Physical activity for older adults

This is an English summary of the Danish report: Fysisk aktivitet for ældre (+65 år) 

'Physical activity for older adults (65+-years) – knowledge about prevention and health benefits' presents the evidence on the association between physical activity, sedentary behaviour and health among adults aged 65 years or older. The report includes scientific literature from the Danish Health Authority (Sundhedsstyrelsen) and international systematic reviews conducted by research institutions and authorities from various countries: World Health Organization, USA, and Canada.

In the report the level of the evidence is described as strong, moderate, low, very low or insufficient. The indicated levels of evidence are based on the assessment made in the literature reviews that form the basis of the report. In these literature reviews, the level of evidence is based on an evaluation of the amount and quality of research in the area and whether there is consistency in the results of the studies. Strong evidence indicates great confidence in the observed relationship between physical activity and a given health outcome. In order to obtain strong evidence for an association, much research and several high-quality studies that point in the same direction is required. In the case of insufficient evidence, there is insufficient research to determine whether there is an association. Amongst other things, this may be because it has not yet been sufficiently investigated, which often characterizes new areas of research.

Physical activity and health

• There is strong certainty evidence that physical activity decreases the risk of all-cause mortality and the risk of cardiometabolic diseases (e.g., cardiovascular disease and type 2 diabetes) among older adults.
• There is strong certainty evidence that physical activity decreases the risk of falls and thus the risk of fractures, and moderate certainty evidence that physical activity reduces risk of future falls among older adults with a history of previously fall.
• There is moderate to strong certainty evidence that physical activity decreases the risk of breast and colon cancer, and moderate certainty evidence that physical activity reduces exacerbation of the diseases.
• There is moderate to strong certainty evidence physical activity reduces risk of cognitive impairment and development of dementia. There is low to moderate certainty evidence that physical activity improves cognitive function among older adults with dementia, including Alzheimer’s.
• There is moderate certainty evidence that physical activity reduces risk of age-related loss of physical functioning and the risk of developing osteoporosis.
• There is low to moderate certainty evidence that regular physical activity reduces risk of developing anxiety and depression and reduces symptoms of anxiety and depression among people with anxiety and major depression.

Dose-response relationship in relation to amount and intensity of physical activity

• There is strong certainty evidence of a dose-response relationship where higher levels of physical activity (primarily aerobic/cardiorespiratory activities) are associated with lower risk of all-cause mortality, cardiometabolic diseases and physical functioning.
• There is moderate to strong certainty evidence of a dose-response relationship between physical activity and breast and colon cancer where higher levels of physical activity is associated with lower risk of the diseases.
• There is insufficient evidence to determine a dose-response relationship between physical activity and risk of falls, cognitive functioning, and mental health, respectively, in older adults.

Types of physical activity

• There is moderate certainty evidence that muscle-strengthening activities in combination with aerobic/cardio activities provide additional health effects. Especially strength and balance training improve physical functioning and reduce the risk of falls among of older adults.

Sedentary behaviour and health

• There is moderate certainty evidence that sedentary behaviour increases all-cause mortality, cardiovascular mortality, and cancer mortality.
• There is moderate certainty evidence that sedentary behaviour is related to increased risk of cardiovascular diseases and type 2 diabetes. Research suggest that longer sedentary bouts may increase risk of accumulation of cardiometabolic risk factors such as insulin resistance and increased blood sugar level which increase the risk of cardiovascular disease and type 2 diabetes.
• There is low to moderate certainty evidence that sedentary behaviour increases risk of colon, endometrial and lung cancer.
• There is moderate certainty evidence that increased physical activity with moderate to high intensity reduce the detrimental effects of high levels of sedentary behaviour on mortality and cardiometabolic health.

Dose-response relationship of sedentary behaviour

• There is moderate certainty evidence of a dose-relationship where higher levels of sedentary time are associated with higher risks of all-cause mortality, cardiovascular diseases, and type 2 diabetes.
• There is insufficient evidence to determine a dose-response between sedentary behaviour and cancer, cognitive function, and mental health.

Knowledge gaps and future perspectives

There has been an increased focus on “healthy aging” due to the rapid aging of populations around the world. Healthy aging is defined by WHO as “the process of developing and maintaining the functional ability that enables well-being in older age”. The benefits of regular physical activity occur throughout life and are essential for healthy aging. Results from a national survey in Denmark (the National Health Profile 2021) show that 71.0% of Danish men and 76.9% of Danish women in the age group 75 years or older do not meet the recommendations for physical activity. It is also within this age group, where the largest proportion of people report that they mainly have sedentary leisure activities (28.5% men and 35.2% women of 75- year-old or older).

There are clear differences in the level of physical activity in relation to gender and socio-economic status. A larger proportion of men than women and adults with a high level of education compared with a low level of education meet the recommendations of physical activity. These findings indicate that a large proportion of older adults in Denmark are not sufficiently physically active. Because older adults are the least physically active and a large proportion spend a significant part of their day being sedentary, promotion of physical activity and reduction of sedentary behavior are of particularly important to maintain healthy aging.

The main pile of evidence on the association between physical activity, sedentary behavior, and different health outcomes is based on the same scientific literature as for adults (18-64 years) except from studies of the risk of dementia and of falls. This is because most studies do not state an upper age limit criterion and therefore include adults over the age of 65 years. In addition to cardiorespiratory activities, it is especially important for older adults to perform strength and balance training, which improve functional ability and prevent falls. It is unclear how many older adults who regularly do strength and balance training, as there are no national statistics on this.

There is still a lack of research focusing on the effects of physical activity among older adults. Furthermore, there is a lack of knowledge about dose-response relationships and the relationship between physical activity and sedentary behavior on health. The stated amounts of physical activity in the existing literature reviews are based on qualified estimates based on the existing evidence in the field. Future research should aim to get a better understanding of how physical activity benefits health among the elderly.

It is also important to gain knowledge about motivating older adults to take up and maintain a physically active lifestyle. Older adults often have reduced physical function and mobility. Therefore, an activity-friendly infrastructure is of great importance to increase physical activity in their everyday life. In addition, being part of a social community can help older adults to engage in physical activity and maintain these activity habits.