Should physical activity be on the healthy ageing agenda?

• Author: Grant, Bevan C.

Abstract

Physical activity makes a notable contribution to one's independence, ability to perform everyday tasks and quality of life in the later years, but engagement in this health-related behaviour decreases with age. It is therefore not surprising that numerous intervention strategies have been applied in many settings to encourage a physically active lifestyle. Nonetheless, these have little long-lasting effect. Knowing how best to promote such behaviour to people over 65 years old in a way that makes them feel I want to engage is still in its infancy. This paper reflects on how ageing influences the decisions people in later life make in relation to adopting a physically active lifestyle, and how any advocacy needs to look beyond the physical experience. Knowing of the potential benefits to be gained from this self-regulating behaviour means it warrants a more prominent place on the promoting healthy ageing agenda.

INTRODUCTION

The positive relationships between physical activity and factors such as functional capacity, motor ability, psychological health, cognitive functioning and wellbeing have been clearly shown (DiPietro 2007, Sarkisian et al. 2005, Spirduso et al. 2005, Taylor and Johnson 2008). Nevertheless, the majority of the 65-plus age group lead a relatively sedentary lifestyle (Chodzko-Zajko et al. 2005, Sport and Recreation New Zealand 2003), something the World Health Organisation lists is a major health risk. It is, therefore, not surprising that many countries are endeavouring to find ways to effectively promote physical activity as one way to support healthy and independent living in people's later years.

However, such developments are in their infancy and the rhetoric of how best to do this is idealistic without being overly effective (Brawley et al. 2003). In this article I comment on how the older person is positioned by multiple discourses with regard to health and well-being, reflect on the value and changing nature of physical activity in later life, and suggest why more credence and resources should be given to promoting physical activity as part of the healthy ageing agenda.

As yet in New Zealand there is no national strategy for promoting this behaviour to the older population, although the message is inherent in many documents without being explicit. For example, when publishing a Positive Ageing Strategy: Diversity, Participation and Change, the Government, via the Ministry of Social Policy (2001), recognised the need for creating a society in which all people can age positively. The intent was to improve and protect the health and wellbeing of the older population and advocate for a full and continued involvement in all aspects of community life--including the physical. Subsequently, the Ministry of Health (2002) published the Health of Older People Strategy, one aim of which was to encourage older people to take responsibility for preserving their health through healthy living, which includes being physically active. The National Heart Foundation, a not-for-profit organisation, is a strong advocate of physical activity, but like so many of their initiatives they primarily target the whole population. Another example is found in the vision statement for another government agency, Sport and Recreation New Zealand (SPARC), which aims for New Zealand to be "the most active nation". However, with the exception of the Green Prescription, where a medical practitioner encourages physical activity in conjunction with or in the place of medication, SPARC gives limited attention to the older population.

When reflecting on the relationship between ageing and physical activity, it is important to realise that the older sector of the population have lived through a time when exercising for the sake of it or for health reasons was deemed unnatural. They have also been subjected to many definitions of good health. For much of the 20th century the emphasis in later life was on passivity and contemplation, with rest being considered the virtue of old age. It was legitimate for older people to take a well-earned rest and opt for a passive lifestyle. However, times have changed. Given older people carry the highest load of chronic disease, disability and healthcare utilisation (Ministry of Health 2002), which can be positively influenced by physical activity, finding ways to promote active ageing seems a worthwhile goal. But in so doing we should be cognisant of the differences that exist between the medical and scientific definitions of exercise, fitness and health, and their socially and culturally constructed meanings. This difference is exacerbated by the beliefs older people have about what their body should or should not do, could or could not do (Grant 2002).

Engaging in a physically active lifestyle during one's later years is about more than a physical experience. Hence, giving attention to physical activity alone is insufficient for the promotion of quality of life in old age (Chodzko-Zajko 2000). Trying to sell physical activity to the older population solely on the basis of quality of life, quantity of life, or even salvation is likely to be a lost cause. As Locke (1996:427) contends, sedentary lives may be endangered lives, perhaps even impoverished lives, but "most people don't exercise because we hold out some distant and existential advantage--living longer or living better". Nevertheless, as this sector of the population increases in the future there will be even greater emphasis placed on the reduction of morbidity and non-communicable diseases through the promotion of self-managed health-related behaviours such as physical activity. But given the less-than-favourable social and cultural meanings attached to "being old" this will not happen by chance.

THE UNKNOWN COST OF AN AGEING SOCIETY

Within a few decades the proportion of people over 65 years old will dramatically increase. As Dunstan and Thomson (2006) have explained, in 2005 10% of the population was aged 68 years old and over and by 2026 over 10% will be over 74 years old. In addition, the fastest growing cohort will be the over 85 years old. Such a change to the structure of the population is expected to have a number of unprecedented social and economic consequences, including a greater demand for health and disability services in New Zealand (Cox and Hope 2006).

Demographic fears are often played upon when arguing how a larger, older population will affect the economy of a country, an idea perpetuated by a belief that growing older is inevitably linked with high levels of frailty and dependency. This attracts considerable attention from politicians, entrepreneurs, researchers, public commentators and community groups. As Julie Robotham (2006), the Medical Editor of the Sydney Morning Herald suggested, it is difficult to know whether longer lives will turn out to be a blessing or a curse. Nevertheless, from an economic perspective and self-preservation point of view, promoting health and wellbeing in later life is a worthwhile endeavour (Staehelin 2005).

In contrast to the tales of woe, groups such as insurance brokers, advertisers and entrepreneurs are inspired by a growth in the older population. After all, it is probable the provision of a diverse range of home-based services (eg gardening maintenance, collecting groceries, hire a 'hubby', exercise tutoring) in addition to multiple forms of health care could represent one of the fastest growing areas of investment and employment over the next couple of decades (Atchley and Barusch 2004). The ageing landscape is seen as a potentially lucrative one as each profession identifies its boundaries when espousing their specialty service (Wilson 2000). Meanwhile, the social and cultural implications of an ageing population remain largely unexplored (Gilleard and Higgs 2000). It is evident the focus tends to be more on the deficits associated with ageing, at the expense of attending to opportunities, growth and development (Cruikshank 2003).

There is no certainty about the demands an older population will place on the healthcare system. Nevertheless, the consumption of health services and the pension link ageing closely to the economy (Victor 2005). For example, in the USA, Medicaid expenditure that targets help for the aged is escalating. It is beginning to outpace the Federal Medicare...