In this special issue of BioMed Research International, the focus is on lifestyle
and in particular physical activity (PA) as a driver for a healthy and long life for
older people.
As populations continue to extend life expectancy, a central concern is whether the
added time comprises years of healthy life and promotes a high health-related quality
of life into old age. PA is defined as any bodily movement produced by skeletal muscles
that result in energy expenditure. PA encompasses exercise, sports, and physical activities
performed as part of daily living, occupation, leisure, or active transportation.
Exercise is a subcategory of PA that is planned, structured, and repetitive and that
has as a final or intermediate objective for improvement or maintenance of physical
fitness. Physical function is the capacity of an individual to perform the physical
activities of daily living. Physical function reflects motor function and control,
physical fitness, and habitual PA [1].
PA is a protective factor for noncommunicable diseases such as cardiovascular disease,
stroke, diabetes, and some types of cancer [2] and PA is associated with improved
mental health [3], delay in the onset of dementia [4], and improved quality of life
and wellbeing [5, 6]. The health benefits of PA are well documented with higher levels
and greater frequency of PA being associated with reduced risk and improved health
in a number of key areas [7].
The dose of PA or exercise is described by the duration, frequency, intensity, and
mode [8]. For optimal effects, the older person must adhere to the prescribed exercise
program and follow the overload principle of training, i.e., to exercise near the
limit of the maximum capacity to challenge the body systems sufficiently, to induce
improvements in physiological parameters such as VO2max and muscular strength [1].
Improvements in mental health, emotional, psychological, and social well-being and
cognitive function are also associated with regular PA. Despite these health benefits,
PA levels amongst older adults remain below the recommended 150 min/week [9]. The
crude global prevalence of physical inactivity is 21.4% [10]. This translates to one
in every four to five adults being physically inactive, or with activity levels lower
than the current recommendations from WHO [11]. Inactivity and aging increase the
risk of chronic disease, and older people often have multiple chronic conditions (NFH,
2010). The exercise recommendations from WHO include both aerobic exercise and strength
exercise as well as balance exercises to reduce the risk of falls. If older adults
cannot follow the guidelines because of chronic conditions, they should be as active
as their ability and conditions allow [12]. It is important to note that the recommended
amount of PA is in addition to routine activities of daily living like self-care,
cooking, and shopping, to mention a few.
Inactivity is associated with alterations in body composition resulting in an increase
in percentage of body fat and a concomitant decline in lean body mass. Thus, significant
loss in maximal force production takes place with inactivity. Skeletal muscle atrophy
is often considered a hallmark of aging and physical inactivity. Sarcopenia is defined
as low muscle mass in combination with low muscle strength and/or low physical performance
[13]. Consequently, low physical performance and dependence in activities of daily
living is more common among older people [14, 15]. However, strength training has
been shown to increase lean body mass [16], improve physical performance [17, 18],
and to a lesser extent have a positive effect on self-reported activities of daily
living [18]. These aspects are at focus in the papers of K. Kropielnicka et al. “Influence
of the Physical Training on Muscle Function and Walking Distance in Symptomatic Peripheral
Arterial Disease in Elderly” as well as G. Piastra et al. “Effects of Two Types of
9-Month Adapted Physical Activity Program on Muscle Mass, Muscle Strength, and Balance
in Moderate Sarcopenic Older Women.”
Participation in PA and exercise can contribute to maintaining quality of life, health,
and physical function and reducing falls [19–21] among older people in general and
older people with morbidities in particular. The increased attention to the relationship
between exercise and HRQOL in older adults over the last decade is reflected in a
recent review, which showed that a moderate PA level combining multitasking exercise
components had a positive effect on activities in daily living, highlighting the importance
of physical, mental, and social demands [22]. To reduce falls, balance training is
also recommended to be included in physical exercise programs for older adults [12].
Exercise has also been shown to reduce falls with 21%, with a greater effect of exercise
programs including challenging balance activities for more than 3 hours/week [23].
The gender perspective and motivators for fall prevention are at focus in M. Sandlund
et al. qualitative study “Gender Perspective on Older People's Exercise Preferences
and Motivators in the Context of Falls Prevention: A Qualitative Study,” in this special
issue.
Exercise training in older people has been associated with health benefits such as
decreased cardiovascular mortality [24]. Explanatory mechanism likely to be involved
following exercise was a change in the cardiac autonomic balance producing an increase,
or a relative dominance, of the vagal component [25]. Furthermore, endurance exercise
training in older people decreases resting and submaximal exercise heart rate and
systolic and diastolic blood pressure and increases stroke volume [26]. This is especially
notable during peak effort in which stroke volume, cardiac output, contractility,
and oxygen uptake are increased, while total peripheral resistance and systolic and
diastolic blood pressure decreased. Thus lowering after-load in the heart muscle,
which in turn facilitates left ventricular systolic and diastolic function, emphasizes
the importance of high intensity training also for the elderly. E. Tamuleviciute-Prasciene
et al. focus on the frail elderly individuals and exercise in their contribution “Frailty
and Exercise Training: How to Provide Best Care after Cardiac Surgery or Intervention
for Elder Patients with Valvular Heart Disease.”
Exercise may also have benefits for the brain centers that support executive control.
It may be that strong executive functioning in itself may facilitate consistency for
this challenging activity. Poor executive control has been associated with lower self-reported
PA rates over a 2-year period [27, 28]. The executive control's contribution to PA
has been found to be 50% greater in magnitude than the contribution of PA to subsequent
changes in executive control [29]. In the paper of M. A. McCaskey et al. “Making More
of IT: Enabling Intensive MOtor Cognitive Rehabilitation Exercises in Geriatrics Using
INFORMATION Technology Solutions,” the authors also include new technology to enhance
and maintain exercise in cognitive rehabilitation.
In order to attain a high level of cardiorespiratory fitness, it is recommended to
be physically active for 6 months or longer. These recommendations may also be applied
to balance exercises in order to reduce falls [23]. Many elderly individuals are incapable
of sustaining activities for this long on their own. Successful maintenance of PA
typically requires substantial support and supervision. Even then, a high percentage
of people drop out due to difficulties negotiating everyday costs of activity participation
like scheduling conflicts and competing sedentary activities or health issues. This
issue is highlighted in the study of T. Adachi et al. “Predicting the Future Need
of Walking Device or Assistance by Moderate to Vigorous Physical Activity: A 2-Year
Prospective Study of Women Aged 75 Years and Above.”
In addition, reduced bodily functions can make it difficult for elderly persons to
maintain exercise under different environmental circumstances, which is demonstrated
in the contribution of B. N. Balmain et al. “Aging and Thermoregulatory Control: The
Clinical Implications of Exercising under Heat Stress in Older Individuals.”
In this special issue, we have included papers that focus on the aging process and
PA in a broad perspective, focusing on different aspects on PA, exercise, and older
people. PA and exercise play an important role in the primary, secondary, and tertiary
prevention, in the management of diseases, to counteract sarcopenia and falls as well
as improving physical performance and activities of daily living, as these papers
illustrate.
Promoting exercise among the older population is an important public health and clinical
issue. A core issue is how to get older people with comorbidities to exercise.