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These recommendations were developed in reference to the existing National Physical Activity Guidelines for Adults published by the Australian Government Department of Health and Ageing, namely:

1. Think of movement as an opportunity, not an inconvenience,
2. Be active every day in as many ways as you can,
3. Put together at least 30 minutes of moderate intensity physical activity on most, preferably all, days,
4. If you can, also enjoy some regular, vigorous activity for extra health and fitness.

The present recommendations are designed to build upon the existing guidelines, by providing advice developed specifically for older Australians. Although the recommendations may be manifested in different ways, according to specific populations or settings, these recommendations apply to older people across all levels of health and ability, and have application for older people living at home or in residential care. Information supporting the recommendations is available in the National Physical Activity for Older Australians Discussion Document.

Definitions

Older people: For the purposes of this document the term “older people” primarily refers to those aged over 65 years, and over 55 years for Aboriginal and Torres Strait Islanders. It is recognised that there are difficulties in ascribing a particular chronological age to define “older people”, and that there is wide variability in health status, function and wellbeing at any age. These recommendations may also have applicability for other age groups, for example, younger people with disabilities.

Physical activity: ‘Any bodily movement produced by skeletal muscles that requires energy expenditure and produces progressive health benefits’ (National Institute of Health Consensus Conference Statement, 1996). Physical activity includes everyday activities like walking to the shop or gardening through to a wide range of organised activities, such as exercise classes.

Moderate level physical activities: 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 (Glasgow et al, 2005).

Vigorous physical activities: Physical activity at a level that causes your heart to beat a lot faster and shortness of breath that makes talking difficult between deep breaths (Glasgow et al, 2005).

General advice when performing physical activities

• Consider physical activities as opportunities for fun with a partner, friends or family members.
• Eating healthy nutritious food in conjunction with being physically active will help to obtain the best health outcomes.
• Drink water during and after physical activity to avoid dehydration.
• A short period of warm up exercises/muscle stretching at the start and at the end of physical activity will help the body adjust to starting or finishing activities that place a physical demand on the body.
• Include some outdoors physical activity, although where possible keep this to a minimum in the hottest part of the day.
• Use appropriate safety and protection equipment to maximise safety and minimise risk of injury during physical activity, for example, use supportive footwear for walking, and a helmet for bicycle riding.

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Recommendation 1

Older people should do some form of physical activity, no matter what their age, weight, health problems or abilities.

Many improved health and well-being outcomes have been shown to occur with regular physical activity.

These include helping to:

• maintain or improve physical function and independent living;
• improve social interactions, quality of life, and reduce depression;
• build and maintain healthy bones, muscles and joints, reducing the risk of injuries from falls; and
• reduce the risk of heart disease, stroke, high blood pressure, type II diabetes, and some cancers.

It’s never too late to start becoming physically active, and to feel the associated benefits. “Too old” or “too frail” are not of themselves reasons for an older person not to undertake physical activity. In fact, older people become sick or disabled more often from not undertaking physical activity, than from participating in a physical activity. Most physical activities can be adjusted to accommodate older people with a range of abilities and health problems, including those living in residential care facilities. Physical activity can also improve health outcomes for older people with chronic health conditions such as stroke or arthritis, although activity may need to be modified in periods of an acute flare up of the condition.

Physical activity is also valuable for well older people, where maintenance of good health, independence, and disease prevention can be achieved.

Many forms of physical activity can be performed with a partner, friends, or in a group, which often increases the enjoyment and takes the mind off the physical nature of the activity.
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Recommendation 2

Older people should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility.

There are many different ways that people can be physically active, including:

• incidental activity, which includes all the moderate intensity routine activities which can be performed as part of everyday life, for example housework, walking to the local shop instead of driving, gardening and raking leaves, and vacuuming;
• leisure pursuits that involve physical activity, including golf, lawn bowls, bocce, woodwork, and various types of dancing (for example, ballroom dancing, line dancing);
• structured activities such as walking groups, strength training, tai chi or other group exercise activities, hydrotherapy classes (exercise in water) and yoga. Depending on preference and availability of classes, these activities can be done in a group or alone.
• supervised physical activity (for example, supervised by a physiotherapist or exercise physiologist), which may be of benefit for older people with moderate health problems, at least when starting out. Examples of older people who may benefit from supervision at least when commencing physical activities are those with heart problems, including following heart surgery; people with chronic respiratory problems; people with neurological problems such as stroke and Parkinson’s disease; people with moderately severe arthritis; people with mental health issues such dementia; and those with a high risk of falls.

There are three main categories of physical activity types that can achieve improved health, independence and well-being for older people:

• endurance / fitness activities, where a major emphasis is on increasing the demand on the heart and lungs. Examples include brisk walking, bicycle riding, swimming and jogging;
• strength training activities, where the emphasis is on building muscle strength. Examples include resistance exercise, lifting weights, and stair climbing, and;
• balance, mobility and flexibility (stretching) activities, where the emphasis is on balance, walking, turning, going up and down steps, muscle flexibility and other mobility related functions.

Sometimes physical activities incorporate just one of these types of activities, while others (such as exercise classes and Tai Chi) may incorporate elements of two or all three of these categories. The range of health benefits achieved is likely to be greater with a mixed range of physical activity options within or between days. In addition, having a number of options or choice in the types of physical activity available can increase motivation and increase the likelihood of uptake and longer term participation in physical activity. Try to include some indoor and outdoor physical activities. Your choice of activities will be influenced by what benefits you want to achieve, what you enjoy doing, and what options are available for you.

There are some health benefits that are most commonly achieved by performing one particular category of physical activity. For example, to improve balance and reduce risk of falling, an activity needs to incorporate some balance related movements, while the effect of endurance training on reducing falls does not appear to be as strong. Therefore there may be a preference for a particular category of physical activity to achieve a particular health benefit. However, if the aim is to improve general health, a mix of physical activity from the three categories is recommended.
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Recommendation 3

Older people should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days.

At least 30 minutes of moderate intensity physical activity on most days has been recommended as the minimum amount to achieve health and well-being benefits, although physical activity does not have to be all in the one episode to achieve these benefits. There is a cumulative effect from activity undertaken in smaller instalments. Therefore, an older person with health problems may be restricted to only doing 10 minutes of physical activity before starting to become short of breath or starting to develop muscle or joint soreness, but can still achieve health benefits by doing 10 minute periods of physical activity at least three
times throughout the day.

The minimum of 30 minutes of moderate physical activity on most days does not have to be restricted to the one type of physical activity within the one session.

Older people who have not been physically active for some time may need to start with less than 30 minutes each day, and gradually build up to 30 minutes or more.
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Recommendation 4

Older people who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up the recommended amount, type and frequency of activity.

While the benefits of participating in physical activity can build up fairly quickly, similarly the benefits can be lost quickly if physical activity is stopped for more than 2-3 weeks. Therefore, if an established physical activity routine is stopped for several weeks, then recommenced, the level of intensity should gradually be built back up to the previous level over several weeks to months, depending on how long the break was for, and the reason for the break (for example, if the break was due to a health problem, then building back up the physical activity routine should be more gradual). A similar approach of gradual build up should be used if starting a new type of physical activity.

People who have stopped physical activity because of a new health problem may need to discuss resuming physical activity with their doctor, or to resume physical activity in a supervised manner at first (for example, by a physiotherapist or exercise physiologist). People who have recently had surgery, including angioplasty should take into consideration the implications of the surgery with their doctor or health professional when commencing physical activity.

If dizziness, palpitations or chest pain occurs during physical activity, the activity should be ceased and advice sought from a doctor. No component of a physical activity routine should cause severe or uncomfortable pain. If such pain is experienced, the activity should be ceased, and discussed with a doctor or health professional such as a physiotherapist.

Recommendation 5

Older people who continue to enjoy a lifetime of vigorous physical activity should carry on doing so in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to.

Generally, higher levels of physical activity are associated with greater health outcomes. People who have undertaken vigorous physical activity throughout their lives can often continue safely with vigorous physical activity in later years.

However, when commencing a new form of vigorous physical activity, it is important that the level of physical activity is suitable for any health problems an older person has. Before commencing a vigorous form of physical activity, the benefits and risks should be discussed with a doctor or health professional.

Gradual progression in the amount and intensity of physical activity is important for older people to gain the best health benefits. This applies for well older people, as well as those with multiple health problems. Some older people who have commenced physical activity in later years can gradually progress to the level of vigorous physical activity.