February 28 — 29, 2008 Advisory Committee Meeting Minutes

Older Adult Summary

Miriam Nelson, Ph.D., presented summary conclusions surrounding adults and older adults and the following health outcomes: Bone health (adults and older adults), joint health (adults and older adults), muscle health (older adults), functional health (older adults), falls (older adults), mental health (adults and older adults).

For bone health, the association between physical activity and reduction in hip fracture the data is Type 3a of moderate strength level and weak evidence for vertebral fractures. At the highest level of physical activity the risk reduction ranges from 36 – 68%. More than 4 hours per week of walking, 2 – 4 hours per week of leisure time activity, 9 to 14.9 MET hours per week are all associated with 36 – 41% risk reduction. The data also suggests a reasonable dose-response effect.

Type 2a, moderate strength evidence supports the conclusion that exercise training can increase bone or attenuate bone loss. Weight bearing endurance training for the hip and spine and resistance training is effective based on moderate-to-high intensity activity 3 – 5 days per week with 30 – 60 minute sessions. The dose-response relationship has not been adequately tested. Individual RCTs support basic science findings that intensity of loading forces is a key determinant of the skeletal response. Walking-only meta-analysis was found to be effective on the spine.

The data supports the following conclusions on joint health in adults and older adults. The evidence that physical activity prevents osteoarthritis is supported by Type 3a, limited and weak level evidence. Both endurance training and resistance training provide disease-specific benefits for persons with OA, RA and Fibromyalgia and is supported by Type 1, strong evidence. The effects of physical activity in delaying the onset of disability in people with OA are supported by weak data. The dose response relationship has not bee studied.

In functional health the evidence that physical activity prevents or delays the onset of functional limitations is supported by Type 3a, strong evidence suggesting a 40% risk reduction. Most of the evidence comes from walking activities. There appears to be a dose-effect. The evidence that physical activity helps maintain or improves functional ability includes Type 1, moderate strength evidence. Most of the evidence is from exercise programs that include moderate-intensity walking and muscle-strengthening activities. There is limited, Type 1, evidence that physical activity doses of less the current guidelines are still beneficial. It is unclear there is a dose-response as it has not been tested.

The level of evidence that high-intensity muscle strengthening activities can preserve or increase skeletal muscle mass, strength, power and intrinsic neuromuscular activation consists of Type 1, strong level data. The benefits are similar in both men and women. There is strong evidence that regular muscle strengthening activities can provide benefit. There is moderate level evidence that endurance type activities do not increase muscle mass or quality, but may attenuate the rate of loss with aging and preserve function. There is strong evidence of a dose-response with the greatest gains in muscle mass and muscle strength experienced with higher-intensity protocols.

There is Type 1 and 3a, strong evidence that physical activity reduces the risk of depression and cognitive decline in adults and older adults. There is limited evidence that activity reduces distress, anxiety and improves sleep. Most of the evidence for benefit suggests a program consisting of 3 – 5 days per week of 30 – 60 minute sessions of moderate-to-high intensity activity. There is moderate level data that suggests a dose-response relationship.

The level of evidence that supports the conclusion that physical activity programs that include balance, strength training and walking reduces the risk of falls by 30% consists of Type 1, strong data. The greatest benefits are seen in people at the greatest risk for falls. Most evidence suggests a program that includes moderate intensity strength and balance training 3 days per week with 30 minute sessions with additional encouragement to walk 30 minutes 2 times a week. It is unclear whether there is a dose-response relationship as it has not been tested.

Overall, to reduce injuries it is important to progress exercise intensity and volume slowly. Older adults are disproportionately at risk for premature all-cause mortality, CHD, CBD, Type 2 Diabetes and stroke. For this reason, the adult recommendations apply to older adults.

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