Physical Activity Initiatives with Older Adults

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					Physical Activity
  Initiatives with
    Older Adults

             A Canadian
            Whistler, B.C.
          December 10, 2001
            Our Challenges
 “It is surely a great criticism of our
  profession that we have not organized a
  critical summary, by specialty of sub-
  specialty, adapted periodically, of all
  relevant randomized controlled trials.”
     • Archie Cochrane
           Our Challenges
 Clear Lake Agreement by Federal,
  Provincial, & Territorial Ministers
  responsible for fitness, active living,
  recreation set a joint target to reduce
  physical inactivity in Canadians by 10%
  from 1998-2003
             Active Old Age
 Director General of the World Health
  Organization described gains in life expectancy
  as one of humanity’s greatest achievements

 Living a full life to reach a healthy, happy and
  active old age is our aspiration
Between Friends
     Not Aging but Saging …
     Wise Beyond Your Years
 It might not affect you now, but it will.
 Growing older is inevitable.
Dignity, Respect, Independence
          and Control
 The importance of older people being able to
  maintain control and autonomy in their lives must
  not be lost
     Definition of Older Adult
 Self-defining (Active Living Coalition for Older
 Varies depending upon initiative
 50-55+ for many initiatives (Physical Activity
      Aging Population - Facts
 Being physically active reduces the risk of heart
  disease, fall and injuries, obesity, high blood
  pressure, adult-onset diabetes, osteoporosis,
  stroke, depression, colon cancer and premature

 One-third of older adults face an increased risk of
  loss of mobility and functional capacity, thereby
  decreasing their functional independence
      Aging Population Facts
 1 in 10 Canadians is an older adult
 This number will double by 2021
 The greatest health risk for older adults is
  sedentary living (WHO, 1997)
 Among adults 55 + only 34% of men and 29% of
  women are physically active
 Among adults 74+ only 29% of men and 19% of
  women are physically active
   The Older Adult Audience

 50% of seniors report physical activity of
  15 min. or more at least 12/month
 Almost 2/3 of those aged 80+report
  needing no help with daily tasks
 Only 16% of older adults use the Internet
 Once online Canadian seniors use the
  Internet on average 12 hours weekly
    The Older Adult Audience
 1/3 of Canadian seniors live in rural areas and
  small towns, the rest in urban areas
 93% of seniors live in private households
 20% of Canadians 65+ have post-secondary
  diploma or degree
 60% did not finish high school
 Considerable number have difficulty with reading
                By 2041….
 46% have a disability but for most part continue
  to enjoy and active lifestyle in their communities
 For those born in 1998 life expectancy increased
  to 92 for men and 100 for women
 By 2041 number of Canadians over 80 will
    Why Older Adults are not as
        Physically Active
   Accessibility
   Safety
   Security
   Support
   Motivational issues
    – Must be addressed to encourage, support and
      ensure that opportunities exist that facilitate
      involvement in Active Living
     Aging and Communication
   Visual acuity
   Hearing acuity
   Agility & Mobility
   Social/emotional changes
    Barriers to Reaching Older
 Physical changes of aging
 Stereotypes, outdated assumptions about older
  adults lifestyles, interests, capabilities
 Communication materials and media not suited to
 Physical Activity Guide for Older Adults
   – -individuals & leaders, practitioners
 Moving through the Years – A Blueprint for
  Action for Active Living and Older Adults
   – Policy, decision makers
 Evidence Based Clinical Guidelines for
   – Physicians (Specialists/ GP,FP), Other Allied Health
    Canada’s Physical Activity
     Guide for Older Adults
 The Guide and the accompanying handbook are
  the Canadian standard for physical activity and
  older adults
 Based on prototype of Physical Activity Guide
  for Canadians and Canada’s Food Guide
 Bilingual (French & English)
    Canada’s Physical Activity
     Guide for Older Adults
 Developed over 3 years
 Done in partnership with the Active Living
  Coalition for Older Adults (ALCOA), Canadian
  Society for Exercise Physiology and Health
 Launched in May 1999
 Multi-disciplinary national advisory committee
  which included older adults
 Focus testing with both older adults and health
  professionals in urban and rural settings
    Canada’s Physical Activity
     Guide for Older Adults
 Guide and Handbook underwent numerous
  reviews by a group of scientific experts
 Guide and handbook used by leaders, health
  providers and program delivers
 Guide includes tips to getting started, how much
  activity is enough, health benefits, and examples
  of endurance, flexibility, strength and balance
  activities to choose from
 Launched in conjunction with the “Blueprint for
 Canada’s Physical Activity
Guide for Older Adults Challenges
 Retain scientific validity
 Retaining balance between consumer wants &
  needs and what science says
 Marketing of message had to be simple, realistic,
  believeable, and inspiring
 Attaining the outcomes & benefits while making
  goal attractive & attainable
 Carry a message to audience that was clear and
  user friendly
 Canada’s Physical Activity
Guide for Older Adults Challenges
 Simple Messages: Age is no barrier
 Be Active, Your Way, Every Day for Life
 Every little bit helps, but more is better
 Add it up principle
 Moderate physical activity most days for 30-60
 Choice of activities from each of three activity
    – Endurance, Flexibility, Strength & Balance
      Canada’s Physical Activity
         Guide for older adults
   Science based facts (benefits/risks)
   Why do this and what is in it for you
   Variety & Safety concerns (start where you can)
   Overcoming barriers
   Pull out Guide to put on refrigerator
   Sample calendar/planning sheet
   Stories/Real people (not cartoons)
   Next steps planner
    Canada’s Physical Activity
    Guide for older adults - Barriers
 I feel too tired to get started
 I don’t want to exercise? I’ve worked hard all my
  life, not its time to relax
 I have arthritis or stiff joints?
 I have osteoporosis?
 I have concerns about my heart? I’m afraid that
  physical activity will do more harm than good
    Canada’s Physical Activity
    Guide for older adults - Barriers
 I don’t have much time…so which activity is
 I am unsteady on my feet?
 I am afraid to go out in winter?
              What’s Different
   Size of print
   Benefits right up front
   Real people
   Practical user friendly suggestions
   Talk about barriers (tell it like it is)
   Safety
   Refers individuals to their physician or health
              What’s Different
   Lots of white space
   Bold headings
   Clear Language
   Stories of real people
  Key Learning from the Guide
 Senior friendliness is an attitude based on
  considering seniors’ needs and respecting
  seniors’ contributions
 Physicians are credible influencers of
  individual’s health behaviours for older adults
 Design communication with your clients not for
    Canada’s Physical Activity
     Guide for Older Adults
 An excellent example of how consensus
  statements and research can be translated into
  simple clear messaging for the target audience
    Canada’s Physical Activity
     Guide for Older Adults
 Outcomes
  – Over 50 National organizations endorsed the
  – Over 2 million copies have been printed and
    College of Family Physicians
          Key Influencers
 Adopted a Physical Activity and Health Strategy
 Developed a unique video on active ageing
 Physicians learn more about barriers to PA
 Describes new counseling & training tools
 New Practice-based Small Group Learning
  Module on PA & older adults
 For info email
    Moving Through The Years:
            A Blueprint for Action

Goal to update 1991 original Blueprint
 Fondation en Adaptation Motrice, ALCOA and
  Health Canada conducted survey in 22
  communities across Canada and over 20 NGO’s
 Over 450 individuals consulted (over half of
  whom were older adults)
 Launched in 1999 in International Year of Older
   Moving Through The Years:
           A Blueprint for Action
 A national framework for plan of action
 Provides a collective direction for current and
  future initiatives
 A tool for planned change
 ALCOA asked to serve as the keeper of the
  Blueprint to ensure its uptake
 Serves as a base for ALCOA’s goals and
    Active Living Coalition for
           Older Adults
 In 1993 three older adult national bodies came
  together (National Walking Campaign, Secretariat for
  Fitness for the Third Age, The Older Adult Active Living
 Became Active Living Coalition for Older Adults
 Mandate to bring together national organizations
  & researchers working with older Canadians in
  Active Living
   Moving Through The Years:
           A Blueprint for Action
 Nine Guiding Principles based on the vision of :
 An active society where all older Canadians are
  leading active lifestyles thereby contributing to
  their physical and overall well-being.
  Moving Through The Years:
          A Blueprint for Action
 Principle 1
  – It is recognized that active living is essential
    for daily living and a cornerstone of health and
    a quality of life.
  Moving Through The Years:
          A Blueprint for Action
 Principle 2:
  – There is a need for more positive attitudes
    toward aging, with realistic images that depict
    older adults as respected, valued, and
    physically active members of society.
  Moving Through The Years:
          A Blueprint for Action
 Principle 3:
  – Older adults should be encouraged to
    participate in decision-making and leadership
    positions, in all phases of program/service
    development and delivery.
  Moving Through The Years:
          A Blueprint for Action
 Principle 5:
  – Issues, needs and interests of older adults in
    their community need to be identified, and
    accessible, affordable active living activities
    and programs designed to meet these needs.
  Moving Through The Years:
          A Blueprint for Action
 Principle 6:
  – While it is recognized that both aging and
    learning are a life-long process, it is
    appreciated that for some, pre-retirement years
    may be a key time to re-focus on active living
    and well-being.
  Moving Through The Years:
          A Blueprint for Action
 Principle 7:
  – Canada is a society for all ages: Programs and
    services should be developed which
    accommodate older adults’ choice to be with
  Moving Through The Years:
          A Blueprint for Action
 Principle 8:
  – There is a need to identify, support, and share
    research priorities that apply to active living
    and aging.
  Moving Through The Years:
          A Blueprint for Action
 Principle 9:
  – There is a need for education and promotion of
    the health benefits of active living as a way of
    life for older adults
   Areas of emphasis for active
     living and older adults
 Increase public awareness about the benefits of
  active living
 Develop competent leaders in active living who
  can meet the needs & interests of older adults
 Ensure resources and social supports needed to
  be active are in place
 Strengthen delivery systems and improve levels
  of cooperation, coordination, and communication
  among organizations
   Areas of emphasis for active
     living and older adults
 Encourage and enable older adults to advocate
  for the right to a quality of life that includes
  physical activity
 Identify, support, and share research priorities
  and results on aging and active living
 Continually monitor and evaluate programs,
  services and outcomes to ensure that active living
  needs, interests, and concerns of older adults are
       Blueprint Implementation
 In 1999 Blueprint implementation Summit held
 Over 50 national and provincial organizations
  attended along with other stakeholders
 Resulted in five priority areas:
   –   Leadership Development
   –   Shared Research in Plain Language
   –   Marketing and Communications
   –   Influencing Policy
   –   Coordination and Capacity Building
     Leadership Development
 ALCOA providing strategic leadership
 Develop a network of community presenters to
  conduct workshops with older adults
 Develop strong delivery system at the community
  level through the members of ALCOA
 Presenting to seniors groups and organizations to
  promote the Guide and the Blueprint and to
  highlight local opportunities in each community
  to be active
   Communicating Research in
       Plain Language
 ALCOA Research Update Launched May 2001
 Goal to interpret current leading edge research
  into user friendly, plan language format
 Included in Research Update is a special Active
  Living Tips sheet for older adults
 Copies available
 Marketing & Communications
 Includes ALCOA’s website, newsletter,
  electronic listserv, national spokesperson and a
  framework for affecting change
 Provides an opportunity to share information,
  network, learn and reach older adults with
  consistent active living messages
          Influencing Policy
 ALCOA partners with key member groups and
 ALCOA to develop information to members of
  parliament/policy and decision makers to
  influence and promote the priority of active
  living opportunities for older adults
           Capacity Building
 Increase and strengthen ALCOA’s membership
 Involve older adults in all planning & decision
 Bring together multidisciplinary professionals,
  volunteers and older adults to share information
  and resources
 To foster a broader collaborative network
 Holds national forums, Mark your calendars for
  Forum Regina Saskatchewan May 9-12, 2002
   Intended Outcomes of these
       Efforts by ALCOA
 Results of these efforts is to increase the
  opportunities for and the possibility of
  healthy aging by all Canadians
Osteoporosis Society of Canada
        Definition of Osteoporosis
 What is osteoporosis?
  – A disease characterized by low bone mass and
    micro-architectural deterioration of bone tissue,
    leading to enhanced bone fragility and a
    consequent increase in fracture risks.
 Thinning of bone that leads to higher risk of
Osteoporosis Society of Canada
    Evidence-Based Clinical Guidelines

 Prevalence of Osteoporosis
  – Major health problem in Canada and other
    industrialized countries
  – Affects up to 1 in 4 Canadian women over 50
  – Affects 1 in 8 men over 50( and increasing)
  – As many as 2 million Canadians at risk over
    their lifetime
Osteoporosis Society of Canada
      Evidence-Based Clinical Guidelines
 Why should we be concerned about
  – Hip fractures strongly related to osteoporosis
       • 20% lead to subsequent premature mortality
  – Vertebral fractures dramatically affect quality of
  –   Often decrease in personal freedom
  –   Annual cost of treatment  $1 billion in Canada
  –   Canada’s population is aging
  –   Frequency of osteoporosis will rise as well
Osteoporosis Society of Canada
   Evidence-Based Clinical Guidelines

 Our goal…
  – To prevent fracture through proven preventive
    measures and effective therapies
Osteoporosis Society of Canada
     Evidence-Based Clinical Guidelines
 Why do we need guidelines?
 Distill a large body of medical knowledge into a
  convenient, readily useable format
 Primary purpose is to educate and create
   – Difficult for physicians to keep up with the
     latest advances
Osteoporosis Society of Canada
     Evidence-Based Clinical Guidelines
 Why Guidelines?
 To keep up to date in Internal Medicine
  physicians need to read 17 articles a day, 365
  days a year
 They don’t
 Nor does anyone else
Osteoporosis Society of Canada
     Evidence-Based Clinical Guidelines
 Why Guidelines?
 Physicians need evidence about
   – The accuracy of diagnostic tests,
   – The power of prognostic markers,
   – The comparative efficacy and safety of interventions, etc

 Need evidence about 5 times for every in-patient
  (and twice for every 3 out-patients)
 Properly structured guidelines are an invaluable
  resource to the busy clinician
Osteoporosis Society of Canada
    Evidence-Based Clinical Guidelines
 1996 Guidelines Project were consensus-based
   – A narrative view
   – Scan through arbitrarily selected documents
     and pick out what seems to address questions
   – Quicker to create
Osteoporosis Society of Canada
     Evidence-Based Clinical Guidelines
 Consensus-based Guidelines
  – Very susceptible to bias
  – Subjective evaluation of literature, opinion
  – No criterion for inclusion of investigation or to
    the grading of quality
  – Often, exalted individuals keep up the least
    with current literature and advances
  – Experts are often less able to produce
    objective reviews of the literature in their area
    than non-experts
Osteoporosis Society of Canada
     Evidence-Based Clinical Guidelines
 What is evidence-based evidence?
 It is the conscientious, explicit and judicious use
  of current best evidence in making decisions
  about the care of individuals (patients)
Osteoporosis Society of Canada
     Evidence-Based Clinical Guidelines
 Evidence-based medicine is the integration of:
   – Individual clinical expertise
   – Best available external clinical evidence from
     systematic research and
   – Individual’s (Patient) values and expectations
Osteoporosis Society of Canada
     Evidence-Based Clinical Guidelines
 Total abstracts caught and searched by the
 Grand Sum: 89,804
 Exercise and Fall Prevention: 11,713
 Nutrition: 16,058
Osteoporosis Society of Canada
    Evidence-Based Clinical Guidelines

 Abstracts selected for formal review:
  – Grand Sum: 6941
  – Exercise and Fall Prevention: 1293
                 The scope
 To this date, no review has ever been published
  that is more comprehensive
 We have searched high and low for every
  possible citation
       Evidence Based Danger
 Systematic bias
   – A few therapies have much good evidence
   – Often can be reflective of funds to prove
   – May be at the expense of other areas without the
     financial wherewithal
 Danger of “without substantial evidence” to it
  being thought to be “without substantial value”
Physical Activity and Osteoporosis
 Physical activity is not a standardized
 Variation in type, frequency and intensity and
  varies in site-specificity
 Moreso that any other intervention compliance is
  a major issue
 Potential for good and for harm
Physical Activity and Osteoporosis
 As yet there is no clear insight into type,
  frequency or intensity is important for bone
 Or how this might change for different ages with
  different levels of bone mass
 Some recent evidence that repetitious loading and
  unloading may work well
 To prevent fractures:
  – a) Through improving bone mass
  – b) Through fall prevention
  Effect of Exercise as Lifestyle
 In children, exercise plus calcium (& Vit D)
  makes better bones
 Lifelong exercisers have better bones then
  sedentary people (& fewer fractures)
 Over-exercising can lead to bone loss in both
  men and women
 Body weight changes might be important: weight
  gain above the waist is good, its loss is not good
       Interim Expert Opinion
 If you have been an exerciser all your life, stick
  with it
 High activity level throughout adult life may be
  protective and lead to fewer fractures in old age
       Interim Expert Opinion
 In people with osteoporosis:
 If exercise has any role to play in reducing bone
  loss it is secondary to pharmaceutical treatment
 Osteoporosis exercise programs are of value and
  should be available to patients
       Interim Expert Opinion
 In Elderly Fallers:
 Strengthening and balance exercises, and where
  relevant, multi-factorial interventions, based on
  individual assessment, will reduce falling risks

      • Dr. Richard Crilly, Scientific Advisory Council. OSC
   Implementation of Evidence
        Based Guidelines
 Partnerships with allied organizations
   –   College of Family Physicians
   –   Other Health Charities
   –   Corporate Health Sector
   –   Other medical specialties
 Web-site
 Nation wide forums with case study approach
  and opportunity to dialogue with experts
 Translate into user friendly language
 Publish in Canadian Medical Association Journal
 New evidence often takes a long time to be
 Established practices persist even if they have
  been proven ineffective or harmful
 Family physicians and non-specialists able to quickly
  establish the best, evidence-based care for a particular
   – Considering the patient’s individual characteristics
 Guidelines for the prevention of osteoporosis
   – Policy changes for governments
   – Forms foundation for all Society public and
     professional information
   – Credible source of osteoporosis information in
     Canada i.e. media
       Summary Comments
     Plain Language Checklist
 Use concrete examples to illustrate ideas or
 Present ideas with illustrations or diagrams
 Highlight main ideas and important information
  with headings, point form and boldface type
         Summary Comments
      Plain Language Check List
   Use familiar words, conversational personal tone
   Proceed logically, most important ideas first
   Use action verbs and active construction
   Favour short words and sentences
   Use short paragraphs
      Promotion & Marketing
 Research and consult guidelines about tailoring
  messages for older consumers
 Focus-test your materials with older adults
 Recognize in your marketing plan that this is not
  a single homogeneous group
 Test a marketing plan and materials with several
  groups of older consumers (include a range of
  ages and literacy levels)
     Promotion and Marketing
 Use older persons or models in your promotional
 Present positive images of people who are
  healthy, happy and representative of OA diversity
  of culture, language, health status, geographic
  location, income level, etc.
  Active Living & Older Adults
    Next Steps in Education
 Continue increasing awareness & education
  about the benefits and importance of active living
 Promote a consistent message
 Decrease fears about physical activity
 Advocacy efforts for policy changes
 Strengthen partnerships so that health
  professionals and organizations at all levels
  promote the active living message
 Active Living for Older Adults
  Next steps in Programming
 Create specialized programs for each stage of the
  older adult continuum
 Incorporate a variety of programming
 Include all components of fitness
 Incorporate progression
 Include social components
 Address environmental and accessibility issues
 Develop community wide plans
 Active Living for Older Adults
     Next steps in Research
 Continue research into physical activity
  and older adults
 Increase investigation of psychosocial
 Translate research into clear language
 Active Living for Older Adults
  Next steps in Empowerment
 Older adults take responsibility for their
  own health and to take an active role in
  program planning and delivery
 Encourage and support role models and
 Foster and promote a change in attitude
 Active Living for Older Adults
  Next steps in Empowerment
 Older adults the fastest growing group on
  Internet users
 Internet expands the world of seniors
 Powerful tool for maintaining health and well-
 New form of intergenerational communication
 Encourage older adults to get online
 Build senior friendly websites
   This is a prime opportunity for governments,
 individuals and organizations to make a positive
       impact on the health of all Canadians
 Physical activity, especially for older adults, is
  overlooked as an effective and essential part of
  health promotion strategy
 Active Living is a long-term, low-cost
  preventative approach
          The Ultimate Goal
 Prolong the independence of older Canadians and
  add life to years
 When Physical Activity has a prominent place in
  the Cochrane Collaboration we will know we
  have been successful.
         Thank you / Merci
 For more information:
Physical Activity Guide: 1-888-334-9769
 ALCOA: 1-888-549-9799
 Osteoporosis Society of Canada