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CDC Backgrounder: CDC’S INITIATIVE ON PHYSICAL ACTIVITY TARGETS HUGE PERCENTAGE OF ELDERS WHO ARE SEDENTARYSpring 2003 Thirty minutes? Sixty minutes? Every day? Every other day? How much physical activity should older adults get? What if they are already frail or have a disability? Can, or should, they still exercise? Adults age 50 and over, like many Americans, are confused about the need for and importance of physical activity in maintaining their health and well-being. But the evidence on physical activity shows that it is important for preventing and treating many chronic diseases – and it can reduce healthcare costs. The U.S. Centers for Disease Control and Prevention (CDC) is very clear about its message. According to David M. Buchner, M.D., M.P.H., chief of CDC’s Physical Activity and Health Branch, “Few factors contribute as much to successful aging as having a physically active lifestyle.” “It is never too late to start a physical activity program,” Dr. Buchner said. Yet, almost three-fourths of the older adult population is sedentary. An estimated 35 million adults are 65 and older, and that number will double by 2030, the U.S. Census Bureau projects. For older Americans, Dr. Buchner explained, activity can extend the years of living independently, reduce disability and improve quality of life. Physical activity may also help with arthritis management, sleep quality, mental alertness and symptoms of depression. “These benefits can be obtained by increasing physical activity at any age,” Dr. Buchner added. “A physically active lifestyle need not mean going to the gym or health club to exercise,” explained David R. Brown, Ph.D., a senior behavioral scientist with the Division of Nutrition and Physical Activity in CDC’s National Center for Chronic Disease Prevention and Health Promotion. “It is a way of life that integrates physical activity into daily routines and chores. It is a personal choice to be more active each day — taking the stairs, gardening or doing yard-work, or walking for fun or to accomplish errands, such as parking farther away from your destination. Doing regular daily physical activity does not have to include a structured program of traditional or vigorous exercise such as ‘working out’ or jogging.” WHAT ARE THE RECOMMENDATIONS FOR OLDER ADULTS? “Older adults can achieve recommended amounts of physical activity by mainly just going for walks,” Dr. Buchner said. “This is good news, since walking is the most common activity of older adults.” CDC recommendation is to walk for a least 30 minutes on five or more days each week. “It is fine to accumulate at least 30 minutes from several separate walks, but each walk should last at least 10 minutes to count toward the goal of at least 30 minutes,” he said. Older adults should also do strengthening activities such as weight lifting on two or three days each week. Since it is preferable to be active every day, a person who walks five days a week could do strengthening exercises on the other two days. Stretching could be done every day, he added. According to Dr. Buchner, “Stretching and balance exercises don’t require equipment and can be done just about anywhere. Balance exercises, such as toe raises or standing heel-to-toe, can also be done anytime, such as part of a home exercise program, or even while waiting for the bus. It’s better to do most stretching exercises after muscles are warm from a bout of activity, but activity bouts should begin with a warm-up that can include some stretching.” Of course, adults who are inactive need to work up to these goals gradually, Dr. Buchner noted. Doing too much too soon is not only unpleasant but also increases risk of injury. Inactive older adults should strongly consider joining an exercise class as a way to get started, because instructor provides advice on how fast to progress, and fellow class members provide social support for an active lifestyle. “Before starting a new program of regular physical activity,” Dr. Buchner said, “older adults with chronic diseases should speak with their physician, and understand what types of exercise programs and physical activities are appropriate for them. If there are concerns about doing regular activity, these should be addressed. Staying in touch with your physician about your physical activity program allows health care providers to provide advice and encouragement. Don’t exercise if you have an unstable medical problem or have developed new symptoms.” According to a report of the U.S. Surgeon General, greater amounts of physical activity provide greater health benefits, and some activity, even if less than the recommended amount is healthier than a sedentary lifestyle. Also, physical activity does not need to be strenuous to be beneficial. Moderate activities similar in level of effort to a brisk walk, such as gardening, biking and swimming, are healthful. HOW MANY OLDER ADULTS ARE PHYSICALLY ACTIVE? CDC data indicate that only about one-fourth to one- third of older adults reach recommended activity levels. “That means 65 percent to 75 percent do not reach the bar” of 30 minutes or more of moderate intensity physical activity most days of the week, or 20 minutes or more of vigorous intensity activity three or more days per week, Dr. Buchner said. He noted that 30 percent to 40 percent of older adults are insufficiently active- -- that is, they get some activity but do not achieve recommended levels. Although some older adults get physical activity doing household chores, on the job or walking for transportation, 28 percent to 34 percent of adults ages 65 to 74 obtain no additional leisure-time physical activity. By age 75, about one-third of men and half of women are inactive in their leisure time. WHY DON’T SENIORS GET ENOUGH PHYSICAL ACTIVITY? “There are many reasons why older adults do not get the physical activity they need,” Dr. Brown explained. “They may think they lack time or the energy to be physically active. They may not have a safe place to participate in physical activities or may be concerned about other environmental factors such as stray dogs, weather conditions or temperature extremes, or a lack of places to periodically sit down or rest. Older adults may also indicate that they dislike physical activity and lack the motivation to be active. For some people, this may, in part, be due to a lack of confidence that they have the skills and abilities to be active. Some older adults may also be afraid of falling or injury, and these fears may be intensified for those who have poor vision or a disability or who experience side effects from medication that affects their balance or alertness.” Older adults are more likely to get enough physical activity if they have a history of activity, are concerned about their weight and health, want to keep up with their grandchildren or know it will make them feel better, according to the Partnership for Prevention, an association that encourages health promotion, in its publication Creating Communities for Active Aging. Physical activity levels are higher among those who have confidence in their ability to be vigorously active, psychologist James Sallis at San Diego State University reported in Preventive Medicine in 1989. WHAT ARE THE BENEFITS OF PHYSICAL ACTIVITY? Research has demonstrated that regular physical activity tends to improve cardiovascular health, balance and joint mobility for older adults, Dr. Buchner said. It also is important for the primary and secondary prevention of many chronic diseases (for example, coronary heart disease, non-insulin-dependent diabetes mellitus, obesity, colon cancer, anxiety and depression), disabling conditions (such as osteoporosis or arthritis), and chronic-disease risk factors (high blood pressure, high cholesterol). A study in the March 2000 issue of the Journal of the American Geriatrics Society shows that those who increase strength may be better able to perform daily activities and avoid disability as they age. Regular physical activity can also delay the start of functional limitations and dependence, and prevent premature mortality. Highly active nonsmoking women at age 65 have a life expectancy of 18.4 years, compared to only 12.7 years for inactive women who do not smoke, researchers reported in the September 2000 Journal of the American Geriatrics Society. Regular physical activity also leads to better balance, coordination and agility, which seem to help prevent falls, researchers reported in 1994 in Medicine and Science in Sports and Exercise. Another study, coauthored by Dr. Buchner and published in the British Medical Journal in 1997, showed a 58 percent reduction in falls among older women who began an exercise program. WHAT ARE THE COSTS OF NOT GETTING ENOUGH PHYSICAL ACTIVITY? Research by the Obesity Research Center in New York City, sponsored by CDC and the National Institutes of Health, estimated in the Journal of the American Medical Association (Oct. 27, 1999) that 300,000 deaths a year in this country are related to being overweight or obese — conditions that respond well to increased physical activity. “That number has probably gone up,” since the study was based on 1990 data, Dr. Buchner noted. CDC epidemiologist Michael Pratt, M.D., M.P.H., lead author of an article published in The Physician and Sportsmedicine (October 2000), found that physically active people had, on average, lower medical costs than inactive people. According to Pratt and his co-investigators, increasing physical activity among the 88 million inactive Americans of all ages could reduce direct medical costs by $330 per person each year (in 1987 dollars), or $77 billion annually (in 2000 dollars). The reduction in medical costs associated with physical activity increases with age, especially for women. For women ages 45 to 54, both inactive and active women pay a little more than $1,000 in annual direct medical costs. By ages 55 to 64, active women pay about $1,200 a year compared to inactive women, who spend about $1,400. Among those ages 65 to 74, active women spend about $1,500 annually, while those who are inactive pay more than $2,000. And for ages 75 and over, active women spend about $2,000 each year, while inactive women pay about $3,200. Furthermore, the U.S. Department of Health and Human Services (HHS) reported in its publication Physical Activity Fundamental to Preventing Disease (June 2002) that Medicare and Medicaid spend $84 billion annually on five chronic conditions (diabetes, heart disease, depression, cancer and arthritis) that can be improved through increased physical activity. This means that increasing activity among older adults might significantly lower expected future elevations in Medicare spending. CAN FRAIL OR DISABLED OLDER ADULTS GET EXERCISE? “Not only healthy older adults benefit from regular physical activity, but adults who are frail or have a chronic disease or disability also benefit,” Dr. Brown explained. “However, a one-size-fits-all physical activity recommendation is difficult to make for people with health problems.” “Beyond a general recommendation to increase physical activity, people with impairments due to chronic disease will need a physical activity program tailored to their individual capabilities, and most likely need some supervision.” Dr. Buchner commented, “Exercise is regarded as beneficial in frail and disabled older adults. In general, they benefit greatly from being active every day, just like relatively healthy older adults do.” Frail older adults can still benefit from 30 minutes a day of physical activity, but they may need to start with a seated- or chair-exercise program with supervision. If they have been sedentary, they need to start at a fairly low level of activity, he noted, and special consideration must be made for conditions such as arthritis and balance problems or for someone who has had joint replacement. Older adults with arthritis who are just starting to be more active might need to exercise in 10-minute increments three times throughout the day at least three days a week, explained Teresa Brady, Ph.D., a senior behavioral scientist with CDC’s Arthritis Program. “That is a lower frequency per week than for the general older adult population,” Dr. Brady noted. She added, though, ongoing research may determine that seniors with arthritis can safely get more exercise than at that level. Ideal activities for this group are swimming, walking, bicycling, gardening, raking leaves or washing the car. CDC has a brochure and public service announcement on physical activity for people with arthritis for distribution by state health departments, Dr. Brady said. Journalists interested in seeing the materials should contact Dr. Teresa Brady at (770) 488-5856 or tob9@cdc.gov. WHAT IS CDC DOING TO PROMOTE PHYSICAL ACTIVITY AMONG SENIORS? Promoting physical activity among older adults is a national public health priority, according to CDC. Along with 50 organizations, CDC developed National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older in 2001. The publication urges changes in communities, workplaces and public policies to help older adults get the physical activity they need. Other contributors include the AARP, the American College of Sports Medicine, the American Geriatrics Society, the National Institute on Aging and the Robert Wood Johnson Foundation. The National Blueprint contains 60 general recommendations for a collaborative approach to getting older adults more physically active. In the coming year, several federal agencies and non-profit organizations will consider how to implement those recommendations. CDC is seeking to educate public health agencies, health professionals, community planners, older adults and their caretakers about promoting physical activity. It is collaborating with various partnering organizations on projects to help primary-care providers encourage older adults to increase their physical activity, to create ways for healthcare providers to quickly assess a person’s health status and physical activity level, to develop more extensive physical activity recommendations and guidelines for older adults, and to research environmental features (such as sidewalks and streetlights) that encourage an active lifestyle for people of all ages. For example, in 1992, CDC and San Diego State University developed the PACE (Physician-Based Assessment and Counseling for Exercise) protocol to help doctors and nurses counsel patients on physical activity. A decade later, a new generation of computerized assessment materials called PACE-Plus (Patient-Centered Assessment and Counseling for Exercise Plus Nutrition) were developed. Preliminary evidence shows PACE-Plus helps increase physical activity among patients and takes only a few minutes of a practitioner’s time, as reported in 2002 in Preventive Medicine. For information on PACE-Plus materials, go to: http://shs.sdsu.edu/PACE/info.html. HHS urges communities to set up programs and environmental supports to encourage seniors to be physically active, such as walking or bike trails. “Most older adults get most of their exercise by walking, so this is very relevant,” Dr. Buchner explained. Activities that build and maintain muscle strength are also important for older adults. Providing a menu of options for strengthening activities to accommodate varying needs and preferences of older adults is important. Certainly older adults can join a health and fitness facility and use weight machines. But there are also programs in which older adults use cuff weights and hand- held weights that can be done in senior centers and similar locations. CDC has been working with investigators Rebecca Seguin and Miriam Nelson at Tufts University on a home- based strength-training program, in which materials and instructions are mainly accessed on the Internet. This program, when released in 2003, will be in the public domain, and the materials will be free to download or copy. Contact: Dr. Miriam Nelson at (617) 636-3735 or miriam.nelson@tufts.edu. CDC’s Prevention Research Centers program is setting up a Healthy Aging Network (HAN) to encourage public health officials to provide physical activity and other health information to local professionals who provide services to elders. The program will develop ways to translate prevention research into practice and train professionals who work with the elderly. HAN is underway in seven states at the universities of California, Colorado, Illinois, North Carolina, Pittsburgh, South Carolina and Washington. Contact: Gwen Moni, University of Washington at (206) 616-1012; gmoni@u.washington.edu; www.aging.unc.edu/groups/healthyaging/network.html; or www.cdc.gov/prc. The Robert Wood Johnson Foundation, a CDC partner on the National Blueprint project, has funded multi-million- dollar projects to support active living. Through grant- based programs, it is promoting changes in local community design, transportation and architecture that make it easier to be physically active, identifying environmental factors and policies that encourage activity; and providing community grants to improve activity levels in adults age 50 and older. In 2002, the foundation and AARP launched a one-year Active for Life pilot project in Richmond, Va., and Madison, Wis., to promote physical activity. Working with city health and recreation departments, fitness centers, faith-based groups, nonprofit organizations and local businesses, the campaign is using advertising, media, advocacy and community-based interventions to increase the number of residents 50 and older who engage in at least 30 minutes of activity for a minimum of five days a week. Additionally, CDC and the U.S. Administration on Aging have been working with state chronic-disease directors and state agencies on aging to stimulate local prevention activities by providing mini-grants that allow state and local representatives to develop prevention programs reflecting local priorities. These initiatives reflect a shared responsibility to implement high-quality health promotion and disease prevention programs for older adults. The goal is to have improved prevention programs in place for older adults, and to enhance the ability of the chronic-disease and aging communities to work together through a common experience. Of the 10 funded pilot projects, nine are focused on physical activity programs in Arkansas, California, Iowa, Maine, Maryland, Michigan, North Carolina, Oklahoma and Wyoming. This media background paper is available online at www.asaging.org/media. It was written by Nancy Aldrich. STORY IDEAS FOR JOURNALISTS 1) Are older adults in your community aware of the importance of physical activity? Interview seniors about why they do and don’t get enough physical activity. What has been done to reach out to this group? 2) Is your community environmentally friendly to encourage older adults to get physical activity? Are there community walking/physical activity opportunities, especially in malls or other protected locations? Are there transportation plans to get older adults to these areas? Do local health clubs encourage or discourage older members? Do HMOs and other health plans in your area offer exercise programs for elderly members? 3) What are physicians doing to urge patients to exercise? What are employers doing to encourage physical activity among their employees, especially older workers? 4) Why hasn’t more research been done on the economics of health cost savings (for Medicare and other health insurance programs) of increasing activity levels among older adults? RESOURCES FOR REPORTERS CENTERS FOR DISEASE CONTROL AND PREVENTION: National Center for Chronic Disease Prevention and Health Promotion 4770 Buford Highway, N.E., MS K-46, Atlanta, GA 30341-3717 CDC physical activity media contact: Tim Hensley, (770) 488- 5820 email cdcinfo@cdc.gov www.cdc.gov/nccdphp/dnpa JOURNALS CITED: British Medical Journal, “Randomized Controlled Trial of a General Practice Program of Home Based Exercise to Prevent Falls in Elderly Women,” by A.J. Campbell, D.M. Buchner, et al. [1997;Oct. 25;315(7116):1065-9] Journal of the American Geriatrics Society, “Exercise and Older Patients: Guidelines for the Clinician,” by C. Christmas and R.A. Andersen, [2000;48(3):318-324.]; and “Characteristics of Nondisabled Older Persons Who Perform Poorly in Objective Tests of Lower Extremity Function,” by L. Ferucchi, et al., [2000;Sept.; 48(9):1102- 10] Journal of the American Medical Association, “Annual Deaths Attributable to Obesity in the United States,” by David B. Allison, et al., [1999;Oct. 27;282(16):1530-8; http://jama.ama-assn.org/issues/v282n16/abs/joc90587.html] Medicine and Science in Sports and Exercise, “Evaluation of Patient Physical Activity after Counseling by Primary Care Providers,” [1994;26(suppl):S4]; and “Balance and Strength Changes in Elderly Subjects after Heavy-Resistance Strength Training,” by D. Parsons, et al. [1992;24(suppl): S21] Physician and Sportsmedicine, “Project PACE: Physician- Based Assessment and Counseling for Exercise,” by K. Patrick, et al. [1994;22:45-55] Physician and Sportsmedicine, “Higher Direct Medical Costs Associated with Physical Inactivity,” by M. Pratt, et al. [2000; Oct. 28:10, 63-70; www.physsportsmed.com/issues/2000/10_00/pratt.htm] Preventive Medicine, “A Multivariate Study of Determinants of Vigorous Exercise in a Community Sample,” by James Sallis [1989;18:20-34] Preventive Medicine, “Preliminary Evaluation of a Multicomponent Program for Nutrition and Physical Activity Change in Primary Care: PACE+ for Adults,” by K. Calfas, et al. [2002;34153-161] GOVERNMENT PUBLICATIONS AND WEBSITES: Exemplary State Programs around Arthritis, www.cdc.gov/nccdphp/exemplary/arthritis.htm Exercise: A Guide from the National Institute on Aging, www.nia.nih.gov/exercisebook/intro.htm Exercise: Feeling Fit for Life, www.nia.nih.gov/health/agepages/exercise.htm Exercise for Older Adults, NIH SeniorHealth, http://nihseniorhealth.gov/exercise/toc.html National Arthritis Action Plan: A Public Health Strategy, www.cdc.gov/nccdphp/pdf/naap.pdf National Blueprint: Increasing Physical Activity among Adults Age 50 and Older, www.cdc.gov/nccdphp/dnpa/press/archive/blueprint.htm, www.rwjf.org/publications/publicationsPdfs/Age50_Blueprint_s inglepages.pdf Physical Activity and Health: Older Adults, A Report of the Surgeon General, www.cdc.gov/nccdphp/sgr/pdf/olderad.pdf and www.cdc.gov/nccdphp/sgr/pdf/execsumm.pdf Physical Activity and Older Americans: Benefits and Strategies, www.ahrq.gov/ppip/activity.htm Physical Activity Fundamental to Preventing Disease, Department of Health and Human Services, June 2002, http://www.aspe.hhs.gov/health/reports/physicalactivity President’s Council on Physical Activity and Sports, (202) 690-9000, www.fitness.gov/ Promoting Active Lifestyles Among Older Adults, www.cdc.gov/nccdphp/dnpa/physical/lifestyles.htm USA on the Move: Steps to Healthy Aging (Administration on Aging), www.aoa.gov/otm/overview.asp OTHER ORGANIZATIONS, WEBSITES AND PUBLICATIONS AARP, public: (800) 424-3410, media: (202) 434-2561, www.aarp.org/indexes/health.html#stayfit Active Aging Partnership, www.agingblueprint.org Active for Life (a campaign by AARP and the Robert Wood Johnson Foundation), www.aarp.org/activeforlife/ America Walks, (503) 222-1077, www.americawalks.org American Academy of Orthopaedic Surgeons, (847) 823-7186 or (800) 824-BONES, fact sheet on Exercises for Persons Age 60 and Older, http://orthoinfo.aaos.org/fact/thr_report.cfm? Thread_ID=27&topcategory=Wellness& American Association of Active Lifestyles & Fitness, (800) 213-7193, www.aahperd.org/aaalf/template.cfm American College of Sports Medicine, (317) 637-9200, www.acsm.org/ American Council on Exercise, (858) 279-8227 or (800) 825- 3636, www.acefitness.org/ American Geriatrics Society, (212) 308-1414, www.americangeriatrics.org/ American Society on Aging, (415) 974-9600, www.asaging.org/ and www.asaging.org/cdc Arthritis Foundation, (404) 872-7100 or 800-283-7800, www.arthritis.org Blueprint Mini-Grant Office, (217) 244-7122, blueprint@kines.uiuc.edu, www.icaa.cc/PressInfo/mini-grant% 20call%20for%20proposals.pdf Creating Communities for Active Aging: A Guide to Developing a Strategic Plan to Increase Walking and Biking by Older Adults in Your Community, www.prevent.org/winword/CCFAA.pdf 50-Plus Fitness Association, (650) 323-6160, www.50plus.org International Council on Active Aging, (604) 734-4466 or (866) 335-9777, www.icaa.cc/ National Center for Bicycling and Walking, (202) 463-6622, www.bikewalk.org National Center on Physical Activity and Disability (University of Illinois), (800) 900-8086, www.ncpad.org/ National Coalition for Promoting Physical Activity (collaborative partnership including American Alliance for Health, Physical Education, Recreation, and Dance; American Cancer Society; American College of Sports Medicine; American Diabetes Association; American Heart Association; International Health, Racquet, & Sports Club Association; National Athletic Trainers Association; National Recreation and Park Association; YMCA of the USA), (202) 454-7522, www.ncppa.org National Council on the Aging, (202) 479-1200, www.ncoa.org National Recreation and Park Association, (703) 858-0784, www.nrpa.org National Safety Council, (630) 285-1121, www.nsc.org/ National Senior Games Association, (225) 766-6800, www.nsga.com/ OWL (formerly the Older Women’s League), (202) 783-6686 or (800) 825-3695, www.owl-national.org/ Partnership for a Walkable America, (630) 285-1121, www.nsc.org/walkable.htm Partnership for Prevention, (202) 833-0009, www.prevent.org, www.prevent.org/publications.htm Pedestrian and Bicycle Information Center, media contact Sara Latta, (919) 962-7419, www.bicyclinginfo.org or www.walkinginfo.org Promoting Physical Activity in Communities, www.prevent.org/Winword/Roundtable%20FINAL.pdf Robert Wood Johnson Foundation, www.rwjf.org, www.activeforlife.info, www.alpes.ws SPRY Foundation, (202) 216-0401, www.spry.org Stanford Center for Research in Disease Prevention research (NIA-funded) recommends that public health interventions focus on building older adults’ confidence to overcome barriers to exercise and reach fitness goals. Contact: Glenn Brassington, gbrassington@stanford.edu, http://prevention.stanford.edu/ University of Illinois at Chicago researchers have a $4.5 million grant from the National Institute on Disability and Rehabilitation Research to help make recreation and fitness activities and programs more accessible to people with disabilities. Contact: Nan Hoffman, (312) 355-2954, nanhoff@uic.edu Walkable Communities, (386) 454-3304, www.walkable.org MEDIA CONTACTS:
At ASA: Paul Kleyman (415) 974-9619
paul@asaging.org
At CDC: Jason Lang, (770) 488-5597
jlang@cdc.gov
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