These guidelines were
prepared by a scientific committee, submitted to the of participants at the 4th
International Congress meeting on Healthy Ageing, Activity and Sports, August 1996 in
Heidelberg, Germany, and finalized at WHO/AHE.
Target: older persons
Physically active lifestyles benefit
individuals throughout the life-span. These guidelines were however developed primarily
for promoting physical activity in the latter half of the life course. Although much of
their content equally applies to individuals in other age groups, the scientific committee
in charge of developing these guidelines selected those aged 50 years and above as the
most appropriate target.
Age 50 marks a point in middle age at which
the benefits of regular physical activity can be most relevant in avoiding, minimizing,
and/or reversing many of the physical, psychological, and social hazards which often
accompany advancing age. These beneficial effects apply to most individuals regardless of
health status and/or disease state.
Within these guidelines, physical activity
is operationally defined as all movements in everyday life, including work, activities of
daily living, recreation, exercise, and sporting activities. The proposed guidelines
recognize that the preventative and rehabilitative effects of regular physical activity
are optimized when physical activity patterns are adopted early in life, rather than when
initiated in old age.
The guidelines focus on the impact of
regular physical activity for both sexes. However, due to historical differences in the
prevalence of physically activity lifestyles between the sexes, as well as the greater
proportion of women in the older adult population, the scientific committee is careful to
emphasize that the guidelines are universal and apply equally to all. Similarly, it is
also clear that the guidelines must be sufficiently flexible to be of meaning to a wide
variety of social and cultural groups.
The aim is to provide guidelines for
facilitating the development of strategies and policies in both population and
community-based interventions aimed at maintaining and/or increasing the level of physical
activity for all older adults.
Evidence
"Appropriate physical activity can be
fun and is good for you!"
Most people who engage in recreational
physical activity do so because it is fun and enjoyable, however, there is ample evidence
to show that physical activity is associated with significant improvements in functional
ability and health status and may frequently prevent certain diseases or diminish their
severity. However, it is important to note that many of these benefits require regular and
continuous participation and can be rapidly reversed by a return to inactivity.
Scientific evidence
Regular physical activity:
enhances general wellbeing;
improves overall physical and psychological health;
helps to preserve independent living;
reduces the risk of developing certain non-communicable diseases (e.g. CHD, hypertension,
etc.);
helps in the control of specific conditions (e.g. stress, obesity) and diseases (e.g.
diabetes, hypercholesterolemia);
helps to minimize the consequences of certain disabilities and can help in the management
of painful conditions;
may help change stereotypic perspectives of old age.
The benefits of physical activity
Individual
Physiological:
1 - Immediate benefits:
glucose levels: physical activity helps
regulate blood glucose levels; catecholamine activity: both adrenalin and noradrenalin
levels are stimulated by physical activity;
improved sleep: physical activity has been shown to enhance sleep quality and quantity in
individuals of all ages;
2 - 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: behavioural slowing is a characteristic of advancing age.
individuals who are regularly active can often postpone these age-related declines;
Psychological:
1 - 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 improvement in mood state following
appropriate physical activity;
2 - Long-term effects:
general wellbeing: 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 depression and
anxiety neurosis;
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;
skills acquisition: new skills can be learned and existing skills refined by all
individuals regardless of age.
Social:
1 - Immediate benefits:
empowering older individuals: a large
proportion of the older adult population gradually 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 integration: physical activity programmes, particularly when carried out
in small groups and/or in social environments enhance social and intercultural
interactions for many older adults;
2 - 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
acquaintanceships;
widened social 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 environments 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.
For society
Physical inactivity and sedentary living
contribute to a decrease in independence and the onset of many chronic diseases.
Physically active lifestyles can help postpone the onset of physical frailty and disease
thereby significantly reducing health and social care costs.
Older individuals have much to contribute to
society. Physically active lifestyles help older adults maintain functional independence
and optimize the extent to which they are able to actively participate in society.
The third benefit is promoting a positive
and active image of older persons. A society which promotes a physically active lifestyle
for older adults is more likely to reap the benefits of the wealth of experience and
wisdom possessed by the older individuals in the community.
Who should be physically active?
"Physical Activity and Sports for
All"
Individuals of all ages can begin to enjoy
physical activity at any age and reap the benefits.
Regular physical activity has significant
physical, psychological, social and cultural benefits for individuals of all ages,
including those with specific limitations and disabilities.
There are individuals and groups with
special needs who may have particular requirements which will have to be met in order to
optimize the effectiveness of both acute and long-term physical activity (e.g. need for
special access, reduction of environmental obstacles, modified programs and equipment).
Implementation strategies, policies, and educational programmes must take into
consideration the exceptional needs and requirements of these populations.
Specific physical activity needs will vary
as a function of the individual`s position along a health-fitness gradient (see Fig. 1).
Fig. 1 Health
and fitness gradient |
|
Physically
fit |
Physically
unfit |
Physically
unfit frail |
Healthy
|
Group 3 |
|
|
Unhealthy
independent |
|
Group 2 |
|
Unhealthy
dependent |
|
|
Group 3 |
Group 1: physically fit -
healthy
These individuals regularly engage in
appropriate physical activity, they can be described as physically fit and can participate
in all activities of daily living.
Group 2: physically unfit - unhealthy
independent
These individuals are not engaged in
physical activity. While they are still living independently, they are beginning to
develop multiple chronic medical conditions which threaten their independence. Regular
physical activity can help improve functional capacity and prevent loss of independence.
Group 3: physically unfit - unhealthy
dependent
These individuals are no longer able to
function independently in society due to a variety of physical and/or psychological
reasons. Appropriate physical activity can significantly enhance the quality of life and
restore independence in some areas of functioning.
Promoting and facilitating increased
physical activity
There is a need to develop strategies which
will lead to increased levels of physical activity throughout all segments of the
population. Such a healthy public policy can only be achieved by influencing the
following.
Health policy
There is a need to stimulate greater
appreciation for the importance of regular physical activity among policy makers at all
levels of administration:
International
National
Regional
Local.
Educating, disseminating, and creating
conducive environments
There is also a need to involve a wide
variety of sectors in the dissemination of information on healthy aging and in supporting
favourable environments in the promotion of physical activity, such as:
family support;
peer support groups (e.g. national
councils on aging);
community and social service providers;
the media;
nongovernmental organizations (NGOs);
self-help groups;
health care providers in primary care
teams, hospitals, nursing homes;
health insurers;
universities;
adult education institutions;
rehabilitation and therapeutic centres;
residential facilities;
private and public sector organizations
(e.g. workplace);
sporting and social clubs.
Implementing physical activity
The setting
It is not necessary to have expensive
facilities and equipment. Physical activity can be effective in environments with limited
space and resources (e.g. home environments). The workplace can be an appropriate site for
providing physical activity programmes.
Safety issues
Medical advice may be desirable for some
individuals before beginning an activity programme. Appropriately training at all levels
(participants, trainers, programme planners and evaluators) is recommended. Safe
environments are important (e.g. ensuring adequate lighting, ramps), as is the reduction
of environmental obstacles.
The motivating factors
Motivating factors include:
physical activity can be fun;
companionship;
enhanced control over one`s own life;
lifelong activity (sport biography);
improved health status and wellbeing.
The barriers
The barriers include:
lack of information about physical
activity and aging: among the elderly, among family members, among primary care givers and
other health service providers, and in society;
stereotypic images of aging;
low social support;
inadequate environmental support for
physical activity (e.g. transportation, access, urban planning);
life history/biographic aspects, including
bad experiences with sports;
negative attitudes towards sports and
exercise;
imbalance of expected effort and perceived
gains;
social obstacles towards a healthy
lifestyle;
inappropriate social and cultural
settings;
certain medical conditions may require
modified activity programmes.
The types of physical activity
Many individuals have a physically active
lifestyle without necessarily participating in formal exercise programmes. Through usual
activities of daily living - such as working, shopping, cooking and cleaning etc., one can
maintain an adequate level of activity, even without a high degree of aerobic performance.
The first message to be given to individuals as they age is that they should be active in
their everyday life. However, in industrialized societies, lifestyles are often associated
with a level of physical activity below adequate levels.
Structured activity programmes provide ways
for individuals to promote a physically active lifestyle. The recommendations for these
programmes include the following.
Individual and/or group activity, need not
necessarily be performed in supervised settings.
There are benefits associated with various
types of physical activity including stretching, relaxation, calisthenics, aerobic
exercise, and strength training among others .
The focus should be on simple and moderate
forms of physical activity (e.g. walking, dancing, stair climbing, swimming, cycling,
chair exercises, etc.).
Important components to consider in an
exercise program include: aerobic exercise, muscular strength, flexibility, and balance.
Exercise must meet individual and group
needs and expectations.
Exercise should be relaxing and enjoyable.
Have fun!
Exercise should be regular, if possible
daily.
Research
Additional research for the promotion of
physical activity in older persons is required. This implies appropriate levels of
funding. Research of special interest include outcomes assessment, and evaluation of
interventions which reflect the different dimensions specified in these guidelines.
|
