Abstract
The ageing population
The population is ageing. In the UK and globally the number of people over 65 years in age continues to increase. Predictions suggest that by 2050 such people will outnumber children whose age is less than 5 years (World Health Organisation, 2018). This demographic shift presents significant challenges to health and social care, with implications for public health and policymakers.
Guidelines
This article focuses on the often-overlooked UK physical activity (PA) guideline for older adults, particularly around muscle and bone strengthening and balance exercises. National recommendations from the Chief Medical Officer state that older adults (65 years and over) should ‘undertake PA to improve muscle strength on at least two days a week’; and that older adults at risk of falls should ‘incorporate PA to improve balance and co-ordination at least twice a week’ (Department of Health, 2011).
Healthy ageing
Intuitively, PA seems good for us. A recent systematic review confirms that PA supports healthy ageing (Daskalopoulou et al., 2017). However, the UK Active Lives Survey (Sport England, 2018) identified that 29% of 65–74 year-olds are classed as physically inactive (undertaking less than 30 minutes of exercise a week), with fewer still meeting muscle strengthening or balance and co-ordination guidelines. Physical inactivity adds significant risk for major non-communicable diseases such as type 2 diabetes, cardiovascular disease, breast cancer, and colon cancer. Physical inactivity has financial implications too. For example, in 2015, inpatient falls cost an estimated £2.3 billion (NHS Improvement, 2017), with poor balance and low muscle strength identified as the commonest preventable risk factor for falls.
Inactivity, sarcopenia and falls
Sarcopenia is a syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength. Sarcopenia is generally considered an age-related condition with many causes. Activity-related sarcopenia can result from bed rest, sedentary lifestyles or zero-gravity mechanisms. Sarcopenia is a major contributing factor to loss of independence associated with fraility and falls (Cruz-Jentoft et al., 2010).
Encouragingly, there is a body of consistently strong evidence supporting the efficacy of resistance training to mitigate or even reverse the impacts of age-related muscle decline, by increasing muscle size and strength (Peterson et al., 2010).
The benefits of strength and balance exercises
Living independently requires a range of activities of daily living (ADL) including lifting shopping, climbing stairs, navigating the terrain underfoot while avoiding falls, and remaining upright if trips occur. Most ADL require a degree of balance, muscular strength, and power, with musculoskeletal function required throughout the life course.
Assessment of positive impacts of different sport, physical activity or exercise on muscle, bone and balance outcomes (Foster and Armstrong, 2018).
1. Key: XXX = strong effect XX = medium effect X = low effect 0 = no effect NK = not known
Reproduced with permission from Foster C, Armstrong MEJ (2018) What types of physical activities are effective in developing muscle and bone strength and balance? Journal of Frailty, Sarcopenia and Falls. 3(2): 58–65
A summary of some of the health benefits of strength and balance activities (Hillsdon and Foster, 2018).
Motivational interviewing for behavioural change
Translating this knowledge into meaningful action is challenging. Not unusually, patients attending their GP bring a list of problems and may perceive a variety of barriers to adopting advice. A framework is helpful when consulting this increasingly complex ageing population, for whom multi-morbidity is the norm, in order for them to engage with support.
Based on some key motivational interviewing techniques, this section introduces two strategies that can be incorporated into consultations about physical activity and behaviour change. These materials are provided with permission from Dr Tim Anstiss of The Academy for Health Coaching.
Case study
Mrs Smith, age 68 years, retired civil servant, attends a routine 10-minute morning appointment. Her body language indicates that she is fairly unsteady on her feet and you notice that she has to grab the desk as she sits down, holding one of her knees and grimacing. ‘I am sorry to bother you Doctor, but I have a list of things I need sorting and I thought best to book in’. Mrs Smith has several long-term conditions: Type 2 diabetes, osteoarthritis of the knee, and hypertension. She was admitted to hospital recently following a mechanical fall at home. This is the first time she has fallen and you recognise her mobility as a priority.
Strategy 1: Agreeing the agenda
Key message
Phrases and questions for use with the Agreeing the agenda approach.
Suggested phrases for topic/issue negotiation.
Strategy 2: Sharing information: Ask-share-ask
Key message
To help patients reach an informed decision when sharing information, it is important to provide ideas without telling the person what they should do.
Suggested Ask-Share-Ask questions and phrases.
Useful resources.
