Promoting Physical Activity with

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• Promoting Physical Activity with
• Older People
• A Guide to Leading Edge Practice
• Seminar programme - Spring 2008

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• Themes and content of the programme
• Update on evidence
• BHF NC Guidelines on older people and physical
  activity
• Active for Later Life resource
• Policy and partnerships

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• Why Leading Edge Practice ?
• In the last few years older people and physical
  activity has begun to move up the agenda but ..
• We need to move from innovation and short termism
  to sustained activities and opportunities by
  implementing effective interventions and
  programmes

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Whats an older person ?

• Age is often an unhelpful indicator
• What models are there ?
• Motivation
• Function and health

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Older people - who are we working with ?
Physically fit
Physically unfit
Physically unfit frail
Group 1
Healthy
Unhealthy independent
Group 2
Unhealthy dependent
Group 3

• (World Health Organization, 1997)

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Fit as a Butchers Dog (Age Concern
2006)
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Spirduso W. (1995)
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Who should we target - Working
with different Older People

• Those Entering Old Age
• Making Activity Choices
• Those in the Transitional Phase
• Increasing the Circle of Life
• Frail Elderly People
• Moving in the Later Years
• (DOH 2001 BHF 2007)
• We all age, but we all age differently

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1. The opportunity to make activity choices

• Those entering old age
• Previous experiences (e.g. school and sport) may
  be very positive
• Will make demands upon service providers
• Avoiding stereotypes
• Looking for adventure, learning and challenge
• Exercise and fitness as a growth area
• The Boomers ?

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What do we know about the Boomers ?

• Trends - SKI-ing (Spending Kids Income)
• Time of much change (life events)
• Trying new things (technology) and experiences
• Redefining retirement
• Luxury, spas, therapies, green and organic
  products
• Access to nature and the environment important
• 61 women would work out more with someone to go
  with

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SWELLS
(Sixty, Well Off and Enjoying Later Life)

• They enjoy disposable time and income
  - but we are competing - with
  new roles
• Grand parenting
• Voluntary work
• Internet and lifelong learning
• 2nd careers
• Saga Travel lifestyles
• (Age Concern 2004)

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Economic trends Wealthier - healthier
generations ?

• 50 is a society of two halves
  the health/wealth
  gap is widening
• 50 spend 240 B per annum 40 of total
  consumer spending and a personal disposable
  income of 205 per week.
• 50 65s spend 2,761 per annum on leisure, under
  30s - 1,679
• But - 31 of those retired survive on less than
  10 K a year.
• (Family Expenditure Survey 1999 2000)

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2. Increasing the Circle of Life

• Those in the Transitional Phase
• From independence to dependence
• Coming into contact with a variety of services
• Spiral of inactivity and decline setting in
• Supported by over caring ? services
• A captured but not captive audience
• Skills of front line staff critical

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The Sit to Stand - The key to independence

• Strength balance and power
• Daily activities such as the displacement of
  body weight during walking or getting up from a
  chair require power rather than strength alone.
  
• The ability to perform activities of daily living
  is therefore related to muscle power.

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3. Moving in the Later Years

• Frailer, older people
• The new and fastest growing generation
• Small proportion in nursing and care.
• Most at home
• Increased prevalence of disease and frailty
• Do we have low expectations of them ?
• Fear and skills factor

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Functional decline and frailty
How active are older people?

• (Spirduso, 1995)

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Inactivity the consequencesProportion of women
aged 70 able to walk for different periods of
time and lengths of walk,
100
1/4 of a mile or more
80
30 min
60
15,
5,
40

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0
70-74
75-79
80
80
70-74
75-79
Age
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Why ? evidence linked to Independence and
problems encountered with physical tasks

• Walking 200 metres
• Climbing 12 stairs
• Picking up items from the floor
• Getting in and out of a chair
• Getting in and out of bed
• Dressing and undressing
• (Kings College 2006)
• (in private households and care homes)

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Reducing the complications of immobility
The benefits of physical activity for older people

• Deep vein thrombosis
• Gravitational oedema
• Intermittent claudication
• Contractures
• Pressure sores
• Faecal impaction
• Effects apparent even among those taking up
• activity at a later age. Movement can be
• passive and aided.

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Strength training 85

• Programmes involving 2-3 sessions per
• week with loads greater than 65 of 1RM (1RM
• the one-repetition maximum, or the load that can
• be lifted once only) have produced significant
• improvements in muscle strength in older people.
• Older people have similar gains in relative
  muscle
• strength to those observed in young adults.
• (Fiatarone et al. High-intensity strength
  training in nonagenarians. Effects on
  skeletal muscle. Journal of the American Medical
  Association 1990 263 3029-3034).

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Who should we target ? Working
with different Older People

• Those Entering Old Age
• Making Activity Choices
• Those in the Transitional Phase
• Increasing the Circle of Life
• Frail Elderly People
• Moving in the Later Years
• Further information on needs and programming
  Section 5 of the Active for Later Life Resource
• www.bhfactive.org.uk