In 2015, Helping Hand aged care centres implemented an innovative, 12-week exercise program. They wanted to see if it could improve cognitive and functional abilities in older adults with significant memory loss or dementia.
The Exercise Physiology in Aged Care Project, led by exercise physiologist Alison Penington, prescribes individually tailored activities to match the skill levels and personal preferences of residents.
Gaynor Parfitt, associate professor in exercise and sports psychology at the University of South Australia, has been evaluating the program and says, “we’ve really been very positively blown away by the impact that the exercise has had.”
Listening to staff interviews, Parfitt said one worker was laughing as she described finding a “stand-assist” resident – who could not stand or walk unassisted – standing up and walking in her room. “She said afterwards, it’s that sort of OMG, I never expected to see that happen.”
Initially, some were sceptical about doing exercise with this population, who are 86 years old on average and “severely declined”. But Parfitt says, “overwhelmingly it’s dispelled the idea that these people are just on one downward trajectory”.
Staff reported improvements in residents’ behaviour, socialisation, communication and alertness. Even language started coming back. Residents became more communicative and started using fuller sentences.
They started socialising and smiling more, as they did some exercises together like passing a medicine ball around.
Family members described being able to hold conversations, and the exercises gave them a point of conversation – or even something they could engage in with them. One man who visits his wife, for instance, started doing the exercises as well.
Because the activities improved their mobility, dressing residents became easier, and they became more independent in activities of daily living, like brushing their hair or teeth.
The exercise physiologists who ran the program prescribe physical activities that individuals find fun and can achieve within their own limits.
“One of the reasons that people tend to stop being active,” Parfitt says, “is because of the fear of falling.” It’s important that they feel safe, and individually targeted activities can overcome this limitation to being active.
Moving beyond aged care, Helping Hand is developing a walking trails program for community dwelling adults that can be adapted to different skill levels; for instance with different trail lengths and difficulties and places for people to sit down and catch their breath.
The key message is to get up and move a bit more than what people are doing.
And the capability of patients who are thought to be severely incapacitated is more than staff believed was possible. “So it’s now actually challenging them to spend more time encouraging them to walk,” Parfitt reports.
This environmental transformation reveals the ripple effects of the program. “It’s changed how people perceived how life can be,” says Parfitt, “and I think that’s quite marked.”
Jane is 52 years old. She suffers chronic neck pain and impaired mobility, resulting from an occupational violence attack. But she needs to continue her activities in the domestic domain and understands the importance of staying active despite the pain.
This is not easy. Although Jane’s house was designed for her ageing parents, the surrounding footpaths are dangerous, and she has already tripped a couple of times. Jane is also a quiet person who enjoys intimate social interactions in the comfort of her own home.
John is a socially and mentally active 44-year old who admits to mildly excessive alcohol consumption and periods of depression. He stays physically active to keep fit and get around.
With an aversion to driving, cycling is his preferred mode of transport. He hopes his physical health will allow him to continue. John lives close to a natural enjoyment which facilitates outdoor physical activities.
As Jane and John age, mobility will become an increasingly important theme in their lives. Their independence will count on it.
A comprehensive survey of long-term studies covering 12.6 million older adults found that mobility improved quality of life and body function capacity and reduced medical expenditure.
Grocery shopping, housework, gardening, visiting friends and family, personal hygiene, going to appointments are things we take for granted. But impaired mobility and chronic conditions in aging can have a significant impact on these daily activities.
“Life space”, the space within which people move in their daily lives, impacts mobility – people who have restricted life space tend to be less mobile.
Walking is an activity that can easily be included in a daily routine as a form of transport to increase life space, thereby enhancing mobility and health.
John and Jane both identify Tai Chi as an activity that they could enjoy in 25 years. It is low impact, and as a bonus includes meditation and breathing for mental relaxation.
Global public health policies increasingly target healthy aging. To this end, a lifestyle index was developed to identify key factors related to aging well.
Core components of the index are vigorous and moderate physical activity, consuming fruit and vegetables, regular meals, plenty of fluids, and psychosocial factors – social engagement, networking and life satisfaction.
There is an interactive element to these. For instance, eating well reduces risk of overweight and chronic disease, both of which restrict mobility. Being socially active, like John, will enhance opportunities to be active.
In turn, higher mobility will enable greater engagement in social networks and activities.
Active aging policies could support people like Jane to be mobile by improving sidewalks and providing walking trails.
More broadly, policies across multiple sectors will empower older adults to remain independent, active community members – characteristic of a healthy, humane society.
Twenty years ago, the term “sarcopenia” – Greek for “poverty of flesh” – was coined to describe the muscle wasting that occurs with aging.
Often unnoticed, this condition can dramatically impact quality of life and independent living. Experts propose that muscle mass, strength and function should be assessed to diagnose sarcopenia.
Awareness of sarcopenia – affecting at least a third of older Australians – is slowly gaining momentum. So too are its wide-ranging effects on health, including its potential to cause type 2 diabetes.
New research suggests it could impact lung function and breast cancer risk.
Poor lung function can lead to respiratory complications like pneumonia and bronchitis as well as broader problems like heart disease and death.
Lungs rely on healthy muscles in the respiratory system, particularly the diaphragm, to help breathe in oxygen and expel carbon dioxide.
Handgrip strength is an easy, quick measure of muscle strength. The test involves simply squeezing a small object as hard as possible to measure the strength of your grip.
Handgrip strength is a useful indicator of general health, and has been related to nutrition status and walking ability. Also a useful indicator of low muscle mass, hand-grip strength can be used to diagnose sarcopenia.
Weak lung function has been linked to poor handgrip strength in hospitals or nursing homes. Korean researchers wanted to test if handgrip strength could predict lung function, measured using standard pulmonary (lung) function tests, in a national population study of healthy community-dwelling women aged 65-79.
They found that as handgrip strength declined, so did lung capacity – after adjusting for several other factors like age, education and physical activity levels.
The researchers suggest handgrip strength could be a useful public health tool for identifying potential impairment in lung function.
Sarcopenia and excess fat have been previously related to higher risk of mortality from metastatic (secondary) breast cancer.
Researchers from the United States and Canada recently investigated whether this was the case with nonmetastatic (primary) breast cancer. They measured muscle mass, muscle quality and fat in 3,241 women with stage 2 or 3 breast cancer, i.e. cancer that has not spread to other organs, and followed them up for at least 6 years.
A third of patients had sarcopenia, and they were 41 percent more likely to die early than those without sarcopenia. Women with highest amounts of fat were 35 percent more likely to die early than those with low fat levels.
Women who had lower muscle mass and higher levels of fat were 89 percent less likely to survive. Interestingly, body mass index (BMI; height/weight ratio) was not associated with survival.
It is possible, the researchers say, that women with more aggressive cancer may have lost more muscle mass early in their cancer as a result. Women with higher muscle mass may also have had healthier lifestyle habits more generally.
They suggest, however, that clinical measures of muscle mass and fat might help provide prognostic information to help guide treatment.
These studies build on evidence that says muscle matters – more than we might realise. Better health outcomes with aging can be achieved with simple lifestyle habits that embrace physical activity and good nutrition to prevent loss of muscle mass.
After sitting through Day 1 of APAC’s Healthy Ageing Summit in Singapore, attendees relaxed at a cocktail reception. “The vibe of the reception was buzzing with excitement and conversations,” according to Nikki King.
Invigorated by the networking and eager to learn more, Day 2 promised an interesting agenda. King was particularly keen to hear about sarcopenia, a research focus of Proportion Foods.
Sarcopenia is not a rare condition; in fact, this accelerated loss of muscle mass and strength afflicts an estimated 5-13 percent of 60-70-year-olds.
But while healthcare professionals and patients are well informed about osteoporosis in aging, awareness levels for sarcopenia are lagging about 10 years behind, according to John Burstow from TSI Pharmaceuticals.
New research has now linked sarcopenia to cancer survival. A recent observational study found that a third of women diagnosed with non-metastatic breast cancer had sarcopenia, and this was associated with a higher risk of dying than those with adequate muscle mass.
In fact, sarcopenia led to a 41 percent reduced risk of survival. Higher body fat was also associated with elevated mortality risk. Women with sarcopenia and excess body fat were 89 percent more likely to die.
Dr Bejit Ideas, from Japan’s Anti-Ageing Society, discussed the Okinawa Centenarian Study – a study of Okinawa’s centenarians and older adults that’s been going since 1975. They not only enjoy the world’s most prolonged life expectancy but also the longest health expectancy.
When the study began, principal investigator Dr Suzuki “found an unusual number of centenarians to be in extraordinarily healthy shape,” according to the study’s website. “They were lean, youthful-looking, energetic, and had remarkably low rates of heart disease and cancer.”
What are their secrets? Lifestyle has emerged as a pivotal feature. Older Okinawans are active both physically and mentally. Their diets are packed with fruit, vegetables, and other foods full of fibre and antioxidants. They also practice “hara hachi bu” – meaning they only eat until they are 80 percent full.
“Signatures of longevity in the gut microbiota profile” could be an important clue to living healthier and longer. According to Italian researchers, humans have a lifelong relationship with the trillions of micro-organisms that inhabit the gut, which in ageing is “an adaptive process of the human superorganism.”
Diet is a key contributor to a healthy microbiome, which helps fight inflammation, leaky gut and declining bone and cognitive health.
Inflammation lurks beneath the chronic diseases that plague modern cultures including biological ageing, as Dr Paul Clayton from the Institute of Food, Brain and Behaviour discussed in a panel debate on the future of ageing.
In fact, researchers have coined the term “inflamm-aging,” a prominent risk factor for unhealthy aging and degeneration in older people.
But how to improve people’s diets and reduce risk of chronic disease? Some propose that personalised nutrition will help, the focus of emerging research. A European project, Food4Me, showed that people find it easier to adopt healthier diets when advice is targeted to their individual needs.
The researchers concluded from a study with four different conditions that “personal is what matters most,” and predict that this could be translated into an array of different technologies to personalise nutrition advice.