"New Updated Physical Activity Guidelines for Older Adults - Part 1"

On August 1, 2007 the American College of Sports Medicine (ACSM) and American Heart Association (AHA) unveiled updated physical activity recommendations for healthy adults ages 18 to 64 years and companion recommendations for those ages 65 and older. The companion recommendations extend to adults ages 50 to 64 years who have chronic health conditions or functional limitations that impact their fitness, physical activity or ability to move.

These guidelines state that all healthy adults ages 18 to 65 years need moderate-intensity aerobic physical activity for at least 30 minutes on five days each week or vigorous-intensity aerobic physical activity for at least 20 minutes on three days each week.

Further, adults will benefit from performing activities that maintain or increase muscular strength and endurance for at least two days each week. It is recommended that eight to 10 exercises using the major muscle groups be performed on two non-consecutive days. To maximize strength development, a resistance (weight) should be used for eight to 12 repetitions of each exercise resulting in willful fatigue.

The preventive recommendation specifies how adults, by engaging in regular physical activity, can promote and maintain health and reduce risk of chronic disease and premature death.

The companion recommendations similar to the updated ACSM/AHA recommendations for adults is specifically applied to adults aged 65 and older and adults aged 50 to 64 with chronic conditions or physical functional limitations (e.g., arthritis) that affect movement ability or physical fitness.

The recommendations are an update and clarification of the 1995 recommendations from the Centers for Disease Control and Prevention (CDC) and ACSM on the types and amounts of physical activity needed by healthy adults to improve and maintain health. The intent is to provide more comprehensive and explicit public health recommendations for adults based upon available evidence of the health benefits of physical activity.

The core recommendations remain fundamentally unchanged, despite more than 10 years passing since they were issued. New science has been evaluated to understand the biological mechanisms by which physical activity provides health benefits and the physical activity profile (type, intensity and amount) that is associated with enhanced health and quality of life. This publication reflects a review of that evidence and considers key issues not fully clarified in the original recommendations.

The updated recommendations for adults are improved in several ways.

1. Moderate intensity physical activity has been clarified. The 1995 document specified “most, preferably all days per week” as the recommended frequency while the new recommendation identifies five days per week as the recommended minimum.

2. Vigorous intensity physical activity has been explicitly incorporated into the recommendations. To acknowledge both the preferences of some adults for vigorous intensity physical activity and the substantial science base related to participation in such activity, this recommendation has been clarified to encourage participation in either moderate and/or vigorous intensity physical activity. Vigorous intensity physical activity was implicit in the 1995 recommendations. It is now explicitly an integral part of the physical activity recommendations.

3. Specified: Moderate and vigorous intensity activities are complementary in producing health benefits, and a variety of activities can be combined to meet the recommendations. This combining of activities is based on the amount (intensity x duration) of activity performed during the week and uses the concept of METs (metabolic equivalents) to assign an intensity value to a specific activity.

4. Specified: Aerobic activity is needed in addition to routine activities of daily life. The updated recommendations now clearly state that the recommended amount of aerobic activity (whether of moderate or vigorous intensity) is in addition to routine, light intensity activities of daily living, such as self care, casual walking or grocery shopping or activity that lasts less than 10 minutes such as walking to the parking lot or taking out the trash. Few activities in contemporary life are conducted routinely at a moderate intensity and last for at least 10 minutes. However, moderate or vigorous intensity activities performed as a part of daily life (e.g., brisk walking to work, gardening with shovel, carpentry) performed in bouts of 10 minutes or more can be counted towards this recommendation. This concept was implied but not effectively communicated in the original recommendations.

5. “More is better.” The new recommendations emphasize the important fact that physical activity above the recommended minimum amount provides even greater health benefits. The point of maximum benefit for most health benefits has not been established but likely varies with genetic endowment, age, sex, health status, body composition and other factors. Exceeding the minimum recommendation further reduces the risk of inactivity related chronic disease. Although the dose-response relation was acknowledged in the 1995 recommendations, this fact is now explicit.

6. Short bouts of exercise are OK. The original recommendations introduced the concept of accumulating short bouts of physical activity toward the 30 minute goal, but there was confusion about how short these episodes could be. For consistency, the minimum length of these short bouts is clarified as being 10 minutes.

7. A muscle strengthening recommendation is now included. Muscle strengthening activities have now been incorporated into the physical activity recommendations. The 1995 recommendations mentioned the importance of muscular strength and endurance but stopped short of making specific declarations in this area. Available evidence now allows the integration of muscle strengthening activities into the core recommendations.

8. Wording has been clarified. Minor wording changes in the recommendations have been made to enhance clarity in communications. For example, the term “aerobic,” or endurance, has been added to clarify the type of physical activity being recommended and to differentiate it from muscle strengthening exercises, which are now part of the core recommendations.

The updates also provide a clearer sketch of what combinations of moderate and vigorous intensity activity can be performed to meet this recommendation. Moderate intensity aerobic activity is described as generally equivalent to a brisk walk or activity that noticeably accelerates the heart rate.

The recommendations also summarize new research that links muscular strength to health benefits such as protection against bone loss and a decreased risk of all-cause mortality.

The updated recommendations emphasize that relatively modest amounts of physical activity will improve health. Physical activity for cardiorespiratory fitness and expanded health gains, such as weight loss, may require more than a minimum 30 minutes of moderate activity most days of the week. In general, there are more agreements than differences when it comes to physical activity recommendations. Differences on “minutes-per-day” recommendations appear because they are intended for different groups and may be gender specific or relevant to overweight or obese individuals.

Guidelines for healthy adults under age 65 include:

* Do moderately intense cardio 30 minutes a day, five days a week... OR
* Do vigorously intense cardio 20 minutes a day, three days a week... AND
* Do eight to 10 strength training exercises, eight to 12 repetitions of each exercise twice a week.

Moderate intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of physical activity may be necessary. The 30 minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease.

Guidelines for adults over age 65 (or adults 50-64 with chronic conditions such as arthritis) include:

* Do moderate intense aerobic exercise 30 minutes a day, five days a week... OR
* Do vigorous intense aerobic exercise 20 minutes a day, three days a week... AND
* Do eight to 10 strength training exercises, 10 to 15 repetitions of each exercise twice to three times per week... AND
* If you are at risk of falling, perform balance exercises... AND
* Have a physical activity plan.

Both aerobic and muscle strengthening activity is critical for healthy aging. Moderate intensity aerobic exercise means working hard at about a level six intensity on a scale of 10. You should still be able to carry on a conversation during exercise.

Older adults or adults with chronic conditions should develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure your safety.

Key Points to the Guidelines for Older Adults

Although the guidelines for older adults and adults with chronic conditions are similar to those for younger adults, there are a few key differences and points to consider.

􀂇 The general recommendation is that older adults should meet or exceed 30 minutes of moderate physical activity on most days of the week. However, it is also recognized that goals below this threshold may be necessary for older adults who have physical impairments or functional limitations.

􀂇 Functional health is an important benefit of physical activity for older adults. Physical activity contributes to the ease of doing everyday activities, such as gardening, walking or cleaning the house.

􀂇 Strength training is extremely important. Strength training is important for all adults, but especially so for older adults, as it prevents loss of muscle mass and bone and is beneficial for functional health.

􀂇 The minimum recommendations are just that: the minimum needed to maintain health and see fitness benefits. If a person can exceed the minimum, he or she can improve personal fitness, improve management of an existing disease or condition and reduce risk for health conditions and mortality.

􀂇 Flexibility is also important. Each day a person should perform aerobic or strength training activities, taking an extra 10 minutes to stretch the major muscle and tendon groups, with 10-30 seconds for each stretch. Repeat each stretch three to four times.
Flexibility training will promote the ease of performing everyday activities.

Flexibility Guidelines

Collagen production and elasticity of the tissues decrease as we age. This impairs both flexibility and range of motion. Scientific evidence, however, suggests that much of this decline is due to inactivity. Stretching and mobilization exercises can effectively increase range of motion and flexibility in older adults, so they are an important part of any fitness program.

To gain true flexibility, you need to use a combination of stretching and “mobilizing.” You might be more familiar with the terms “limbering” or “range of motion” instead of “mobilizing.” This type of exercise is not the same as stretching, but it is closely related. With mobilizing exercises, the emphasis is on movement in the joints rather than stretching the muscles. Mobility exercises consist of active, gentle and controlled movements performed fluidly and consistently. On the other hand, stretching to improve flexibility involves assuming a position and holding it for 10 to 30 seconds to elongate the muscle.

Mobility exercises help loosen up and lubricate the joints with synovial fluid so that the joint moves freely and smoothly. This type of exercise is important for everyone, but even more so for older people, especially those with arthritis. Arthritis reduces a person’s ability to move the joints through a full range of motion. Impaired range of motion translates into a lower functional capacity and lessens a person’s ability to perform the activities of daily living.

A person who begins mobility exercise might hear a variety of grinding, grating and popping noises. These sounds might seem extremely loud to the person exercising, and that person might worry that others can hear them. This is normal, though, and as the joints are limbered, warmed and bathed in synovial fluid, the noises and sensations will go away.

This is actually not a painful condition. The usual stiffness that accompanies arthritis and periods of inactivity should be expected, but there should not be pain associated with the “snap, crackle and pop.”

Mobility exercises in sets of three to five that end in a slight two to three second stretch for each movement are especially beneficial. Two examples include:

1. Arm Raises for Shoulder Range of Motion - To do this exercise, stand with arms hanging at the sides of the body. Raise both arms out to the side and then up towards the ears. As the arms reach parallel with the floor, the palms should be turned towards the ceiling and end up facing each other as they are raised above the head. Arms should be mostly straight, but do not lock the elbows (just keep them slightly bent). Hold arms in the “up position” gently pushing upwards for a couple of seconds. Lower arms and repeat. Remember to use only slow and controlled movements. Think “fluid,” not “jerky.”

2. Standing Hip Extension for Hip Range of Motion - Stand near a wall or other object for balance. While keeping the back straight, bend both knees slightly while keeping them loose and unlocked. Keep one foot in place and pick up the other foot while pressing the leg back behind as far as comfortably possible. Hold for a couple of seconds and repeat. Other examples of mobility or range of motion exercises are elbow curls, side waist bends, wrist circles, finger curls, head turns and tilts, shoulder blade pulls, and ankle circles. If there is a movable joint, move it smoothly and gently through its range of motion to lubricate and warm it.

Stretching

Stretching refers to the process of elongating the muscles. It prevents injuries, keeps muscles relaxed and the body flexible, makes daily activities easier to perform, improves posture and reduces muscle soreness after workouts. When performing stretches, concentrate on muscles that are most frequently used in both normal activities and during training. Don’t leave out any major muscle group.

The basics of stretching include the following:

􀂇 Hold each stretch for 10 to 30 seconds.
􀂇 Rest about 15 seconds before stretching the same muscle again.
􀂇 When the muscle loosens or “releases,” slowly stretch a little further.
􀂇 Stretch only to the point of mild tension, not pain.
􀂇 Stretch slowly and smoothly - don’t bounce.

Inhale through the nose deeply before each stretch and exhale through the mouth while moving into a stretch. Continue breathing while holding the stretch. Make sure your clients do not hold their breath!

It is useful to do mobilization exercises as part of the warm up before strength, endurance or flexibility sessions. You could spend a couple of minutes on range of motion exercises to loosen joints about to be used, five minutes on light aerobics like walking in place or stationary biking and then a short time on a standing stretch sequence for the main muscle groups like the calf stretch, hamstring stretch, quadriceps stretch, chest stretch and upper back stretch. The true flexibility work should only take place once the muscles are warm. This could be after the initial warm up or after other exercises.

Stay tuned for Part 2, where we'll cover updated endurance training and strength training guidelines for older adults!

References:

1. American College of Sports Medicine Position Stand. The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Med. Sci. Sports Exerc 30:975–991,1998.
2. Haskell W. L., I. M. Lee, R. R. Pate K. E. Powell, S. N. Blair, B. A. Franklin, C. A.Macera, G. W. Heath, P. D. Thompson, and A. Bauman. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39:1423 1434, 2007.
3. Petersen TJ. SrFit: The Personal Trainer’s Resource for Senior Fitness. The American Academy of Health and Fitness, 2004.
4. Tammy Peterson

By, Natalie Pyles

Fitness & Nutrition Expert, Author, Speaker