Exercise is key to happy, healthy, and joyful ageing with a great quality of life. The body of evidence showing the health benefits of exercise for seniors is large and growing. Physical and mental health and wellbeing, cognition, falls, and even lifespan are areas where studies have shown regular exercise to be beneficial. Click specific topics below to learn more.
Best exercise for older adults
The current international guidelines recommended that older people should include at least 30 minutes of daily endurance exercise in bouts of 10 minutes with a total 150 – 300 minutes of weekly activity. Progressive resistance training is recommended at least twice a week including all the major muscle groups, with the recommendation of balance and flexibility exercises also to be included. Some of the research on targeted exercise for specific issues related to ageing, and the best exercise methods to counteract physiological ageing is presented in this text.
Common medical concerns for older adults
"Exercise can add years to life, but more importantly, add life to years."
(Gremeaux et al. 2012)
Ageing, Health and Wellness
Ageing is a natural decline of physiological functions and processes, causing a reduction in physical and mental capacity, and a growing risk of diseases. These changes, however, are not consistent and are only loosely associated with a person’s age in years. Whilst 25% of the ageing process is controlled by our genes, the rest are due to modifiable risk factors, determined by our physical and social environments (RACGP, 2019; WHO, 2021). With a healthy diet, psychosocial wellbeing and regular exercise, chronic diseases may be prevented, and life expectancy and quality increased.
Physical exercise can partially reverse some effects of ageing, as well as preserve function. Research evidence shows that physical activity is beneficial for longevity with a larger training volume associated with better benefits. Regular exercise has been attributed to the reduction in all-cause mortality by 30%.
BEST EXERCISE FOR OLDER ADULTS
Strength training, also known as resistance training or weight training, is the use of resistance to muscular contraction to build the strength, anaerobic endurance and size of skeletal muscles. The resistance can be provided by a weight, rubber bands, pneumatic or hydraulic pistons, or the weight of the body.
Strength training has many health benefits; From improved musculoskeletal, cardiovascular, and cognitive health, to improved metabolism, thus reducing the risk of chronic diseases, among others. Strength training is especially important for older populations as muscle mass decreases by approximately 2% every year after the age of 50. This loss can be combated with strength training that also offers numerous advantages on top of strength itself.
Strong research evidence exists for improvements in balance, functional mobility, stability limits, quality of life, and fall prevention. Strength training can aid in combating age-related changes in muscle function and improve activities of daily living, such as walking endurance, gait speed, and stair climbing. Strength training is an essential part of prescribed exercise routines.
Whilst strength training has different modalities, there are clear benefits for training in a gym setting, especially for older adults. Before starting an exercise program, it is important to establish a baseline for strength and fitness that allows for the creation of an appropriate individual program. Working with an allied health professional is suggested, to include the best exercise modalities and gain safe and appropriate training.
HUR Strength training equipment provides a safe training environment for all. The Natural Transmission Method used in the HUR resistance system is based on pneumatic technology that allows for resistance to be adapted in response to the muscle’s own force production, regardless of the speed of movement.
Also fitted with ergonomic equipment design, an intelligent technology system for automated program setting and reporting, close to zero starting load, 100 g/1 kg increments in resistance, range limiters and additional support with connected outcome measures to document the effectiveness of training. The equipment enables the user to start strength training safely with individually appropriate progression.
The equipment in the Rehabilitation range also allows for testing of maximal isometric strength using the same equipment. The Performance Recorder (HUR Performance Recorder 9200 | HUR Australia) can be directly connected to the machines, which are equipped with the isometric testing sensor attachment.
Isometric testing is a valuable assessment of how much progress an individual is making within their personalised strength training program.
Balance training is a key part of an exercise program in older adults, especially to combat falls and prevent fall related injuries. In their literature review El-Khoury et al. (2013) stated that appropriate exercise programs, some specifically focusing on balance, reduced falls that caused injuries by 37%, falls leading to serious injuries by 43%, and broken bones by 61%.
The purpose of balance training is to challenge balance organs; eyes, muscles, joints and vestibular system. Balance training is usually undertaken to maintain the centre of gravity for the body within the base of support that produces minimal postural sway.
Balance training includes both static and dynamic balance and should also be difficult enough to pose a challenge to the individual, as appropriate. Common balance exercises include standing on unstable surfaces, standing in different postures and positions and doing different stepping exercises. Indeed, balance training can be considered a form of strength training with a distinction that both fast- and slow-twitch muscles are exercised.
The significance of balance testing and training for older, at risk, populations has long been recognised by HUR. As balance training is a key part for a full falls prevention program, HUR has developed a balance setup. The HUR SmartBalance is a complete solution for testing and training balance using scientifically proven testing methods and motivational and fun balance training programs.
The games can be individually set up based on the testing, with variations on the training patterns, difficulty level and training time. With he smart balance system, improvements can be tracked with comprehensive reporting and also analysed against normative data.
Traditional floor-based balance exercises can be included into the training program by using HUR Freetrainer. The trainer also gives the possibility to include surveys that also are an essential part of a falls risk assessment
Cognitive training, also referred to as brain training, is a combination of processes, including paying attention, learning and reacting to objects in the environment, and using language and memory. If cognition becomes impaired, an individual may have difficulty performing everyday tasks. Cognition in the aged care setting is particularly relevant with the aging population and the commensurate rise in cases of dementia.
Cognitive training is the attempt to slow, halt or even reverse decline. Training can involve memory exercises on computers or delivered in person, either individually or in small groups. It typically involves using repetitive exercises designed to improve single or multiple cognitive abilities for example memory and reasoning. Recent research findings have shown impressive results by linking cognition tasks to movement tasks, such as responding, with stepping, to changing lights, as quickly as possible.
A recent study from Belgium has shown that cognitive motor training improves both the cognitive and physical skills of significantly impaired dementia patients. This study, carried out on the HUR Senso, was found to be particularly successful because the use of ‘exergaming’ proved to be motivating, something which is typically difficult to achieve with dementia sufferers.
Another study using Senso, recently studied the physical, mental, and cognitive effects of an exergame program which was added to the care program for people with dementia residing in long-term care facilities. The results showed that exergaming with Senso significantly improved gait speed, mobility, balance, step reaction time and cognitive function. In addition, symptoms of depression were significantly reduced.
The research evidence on progressive strength training is clear in showing that mild cognitive decline can be reversed with appropriate training principles. The automated progressions and training control allow the system to aid in specific training modalities towards clinical goals. Furthermore, the addition of balance assessment and training solutions, as well as partnership with SENSO for cognitive specific games, allows HUR to provide a full training package, covering all aspects of training for falls prevention, suitable for all clientele.
Cardiovascular exercise, also called aerobic exercise and endurance exercise, is any activity that uses aerobic metabolism. Any exercise that raises the heart rate and respiration and raises oxygen and blood flow throughout the body is referred to as aerobic training, as long as the intensity is such that it raises the heart rate by at least 50% above normal and it lasts for at least 10 minutes.
Cardiovascular health declines with aging due to a number of factors and leads to an increased risk of cardiovascular disease. Aerobic exercising has been shown to have beneficial outcomes re cardiac health in healthy elderly as expressed by peak VO2 max. However, cardiovascular health is also improved via strength training. When prescribing aerobic training for seniors it is important to consider the risks associated with tripping and falling, such as when using a treadmill. Low step-up heights are important, as are auto-stop mechanisms for powered equipment.
HUR is proud to partner with a number of cardio equipment suppliers to offer a range of cardio equipment developed with seniors in mind, allowing for safe training and easy access with standing and seated options.
Specific exercise Programs – Community Care
The Muscling Up Against Disability (MUAD)
In 2017 a major, Australian government funded, study was completed with the aim of showing that resistance and balance training is an under-utilised approach to tackling later life disability. The Muscling Up Against Disability (MUAD) Project, led by Dr Tim Henwood and supported by HUR equipment, enrolled 240 older adults, ranging in age from 65 to 92, with a Government supported aged care package, who took part in a twice weekly progressive resistance training program, using HUR equipment, and floor based balance exercises for 24 weeks.
The first four weeks of the program were considered a “conditioning phase” starting at two sets of 8 repetitions at 50% of predicted maximum resistance. In the third and fourth week, the intensity was increased to three sets of eight repetitions at 65% of predicted maximum. At the fifth week resistance was increased to 75% with further increases as tolerated by the individuals across the duration of the study.
These participants experienced on average greater than a 230% increase in upper-, lower-, and core body strength. A In addition, participants experienced improvements in grip strength, balance, walking speed and physical performance. Complimenting this were a number of positive reports of improved mobility and energy, and reduced symptoms of disease and medication needs. At the completion of the study, an impressive 80% paid to continue their gym work at the Club MUAD.
Specific exercise Programs – Residential Care
Strength and Balance Exercise in Aged Care) (SUNBEAM)
Dr Jennifer Hewitt et al. developed an evidence-based strength and balance program for the prevention and management of physical injuries from falls amongst people in residential aged care in Australia. The SUNBEAM (Strength and Balance in Aged Care) study collected data from 221 residents living in 16 facilities. During the first 6 months, the participants took part in an exercise class led by an allied health professional, twice weekly, consisting of progressive resistance exercise, using HUR equipment, and balance exercises. The initial period was followed by a 6 month, non-machine based weight-bearing and functional exercises. The results provided clear evidence on the benefits of resistance and balance training, demonstrating a 55% reduction in falls. Furthermore, the subjective stories told about the real-life impact: participants were able to get in and out of the car and go out with their family, things which materially improve quality of life.
COMMON MEDICAL CONCERNS FOR OLDER ADULTS
In 2012 The Lancet published a special series of articles of the consequences of inactivity (Vol. 380, issue 9838). It was then stated that physical inactivity causes 6-10% of the major non-communicable diseases globally, with inactivity having a similar effect as smoking and obesity. The World Health Organisation (WHO) has stated that inactivity is the 4th leading cause of mortality with approximately 3.2 million deaths annually.
The burden of inactivity is even higher in older people as ageing can easily lead to frailty due to the rapid decline in cardiorespiratory muscular health, leading lowered functional abilities, and quality of life, creating a “Vicious cycle” of inactivity as presented by Gremeaux et al. (2012).
“Vicious Circle” of inactivity – the negative impact of inactivity and the positive effect of physical activity (Adapted from Gremeaux et al., 2012).
To combat inactivity, it is important to promote activity at older age as the benefits of inclusion of exercise are clear; From prevention of falls and improvements in cognitive function to reduced mortality, exercise is a key aspect in improving quality of life. When we state that “Exercise is medicine”, for physically active older adults this means a reduced risk of all-cause and cardiovascular mortality, breast and prostate cancer, fractures, recurrent falls, activities of daily living disability and functional limitation and cognitive decline, dementia, Alzheimer disease, and depression.
Skeletal muscle is the largest organ in the body accounting for around 40-45% of body mass and is critical for both movement and metabolic functions. During age 20-80 years, the average person can lose around 30-40% of their muscle mass (Daly, 2021), with the muscle loss speeding up in older age. Progressive loss of muscle mass, strength and function, sarcopenia, currently affects one in five Australians over the age of 65 (Sui, 2021).
Loss of muscle has been linked to almost all common chronic diseases (Kalyani et al. 2014), as well as impaired functional performance associated with an increased risk of disability, falls, osteoporosis, fragility fractures, frailty, loss in independence, reduced quality of life and premature mortality. Furthermore, muscle loss has been associated with cognitive impairment and an increased risk of dementia as well as impaired immunity and various hospital complications (e.g, an increased risk of infection and poor outcomes post-surgery).
Progressive resistance (strength) training is the most effective strategy to improve muscle mass and strength. For older people, the gains in muscle mass and strength observed after just 12 weeks can be equivalent to regaining the muscle loss that typically occurs over a decade. Maintaining an adequate intake of dietary protein, particularly when undertaking resistance training, is also important to maximise skeletal muscle mass and strength benefits. In terms of optimising physical function (e.g, improving balance, mobility, gait), challenging balance, stepping and mobility activities and/or include high speed resistance or functional training focused on improving muscle power appear best (Daly, 2021).
HUR equipment can automatically monitor training, and create progression for training, if required. The new Hi5 system also allows for monitoring of range of movement and power, defined as an important aspect in the treatment and prevention of sarcopenia.
Osteoporosis is the most prevalent bone disorder in the world (Coughlan, T., & Dockery, F. 2014), and affects over 1 million Australians with over 66% of over 50’s struggling with osteoporosis or osteopenia (Healthy Bones Australia. 2021). It is characterised by low bone mass, deterioration of bone tissue, and decreased bone strength (Coughlan, T., & Dockery, F. 2014). There are many risk factors associated with poor bone health including both lifestyle and non-modifiable factors such as genetics. In terms of lifestyle factors, Pouresmaeili, F.et al. (2018) highlights nutritional deficiency and sedentary lifestyle to increase the impact of chronic diseases such as osteoporosis.
Exercise modalities are important when planning the appropriate exercises when treating osteoporosis. Research evidence has shown that bone responds positively to impact activities and high intensity progressive resistance training. Additionally, with appropriate training and optimal exercise prescription of muscle strength, balance and mobility, and the risk of falls is minimised thus lowering fracture risk that is normally increased due to osteoporosis.
It is important that all exercise programs are done together with dietary planning, with sufficient intake of calcium and vitamin D, also addressing issues of comorbidity and safety, Indeed, appropriately planned exercise programming, including regular, brief, weight-bearing, high-impact exercise and high intensity progressive resistance training, is a vital strategy in the prevention and management of osteoporosis (Beck et al. 2016).
Osteoarthritis (OA) is the most common chronic condition of the joints and occurs most often in hips and knees. Degenerative diseases of the joints have become the primary cause of pain and reduced health related quality of life, especially in the senior population. Osteoarthritis causes pain, stiffness, swelling, joint instability and muscle weakness, characterised by loss of articular cartilage and changes to bone and joint structures (Bennel, K et al. 2010). Osteoarthritis is associated with difficulty in daily living activities such as walking, stair climbing and housekeeping and a decreased quality of life.
There are multiple risk factors associated with osteoarthritis including older age (approximately 30% of people over 65 have OA), obesity (estimated to be the cause of 24.5% of OA in Australia), previous joint injury and muscle weakness as well as genetics and female gender.
Regular daily physical activity and appropriate exercise training are major contributing factors in prevention, treatment and rehabilitation of OA. The effectiveness of exercise in hip and knee OA is well recognized to improve muscle function, prevent abnormal movement and restore normal biomechanics of hip and knee. In addition, it has been shown that strength training and weight reduction decrease the pain experience and regular medication use and prolong the time until total joint replacement.
Whilst a variety of exercise modalities is beneficial, muscle strengthening is a key component for hip and knee OA and combining it with aerobic fitness is optimal (Lange, A et al. 2008; Ettinger, W. H., et al.1997; Bennel, K et al. , 2010).
HUR offers a safe training for clients suffering with OA, The combination of Natural transmission pneumatic system, accurate load initial load and progression, together with the ability to limit the range of movement during training, make training with HUR equipment suitable for prevention and management of OA related pain, as well as postoperative management.
It is estimated that in 2020 there are between 400,000 and 459,000 Australians with dementia with an expected increase to 550,000 - 590,000 by 2030 10. Dementia is the leading cause of death for women in Australia and the third highest cause for men (ABS 2019). Almost half of all people in aged care in Australia have diagnosed dementia.
There are many risk factors for dementia, some fixed, some modifiable. Smoking, hearing loss, depression, diabetes, hypertension, and obesity are all linked to an increased risk of developing dementia whilst high levels of education, physical activity and social engagement are all protective against developing dementia (Livingston et al. 2017).
Research has shown that exercise can improve cognitive function in individuals over 50 years of age, regardless of the cognitive status. Both aerobic and resistance exercise, performed at moderate to high intensity on as many days of the week as possible, in line with exercise guidelines, is beneficial.
Cognition can also be trained with specific exercise modalities. Cognition training, also referred to as brain training, is a combination of processes, including paying attention, learning and reacting to objects in the environment, and using language and memory.
If cognition becomes impaired, an individual may have difficulty performing everyday tasks. Cognition in the aged care setting is particularly relevant with the aging population and the commensurate rise in cases of dementia.
Previous research has provided evidence that muscle strength is associated with cognition in ageing men and women. Furthermore, when strength-balance training is combined with specific cognitive training, positive effects can be noted on dual task costs of walking, gait initiation, and divided attention.
Therefore, exercise solutions provided with HUR equipment, combining strength, balance and cognitive training, create a multimodality approach for gaining the best outcomes for an exercise program to combat cognitive issues. Together with the inbuilt testing protocols, strength and health can be assessed, monitored and trained.
Incontinence is the inability to control the flow of urine from the bladder or the escape of stool from the rectum. It affects people of all ages but is most prevalent in women and older populations.
A key factor in managing incontinence is exercise. While general exercise stimulates the bowel and so encourages bowel movements, specific exercises for strengthening the pelvic floor muscles are regarded as foundational for reducing incontinence in both men and women. Pelvic floor muscle exercises, combined with pelvic health education, can be an effective way to manage urinary incontinence in elderly women.
The working assumption is that exercising virtually any muscles that target the muscles of the “core” will also activate the pelvic floor muscles to some extent. Pelvic floor exercises can also be incorporated into a gym routine with multi-purpose equipment, such as the Adduction/Abduction machine from HUR. With this method users can exercise the specific muscles required for incontinence prevention without anyone else being aware.
In people over 65 years of age, approximately 30% of community-dwelling adults fall each year. In Australia, falls are the largest contributor to hospitalised injury cases and a leading cause of injury deaths. One in three Australians over the age of 65 has experienced a fall in the last 12 months; 20 percent of these have needed hospitalisation. A single fall is also a predictor of further falls as it can lead to an increased fear of falling and this in turn can alter behaviour - being less active, limiting exposure to uneven ground when walking – which leads to a greater risk of more falls.
Most falls happen during ambulation with tripping, slipping and poor balance noted as the main reasons for falls. In addition to this insecurity is also reported as a relatively common reason behind falls.
Most of the environment-related falls are associated with one or more identifiable risk factors such as muscular weakness, gait or balance disorders, and postural hypotension. Attention to these risk factors can significantly reduce rates of falling whereby many of these are either directly or indirectly mitigated by exercise.
Exercise interventions have been shown to reduce the rate of falls (number of falls per person) and the risk of falling (proportion of people having one or more falls) in community-dwelling older people. Furthermore, exercise as a single intervention has a falls prevention effect comparable to that of multi-factorial programs which suggests that implementation of exercise as a stand-alone intervention may be the optimal and potentially most cost-effective-approach to falls prevention at a population level.
A large body of evidence supports the recommendation that balance, strength, gait, and coordination training is effective in reducing falls, and therefore it should be included as part of a multi-component intervention to prevent falls in older persons and may be considered as a single intervention. In most scientific trials, the exercise program has been longer than 12 weeks (1–3 times per week) with variable intensity.
A successful falls prevention exercise program includes training for strength, balance and cognition. HUR equipment allows for both testing and training in all these areas, using the same machines. With the benefits of HUR Strength training, Smart balance and SENSO, many aspects of balance control can be trained. With the addition of the Freetrainer, common floor based exercises, as used in SUNBEAM and MUAD studies, can also be included in the program.
Exercise is beneficial for people of all ages and all fitness levels, both in terms of preventing morbidities and of reducing and possibly removing the symptoms of them. Everyone should be active for the best health outcomes and this is especially so for seniors who face a rapid change to their bodies. Safe, effective and motivating exercise is key to successful ageing.
At HUR Australia we are proud to be in active collaboration with multiple universities around the world providing research based evidence to practices we recommend. Through our constant product development over our 30+ year journey we have established recommended practices to target particular areas of concern that are verified from success stories from our clients.
For a free consultation or other information please contact the HUR Australia sales team:
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