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A literature review of evidence on physical activity for ...

A literature review of evidence on physical activity for older people and a review of existing physical activity guidelines for older people June 2011 (Draft 3). June 2011. New Zealand Guidelines Group and University of Western Sydney evidence Report: prepared for the Ministry of Health, New Zealand Contributors Dr Julie Brown Senior Researcher New Zealand Guidelines Group Dr Richard Rosenkranz Lecturer/Research Fellow School of Biomedical and Health Sciences University of Western Sydney, Australia Professor Gregory Kolt (Lead researcher). Head of School School of Biomedical and Health Sciences University of Western Sydney, Australia Dr Jessica Berentson-Shaw Research Manager New Zealand Guidelines Group Emma George (School of Biomedical and Health Sciences, University of Western Sydney), Karen Cheer (Liaison Librarian, University of Western Sydney), Stuart McCaw (Business Development Manager, NZGG) and Margaret Paterson (Information Specialist, NZGG) are also acknowledged for their assistance with various aspects of this report.

osteoarthritis, obesity, type 2 diabetes, and depression. Strong evidence exists for the benefits of physical activity for older people in enhancing physical fitness (including strength and aerobic endurance), quality of life and wellbeing, cognitive function, and physical function.

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1 A literature review of evidence on physical activity for older people and a review of existing physical activity guidelines for older people June 2011 (Draft 3). June 2011. New Zealand Guidelines Group and University of Western Sydney evidence Report: prepared for the Ministry of Health, New Zealand Contributors Dr Julie Brown Senior Researcher New Zealand Guidelines Group Dr Richard Rosenkranz Lecturer/Research Fellow School of Biomedical and Health Sciences University of Western Sydney, Australia Professor Gregory Kolt (Lead researcher). Head of School School of Biomedical and Health Sciences University of Western Sydney, Australia Dr Jessica Berentson-Shaw Research Manager New Zealand Guidelines Group Emma George (School of Biomedical and Health Sciences, University of Western Sydney), Karen Cheer (Liaison Librarian, University of Western Sydney), Stuart McCaw (Business Development Manager, NZGG) and Margaret Paterson (Information Specialist, NZGG) are also acknowledged for their assistance with various aspects of this report.

2 Page iii 07/06/2011. Table of Contents 1 Executive summary 1. Key messages 1. 2 Introduction 6. Purpose 6. Definitions 6. Epidemiological and demographic context 7. How older people participate in physical activity 8. Conclusions that can be drawn 9. The Australian national policy response 9. New Zealand national policy response 10. References 12. 3 Methods 14. Date range of publications 14. Type of publications 14. Participants 15. physical activity 15. Sedentary behaviour 15. Types of physical activity intervention 15. Outcome measures 15. Search sources 16. Appraisal 18. References 20. 4 What are the benefits associated with physical activity participation for older people? 21. Background 21. Definitions 22. physical activity and the prevention of health-related conditions 22. physical activity and the management of health conditions 51. physical activity and the enhancement of functioning 71. Overall conclusions 89. References 90.

3 Page v 07/06/2011. 5 What are the risks associated with physical inactivity for older people? 100. Background 100. Definitions 100. Body of evidence 100. Risks associated with low levels of moderate to vigorous physical activity (mortality) 101. Risks associated with low levels of moderate to vigorous physical activity (morbidity) 105. Risks associated with sitting or sedentary behaviour (mortality) 113. Risks associated with sitting or sedentary behaviour (morbidity) 114. Conclusions 115. References 116. 6 What are effective types of physical activity interventions in improving outcomes for older people? 120. Background 120. Definitions 121. Body of evidence 123. Summary of findings 124. Overall conclusions 198. References 207. 7 What are the enablers and barriers to physical activity participation in older people? 214. Background 214. Definitions 214. Body of evidence 215. Summary of findings 215. Detailed findings 223. Conclusions 234.

4 References 234. 8 What are the safety and risk issues associated with physical activity participation by older people? 237. Introduction 237. Body of evidence 237. Summary of findings 238. Conclusion 249. References 250. Page vi 07/06/2011. 9 International guidelines, policies and principles 253. Introduction 253. Definitions 253. Sentinal report from the US Surgeon General 254. Guidelines 254. Policies and scientific statements 263. Horizon scanning 271. Conclusions 272. References 272. 10 New Zealand specific issues and cultural considerations 276. Background 276. Body of evidence 276. Summary of findings 277. Conclusion 288. References 288. 11 Search strategies 291. Search strategies 291. 12 Research questions 298. Glossary 299. Page vii 07/06/2011. 1 Executive summary Consistent with worldwide trends, the population of New Zealand is ageing. Based on the 2006 Census data, the New Zealand population aged over 65 years at the end of 2006 was 519,940 (12% of the total population) (Ministry of Social Development 2007).

5 It has been estimated that the older adult cohort is projected to increase to 25% of the total population by 2051 (Dunstan et al 2006). Along with the ageing population come challenges in maintaining health and wellbeing. An important key to healthy ageing is the maintenance of a physically active lifestyle. physical inactivity has both direct and indirect costs to the health of a population, with evidence showing graded health benefits of physical activity for reducing of a range of non- communicable diseases (US Surgeon General 1996). The phrase older people , as used in this report, refers to people over the age of 65 years. This report examines the evidence since 2004 on the benefits and risks of physical activity , as well as the risks of inactivity. It draws conclusions from the evidence as to what the most effective types of physical activity are for older people and does this from the perspective of both preventing the onset of chronic conditions and also the management of those conditions.

6 The report addresses the enablers and barriers to participation in physical activity for older people; and examines specific issues (especially with regard to safety) and cultural considerations for New Zealand older people. It also examines the existing evidence from international guidelines and policies on physical activity for older people. Key messages The key messages identified below are grouped by area of focus and highlight the main findings of the report. Each chapter of the report outlines the details and evidence supporting each of the key messages. Benefits associated with physical activity participation for older people The strongest evidence for the benefits of physical activity for older people in preventing negative health and disability relates to all-cause mortality, cardiovascular mortality, cancer mortality, falls, stroke, heart disease, breast cancer, and colon cancer. The strongest evidence for the benefits of physical activity for older people in the management of health and disability relates to vascular disease, heart disease, stroke, osteoarthritis, obesity , type 2 diabetes, and depression.

7 Strong evidence exists for the benefits of physical activity for older people in enhancing physical fitness (including strength and aerobic endurance), quality of life and wellbeing, cognitive function, and physical function. Page 1. 07/06/2011. Risks associated with physical inactivity and sedentary behaviour for older people Having a less active and more sedentary lifestyle increases the risk of premature mortality relative to leading an active lifestyle. The lack of moderate to vigorous physical activity and large amounts of time spent sitting (sedentary behaviour) are independent risk factors for negative health outcomes. Incremental increases in physical activity or decreases in sedentary behaviour are both independently associated with reductions in mortality and morbidity risk. Effectiveness of various types of physical activity in improving health outcomes for older people Ample evidence exists that physical activity intervention programmes are effective in preventing disease, injury, and other undesirable health conditions: moderate to vigorous intensity aerobic endurance interventions can be effective in preventing osteoporosis, hypertension, type 2 diabetes, disability, and hospitalisation resistance training, done at a moderate to high intensity, has effectiveness in preventing osteoporosis and disability mobility and balance interventions are effective in preventing falls interventions combining mixed types of moderate to vigorous intensity physical activity can be effective in preventing falls, physical disability, osteoporosis, hospitalisation, hypertension, and type 2 diabetes.

8 evidence exists that physical activity interventions are effective in the management of health- related conditions in older people: moderate to vigorous intensity aerobic endurance interventions are effective in vascular disease, heart disease, stroke, cancer, osteoarthritis, neurological disorders, hip injury, and depression resistance training interventions, across a range of intensities, have been shown to be effective in managing vascular disease, stroke, osteoarthritis, frailty, obesity and overweight, hip injury, sleep problems, and depression mobility and balance interventions are effective in managing stroke, osteoarthritis, frailty, and sleep problems interventions combining mixed types of physical activity , across a range of intensities, have shown effectiveness in managing vascular disease, heart disease, stroke, cancer, osteoarthritis, frailty, obesity and overweight, type 2 diabetes, pulmonary disease, neurological disorders, depression, and sleep problems.

9 Page 2. 07/06/2011. There is evidence that demonstrates that physical activity interventions are effective in enhancing a range of functions in older adults: moderate to vigorous intensity aerobic endurance interventions have been shown to enhance cognitive function, physical function and mobility, balance, aerobic capacity, and strength resistance training, across a range of intensities, is effective in enhancing cognitive function, physical function and mobility, activities of daily living, balance, aerobic capacity, and strength moderate intensity mobility and balance interventions are effective in enhancing cognitive function, physical function and mobility, and balance interventions combining mixed types of moderate to high intensity physical activity have shown effectiveness in enhancing physical function and mobility, activities of daily living, balance, aerobic capacity, strength, and quality of life . Enablers and barriers to physical activity participation in older people Differences were not generally evident between enablers and barriers to physical activity in New Zealand-specific literature and that from international studies.

10 The New Zealand specific literature identified enablers for physical activity to include guidance/encouragement from health professionals, institutional (including religious) encouragement, and access to community-based programmes, For M ori, it was highlighted that programmes be based on the principles underpinning the Treaty of Waitangi, are culturally appropriate, include facilitators trained on marae, and demonstrate an understanding of tikanga. Identified barriers to physical activity in New Zealand specific literature included health problems and concerns, lack of support and encouragement, and cultural and social norms/expectations. In looking at the broader international literature , the most frequently cited enablers were positive experiences and outcome expectations, promotion of health and feeling healthy, social support for physical activity , easy access to parks/facilities, and low-cost or no-cost programmes. The most frequently cited barriers were problems with health, functional ability, and fear of falling and sustaining injury.


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