Frailty Matters / AVOID Frailty / Activity

Activity

Activity is vital to living well and preventing frailty, and it’s never too late to start! Activity plays an important role in frailty prevention, but it has also been shown to help reverse the effects of frailty in older adults.

Physical Activity and Frailty: What do we Know?

Physical activity is as an umbrella term for being active. It includes exercise (a planned, structured, repetitive and deliberate program) as well as leisure time activities.

Everyone benefits from physical activity:

  • Adults at risk of frailty and those living with frailty
  • Adults living in long term care, including those at the extremes of age
  • Hospitalized adults, including those who are critically ill

Download the Inactivity Prevention Package from the National Centre for Geriatrics and Gerontology

Watch Hal Johnson and Joanne McLeod of BodyBreak discuss the importance of staying active here:

The Evidence

Experimental trials have shown that even individuals living with frailty can improve their physical function, helping them to minimize and delay aging-related declines. Aerobic, muscle-strengthening, and multi-component physical activity programs all demonstrate benefits. The improvements appear to be somewhat greater with activity programs that include specific muscle strengthening and balance training activities.

Physical activity has many benefits. Even moderate but regular exercise can produce improvements, and adjusting exercises for your ability and fitness levels is important.

Download the 24-Hour Movement Guidelines for Adults Aged 18-64

Download the 24-Hour Movement Guidelines for Adults Aged 65+

Benefits include:

  • Improves ability to perform daily tasks
  • Helps prevent weak bones and muscle loss
  • Improves joint mobility
  • Improves sleep quality
  • Reduces the risk of chronic conditions
  • Extends years of activity and independent living
  • Lowers risk of dementia
  • Reduces likelihood of falling and risk of serious injury if you do fall

The Evidence

There is well-documented evidence that muscle strength decreases with advancing age. Muscle strength decreases approximately 12% to 15% each decade after the age of 50 in both males and females.

Many people know that strength training can help build and maintain muscle mass and strength even into old age. What many of us don’t know is that strong muscles also keep our bones strong. Stronger bones are less likely to break as we age, and keeping our muscles and bones strong is very important for mobility into old age.

The effect of physical activity on physical function is of high importance to older adults living with frailty. Evidence suggests the effects of physical activity are greater in older adults living with frailty compared to non-frail older adults.

For the maximum health benefit, a combination of activities is best!

Choose a variety of physical activities that you enjoy. Challenge your balance and get your heart beating a little faster each day. Keep your muscles strong with muscles strengthening exercises at least twice a week.

Multi-component physical activity training is better than any one type of activity. Multi-component activities include a combination of activity types, such as:

Aerobic exercise (or endurance activities):

  • Gets your heart pumping and supplies oxygen to your brain and organs
  • Involves many repetitions and use of large muscle groups: walking, jogging, swimming, cycling, taking a dance class, pushing a lawn mower
  • Aim to do these at least 20-30 minutes per day at a moderate intensity

Strength exercise:

  • Make muscles do more work than they are used to doing during activities of daily living
  • Weight training with free weights, weight machines, resistance bands or even just your own body weight

Download the Strengthening Package from the National Centre for Geriatrics and Gerontology

For more information, watch Hal Johnson & Joanne McLeod of BodyBreak discuss the importance of strength exercises: 

Strength Exercise Tips

  • Aim to do strength exercises 2 days/week
  • Key to building strength is that you must make your exercise program more difficult week by week and month by month. This is called progression.

Possible ways to challenge yourself with muscle-strengthening activities:

  • Increase the number of repetitions (but no more than 12)
  • Increase the number of sets
  • Increase the resistance
  • Increase the number of muscle groups or exercises
  • Resistance exercise training has been found to increase strength in older adults. In fact, there have been multiple studies demonstrating that these changes can occur even into one’s 90s

Flexibility exercise:

  • Stretches your muscles to help your body stay flexible
  • Being flexible gives you more freedom of movement, which benefits your everyday activities and other forms of exercise
  • Challenge your flexibility and balance with exercises like yoga, leg raises, swimming, and tai chi

Balance exercise:

  • Strengthens the muscles that help keep you upright, including your legs and core
  • These kinds of exercises can improve stability and help prevent falls

Download the Balance Improvement Package from the National Centre for Geriatrics and Gerontology

For more information, watch Hal Johnson & Joanne McLeod of BodyBreak discuss ways to improve your balance:

Functional exercise:

  • Trains your muscles to work together and prepares them for daily tasks by reproducing common movements you might do during everyday living
  • Involves using various muscles in the upper and lower body at the same time

Endurance

Strength

Flexibility

Balance

How Can I Get Active?

Health Canada recommends that older adults take part in physical activity at least 2.5 hours per week—so thirty minutes each day—which you can break into 10 minute intervals: minutes count!

Start with doing activities that you enjoy: dance, gardening, etc. Even daily chores count as activity: walking to get the mail, mopping the floor, carrying groceries, etc.

After being physically active, it is important to recover and recharge our body systems. Sleep changes as we age, but older adults still need 7 to 8 hours of sleep per day. Learn more about how to get the best sleep possible.

CFN Related Work and Network Members

A Scoping Review of Interventions to Prevent and Treat Frailty Project

The Jintronix Technology in Emergency Departments Project

E-CYCLE Project

Intensive Resistance Training in Pre-frail Older Adults Project

Exercise Before Surgery for Older People with Frailty Project

The Breaking “Bad Rest” Study

Promoting Movement in Older Adults in the Community Project

Stand If You Can Project

 

Principal Investigator: Mylène Aubertin-Leheudre, PhD

Principal Investigator: Susan Baptiste, MSc, OT(C)

Principal Investigator: Danielle Bouchard, PhD, MSc

Principal Investigator: Lora Giangregorio, PhD

Principal Investigator: Michelle Kho, PhD, PT

Principal Investigator: Barbara Liu, MD, FRCPC

Principal Investigator: Laurie Mallery, MD

Principal Investigator: Daniel McIsaac, MD, MPH, FRCPC

Principal Investigator: Marie-Josée Sirois, OT, PhD

Principal Investigator: Ada Tang, PT, PhD, MSc

Principal Investigator: Olga Theou, PhD

Interdisciplinary Fellowship Program Supervisor: Sandra Hundza, BSc(PT), PhD

Board of Directors Member and Citizen Engagement Committee Chair: Joyce Resin, MSW

Citizen Engagement Committee Member: Chelsia Gillis, RD, PhD(c)

International Scientific Advisory Committee Member: Matteo Cesari, MD, PhD

International Scientific Advisory Committee Member: Fabian Chin Leong Lim, BSc, MSc, MBA, PhD

Network Member: Vanina dal Bello-Haas, PhD, PT

 

Network Partner: Heart & Stroke Foundation

Network Partner: Reh-Fit Centre

Network Partner: Canadian Physiotherapy Association

 

Innovations Presented at CFN’s Annual Conference

2019:

ABLE – Arts-Based exercise enhancing LongEvity

2018:
ABLE –Arts-Based exercise enhancing LongEvity (p. 16)

The Mobilization of Vulnerable Elders (MOVE) Program (p. 27)

Elders in Motion (p. 29)

Citations

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Centers for Disease Control and Prevention. (1999). A report of the surgeon general: Physical activity and health, older adults. [Website]. Retrieved from https://www.cdc.gov/nccdphp/sgr/olderad.htm

Cesari, M., Vellas, B., Hsu, F. C., Newman, A. B., Doss, H., King, A. C., Manini, T. M., Church, T., Gill, T. M., Miller, M. E., & Pahor, M. (2015). A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 70(2), 2216-222. doi: 10.1093/gerona/glu099

Crocker, T., Forster, A., Young, J., Brown, L., Ozer, S., Smith, J., Green, J., Hardy, J., Burns, E., Glidewell, E., & Greenwood, D. C. (2013). Physical rehabilitation for older people in long-term care. Cochrane Database Systematic Review. (2). doi: 10.1002/14651858.CD004294.pub3

de Souto Barreto, P., Morley, J. E., Chodzko-Zajko, W., H Pitkala, K., Weening-Djiksterhuis, E., Rodriguez-Mañas, L., Barbagallo, M., Rosendahl, E., Sinclair, A., Landi, F., Izquierdo, M., Vellas, B., & Rolland, Y. (2016). Recommendations on physical activity and exercise for older adults living in long-term care facilities: A taskforce report. Journal of the American Medical Directors Association, 17(5), 381-392. doi: https://doi.org/10.1016/j.jamda.2016.01.021

Ferri, A., Scaglioni, G., Pousson, M., Capodaglio, P., Van Hoecke, J., & Narici, M. V. (2003). Strength and power changes of the human plantar flexors and knee extensors in response to resistance training in old age. Acta Physiologica Scandinavica, 177(1), 69-78. doi: 10.1046/j.1365-201X.2003.01050.x

Fiatarone, M. A., Marks, E. C., Ryan, N. D., Meredith, C. N., Lipsitz, L. A., & Evans, W. J. (1990). High-intensity strength training in nonagenarians: Effects on skeletal muscle. The Journal of the American Medical Association, 263(22), 3029-3034. doi: https://doi.org/10.1001/jama.1990.03440220053029

Fiatarone, M. A., O’Neill, E. F., Ryan, N. D., Clements, K. M., Solares, G. R., Nelson, M. E., Roberts, S. B., Kehayias, J. J., Lipsitz, L. A., & Evans, W. J. (1994). Exercise training and nutritional supplementation for physical frailty in very elderly people. The New England Journal of Medicine, 330(25), 1769-1775. doi: 10.1056/NEJM199406233302501

Kho, M. E., Molloy, A. J., Clarke, F. J., Reid, J. C., Herridge, M. S., Karachi, T., Rochwerg, B., Fox-Robichaud, A. E., Seely, A. J. E., Mathur, S., Lo, V., Burns, K. E. A., Ball, I. M., Pellizzari, J. R., Tarride, J. E., Rudkowski, J. C., Koo, K., Heels-Ansdell, D., & Cook, D. J. (2019). Multicentre pilot randomised clinical trial of early in-bed cycle ergometry with ventilated patients. BMJ Open Respiratory Research, 6(1), e000383. doi: 10.1136/bmjresp-2018-000383

Kredlow, M. A., Capozzoli, M. C., Hearon, B. A., Calkins, A. W., & Otto, M. W. (2015). The effects of physical activity on sleep: A meta-analytic review. Journal of Behavioral Medicine, 38(3), 427-449. doi: 10.1007/s10865-015-9617-6

Landi, F., Abbatecola, A. M., Provinciali, M., Corsonello, A., Bustacchini, S., Manigrasso, L., Cherubini, A., Bernabei, R., & Lattanzio, F. (2010). Moving against frailty: Does physical activity matter? Biogerontology, 11(5), 537-545. doi: 10.1007/s10522-010-9296-1

Larsson, L. (1983). Histochemical characteristics of human skeletal muscle during aging. Acta Physiologica Scandinavica, 117(3), 469-471. doi: https://doi.org/10.1111/j.1748-1716.1983.tb00024.x

Lindle, R. S., Metter, E. J., Lynch, N. A., Fleg, J. L., Fozard, J. L., Tobin, J., Roy, T. A., & Hurley, B. F. (1997). Age and gender comparisons of muscle strength in 654 women and men aged 20-93 yr. Journal of Applied Physiology, 83(5), 1581-1587. doi: 10.1152/jappl.1997.83.5.1581

Liu, C. K., & Fielding, R. A. (2011). Exercise as an intervention for frailty. Clinics in Geriatric Medicine, 27(1), 101-110. doi: 10.1016/j.cger.2010.08.001

McCartney, N., Hicks, A. L., Martin, J., & Webber, C. E. (1995). Long-term resistance training in the elderly: effects on dynamic strength, exercise capacity, muscle, and bone. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 50(2), B97-104. doi:  10.1093/gerona/50a.2.b97

McCartney, N., Hicks, A. L., Martin, J., & Webber, C. E. (1996). A longitudinal trial of weight training in the elderly: Continued improvements in year 2. The Journals of Gerontology Series A Biological Sciences and Medical Sciences, 51(6), B425–433. doi: 10.1093/gerona/51a.6.b425

National Institute on Aging. (2004). Exercise: A guide from the National Institute on Aging. [Website]. Retrieved from https://www.onhealth.com/content/1/exercise_for_seniors#toca

Public Health Agency of Canada. (2019). Physical activity tips for older adults (65 years and older). [Website]. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/physical-activity-tips-older-adults-65-years-older.html

Puts, M. T. E., Toubasi, S., Andrew, M. K., Ashe, M. C., Ploeg, J., Atkinson, E., Ayala, A. P., Roy, A., Rodríguez Monforte, M., Bergman, H., & McGilton, K. (2017). Interventions to prevent or reduce the level of frailty in community-dwelling older adults: A scoping review of the literature and international policies. Age and Ageing, 46(3), 383-392. doi: 10.1093/ageing/afw247

Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J. C. T., & Lord, S. R. (2017). Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. British Journal of Sports Medicine, 51(24), 1750-1758. doi: 10.1136/bjsports-2016-096547

These are general health guidelines and should not be considered personal medical advice. Speak to your doctor before starting any new exercise programs. You should consult your health care provider and discuss each element outlined above to ensure that each element of the AVOID Frailty campaign is personally customized for you.