Exercise for Healthy Ageing

By Annina Whipp, Registered Dietitian and Personal Trainer 

Healthy Ageing Month 

September is ‘Health Ageing Month’. The World Health Organization defines healthy ageing as the maintenance of both mental and physical capacity¹. With nearly 12 million people aged 65 and over living in the UK, the preservation of health and function in older age is an important challenge for healthcare professionals². There is growing evidence to support the use of physical activity interventions to improve the health outcomes of older people³.  

The Benefits of Exercise 

Older adults who participate in physical activity obtain health benefits including reduced risk of falls, alongside improved physical function and cognition⁴. 

Body composition changes with age. Longitudinal studies have shown that from the age of 75 years, muscle mass is lost at a rate of  0.64–0.70% per year in females and 0.80–00.98% per year in males. Strength is lost 2–5 times faster than muscle mass and is an indicator of poor health outcomes⁵. Regular resistance training is an effective way of preserving functional strength and muscle mass in older adults⁶. 

Nutritional status should not be a barrier to physical activity. A systematic review reported improvements in muscle strength in older adults with malnutrition when regular exercise was combined with oral nutritional support, although this was low quality evidence⁷. It does, however, suggest that physical activity should be encouraged in malnourished older adults, providing their diet contains adequate amounts of energy and protein.   

Guidelines for Exercise in Older People  

Current government guidelines encourage adults aged 65 and over to⁸:

• Aim to be physically active every day. Any activity is better than none, however the more that is done, the better the health effects.   
• Participate in resistance-based activities that improve  strength, balance and flexibility on at least 2 days a week. 
• Aim to do at least 150 minutes of  moderate intensity activity a week or 75 minutes of  vigorous intensity activity if you are already active, or a combination of both. 
• Limit time spent sitting or lying down and break up long periods of not moving with some activity.  

Ways to Help Older People Exercise 

Older people should be encouraged to participate in a form of daily activity which increases their rate of breathing, according to what they can manage. 

Examples of Cardiovascular Activity  

Examples of Resistance-based Activity

Resistance activity strengthens muscles using body weight or working against a resistance and should involve all the major muscle groups. 

• Carrying or moving heavy loads, for example groceries. 
• Any activity which involves jumping or stepping, for example dancing. 
• Yoga, Pilates, TiChi 
• Wall press, bicep curl, tricep press, chest press, overhead press(depending on fitness, omit weight or use light weight, household object or resistance band). 
• Squats, sit to stand, lunges and leg presses(depending on fitness, omit weight or use light weight, household object or resistance band). 

These exercises should be encouraged on at least two days each week and should be repeated until a short rest is needed⁸.  

Nutritional Considerations When Exercising inOlder Age 

It is important to provide older people with adequate energy, protein, micronutrients and fluid to maintain optimal nutritional status.  Age-associated changes in body composition results in reduced energy requirements⁹. However, energy utilised during physical activity needs to be replaced through the diet to prevent unintentional weight loss and muscle wasting. This is particularly important in malnourished individuals.  

Older people should aim to have 1g protein per kg body weight per day for preservation of muscle mass and function. The amount should be adjusted in view of individual nutritional status, physical activity level and disease status. To maintain adequate hydration, older people should have between 1.6 - 2L of fluid each day⁹. 

To maximise energy levels, it may be beneficial for an older person to have a snack or light meal 2-3 hours prior to starting physical activity¹⁰. 

Examples include:  

• Crumpet with sliced banana 
• Bowl of cereal with chopped fruit and milk 
• Fruit smoothie 
• Small bowl of pasta with tomato-based sauce and cheese 
• Cereal bar  

To help muscle repair and recovery post exercise, encourage older people to have a small snack or meal containing carbohydrate and protein within 60 minutes of activity¹⁰. 

Examples include: 

• 250g Greek yoghurt with fruit salad 
• Small tin of tuna in a pitta  
• Chicken and salad roll 
• Bowl of muesli with yoghurt 
• 300-500mls milk with flavouring (nesquik powder). 
• High energy, high protein, over the counter milkshake-style drinks such as  AYMES Retail are an effective way of refuelling post exercise, particularly if appetite is poor.   

It is never too late to start feeling the health effects of regular physical activity. For further help and support please visit the resources below. 

Age UK  

Many local Age UK centres run activity classes tailored for older people. 

Get Active 

Hosts live and online fitness classes that are focused at older people and with chronic conditions. 

National Institute on Aging 

Offers workout information and fitness tips for older people. 

NHS Exercises videos 

Instructor-led online videos endorsed by the NHS. Includes aerobics, strength and resistance exercise classes.

References: 

1. Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The World report on ageing and health: A policy framework for healthy ageing. Vol. 387, The Lancet;. 2016.pp2145–54. Available from: http://www.thelancet.com/article/S0140673615005164/fulltext

2.  Demographics of an Ageing Population. Available from:https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/later_life_uk_factsheet.pdf

3.  Izquierdo M, Morley JE, Lucia A. Exercise in people over 85. Vol. 368, The BMJ. 2020. Available from:http://group.bmj.com/group/rights-licensing/

4. García-Hermoso A, Ramirez-Vélez R, Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Valenzuela PL, et al. Safety and Effectiveness of Long-Term Exercise Interventions in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Vol. 50, Sports Medicine. Springer; 2020. pp. 1095–106. Available from:https://link.springer.com/article/10.1007/s40279-020-01259-y

5. Mitchell WK, Williams J, Atherton P, Larvin M, Lund J, Narici M. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Vol. 3 JUL, Frontiers in Physiology. Frontiers Media SA; 2012. Available from: /pmc/articles/PMC3429036/?report=abstract

6. Vikberg S, Sörlén N, Brandén L, Johansson J, Nordström A, Hult A, et al. Effects of Resistance Training on Functional Strength and Muscle Mass in 70-Year-Old Individuals With Pre-sarcopenia: A Randomized Controlled Trial. Journal of the American Medical Directors Association. 2019;20(1):28–34.  

7. Wright J, Baldwin C. Oral nutritional support with or without exercise in the management of malnutrition in nutritionally vulnerable older people: A systematic review and meta-analysis. Clinical Nutrition. 2018;37(6):1879–91. Available from:https://pubmed.ncbi.nlm.nih.gov/28969866/

8. UK Chief Medical Officers’ Physical Activity Guidelines. 2019.  Available from:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf.

9. Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al. ESPEN Guideline ESPEN guideline on clinical nutrition and hydration in geriatrics. 2018; Available from:https://www.sciencedirect.com/science/article/pii/S0261561418302103

10. British Dietetic Association. Sport and exercise. Available from:https://www.bda.uk.com/resource/sport-exercise-nutrition.html