These guidelines are relevant to all healthy adults aged 65 years and above. They are also relevant to individuals in this age range with chronic NCDs. Individuals with specific health conditions, such as cardiovascular disease and diabetes, may need to take extra precautions and seek medical advice before striving to achieve the recommended levels of physical activity for older adults.
These recommendations are applicable for all older adults irrespective of gender, race, ethnicity or income level. However, the communication strategies, dissemination and messaging of the recommendations may differ in various population groups in order to be most effective.
The recommendations can be applied to older adults with disabilities however they may need to be adjusted for each individual, based on their exercise capacity and specific health risks or limitations.
The review of the literature relating cardio respiratory fitness, muscular strength, metabolic health and bone health to the rationale for relation and dose response patterns was based on an evaluation from the CDC literature review (2008) the evidence reviews from Warburton et al (2007 and 2009), the review by Bauman et al (2005) and the systematic reviews by Paterson et al (2007 and 2009). (11, 13, 20, 21)
There is strong scientific evidence that regular physical activity produces major and extensive health benefits in both adults aged 18–64 and in older adults aged 65 and above. In some cases the evidence of health benefits is strongest in older adults because the outcomes related to inactivity are more common in older adults. This results in an increased ability of observational studies to detect the protective effect of physical activity in this age group. Overall, conclusive evidence shows that both moderate-intensity and vigorous-intensity activity provide similar health benefits in both adult age groups. (11, 13, 20, 21)
The overall evidence for adults aged 65 years and above demonstrates that, compared to less active individuals, men and women who are more active have lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, colon cancer, breast cancer, a higher level of cardiorespiratory and muscular fitness, healthier body mass and composition, and a biomarker profile that is more favourable for the prevention of cardiovascular disease, type 2 diabetes and the enhancement of bone health. (11, 13, 20, 21)
These benefits are observed in adults in the older age range, with or without existing NCDs. Hence inactive adults of the 65 years and above age group, including those with NCDs, are likely to gain health benefits by increasing their level of physical activity. If they cannot increase activity to levels required to meet guidelines, they should be active to the level their abilities and health conditions allow. Older adults who currently do not meet the recommendations for physical activity should aim to increase physical activity gradually, starting with increasing duration and frequency of moderate-intensity activity before considering increasing the intensity to vigorous-intensity activity. In addition, strong evidence indicates that being physically active is associated with higher levels of functional health, a lower risk of falling, and better cognitive function. There is observational evidence that mid-life and older adults who participate in regular physical activity have reduced risk of moderate and severe functional limitations and role limitations. In older adults with existing functional limitations, there is fairly consistent evidence that regular physical activity is safe and has a beneficial effect on functional ability. However, there is currently little or no experimental evidence in older adults with functional limitations that physical activity maintains role ability or prevents disability. The CDC literature Review (2008) and the systematic reviews by Paterson (2007) and Patterson and Warburton (2009) were used to develop the recommendation related to limited mobility due to health conditions. The dose-response pattern related to depression and cognitive decline were reviewed from the CDC Literature review (2008). (11, 20, 21)
In older adults with poor mobility, there is consistent evidence that regular physical activity is safe and reduces risk of falls by nearly 30%. For prevention of falls, most evidence supports a physical activity pattern of balance training and moderate-intensity muscle-strengthening activities three times per week. There is no evidence that planned physical activity reduces falls in adults and older adults who are not at risk of falls. Evidence specific for this age group related to the maintenance or improvement of balance for those at risk of falling was reviewed from the systematic reviews by Paterson (2007) and Patterson and Warburton (2009). (20, 21)
A more detailed reference of the literature used by the guidelines group to develop these recommendations can be found in Appendix 2.
In older adults of the 65 years and above age group, physical activity includes leisure time physical activity, transportation (e.g. walking or cycling), occupational (if the individual is still engaged in work), household chores, play, games, sports or planned exercise, in the context of daily, family and community activities.
The guidelines group reviewed the above cited literature and recommended that in order to improve cardiorespiratory and muscular fitness, bone and functional health, reduce the risk of NCDs, depression and cognitive decline:
Adults aged 65 years and above should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
Aerobic activity should be performed in bouts of at least 10 minutes duration.
For additional health benefits, adults aged 65 years and above should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.
Adults of this age group, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.
Muscle-strengthening activities should be done involving major muscle groups, on 2 or more days a week.
When adults of this age group cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.
Despite the similarities between the recommendations for adults aged 18–65 and for adults aged 65 and above, separate recommendations should be adopted and implemented. Promoting and facilitating the regular practice of physical activity in older adults is especially important because this population group is very often the least physically active. Efforts to promote physical activity in older adults will generally place less emphasis on attaining high volumes of activity, or engaging in vigorous-intensity activity. However, the health status and abilities of older adults vary widely, and some older adults are capable of, and regularly perform, high volumes of moderate- and vigorous-intensity activity.
Conclusive scientific evidence based on a wide range of well-conducted studies shows that adults of the 65 years and above age group, who are physically active, have higher levels of cardiorespiratory fitness, a lower risk profile for developing a number of disabling medical conditions, and lower rates of various chronic noncommunicable diseases than do those who are inactive.
If an individual has a low exercise capacity (i.e. low physical fitness), the intensity and amount of activity needed to achieve many health-related and fitness benefits are less than for an individual who has a higher level of activity and fitness. Because the exercise capacity of adults tends to decrease as they age, older adults generally have lower exercise capacities than younger persons. They therefore need a physical activity plan that is of lower absolute intensity and amount (but similar in relative intensity and amount) than is appropriate for people of greater fitness, especially when they have led sedentary lifestyles and are starting out on an activity programme.
As with adults of the 18–65 age group, there are a number of ways older adults can accumulate the total of 150 minutes per week. The concept of accumulation refers to meeting the goal of 150 minutes per week by performing activities in multiple shorter bouts of at least 10 minutes each spread throughout the week then adding together the time spent during each of these bouts: e.g. 30 minutes of moderate-intensity activity 5 times per week.
It is worth noting that the recommended moderate- to vigorous-intensity activity is relative to the capacity of the individual to perform such activities.
Evidence of acute effects on biomedical markers points to benefits of undertaking regular physical activity throughout the week (such as 5 or more times per week). This also has the potential to encourage integrating physical activity as part of daily lifestyle such as active travel through walking and cycling.
The recommendations listed above are applicable to the following health conditions: cardio-respiratory health (coronary heart disease, cardiovascular disease, stroke and hypertension); metabolic health (diabetes and obesity); bone health and osteoporosis; breast and colon cancer and prevention of falls, depression and cognitive decline.
The volume of physical activity associated with the prevention of different chronic NCDs varies. Although the current evidence is insufficiently precise to warrant separate guidelines for each specific disease, it is sufficiently sound to cover all the health outcomes selected.
Higher levels of activity (i.e. greater than 150 minutes per week) are associated with additional health benefits. However the evidence suggests there is decreasing marginal benefit from engaging in physical activity above volumes equivalent to 300 minutes per week of moderate-intensity activity, and an increased risk of injuries.
The costs of endorsing these recommendations are minimal and essentially related to the translation into country settings, communication and dissemination. Implementation of comprehensive policies that will facilitate the achievement of the recommended levels of physical activity will require additional resource investment.
These recommendations are applicable in low- and middle-income countries. However, national authorities need to adapt and translate them into culturally appropriate forms for country level taking into consideration, among other factors, the physical activity domain which is more prevalent at population level (i.e. leisure time, occupational or transportation physical activity).
Overall, the benefits of being physically active and implementing the above recommendations outweigh the harms. Activity-related adverse events such as musculoskeletal injuries are common but are usually mild, especially for moderate-intensity activities such as walking. The inherent risk of adverse events can be significantly reduced by a progressive increase in the activity level, especially in sedentary older adults. A series of small increments in physical activity, each followed by a period of adaptation, is associated with lower rates of musculoskeletal injuries than is an abrupt increase to the same final level. For sudden cardiac adverse events, intensity of activity, rather than frequency or duration appears to have more adverse effect. The selection of low-risk activities, and prudent behaviour while performing any activity, can minimize the frequency and severity of adverse events and maximize the benefits of regular physical activity.
It should be noted that in populations that are already active, the national physical activity guidelines should not promote a physical activity target that would encourage a reduction in their current levels.