Ever heard these statements before?
"I am getting older, my knees are starting to hurt every time I try to exercise so I have decided it would better to stop exercising."
"This exercise is for younger people, not me. I used to be more active but now that I am older, this kind of exercises are too intense for me."
"I do low intensity exercise nowadays. It's gentler on my joints and my doctor recommended that I should not do high impact exercises anymore as I am getting older."
Do you think that older people should avoid exercising?
YES
NO
In the context of Singapore, the healthcare system is gearing up to cope with what is to referred to as the 'Silver Tsunami' - the increase in the elder segment of the population.
The layperson is much more familiar with the medical side of health. That is to be aware of conditions like having high blood sugar levels (diabetes), having high cholesterol (hyperlipidemia), and having high blood pressure (hypertension). This is so common in patients admitted to the hospitals in Singapore that they are given an abbreviated expression: 'The 3 Highs' or '三高' in Chinese.
However, what is lesser known, is the physical or functional aspect of health. Is it true that exercises have an expiry date? Best before but not great after a certain age? Or is it true that there is such a thing as the 'best' exercise? And how do I really know an exercise is good for me?
The answers to the above questions are that exercises are highly personalised and need to be tuned to the individual based on a myriad of factors including lifestyle, genetic predispositions, environment, diet, and so and so forth. The whole laundry list of factors is simply too complex to list in an article such as this, but hopefully this gets you thinking about moving in your best way to live your best life.
Exercising in older adults: what do the research say?
The belief that a certain age limits one's ability to exercise is a common misconception. Research and clinical evidence support that people of all ages can and should engage in physical activity, with appropriate modifications to suit individual capabilities and health conditions.
A meta-analysis conducted on the effects of exercise and older adults revealed interesting insights. (A meta-analysis is a type of research study that aggregates the data across individual journals, and compiles the results to draw evidence-based conclusions).
Di Lorito, C., Long, A., Byrne, A., Harwood, R. H., Gladman, J. R., Schneider, S., Logan, P., Bosco, A., & Van Der Wardt, V. (2021). Exercise interventions for older adults: A systematic review of meta-analyses. Journal of Sport and Health Science/Journal of Sport and Health Science, 10(1), 29–47. https://doi.org/10.1016/j.jshs.2020.06.003
56 peer-reviewed journal articles, which have been screened from databases including CINAHL, Embase, MEDLINE etc. have been selected for the study.
The study included older adults, with a mean age of 75 years, both men and women, with:
physical health problems (including reduced physical capacity and frailty)
older adults with cognitive impairment and/or dementia
older adults with mood disorders (such as depression)
and post menopausal women
The study looked at what kind of interventions (exercise programs) would be helpful for older adults, and specifically in which aspects of their function.
The findings of the study under their respective domains, are as such:
Physical Functioning and Health
Muscle Strength: Exercise, especially resistance training, improves muscle strength in older adults. Supervised training and nutritional supplements, like vitamin D3 and protein, further enhance these gains.
Balance and Gait: Multimodal exercises improve balance and gait speed. Supervision of rehab show additional benefits.
Long-Term Benefits: Short-term exercise benefits often diminish over time, though some improvements, like increased exercise time and walking distance, can last up to six months post-intervention.
Falls, Injuries and Mortality
Falls Reduction: Exercise reduces falls in both community-dwelling and institutionalized older adults. Multimodal exercises and combining exercise with home visits or risk assessments are particularly effective.
Injury and Hospitalization: Exercise decreases injuries and hospitalizations due to falls but has no significant effect on mortality.
Independence and Quality of Life
Activities of Daily Living (ADLs): Exercise enhances ADL independence in older adults, especially those in residential care or with frailty.
Quality of Life: Exercise generally does not significantly improve quality of life, except for specific activities like whole-body vibration.
Sleep and Social Participation: Meditative movement improves sleep quality more than traditional therapies. Exercise combined with other components enhances societal participation.
Cognitive functioning
Cognitive Benefits: Exercise, particularly when done regularly and in groups, shows some cognitive benefits, such as improved executive attention and reduced dementia risk.
Biological Markers: Aerobic and strength training can increase brain-derived neurotrophic factor concentrations, supporting cognitive health.
Mood improvement: Cardiovascular and resistance training improve mood and reduce depression, especially when supervised. Mind-body exercises like Tai Chi also show significant benefits in reducing depressive symptoms.
Bone density and muscular strength
Bone Density: Exercise has mixed effects on bone density, with some improvements seen in the lumbar spine.
Muscle Mass: Combined exercise and protein supplementation improve muscle mass, particularly in older adults with sarcopenia.
In short, exercise in older adults have improvements in strength, quality of life, cognitive function, bone density as well as reducing the risk of death.
But what is the catch?
The catch, as alluded to before at the start of this article, is that exercises have to be personalised and goal oriented to be effective to see results.
Certain exercises that might be safe for others might not be safe for everyone to do. This assessment has to be done by a trained professional, preferably with accreditations, to minimise injury risk. People at different time points of their lives also require specific training.
Consider these scenarios:
New mum who has given birth 1 year ago and is looking to get back to work and fitness
Professional league football player coming out of a recurrent ankle sprain and is keen to return to high level sport
Office worker who is now planning to do a marathon in 6 months, but would like his neck pain to be treated first
Retiree who wants to be able to have the energy and strength to carry his/her grandkids
As illustrated, these people would have drastically different training programmes as their function and goals might be different. Engaging in regular physical activity is not only a key to physical vitality but also a cornerstone of mental and emotional well-being, making it an essential practice for older adults seeking to enhance their quality of life. If in doubt, do consult your healthcare professionals before starting an exercise programme!
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