Sports + Orthopedic Leaders : Physical Therapy and Rehabilitation

by
Stephen J. Ryan, MS, PT, CSCS, FAAOMPT

Wouldn't it be great if we had control over how we aged? We do! In 1996 the Surgeon General published a landmark, yet not well known, report that clearly demonstrated the myriad health benefits of moderate physical activity.⁵ One thousand scientific studies were reviewed for the report. Along with several other recent reports,^3,4,6,7 it has forever dispelled the long held convention that loss of functional ability is a natural consequence of aging. The primary point of these reports is that by simply performing brief periods of moderate physical activity, older adults can reap profound improvements in health, sustain independence, and enrich overall quality of life. This is true for all older adults, including the frail, the very old, and those with chronic medical conditions. Few factors contribute as much to successful aging as leading a physically active lifestyle.⁶ One study showed that highly active nonsmoking women at age 65 have approximately 6 more years of active life expectancy than nonsmoking women who are inactive.¹

Being physically active improves endurance or cardiorespiratory fitness.^4,5This has many benefits including: lower overall mortality; lower risk of colon cancer, diabetes, obesity, high blood pressure; improved mood and relief of symptoms of depression; and decreased aches and pains from osteoarthritis.³ Conversely, and most disturbing, the cardiac risk of being inactive is comparable to the risk from smoking cigarettes!⁶
Loss of lower body strength is an especially powerful predictor of the onset of disability and loss of independence for older adults.² Contrary to what was once thought, we now know that all older adults can markedly increase their muscle strength by performing strengthening exercises.^4,5 The research also suggests that improving muscle strength may protect against the decline in bone mass experienced by post menopausal women, and helps decrease the risk for falls.^4,5
Control over how we age can be achieved by engaging in moderate physical activity on 5 or more days per week. Moderate physical activity is defined as burning approximately 150 calories daily, roughly equivalent to taking a brisk 30 minute walk, washing windows for 45-60 minutes or gardening for 30-45 minutes (see table). More vigorous, more frequent or longer duration activity yield yet greater health benefits. Making it even easier to take control of our health and independence is evidence that several shorter bouts of moderate physical activity are as effective as one longer bout.^4-7 Additionally, it has been recommended that twice weekly strengthening exercises supplement daily moderate physical activity to improve gross strength.⁴ Stretching exercises should also be performed regularly.

Many community and senior centers offer exercise groups for those interested in participating in more "formal exercise". There are also several books on the market that address strengthening and stretching exercises for older adults. A consultation with a physical therapist is an excellent way to design a safe and individualized exercise program, especially for people who are frail, severally deconditioned or who have chronic medical conditions. But remember, simply increasing normal daily activity is all that is necessary to improve one's fitness level.

When increasing activity, start slowly and gradually build up to the desired amount to give the body time to adjust. People with chronic medical conditions, such as heart disease, diabetes, or obesity, or who are at high risk for these problems, should consult their physician before increasing their physical activity. Also, men over age 40 and women over age 50 should consult a physician before engage in a new vigorous exercise program.^4,5
This is truly exciting news. By simply engaging in moderate physical activity on most days of the week, we can reduce the risk of developing or dying from some of the leading causes of illness and death, control many chronic medical conditions, markedly increase our quality of life, and take control over how we age.

EXAMPLES OF MODERATE AMOUNTS OF ACTIVITY⁴
(from less vigorous to more vigorous)

Less Vigorous, More Time

Washing and waxing a car for 45-60 minutes
Washing windows or floors for 45-60 minutes
Gardening for 30-45 minutes
Wheeling self in wheelchair for 30-40 minutes
Walking 1 3/4 miles in 35 minutes (20 min/mile)
Bicycling 5 miles in 30 minutes
Dancing fast (social) for 30 minutes
Pushing a stroller 1 1/2 miles in 30 minutes
Raking leaves for 30 minutes
Walking 2 miles in 30 minutes (15 min/mile)
Water aerobics for 30 minutes
Swimming laps for 20 minutes
Bicycling 4 miles in 15 minutes
Jumping rope for 15 minutes
Running 1 1/2 miles in 15 minutes (10 min/mile)
Shoveling snow for 15 minutes
Stair walking for 15 minutes

References

Note: Articles 4-7 are available on-line and are linked. Click on the underlined reference number to be redirected to that article.

1. Ferucchi L, Penninx BW, Leveille SG, et al. (2000) Characteristics of nondisabled older persons who perform poorly in objective tests of lower extremity function. J Am Geriatr Soc.,48(9) (Sept), 1102–10.

2. Guralnik J, Ferrucci L, Simonsick E, et al. (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability, New England Journal of Medicine, 332, 556-561.

3. Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. (1992) Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med.,(Apr 1), 116(7), 529–34.

4. Mazzeo RS, Cavanagh P, Evans WJ, et al. (1998) American College of Sports Medicine's Position Stand on Exercise and Physical Activity for Older Adults. Med. Sci. Sports. Exerc. (June), 30(6), 992-1008.
http://www.zajko.com/ExerciseandPhysicalActivityforOlderAdults.htm

5. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 1996
http://www.cdc.gov/nccdphp/sgr/sgr.htm

6. U.S. Department of Health and Human Services. Physical Activity and Older Americans: Benefits and Strategies. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality and the Centers for Disease Control. June 2002.
http://www.ahrq.gov/ppip/activity.htm

7. U.S. Department of Health and Human Services. Physical Activity Fundamental To Preventing Disease. U.S. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. June 20, 2002.
http://aspe.hhs.gov/health/reports/physicalactivity/

Being physically active improves endurance or cardiorespiratory fitness.^4,5This has many benefits including: lower overall mortality; lower risk of colon cancer, diabetes, obesity, high blood pressure; improved mood and relief of symptoms of depression; and decreased aches and pains from osteoarthritis.³ Conversely, and most disturbing, the cardiac risk of being inactive is comparable to the risk from smoking cigarettes!⁶
Loss of lower body strength is an especially powerful predictor of the onset of disability and loss of independence for older adults.² Contrary to what was once thought, we now know that all older adults can markedly increase their muscle strength by performing strengthening exercises.^4,5 The research also suggests that improving muscle strength may protect against the decline in bone mass experienced by post menopausal women, and helps decrease the risk for falls.^4,5
Control over how we age can be achieved by engaging in moderate physical activity on 5 or more days per week. Moderate physical activity is defined as burning approximately 150 calories daily, roughly equivalent to taking a brisk 30 minute walk, washing windows for 45-60 minutes or gardening for 30-45 minutes (see table). More vigorous, more frequent or longer duration activity yield yet greater health benefits. Making it even easier to take control of our health and independence is evidence that several shorter bouts of moderate physical activity are as effective as one longer bout.^4-7 Additionally, it has been recommended that twice weekly strengthening exercises supplement daily moderate physical activity to improve gross strength.⁴ Stretching exercises should also be performed regularly.

Many community and senior centers offer exercise groups for those interested in participating in more "formal exercise". There are also several books on the market that address strengthening and stretching exercises for older adults. A consultation with a physical therapist is an excellent way to design a safe and individualized exercise program, especially for people who are frail, severally deconditioned or who have chronic medical conditions. But remember, simply increasing normal daily activity is all that is necessary to improve one's fitness level.

When increasing activity, start slowly and gradually build up to the desired amount to give the body time to adjust. People with chronic medical conditions, such as heart disease, diabetes, or obesity, or who are at high risk for these problems, should consult their physician before increasing their physical activity. Also, men over age 40 and women over age 50 should consult a physician before engage in a new vigorous exercise program.^4,5
This is truly exciting news. By simply engaging in moderate physical activity on most days of the week, we can reduce the risk of developing or dying from some of the leading causes of illness and death, control many chronic medical conditions, markedly increase our quality of life, and take control over how we age.

EXAMPLES OF MODERATE AMOUNTS OF ACTIVITY⁴
(from less vigorous to more vigorous)

Less Vigorous, More Time

Washing and waxing a car for 45-60 minutes
Washing windows or floors for 45-60 minutes
Gardening for 30-45 minutes
Wheeling self in wheelchair for 30-40 minutes
Walking 1 3/4 miles in 35 minutes (20 min/mile)
Bicycling 5 miles in 30 minutes
Dancing fast (social) for 30 minutes
Pushing a stroller 1 1/2 miles in 30 minutes
Raking leaves for 30 minutes
Walking 2 miles in 30 minutes (15 min/mile)
Water aerobics for 30 minutes
Swimming laps for 20 minutes
Bicycling 4 miles in 15 minutes
Jumping rope for 15 minutes
Running 1 1/2 miles in 15 minutes (10 min/mile)
Shoveling snow for 15 minutes
Stair walking for 15 minutes

References

Note: Articles 4-7 are available on-line and are linked. Click on the underlined reference number to be redirected to that article.

1. Ferucchi L, Penninx BW, Leveille SG, et al. (2000) Characteristics of nondisabled older persons who perform poorly in objective tests of lower extremity function. J Am Geriatr Soc.,48(9) (Sept), 1102–10.

2. Guralnik J, Ferrucci L, Simonsick E, et al. (1995) Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability, New England Journal of Medicine, 332, 556-561.

3. Kovar PA, Allegrante JP, MacKenzie CR, Peterson MG, Gutin B, Charlson ME. (1992) Supervised fitness walking in patients with osteoarthritis of the knee. A randomized, controlled trial. Ann Intern Med.,(Apr 1), 116(7), 529–34.

4. Mazzeo RS, Cavanagh P, Evans WJ, et al. (1998) American College of Sports Medicine's Position Stand on Exercise and Physical Activity for Older Adults. Med. Sci. Sports. Exerc. (June), 30(6), 992-1008.
http://www.zajko.com/ExerciseandPhysicalActivityforOlderAdults.htm

5. U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. 1996
http://www.cdc.gov/nccdphp/sgr/sgr.htm

6. U.S. Department of Health and Human Services. Physical Activity and Older Americans: Benefits and Strategies. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality and the Centers for Disease Control. June 2002.
http://www.ahrq.gov/ppip/activity.htm

7. U.S. Department of Health and Human Services. Physical Activity Fundamental To Preventing Disease. U.S. Department of Health and Human Services. Office of the Assistant Secretary for Planning and Evaluation. June 20, 2002.
http://aspe.hhs.gov/health/reports/physicalactivity/