You have probably heard the saying, "A family that plays together, stays together." If this saying is true, our goal must be to provide the environments and programs that support this intergenerational bonding activity. The question is, How do we, as providers of health and wellness services, achieve this goal? Two words: active aging.

The active-aging approach enables you and your organization - as well as governments, product and service providers, employers and the health care industry - to create and implement strategies that provide fitness and wellness offerings over the life span. To help guide this process, the International Council on Active Aging (ICAA) offers a roadmap with its "Nine Principles of Active Aging."

Nine Principles of Active Aging

As you develop and deliver programs and environments for the family, remember to take the following into consideration:

1. Populations: Who is your consumer? The US population is extremely diverse - from ability and age, to income and culture, to sexual orientation. How will you meet the needs and interests of the different individuals you serve? And consider how these challenges may be heightened in centers that serve multiple population segments.

2. Perceptions: Ageism, racism, and negative stereotypes are stalling the opportunity for inclusion. Moving forward means leaving old ways of thinking behind. What family programs can you offer that are inclusive and give people opportunities to discover misperceptions they may have about others?

3. People: What personnel will you need? If you offer a fitness program for grandparents and grandkids, what staff and staff knowledge will be required to run the program? With fewer people working in the field of aging, where will the workers come from if the program should need to accommodate special needs, such as those of frailer individuals or those living with disabilities?

4. Potential: With the population aging, age 50-plus consumers will dominate purchasing decisions for decades to come, creating untold business opportunities for those who attract them. What are these opportunities, and how can businesses tap them? One opportunity is to offer programs that grandparents will support. Engaging these consumers in family activity is good for the whole family - and for your bottom line.

5. Products: What products and services will you need to meet the needs and interests of multiple generations? From technology to fitness equipment, to outdoor playgrounds and fitness trails, are the products and services you use accessible and inclusive for all? Or will your choices limit the family experience?

6. Promotions: Effective promotions are important ways to inspire connections between generations. Yet marketers often earn a failing grade with the older population by being youth-oriented in their promotions. Did you know, for example, that 95% of all marketing dollars are spent on attracting people 35 years of age and younger? To be effective, promotions must be rooted in the realities of today's diverse population, including young and old, fit and non-fit, and individuals from a variety of cultures.

7. Places: Environments can encourage or discourage families in leading active, engaged lives. What environments - both indoors and outdoors - will you use to support active aging across the generations? Also, how will you create an environment that feels welcoming to all? It may make all the difference to people continuing to participate in your programs.

8. Policies: How do policy decisions affect active aging? Consider how important policies are in areas such as age discrimination, where policies can help avoid the unfair exclusion of young or old, and encourage intergenerational relationships. Are your policies inclusive, or do you need to revisit them?

9. Programs: As promoted by ICAA, the seven dimensions of wellness - physical, social, spiritual, intellectual, emotional, vocational and environmental wellness - are the backbone of active aging. They are also key to meeting the challenges of providing the wide variety of programs and environments that fulfill the needs and interests of a diverse population. What programs can you offer in each dimension of wellness that will support your family plan? One example is a program where adults mentor children through lifelong learning... Why? Research from the MacArthur Foundation Network on Aging in Society shows that children who fail to graduate high school live 10 years less than their counterparts who graduate. No matter which programs you decide to create - and there are many possibilities - focus on getting the family involved.

What is your family plan? Only you can answer this question. But the Nine Principles can help guide you in establishing your plan of action - from recognizing the populations you serve to choosing the place, products, and programs you offer to those who participate.

What do we know about physical activity among older adults?

For starters, physical activity is a powerful means to help prevent age-related loss of function, reduce the risk of chronic disease, improve mental and physical health, and support quality of life.

Older adults who exercise can:

• Reduce their risk of heart disease, some cancers, hypertension, high cholesterol and obesity;
  
• Mediate hypertension, diabetes and depression;
  
• Lower their risk of falls and injury;
  
• And improve their sleep.

The American College of Sports Medicine (ACSM) recommends that older adults get 150 minutes of moderate-intensity cardiovascular exercise per week. Recommended activities include strength-training, neuromotor exercise, functional training to improve balance, and flexibility excerise.

In general, strength training is important not only for fall prevention, fat metabolism, and bone health, but for the ability to perform daily activities such as lifting groceries. Cardiovascular conditioning reduces the risk of heart disease, improves endurance, and elevates mood. Improvements in flexibility aid regular activities like reaching, and ease certain conditions like arthritis. Improvements in balance help prevent falls and improve performance in sports and games.

Walking is the primary recommended activity, since it is inexpensive and simple. Only 12% of adults age 65 to 74 years old do strength training, but this is also an equally encouraged activity.

Aging is such a personal process that levels of physical fitness and function can not be recommended by chronological age. Some people in their '70s and '80s run marathons, while others are confined to wheelchairs. The prescription for physical actiivty must account for individual levels of function as well as the biological process of aging.

While the value of physical activity for older adults is well-documented,the number of older adults who exercise remains small. There is an unhealthy trend toward obesity in the older population, which is a future health problem. Other reports show that physical activity is more prevalent among white Americans than among ethnic groups or people of color.

Survey after survey finds that older adults know about the benefits of exercise, yet few take action. How do we change this?

The National Physical Activity Plan (NPAP) is clearly a positive step forward, as it is filled with solid research and recommendations. However, like older adults themselves, we need to move from recognizing that physical activity is important to actually making change happen.

Making an Impact

How do we make an impact? How do we get organizations and individuals to embrace exercise? How do we fulfill the visions of the National Physical Activity Plan?

Maybe the answer lies within an August 27, 2012 New York Times article by Jane Brody. In the article, entitled, "Changing our Tunes on Exercise," Brody interviews Michelle L. Segar, a research investigator at the Institute for Research on Women and Gender at the University of Michigan. Brody writes that "based on studies of what motivates people to adopt and sustain physical activity, Dr. Segar is urging that experts stop framing moderate exercise as a medical prescription that requires 150 minutes of aerobic effort each week. Instead, public health officials must begin to address 'the emotional hooks that make it essential for people to fit it into their hectic lives.'"

"Immediate rewards are more motivating than distant ones," says Segar. "Feeling happy and less stressed is more motivating than not getting heart disease or cancer, maybe, someday in the future."

How can we benefit from this information? According to Brody, "stop thinking about future health, weight loss, and body image as motivators for exercise. Instead, experts recommend a strategy marketers use to sell products: portray physical activity as a way to enhance current well-being and happiness."

What do you think? Is this a promising strategy? And how will you use it to increase the physical activity level of your older consumer?

National Falls Prevention Awareness Day is observed on the first day of fall (today!) to increase public awareness and promote activities to reduce falls among older adults. This year's awareness day is themed "Standing Together to Prevent Falls," and 46 states are planning to participate. National Falls Prevention Awareness Day is just one example of the tremendous work over 70 professional organizations, including APTA, federal agencies, and 42 state falls prevention coalitions have done through the Falls Free Initiative.

According to the Centers for Disease Control and Prevention (CDC), one-third of older adults fall at least once each year. Falls are the leading cause of fatal injury and nonfatal trauma-related hospital admissions among older adults. Muscle weakness, balance impairments, and walking difficulties are among the leading risk factors for falls among older adults. Fortunately, various types of exercise can lessen the impact of these factors and reduce one's chances of falling.

The US Preventive Services Task Force recently supported exercise or physical therapy and Vitamin D supplementation to prevent falls among community-dwelling older adults. These recommendations are also supportive of those proposed by the American Geriatrics Society, which recommends balance, walking, and strength training to reduce falls risk.

The Physical Activity Guidelines for Americans (PAG) also recommend balance training at least 3 times per week for older adults at increased risk for falls. This is in addition to the general recommendation for a minimum of 150 minutes of moderate-intensity or 75 minutes of vigourous-intensity aerobic exercise per week and 2 days per week of strength training.

Balance training should be challenging and progressive in difficulty (such as reducing base of support and/or increasing movement in multiple directions). Group or individual programs that combine balance and strengthening exercises, such as tai chi, have been proven to effectively reduce falls among older adults.

Evidence-based balance exercise programs can be offered in any number of settings. It is also acknowledged that a variety of other healthy aging programs can be strategically offered within facilities to promote and sustain behavior change, address intermediate risk factors or barriers, or serve as entry programs for referral to more targeted fall prevention programming. Many of these programs are already found within communities supported by the US Administration on Community Living. Research supports a minimum of 50 hours of exercise, over a minumum of 12 weeks (6 months is best) to affect balance and falls, so physical therapists need to partner with agencies that can help to augment or supplement our plans of care.

There are many examples of successful partnerships among community agencies and exercise professionals to offer evidence-based and best-practice programs that deliver the recommended type and amount of exercise. Community agencies are also in a strategic position to offer assistance with marketing, recruiting participants, and providing activity space. Potential partners include senior centers, older adult housing, churches, fitness and wellness centers, and nutrition sites.

APTA provides website resources on falls prevention to its members and promotes the Falls Prevention Awareness Day through its e-newsletter. Other awareness and planning resources are also available from the National Coalition on Aging Center for Healthy Aging. How can your organization and members join together to help your communities' older adults improve balance and reduce falls?

Guest bloggers: Lori Schrodt, PT, PhD, Chair of the Health Promotion & Wellness Special Interest Group, Section of Geriatrics, American Physical Therapy Association; (Bonita) Lynn Beattie, PT, MP, MHA, Vice President, Injury Prevention Lead, Falls Free Initiative; Center for Healthy Aging; National Council on Aging; and physical therapist students from Western Carolina University, Andrea Cahoon, Sherrie Flory, Anna King, Caitlin Laemmle, Kenneth Richards, and Monica Vargas.