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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.

Recordman at 105 years old

Most centenarians are thrilled to be able to walk. Not Hidekichi Miyazaki! This 105-year-old Japanese man wants to run, and that too, competitively. Hence, it was only natural for “Golden Bolt” to celebrate his latest birthday with a record-breaking 100-meter sprint.

The epic race took place on September 23rd, the day after Mr. Miyazaki turned 105. It took the sprinter a mere 42.22 seconds to cover the distance. While that earned him a place in the Guinness World Records as the fastest man in the over 105-year-old category, Mr. Miyazaki was not happy. That’s because “Golden Bolt” who celebrated by striking a lightning pose just like his namesake Usain Bolt, had hoped to complete the 100-meters in 36 seconds, like he had been able to, during training.

92 year old Harriette Thompson finishes the marathon

A 92-year-old cancer survivor has become the oldest woman to finish a marathon. American Harriette Thompson ran the Rock ‘n’ Roll Marathon in San Diego in seven hours, 24 minutes and 36 seconds. Having survived three bouts of oral cancer, Thompson crossed the line accompanied by her son Brenny, 56. Aged 92 years and 65 days, Thompson took the record of 92 years and 19 days set by Gladys Burrill in the Honolulu Marathon in 2010. ”I guess it’s sort of unusual now,” she said. “But in 10 years it won’t be ususual at all. People are living longer … I guess the secret is just keep going and pleasant thoughts.” Thompson, a two-time cancer survivor,  runs to raise awareness and funds for the Leukemia & Lymphoma Society.

Charles Eugster 95-year-old is the 200m world champion

Charles Eugster, Britain’s 95-year-old world sprint champion. The nonagenarian broke the 200m sprint world record for his age group at the World Masters Athletics in Birmingham last August and has now gone viral, after footage of his run was posted on YouTube on Sunday. Eugster, who is also a competitive rower, says he has always been interested in competing, but more importantly winning. He run 200m in 55,48 seconds.

Lifestyle and dementia

Lifestyle is responsible for up to 76% of changes in the ageing of the brain according to “Age UK and there are 5 steps people can take to maintain brain health and reduce their risk of developing dementia.

The review of academic studies and data reveals that about 76% of cognitive decline – changes in thinking skills with age including memory loss and speed of thinking – is accounted for by lifestyle and other environmental factors including level of education.

The finding from The Disconnected Mind, an Age UK funded research project into how thinking skills alter with age, which was part of the analysis, suggests that there is significant potential to influence these changes.

Furthermore, Age UK’s review, which included the latest international dementia studies, indicates that certain lifestyle factors – regular physical exercise, eating a Mediterranean diet, not smoking and drinking alcohol in moderation  – decrease the risk of developing Alzheimer’s, and other forms of dementia. In addition, preventing and treating diabetes, high blood pressure and obesity were also found to reduce the risk of dementia.

Exercise ‘most effective’ way to prevent cognitive decline

One large UK study carried out over 30 years found that men aged between 45 and 59 who followed 4-5 of the identified lifestyle factors were found to have a 36% lower risk of developing cognitive decline and a 36% lower risk of developing dementia than those who did not.

Age UK’s evidence review  also revealed  that physical exercise – aerobic, resistance or balance -  was the most effective way to ward off cognitive decline in healthy older people and reduce the risk of developing Alzheimer’s disease. Studies suggest that exercise 3 to 5 times a week for between 30 minutes and an hour is beneficial.

Significantly more cases of Alzheimer’s among smokers

But the evidence review also showed that a healthy diet, moderate alcohol intake and not smoking also play a role in ensuring healthy brain ageing  as well as reducing the risk of developing dementia.

It found that there are significantly more new cases of Alzheimer’s among current smokers compared with those who have never smoked.

The review also backed up claims that very heavy drinking is also linked to dementia, resulting in the loss of brain tissue particularly in the parts of the brain responsible for memory and processing and interpreting visual information.

Moderate levels of alcohol, however, were found to protect brain tissue by increasing good cholesterol and lowering bad cholesterol.

According to the latest estimates, there are 850,000 people in the UK living with dementia. It will affect one in three people over the age of 65.

‘There are simple and effective ways to reduce our risk’

Age UK hopes the new evidence will spur people to make changes which will help them reduce the risk of developing dementia.

Caroline Abrahams, Charity Director of Age UK said ‘While there’s still no cure or way to reverse dementia, this evidence shows that there are simple and effective ways to reduce our risk of developing it to begin with.

‘What’s more, the changes that we need to make to keep our brains healthy are already proven to be good for the heart and overall health, so it’s common sense for us all to try to build them into our lives. The sooner we start, the better our chance of having a healthy later life.”

(From Age UK)