Aging and Fitness — The Shape of Things to Come
By Jennifer Sisk and Kara McDonald
Social Work Today
Vol. 4, No. 7, Page 34

Exercise can help prevent the physical and mental deterioration of aging. Older patients who exercise may be swimming in the fountain of youth.

Most of us dread getting older, associating old age with aches and pains, disease, loneliness, and senility. A 70-year-old body is quite different from a 25-year-old body, and we all must cope with those age-related changes. However, aging need not be dreaded. Research indicates that regular exercise can prevent or delay the development of age-related conditions, such as osteoarthritis and Alzheimer’s disease, and alleviate depression. And exercise has even been shown to decrease the risk of developing certain cancers, decrease mortality associated with cardiovascular disease, and speed recovery following stroke, heart attack, and cancer.

The Research
Long-term National Institute of Aging studies have revealed that normal physiological aging varies among individuals, and chronological age does not always correlate with physiological age.1 Our genes and lifestyle interact to affect the rate of aging, and while we cannot change our genes, certain lifestyle modifications—such as exercising and not smoking—can influence how we age. Regular physical activities that include strength training, cardiovascular conditioning, flexibility, and balance training can offset age-related changes. Researchers have concluded that while normal aging is variable, in general, the following physiological age-related changes occur:

• The heart muscle thickens and arteries stiffen, causing a decline in maximal pumping rate and the body’s ability to use oxygen from the blood.

• Maximum breathing capacity decreases by approximately 40%.

• Brain function diminishes.

• Bone loss accelerates and often results in osteoporosis and/or osteopenia.

• Muscle mass, strength, and power decline significantly.

In addition, body fat typically decreases with age. Although body fat tends to increase into middle age, we begin to lose muscle and body fat as we age beyond that—the process that makes older adults appear to shrink and become frail. However, the obesity epidemic has affected the older population; a disturbing recent trend in age-related physiology is an increase in overweight and obesity. According to 2003 statistics from the National Center for Health Statistics, more than 70% of men and women aged 50 to 74 are overweight and more than 30% are obese. Approximately 66% of men aged 75 and older are overweight and 20% are obese; roughly 60% of women this age are overweight and 25% are obese.

Clinical studies support regular physical activity to improve physiological decline. Brach et al2 studied physical activity of 3,075 men and women aged 70 to 79 and found that those who participated in 20 to 30 minutes of moderate-intensity exercise on most days functioned better than those who engaged in lower-intensity activities or no activities. Tsang and Hui-Chan3 found that older adult men who were experienced and active golfers or tai chi practitioners demonstrated joint movement, standing balance control, and reaction time comparable with young university students. Brandon et al4 found that moderate-intensity lower body resistance training two to three days per week significantly improved mobility and leg strength in diabetic older adults. Teri et al5 concluded that exercise combined with behavioral management in 153 Alzheimer’s patients significantly improved physical functioning and depression.

Research also supports the role of exercise in decreasing the risk of certain cancers. McTiernan et al6 studied more than 70,000 women aged 50 to 79 to determine the relationship between physical activity and breast cancer risk. Women who walked briskly for 1.25 to 2.5 hours weekly had an 18% decreased risk of breast cancer, and women who exercised for 10 hours or more weekly had slightly greater risk reduction. In a review of published data on exercise and cancer risk reduction, Lee7 concluded that 30 to 60 minutes daily of moderate- to vigorous-intensity exercise reduced the risk of colorectal cancer in men and women by up to 40% and the risk of breast cancer by 20% to 30%.

Resources for Professionals and Seniors
Keeping up with recent ongoing research can be difficult for busy professionals. Two organizations dedicated to promoting fitness in our aging population are rapidly expanding and offer resources for those interested in working in the growing field of older adult fitness. In 2001, the International Council on Active Aging (ICAA) in Vancouver, British Columbia, Canada, was launched with the goal of uniting professionals in the fitness, rehabilitation, wellness, long-term care, and assisted-living fields and providing information, education, and tools for serving our aging population. The ICAA emphasizes whole-person wellness based on the six dimensions of wellness for older adults: emotional, intellectual, social, physical, spiritual, and vocational health.

As the world’s largest senior fitness trade association, the ICAA ultimately hopes to change the way we age by encouraging people to make more healthful lifestyle choices through support of their members involved with the aging population. Colin Milner, ICAA CEO, says, “We support our professional members who serve older adults with the information, education, resources, and tools they need to be more successful with the older adult.” The ICAA provides publications, a research e-newsletter, conferences, and online and consultative resources. For example, ICAA members can access resources to help them design and operate “age-friendly” fitness centers. “If professionals are serious about serving their older clients, we offer them the support to do a better job by helping them stay current on information pertaining to programming, marketing, operations, and facility design,” Milner says.

This year, the ICAA sponsored its second national health initiative—Active Aging Week—supported by the Presidential Council on Fitness and the Administration on Aging. Held from September 27 to October 3, this national health observance boosted awareness of the importance of physical activity for older adults and features free fitness and wellness classes nationwide. Active Aging Week coincided with the World Health Organization’s International Day of the Older Adult (October 1), a day established to promote the importance of health and productivity for the world’s increasing older adult population. Information on Active Aging Week can be found online at www.icaa.cc.

Fifty-Plus Lifelong Fitness in Palo Alto, CA (www.50plus.org), is a 25-year-old nonprofit organization founded by a group of elite older runners who were participating in research studies on disease prevention at Stanford University. Since its launch in 1979, the organization gradually changed its emphasis from individuals who were already exercising to those who were not. Fifty-Plus has more than 2,000 members worldwide. Its mission is to encourage fitness and a longer and more independent lifestyle for adults by expanding awareness and involvement in health and fitness activities to prevent illness, disability, and obesity. On its Web site, the organization emphasizes the need for improving the physical fitness of older individuals and focuses on disuse of the mind and body as a significant cause of physical frailty.

To implement its mission, Fifty-Plus has established a Fitness Ambassador Corps that uses community volunteers to help older people find local programs to assist them in achieving higher levels of physical activity. Fitness Ambassadors organize community activities and provide information to encourage older adults to enhance their health and quality of life through regular physical activity.

According to Patricia Ernstrom, chief operating officer of Fifty-Plus, Fitness Ambassadors serve as catalysts for change in the lives of individuals and in their communities. “Fitness Ambassadors either lead activities themselves or advocate and help start programs that others lead,” says Ernstrom. “This way, the ambassadors expand programs and opportunities for fitness among seniors in their community.”

Fifty-Plus provides a Fitness Tool Kit to assist volunteers in implementing local programs, such as group fitness walks. The ambassadors also collaborate with community organizations such as YMCAs, fitness clubs, local senior centers, retirement communities, and physician groups. “This grassroots network provides peer encouragement, which we believe is the strongest catalyst for getting people over 50 to exercise more,” Ernstrom says. “Fifty-Plus really bridges the gap between awareness to action by not only providing information but also opportunities and incentives for older adults to improve their fitness.”

According to Stanford University research on aging and exercise, Fifty-Plus members have a 70% less death and disability rate compared with the general older population. Research sponsored by Fifty-Plus has shown that huge savings in medical costs could result from simply walking 30 minutes each day. Because walking two to three hours weekly can reduce the risk of hip fracture by almost 25%, increasing the number of older adults in walking programs could potentially save some of the billions of dollars spent on treating the thousands of new hip fractures that occur each year in the United States.

From Research to Real Life
Although research undoubtedly supports the benefits of exercise as we age, little research addresses the actual implementation and design of age-appropriate exercise. Janet E. Fisher, MEd, director of the Fitness Business and Senior Fitness Limited in West Chester, PA, works with elders every day, emphasizing functional fitness to improve their quality of life. At the age of 67, Fisher has more than 30 years’ experience in the business of fitness for older adults. Over the last decade, she has seen increasing interest and participation in senior exercise. “Ten years ago, I had five people in a class. Now, I have 35 to 50 in class,” she notes.

The Good Shepherd, a skilled nursing and rehabilitation community in Columbus, OH, is also seeing an increase in fitness-conscious seniors—thanks to a recently implemented program called SeniorFit. Open to both long-term residents and rehabilitation patients, as well as local community members, SeniorFit caters specifically to residents aged 55 and older.

“SeniorFit is a specialized program that focuses on increasing senior independence,” explains Cara Schuster, director of clinical services at The Good Shepherd. “We saw it as an opportunity to put ourselves in the model of wellness and independence. A lot of times, nursing facilities focus solely on residents’ medical conditions. Our goal was to look at residents from a different component of achieving both independence and increasing functional status.”

The SeniorFit facility offers the same machines as a typical gym—with several important differences. “We have state-of-the-art equipment that’s specifically designed for seniors,” Schuster says. “Instead of the typical 10-pound weight increments, we have 1-pound increments. The equipment is run with hydraulics, so it’s a smooth transition for the muscles. And we have accommodating seating for members in wheelchairs.”

Schuster says the results have been impressive. Members of the SeniorFit program have shown increased muscle strength and coordination in the upper arms, lower back, and legs—an especially important area to focus on since, according to Milner, “the loss of leg strength is one of the major factors for entry into a skilled nursing facility. Stability is a huge issue since one out of three people over age 65 fall each year.”

Kellie Lawrence, admissions counselor and director of healthcare marketing at The Good Shepherd, says that in addition to the obvious benefits of increased strength and coordination, there are vast social, emotional, and mental benefits as well. “All the participants have responded really well,” she says. “It’s helped decrease depression and increase confidence in the ability to perform their activities of daily living. Residents are sleeping better, too. It keeps residents at a higher-functioning level for longer periods of time.”

Schuster agrees, adding that the program has actually exceeded initial expectations. “An area we didn’t expect to see a lot of success in was our Alzheimer’s unit. But the equipment in this program can be utilized by any resident who can follow a one-step command, which most Alzheimer’s patients can do. So we’ve seen a lot of success as far as decreased sundowners syndrome, as well as less agitation and fewer behavioral issues overall. This, in turn, increases their ability to eat and sleep independently.”

Lawrence says that while the SeniorFit program is the first of its kind in Ohio, she predicts that more facilities will soon be adding similar ventures. “More and more, we’re seeing residents who used to go to facilities to play Bingo and checkers, and that was their exercise,” she says. “But now the growing trend is that people want to know how they can maintain their independence and increase their functional endurance. Facilities must be able to change with the times and offer seniors that opportunity.”

— Jennifer Sisk is a certified wellness educator/consultant with the American College of Wellness and a certified fitness instructor with the Aerobics and Fitness Association of America.

— Kara McDonald is assistant editor of Social Work Today.

References for this article are available upon request by e-mailing SWTeditor@gvpub.com.