Exercise Prescriptions in Older Adults

 

Regular physical activity and exercise are important for healthy aging and are beneficial for chronic disease management. Exercise prescriptions for older adults should account for the individual's health status and functional capacity. Any amount of exercise is better than being sedentary, even if health status prevents a person from achieving recommended goals. For most health outcomes, more benefits occur with physical activity performed at higher intensity, greater frequency, or longer duration. Guidelines recommend at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity and at least two days of muscle-strengthening activities per week. Key components of the prescription include setting achievable activity goals, identifying barriers and providing potential solutions, and providing specific recommendations on the type, frequency, and intensity of activities. Older adults will derive distinct benefits from aerobic exercise, strength or resistance training, flexibility or stretching exercises, and balance training. Many community resources are available to help older adults begin a more active lifestyle.

The benefits of regular physical activity and exercise on general health and overall quality of life in older adults are well established,1 and these benefits are particularly salient among patients with chronic medical conditions such as osteoarthritis or cardiovascular disease (CVD).2 However, in 2013, more than 33% of adults 65 years or older reported no leisure-time physical activities.1 Only 16% of older adults met national guideline recommendations for physical activity, which are at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity and two or more days of muscle-strengthening activities per week.1 Barriers to exercise include a lack of knowledge, lack of motivation, and poor health.2

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

For older adults, any physical activity is better than being sedentary. Reducing sedentary time has cardiovascular, metabolic, and functional benefits.

B

10, 11, 14, 16, 24

Resistance training preserves muscle strength and physical functioning in older adults.

A

21, 22

To promote and maintain health, older adults should aim for at least 150 minutes of moderate-intensity aerobic activity and two or more days of resistance training per week.

B

21, 24, 30

Flexibility exercises improve and maintain joint range of movement in older adults.

C

24

Balance exercises (e.g., tai chi, yoga) can improve or maintain physical function and reduce falls in older adults at risk of falling.

A

20, 25

Physical activity decreases the risk of chronic diseases and enhances treatment.

B

14, 16, 24, 38


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

For older adults, any physical activity is better than being sedentary. Reducing sedentary time has cardiovascular, metabolic, and functional benefits.

B

10, 11, 14, 16, 24

Resistance training preserves muscle strength and physical functioning in older adults.

A

21, 22

To promote and maintain health, older adults should aim for at least 150 minutes of moderate-intensity aerobic activity and two or more days of resistance training per week.

B

21, 24, 30

Flexibility exercises improve and maintain joint range of movement in older adults.

C

24

Balance exercises (e.g., tai chi, yoga) can improve or maintain physical function and reduce falls in older adults at risk of falling.

A

20, 25

Physical activity decreases the risk of chronic diseases and enhances treatment.

B

14, 16, 24, 38


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

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BEST PRACTICES IN GERIATRIC MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not prescribe underdosed strength training programs for older adults. Instead, match the frequency, intensity, and duration of exercise to the individual's abilities and goals.

American Physical Therapy Association


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN GERIATRIC MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not prescribe

The Authors

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PEARL GUOZHU LEE, MD, MS, is an assistant professor in the Department of Internal Medicine, Division of Geriatric and Palliative Medicine, at the University of Michigan School of Medicine in Ann Arbor....

ELIZABETH A. JACKSON, MD, MPH, is an associate professor in the Department of Internal Medicine, Division of Cardiovascular Medicine, at the University of Michigan School of Medicine.

CAROLINE R. RICHARDSON, MD, is a professor and associate chair for research programs in the Department of Family Medicine at the University of Michigan School of Medicine.

Address correspondence to Pearl Guozhu Lee, MD, MS, University of Michigan School of Medicine, 2215 Fuller Rd., 11G, Ann Arbor, MI (e-mail: pearllee@med.umich.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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