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Promoting Physical Activity in Older Adults: Benefits and Risks Sarah Elser Ferris State University

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Abstract Many older adults suffer from chronic conditions such as osteoarthritis, cardiovascular diseases, diabetes, and mental illnesses like depression and anxiety. Physical inactivity can contribute to these conditions and even make the symptoms worse. By promoting exercise and increased physical activity in the older adult, their strength, endurance, balance, flexibility, and overall health and quality of life can be greatly increased. This paper examines the most common chronic conditions facing the older adult, the benefits and risks of increasing physical activity, and keys to creating and promoting a successful exercise program for the older adult. Keywords: physical activity, exercise, older adult, elderly, chronic diseases, falls

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Promoting Physical Activity in Older Adults: Benefits and Risks “If I’d known I was going to live this long, I’d have taken better care of myself.” This is a quote by Eubie Blake that adequately describes the perspective on aging that many elderly adults take because unfortunately, living a long life does not always mean living a healthy life. However, as the average life expectancy of American seniors continues to rise, it is never too late to adapt a healthier lifestyle; the average American lived to be only 47 years old in 1900 as compared to the age of 78 in 2006 (Hackstaff, 2009, pg. 799). According to the National Academy on an Aging Society, 45% of the population ages 75 and older are limited in activities because of chronic conditions such as arthritis, diabetes, and cardiovascular diseases (2009, pg. 4). These conditions can be physically debilitating but can also lead to emotional and psychosocial deficits. The Centers for Disease Control and Prevention states that there are four modifiable health risk behaviors that contribute to chronic diseases: lack of physical activity, poor nutrition, tobacco use, and excessive alcohol intake (CDC, 2012). All of these factors should be taken into consideration when creating a plan for promoting a healthy lifestyle for the older adult, but this paper will focus mainly on the benefits and risks associated with promoting physical activity as a means for decreasing side effects of chronic illnesses, increasing mobility and functioning, and most importantly, improving overall quality of life. Health Issues Facing the Average Older Adult As one ages, it is a normal physiologic process for both the physical and mental capabilities of a person to decline. The rate and ways that these capacities decline vary widely in each person and are caused by factors such as genetics, environment, and lifestyle. The average older adult faces several health issues including increased prevalence to chronic diseases and

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mental health illnesses and a general decrease in mobility, physical functioning, and balance resulting in an increased risk for falls and fractures. While most genetic and some environmental factors are uncontrollable, the lifestyle factors, including physical activity, are modifiable and even small changes can lead to great improvements in the quality of one’s life. Chronic Disease According to the CDC, almost half of all Americans suffered from at least one chronic condition in 2005 (2012). Narrowing it down to just older adults, the NCOA states that “about 91% of older adults have a least one chronic condition, and 73% have at least two” (NCOA, 2012). Of these chronic conditions, osteoarthritis is the most common cause of disability, affecting half of all people ages 75 and older (CDC, 2012)(NAAS, 2009). Other common chronic diseases affecting the elderly are diabetes and cardiovascular diseases such as hypertension, heart disease, and congestive heart failure. Currently, these forms of cardiovascular disease account for 50% of all deaths in the U.S. (Hackstaff, 2009, pg. 806). In both cardiovascular and musculoskeletal conditions, it has been proven that physical inactivity is a main cause of loss of physical functioning (Hackstaff, 2009, pg. 806). Mental Health Depression currently affects over 7 million older adults and according to the National Council on Aging, “people aged 85+ have the highest suicide rate of any age group. Older white men have a suicide rate almost six times that of the general population” (NCOA, 2012). These figures are shockingly high and worse yet, depression symptoms are often overlooked in older adults and therefore go untreated (CDC, 2012). A decrease in functioning, mobility and independence may contribute to this higher level of depression in older adults, along with the frequent loss they may experience as their family and friends also age.

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Erik Erikson’s psychosocial theory of growth and development can be applied in understanding of this increase of depression in the older adult. According to Erikson, a person aged 65 years and older is in the stage “maturity” and has a central task of “integrity vs. despair” (Berman, Snyder, Kozier, Erb, 2008, pg. 353). The theory states that a person in the stage of life has to decide between “acceptance of worth and uniqueness of one’s own life and acceptance of death” and a “sense of loss and contempt for others” (Berman, Snyder, Kozier, Erb, 2008, pg. 353). Failure to accept the life one has led could easily be a risk factor for depression or other mental health issues. Falls/Fractures A very prevalent health concern for older adults is the risk of falling, which may or may not result in a fracture. “Among older adults, falls are the leading cause of fractures, hospital admissions for trauma, and injury deaths. Falls are the most common cause of older adult traumatic brain injuries, accounting for over 46% of fatal falls” (NCOA, 2012). Even more, one out of every three adults aged 65 and older fall every year (CDC, 2012). Risk factors for falls include increased age, decreased muscle strength, body mass, and mobility, and impaired vision and cognition (Gregg, Pereira, & Caspersen, 2000). Perhaps just as debilitating as a fall itself is the fear of falling; many older adults may inadvertently decrease their physical activity for fear of suffering a fall. Lynn Hackstaff adequately explains this phenomenon: “Physical inactivity can easily set a cycle of increasing disability in motion: lack of physical activity leads to muscle weakness, which incurs weight gain, which impairs balance and creates risk for falls. The fear of falling or simply the pain caused by immobility reinforces further avoidance of activity, leading to further muscular atrophy” (2009, pg. 806).

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Benefits of Physical Activity There are an endless number of benefits to initiating and maintaining an exercise regimen. Increased physical activity, even when introduced late in life, can drastically improve one’s quality of life; “physical activity initiated in late life continues to improve mortality, having a strong effect on longevity” (Bean, 2004, pg. 32). Also, physical activity can increase mobility, physical functioning, bone mineral density, muscle strength, and balance; all factors that can reduce the risk for falls in the older adult (Gregg, Pereira, Caspersen, 2000). Another benefit of increased physical activity includes improving emotional and mental states. Exercise can improve self-esteem and decrease mental illnesses such as depression and anxiety. Even more, active older adults report higher levels of subjective well-being (Pender, Murdaugh, & Parsons, 2011, pg. 273). By potentially improving and alleviating the symptoms of chronic conditions, increased physically activity can help to give a more positive outlook on life to the chronically ill older adult. With osteoarthritis being the number one chronic condition in the older adult, it is important to address the benefits of increased physical activity on this potentially debilitating condition. While some older adults may avoid increased activity for fear of increased pain, studies have suggested that increased exercise can improve the underlying physical impairments causing the pain and also that it does not cause disease progression (Bean, 2004, pg. 35). The increase in strength, endurance, and flexibility that will be experienced by the older adult engaging in physical activity will all contribute in alleviating the pain of osteoarthritis. Risks of Physical Activity for the Older Adult Perhaps the greatest risk for the older adult of engaging in more physical activity is the increased risk for falls. Ironically, the increase in strength and balance that comes with better

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physical fitness has been proven to decrease the risk for falls, but completing those very exercises can put one at a greater risk for falling; “physical activity could increase risk for injurious falls because physical activities involve skeletal muscle movement that displaces the body’s center of gravity and balance” (Gregg, Pereira, & Caspersen, 2000). Engaging in intense physical activity could also place an older adult with chronic health issues at a greater risk for suffering an acute coronary event. However, the benefits of moderate-intensity exercise greater outnumber the risks. Creating an Exercise Regimen for the Older Adult There are several key factors that will make an exercise regimen for the older adult successful. First and foremost, they should be encouraged to collaborate with their physician to decide on an exercise plan that is safe and effective considering their individual level of health. According to the CDC, the older adult should aim for 150 minutes of moderate-intensity aerobic exercise each week (CDC, 2012). It is also important to incorporate strength training, balance, and flexibility exercises; tai chi can be a good way to improve balance (CDC, 2012). For the older adult, it is important to make the exercise routine fun and engaging. Activities such as gardening, dog walking, or playing at the park with grandchildren can incorporate several of these aspects of well-rounded exercise into fun, meaningful activity; dance, aerobic, or swimming classes can be a great method of both exercise and social time (Bean, 2004, pg. 32). There may be a psychosocial benefit for the older adult to participate in group or peer-led classes. There are also specifically designed programs such as SilverSneakers which have great benefits; according to their website “SilverSneakers is a fun, energizing program that helps older adults take greater control of their health by encouraging physical

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activity and offering social events” (2012). The program provides specially designed workouts, seminars, and social events tailored to the needs of the older adult population. Conclusion The majority of older adults in our country suffer from chronic health conditions that can be both physically and mentally debilitating. The effects and symptoms of these chronic conditions, such as osteoarthritis, cardiovascular diseases, and diabetes, can be alleviated and improved by an increase in physical fitness; engaging in regular physical activity can be beneficial in improving this age group’s strength, endurance, flexibility, balance, mood, and overall health. Although there are some risks for the older adult in participating in exercise and increased physical activity, the benefits are much greater and with the help of a physician, a thorough and beneficial exercise routine can greatly improve one’s quality of life.

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References Bean, J.F., Vora, A., & Frontera, W.R. (2004). Benefits of exercise for community-dwelling older adults. Arch Phys Med Rehabilitation 85(3): 31-42. Berman, A., Snyder, S.J., Kozier, B., & Erb, G. (2008). Fundamentals of nursing: Concepts, process, and practice (8th ed). Upper Saddle River, NJ: Pearson Prentice Hall. Brainy Quote. (2012). Eubie Blake Quotes. Retried from: http://www.brainyquote.com/quotes/quotes/e/eubieblake131780.html Centers for Disease Control and Prevention. (2011). Making physical activity a part of an older adult’s life. Retrieved from: www.cdc.gov/physicalactivity/everyone/getactive/olderadults.html Centers for Disease Control and Prevention. (2012). Chronic disease prevention and health promotion. Retrieved from: http://www.cdc.gov/chronicdisease/overview/index.htm Centers for Disease Control and Prevention. (2012). Falls among older adults: An overview. Retrieved from: http://www.cdc.gov/homeandrecreationalsafety/Falls/adultfalls.html Gregg. E., Pereira, M., & Caspersen, C. (2000). Physical activity, falls, and fractures among older adults: A review of the epidemiological evidence. Journal of the American Geriatrics Society, 48(8), 883-893. Hackstaff, L. (2009). Factors associated with frailty in chronically ill older adults. Social Work in Health Care, 48(8), 798-811. doi:10.1080/00981380903327897 National Academy on an Aging Society. (1999). Chronic conditions: A challenge for the 21st century. Retrieved from: www.agingsociety.org/agingsociety/pdf/chronic.pdf National Council on Aging. (2012). Center for healthy aging. Retrieved from: http://www.ncoa.org/improve-health/center-for-healthy-aging/ Pender, N. J., Murdaugh, C. L., Parsons, M. A., (2006). Health promotion in nursing practice (6th ed.). Upper Saddle River, NJ: Pearson Prentice Hall. Silver Sneakers. (2012). What is the silver sneakers fitness program?. Retrieved from: http://www.silversneakers.com/TellMeEverything/WhatisSilverSneakers.aspx