Promoting Physical Activity with

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• Promoting Physical Activity with
• Older People
• A Guide to Leading Edge Practice
• Seminar programme - Spring 2008

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• Themes and content of the programme
• Update on evidence
• BHF NC Guidelines on older people and physical
  activity
• Active for Later Life resource
• Policy and partnerships

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• Why Leading Edge Practice ?
• In the last few years older people and physical
  activity has begun to move up the agenda but ..
• We need to move from innovation and short termism
  to sustained activities and opportunities by
  implementing effective interventions and
  programmes

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Physical activity and older people

• Update on evidence
• Overall summary
• New areas to highlight (and some old !)
• Key messages
• making use of specific and targeted evidence
• The benefits extending into later, later life
• www.bhfactive.org

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Physical activity levels among older people

• Physical inactivity declines with age
• Women are less active than men but the gap closes
  with increased age
• Ethnic minority elders are less active
• Data available at www.bhfactive.org.uk

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The benefits of physical activity
The benefits of physical activity for older people

• Increasing/overwhelming evidence in relation to
• Disease prevention and management, psychosocial
  benefits and complications of immobility
• Maintaining independence, improving the quality
  of life, and successful ageing.
• Opportunities for significant savings to health
  and social care services DOH (2005)
• Benefits can be achieved by healthy older
• people as well as the frail and very old.

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Prevention and management of disease
The benefits of physical activity for older people

• Coronary heart disease
• Stroke
• Increased blood pressure
• Late onset (Type 2) diabetes
• Osteoporosis
• Colon and other cancers
• Cognitive impairment
• Weight control
• Reduction in accidental falls
• Effects apparent even among those taking up
• activity at a later age.

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Selecting the evidence for target groups and
partners

• Psychological (mental) health and well being
• Cognitive functioning and dementia
• Energetics
• People over 85
• Older Men and gender equity

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1. Psychological benefits
The benefits of physical activity for older people

• Reduction in stress and anxiety
• Reduction in depression, enhancement of mood
• Improvement in overall psychological well-being
• Improvements in self-esteem and self-worth
• Reduction in isolation and loneliness
• Effects apparent even among those taking up
• activity at a later age.

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Improving psychological health

• Is a priority for older people and a growing need
• Different measures e.g. loneliness, isolation,
  well being, self esteem and self worth, anxiety
  and depression
• In touch with friends and family, getting out of
  the house, letting off steam, being in the open
  air, achieving something
• Evidence of effect as strong amongst older people
  as young people
• Physical activity as effective as medication ?
• Outcomes most reported by older people and most
  easily captured

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Psychological health why is this important ?

• UK Enquiry into Mental Health of Older People
  (Age Concern and NIMH 2006)
• NICE draft Guidance (2008)
• High prevalence amongst older population and
  always under reported
• Addressing National Service Frameworks and other
  Gaps
• Increase in GP referrals reported

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2. Cognitive functioning and dementia

• Physical activity associated with
• Improvement in both the function and structure of
  the brain
• Reduced risk of cognitive impairment
• Increasing evidence of links with stroke and
  diabetes (vascular dementia)
• Taking its place among preventable/lifestyle
  diseases
• (NICE Guidance 2006)

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Cognitive decline and dementias

• Benefits to both people with dementia and their
  carers (family or professional)
• Maintenance of function and independence
• Dementia may be accompanied by significant
  depression and increased risk of falls
• Quality of life the greatest challenge
• Applicable to a range of services, home based,
  day care, residential services and nursing care

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People with dementia Why is this
important ?

• Currently 7000,000 in UK set to rise to 1,000,000
  in 2020
• 2/3 live at home but 65 of residential beds
  and rising
• Significant impact on carers and families
• Dementia is also a young persons disease
• Dementia strategy in England/Scotland this year
  (2008) and NICE guidance already published
• The costs of dementia already outstrip CHD, Stoke
  and Cancers together (17 B)

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3. Energetics Physical activity as a personal
resource

• The capacity to live life to the full e.g. engage
  in life, hobbies, grandchildren
• Energy as building capacity and reserve
• Improvements to quality and quantity of sleep
  well documented
• Improvements in appetite and digestion
• A message for the older person

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Physical Activity as a resource

• Provides energy, dynamism and vitality to enjoy
  life and to succeed.
• Enriches peoples lives.
• Conditions the body to enable people to
  participate more effectively in sport/dance.
• Widens peoples perceptions of what they can do
  in their lives.

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4. People over the age of 85

• The new and fastest growing generation
• Small proportion in nursing and care.
• Most live at home
• Increased prevalence of disease and frailty
• Do we have low expectations of them ?
• Fear and skills factor

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Older, older people

• The benefits
• Protective effects (e.g. CHD, Stroke, Falls are
  increasingly evident in to the later years)
• Prevalence of poor mental health and depression
  (always under-reported)
• Management of Long Term Conditions (all the other
  benefits as well)
• Maintenance of function and independent living
  key motives

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Functional decline and frailty
How active are older people?

• (Spirduso, 1995)

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Too frail to benefit?

• Dose response curve
• The lower the baseline level of physical
  activity, the greater the health benefit
  associated with an increase in physical activity.
  Exercise can be adapted for any medical condition
• (Haskell 1994)

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Inactivity the consequencesProportion of women
aged 70 able to walk for different periods of
time and lengths of walk,
100
1/4 of a mile or more
80
30 min
60
15,
5,
40

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0
70-74
75-79
80
80
70-74
75-79
Age
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Why ? evidence linked to Independence and
problems encountered with physical tasks

• Walking 200 metres
• Climbing 12 stairs
• Picking up items from the floor
• Getting in and out of a chair
• Getting in and out of bed
• Dressing and undressing
• (Kings College 2006)
• (in private households and care homes)

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Activities of Daily Living.

• Wash hair comfortably?
• 20 women 14 of men 50 do not have
  sufficient shoulder flexibility
• Confident of getting out of a chair without using
  arms ?
• 25 women 7 men aged 70 74 do not have
  sufficient leg strength
• Ease of stair use?
• 47 women aged 70 74 do not have sufficient leg
  power
• Walk comfortably at a 20 minute a mile pace?
• 35 men and 80 women aged 70 74 do not have
  sufficient aerobic capacity

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Reducing the complications of immobility
The benefits of physical activity for older people

• Deep vein thrombosis
• Gravitational oedema
• Intermittent claudication
• Contractures
• Pressure sores
• Faecal impaction
• Effects apparent even among those taking up
• activity at a later age. Movement can be
• passive and aided.

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Strength training 85

• Programmes involving 2-3 sessions per
• week with loads greater than 65 of 1RM (1RM
• the one-repetition maximum, or the load that can
• be lifted once only) have produced significant
• improvements in muscle strength in older people.
• Older people have similar gains in relative
  muscle
• strength to those observed in young adults.
• (Fiatarone et al. High-intensity strength
  training in nonagenarians. Effects on
  skeletal muscle. Journal of the American Medical
  Association 1990 263 3029-3034).

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5 Older men and gender equity

• An inequality in health ?
• Men die younger
• At most ages PA levels are higher, but gap closes
  with increased age
• Different disease patterns e.g. CHD, prostate
  cancer
• But men do not use health services why ?

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Older men

• Glasgow Silver Programme only 14 of participants
  were men
• Are services designed or appropriate for men ?
• e.g. developing attractive activities
• Developing male roles within services
• Increasing volunteer opportunities
• NHS Gender Equity
• (BHF NC 2007)

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Evidence update - summary

• CMO Report - At Least Five a Day (2005)
• CD available as download
• BHF NC fact sheets
• Target to priority groups and partners
• Smarter Use linked to people, policies and
  outcomes
• Further evidence available
• Section 1 of the Active for Later Life Resource
• www.bhactive.org.uk