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    The Problem of Physical Inactivity

    By Kaci Fairchild, PhD, ABPP–

    Physical inactivity is a global public health crisis that accounts for nearly 3.2 million deaths annually, or 49,837 deaths each day. To put that in perspective, if physical inactivity were a disease, it would be the third leading cause of global deaths behind heart disease and stroke. 

    In the United States, rates of physical inactivity have decreased slightly over the past eight years. In 2010, approximately 20% of adults met the federal physical activity guidelines for aerobic and muscle-strengthening activities compared to 22% of adults in 2016. Unfortunately, the prevalence of physical inactivity grows with age as only 15% of adults aged 65–74 years and 8.7% of adults aged 75 years and older met the federal guidelines for aerobic and muscle-strengthening exercises. Importantly, this reduction in physical activity occurs at a time in life in which the importance of physical activity is heightened. 

    Older adults have long been encouraged to be physically active. The term “Use It or Lose It” may sound trite, but the evidence of the importance of physical activity and exercise in successful aging cannot be ignored. Physical activity and exercise are key to the primary and secondary prevention, as well as the management, of many age-related conditions including cardiovascular disease, diabetes, cancer, obesity, osteoporosis, and cognitive impairment. Recent research has highlighted the potential of physical activity and exercise to prevent or delay development of serious cognitive impairment such as Alzheimer’s disease and dementia. In fact, the American Academy of Neurology updated their practice guidelines to include recommendations for physical activity for those patients at-risk for dementia.

    If physical activity is associated with so many positive health outcomes, why aren’t people more active? Rarely is there one reason that fully accounts for a person’s physical activity behavior. Often it is an array of factors that interact with each other to influence physical activity behavior. The rise in physical inactivity can be partially attributed to the co-occurring decrease in leisure-time physical activity behavior and increase in sedentary behavior at work and at home.  Yet while these are important factors to consider when discussing physical inactivity, there are other contributing factors that are particularly salient to older adults that warrant discussion.

    Demographic factors such as ethnicity, education, and marital status are associated with physical activity behavior in older adults. Older women tend to be more physically inactive than older men, as do Hispanics and non-Hispanic blacks compared to non-Hispanic white and those of other ethnicities. Older adults with less than a secondary education are more likely to be physically inactive compared to those with at least some secondary education, and older adults who aren’t married are more likely to be physically inactive than their married counterparts. 

    Older adults also experience physiological changes as part of the aging process that have direct implications on physical activity behavior. For instance, changes throughout the musculoskeletal system reduce a person’s range of motion and mobility as well as limit engagement in weight-bearing exercises. Older adults also experience many age-associated medical conditions that limit physical activity behavior including arthritis, cancer, diabetes, coronary heart disease, chronic obstructive pulmonary disease, and stroke. The detrimental impact of these conditions should not be discounted. Recent research by the CDC found that rates of physically inactivity were 40% higher in older adults who experienced at least one of these medical conditions.

    Emotional factors such as depression, isolation, and loneliness also impact physical activity behavior. Older adults are vulnerable to these emotional factors, which in turn can interact with other factors to reduce physical activity. Notably, there are emotional factors that are associated with the positive effects on physical activity behavior, namely self-efficacy and self-regulation. Self-efficacy is a person’s confidence regarding completing a task or achieving a goal, whereas self-regulation is the ability to manage one’s behavior in accordance with the demands of the situation. Older adults who are more confident in their ability to exercise are more likely to be physically active as are those older adults who are better able to set goals and track their progress towards meeting those goals.  

    Older adults are vulnerable to environmental factors that serve as barriers to exercise engagement. Frequently cited barriers to exercise include the costs associated with gym memberships and exercise classes, access to gyms or senior centers, scarcity of exercise classes suited for older adults, and lack of safe walking paths with available benches or resting spots. The World Health Organization also highlighted the unique impacts of urbanization on physical activity.  Older adults in urban areas may be discouraged from engaging in exercise because of safety concerns related to violence, poor air quality due to pollution, heavy congestion and traffic, and lack of parks, sidewalks, or recreation facilities.

    When discussing exercise with patients, the first question I am often asked is: “How much exercise do I really need?”  The answer to that question differs for each person, but a great starting point are the federal recommendations that are based on the CDC’s guidelines for physical activity in older adults. These guidelines recommend a minimum of 30 minutes/5 days each week (150 minutes) of moderate-intensity aerobic activity or 20 minutes/3 days each week of vigorous-intensity aerobic activity.

    Older adults can also engage in some equivalent combination of moderate and vigorous intensity exercise each week to get similar benefits. In addition to the recommended aerobic exercise, older adults should also engage in at least two days of muscle-strengthening exercise, on non-consecutive days, each week, and at least 10 minutes, twice a week, of exercises designed to increase flexibility and maintain or improve balance. 

    There are several important things to note about these recommended guidelines. First, these guidelines provide recommendations in terms of “moderate” and “vigorous” levels of exercise intensity. Levels of exercise intensity are measures of how hard a person feels like they are working during exercise. Each level of exercise intensity has a corresponding heart rate training zone based on a person’s age-adjusted maximum heart rate.

    For people who do not have access to a heart rate monitor or do not know their heart rate training zones, an equally effective way of gauging the level of exercise intensity is the “Talk Test.” Using this method, a person is able to sing during low intensity exercise, talk but not sing during moderate intensity exercise, and only manage a few words at a time during vigorous intensity exercise. 

    Second, for those people who are not physically active, the idea of exercising for 20–30 minutes may be quite daunting.  This group should be encouraged to know that aerobic activity need only be performed for at least 10 minutes to obtain the physiological benefits. Thus, for those people who are physically inactive or have limited exercise capacity, the 30 minutes of daily aerobic exercise can be divided into three 10-minute segments each day and still be adequate to meet the recommended amounts of physical activity. 

    Third, what is moderate intensity exercise for one person may be low intensity exercise for another person or vigorous intensity exercise for someone else. People often overestimate how physically active they are, which can lead to a mismatch in the types of activities and exercises that people think they can do versus what activities people are able to do. People then exercise too much or ramp up their exercise program too quickly, resulting in burnout or even worse, injury or illness. 

    If you are new to exercise or you have not exercised in some time, you should consult with a physician before beginning any exercise program. A physician can help make adjustments for any health concerns that may impact the ability to engage in exercise. Also, when beginning any new exercise program, or if you have not been active in a while, you should follow the recommendation to start low and go slow. This conservative approach will protect against potential injury and allow you to build your strength. The choice to become more physically active is important as it has direct implications on how you will age. In choosing to become more physically active, you are increasing the likelihood of successfully aging.

    Dr. Kaci Fairchild is a board-certified Geropsychologist at the Sierra Pacific Mental Illness Research, Education, and Clinical Center at the VA Palo Alto and a Clinical Associate Professor (Affiliated) of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine. Dr. Fairchild’s research seeks to develop non-pharmacological interventions to prevent or delay the development of late life cognitive impairment. Dr. Fairchild’s research is funded by the VA Office of Research and Development, the Department of Defense, the National Institute on Aging, and the Alzheimer’s Association.


    Marcy Adelman, Ph.D., a clinical psychologist in private practice, is co-founder of the non-profit organization Openhouse. She is also a leading advocate and educator in LGBT affirming dementia care and a member of the Advisory Council to the Aging and Adult Services Commission.