Despite overwhelming benefits, physical activity remains underutilized in clinical care for older adults.

Study: Move more, age well: prescribing physical activity for older adults. Image Credit: NDAB Creativity / Shutterstock.com

A recent study published in the Canadian Medical Association Journal explores the health benefits of physical activity in the elderly.

How does physical activity reduce mortality?

In 2025, about 20% of Canadians will be 65 years old or older, with the number of older people over the age of 85 years predicted to increase three-fold by 2045. Although life expectancy rates have significantly increased over the past several decades, about 66% of older adults in Canada live with two or more chronic conditions, thereby reducing the quality of life of these older individuals.

Thirty minutes of moderately vigorous physical activity for at least five days every week reduces the risk of death from any cause by 31%, with these health benefits increasing with greater durations of physical activity. Alternatively, lower levels of physical activity are associated with poorer health outcomes, with one hour or 30-60 minutes of resistance exercise every week reducing an individual’s mortality risk by 27% and 10-20%, respectively.

Cardiorespiratory fitness and peak exercise capacity are associated with reduced mortality among individuals 60 years of age and older. In fact, peak exercise capacity reflects cardiovascular risk more accurately than traditional risk factors like hypertension, smoking, and diabetes mellitus.

Peak oxygen consumption (VO2) is a strong indicator of mortality. Improvements in VO2 have been observed in older people who complete 90 minutes of moderate exercise every week for 16-20 weeks. Improved hand grip strength, a common endpoint of strength assessments, is also associated with lower mortality from any cause among older adults. 

Physical activity and healthy aging

Physical activity promotes functional independence, as older individuals who are physically fit can more easily perform activities of daily living (ADL). Physical activity has also been shown to improve cognitive function, social identity, and quality of life.

Physical activity, including strength training, supports muscle strength and mobility, while also preventing frailty. Thus, current recommendations advise all older individuals to maintain regular physical activity, even frail people or those at risk for falls, as it promotes bone and muscle strength, coordination, and balance.

Pilates and other core strength exercises are low impact, adaptable for both individual or group settings, and require minimal space or specialized equipment. These workouts enhance balance, strength, flexibility, and overall function, thereby reducing the risk of falls in older individuals.

Physical activity can also prevent and alleviate osteoarthritis-associated changes and symptoms, which affect 20% of Canadians, particularly those 65 years of age and older. A multicomponent regime including aerobic, weight training, and whole-body vibration may even prevent osteopenia, along with a healthy diet and medication as necessary.

One in three older Americans reports a fall every year; however, existing evidence suggests that the risk of falls could be reduced by 21% with long-term exercise programs. Older adults with neurologic or cardiometabolic disease, including Alzheimer’s disease (AD), could benefit from the postural stability imparted by physical activity; however, additional studies are needed to confirm this association.

Patients who are at an increased risk of falls should have individualized and gradually progressive exercise schedules. Although brisk walking may not be recommended for these patients, high-intensity interval training with necessary precautions is considered safe and well-tolerated.

Cognitive benefits

Physical activity improves the hormonal composition and vascularity of the brain and reduces inflammatory cytokines. As a result, physical activity improves cognitive function, may reverse the progression from mild to severe dementia, and prevents the development of mild cognitive impairment.

With nearly 600,000 Canadians suffering from dementia in 2020, the role of physical activity in protecting brain health should be recognized and utilized.

Reduction in chronic illness

According to the World Health Organization (WHO), 150-300 minutes of moderate-to-vigorous physical activity every week that is accompanied by resistance exercises twice a week and exercises to improve balance three times a week is crucial.

Physical activity has been shown to prevent heart failure, coronary artery disease, chronic obstructive pulmonary disease, and osteoporosis. Furthermore, physical activity can mitigate the severity of existing illnesses by improving functional independence and reducing the number of medications or treatments needed.

Despite these advantages, physical activity is not typically prescribed to patients. In fact, current estimates indicate that over 80% of adults are not adequately physically active based on the Canadian Physical Activity Guidelines.

Higher quality of life

Physical activity and exercise groups can prevent loneliness and may promote endorphin release, thereby improving mood and overall mental health in older adults. In long-term care institutions, physical activity has positive effects on depression, anxiety, and self-esteem.

Older adults who regularly exercise have a better quality of life, even if they have AD or suffer from depression. Increased time spent outdoors during forms of exercise like walking or swimming further increases the positive effects of physical activity on mood and anxiety.

Promoting physical activity among older adults

The WHO has published a five-step framework to promote PA called the “5As.” This framework involves assessing physical activity status, as well as risks and contraindications, provides advice on how much physical activity of what type should be done and how to reduce sedentary behavior, assists with support strategies, determines appropriate goals for each individual, and arranges follow-up visits.

Home-based or group exercise programs may be selected and customized based on the patient’s p. Talking about the importance of physical activity with people of the same age encourages older adults to begin and maintain physical activity over longer durations more effectively than doing it on their own.  

The underutilization of physical activity

In the absence of guidance from clinicians, additional research is needed to assess the relative efficacy of follow-up tools such as incorporating PA into vital signs assessment over time or eHealth tools. To avoid injuring patients or worsening chronic conditions, screening tools like the Physical Activity Readiness Questionnaire may be used, followed by physician evaluations.

Age, frailty, or existing functional impairments should not be viewed as absolute contraindications to physical activity but rather key reasons to prescribe it.”