THE ACTIVE AGEING CHALLENGE FOR EXERCISE PROFESSIONALS: HOW WE COULD SUPPORT INACTIVE AGEING POPULATIONS TO BECOME ACTIVE AND ENJOY A HEALTHY LIFESTYLE
Alfonso Jimenez – Coventry University, United Kingdom
This session is partially based on the results of an EU funded Erasmus+ project “Physical Activity & Healthy Ageing” (PAHA) led by EuropeActive1 . As part of the dissemination strategy for the project we published a Good Practice Guide to support ageing inactive people starting an exercise intervention. This abstract contains some of the key information, resources and lessons learned during the development and implementation of the project. The full PAHA project Good Practice Guide can be downloaded in the following link: http://www.europeactive.eu/sites/europeactive.eu/files/projects/PAHA/EN_Good_Practice_Guide_WEB.pdf The Good Practice Guide is based on the successful outcomes of the PAHA project and it is intended that the principles of the intervention can be used in many other recreational sporting settings. How we could support inactive ageing populations to become active and enjoy a healthy lifestyle? Educating People + Understanding and Translating Research Evidences + Facilitating Behavioural Change + Supporting + Empowering + Engaging + Informing Policy + Advancing Current Practice Our Challenging Context Physical activity is one of the most basic human functions. It is an important foundation of health throughout life. Its known health benefits include a reduced risk of cardiovascular disease, hypertension, diabetes and certain forms of cancer; it also has an important role in the management of certain chronic conditions. In addition, it has positive effects on mental health by reducing stress reactions, anxiety and depression and by possibly delaying the effects of Alzheimer’s disease and other forms of dementia. Furthermore, physical activity is a key determinant of energy expenditure and is therefore fundamental to achieving energy balance and weight control. Throughout childhood and adolescence, physical activity is necessary for the development of basic motor skills, as well as musculoskeletal development. Furthermore, physical activity is also embedded in the United Nations Convention on the Rights of the Child. In adults, physical activity maintains muscle strength and increases cardiorespiratory fitness and bone health. Among older people, physical activity helps to maintain health, agility and functional independence and to enhance social participation and quality of life. It may also help to prevent falls and assists in chronic disease 1 The PAHA Project Erasmus+ Collaborative Partnership Promoting Physical Activity and Health in Ageing (PAHA) Number 557041-EPP-1-2014-1-BE-SPO-SCP 3 The Promoting Physical Activity and Health in Ageing (PAHA) project was a tailored intervention for older adults with different functional capacities, but who were classified as being “inactive” when using World Health Organisation guidelines. Through supervised and structured exercise programmes for selected senior citizens (55–65 years old), the PAHA project set about to convert currently inactive people into regular exercisers at a level that was beneficial to their health, and which would support the EU Guidelines on Physical Activity. There were 7 project partner countries – Finland, Germany, Greece, Hungary, Ireland, Portugal and the United Kingdom – and by special arrangement in Denmark. In each country 3 fitness centres ran specially designed trial sessions of supervised exercise programmes of 6 weeks duration. The personal trainers who supervised the delivery of the exercise sessions went through some additional technical training (in active ageing) and also in behavioural and motivational techniques so that they could close adapt the programmes to suit each of the new clients taking part in the trial sessions. Participation in the trial periods was offered free of charge, and the older adults who took part were then re-assessed at 3 months and 6 months intervals to determine if the programme had been an effective intervention, and that they had maintained activity levels which were beneficial to their health. The focus of the project was to make sure that within the 6 week trials the individuals would experience the positive benefits of regular exercise so that they would voluntarily maintain a healthy lifestyle. The considerations of the benefits and motivation for older adults to exercise can include: Sleeping better; Having more energy; Reducing the symptoms of disease; Maintaining an independent lifestyle; Keeping up with the grandchildren; Extending a working life. International Scientific-practical Symposium In collaboration with the European Group for Research into Elderly and Physical Activity “CLIMBING THE LADDER OF LIFE, ACTIVE AND FIT” 19 Research Council of Lithuania rehabilitation, becoming a critical component of a healthy life. Despite the known benefits of physical activity, there is a worldwide trend towards less total daily physical activity. Globally, one third of adults do not achieve the recommended levels of physical activity. In Europe, estimates indicate that more than one third of adults are insufficiently active (Hallal et al., 2012). While there are some continuing challenges in terms of the validity and comparability of data on levels of physical activity across Europe, recent figures from member States of the European Union (EU) indicate that six in every 10 people above 15 years of age never or seldom exercise or play a sport and more than half never or seldom engage in other kinds of physical activity, such as cycling, dancing or gardening. At the same time, a high proportion of adults in Europe spend more than four hours a day sitting, which could be a contributing factor to sedentary lifestyles. As a consequence, physical inactivity has become a leading risk factor for health chronic disorders: 1 million deaths (about 10 % of the total) and 8.3 million disability-adjusted life years lost per year in the WHO European Region are attributable to physical inactivity. It is estimated to cause 5 % of the burden of coronary heart disease, 7 % of type 2 diabetes, 9 % of breast cancer and 10 % of colon cancer (Lee et al., 2012). Rising rates of overweight and obesity have also been reported in many countries in the Region during the past few decades. The statistics are disturbing: in 46 countries (accounting for 87 % of the Region), more than 50 % of adults are overweight or obese; in several of those countries the rate is close to 70 % of the adult population. Overweight and obesity are also highly prevalent among children and adolescents, particularly in Southern European countries. Physical inactivity has been identified as contributing to the energy imbalance that leads to weight gain. Collectively, physical inactivity not only has substantial consequences for direct health-care costs but also causes high indirect costs due to increased periods of sick leave, work disabilities and premature deaths. For a population of 10 million people, where half the population is insufficiently active, the overall cost is estimated to be €910 million per year (WHO, 2007). Participation in physical activity and exercise can result in desirable health outcomes in terms of both acute and chronic adaptations in the physiological and psychological domains. Physical activity, exercise, health and the quality of life are closely interconnected, as the human body was designed to move and therefore needs regular physical activity in order to function optimally and to avoid illness. There are numerous key concepts, elements, factors and theories regarding motivation and behavioural change, and it is important to offer an evidence-based and practical approach to exercise and sport professionals in helping their clients and customers to deal with a significant challenge to become more active. Understanding behavioural and motivational change is essential to help people to change their lives by being more active and especially more often (as frequency of activity will be the real and critical key factor to improve health status in inactive population). The PAHA project included specific additional training for the fitness instructors in active ageing and motivational change for this reason. The available evidence from observational studies support the conclusion that physical activity and exercise, performed on a regular basis (as a behaviour), will have protective benefits for several aspects of physical, mental health and general wellbeing. There is strong evidence for their protection against all the chronic pathologies, as well as for symptoms of the major mental disorders such as depression and cognitive decline, anxiety and poor sleep, feelings of distress and fatigue. Thus, current evidence supports the conclusion that regular participation in moderate-to vigorous physical activity and/or exercise, consistent with current public health guidelines, confers physical and mental health benefits when compared to participation in low levels of activity or a sedentary lifestyle. The best element linked into the health benefits is the fact that exercise means regular practice, a systematic, progressive and tailored stimulus that will improve health status of anyone as a result of frequency of practice. The most updated evidence-based guidelines for exercise from the American College of Sport Medicine employs the frequency (how often), intensity (how hard), time (duration or how long), and type (mode or what kind), with the addition of total volume (amount) and progression (advancement), formulated as the FITT-VP principle for exercise prescription. Exercise, health or sport professionals play a critical role in addressing specific needs of individuals – and in this case, older adults – to offer safe and International Scientific-practical Symposium In collaboration with the European Group for Research into Elderly and Physical Activity “CLIMBING THE LADDER OF LIFE, ACTIVE AND FIT” 20 Research Council of Lithuania effective exercise programmes. Behaviour change is critical to the prevention, management, and treatment of many important health conditions. However, the initiation and maintenance of behaviour change can be very difficult, and even those interventions that succeed in controlled clinical trials do not always scale well. It is not enough for behavioural and social scientists to do rigorous research and develop effective interventions; there must also be delivery channels and systems in place to disseminate these interventions to the public, policymakers, and other decision makers to ensure that they are implemented, adopted, and maintained. From a behavioural change perspective, it will be easier and more rewarding for an individual to incorporate new behaviour instead of removing existing ones. This is one of the key positive messages to work on with inactive people, adding exercise as a positive behaviour will provide always positive outcomes (if the dose is appropriate to the capacity level of the person and the program allows a progressive increase of the challenge). Exercise, health and sport professionals have a relevant role to play, and should be ready to meet individual people’s expectations. Understanding the implications of health behaviours in the overall exercise intervention will be a key asset to effectively produce significant and sustainable health changes in inactive populations. Specific, tailored, and very simple and applied approaches to modify behaviours should be integrated in health behaviour programmes, for example in exercise interventions. A positive combination of physical activity (i.e. as a mean of transportation) and individualised exercise doses, addressing specific needs and limitations of the individuals, will provide the kind of engaging and positive stimulus to help inactive population to change behaviour. Getting and staying fit is the result of the integration of both physical activity and exercise in a person’s lifestyle and the application of solid evidence-based interventions will guarantee effective positive results achieved safely and progressively. Science and applied research are progressing faster than ever, and we, exercise professionals, should be able to build the bridge between theory and practice. Exercise professionals should be upskilled based on the current evidences allowing the public to achieve their exercise goals easier, faster and safer (Jimenez, Pajaujiene, 2017). The physical activity sector, including the health and fitness industry, have been actively involved in projects and activities in partnership with Governments across Europe to promote an active and healthy behaviour, and significant funding support has been received from the European Commission in that regard (EHFA, 2011). In fact, the overall physical activity and sports sector recognizes its responsibility to work with partners at all levels across the European Union to create a healthier society, where living an active lifestyle is the social norm, rather than an exception, and where daily physical activity and exercise is seen as part of the routine part of the prevention and management of disease (Matheson et al., 2013). But despite the obvious capacity of sports and physical activity sector across Europe, its willingness to contribute to increased levels of physical activity, and its track record of positive performance, the sector is rarely recognized in national governments’ physical activity promotion programmes and campaigns. Exercise professionals should become the main source to convey exercise-related information for the general public. They should provide information and implement exercise counselling, exercise prescription, individual’s fitness assessment and guidance (Jimenez, Pajaujiene, 2017). Unfortunately, there is a lack of review studies on the analysis of their education and professional competencies (Stacey et al., 2010), it is unclear how they obtain evidence-based information and other issues associated with their education and lifelong learning (Stacey et al., 2010; Waryasz et al., 2016). However, it is revealed that exercise professionals with higher level of education (e.g., graduate degrees) are more likely to use scholarly sources of evidence compared to those with lower levels of education who are more likely to rely on mass media, including the internet [Hare et al., 2000; Forsyth et al., 2005). Therefore, given exercise professionalʼs role in advising the general public, their accessibility, and the emerging evidence-based guidelines on the best practices related to the use of exercise and nutrition interventions, further research, education and support are needed to ensure that exercise professionals, International Scientific-practical Symposium In collaboration with the European Group for Research into Elderly and Physical Activity “CLIMBING THE LADDER OF LIFE, ACTIVE AND FIT” 21 Research Council of Lithuania working with the public, integrate new applied research knowledge into their fitness assessment and exercise guidance to facilitate a sustainable behavioural change in inactive populations, specially in ageing people (Stacey et al., 2010). How we could support inactive ageing populations to become active and enjoy a healthy lifestyle? Educating People + Understanding and Translating Research Evidences + Facilitating Behavioural Change + Supporting + Empowering + Engaging + Informing Policy + Advancing Current Practice
