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PCPFS Research Digests

Physical Activity & Aging: Implications for Health &

Quality of Life in Older Persons

Introduction

America is aging rapidly. At the beginning of the twentieth century persons over

sixty five years of age constituted approximately four percent of the American

population, whereas they now represent more than 12 percent of all Americans.

By the year 2020 this group is expected to increase to nearly twenty percent of

the population (U.S. Census Bureau, 1990). When expressed in absolute

number, the statistics are equally impressive, in the United States today there

are currently approximately 36 million people over the age of 65. This number

is expected to almost double to 70 million by the year 2030 (Geographic Profile,

1993). Even more remarkable is the increase in the number of the very oldest

members of our society. The "old-old", that is, individuals over the age of 85

years, constitute the most rapidly growing segment of society (Shephard, 1997).

By the year 2030, it is anticipated that over eight million Americans will be 85

years of age or older (Fowles, 1991).

There can be little doubt that such a dramatic increase in the number of older

adults will have far reaching implications for society. Advancing age is associated

with predictable sensory, motor, and cognitive changes, many of which have the

potential to impact on an older person's ability to function effectively in society

(Chodzko-Zajko, 1996). Fortunately, although functional decline is an inevitable

consequence of old age, aging does not occur at a similar rate in all individuals.

In recent years, researchers have focused considerable attention on increasing

our understanding of the factors responsible for the individual differences in the

rate and extent at which we age. It is well established that hereditary factors

play an important role in determining the pattern of changes observed in

senescence (our later years of life). However, in addition to the genetic factors

influencing human aging, many aspects of the aging process are also sensitive

to modification through environmental factors. Among the environmental factors

known to influence human aging are lifestyle interventions, such as, healthy

nutrition, stress reduction, smoking cessation, and regular physical activity

(Bokovy and Blair, 1994). This review summarizes what is known about the

influence of one of these lifestyle factors: regular physical activity.

The Benefits of Regular Physical Activity:

In this section, a brief overview of some of the physiological, psychological, and

social benefits of regular exercise is presented. Whenever possible an attempt is

made to address both the acute ffects of a single bout of physical activity, as

well as the more persistent and long term effects of sustained participation in

exercise and physical activity. Because physical activity has been defined in
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many different ways, in this section, the World Health Organization's broad and

inclusive definition of physical activity which includes all movements in everyday

life, including work, recreation, exercise, and sporting activities (WHO, 1997) is

used.

Physiological Benefits of Physical Activity:

Participation in regular physical activity is associated with a number of

physiological benefits (see Table 1).

Cardiovascular Function:

Maximal oxygen consumption (VO2max) during exercise is often considered to

be the single best measure of cardiovascular fitness (McArdle, Katch & Katch,

1994). It was initially thought that VO2max declines at a constant rate with

advancing age (about 10% per decade). However, a number of recent studies

have suggested that age-related changes in VO2max may be more variable than

initially thought (Heath et al., 1981; Rogers et al., 1990). For example, highly

trained individuals who maintain high activity levels, often experience little or no

decline in VO2max over time periods of a decade or more (Kasch, Wallace &

VanCamp, 1985; Pollock et al., 1987). It is not possible to postpone age-related

declines in aerobic capacity forever. Nonetheless, there is increasingly strong

evidence to suggest even modest levels of physical activity can result in

significant increases in cardiovascular efficiency in old age.

Blood Pressure:

Hypertension is a serious medical problem which afflicts more than 20 million

older Americans (Kannel and Vokonas, 1986). On average, both systolic and

diastolic blood pressure increase significantly with advancing age (Shephard,

1997). Several exercise training studies have shown that physical activity can

reduce systolic and diastolic blood pressure in patients with borderline

hypertension (Goldberg & Hagberg, 1990; Kasch et al., 1988). For example,

Hagberg et al., (1985) found that a six month program of low-intensity walking

significantly lowered both systolic and diastolic blood pressure in hypertensive

adults ranging in age from 60-65 years. These data suggest that exercise may

have similar anti-hypertensive effects in older individuals as those previously

reported in younger populations.

Blood Lipids:

Aging is associated with increases in both total cholesterol and serum

triglycerides (Shepherd, 1997). Hypercholesterolemia and hyperlipidemia are

major medical problems which lead to the premature development of coronary

artery disease (Castelli et al., 1977). It is now well known that exercise training

is associated with a reduction of coronary heart disease risk. Indeed the

American Heart Association (AHA) has recognized that sedentary living is an

independent risk factor for the development of atherosclerosis (Fletcher et al.,

1992). A number of studies have shown that highly trained masters athletes

exhibit favorable biochemical profiles (reduced low density lipoprotein

cholesterol, elevated high density lipoprotein cholesterol) when compared with

sedentary individuals of the same chronological age (Seals et al., 1984; Tamai,

et al., 1988). Because almost all instances of favorable improvements in

biochemical profiles are associated with coincident decreases in body weight, it

is frequently difficult to dissociate the effects of exercise from the effects of

weight loss (Shephard, 1997). These problems notwithstanding, there appears

to be sufficient evidence to suggest that regular exercise is associated with a

decrease in body fat which, in turn, is associated with a decrease in circulating

lipids. However, the effect of exercise on blood lipids appears to be transient

and blood lipids return to pre-exercise values within a few days of cessation of

physical activity.
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Table 1

A SUMMARY OF THE PHYSIOLOGICAL BENEFITS OF PHYSICAL ACTIVITY

FOR OLDER PERSONS

World Health Organization, 1997

Immediate Benefits:

Glucose levels: Physical activity helps regulate blood glucose

levels.

Catecholamine activity: Both adrenalin and noradrenaline levels

are stimulated by physical activity.

Improved sleep: Physical activity has been shown to enhance

sleep quality and quantity in individuals of all ages.

Long Term Effects:

Aerobic/Cardiovascular Endurance: Substantial improvements in

almost all aspects of cardiovascular functioning have been

observed following appropriate physical training.

Resistive training/muscle strengthening: Individuals of all ages can

benefit from muscle strengthening exercises. Resistance training

can have a significant impact on the maintenance of independence

in old age.

Flexibility: Exercise which stimulates movement throughout the

range of motion assists in the preservation and restoration of

flexibility.

Balance/Coordination: Regular activity helps prevent and/or

postpone the age associated declines in balance and coordination

that are a major risk factor for falls.

Velocity of movement: Behavioral slowing is a characteristic of

advancing age. Individuals who are regularly active can often

postpone these age-related declines.

The WHO Guidelines have been placed in the public domain and can be

freely copied and distributed. (WHO, 1997)

Muscle Strength and Endurance:

Muscle strength and endurance decline significantly with advancing age

(Tzankoff & Norris, 1978; Lexell et al., 1983). Until fairly recently, strength

training was seldom emphasized as a component of exercise programs designed

for older adults. The lifting of heavy weights requires maximal or near maximal

muscular contractions which, if incorrectly performed, can result in sharp

increases in blood pressure due to a physiological mechanism known as the

valsalva maneuver. Since these acute elevations in blood pressure are

potentially dangerous for hypertensive individuals, in the past, most professional

organizations have chosen to de-emphasize the importance of strength training

for older adults. Recently, however, a number of studies have examined the

effect of dynamic strength training in elderly adults. In one such study, Frontera

et al., (1988) demonstrated that older adults who trained with weights for 12

weeks were able to gain appreciable increases in muscular strength and

endurance. No adverse consequences associated with weight training were

reported in this study. In another widely reported study, Fiaterone et al. (1990)

demonstrated that men and women as old as ninety years of age can safely lift

very heavy weights (80 percent of 1 repetition maximum). Remarkable gains in
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strength in excess of 100 percent were reported for some of the muscle groups

trained in this study.

Since the maintenance of adequate levels of muscular strength is critical for the

successful performance of many of the activities of daily living (Bassey, Bendall

& Pearson, 1988; Phillips & Haskell, 1995), exercise scientists have begun to

reevaluate the importance of strength training as a component of exercise

programs for elderly adults. Both the American College of Sports Medicine and

the Surgeon General' Report on Physical Activity and Health recommend that

muscle strengthening exercises be included as part of the exercise training

regimen for older adults (ACSM, 1995; US Surgeon General's Report, 1996).

Flexibility:

Aging is associated with changes in the elasticity and compliance of connective

tissue (Spirduso, 1995). This results in significant decreases in flexibility and

range of motion (Kuhlman, 1994; Nigg et al., 1992). Although declines in

flexibility and active range of motion are observed in most seniors, there is

some evidence to suggest that declines in these areas are, in part due to

decreased physical activity, and that not all older individuals lose flexibility at

the same rate (Campanelli, 1996; Morey et al., 1991). Stretching exercises

which emphasize range of motion and flexibility have been shown to increase

ankle, knee joint and lower back flexibility in older adults (Frekany & Leslie,

1975). The importance of pre-exercise stretching is reflected in the fact that

almost all structured exercise programs advocate the inclusion of calisthenic

exercises prior to the commencement of aerobic exercise (Spirduso, 1995).

Balance:

Postural stability and dynamic balance are effected by the integrity of the

vestibular, visual, and somatosensory systems, all of which undergo structural

and functional changes with advancing age (Woollacott & Schumway-Cook,

1996). Age-related declines in postural stability and dynamic balance are risk

factors for falls and fall-related injuries in older adult populations (Lord et al.,

1994: Tinetti, Doucette, & Claus, 1995). Although falling occurs due to a

complex combination of factors including medication use, cognitive status,

environmental hazards, sensory decline, and decreased muscle strength and

coordination, there is some evidence to suggest that improving postural stability

reduces the likelihood of falling (MacRae, Feltner & Reisch, 1994; Tinetti et al.,

1994). Improvements in balance and body sway have been reported following

participation in a general exercise program emphasizing walking, flexibility, and

strength exercises (Lord & Castell, 1994), as well as in response to specialized

balance training (Wolfson et al., 1996; Ian, 1998).

Psychological Benefits of Physical Activity:

In addition to its effects on physiological variables, physical activity can also have significant

psychological consequences. A summary of the long and short term benefits of physical activity for

psychological functioning is included in Table 2.

General Psychological Well-being:

Although psychological health consists of both positive and negative components, until recently,

research in the exercise sciences has tended to focus on the effects of physical activity on negative

components of psychological health, such as, depression, anxiety, and other stress-related disorders.

McAuley and his colleagues (McAuley, 1994; McAuley and Rudolph, 1995) have argued that it is

important to also examine the relation between physical activity and more positive elements of

psychological functioning, including self-esteem, self-efficacy, and general well-being. In a review of 38

studies which have examined the relation between regular physical activity and general psychological

well-being in older adult populations, McAuley and Rudolph (1995) found that the vast majority of

studies report a positive a ssociation between physical activity and well-being. This relationship appears

to be independent of the mode of exercise employed (Mihalko & McAuley, 1996), however, the strength

of the association is greatest in programs of more than ten weeks in duration.

Depression and Anxiety:

It is generally accepted that the incidence of depression increases significantly

with age (LaRue, Dessonville & Jarvik, 1985). When statistical procedures are
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used to control for differences in fitness between individuals, the association

between advancing age and depression is substantially reduced (Chodzko-Zajko,

1990). Accordingly, data which suggest that depression increases with age may

be, at least partially, due to the tendency for physical activity levels to decline

with age and not simply due to the passage of time. With respect to the effect

of exercise training on depression, a number of authors have shown that

participation in regular exercise reduces depression in patients with mild to

moderate levels of clinical depression (Greist et al., 1979, Martinsen, Medhus &

Sandvik, 1985). Similarly, studies with non-clinical populations have also

reported beneficial effects of exercise on mood state and anxiety (Morgan &

O'Connor, 1987). Despite the presence of an association between physical

activity and depression, it has yet to be demonstrated conclusively that exercise

plays a causal role in the reduction of depression (O'Connor, Aenchbacher, &

Dishman, 1995).

Cognitive Functioning:

Age-related decrements in cognitive performance are now well established.

However, cognition is not a unitary phenomenon and there are wide variations

between cognitive tasks with respect to the magnitude of changes observed with

advancing age. Age-related changes in cognitive performance appear to be

maximized for tasks which require rapid and complex processing, and are

minimized for tasks which are more automatic or which can be performed at a

self-paced rate (Chodzko-Zajko & Moore, 1994).

Despite the presence of a cross-sectional association between fitness and

cognitive performance, no clear picture has emerged with respect to the effect

of exercise on cognitive performance. Several well controlled studies have

successfully demonstrated improvement in cognitive performance following

training (Dustman et al., 1984; Hawkins, Kramer & Capaldi; 1992; Moul,

Goldman & Warren, 1995). However, at least as many studies have not been

able to replicate these findings (Blumenthal et al., 1989; 1991; Panton et al.,

1990). There is some reason to believe that the magnitude of the improvement

in aerobic capacity, as well as the demand-level of the cognitive task may be

important factors in determining the presence or absence of training effects.

However, it is important to point out that when changes in cognitive

performance have been observed following exercise training, the magnitude of

these changes has always been small.

Table 2

A SUMMARY OF THE PSYCHOLOGICAL

BENEFITS OF PHYSICAL ACTIVITY FOR OLDER PERSONS

World Health Organization,

1997 Immediate Benefits:

Relaxation: Appropriate physical activity enhances relaxation.

Reduces Stress and Anxiety: There is evidence that regular

physical activity can reduce stress and anxiety.

Enhanced Mood State: Numerous people report elevations in mood

state following appropriate physical activity.

Long Term effects:

General Well Being: Improvements in almost all aspects of

psychological functioning have been observed following periods of

extended physical activity.

Improved Mental Health: Regular exercise can make an important

contribution in the treatment of several mental illnesses, including
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depression and anxiety neuroses.

Cognitive Improvements: Regular physical activity may help

postpone age related declines in Central Nervous System

processing speed and improve reaction time.

Motor Control and Performance: Regular activity helps prevent

and/or postpone the age associated declines in both fine and

gross motor performance.

Skill Acquisition: New skills can be learned and existing skills

refined by all individuals regardless of age.

The WHO Guidelines have been placed in the public domain and can be

freely copied and distributed, (WHO, 1997)

Social Implications of Regular Physical Activity:

The vast majority of research studies examining the effects of exercise on the

aging process have focused on the physiological and psychological benefits of

activity. However, it would be inappropriate to conclude this section without a

brief comment about the importance of physical activity for the social

functioning of older people. In recent World Health Organization Guidelines for

Promoting Physical Activity in Older Persons (WHO, 1997) a number of

significant short and long-term effects of physical activity on socio-cultural

variables are discussed (see Table 3)

Who should be Physically Active?

Until fairly recently physical activity programming for older adults has tended to

focus on a relatively small and healthy subgroup of the older adult population

(Chodzko-Zajko, 1995). However, it is now clear that beneficial effects of regular

physical activity can be observed in almost all older persons regardless of their

physical health. Several excellent and well publicized studies have focused our

attention on the benefits of regular physical activity in those cohorts of seniors

who were previously thought to be "too old" or "too frail" to partake in

structured exercise programming (Fiatarone & Evans, 1990).

Physical Activity Programs for Older Adults:

It is not possible to formulate generic exercise prescriptions which can be

applied across the board for all older adults. Individual differences in health

status, physical fitness and previous exercise experience require that exercise

prescription be tailored to meet the specific needs of each person. Older adults

should be encouraged to seek advice from a health or exercise professional, who

can assist them in the preparation of an optimal program designed to meet their

individual needs. It is recommended that previously sedentary individuals over

the age of 40 years should obtain a thorough medical examination before

embarking on an exercise program (ACSM 1995). In cases where a physician's

examination is not possible, pre-exercise screening questionnaires have been

developed which can assist in identifying contraindications to exercise (Cardinal

and Cardinal, 1995).

In the past, a large percentage of the elderly population has remained sedentary

due to the mistaken belief that they were not candidates for participation in

regular physical activity. While there is an extremely small number of individuals

for whom exercise is medically contraindicated, the vast majority of the elderly

populations can benefit from participation in some form of physical activity

(WHO, 1997). The major absolute contraindications to exercise training are

recent ECG changes or myocardial infarction, unstable angina, uncontrolled

arrhythmias, third degree heart block, and congestive heart failure (ACSM,
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1995). The emergence of specialized programs for specific clinical populations,

such as, cardiac rehabilitation programs, the Arthritis Foundation's PACE

program and programs for diabetics, are a testament to the realization that the

benefits of physical activity apply across the continuum of health levels and

exercise need not be restricted to "jocks" and exercise fanatics.

The WHO Guidelines for Promoting Physical Activity acknowledge the wide

diversity of different exercise regimens which can be followed by older adults.

Exercise can be an individual or group activity, it can be carried out in

supervised or unsupervised settings. It is not necessary to have expensive

facilities and equipment, and that successful programs are quite possible with

very limited resources (WHO, 1997). While recognizing the importance of

individualized exercise prescription, it is nonetheless possible to make some

comments about general principles of exercise prescription which may be of

value when designing exercise programs for older adults.

Table 3

A SUMMARY OF THE SOCIAL

BENEFITS OF PHYSICAL ACTIIVTY FOR OLDER PERSONS

World Health Organization, 1997

Immediate Benefits:

Empowering Older Individuals: A large proportion of the older

adult population voluntarily adopts a sedentary lifestyle which

eventually threatens to reduce independence and self-sufficiency.

Participation in appropriate physical activity can help empower

older individuals and assist them in playing a more active role in

society.

Enhanced Social and Cultural Integration: Physical activity

programs, particularly when carried out in small groups and/or in

social environments enhance social and inter-cultural interactions

for many older adults.

Long Term Effects:

Enhanced Integration: Regularly active individuals are less likely

to withdraw from society and more likely to actively contribute to

the social milieu.

Formation of new friendships: Participation in physical activity,

particularly in small groups and other social environments,

stimulates new friendships and acquaintances.

Widened Social and Cultural Networks: Physical activity frequently

provides individuals with an opportunity to widen available social

networks.

Role maintenance and new role acquisition: A physically active

lifestyle helps foster the stimulating environment necessary for

maintaining an active role in society, as well as for acquiring

positive new roles.

Enhanced Intergenerational Activity: In many societies, physical

activity is a shared activity which provides opportunities for

intergenerational contact thereby diminishing stereotypic

perceptions about aging and the elderly.

The WHO Guidelines have been placed in the public domain and can be

freely copied and distributed. (WHO, 1997)
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Activity Mode:

Low and moderate intensity, rhythmic activities which utilize large muscle groups

are optimal for the enhancement of aerobic capacity. Common examples of such

activities are walking, jogging, bicycling, and swimming. The particular activity

selected by an individual is often a matter of personal preference. However,

among many older persons, orthopedic and/or other medical factors may restrict

the number of available options. In addition to these exercises, an increasing

number of older adults participate in other activities, such as, various forms of

dancing and weight training. While these activities may not be appropriate for all

older individuals, there is little doubt that many people can obtain significant

physiological benefits and much enjoyment from these forms of activity (ACSM,

1995).

Training Frequency:

In order to obtain a reliable training effect, it is generally recognized that a

frequency of training two to three times per week is required. However, habitual

exercisers often exercise five or six days per week without adverse

consequences (ACSM, 1995). It is important to note that many of the

physiological, psychological and social benefits of physical activity require regular

and continuous participation and can be rapidly reversed by a return to

inactivity.

Duration of Exercise:

Most structured exercise programs are designed to last about 45 minutes - 1

hour. This time period is typically divided up into 15-20 minutes of warm up and

stretching, 20-30 minutes of aerobic activity and 5-10 minutes of cool down.

While this format is flexible, there is some evidence to suggest that the aerobic

component of exercise programs should last at least 20 minutes in order to

obtain optimal cardiovascular benefits (Spirduso, 1995). For many sedentary and

frail individuals, continuous activity for 45-60 minutes may be an unrealistic

goal, at least at the onset of an exercise program. For these individuals more

modest exercise targets should be set. As these individuals slowly become

accustomed to renewed physical activity, exercise prescriptions can be adjusted

accordingly.

Intensity of Exercise:

It is a popular misconception that high intensity exercise is required for

significant physiological gain. The saying "no pain, no gain" is simply not true.

Such misconceptions perpetuate inappropriate attitudes about exercise and

result in large numbers of individuals avoiding potentially beneficial and

enjoyable behaviors. Many older adults first learned to exercise at a time when

high intensity exercise was widely considered to be more effective than more

modest levels of activity. In recent years there has been extensive debate

regarding the utility of traditional exercise prescriptions when applied to the

sedentary population (Blair, 1994). Rather than adopt an absolutist stance

regarding the minimum frequency, duration, and intensity of exercise necessary

to achieve a training effect, it may be more prudent to encourage individuals to

simply increase or maintain their activity levels without setting rigid (and

frequently intimidating) exercise prescriptions.

Conclusions And Recommendations:

The scientific and medical evidence reviewed above clearly demonstrates that

participation in regular physical activity is associated with tangible health

benefits for almost all older adults.
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The disappointingly low rates of participation in physical activity among older

persons has led to considerable speculation with respect to why so many seniors

choose not to be active. Commonly cited reasons for the failure to engage in

regular physical activity include lack of time, money, or motivation (Lee, 1993).

Additionally, the lack of safe, accessible facilities that are nearby and convenient

to attend are often mentioned as perceived barriers to physical activity (Lee,

1993). There are also other reasons that pertain more specifically to older

adults. These include societal stereotypes about aging and activity and the lack

of social support for physical activity (Duncan & McAuley, 1993). A number of

researchers have suggested that society holds certain attitudes about what is or

is not appropriate behavior for particular age groups (Lee, 1993; Ostrow, Jones,

& Spiker, 1981). For example, the disengagement theory of aging suggests that

society encourages older adults to slow down and take it easy and, thus, acts to

discourage participation in physical activity (McPherson, 1990). Others have

suggested that older women, in particular, often lack meaningful role models

who are physically active (O'Brien & Vertinsky, 1991).

Although it is beyond the scope of this paper to propose specific strategies for

increasing the physical activity levels of the older adult population, there can be

little doubt that considerable additional efforts are needed. Within the area of

education, there is a need to increase awareness of the role of physical activity

in healthy aging throughout all segments of society. In most countries,

physicians are presently inadequately prepared to advise their older patients in

the area of exercise and physical activity. Medical school curricula pay

insufficient attention to the importance of preventive medicine in general, and

almost no attention to specific issues such as exercise prescription and

evaluation. Similarly, few allied health professions have developed

comprehensive curricula focusing on the special activity needs of older persons.

For example, within exercise science and physical education, almost all

universities offer specialist degrees and concentrations in childhood physical

education, in contrast, very few offer courses in physical activity and aging

(Jones & Rikli, 1994).

In addition to educating health professionals, it is also important to disseminate

information to health policy makers in both the public and private sectors.

Elected representatives at all levels of government should be informed about the

many benefits associated with promoting physical activity. Leaders of the health

insurance industry must be educated about the cost effectiveness of

preventative exercise interventions (Shephard, 1997). Unless we are able to

successfully disseminate information to this segment of our society, it is doubtful

that we will be able to develop a truly cooperative and comprehensive strategy

forsuccessful aging.

Finally, but most importantly, we must not forget that the most important

people in the education process are the older people themselves. A large

number of senior citizens remain unaware of the health benefits of physical

activity. Many older adults continue to believe that physical activity is only for

the physically fit and elite seniors. On the contrary, there is now strong

evidence that virtually all older adults, even the sedentary and physically frail

are candidates for some form of physical activity. Extensive efforts are needed

to spread the word about physical activity and successful aging to the

population at large.

Parts of this review have been adapted with permission from:

Chodzko-Zajko, W.J. (1998). The Physiology of Aging and Exercise, in R.T.

Cotton & C.Ekeroth (Eds). Exercise for Older Adults, Champaign, IL., Human

Kinetics

Published quarterly by the

President's Council on Wojtek J. Chodzko-Zajko, Ph.D.
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Physical Fitness and Sports

Washington, D.C.

School of Exercise, Leisure and

Sport Kent State University

Kent, OH 44242-0001

Co-edited by

Drs. Chuck Corbin and Bob

Pangrazi Arizona State University

The PCPFS Research Digest

is available on line at

http://www.indiana.edu/~preschal

Physical Activity and Fitness Quote

"Physiological responses of elderly adults to exercise training

are essentially similar to those experienced by younger

individuals. Some of the more common physiological adaptations

are improved cardiovascular function, an increase in muscular

strength and endurance, and lowered blood pressure."

Wojtek J. Chodzko-Zajko, Ph.D.

School of Exercise, Leisure, and Sport

Kent State University Kent, OH 44242-0001

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