The American College of Sports Medicine, in conjunction with the American Heart Association, recently released their Position Stand on "Exercise and Physical Activity for Older Adults" in the July 2009 issue of Medicine & Science in Sports & Exercise.  This updated version has been expanded to include evidence compiled since 1998 (when the last Position Stand was published) supporting the role of exercise in older adults with chronic diseases and functional limitations, a population in which the safety of exercise was once questioned.  In addition, it addresses the positive impact exercise has on psychological health and well-being and cognitive functioning in older adults.

     These new guidelines were developed for adults 65 years and older.  However, the recommendations are relevant for those individuals between the ages of 50-64 years who have clinically apparent chronic health conditions or who have functional restrictions that limit physical activity, fitness, and mobility.  In general, these new recommendations are consistent with the recently released 2008 Physical Activity Guidelines for Americans by the Department of Health and Human Services.*

  Based on a growing body of knowledge, the ACSM and the AHA have made the following conclusions regarding the effects of exercise and physical activity on the older adult population:**

• Inactivity should be avoided.  Some exercise is better than none.  Health benefits are gained with any amount of physical activity; although, health gains are greater as the frequency, duration and/or intensity of exercise and physical activity increases.
• If chronic health conditions are present, physical activities should be performed as abilities and health status allow.
• Physical fitness can be improved through an accumulation of physical activity and participation in exercise.
• Advancing age is associated with an increased relative risk for developing and dying from cardiovascular disease, certain cancers, obesity, and type 2 diabetes.  It is also associated with a greater incidence of osteoporosis, muscle tissue loss (sarcopenia), and arthritis.  However, engaging in regular physical activity greatly reduces these risks.  In addition, exercise can be used to treat these diseases.
• Independent of cardiovascular fitness, muscular strength and power are indicators of all-cause and cardiovascular mortality.
• Average life expectancy is increased by participation in regular physical activity which maintains functional capacity and reduces risk of chronic diseases.
• Middle-aged and apparently healthy older adults can initiate aerobic and resistance training exercise and experience a qualitatively similar physiological response to that of younger adults.  In fact, the body's ability to adapt to such physical activities is well preserved into the 70's.  Therefore, age-related declines in functional capacity should not prevent an individual from participating in these exercises.
• Older adults may take longer to reach the same level of physiological improvements than their younger counterparts.
• Older adults do not tolerate exercise in temperature extremes as well as younger adults.
• Compared to their sedentary peers, athletic older adults who engage in vigorous-intensity aerobic exercise have a more desirable body composition (greater bone mineral density, larger relative muscle mass, and less abdominal and total body fat), lower blood pressure, better cholesterol profile, and can sustain exercise longer for a given workload (i.e. experience less cardiac stress and muscular fatigue).
• Compared to their sedentary peers, older adults who engage in regular resistance training activities are approximately 30-50% stronger, have a greater muscle mass, and tend to be leaner.  Furthermore, compared to older adults who engage in aerobic training alone, those who participate in resistance training exercises have greater bone mineral densities and increased muscular strength and power.
• Participation in moderate- to high-intensity resistance training increases lean body tissue and decreases fat mass.  In addition, high-intensity resistance training has been shown to be an effective treatment modality for clinical depression.
• Exercise programs that include aerobic, strength, flexibility, and balance activities reduce the risk of falls for older adults.
• Both fitness level and participation in aerobic exercise are associated with a lower incidence of clinical depression and anxiety and a reduced risk for cognitive decline and dementia.

The ACSM and the AHA recommend the following in their recent Position Stand:

• Engage in regular moderate-intensity physical activity for at least 150-300 minutes per week or 75-150 minutes per week of vigorous-intensity exercise.
• Participate in moderate- to vigorous-intensity strength training exercises at least 2-3 days per week.  A regimen of eight to ten exercises of 8- 12 repetitions each that involve the major muscle groups of the body should be followed.
• Incorporate flexibility exercises into the exercise program on a least 2 days of the week.
• Perform balance exercises, especially for individuals who frequently fall or who have mobility limitations.

* For a summary of the national guidelines read my February 17, 2009 post "Exercise Recommendations: An Overview."  For more detailed information, visit www.health.gov.paguidelines.

** For the purposes of the Position Stand, physical activity is defined as body movement that results from contracting muscles and requires an increase in energy expenditure.  Raking the yard is an example of physical activity.   Exercise is defined as planned and structured participation in physical activity with the purpose to improve health/fitness.  An aerobic dance class is an example of exercise.

Note:  Before beginning an exercise program or increasing the intensity level of a current routine, a physician's approval should be obtained, especially for older adults and those at risk for or who currently have chronic health conditions.

Resources:

Medicine & Science in Sports & Exercise Vol. 41, No. 7, July 2009 "Position Stand; Exercise and Physical Activity for Older Adults," pp. 1510-1523; Wojtek J et al.