Perspectives in Disease Prevention and Health Promotion Surgeon General's Workshop on Health Promotion and Aging: Summary Recommendations of the Physical Fitness and Exercise Working Group

In March 1988, the Surgeon General's Workshop on Health Promotion and Aging met in Washington, D.C., and provided health professionals with recommendations that address the health needs of the elderly. The recommendations of the Alcohol Working Group and the Medications Working Group have been summarized (1,2). Following is a summary of the recommendations of the Physical Fitness and Exercise Working Group. Although many of the recommendations have general application, they are targeted toward the elderly. SUMMARY RECOMMENDATIONS OF THE PHYSICAL FITNESS AND EXERCISE WORKING GROUP Education and Training

• Physicians should receive additional training and continuing medical education about the physiologic, psychologic, and other health benefits of physical activity.

• Health-care providers should be encouraged to develop and use physical activity assessment, prescription, and follow-up protocols for increasing physical activity among the elderly.

• Training opportunities regarding the health benefits of physical activity for the elderly should be increased for health-care providers, including psychologists, exercise physiologists, epidemiologists, nurses, physicians, physical educators, health educators, nutritionists, and gerontologists.

• Care providers in nursing homes should be offered in-service training programs on appropriate physical activity for their patients. Service

• Governments at all levels should provide leadership and support for local communities in identifying and developing focal points (e.g., senior centers, health-care institutions, and other community resources) for coordinating physical activity promotion for older citizens.

• Multifamily housing should include such facilities as exercise rooms, open spaces, and gardens to provide physical activity options for tenants and their families.-- Health and medical professional associations should develop position statements regarding appropriate physical activity for older persons and should reinforce those statements with educational programs.

• A physical activity assessment protocol should be incorporated into regular physical examinations and routine medical visits. Research

• Basic research should examine the effects of exercise on degenerative processes, such as cardiovascular disease, glucose and lipid impairment, osteoporosis and osteoarthritis, psychosocial dysfunction, and immune dysfunction.

• Research should determine the role of physical exercise in maintaining functional capacity and preventing degenerative disease, especially in perimenopausal and postmenopausal women, by increasing or maintaining muscular strength and endurance, cardiorespiratory function, agility, coordination, and flexibility.

• Research should determine the appropriate types and levels of physical activity (i.e., in terms of intensity, frequency, and duration) necessary to safely achieve the potential benefits in health and functional capacity for persons of various ages and abilities.

• To determine behavioral and environmental factors that can affect whether a person adopts and maintains a physical activity program, studies should assess gender, ethnic, social support, and socioeconomic differences. Studies should also evaluate the interaction between physical activity and other health-related behaviors.-- Reliable measures of physical activity should be established for epidemiologic, behavioral, and evaluation research. Policy

• Persons in all age groups should be encouraged to engage in regular physical activity to maintain functional capacity and protect against conditions such as obesity and against disease processes such as coronary heart disease and adult-onset diabetes.

• Specific physical activity recommendations and physical activity prescription for the management of selected chronic diseases should be individualized according to age, health status, and current level of physical conditioning.

• Institutions (e.g., schools, medical settings, and workplaces) should provide the time, physical facilities, and behavioral programs that lead to increased participation at low levels of physical activity and to more vigorous exercise activity.

• Governments at all levels should promote the expansion and development of parks and recreation systems to provide places for physical activity participation.

• Governments should ensure that gerontologic research findings and training information on the beneficial effects of physical activity and exercise are disseminated to health professionals. Reported by: Office of the Surgeon General, Public Health Svc. Cardiovascular Health Br, Div of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, CDC.

  Editorial Note

Editorial Note: Regular physical activity and exercise are critical elements in adult health promotion. Increased levels of physical activity are associated with a reduced incidence of coronary heart disease (3), hypertension (4), noninsulin-dependent diabetes mellitus (5), colon cancer (6), and depression and anxiety (7). In addition, increased physical activity increases bone mineral content (8), reduces the risk for osteoporotic fractures (9), helps maintain appropriate body weight (10), and increases longevity (11).

Maximal oxygen uptake (VO2max), an index of cardiorespiratory fitness, declines with age (12). Physical activity, however, can dramatically influence the rate of decline. Athletes aged 55-80 years who engage in regular endurance training experience less decline in VO2max than comparably aged persons who are more sedentary (13). These athletes may also reduce risks for chronic disease by maintaining normal body weight, blood pressure, glucose tolerance, and lipoprotein lipid levels (13-14). Recent studies of exercise training among the elderly have shown that older persons can adapt to increased exercise (15). Positive health benefits result from both high-intensity (greater than or equal to 60% of VO2max) and low-intensity ( less than 60% VO2max) exercise (16).

Analysis of the 1985 National Health Interview Survey supplemental questionnaire on health promotion and disease prevention found that regular, appropriate exercise is uncommon among persons aged greater than or equal to 65 years. Only 7%-8% of this age group regularly engage in exercise capable of maintaining or improving cardiorespiratory fitness. Moreover, about two thirds of persons in this age group are either active irregularly or completely sedentary (17). The remainder exercise regularly but at an intensity too low to improve their cardiorespiratory fitness (17). However, this latter group may receive other health benefits from exercise (18).

The survey and the exercise studies underscore the need for improved understanding of the determinants and health effects of physical activity among the elderly. Greater efforts should be made to promote increased levels of exercise among the elderly to ensure the maintenance of vitality and an acceptable quality of life for older persons. The implementation of the Surgeon General's recommendations for physical fitness and exercise should help promote the type and quantity of exercise most appropriate for improving the health of older persons.

References

1. CDC. Surgeon General's Workshop on Health Promotion and Aging:

summary recommendations of the Alcohol Working Group. MMWR 1989;38:385-8.

2. CDC. Surgeon General's Workshop on Health Promotion and Aging: summary recommendations of the Medication Working Group. MMWR 1989;38:605-6,612.

3. Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Ann Rev Public Health 1987;8:253-87.

4. Paffenbarger RS Jr, Wing AL, Hyde RT, Jung DL. Physical activity and incidence of hyper tension in college alumni. Am J Epidemiol 1983;117:245-57.

5. Frisch RE, Wyshak G, Albright TE, Albright NL, Schiff I. Lower prevalence of diabetes in female former college athletes compared with nonathletes. Diabetes 1986;35:1101-5.

6. Kohl HW, LaPorte RE, Blair SN. Physical activity and cancer: an epidemiological perspective. Sports Med 1988;6:222-37.

7. Taylor CB, Sallis JF, Needle R. The relation of physical activity and exercise to mental health. Public Health Rep 1985;100:195-202. 8. Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178-208.

9. Cooper C, Barker DJP, Wickham C. Physical activity, muscle strength, and calcium intake in fracture of proximal femur in Britain. Br Med J 1988;297:1443-6. 10. Blair SN, Jacobs DR Jr, Powell KE. Relationships between exercise or physical activity and other health behaviors. Public Health Rep 1985;100:172-80. 11. Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med 1986;314:605-13. 12. Buskirk ER, Hodgson JL. Age and aerobic power: the rate of change in men and women. Fed Proc 1987;46:1824-9. 13. Heath GW, Hagberg JM, Ehsani AA, Holloszy JO. A physiological comparison of young and older endurance athletes. J Appl Physiol 1981;51:634-40. 14. Seals DR, Allen WK, Hurley BF, Dalsky GP, Ehsani AA, Hagberg JM. Elevated high-density lipoprotein cholesterol levels in older endurance athletes. Am J Cardiol 1984;54:390-3. 15. Seals DR, Hagberg JM, Hurley BF, Ehsani AA, Holloszy JO. Endurance training in older men and women. I. Cardiovascular responses to exercise. J Appl Physiol 1984;57:1024-9. 16. Seals DR, Hagberg JM, Hurley BF, Ehsani AA, Holloszy JO. Effects of endurance training on glucose tolerance and plasma lipid levels in older men and women. JAMA 1984;252:645-9. 17. Caspersen CJ, Christenson GM, Pollard RA. Status of the 1990 physical fitness and exercise objectives--evidence from NHIS 1985. Public Health Rep 1986;101:587-92. 18. Sallis JF, Haskell WL, Fortmann SP, Wood PD, Vranizan KM. Moderate-intensity physical activity and cardiovascular risk factors: the Stanford Five-City Project. Prev Med 1986;15:561-8.

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