By 2025, the 65+ population will significantly outstrip all other age groups in Malta. In fact, our rapidly ageing society was the underlying driving force behind the National Strategic Policy for Active Ageing (2014-2020). Without delving into the socio-economic and general health aspects of this document I will instead focus on a single aspect, namely, the vital role physical activity plays in maintaining health among the older population.
Chronic diseases account for a substantial burden of healthcare costs. The knowledge that a significant proportion of our elderly live with not one, but at least two chronic diseases, implies that Maltese society should be trying to lower the latter by tackling the former.
Chronic disease is often accompanied by low levels of daily physical activity, thereby compounding the risk of a functional decline leading to earlier mortality and morbidity and an overall poorer quality of life.
The American College of Sports Medicine (ACSM) strongly emphasises that physical inactivity is among the strongest predictors of physical disability in older people and chronic disease sufferers. Hence the concept of ‘prescribing exercise’ and not just medication, in the prevention and management of disease. In the older generation, this should be in the form of a multicomponent programme that incorporates elements of aerobic (endurance), resistance (muscle strengthening) and proprioceptive (balancing) exercise.
The older generation should still be as physically active as their abilities and conditions allow
The World Health Organisation (WHO) presented physical activity guidelines for all adults aged 65+ so long are there was no concomitant medical contraindication. Hence, older adults should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity. This physical activity can be undertaken in bouts of 10 minutes or even less at various times of a day and for additional health benefits, their weekly activity goals can even be doubled.
Ideally one should also include exercises to enhance balance and prevent falls on three or more days per week, as well as muscle-strengthening activities at least twice a week. What is important is that although these numbers may appear daunting, the older generation should still be as physically active as their abilities and conditions allow and that the concept of ‘one size does not fit all’ should always be followed.
Quoting the ACSM, these activities “may delay or improve mobility disability, frailty and loss of independence in ageing and it is never too late to attain the benefits of an active lifestyle!”
Now before we start envisaging a rush to the gyms, in the older age groups physical activity may include leisure time physical activity, transportation (eg, walking or cycling), occupational (if the individual is still working), household chores, play, gardening, games, sports or planned exercise. Sometimes all it takes is increased awareness, opportunity, support and a tweak to one’s daily activity.
By incorporating the WHO’s physical activity recommendations, one stands to improve cardiorespiratory and muscular fitness, bone and functional health, mental health and slow cognitive decline as well as significantly reduce the risk of non-communicable diseases (such as hypertension, obesity, heart disease, etc.).
All well and good. We know that we must be more physically active at all age groups, but among the elderly what are the possible solutions? Do we have to rely on the government to do everything? Involve the private sector? Individual choices? Well, I personally do not think that this is a job for any stakeholders, but rather a juxtaposition of different ideas, schemes and initiatives that will allow us to reach as many physically inactive elderly as possible and guide them on the way to an appropriate physical activity programme.
In fact, the WHO ‘Global action plan on physical activity 2018-2030’ stresses that increasing physical activity requires a systems-based approach – there is no single policy solution! In other words, we all must put our heads together, roll up our sleeves and tuck in to achieve results that will significantly affect the well-being of our elderly and maybe, who knows, save a few million euro in healthcare expenses.
Kirill Micallef Stafrace is a sports and exercise medicine consultant who is inspired by a mother that goes on daily walks, even in her late 80s.