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Empowering Healthy Aging

he World Health Organization (WHO) has published a comprehensive toolkit aimed at catalyzing action to promote physical activity among older adults. This initiative is part of a broader series designed to assist countries in crafting and executing policies to increase population participation in physical activity. Aligned with the Global Action Plan on Physical Activity (GAPPA) 2018–2030 and the ACTIVE technical package, this toolkit focuses on interventions that can be delivered through primary health and community care services. Its strategic design also supports the objectives of the UN Decade of Healthy Ageing (2021–2030).

The development of this toolkit was a collaborative endeavor, drawing upon the collective wisdom and expertise of global leaders in health, ageing, and physical activity. It consolidates evidence-based strategies aimed at enhancing physical activity among older adults, with a range of case study examples of what this could look like in practice.

At its core, this toolkit seeks to empower nations to proactively address the challenges posed by an ageing demographic. By fostering physical activity among older adults, countries can positively impact health outcomes, enhance quality of life and physical function, and mitigate the burden of chronic disease. The toolkit provides a roadmap for policymakers, healthcare professionals, and community leaders to design, implement, and evaluate interventions tailored to the unique needs of their ageing populations.

The toolkit details three key activities needed to support and promote physical activity among older people: 1. educating and encouraging – communicating why physical activity is important; 2. engaging and supporting – ensuring physical activity programmes and services meet the needs of older people; 3. enabling every day – ensuring that environments where older people live, work and socialise support physical activity.

The toolkit describes five enabling factors that underpin effective and sustainable provision of physical activity opportunities for older people. These include: 1. governance, leadership and finance; 2. advocacy; 3. partnerships and community links; 4. training; 5. monitoring and evaluation.

To members of the International Society for Physical Activity and Health (ISPAH), we see this toolkit as a catalyst for furthering your commitment to global physical activity promotion. We hope you will embrace the insights provided to inform your advocacy efforts, guide your research pursuits, and strengthen collaborative initiatives. By integrating these evidence-based strategies into your work, you are pivotal in contributing to the realisation of GAPPA’s objectives and the broader vision of fostering active and healthy ageing worldwide.

This toolkit supports a future where older adults can not only live longer but live in better health. It provides the tools, the guidance, and the inspiration to pave the way for positive change, redefining what it means to age with grace, health, and vibrancy. As we share this resource with the global community, let us all commit to championing the cause of healthy ageing, confident in our collective ability to create a world where older age brings vitality, resilience, and the joy of physical activity.

To explore the toolkit and access additional resources, visit the WHO website or ISPAH website.

Better balance = longer life

To underscore the importance of the article published in June by Araujo, C. et al. (2022) “Successful 10-second one-legged stance performance predicts survival in middle-aged and older individuals” in the British Journal of Sports Medicine also Harvard Medical School underlines the relevance of this data for health namely the ability to remain for 10 seconds balanced on one leg writing:

A study published online June 21, 2022, by the British Journal of Sports Medicine found that people who are unable to stand on one leg for 10 seconds in middle and later life have almost double the usual risk of premature death. Researchers evaluated the health information and balance test results of 1,700 people (ages 51 to 75, and all free of walking problems), and then followed them for seven years. During the study, 123 participants died of various causes. After taking participants’ age, underlying conditions, weight, and other factors into account, scientists determined that failing the balance test was associated with an 84% higher risk of dying within the study period, compared with passing the balance test. The study was observational and found only an association (not a cause-and-effect relationship) between balance ability and early death. But if you want to give the test a try, it happens also to be a good way to boost balance — which reduces your risk of falls, regardless of any possible effect on longevity. Here’s what to do: Stand near a counter (for support if necessary). To balance on your left leg, keep your arms at your sides and slowly place the top of your right foot on your left calf. Stand that way for 10 seconds. Then repeat, reversing leg positions. Practice every day, and see how much your balance improves”.

Elderly well-being: optimism and perceiving oneself younger

Daphna Magda Kalira, Amit Shrirab, Aya Ben-Eliezerd, Noemi Heymane, Inna Shugaevd, and Oleg Zaslavskyh. Feeling Younger, Rehabilitating Better: Reciprocal and Mediating Effects between Subjective Age and Functional Independence in Osteoporotic Fracture and Stroke Patients, Gerontology, Published online: May 25, 2022

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The current study aimed to find reciprocal effects between subjective age and functional independence during rehabilitation from osteoporotic fractures and stroke and whether these effects can be mediated by indicators of well-being. Methods:Participants were 194 older adults (mean age = 78.32 years, SD = 7.37; 64.8% women) who were hospitalized following an osteoporotic fracture or stroke. Participants completed measures of subjective age and well-being (i.e., optimism, self-esteem, and life satisfaction) several times during rehabilitation. Functional Independence Measure (FIM) was completed by nursing personnel at admission and at discharge. Results:Younger subjective age at admission predicted higher FIM scores at discharge. The reverse effect, that is, of FIM scores at admission on subjective age at discharge, was nonsignificant. Optimism during hospitalization mediated the effect of subjective age on subsequent FIM scores while self-esteem and life satisfaction did not. Sensitivity analyses further showed that the effect of subjective age on FIM was significant for both fracture and stroke patients. Discussion: The findings highlight the effect of subjective age on rehabilitation outcomes among osteoporotic fractures and stroke patients and suggest several potential mechanisms behind this effect. Rehabilitation outcomes following osteoporotic fractures or strokes could improve if subjective age and an optimistic outlook are taken into consideration.

In summary: an optimistic mindset and perceiving oneself as younger are predictors of better recovery after fractures and strokes in older people.

Yvonne Dowlen: Figure skaters at 90

90-Year-Old Figure Skater Will Warm Your Heart with Her Amazing Talent

90-Year-Old Figure Skater Will Warm Your Heart with Her Amazing Talent |  Short Film Showcase - YouTube

Copenhagen Consensus statement 2019: physical activity and ageing

Bangsbo J, Blackwell J, Boraxbekk C, et al Copenhagen Consensus statement 2019: physical activity and ageing. Br J Sports Med Published Online First: 21 February 2019.
Abstract

From 19th to 22nd November 2018, 26 researchers representing nine countries and a variety of academic disciplines met in Snekkersten, Denmark, to reach evidence-based consensus about physical activity and older adults. It was recognised that the term ‘older adults’ represents a highly heterogeneous population. It encompasses those that remain highly active and healthy throughout the life-course with a high intrinsic capacity to the very old and frail with low intrinsic capacity.

The consensus is drawn from a wide range of research methodologies within epidemiology, medicine, physiology, neuroscience, psychology and sociology, recognising the strength and limitations of each of the methods. Much of the evidence presented in the statements is based on longitudinal associations from observational and randomised controlled intervention studies, as well as quantitative and qualitative social studies in relatively healthy community-dwelling older adults.Nevertheless, we also considered research with frail older adults and those with age-associated neurodegenerative diseases, such as Alzheimer’s and Parkinson’s disease, and in a few cases molecular and cellular outcome measures from animal studies.

The consensus statements distinguish between physical activity and exercise. Physical activity is used as an umbrella term that includes both structured and unstructured forms of leisure, transport, domestic and work-related activities. Physical activity entails body movement that increases energy expenditure relative to rest, and is often characterised in terms of intensity from light, to moderate to vigorous. Exercise is defined as a subset of structured physical activities that are more specifically designed to improve cardiorespiratory fitness, cognitive function, flexibility balance, strength and/or power.

This statement presents the consensus on the effects of physical activity on older adults’ fitness, health, cognitive functioning, functional capacity, engagement, motivation, psychological well-being and social inclusion. It also covers the consensus on physical activity implementation strategies. While it is recognised that adverse events can occur during exercise, the risk can be minimised by carefully choosing the type of activity undertaken and by consultation with the individual’s physician when warranted, for example, when the individual is frail, has a number of co-morbidities, or has exercise-related symptoms, such as chest pain, heart arrhythmia or dizziness.

The consensus was obtained through an iterative process that began with the presentation of the state-of-the-science in each domain, followed by group and plenary discussions. Ultimately, the participants reached agreement on the 30-item consensus statements.

+ age + physical activity

A new report, produced by Sheffield Hallam University, ukactive and DataHub, argues something health industry professionals have long known to be true – that people should become more active as they age, not less.

Reimagining Ageing, released at the ukactive National Summit in September, says older people’s lives are being cut short by inactivity and paints a compelling picture of how the cost of not tackling this challenge could threaten the NHS.

A few key facts: by 2030 the number of people in the UK aged 60 or over will hit 20 million – up 31 per cent from today’s figure of 15.3 million.

“Our population is ageing fast, with a proliferation of health problems. It has long been assumed such problems were directly caused by ageing, and could, therefore, be neither prevented nor treated,” says Sir Muir Gray, formerly chief knowledge officer for the NHS.

“However, we have clear evidence that ageing by itself is not a cause of major health problems until people are in their mid-90s. In fact, the problems we’ve ascribed to ageing are due to disease – much of it preventable – such as loss of fitness and negative attitudes to growing older.

“The loss of function and resilience we’ve assumed to be the result of ageing can, in fact, be influenced principally by activity: physical, mental and social,” he says.

Getting our ageing population active will require a ‘cultural transformation’ of the perceptions we have towards ageing. As a sector, we must be prepared with the facilities, products, services, programmes and expertise required to meet the demands of an older population.

“We need to inspire a shift in how we approach our ageing years, with a major emphasis on building physical activity in at every step, to ensure long lives are also healthy lives,” says ukactive CEO Steven Ward. “The phrase ‘put your feet up’ is one of the most dangerous in the English language.”

The report calls for whole-society collaborations to create active environments via accessible community facilities, to embed physical activity promotion into the healthcare system and to harness new technology to make activity and exercise the natural choice for older people.

ukactive believes that one solution is Wellness Hubs, where physical activity facilities sit alongside local services such as libraries, police stations and GP surgeries, creating a single community focal-point that offers inclusive, welcoming and holistic physical activity experiences for a broad range of people. Evidence from existing Wellness Hubs has shown a positive impact on local communities, particularly among older populations.

Physical activity, age, physiological functions

Stephen D. R. Harridge and Norman R. Lazarus, Physiology, 32: 152–161, 2017.

At the anatomical level, muscle loss in older people is associated with atrophy of fast-contracting, type II muscle fibers. Indeed, it has been suggested that type II fiber atrophy might completely explain the loss of muscle bulk in later life. However, a prevailing view is that skeletal muscle loss also relates to a loss of muscle fibers secondary to a loss of motor units. Partial re-innervation of abandoned fibers is believed to occur, resulting in an increased size of remaining motor units, with knock-on effects for fine motor control. This hypothesis is supported with histological evidence of fiber-type grouping and through electromyo- graphic estimates of motor unit number.

Whereas evidence of streaming of Z line and rod formation, and angulated fibers further point to dysregulation of skeletal muscle in later life (81). Studies of mas- ter athletes paint a very different picture (as illustrated in FIGURE 3), which once more challenges the assertion that these changes can be explained by an inherent aging process and are inevitable consequences of getting older.

Figure 3. MRIs taken across the mid region of the thigh. Images taken across the mid region of the thigh, showing a sarcopenic muscle (middle) from a sedentary individual with reduced contractile mass, more subcutaneous fat, and infiltration of fat and connective tissue. By contrast, the muscles of a similarly aged master triathlete (bottom) shows little difference to that of a younger athlete (top).

Delaying and reversing frailty in old age: a systematic review

John Travers, Roman Romero-Ortuno, Jade Bailey and Marie-Therese Cooney
Br J Gen Pract 3 December 2018

Abstract

Background Recommendations for routine frailty screening in general practice are increasing as frailty prevalence grows. In England, frailty identification became a contractual requirement in 2017. However, there is little guidance on the most effective and practical interventions once frailty has been identified.

Aim To assess the comparative effectiveness and ease of implementation of frailty interventions in primary care.

Design and setting A systematic review of frailty interventions in primary care.

Method Scientific databases were searched from inception to May 2017 for randomised controlled trials or cohort studies with control groups on primary care frailty interventions. Screening methods, interventions, and outcomes were analysed in included studies. Effectiveness was scored in terms of change of frailty status or frailty indicators and ease of implementation in terms of human resources, marginal costs, and time requirements.

Results A total of 925 studies satisfied search criteria and 46 were included. There were 15 690 participants (median study size was 160 participants). Studies reflected a broad heterogeneity. There were 17 different frailty screening methods. Of the frailty interventions, 23 involved physical activity and other interventions involved health education, nutrition supplementation, home visits, hormone supplementation, and counselling. A significant improvement of frailty status was demonstrated in 71% (n = 10) of studies and of frailty indicators in 69% (n=22) of studies where measured. Interventions with both muscle strength training and protein supplementation were consistently placed highest for effectiveness and ease of implementation.

Conclusion A combination of muscle strength training and protein supplementation was the most effective intervention to delay or reverse frailty and the easiest to implement in primary care. A map of interventions was created that can be used to inform choices for managing frailty.

Physically active older adults live longer

Physically active older adults live longer with lower rates of heart disease, type 2 diabetes, arthritis, cognitive decline, and osteoporosis. If that’s not enough incentive, they also enjoy more independence, balance, flexibility, cognitive function and improved self-esteem.

In order to reap these benefits, people over the age of 65 need at least 150 minutes of moderate-to-vigorous- physical activity per week according to Canadian Physical Activity Guidelines.

Looking for ways to incorporate more heart-pumping activity into your week?  Here are some tips to keep you moving:

1) INCORPORATE PHYSICAL ACTIVITY INTO YOUR REGULAR ROUTINE

Bending, squatting, stretching and lifting are all part of everyday activities such as gardening, grocery shopping, and even putting on your socks. Up the ante by sneaking in some resistance-type moves like doing some heavier digging or lifting of grocery bags. Even something as simple as berry picking or walking can strengthen your bones and muscles.

2) KEEP A MOVEMENT LOG

Those who track, stay on track! Noting your activity daily can really help you reach your fitness  goals. Use a wearable tracker, an app on your smartphone, or simply mark your progress in a calendar.

3) GET IN THE WATER

Water supports your body weight and adds resistance. Swim laps or look out for a local aquafit class which can help you build endurance and muscle strength. Many pools have accessible ramps making it easier to get in and out. The warmth of the water can also soothe aching joints.

4) EMBARK ON AN 8-WEEK WALKING PROGRAM

Walking is one of the safest and most enjoyable forms of fitness, not to mention it’s free! Aim for 15 min to start then gradually work your way up to 30 minutes per day. This is a great option for people with arthritis because it doesn’t put a lot of strain on the joints.

5) EXPLORE NEW ACTIVITIES

You’ve probably heard of tai chi (great for building strength and balance!), but have you ever tried geocaching? Participants use a GPS to find containers called geocaches. They’re hidden all over the world so you can participate anywhere. If that doesn’t appeal, go dancing, do yoga, or play pickleball. Trying something new will help keep you motivated and inspired!

6) PLAY IT SAFE

Whatever activity you choose, make sure to start slow, wear appropriate footwear, stay hydrated, and always check with your doctor before starting any new physical activity program.

82-year-old hiked the Appalachian Trail: 2190 miles

There was a moment back in August when Dale “Grey Beard” Sanders considered giving up.

In the middle of the 100-Mile Wilderness in Maine, far from help, he was bleeding internally and having heart palpitations — not surprising considering that he was 50 or 60 years older than most of the people he had met on the Appalachian Trail.

Sanders called his wife in Bartlett, Tenn., and she urged him to keep going. With a go-ahead from his doctors, he did, and on Thursday, Sanders, 82, officially became the oldest person to hike the entire 2,190-mile trail in a year.