Physical Activity mini-review

Strength and Balance for Better Health and WellbeingJanuary 2017Louise AnsariAideen YoungThe Centre for Ageing Better received 50 million from the Big Lottery Fund in January 2015 in the form of an endowment to enable it to identify what works in the ageing sector by bridging the gap between research, evidence and practice.

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Declines in strength and balance with ageStrength and Balance for Better Health and WellbeingStrength (muscle and bone)Loss of muscle mass per decade in adults aged 4070 years1: 8% Loss of muscle mass per decade in adults aged 70+: 15%Decrease in muscle strength per decade for someone in their 50s and 60s: 15% Decrease in muscle strength for someone aged 70+2: 30% Proportion of people aged 85+ in the UK who suffer from sarcopenia (degenerative loss of skeletal muscle mass quality and strength)3: 21%Bones become more brittle with age, particularly for post-menopausal women

BalanceAs we age, our balance and reaction times and reflexes get slowerProportion of adults 72+ who experience some form of dizziness4: 20-30%Dizziness, caused by medical conditions or medications can also affect balance

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ReferencesGrimby G, Saltin B.Clin. Physiol.1983;3:209218.American College of Sports Medicine. ACSM position stand on exercise and physical activity for older adults. Medicine and Science in Sports and Exercise 1998;30:9921008.Dodds RM et al. Prevalence and incidence of sarcopenia in the very old: findings from the Newcastle 85+ study. J. Cachexia, Sarcopenia Muscle 2016;Nov 16. doi: 10.1002/jcsm.12157. [Epub ahead of print]Iwasaki S, Yamasoba T. Dizziness and imbalance in the elderly: age-related decline in the vestibular system. Aging Dis. 2014;6:3847.2

Strength and Balance for Better Health and WellbeingAge-related changes+medication or disease

Cycles of adverse outcomesDisabilityDependencyInstitutionalizationDeath3Reduced bone strengthLoss of muscle mass (sarcopenia)Impaired balance

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Frailty, a syndrome related to the ageing processStrength and Balance for Better Health and Wellbeing

Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves1 Frailty is a social care and healthcare challenge because it strongly predicts nursing home placement2Frailty is associated with an increased risk of3:Difficulty staying upright, maintaining balance and walking, leading to disability

Inability to take part in activities necessary for daily life such as bathing

Leading to loss of memory, problems with language, thinking and judgment and delirium

4The more vulnerable an individual is, the higher the risk of falls,immobility or disability, institutionalisation and death

PHYSICAL DECLINEFUNCTIONAL DECLINECOGNITIVE DECLINE

Referenceshttp://www.bgs.org.uk/frailty-explained/resources/campaigns/fit-for-frailty/frailty-what-is-itKojima G. Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis. J Geriatr Phys Ther. 2016 Jun 23. [Epub ahead of print]Vermeiren S et al.. Frailty and the prediction of negative health outcomes: A meta-analysis. J Am Med Dir Assoc. 2016;17:11634

Falls and fractures: the impact on peopleStrength and Balance for Better Health and WellbeingOne-third of people aged 65+ and 50% of over-80s living at home fall at least once a year1Over 60% of those living in nursing homes fall repeatedly2Around 70,000-75,000 hip fractures occur in the UK each year, mainly due to falls3Of those who experience hip fracture4:24% return to their pre-fracture level of function42% require extra help with day to day activities21% require an increased level of residential or hospital care35% receive increased community health and social service care at home1 month after hip fracture 1 in 12 people will have died and only half will have returned home6Falls reduce confidence, increase isolation and reduce independence, with around 1 in 10 older people who fall becoming afraid to leave their homes in case they fall again7

At 90 days post-fracture)5

ReferencesNICE Quality standard QS86, Falls in older people, March 2015Baranzini F et al. Fall-related injuries in a nursing home setting: is polypharmacy a risk factor? BMC Health Serv Res. 2009;9:228NICE Clinical guideline CG124. Hip fracture: management. https://www.nice.org.uk/guidance/cg124/chapter/introduction. Accessed January 7th 2017.Laxton C et al. Morbidity at 3 months after hip fracture: data from the East Anglian audit. Health Trends 1997;29:5560.National Osteoporosis Society (2014) Life with Osteoporosis report, Oct 2014Royal College of Physicians. Falls and Fragility Fracture Audit Programme (FFFAP): National Hip Fracture Database (NHFD) annual report 2014. London.Help the Aged, 2008. Spotlight Report, 2008.

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Cost of fragility fractures: 2 billion per year2Increase in care home admissions due to falls by 20201: 17.7%

Number of people in the UK who end up in A&E after a fall: 280,000; cost to the NHS: 1.5 billion1Number of hospital bed days each year in England because of falls and fractures in people aged 65+: 4 million2

Falls and fractures: the impact on servicesPhysiotherapy and tailored physical exercise programmes Strength and Balance for Better Health and Wellbeing6

6ReferencesChartered Society of Physiotherapy. The costs of falls. http://www.csp.org.uk/professional-union/practice/your-business/evidence-base/cost-falls. Accessed January 8th 2017.Royal College of Physicians. 2011. Falling Standards, broken promises: report of the national audit of falls and bone health in older people 2010.

Strength and Balance for Better Health and Wellbeing

Specific, well-directed programmes that include strength and balance training:improve body balance and muscle structure in older people1can reduce the risk of falls by up to 55%2are beneficial both in terms of preventing and treating frailty3,4 resulted in a significant difference in the occurrence of frailty5significantly improved knee joint pain among older adults6has positive effects on risk factors for cardiovascular disorders, cancer, diabetes, and osteoporosis7-10In contrast, in healthy, active men and women, running alone was not sufficient to prevent the loss in muscle strength that occurs with ageing11

Effectiveness of strength and balance trainingeither as a single intervention or as a component of multicomponent interventions

Falls and frailty can be prevented through strength and balance training

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ReferencesZampieri S et al. Lifelong physical exercise delays age-associated skeletal muscle decline. J. Gerontol. A Biol. Sci. Med. Sci. 2015;70:163173.Logan PA. et al, Community falls prevention for people who call an emergency ambulance after a fall: randomised controlled trial. BMJ 11 May 2010.Fried LP. Interventions for human frailty: physical activity as a model"Cold Spring Harbor perspectives in medicine2016;6:a025916.Cesari M et al; LIFE Study Group. A physical activity intervention to treat the frailty syndrome in older persons-results from the LIFE-P study. J .Gerontol. A Biol. Sci. Med. Sci. 2015;70:216222.Cruz-Jentoft AJ et al. Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 2014;43:748759.Hasegawa R, Takeshima N. Effects of Combined Balance and Resistance Exercise on Reducing Knee Pain in Community-Dwelling Older Adults. Phys. Occ. Ther. Geriatr.. 2010;28:4456.Liu CJ, Latham NK: Progressive resistance strength training for improving physical function in older adults. Cochrane Database of Systematic Reviews 2009, Issue 3.Martyn-St James M, Carroll S: High-intensity resistance training and postmenopausal bone loss: a meta-analysis. Osteoporosis Int 2006;17:122540. Daniels R et al. Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Services Research 2008;8:278. Mc Dermott AY, Mernitz H: Exercise and older patients: prescribing guidelines. Am Fam Physician 2006;74:43744. Marcell TJ et al. Leg strength declines with advancing age despite habitual endurance exercise in active older adults. J Strength Cond Res 2014;28:504513

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Examples of exercise for strength and balanceStrength and Balance for Better Health and WellbeingEvidence-based multicomponent exercise programmes: Otago falls programmeZumba Gold 8

ReferencesKim SB, OSullivan DM. Effects of aqua aerobic therapy exercise for older adults on muscular strength, agility and balance to prevent falling during gait. J Phys Ther Sci. 2013;25:923927.Mohammadi M. et al. The effect of pilates exercise on gait speed and strength of lower limb in elderly male. Adv Appl Sci Res. 2015;6:16. Theodorou AA et al. Stair descending exercise increases muscle strength in elderly males with chronic heart failure. BMC Res Notes 2013;6:87.Hakim RM, Leininger PM. A Cross-Sectional Study of Balance-Related Measures with Older Adults Who Participated in Tai Chi, Yoga, or No Exercise. Phys Occ Ther Geriatr. 2010;28:6374.Song QH et al. Effect of Tai-chi exercise on lower limb muscle strength, bone mineral density and balance function of elderly women. Int J Clin Exp Med. 2014;7:15691576.Liu H, Frank A. Tai chi as a balance improvement exercise for older adults: a systematic review. J Geriatr Phys Ther. 2010;33:103109.Grande GH et al. Effect of pilates exercise for improving balance in older adults (PEDro synthesis). Br J Sports Med. 2016 Nov 4.Kwak C-J. et al. Effects of elastic-band resistance exercise on balance, mobility and gait function, flexibility and fall efficacy in elderly people. J Phys Ther Sci. 2016;28;31893196.Seo B-D et al. Effect of 12-week Swiss Ball Exercise Program on Physical Fitness and Balance Ability of Elderly Women. J Phys Ther Sci. 2012;24:1115.De Oliveira MR et al. Effect of different types of exercise on postural balance in elderly women: a randomized controlled trial. Arch Gerontol Geriatr. 2014;59:506514.Lee C-W, Cho G-H. Effect of Stationary Cycle Exercise on Gait and Balance of Elderly Women. J Phys Ther Sci. 2014;26:431433.Cromwell RL et al. Tae Kwon Do: an effective exercise for improving balance and walking ability in older adults. J Gerontol A Biol Sci Med Sci. 2007;62:641646.8

Chief Medical Officers guidelines (2011)Older adults should undertake physical activity to improve muscle strength on at least two days a weekOlder adults at risk of falls should incorporate physical activity to improve balance and coordination on at least two days a week Physical activities that strengthen muscles involve using body weight or working against a resistance. This should involve using all the major muscle groups. Examples include: Carrying or moving heavy loads such as groceriesActivities that involve stepping and jumping such as dancingChair aerobics Activities to improve balance and coordination may include: Tai chiYogaPilatesStrength and Balance for Better Health and WellbeingFrom: Department of Health. UK physical activity guidelines. 2011

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ReferencesDepartment of Health. UK physical activity guidelines. https://www.gov.uk/government/publications/uk-physical-activity-guidelines. Accessed July 25th 2016.

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Who does muscle-strengthening activities? From: Health Survey for England - 2012

Strength and Balance for Better Health and Wellbeing

10Proportion of men 5564 years who meet the guidelines for muscle-strengthening activity: