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Try out PMC Labs and tell us what you think. Learn More. There is no evidence to inform a moderate intensity cadence i. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least minutes over the week. In reviewing their release of federal physical activity guidelines, the U. Advisory Committee Report concluded that, in addition to the well known cardiovascular and metabolic health Older woman 55 plus gym in ro, there was "strong evidence" that physically active older adults have higher levels of functional health, lower risks of falling, and improved cognitive health [ 2 ].
A recent systematic review further confirmed that greater aerobic physical activity was associated with reduced risk of functional limitations and disability with age [ 3 ]. A systematic review of the benefits of physical activity for special populations is lacking, but it is pd that similar returns are reasonable to expect.
Evidence-based guidelines for older adults communicate the benefits of a physically active lifestyle using frequency- duration- and intensity-based parameters. Variations on the message exist: the World Health Organization promotes at least 30 minutes of moderate intensity physical activity 5 days per week for older adults [ 4 ]. All older adults should avoid inactivity and some physical activity is considered better than none [ 5 ]; however, public health recommendations answer a pragmatic need to provide generalized guidance.
Regardless of the message specifics, as framed, time- and intensity-based guidelines imply that this dose of physical activity should be taken over and above a baseline level which is yet to be quantified. This is problematic, since it is likely that this baseline level of non-exercise physical activity has been most susceptible to secular transitions in occupation in favour of desk jobs and reductions in physical demands of most other jobs, reliance on labour-saving devices to supplement or replace domestic tasks and other activities of daily living, dependence on motorized transportation, and an insidious and pervasive predilection for passive leisure time pursuits [ 6 ].
Since self-reported leisure time physical activity specifically walking for exercise increases in older adults with age [ 7 ], yet objectively monitored physical activity decreases [ 8 ], it is also likely that this baseline level of non-exercise physical activity is vulnerable to advancing age, disability, and chronic illness. Step counting devices i. Accelerometers can provide additional data with regards to time spent in various intensities of physical activity and inactivity in addition to providing step data.
However, due to their relative expense and associated intensive data management requirements their use is typically limited to research. In contrast, simple and inexpensive pedometers, even if they are less sensitive to very slow walking [ 9 ], are more likely to be adopted for clinical and real world applications, including direct use by members of the public. The Public Health Agency of Canada PHAC commissioned a literature review in February to inform an evidence-based approach to converting step count data into minutes of active time congruent with public health guidelines.
The list was subsequently reduced to articles after duplicates, remaining non-English language articles, dissertations, non-peer reviewed articles, and those obviously not dealing with step-defined human physical activity were removed. Abstracts were reviewed, identified articles were assembled, and a report was written. Selected researchers from around the world with first-hand experience collecting step data in the relevant population were invited to critically review the report, identify any gaps or offer additional literature, check and verify data pulled from original sources, and intellectually contribute to this consensus article.
For the purposes of this article, we defined older adults as those older than 65 years of age, although much of the identified literature represents even older individuals.
At times we considered studies that included at least some participants under 65 years of age, for example, as low as 50 years of age if the sample mean age was over 65 years of age. Older adults with disabilities or chronic health problems, and frail older adults would more appropriately fit into the special populations category, however, this category is not necessarily defined solely by age. The final product herein is centred on the literature relevant to older adults and special populations with regards to: 1 normative data i.
Each section represents a 'mini-review. Where current reviews were identified e. Where appropriate, details of studies were tabulated. Any apparent inconsistencies in reporting within tables e. The authors acknowledged that these expected values were derived from an amalgamation of few and disparate studies published at that time. Further, they anticipated that these normative data would and should be modified and refined as evidence and experience using pedometers to assess physical activity would inevitably continue to accumulate.
Since that time a of studies focused on objectively monitored data have been published and the expected values for healthy older adults have been updated [ 13 ]. These incremental were reinforced in a second review in [ 16 ]. Recognizing a considerable floor effect i. As it stands, this graduated step index represents an absolute classification scheme. As such older adults and special populations will be always compared to younger populations with less disability or illness. Studies of free-living behaviour reporting percent meeting select step-defined cut points in older adults.
Further, individuals with a chronic illness are not necessarily "older," further exacerbating this wide variability.
Normative data continue to be published. These normative data provide an important set of reference values by which individual or group data can be compared to assumed peers. Use of a graduated step index permits classification of older adults and special populations by multiple step-defined physical activity.
On-going surveillance of step-defined physical activity is required to track progress, identify areas of concern, and evaluate the efficacy and effectiveness of public health strategies. The next step will be to improve understanding about determinants of step-defined physical activity, including the impact of disability and chronic illness on contexts e.
Although three reviews have documented the effects of pedometer-based programming on physical activity [ 19 - 21 ], weight loss [ 1920 ], and blood pressure [ 19 ] in samples that have included older adults and special populations, no review has specifically examined intervention effects in either of these groups at this time. Yet these are the groups that may be most attracted to pedometer-based programming. Participants in pedometer-based community interventions delivered in Ghent, Belgium [ 22 ] and Rockhampton, Australia [ 23 ] were more likely to be older than younger.
The majority of participants were community-dwelling, however a few studies reported interventions with older adults living in continuing care [ 24 ], congregate housing [ 25 ], or assisted living situations [ 26 ]. Interventions have lasted from 2 weeks [ 24 ] to 11 months [ 27 ] in duration.
The mean delta i. Overall, the weighted effect size was 0. This effect size is also smaller than what is expected in younger adult populations i. Specifically, we located 10 studies in cancer populations, three in COPD populations, two in coronary heart disease and related disorders, 15 in diabetes populations, and 3 in populations with t or muscle disorders. Across conditions, intervention durations have ranged from 4 weeks [ 2829 ] to 12 months [ 3031 ].
Some researchers have chosen to intervene using a pedometer but to assess outcomes using an accelerometer [ 31 - 36 ]. Delta values and effect sizes were computed for each study where requisite data were reported. Additionally, we have presented unweighted and weighted taking into consideration sample size deltas and effect sizes by condition. Weighted effect sizes ranged from 0. Weighted values were 2, and 0. Controlled studies conducted on treadmills or deated walking courses can provide direct information about the of steps in continuous timed walks.
The only study identified that focused on older adults was conducted by Tudor-Locke et al. Older woman 55 plus gym in ro was not directly measured and it is plausible that the group nature of the walk influenced individual paces. This suggests that 1, steps taken in 10 minutes of walking, or 3, steps taken in 30 minutes, could be used to indicate a floor value for absolutely-defined moderate intensity walking.
However, it is important to note that this cadence may be unattainable for some individuals living with disability or chronic disease including frail older adultsreflecting known differences between absolute and relative intensity with age and illness [ 46 ].
Unfortunately, there are no data to specifically inform absolute or relative intensity of different cadences in healthy older adults. With that being said, it is possible that any increase in daily step count relative to individualized baseline values could confer health benefits. This is congruent with the now accepted concept that some activity is better than none, and that some relatively important health benefits may be realized even with improvements over the lowest levels [ 5 ].
Given that these research participants were instructed to cover as much distance as possible, this average cadence represents a relatively high exercise intensity i. This is confirmed by the of a separate study that demonstrated that for these patients, walking at a slightly slower speed of 2.
The maximum cadence for one minute of free-living ambulation i. Thus, the cadence observed under testing conditions may not be representative of that performed during everyday life. No other controlled study of cadence or steps taken in timed walks related to intensity was identified for any other special population group.
However, the data in older adults with PAD indicate that the relative intensity of walking speeds captured as cadence is higher for some groups of older adults, particularly special populations living with disability or chronic illness, than for younger and healthy adults [ 5051 ]. Although there appears to be general agreement with regards to the cadence i. Physical activity guidelines from around the world do not generally recommend that older adults do less aerobic activity than younger adults [ 552 ].
If anything, there seems to be even more emphasis on the importance of obtaining adequate amounts of MVPA over and above activities of daily living [ 3 ]. It therefore makes sense to recommend a similar step-based translation of physical activity guidelines for healthy older adults as for their younger counterparts.
However, in special populations, specifically individuals young or old living with disability and chronic illness, it is important to promote a physically active lifestyle to the fullest extent that it is possible, even if this may fall short of general public health recommendations. For these groups where an absolute intensity or cadence interpretation may not be realistic, a shift to promoting relative intensity and therefore relative cadence may become increasingly important to maintain physical function and independence.
In essence, for those living at the lowest levels of habitual physical activity, the clinical perspective becomes paramount and overtakes the need for more generic public health messaging.
As noted above, there is no evidence to inform a moderate intensity cadence specific to older adults at this time. To be a true translation of public health guidelines these steps should be taken over and above activities of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least minutes spread out over the week [ 3553 ]. Admittedly, these estimates are based on assumed baseline levels, but also an increment that is tied to a cadence that has only been established as an indicator of absolutely-defined moderate-intensity walking in younger adults.
Communication using a graduated step index would span these two concerns by providing additional "rungs on the ladder" that take into consideration individual variability while still promoting healthful increases in physical activity. Barring health issues that might compromise abilities, there appears to be no need to otherwise reduce physical activity guidelines for apparently healthy older adults compared to those for young to middle-aged adults.
Any lower accommodation is only in recognition of anyone including both younger adults and older adults living with disabilities or chronic illness that challenge their physical abilities. It is important to emphasize that both of the computational strategies outlined above produce minimal or threshold estimates and it is expected that even more physical activity will be beneficial.
Rowe et al. Aoyagi and Shephard [ 56 ] reviewed of a of studies based on the Nakanajo Study of Older Adults and shared data related to patterns of physical activity collected using an accelerometer modified Kenz Lifecorder, Suzuken Co.
To be clear, although continuous walking performed under laboratory conditions consistently demonstrates that 1, steps taken continuously over 10 minutes meets the criterion for absolutely-defined moderate intensity [ 41 - 45 ], step accumulation patterns under free-living conditions include lighter intensity activities and ultimately suggest that substantially more total steps must be accrued in order to achieve recommended amounts of MVPA performed in the course of daily living.
Ayabe et al.
Achievement of minimal amounts of recommended PAEE i. In addition, as presented above, the wide variety and types of disabilities observed in special populations may limit individual ability to perform exercise at any rigidly defined absolute moderate intensity, thus requiring a shift toward clinical strategies focused on relative goal attainment and related improvements. Eight cross-sectional studies have focused on older adults.
Newton et al. Yasunaga et al. Although these were cross-sectional data, the authors suggested that an increase of 2, steps over baseline might be recommended for enhanced HRQoL in older adults.Older woman 55 plus gym in ro
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