The Journals of Gerontology Series A · 2002

Exercise Comes of Age: Rationale and Recommendations for a Geriatric Exercise Prescription

M. A. F. Singh

THERE has been a gradually growing awareness among policy makers and health care professionals during the past several decades of the importance of appropriate exercise habits to major public health outcomes, resulting in numerous position stands and policy recommendations that include physical activity prescriptions (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). However, there is still skepticism among some clinicians and investigators as to the actual potency of exercise for disease and/or disability prevention and treatment, particularly in already frail or near frail adults (13). It is likely that some of the discrepancies among research findings, clinical practice, and policy recommendations result from a lack of appreciation of the heterogeneity of the terms “exercise” and “physical activity” as they are used in the literature. Posing the question “Does exercise prevent or treat disease in older persons?” is analogous to asking “Does medication prevent or treat disease in older persons?” The answer only makes sense when exercise is described in terms of its modality, dose (frequency and intensity), duration of exposure, and compliance with the prescription, and in relation to a specific disease, syndrome, or biological change of aging. In addition, it does not necessarily follow that the same type or dose of exercise is needed for treatment of overt or advanced disease as that which would be required for prevention. Such observations are obvious to clinicians when thinking about surgical, pharmacological, or nutritional management of disease, but lack of explicit training in exercise physiology for most physicians has often obscured this point in discussions of the value of exercise for geriatric health care problems. Therefore, in the sections that follow, a rationale for the use of exercise and physical activity for health promotion and disease prevention is offered. Exercise will be discussed in terms of the specific modalities and doses that have been studied for their role in the physiological changes of aging, disease prevention, and treatment of older persons with chronic disease and disability. Finally, an overview of the current recommendations, reflective of the current consensus of knowledge, is provided. Gaps in knowledge and controversial areas requiring further study are identified. The interaction of physical activity, exercise, and physical fitness with health and aging is complex and multifaceted. Although many questions remain about mechanisms of effect and dose-response curves (14), a synthesis of the literature indicates many potentially positive effects of participation in physical activity on the aging process. Any discussion of these issues must begin with definitions of the terminology. Physical activity has been traditionally defined as any bodily movement produced by contraction of skeletal muscle that substantially increases energy expenditure, although the intensity and duration can vary substantially (15). It should be noted that some forms of physical activity that may have particular relevance to an aging population (e.g., balance training) may not conform to this standard definition. This activity may be performed in leisure or occupational hours, and surveys for the older adult should capture both paid and unpaid (volunteer) work (16). Exercise is a subcategory of leisure time physical activity in which planned, structured, repetitive bodily movements are performed, with or without the explicit intent of improving one or more components of physical fitness. Physical fitness is defined as a set of attributes that contribute to the ability to perform physical work (e.g., cardiorespiratory endurance, muscle power, balance, flexibility, and body composition) or influence health status. “Metabolic fitness” has been advanced more recently as a term that encompasses a range of biologically important adaptations to exercise (increased insulin sensitivity, lipoprotein lipase activity, etc.) that may contribute to health status, but do not directly affect exercise capacity. Therefore, to understand the potential role of exercise in the aging process and to incorporate it into clinical practice, health care professionals should understand the risks and benefits of various modalities and doses of exercise and categories of physical activity in relation to specific health-related goals. 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