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CHAPTER 7 Physical fitness and exercise
Maria A. Fiatarone Singh1, Mikel Izquierdo2, and John E. Morley3
1 Faculty of Medicine and Health, School of Health Sciences and Sydney Medical School, University of Sydney, New South Wales, Australia; Hebrew SeniorLife, Roslindale, Massachusetts, USA
2 Navarrabiomed, Hospital Universitario de Navarra (HUN), Navarra Institute for Health Research (IdiSNA), Universidad Pública de Navarra (UPNA), Pamplona, Spain, CIBER of Frailty and Healthy Aging, Instituto de Salud Carlos III, Madrid, Spain
3 Saint Louis University School of Medicine, St Louis, Missouri, USA
Introduction
The interaction of physical activity, exercise, and physical fitness with health and ageing is complex and multifaceted. Although many questions remain about mechanisms of effect and optimal modalities, a synthesis of the literature indicates many positive effects of participation in physical activity on the ageing process and mortality, with dose‐response curves indicating benefits are linked to both intensities and volumes of exercise. All recent position stands and policy recommendations1 include exercise prescriptions for health promotion and disease prevention and treatment in older adults, including cardiovascular disease, diabetes, arthritis, renal failure, depression, emphysema, peripheral vascular disease, stroke, and Parkinson’s disease, among others. There is strong evidence that exercise training is an effective intervention for improving muscle strength, muscle mass, bone density, incidence of falls, and mobility in older adults across the health status and frailty spectrum.1 Exercise also has an emerging role in preventing and treating cognitive decline and dementia, with specific robust forms of exercise such as high‐intensity resistance training most promising, particularly in those with mild cognitive impairment.2‐4 In addition, multicomponent exercise intervention programmes, including resistance, balance, and mobility training, are an effective strategy for improving the hallmarks of frailty (low body mass, strength, mobility, physical activity level, energy) and thus optimising functional capacity during ageing.5 Based on the association between muscle power output and physical function, and the very dramatic loss of muscle power specifically with ageing (due to fast‐twitch fibre atrophy and changes in neural recruitment), there is a rationale for a central role for explosive resistance training (known as power training) in the exercise prescription whenever possible to optimise functional outcomes in both fit and frail older adults.6
Exercise has not become fully integrated into usual geriatric medicine practice and is still virtually absent from the core training of most geriatricians and other healthcare professionals. Therefore, this chapter attempts to provide a rationale for using exercise and physical activity for health promotion and disease prevention and treatment in older adults. Exercise is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their role in the physiological changes of ageing, disease prevention, and treatment of older people with chronic disease and disability. Recommendations will be offered to address gaps in knowledge and also clinical implementation needs in this field.
What is physical activity or exercise?
Any discussion of these issues must begin with definitions of terminology.7 Physical activity has traditionally been defined as any bodily movement produced by contraction of skeletal muscle that significantly increases energy expenditure, although the intensity and duration can vary substantially. This activity may be performed during leisure or occupational hours, and surveys of older adult should capture both paid and unpaid (volunteer) work. Exercise is a subcategory of leisure‐time physical activity
