It

1
Its too bloody late for me !Physical activity
and older people

• Bob Laventure
• BHF National Centre for Physical Activity and
  Health
• Loughborough University
• Bassetlaw Partnership for Health
• November 2007

2
Overview

• Update on evidence
• PSA Targets and themes
• Targeting and priorities
• Activity recommendations
• The BHF National Centre at Loughborough
  University
• No, its not too by late for me !

3
New evidence

• Diabetes
• Cancers
• Obesity
• Cognitive functioning
• Prevention of dementia
• Falls prevention
• All linked to lifestyle
• Just how much more do we need ?
• www.bhfactive.org.uk

4
Older evidence mental health have we
forgotten ?
The benefits of physical activity for older people

• Reduction in stress, anxiety and depression
• Improvement in overall psychological well-being
• Improvements in cognitive function
• Improvements in self-esteem and self-worth
• Increased contact with friends, community and
  reduction in isolation and loneliness
• Increased prevalence and most frequently reported
  by participants across the age range
• (UK Enquiry into Mental Health of Older People
  (NIMH and Age Concern 2006)

5
Evidence of effectiveness

• Brief interventions (NICE 2006/7)
• Public health interventions (BHF NC 2007, NICE
  2007)
• Multi level interventions ecological health
  promotion

6
Evidence of effectiveness
Can we help to change matters?

• From a critical review of 29 physical activity
  interventions
• Increased activity levels over a longer period of
  time 18 months (75)
• Group/class-based and home-based activity were
  effective
• Tailored to individual needs
• Cognitive-behavioural strategies and goal-setting
• Telephone support and continued contact
• More likely than young adults
• (King et al, 1998)

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Policy drivers, PSA Targets and themes

• PSA 17 Tackle poverty and promote greater
  independence and well being in Later Life
• PSA 18 Promote better health and well-being for
  all
• PSA 19 Ensure better care for all
• PSA 21 Build more cohesive, empowered and active
  communities
• PSA 23 Make communities safer

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PSA 17 - Independence and well being in later life

• Indicators 1 2 - employment and pensions
• Indicator 3 - healthy life expectancy at age 65
• Indicator 4 - Satisfaction with home and
  neighbourhood
• Indicator 5 - Support to live independently at
  home

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PSA 18 - Better health and well-being for all

• Indicator 1 - All age all cause mortality rate
• Indicator 2 AAACM (spearhead areas)
• Indicator 4 people to supported to live
  independently

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PSA 18 - Better health and well-being for all

• All age all cause mortality indicators/measures
• reducing the mortality rate by 2010 for cancer by
  at least 20 per cent in people under 75, with a
  reduction in the inequalities gap by at least 6
  per cent
• reducing the mortality rate by 2010 for heart
  disease, stroke and related diseases by at least
  40 per cent in people under 75, with a reduction
  in the inequalities gap by at least 40 per cent
• National stroke strategy

11
PSA 19 - Ensure better
care for all

• Patient services and waiting times
• Indicator 5 - Long term conditions
• (preventative care and self care self management)

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PSA 21 - More cohesive active communities

• Indicator 5 Thriving communities strong
  emphasis on 3rd sector and volunteering
• Indicator 6 - participation in culture or sport
  (beware of measures !)

13
PSA 23 - Make communities safer

• A pre-requisite for older peoples mobility,
  independence, confidence to travel, get out and
  about and participate in their community

14
PSA targets

• Distinguish between
• Those with direct association with Physical
  activity
• Those by inference/contribution e.g. stronger
  communities
• Support from other frameworks e.g. NSFs

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LIFE STAGES IN ACTIVITY all older people but a
change in focus

• Entering Old Age
• disease prevention
• recreation and social activity
• Transitional Phase
• reduce disability
• maintain mobility and independence
• Activity in the later years
• occupational activities
• maintain autonomy and dignity

Promote and extend healthy active life Compress
morbidity
Identify emerging problems ahead of crisis Reduce
long-term dependency
Recognise complex interaction of physical, mental
and social care factors compromising independence
and quality of life
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Priority groups and conditions

• Who should we be targeting ?
• Boomers
• Older men
• The transitional phase between independence and
  frailty and especially people isolated at home
• People over 85
• People with dementia

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Boomers

• Prevention - Evidence on impact of an active
  lifestyle is increasing
• New generation, new ideas, new challenges
• Busier than ever, we are competing for their
  time, counter-attractions
• We need to be innovative and provide high quality
  experiences

Hope I die before I get old My generation -
The Who 1966
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Older men

• Inequality in health
• Men die younger
• Different disease patterns
• Do not use health services
• Are services designed or appropriate for men ?

19
People isolated at home

• Poor mental health, significant isolation and
  loneliness
• Downward spiral of functional decline and loss of
  independence
• Circle of Life (contact with friends, neighbours
  and community) diminishes
• Inactivity is life limiting

20
People over the age of 85

• The new generation
• Small proportion in nursing and care.
• Most at home
• Increased prevalence of disease and frailty
• We have low expectations of them
• Fear and skills factor

21
People with dementia

• Prevalence set to increase (Im by 2025)
• Not all in advanced years and 2/3 live at home
• D is accompanied by depression, anxiety and
  increased risk of falls
• Impact on carers
• National Dementia strategy next year
• New skills and ways of working required

22
People with dementia

• Costs of care CHD, Stroke and cancers together
  in UK (17b)
• IN USA someone under 65 develops D every 79
  seconds
• By 2030 costs in USA will total medicare budget
• The New Cancer ? Fear and ignorance
• Prevalence is increasing, cure not in sight,
  delayed onset by 5 years would halve deaths

23
New guidelines

• BHF National Centre for Physical Activity and
  Health
• How much is physical activity is enough and how
  do we communicate this ?
• What works in practice ?
• www.bhfactive.org.uk

24
Effective health promotion for older people and
physical activity

• What works ?
• Ecological models that recognise multilevel
  components e.g.
• Population wide interventions
• Community interventions and programmes
• 1 to 1 interventions
• (Whitehead 1999, Sallis et al 1999, CDC 2000)

25
New activity

• Active for Later Life resource updated and now
  available online as website
• BHF Campaign 30 Mins. a Day, Any
  Way,
• Policy calls for the 50 65 population
• Fit for Life Plan - (motivating the older person)

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Activity recommendations

• 30 mins moderate intensity on 5 or more days a
  week
• Strength, flexibility, balance and coordination
  are vital (2 x per week)
• CMO 2005, BHF NC 2007, AHA ACSM 2007
• Different for obesity and weight loss
• Different for falls prevention and management

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Activity recommendations

• Distinguishing between
• Authoritative Guidelines
• Professional understanding (PA and non
  specialist)
• Public education (clear and accurate messages)

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Its too by late for me !

• Fiatarone et al (1990) strength training among
  nono-generians
• Campbell et al 75 (fallers)
• Prevalence of depression and anxiety amongst
  oldest old
• Older people respond to training in the same way
  as young people
• So detrained that gains are greater
• Quick wins

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The good news ! - Improvements in fitness and
functional capacity

• Balance - Static 8 weeks , dynamic 8 weeks
• Muscle strength (8 - 12 weeks)
• Gait (8 weeks)
• Muscle power (12 weeks)
• Postural Hypotension (24 weeks)
• Transfer (24 weeks)
• Endurance (26 weeks)
• Bone strength 1 year for femur and lumbar spine
• (Skelton 1999)

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Thank you for listening !bob.laventure_at_ntlworld.c
om

• www.bhfactive.org.uk