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1 NATIONAL . AGEING . RESEARCH . INSTITUTE . Incorporated A 0029603G. NATIONAL physical activity recommendations for older Australians: Discussion Document Prepared for the Australian Government Department of Health and AGEING By the NATIONAL AGEING RESEARCH INSTITUTE 12th May, 2006 NATIONAL AGEING RESEARCH INSTITUTE (NARI) - FINAL 1. This document has been prepared for the Department of Health & AGEING by members of the Public Health Division, NATIONAL AGEING RESEARCH INSTITUTE : Jane Sims, Keith Hill, Sue Hunt and Betty Haralambous. We acknowledge the advice and feedback provided by the project's Expert Advisory Group members: Annette Brown, Lisa Engel, Nancy Huang, Ngaire Kerse and Marcia Ory. Suggested citation: Sims J, Hill K, Hunt S, Haralambous B, Brown A, Engel L, Huang N, Kerse N, and Ory M.

2 2006. NATIONAL physical activity recommendations for older Australians: Discussion document. Canberra: Australian Government Department of Health and AGEING . 12th May, 2006 NATIONAL AGEING RESEARCH INSTITUTE (NARI) - FINAL 2. Table of Contents List of Figures ..4. Definitions ..7. Executive 1 2 3 Physical activity patterns in older Australians ..20. 4 The health consequences of physical inactivity and the benefits of physical activity ..24. 5 Determinants of physical activity behaviour in older 6 Measurement of physical activity in older people ..46. 7 A description and critique of existing guidelines and 8 Physical activity options for older people: Types and 9 Physical activity considerations for population sub-groups.

3 70. 10 Draft 11 Where to next ..91. Appendix 1 Stakeholders consulted ..115. Appendix 2 Websites searched ..117. Appendix 3 Search strategies Appendix 4 The measurement of physical activity in older people ..119. Appendix 5 Randomised controlled trial and review Appendix 6 Recommendations derived from previous physical activity guidelines ..149. Appendix 7 Appendix 8 Strategic priority areas from the Blueprint document ..160. 12th May, 2006 NATIONAL AGEING RESEARCH INSTITUTE (NARI) - FINAL 3. List of Figures Figure Project activity flowchart ..15. Figure Potential outcomes of exercise that may be related to quality of life Figure Age-specific prevalence of coronary heart disease, Australia, 2001 ..26. Figure Age-specific prevalence rates of Type 2 diabetes among Australians aged 25+, 1999- 2000.

4 28. Figure Age-specific incidence of colorectal cancer, Australia, Figure A heuristic multilevel model of influences on physical Figure Recommendations for physical activity in the management of osteoarthritis of the hip or Figure Recommendations for conducting culturally appropriate physical activity programs ..82. List of Tables Table The prevalence of sedentary behaviour in older Australians 1995 to 2005 ..20. Table Physical activity patterns in three Western countries ..23. Table Relative risk for overall mortality in older people ..24. Table Common outcome measures and measurement tools used..46. Table Physical activity guidelines and recommendations reviewed..49. Table Review of existing physical activity guidelines and recommendations for older Table Influence of walking pace on coronary disease Table Illustrative Components of Fitness and Physical Activity Programs.

5 66. Table Registered fitness professionals in Table Randomised controlled trials: residential care setting ..121. Table Randomised controlled trials: Community setting ..127. Table Review articles for the promotion of physical activity to prevent or treat depression ..137. Table Review articles for the promotion of physical activity in older people ..138. Table Review articles for types of physical activity used to promote health in older Table Review articles of benefits of physical activity for Table Recommendations for physical activity for older people derived from previous physical activity 12th May, 2006 NATIONAL AGEING RESEARCH INSTITUTE (NARI) - FINAL 4. Glossary ADL: Activities of daily living Aged care staff: includes non-professional staff such as care assistants, and professional staff such as registered nurses, general practitioners, and allied health staff (for example: social workers, physiotherapists, diversional therapists, podiatrists, pastoral care workers, music therapists).

6 Volunteers may provide aspects of care or play a role in supporting residents and/or their families. AGREE: Appraisal of Guidelines RESEARCH and Evaluation BMI: Body Mass Index BP: Blood pressure CATI: Computer assisted telephone interview CHD: Coronary heart disease CHF: Congestive heart failure CI: Confidence interval Clinical practice guidelines: Statements guiding the practice of health care practitioners that are developed from the collation and synthesis of the available evidence for the effective management of those with specific diseases or clinical conditions ( NATIONAL Health and Medical RESEARCH Council [NHMRC], 1999). These guidelines have the potential to aid in health care decision making and quality improvement, describe care that is fitting, and focus on particular circumstances while taking into account the specific care context.

7 Connectivity: The directness or ease of travel between two points that is directly related to the characteristics of street design. COPD: Chronic obstructive pulmonary disease CLDB (Culturally and linguistically diverse backgrounds): Persons born overseas in countries where English is not the main language spoken' (Gibson, Braun et al. 2001)pg 1. CVD: Cardiovascular disease DALYs: Disability adjusted life years Delphi survey process: A technique used to elicit opinions with the goal of obtaining a group response from a panel of experts FM: Fat mass Geographical information systems: Computer based systems designed to integrate different types of spatial and attribute information. Data relevant to physical activity includes topography, geological feature, existing land uses, infrastructure systems, recreation facilities and residences Hazard ratio: A statistical term describing the relative risk of a complication (eg colorectal cancer).

8 Based on comparison of event rates between two groups categorised by presence or absence of a predictor variable (eg previous physically active or not). 12th May, 2006 NATIONAL AGEING RESEARCH INSTITUTE (NARI) - FINAL 5. IHD: Ischemic heart disease IRM: One repetition maximum an indication of current muscle strength in a particular muscle group, used as a basis for determining the weight that should be lifted in a strength training program (usually a percentage of the 1RM). Land-use mix is the level of integration within a given area of different types of uses for physical space, including residential, office, retail/commercial and public space. LDL-cholesterol: low density lipoprotein cholesterol Moderate level physical activities is physical activity at a level that causes your heart to beat faster and some shortness of breath, but that you can still talk comfortably while doing.

9 NHPA: NATIONAL Health Priority Area OA: Osteoarthritis OR: Odds ratio Primary, secondary and tertiary prevention: Primary, secondary and tertiary prevention refer to health promoting activity, early disease detection and management, and treatment of established disease respectively. PRT: Progressive resistance training PTSD: Post traumatic stress disorder RCT: Randomised controlled trial Residential aged care: The care provided for residents of aged care facilities. Residential Aged Care Facilities (RACFs), previously known as nursing homes and hostels, provide personal care, support services, allied health services, and accommodation for elderly people assessed by Aged Care Assessment Teams to be in need of such care and services.

10 ACFs provide high level care, which includes 24-hour access to professional nursing care; low level care, where access to professional nursing care is more limited; or a combination of both high and low level care Residential aged care worker: Any person providing care in a residential aged care facility. This term will cover professional staff, non-professional staff, and volunteers. Residential density the number of dwellings per unit of land. ROM: Range of motion RR: Rate ratio SEPA: Supportive Environments for Physical Activity 12th May, 2006 NATIONAL AGEING RESEARCH INSTITUTE (NARI) - FINAL 6. Definitions Older Australians' can be defined as the heterogenous group of older adults who are members of our society.