificity
  • Moreso that any other intervention compliance is
    a major issue
  • Potential for good and for harm

69
Physical Activity and Osteoporosis
  • As yet there is no clear insight into type,
    frequency or intensity is important for bone
    health
  • Or how this might change for different ages with
    different levels of bone mass
  • Some recent evidence that repetitious loading and
    unloading may work well

70
Goals
  • To prevent fractures
  • a) Through improving bone mass
  • b) Through fall prevention

71
Effect of Exercise as Lifestyle
  • In children, exercise plus calcium ( Vit D)
    makes better bones
  • Lifelong exercisers have better bones then
    sedentary people ( fewer fractures)
  • Over-exercising can lead to bone loss in both men
    and women
  • Body weight changes might be important weight
    gain above the waist is good, its loss is not good

72
Interim Expert Opinion
  • If you have been an exerciser all your life,
    stick with it
  • High activity level throughout adult life may be
    protective and lead to fewer fractures in old age

73
Interim Expert Opinion
  • In people with osteoporosis
  • If exercise has any role to play in reducing bone
    loss it is secondary to pharmaceutical treatment
  • Osteoporosis exercise programs are of value and
    should be available to patients

74
Interim Expert Opinion
  • In Elderly Fallers
  • Strengthening and balance exercises, and where
    relevant, multi-factorial interventions, based on
    individual assessment, will reduce falling risks
  • Dr. Richard Crilly, Scientific Advisory Council.
    OSC

75
Implementation of Evidence Based Guidelines
  • Partnerships with allied organizations
  • College of Family Physicians
  • Other Health Charities
  • Corporate Health Sector
  • Other medical specialties
  • Web-site
  • Nation wide forums with case study approach and
    opportunity to dialogue with experts
  • Translate into user friendly language
  • Publish in Canadian Medical Association Journal

76
Implementation
  • New evidence often takes a long time to be
    implemented
  • Established practices persist even if they have
    been proven ineffective or harmful

77
Outcomes
  • Family physicians and non-specialists able to
    quickly establish the best, evidence-based care
    for a particular patient
  • Considering the patients individual
    characteristics
  • Guidelines for the prevention of osteoporosis
  • Policy changes for governments
  • Forms foundation for all Society public and
    professional information
  • Credible source of osteoporosis information in
    Canada i.e. media

78
Summary CommentsPlain Language Checklist
  • Use concrete examples to illustrate ideas or
    concepts
  • Present ideas with illustrations or diagrams
  • Highlight main ideas and important information
    with headings, point form and boldface type

79
Summary CommentsPlain Language Check List
  • Use familiar words, conversational personal tone
  • Proceed logically, most important ideas first
  • Use action verbs and active construction
  • Favour short words and sentences
  • Use short paragraphs

80
Promotion Marketing Checklist
  • Research and consult guidelines about tailoring
    messages for older consumers
  • Focus-test your materials with older adults
  • Recognize in your marketing plan that this is not
    a single homogeneous group
  • Test a marketing plan and materials with several
    groups of older consumers (include a range of
    ages and literacy levels)

81
Promotion and Marketing Checklist
  • Use older persons or models in your promotional
    materials
  • Present positive images of people who are
    healthy, happy and representative of OA diversity
    of culture, language, health status, geographic
    location, income level, etc.

82
Active Living Older AdultsNext Steps in
Education
  • Continue increasing awareness education about
    the benefits and importance of active living
  • Promote a consistent message
  • Decrease fears about physical activity
  • Advocacy efforts for policy changes
  • Strengthen partnerships so that health
    professionals and organizations at all levels
    promote the active living message

83
Active Living for Older AdultsNext steps in
Programming
  • Create specialized programs for each stage of the
    older adult continuum
  • Incorporate a variety of programming
  • Include all components of fitness
  • Incorporate progression
  • Include social components
  • Address environmental and accessibility issues
  • Develop community wide plans

84
Active Living for Older Adults Next steps in
Research
  • Continue research into physical activity and
    older adults
  • Increase investigation of psychosocial aspects
  • Translate research into clear language

85
Active Living for Older AdultsNext steps in
Empowerment
  • Older adults take responsibility for their own
    health and to take an active role in program
    planning and delivery
  • Encourage and support role models and leadership
  • Foster and promote a change in attitude

86
Active Living for Older AdultsNext steps in
Empowerment
  • Older adults the fastest growing group on
    Internet users
  • Internet expands the world of seniors
  • Powerful tool for maintaining health and
    well-being
  • New form of intergenerational communication
  • Encourage older adults to get online
  • Build senior friendly websites

87
This is a prime opportunity for governments,
individuals and organizations to make a positive
impact on the health of all Canadians
  • Physical activity, especially for older adults,
    is overlooked as an effective and essential part
    of health promotion strategy
  • Active Living is a long-term, low-cost
    preventative approach

88
The Ultimate Goal
  • Prolong the independence of older Canadians and
    add life to years
  • When Physical Activity has a prominent place in
    the Cochrane Collaboration we will know we have
    been successful.

89
Thank you / Merci
  • For more information
  • Physical Activity Guide 1-888-334-9769
  • www.paguide.com
  • ALCOA www.alcoa.ca 1-888-549-9799
  • Osteoporosis Society of Canada
  • www.osteoporosis.ca
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