Fit for Life: Promoting Physical Fitness for Older Adults

1. Fit for Life: Promoting Physical Fitness for Older Adults David M. Morris, PT, PhD Professor and Vice Chair Department of Physical Therapy University of Alabama at Birmingham

2. Session Objectives • Describe the health benefits that have been shown to be associated with exercise. • Discuss established exercise guidelines for exercise for older adults. • Describe evidenced based programs that promote physical fitness for older adults. • Locate and utilize resources that assist health care professionals to promote physical fitness with their older adult consumers.

3. Plan for today • The language of physical fitness • Why physical fitness is important • Physical activity guidelines • Are Americans meeting these guidelines? • Knowing if an older adult is ready to initiate a physical fitness program • Behavior change issues • Evidenced based programs • Resources

4. Health and Human Services: Physical Activity Guidelines • Physical fitness includes a number of components consisting of cardiorespiratory endurance (aerobic power), skeletal muscle endurance, skeletal muscle strength, skeletal muscle power, flexibility, balance, speed of movement, reaction time, and body composition.

5. Physical Activity • Any bodily movement produced by the contraction of skeletal muscle that increases energy expenditure above a basal level. • Occupational • Leisure • Transportation Physical Activity Guidelines Advisory Committee Report. Washington, DC: US Department of Health and Human Services, 2008

6. Exercise • A subcategory of physical activity that is “planned, structured, and repetitive and purposive in the sense that the improvement or maintenance of one of more components of physical fitness is the objective.”

7. Benefits: Moderate Evidence • A lower risk of hip fracture • Lung cancer • Endometrial cancer • Weight maintenance after weight loss • Increased bone density • Improved sleep quality

8. Benefits: Moderate to Strong Evidence • Better functional health (for older adults) • Reduced abdominal obesity

9. Benefits: Strong Evidence • A lower risk of: • Early death • Coronary heart disease • Stroke • High blood pressure • Adverse blood lipid profile • Type II Diabetes • Metabolic syndrome

10. Benefits: Strong Evidence • A lower risk of: • Colon Cancer • Breast Cancer • In addition to: • Weight loss, particularly when combined with reduced caloric intake • Improved cardiorespiratory fitness & muscular fitness • Prevention of falls • Reduced depression • Better cognitive function in older adults

11. Physical Activity Guidelines • HHS Physical Activity Guidelines • American College of Sports Medicine (ACSM)/ American Heart Association (AHA) • Australian Guidelines • World Confederation for Physical Therapy (WCPT) • World Health Organization (WHO) • APTA Physical Fitness for Special Populations (PFSP) Pocket Guides

12. Physical Activity Guidelines for Americans (HHS) • Methodology established first • All research rated based on pre-established methodology • All recommendations rated based on pre-established methodology

13. Physical Activity Guidelines for Americans (HHS) • Older adults need at least: • Aerobic exercise: • 2 hrs 30 min at moderate intensity OR • 1 hr 15 minutes or vigorous intensity OR • An equivalent mix of moderate and vigorous intensity AND • Muscle strengthening on 2 or more days/week that work all major muscle groups

14. Physical Activity Guidelines for Americans (HHS) • Older adults get even greater benefits from: • Aerobic exercise: • 5 hrs at moderate intensity OR • 2 hrs 30 minutes or vigorous intensity OR • An equivalent mix of moderate and vigorous intensity AND • Muscle strengthening on 2 or more days/week that work all major muscle groups

15. Physical Activity Guidelines for Americans (HHS) • Intensity - How hard* is your body working? • Moderate activity = 5 or 6 • Vigorous activity = 7 or 8 * On a 10-point scale – “0” is sitting AND “10” is working as hard as you can.

16. WHO

17. WHO and WCPT • Adults (18-65 years old) • 30 minutes of moderate-intensity physical activity 5 days per week; OR • 20 minutes of vigorous-intensity physical activity 3 days per week; OR • An equivalent combination of moderate- vigorous intensity physical activity; AND • 8-10 muscular strengthening exercises (8-12 repetitions) at least 2 days per week.

18. WHO and WCPT • Adults (65 years and older) • same recommendations as described for adults (outlined previously) with due consideration for the intensity and type of physical activity appropriate for older people; AND • exercises to maintain flexibility; AND • balance exercises

19. How are we Doing? • Less than half (48%) of US adults meet the PA guidelines • Racial disparities • Non-Hispanic white adults (22.8%) • Non-Hispanic black adults (17.3%) • Hispanic adults (14.4%) • Men (52.1%) more likely than women (42.6%) to meet the 2008 PAG for aerobic activity • Younger adults are more likely than older adults • Income level above poverty level more likely than below

20. How are we doing?: 2008 Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive

21. Are You Ready for Exercise? • Physical Activity Readiness Questionnaire (PARQ) • Has your doctor ever said that you have a heart condition and that you should only do PA recommended by your doctor? • Do you feel pain in your chest when you do PA? • In the past month, have you had chest pain when you were not doing PA? • Do you lose your balance because of dizziness or do you ever lose consciousness

22. Are You Ready for Exercise? Cont… • Do you have a bone or joint problem that could be made worse by a change in your PA? • Is your doctor currently prescribing drugs for your blood pressure or heart condition? • Do you know of any other reason why you should not do PA? If you answered yes to one or more questions, see your doctor before you start becoming more PA.

23. Why do people change their behavior? What we know and think influences our behavior. But Knowledge is not sufficient to produce behavior change. • People change when: • THEY have a perceived need to change. • THEY are ready to change. • THEY have the necessary knowledge, skill and tools. • THEY have a supportive environment.

24. Particularly Important for PA and Older Adults • Increasing Self-efficacy • Readiness to change • Overcoming barriers

25. Self Efficacy • The level of confidence individuals have in their ability to perform a certain behavior (Bandura, 1997) • Influences: • Choice of behaviors • How much effort a person will expend • How long they will persevere • How resilient in the face of setbacks • How much stress and anxiety they will experience • Motivation

26. Measuring Self Efficacy Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or any other activity in which the exertion is at least as intense as these activities. Scale 1 = not at all confident, 2 = slightly confident, 3 = moderately confident, 4 = very confident 5 - extremely confident

27. Improving Self Efficacy

28. Stages of Change

29. Physical Activity Stages of Change • B. Marcus and L. Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL: Human Kinetics) • Instructions: • For each of the following questions, please circle Yes or No. Please be sure to read the questions carefully • Physical activity or exercise includes activities such as walking briskly, jogging, bicycling, swimming, or any other activity in which the exertion is at least as intense as these activities.

30. From B. Marcus and L Forsyth, 2009, Motivating people to be physically active, 2nd ed. (Champaign, IL: Human Kinetics). Physical Activity Stages of ChangeQuestions

31. Physical Activity Stages of ChangeScoring Algorithm • If (question 1 = 0 and question 2 = 0) stage 1 • If (question 1 = 0 and question 2 = 1) stage 2 • If (question 1 = 1 and question 3 = 0) stage 3 • If (quest. 1 = 1, quest. 3 = 1 & quest. 4 = 0 ) stage 4 • If (quest. 1 = 1, quest. 3 = 1 & quest. 4 = 1 ) stage 5

32. Stages of Change

33. Process of Change

34. Process of Change

35. Barriers to Exercise (Sallis and Hovell, 1990; Sallis et al., 1992; McCormack et al., 2003) • Do not have time • Find it inconvenient • Lack self-motivation • Find exercise boring • Lack confidence (low self-efficacy) • Instructors don’t understand needs • Stereotypical images of aging • Poor health • Fear of injury • Lack of self-management skills • Lack of encouragement, support, companionship • Transportation and access issues • Cost

36. Selected Evidence Based Physical Activity Programs for Older Adults

37. Active Living Every Day (ALED)

38. EnhanceFitness

39. Fit and Strong!

40. Geri-Fit Strength Training Workout

41. Healthy Moves for Aging Well

42. Walk with Ease

43. Helpful Resources

44. Centers for Disease Control and Prevention here • Consumer information • Varied formats including videos • Selecting PA • Measuring PA • Success stories • Resources for health professionals • Facts • Handouts • Social media tools

45. Go4Life here • National Institute on Aging • Consumer information: • Getting started • Staying active • Resources • Information for: • Consumers • Family and friends • Organizations • Health professionals • Success stories • E-news and Twitter feed

46. Exercise is Medicine here • Coordinated by the American College of Sports Medicine • Vision: • “Make physical activity and exercise a standard part of global disease prevention and treatment medical paradigm.” • “All health care providers consider physical activity as a vital sign in every patient”

47. Lakeshore Foundation here • Available to people with physical disabilities and chronic health conditions AND Anyone age 60 and older!

48. Human Kinetics PA Intervention Series

49. Your Professional Organization • American Physical Therapy Association here • Positions and Policies • Podcasts and continuing educaio • Physical Fitness for Special Populations • Examination Strategies

50. Summary • Our physical activity should not decrease as we age…we should actually do more! • Promoting physical activity is the responsibility of the entire health care team • Merely knowing that one should be physically active is not enough…they must be ready, motivated, and confident • Many great resources exist for health professionals to integrate physical fitness promotion into their clinical practice.