Sweating with the Oldies: Physical Activity and Successful Aging.

The dramatic increase in human life span over the course of this century has resulted in the greater use of recreation centers by older adults (55 and over) who desire to age well. To offer effective programming for this population, leisure professionals must understand the aging process. Primary aging, the universal and gradual degenerative process, is determined by individual genetics. While factors of secondary aging, which include lifestyle choices and environment, can accelerate genetically determined aging (McGuire, Boyd & Tedrick, 1996).

The primary aging process cannot be altered; therefore, much of the research on aging seeks to identify interventions to lessen the effects of secondary aging factors. Lifestyle changes, such as exercising regularly, are major determinants in increasing life expectancy (Baker & Martin, 1994).

A plethora of research published in recent years espouses the contributions of physical activity to successful aging. Several hundred publications resulted from the Network on Successful Aging, supported by the MacArthur Foundation. In addition, the Journal of Aging and Physical Activity began publishing quarterly in 1993.

And while successful aging is difficult to define, several characteristics have been identified: length of life, biological health, mental health, Cognitive efficacy, social competence and productivity, personal control, and life satisfaction (Baltes & Baltes, 1990). Rowe and Kahn (1997) conceptualize successful aging through three primary components: low probability of disease and disease-related disability, high cognitive and physical functional capacity, and active engagement with life.

Research suggests that physical activity can contribute to each of these areas. Within the scope of this column, a complete review of physical activity and the literature of aging is impossible. Therefore, this "Research Update" will be limited to selected studies that offer greater application to leisure service providers.

The research efforts in physical activity and aging concentrate primarily on the effects of physical activity on biological, cognitive, and psychological aspects of aging. As used in the literature, physical activity refers to "any skeletal muscle activity that would result in a caloric expenditure above resting metabolism" (O'Conner, Aenchbacher & Dishman, 1993). In addition to structured, high-intensity exercise sessions, such as riding a stationary bicycle or walking, low-intensity activities, such as gardening, housework, or golf, also are considered physical activity (O'Conner, Aenchbacher & Dishman, 1993).

Just how much physical activity must one perform for it to be considered beneficial? Regular leisure-time physical activity (LTPA) has been defined by some as participation for a minimum of 30 minutes, at least three times a week, in activities such as walking, swimming, dancing, aerobic exercise, yoga, weightlifting, and bowling (Yusuf et al., 1996). Others suggest that this recommendation is higher than necessary, particularly for individuals who have been inactive, and argue that any activity is better than nothing (Johnson, Boyle & Heller, 1995). The following studies use a variety of measures of physical activity and exercise.

Biological and Cognitive Aspects

Biological change is the most frequently examined aspect of physical activity and aging. Biological aging may result in increased incidence of injury from falls, a decrease in muscular strength, lower cardiovascular fitness, and a greater likelihood of coronary heart disease.

There is significant evidence that regular physical activity can enhance muscle and cardiovascular fitness, exacerbate weight loss and reduce body-fat content, lower blood pressure, and increase glucose tolerance and insulin responsiveness (Baker & Martin, 1994; Fiatarone et al., 1994; Kohrt, Snead, Slatopolsky & Birge, 1995; Yusuf et al., 1996). Even individuals who begin moderate-intensity exercise late in life can experience significant improvements (Yusuf et al., 1996).

Many older adults face loss of mobility as a result of hip fractures. Smith and Tommerup (1995) report that falls account for 90 percent of all hip fractures. These falls typically occur when an older adult trips over an obstacle, such as a rug or electrical cord, and lacks the strength and flexibility to regain balance. This study's findings indicate that exercise can reduce the risk and severity of falls by increasing muscular strength, flexibility, reaction time, and balance.

Improved balance, flexibility, and reaction time also enhance overall motor performance in older adults (Rikli & Edwards, 1991), thus making it possible for individuals to be more active. Exercise, particularly weight-bearing activities such as walking, jogging, and tennis, increases bone quantity and quality, making fractures less likely in the event of a fall (Kohrt et al., 1995; Smith & Tommerup, 1995).

A promising intervention, Tai Chi Chuan has provided general health benefits to participants. Traditionally a martial arts form, more recently it has gained popularity in the United States as a form of exercise. Lai, Lan, Wong, and Teng (1995) recommend it as a conditioning exercise for older people because of its low impact, low velocity, and minimal orthopedic complications. They found that older adults who regularly practiced Tai Chi maintained greater cardiorespiratory function.

In addition, practicing Tai Chi can help participants reduce the likelihood of falling. After 15 weeks of semiweekly Tai Chi sessions, students experienced significantly fewer falls, as well as a reduced fear of falling. They reported that they were able to abort falls through appropriate body maneuvers. And nearly half of the participants continued to meet and practice their Tai Chi after the study concluded (Wolf et al., 1996).

Older participants may also benefit from resistance weight training using simple equipment. Fiatarone et al. (1994) report that even the frail elderly benefit from progressive resistance training of the hip and knee extensors. After 10 weeks of 45-minute sessions, three days a week, participants had improved muscle strength and increased muscle size. This resulted in improved mobility and increased spontaneous physical activity.

The greatest benefit was experienced by those who were initially the weakest. Similar results were reported by Judge, Whipple, and Wolfson (1994) in a study of healthy-community-dwelling older adults. Improvement in leg strength and walking endurance were noted upon completion of three months of resistance training. These gains are valuable to older adults, as walking endurance and leg strength are important components of independent living (Ades, Ballor, Ashikaga, Utton & Nair, 1996).

General exercise programs provide various physical benefits as well. Older women who participated in hour-long exercise sessions enjoyed improvements in lower-limb strength, reaction time, and neuromuscular control. The semiweekly sessions continued for four 10- to 12-week terms and included warm-up, conditioning, stretching, and cool-down time. As a motivational tool, strong emphasis was placed on social interaction and enjoyment (Lord, Ward, Williams & Strudwick, 1995).

There is also substantial evidence that physical activity helps maintain or enhance cognitive functioning -- memory, intelligence, language, and decision-making -- in older adults (McGuire, Boyd & Tedrick, 1996). Changes in cognitive function appear to vary depending upon type and amount of physical activity. Some researchers (Albert et al., 1995) indicate that strenuous physical activity is necessary to maintain cognitive function, while others report that physical activity has no effect (Baker & Martin, 1994). Older adults who engaged in higher levels of strenuous activity -- accomplishing daily chores around the house such as yard work and cleaning -- experienced smaller declines in cognitive performance than those who did not (Albert et al., 1995).

Some research supports the idea that physical activity can enhance cognitive function even for individuals with a history of inactivity. A 16-week walking program generated improved cognitive performance in previously sedentary older participants (Moul, Goldman & Warren, 1995). Similarly, previously inactive older women who engaged in hour-long moderate-intensity exercise classes three times a week for three years improved physical and cognitive performances.

In contrast, a comparable group of women who did not exercise tended to decline in physical and cognitive function (Rikli & Edwards, 1991). Among relatively healthy older adults, higher levels of self-reported physical activity were associated with some cognitive benefits (DiPietro, Seeman, Merrill & Berkman, 1996).

In contrast, Baker and Marfin (1994) indicate that exercise has little or no effect on cognitive performance, and Emery, Huppert, and Schein (1995) suggest that exercise such as walking may have little direct effect on cognitive functioning. However, cognitive functioning may be supported indirectly through overall health benefits that stem from exercise.

Psychological Aspects

Physical activity has been reported to improve psychological well-being among the elderly, and a recent study indicated that depressive symptoms were less frequent among those who engaged in intensive physical exercise, which was defined as "regular activity that caused at least some sweating and breathlessness." These exercisers also reported better health and greater meaningfulness of life (Ruuskanen, & Ruoppila, 1995). Similarly, physically active older women rated their health better than that of inactive women (Gregg, Kriska, Fox & Cauley, 1996).

Physical activity also helps reduce stress in older adults (Zuzanek, Robinson & Iwasaki, 1998). Higher levels of physical activity have been related to quality of life indices and to mental health benefits such as decreased depression and anxiety and enhanced mood and self-efficacy (Rejeski et al., 1996).

In an examination of specific activities, Dupuis and Smale (1995) found that swimmers had higher psychological well-being and lower levels of depressive symptoms than nonswimmers. Those with higher levels of participation experienced greater benefits. Clinically depressed older adults can benefit from physical activity as well. Moore et al. (1999) found that depressed individuals who engaged in higher levels of physical activity had fewer depressive symptoms than those with lower levels of activity.

Implications and Recommendations

In summary, the research consensus appears to be that any activity, regardless of frequency and intensity, is better than no activity at all. Despite past history in physical activity or current level of fitness, becoming more active is beneficial to biological and psychological health. Older individuals who are in good health, have a history of activity, and are knowledgeable about the benefits of exercise are more likely to be active. However, those who eschew the sedentary lifestyle to become physically active experience the greatest benefits. Unfortunately, the majority of older Americans do not engage in any leisure-time physical activity (Yusuf et al., 1996).

It may be fear of injury, lack of perceived competence or experience, fear for personal safety, or a perception that they are "too old" that prevents older adults from participation. Leisure providers can do a number of things to help individuals negotiate these constraints. Understanding the needs and desires of older adults and designing programs to meet specific needs are critical.

A study of older mall walkers revealed four motivating factors that were driving individuals. First, mall walking was perceived as meaningful postretirement work because it provided a structure and routine to the day.

Second, it met a need for socialization, as friendships developed and walking led to mall-walker group dinners and parties. Third, walkers developed a sense of belonging to a community that shared common beliefs and values. Fourth, the enclosed mall environment provided a sense of safety. Programs that are designed with these factors in mind are more likely to attract older participants (Duncan et al., 1995).

Other factors that can contribute to participation include reserving special hours at a facility, providing transportation, holding classes in venues that are easily accessible, and providing instruction by personnel trained in running programs for older people (Lord et al., 1995; Yusuf et al., 1996). As indicated in the mall-walking study, social interaction is an important element for many older adults. Programs that emphasize group activities and opportunities to socialize are more appealing and, therefore, more likely to attract sustained and frequent participation (Duncan et al., 1995; Lord et al., 1995).

If exercise programs are designed with the needs of older participants in mind, continued participation -- even among the previously sedentary -- is more likely. The Duke Exercise and Aging study included a yoga group and an aerobic exercise group. Participants enjoyed the program and perceived substantial increases in their alertness and energy. As a result, most study participants continued their physical activity after the study concluded (Emery, Hauck & Blumenthal, 1999.). Also, Duncan et al. (1995) suggest that record-keeping, tangible rewards, and recognition motivate participants to establish a routine.

A sense of competence is essential. Instruction that enables individuals to participate successfully and confidently will increase involvement. Equipment that accommodates those with less strength or range of motion and provides support and stability presents a more comfortable environment for frailer individuals.

Individuals are more likely to participate if they perceive program intensity to be within their abilities. This is particularly important to remember when dealing with those who have been sedentary. Facilitators and leaders may be tempted to push participants to do more than they can handle. Although benefits increase with heightened activity, the objective is not to develop elite senior athletes. The objective is to increase overall physical activity in older adults.

Leisure professionals must strive to accomplish three major objectives: help older adults understand the contribution of physical activity to their own successful aging, help them identify activities that are enjoyable, and provide opportunities engage in activity at comfortable levels of intensity.

Information about the importance of physical activity should be presented in a positive manner rather than as a warning of the dire consequences of inactivity. High-pressure tactics, particularly when used with the previously sedentary, are not likely to boost participation numbers. Providing services such as leisure education and counseling, introductory classes, no-risk trial participation periods, specific information about the physical demands of programs, and age-integrated and age-segregated options enable older individuals to find activities that match their interests and abilities.

References

Ades, P.A., D.L. Ballor, T. Ashikaga, J.I. Utton, and K.S. Nair. 1996. "Weight training improves walking endurance in healthy elderly persons." Annals of Internal Medicine 124 (6): 568-72.

Albert, M.S., K. Jones, C.R. Savage, L. Berkman, T. Seeman, D. Blazer, and J.W. Rowe. 1995. "Predictors of cognitive change in older persons: MacArthur studies of successful aging." Psychology and Aging 10 (4): 578-89.

Baker, G.T., and G.R. Martin. 1994. "Biological aging and longevity: Underlying mechanisms and potential intervention strategies." Journal of Aging and Physical Activity 2: 304-28.

Baltes, P.B., and M.M. Baltes. 1990. "Psychological perspectives on successful aging: The model of selective optimization with compensation." In P.B. Baltes and M.M. Baltes (eds.) Successful Aging (1-34). Cambridge: Cambridge University Press.

DiPietro, L., T.E. Seeman, S.S Merrill, and L.E Berkman. 1996. "Physical activity and measures of cognitive function in healthy older adults: The MacArthur Study of Success Aging." Journal of Aging and Physical Activity 4 (4): 362-76.

Duncan, H.H., S.S. Travis, and W.J. McAuley. 1995. "An emergent theoretical model for interventions encouraging physical activity (mall walking) among older adults." Journal of Applied Gerontology 14 (1): 64-77.

Dupuis, S.L., and B.J.A. Smale. 1995. "An examination of relationship between psychological well-being and depression and leisure activity participation among older adults." Society and Leisure 18: 67-92.

Emery, C.F., E.R. Hauck, and J.A. Blumenthal. 1992. "Exercise adherence or maintenance among older adults: 1year follow-up study." Psychology and Aging 7 (3): 466-70.

Emery, C.F., F.A. Huppert, and R.L. Schein. 1995. "Relationships among age, exercise, health, and cognitive function in a British sample." The Gerontologist 35 (3): 378-85.

Fiatarone, M.A., E.F. O'Neill, N.D. Ryan, K.M. Clements, G.R. Solares, M.E. Nelson, S.B. Roberts, J.J. Kehayias, L.A. Lipsitz, and W.J. Evans. 1994. "Exercise training and nutritional supplementation for physical frailty in very elderly people." The New England Journal of Medicine 330 (25): 1769-75.

Gregg, E.W., A.M. Kriska, K.M. Fox, and J.A. Cauley. 1996. "Self-rated health and the spectrum of physical activity and physical function in older women." Journal of Aging and Physical Activity 4: 349-61.

Johnson, N.A., C.A. Boyle, and R.F. Heller. 1995. "Leisure-time physical activity and other health behaviours: Are they related?" Australian Journal of Public Health 19 (1): 69-75.

Judge, J.O., R.H. Whipple, and L.I. Wolfson. 1994. "Effects of resistive and balance exercises on isokinetic strength in older persons." Journal of the American Geriatric Society 42: 937-46.

Kohrt, W.M., D.B. Snead, E. Slatopolsky, S.J. Birge. 1995. "Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women." Journal of Bone and Mineral Research 10 (9): 1303-11.

Lai, J., C. Lan, M. Wong, and S. Teng. 1995. "Two-year trends in cardiorespiratory function among older Tai Chi Chuan practitioners and sedentary subjects." Journal of the American Geriatric Society 43: 1222-27.

Lord, S.R., J.A. Ward, P. Williams, and M. Strudwick. 1995. "The effect of a 12-month exercise trial on balance, strength, and falls in older women: A randomized controlled trial." Journal of the American Geriatric Society 43: 1198-1206.

McGuire, F.A., R.K. Boyd, and R.T. Tedrick. 1996. Leisure and aging: Ulyssean riving in later life. Champaign: Sagamore.

Moore, K.A., M.A. Babyak, C.E. Wood, M.A. Napolitano, P. Khatri, W.E. Craighead, S. Herman, R. Krishnan, and J.A. Blumenthal. 1999. "The association between physical activity and depression in older depressed adults." Journal of Aging and Activity7: 55-61.

Moul, J.L., B. Goldman, and B. Warren. 1995. "Physical activity and cognitive performance in the older population." Journal of Aging and Physical Activity 3: 135-45.

O'Conner, P.J., L.E. Aenchbacher, and R.K. Dishman. 1993. "Physical activity and depression in the elderly." Journal of Aging and Physical Activity 1: 34-58.

Rikli, R.E., and D.J. Edwards. 1991. "Effects of a three-year exercise program on motor function and cognitive processing speed in older women." Research Quarterly for Exercise and Sport 62 (1): 61-7.

Rowe, J.W., and R.L. Kahn. 1997. "Successful aging." The Gerontologist 37 (4): 433-40.

Ruuskanen, J., and I. Ruoppila. 1995. "Physical activity and psychological well-being among people aged 65 to 84 years." Age and Ageing 24 (4): 292-96.

Smith, E.L. and L. Tommerup. 1995. "Exercise: A prevention and treatment for osteoporosis and injurious falls in the older adult." Journal of Aging and Physical Activity 3: 178-92.

Wolf, S.L., H.X. Barnhart, N.G. Kutner, E. McNeely, C. Coogler, T. Xu, and the Atlanta FICSIT Group. 1996. "Reducing frailty and falls in older persons: An investigation of Tai Chi and computerized balance training." Journal of the American Geriatric Society 44: 489-97.

Yusuf, H.R., J.B. Croft, W.H. Giles, R.F. Anda, M.L. Casper, C.J. Caspersen, and D.A. Jones. 1996. "Leisure-time physical activity among older adults." Archives of Internal Medicine 156 (12): 1321-26.

Zuzanek, J., J.P. Robinson, and Y. Iwasaki. 1998. "The relationships between stress, health, and physically active leisure as a function of life-cycle." Leisure Sciences 20: 253-75.