5. Physical Activity and Healthy Aging

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• Benefits of Physical Activity
• Costs and Savings Associated with Physical Activity
• Activity Levels of Older Canadians
• Barriers to Participation
• Knowledge Gaps
• Promising Practices
• Directions for Policy and Practice

Benefits of Physical Activity

A solid evidence base supports the positive relationship between regular physical activity and healthy aging. Often called the "elixir" of healthy aging, regular physical activity adds vitality and quality to life. It positively affects functional capacity, mental health, fitness levels, the prevention and management of chronic diseases, and overall well-being (Health Canada, 2002a; Shields and Martel, 2006). Older Canadians who participate in regular physical activity are less likely to experience illness than those who are sedentary, and they are more able to delay some of the declines associated with aging (Colman and Walker, 2004). Engaging in physical activity with others can help seniors make connections and build social networks that promote overall health (Health Canada, 1999).

The benefits of physical activity are cumulative when sustained over time and incorporated into activities of daily living (Shields and Martel, 2006; Health Canada, 2002a). The association between good health and leisure-time physical activity is particularly strong for seniors, even when socioeconomic factors and the number of chronic conditions are taken into account. Data from the Canadian Community Health Survey show that 67 percent of seniors who are active three or more times a week are in good health, compared to 36 percent who are infrequently active. Participating in regular physical activity is also associated with improved odds for staying healthy over time and for recovering from poor health (Shields and Martel, 2006).

Physical activity is associated with improved mental health and psychological functioning in older adults, including self-efficacy-a belief in one's ability to complete a specific task or control one's situation (Mendes de Leon et al, 1996). It may also be an important factor in protecting against anxiety and depression, which can be triggered by the changes and losses people experience in later life (Health Canada, 2002a). While not yet conclusive, there is increasing evidence linking participation in regular physical activity with a decreased likelihood of developing dementia (Larson et al, 2006; Wang et al, 2006).

It is never too late to attain the benefits associated with regular physical activity. With appropriate levels and types of physical activity, older Canadians of all ages and abilities can experience improvements in physical, mental and emotional wellbeing (Health Canada, 1999; Health Canada, 2002a; BC Ministry of Health, 2005; Shields and Martel 2006).

Costs and Savings Associated with Physical Activity

Physical inactivity represents a critical cost burden in Canada, estimated at $5.3 million (Canadian Fitness and Lifestyle Research Institute (CFLRI), 2004; Katzmarzyk et al, 2000). Even modest reductions in inactivity levels could result in substantial cost savings. For example, a 10 percent reduction in the prevalence of physical inactivity has the potential to reduce direct health care expenditures by $150 million a year (Katzmarzyk et al, 2000).

Seniors with chronic illnesses and injuries are the highest users of health care and most likely to have long stays in hospital (Rotermann, 2006). Enabling and encouraging increased physical activity among this population group may be one of the most effective ways of preventing and lowering the high costs associated with acute health care services. Investing in age-friendly environments that support physical activity and active living will also enable seniors to continue to make important contributions to society and the economy.

Activity Levels of Older Canadians

Despite the remarkable benefits of regular physical activity to aging, older adults are the most inactive segment of the Canadian population (see Figure 5.1). Almost twothirds (65 percent) do not engage in sufficient levels of physical activity to maintain or improve health (CFLRI, 2004). However, it is instructive to look more specifically at the differences in age groups and between men and women. Among women there is a dramatic decline in the percentage that are physically active and moderately active after age 65, and a significant increase in the rates of inactivity. Among men, the pattern is somewhat different. Senior men aged 65 to 74 are just as (or more) likely to be physically active or moderately active than younger adult males. Significant declines in activity levels and increases in inactivity only begin at age 75 and over.

Figure 5.1 Physical Activity by Age Group and Sex, Household Population, 2005

Note: "Active" = physically active and moderately active
Source: Statistics Canada, Canadian Community Health Survey (2005b)

There are strong regional differences in physical activity levels among seniors (data not shown). The highest rates of physical inactivity are in Prince Edward Island (59 percent); the lowest rates of inactivity are in British Columbia (42 percent) (CFLRI, 2004).

Some specific high-risk and hard-to-reach groups are particularly vulnerable to physical inactivity and the associated risks for health and well-being. Gender is an important factor: as shown in Figure 5.1, senior women are consistently less active than older men. Other vulnerable groups include seniors over age 80, seniors with low incomes and/or low education levels, seniors with disabilities and/or chronic health conditions, seniors who live in institutions or in isolation, and seniors who are members of ethnocultural and ethnolinguistic minority population groups (Health Canada, 2002a).

Barriers to Participation

Seniors report that some of the major barriers to participating in physical activity include fear of injury, illness, disability and pain, lack of energy, motivation, skill and time, feeling ill at ease, inadequate facilities, excessive cost and lack of safe places (CFLRI, 1995). All of these factors influence one's choice to remain inactive or to become and stay active.

Other examples of barriers that have been identified by leaders in the field include:

• Weather: Long cold winters and icy surfaces make it difficult for older people to walk and resume activity out-of-doors. High levels of smog on hot summer days pose a significant risk to health and life, particularly for older people who have chronic respiratory problems.
• Inadequate support: Health professionals may not have the time, expertise or resources to address physical inactivity among their older patients.
• Caregiving responsibilities: Caring for children or a relative who is ill can restrict older people's time and ability to participate in physical activities outside the home (especially older women).

Knowledge Gaps

There is plentiful evidence supporting the positive effects of physical activity on aging. However, community-based, solution-oriented research is lacking. This type of investigation puts an innovative intervention in place (e.g., free stationary bicycles or tai chi programs in malls), documents the efficacy of the intervention, and analyses how the results may influence policies and programs that are needed to encourage an increase in physical activity levels among older adults. There is also a need for cost saving data related to seniors' participation in physical activity.

While the relationship between social inequities, barriers and involvement in physical activity is recognized, there is a need to better understand the processes underlying these inequities and how public policies can overcome them (Spence et al, 2001; O'Brien Cousins, 2005). Of particular concern is the dramatic increase in inactivity among women after they reach age 65. There is a need to determine if this is primarily due to high rates of mobility problems and pain linked to musculoskeletal conditions such as arthritis and osteoporosis, or to other factors.

Promising Practices

While personal attitudes and motivation are important, supportive social and physical environments play a major role in enabling seniors to integrate physical activity into their daily lives (Health Canada 2002a; Active Living Coalition for Older Adults (ALCOA), 1999). Research has identified a number of key strategies for enabling older Canadians to be more active. Most notable is the success associated with comprehensive approaches that incorporate education and awareness raising, community-based initiatives and home-based interventions (Health Canada, 2002a; King et al, 1998). In other words, instead of focusing solely on the individual, it is better to intervene at multiple levels in a variety of settings. This approach recognizes that physical activity is influenced by many factors, including individual dispositions, culture, family support, community programs, climate, and physical environments (Spence et al, 2001; Craig et al, 2004).

It has been suggested that regular, moderate activity such as walking and gardening is the most important thing seniors can do to maintain mobility and prevent disability (Lacroix et al, 1993; Leveille et al, 1999). Some immediate ways to begin improving opportunities for these activities is by improving pedestrian safety and providing raised neighbourhood garden plots for seniors and others with disabilities.

Directions for Policy and Practice

The evidence implies that policies and practices to encourage and enable physical activity among older adults in both community and institutional settings need to:

• Use multi-pronged approaches that incorporate education and awareness raising, community-based initiatives and home-based interventions
• Focus on and evaluate solution-oriented changes in the physical and social environments
• Promote positive, safe and inclusive environments, minimize barriers, and increase choices and opportunities to participate in age- and activity-friendly environments
• Increase efforts to involve older adults with disabilities and chronic illnesses in appropriate physical activity. This will require a stronger role by health professionals
• Adopt Pan-Canadian targets for increasing physical activity levels and reducing inactivity levels among senior women and men in different age groups, and put mechanisms in place to achieve these targets
• Stress the mental and social as well as physical benefits of physical activity in later life, and the association of physical activity with maintaining health over the years

Physical activity is a cornerstone of healthy aging. The challenge and the opportunity are to make it more accessible and attractive to older Canadians of all ages, abilities and interests.

 

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