Promoting and Prescribing Exercise for the Elderly -- American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 419 Benefits of Exercise As is the case in younger adults, regular exercise has been shown to provide a myriad of benefits in older adults (Table 1). Improvements in cardiovascular, metabolic, endocrine, and psychologic health are well documented. Cardiovascular fitness, although not directly correlated with health benefits, is a determinant of functional independence. Up to one third of the age-related decline in aerobic capacity (V̊O2 max) can be reversed with prolonged (six months or more) aerobic training. Regular exercise and/or increased aerobic fitness are associated with a decrease in allcause mortality and morbidity in middleaged and older adults. Subgroup analysis of the Harvard Alumni study found that modest increases in life expectancy were possible even in those patients who did not begin regular exercise until age 75. Mortality rates were also lower in those patients who did not begin regular exercise until late in life compared with patients who were active only in younger years and then subsequently stopped exercising. Thus, it is never too late for patients to benefit from physical activity. R egular exercise has been shown to decrease mortality and agerelated morbidity in older adults. Despite this, up to three fourths of the older adult population do not currently exercise at recommended levels. The relative risk (RR) for cardiovascular disease caused by sedentary living has been estimated to be 1.9, compared with other modifiable risk factors such as hypertension (RR = 2.1) and cigarette smoking (RR = 2.5), but it occurs at a much higher prevalence. Fewer than 10 percent of women over age 75 smoke cigarettes while greater than 70 percent are insufficiently active. By the year 2030, 22 percent of the U.S. population will be older than 65 years, a total of 70 million people. The fastest growing segment of the elderly population is the group older than 85 years, classified as “old old.” Because activity levels generally decline with advancing age, the absolute number of inactive older Americans will most likely increase dramatically. As the population of older adults increases, it will become vitally important for family physicians to counsel sedentary patients to become physically active. Regular exercise provides a myriad of health benefits in older adults, including improvements in blood pressure, diabetes, lipid profile, osteoarthritis, osteoporosis, and neurocognitive function. Regular physical activity is also associated with decreased mortality and age-related morbidity in older adults. Despite this, up to 75 percent of older Americans are insufficiently active to achieve these health benefits. Few contraindications to exercise exist, and almost all older persons can benefit from additional physical activity. The exercise prescription consists of three components: aerobic exercise, strength training, and balance and flexibility. Physicians play a key role in motivating older patients and advising them regarding their physical limitations and/or comorbidities. Motivating patients to begin exercise is best achieved by focusing on individual patient goals, concerns, and barriers to exercise. Strategies include the “stages of change” model, individualized behavioral therapy, and an active lifestyle. To increase long-term compliance, the exercise prescription should be straightforward, fun, and geared toward a patient’s individual health needs, beliefs, and goals. (Am Fam Physician 2002;65:419-26,427-8. Copyright© 2002 American Academy of Family Physicians.) Promoting and Prescribing Exercise for the Elderly