Post on 23-Dec-2015
Physical Activity Physical Activity Initiatives with Initiatives with
Older AdultsOlder Adults
A Canadian Perspective
Whistler, B.C.
December 10, 2001
Our Challenges
“It is surely a great criticism of our profession that we have not organized a critical summary, by specialty of sub-specialty, adapted periodically, of all relevant randomized controlled trials.”
• Archie Cochrane
Our Challenges
Clear Lake Agreement by Federal, Provincial, & Territorial Ministers responsible for fitness, active living, recreation set a joint target to reduce physical inactivity in Canadians by 10% from 1998-2003
Active Old Age
Director General of the World Health Organization described gains in life expectancy as one of humanity’s greatest achievements
Living a full life to reach a healthy, happy and active old age is our aspiration
Between Friends
Not Aging but Saging …Wise Beyond Your Years
It might not affect you now, but it will.
Growing older is inevitable.
Dignity, Respect, Independence and Control
The importance of older people being able to maintain control and autonomy in their lives must not be lost
Definition of Older Adult
Self-defining (Active Living Coalition for Older Adults)
Varies depending upon initiative 50-55+ for many initiatives (Physical Activity
Guide)
Aging Population - Facts
Being physically active reduces the risk of heart disease, fall and injuries, obesity, high blood pressure, adult-onset diabetes, osteoporosis, stroke, depression, colon cancer and premature death
One-third of older adults face an increased risk of loss of mobility and functional capacity, thereby decreasing their functional independence
Aging Population Facts
1 in 10 Canadians is an older adult This number will double by 2021 The greatest health risk for older adults is
sedentary living (WHO, 1997) Among adults 55 + only 34% of men and 29% of
women are physically active Among adults 74+ only 29% of men and 19% of
women are physically active
The Older Adult Audience
50% of seniors report physical activity of 15 min. or more at least 12/month
Almost 2/3 of those aged 80+report needing no help with daily tasks
Only 16% of older adults use the Internet Once online Canadian seniors use the
Internet on average 12 hours weekly
The Older Adult Audience
1/3 of Canadian seniors live in rural areas and small towns, the rest in urban areas
93% of seniors live in private households 20% of Canadians 65+ have post-secondary
diploma or degree 60% did not finish high school Considerable number have difficulty with
reading
By 2041….
46% have a disability but for most part continue to enjoy and active lifestyle in their communities
For those born in 1998 life expectancy increased to 92 for men and 100 for women
By 2041 number of Canadians over 80 will quadruple
Why Older Adults are not as Physically Active
Accessibility Safety Security Support Motivational issues
– Must be addressed to encourage, support and ensure that opportunities exist that facilitate involvement in Active Living
Aging and Communication
Visual acuity Hearing acuity Agility & Mobility Social/emotional changes
Barriers to Reaching Older Adults
Physical changes of aging Stereotypes, outdated assumptions about older
adults lifestyles, interests, capabilities Communication materials and media not suited to
audience
Initiatives
Physical Activity Guide for Older Adults– -individuals & leaders, practitioners
Moving through the Years – A Blueprint for Action for Active Living and Older Adults– Policy, decision makers
Evidence Based Clinical Guidelines for Osteoporosis– Physicians (Specialists/ GP,FP), Other Allied Health
Professionals
Canada’s Physical Activity Guide for Older Adults
The Guide and the accompanying handbook are the Canadian standard for physical activity and older adults
Based on prototype of Physical Activity Guide for Canadians and Canada’s Food Guide
Bilingual (French & English)
Canada’s Physical Activity Guide for Older Adults
Developed over 3 years Done in partnership with the Active Living
Coalition for Older Adults (ALCOA), Canadian Society for Exercise Physiology and Health Canada
Launched in May 1999 Multi-disciplinary national advisory committee
which included older adults Focus testing with both older adults and health
professionals in urban and rural settings
Canada’s Physical Activity Guide for Older Adults
Guide and Handbook underwent numerous reviews by a group of scientific experts
Guide and handbook used by leaders, health providers and program delivers
Guide includes tips to getting started, how much activity is enough, health benefits, and examples of endurance, flexibility, strength and balance activities to choose from
Launched in conjunction with the “Blueprint for Action”
Canada’s Physical Activity Guide for Older Adults Challenges
Retain scientific validity Retaining balance between consumer wants &
needs and what science says Marketing of message had to be simple, realistic,
believeable, and inspiring Attaining the outcomes & benefits while making
goal attractive & attainable Carry a message to audience that was clear and
user friendly
Canada’s Physical Activity Guide for Older Adults Challenges
Simple Messages: Age is no barrier Be Active, Your Way, Every Day for Life Every little bit helps, but more is better Add it up principle Moderate physical activity most days for 30-60
minutes Choice of activities from each of three activity
groups:– Endurance, Flexibility, Strength & Balance
Canada’s Physical Activity Guide for older adults
Science based facts (benefits/risks) Why do this and what is in it for you Variety & Safety concerns (start where you can) Overcoming barriers Pull out Guide to put on refrigerator Sample calendar/planning sheet Stories/Real people (not cartoons) Next steps planner
Canada’s Physical Activity Guide for older adults - Barriers
I feel too tired to get started I don’t want to exercise? I’ve worked hard all my
life, not its time to relax I have arthritis or stiff joints? I have osteoporosis? I have concerns about my heart? I’m afraid that
physical activity will do more harm than good
Canada’s Physical Activity Guide for older adults - Barriers
I don’t have much time…so which activity is best?
I am unsteady on my feet? I am afraid to go out in winter?
What’s Different
Size of print Benefits right up front Real people Practical user friendly suggestions Talk about barriers (tell it like it is) Safety Refers individuals to their physician or health
professional
What’s Different
Lots of white space Bold headings Clear Language Stories of real people
Key Learning from the Guide
Senior friendliness is an attitude based on considering seniors’ needs and respecting seniors’ contributions
Physicians are credible influencers of individual’s health behaviours for older adults
Design communication with your clients not for them.
Canada’s Physical Activity Guide for Older Adults
An excellent example of how consensus statements and research can be translated into simple clear messaging for the target audience
Canada’s Physical Activity Guide for Older Adults
Outcomes– Over 50 National organizations endorsed the
Guide– Over 2 million copies have been printed and
distributed
College of Family PhysiciansKey Influencers
Adopted a Physical Activity and Health Strategy Developed a unique video on active ageing Physicians learn more about barriers to PA Describes new counseling & training tools New Practice-based Small Group Learning
Module on PA & older adults For info email pmaturano@cfpc.ca
Moving Through The Years:A Blueprint for Action
Goal to update 1991 original Blueprint Fondation en Adaptation Motrice, ALCOA and
Health Canada conducted survey in 22 communities across Canada and over 20 NGO’s
Over 450 individuals consulted (over half of whom were older adults)
Launched in 1999 in International Year of Older Persons
Moving Through The Years:A Blueprint for Action
A national framework for plan of action Provides a collective direction for current and
future initiatives A tool for planned change ALCOA asked to serve as the keeper of the
Blueprint to ensure its uptake Serves as a base for ALCOA’s goals and
objectives
Active Living Coalition for Older Adults
In 1993 three older adult national bodies came together (National Walking Campaign, Secretariat for Fitness for the Third Age, The Older Adult Active Living Association)
Became Active Living Coalition for Older Adults (ALCOA)
Mandate to bring together national organizations & researchers working with older Canadians in Active Living
Moving Through The Years:A Blueprint for Action
Nine Guiding Principles based on the vision of : An active society where all older Canadians are
leading active lifestyles thereby contributing to their physical and overall well-being.
Moving Through The Years:A Blueprint for Action
Principle 1– It is recognized that active living is essential
for daily living and a cornerstone of health and a quality of life.
Moving Through The Years:A Blueprint for Action
Principle 2:– There is a need for more positive attitudes
toward aging, with realistic images that depict older adults as respected, valued, and physically active members of society.
Moving Through The Years:A Blueprint for Action
Principle 3:– Older adults should be encouraged to
participate in decision-making and leadership positions, in all phases of program/service development and delivery.
Moving Through The Years:A Blueprint for Action
Principle 5:– Issues, needs and interests of older adults in
their community need to be identified, and accessible, affordable active living activities and programs designed to meet these needs.
Moving Through The Years:A Blueprint for Action
Principle 6:– While it is recognized that both aging and
learning are a life-long process, it is appreciated that for some, pre-retirement years may be a key time to re-focus on active living and well-being.
Moving Through The Years:A Blueprint for Action
Principle 7:– Canada is a society for all ages: Programs and
services should be developed which accommodate older adults’ choice to be with others.
Moving Through The Years:A Blueprint for Action
Principle 8:– There is a need to identify, support, and share
research priorities that apply to active living and aging.
Moving Through The Years:A Blueprint for Action
Principle 9:– There is a need for education and promotion of
the health benefits of active living as a way of life for older adults
Areas of emphasis for active living and older adults
Increase public awareness about the benefits of active living
Develop competent leaders in active living who can meet the needs & interests of older adults
Ensure resources and social supports needed to be active are in place
Strengthen delivery systems and improve levels of cooperation, coordination, and communication among organizations
Areas of emphasis for active living and older adults
Encourage and enable older adults to advocate for the right to a quality of life that includes physical activity
Identify, support, and share research priorities and results on aging and active living
Continually monitor and evaluate programs, services and outcomes to ensure that active living needs, interests, and concerns of older adults are met
Blueprint Implementation Summit
In 1999 Blueprint implementation Summit held Over 50 national and provincial organizations
attended along with other stakeholders Resulted in five priority areas:
– Leadership Development– Shared Research in Plain Language– Marketing and Communications– Influencing Policy– Coordination and Capacity Building
Leadership Development
ALCOA providing strategic leadership Develop a network of community presenters to
conduct workshops with older adults Develop strong delivery system at the community
level through the members of ALCOA Presenting to seniors groups and organizations to
promote the Guide and the Blueprint and to highlight local opportunities in each community to be active
Communicating Research in Plain Language
ALCOA Research Update Launched May 2001 Goal to interpret current leading edge research
into user friendly, plan language format Included in Research Update is a special Active
Living Tips sheet for older adults Copies available
Marketing & Communications
Includes ALCOA’s website, newsletter, electronic listserv, national spokesperson and a framework for affecting change
Provides an opportunity to share information, network, learn and reach older adults with consistent active living messages
Influencing Policy
ALCOA partners with key member groups and stakeholders
ALCOA to develop information to members of parliament/policy and decision makers to influence and promote the priority of active living opportunities for older adults
Capacity Building
Increase and strengthen ALCOA’s membership Involve older adults in all planning & decision
making Bring together multidisciplinary professionals,
volunteers and older adults to share information and resources
To foster a broader collaborative network Holds national forums, Mark your calendars for
Forum Regina Saskatchewan May 9-12, 2002
Intended Outcomes of these Efforts by ALCOA
Results of these efforts is to increase the opportunities for and the possibility of healthy aging by all Canadians
Osteoporosis Society of CanadaDefinition of Osteoporosis
What is osteoporosis?– A disease characterized by low bone mass and
micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risks.
Thinning of bone that leads to higher risk of fracture.
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Prevalence of Osteoporosis– Major health problem in Canada and other
industrialized countries– Affects up to 1 in 4 Canadian women over 50– Affects 1 in 8 men over 50( and increasing)– As many as 2 million Canadians at risk over
their lifetime
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Why should we be concerned about osteoporosis?– Hip fractures strongly related to osteoporosis
• 20% lead to subsequent premature mortality
– Vertebral fractures dramatically affect quality of life
– Often decrease in personal freedom– Annual cost of treatment $1 billion in Canada– Canada’s population is aging– Frequency of osteoporosis will rise as well
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Our goal…– To prevent fracture through proven preventive
measures and effective therapies
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Why do we need guidelines? Distill a large body of medical knowledge into a
convenient, readily useable format Primary purpose is to educate and create
awareness– Difficult for physicians to keep up with the
latest advances
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Why Guidelines? To keep up to date in Internal Medicine
physicians need to read 17 articles a day, 365 days a year
They don’t Nor does anyone else
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Why Guidelines? Physicians need evidence about
– The accuracy of diagnostic tests,– The power of prognostic markers,– The comparative efficacy and safety of interventions, etc
Need evidence about 5 times for every in-patient (and twice for every 3 out-patients)
Properly structured guidelines are an invaluable resource to the busy clinician
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
1996 Guidelines Project were consensus-based guidelines– A narrative view– Scan through arbitrarily selected documents
and pick out what seems to address questions– Quicker to create
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Consensus-based Guidelines– Very susceptible to bias– Subjective evaluation of literature, opinion– No criterion for inclusion of investigation or to
the grading of quality– Often, exalted individuals keep up the least with
current literature and advances– Experts are often less able to produce objective
reviews of the literature in their area than non-experts
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
What is evidence-based evidence? It is the conscientious, explicit and judicious use
of current best evidence in making decisions about the care of individuals (patients)
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Evidence-based medicine is the integration of:– Individual clinical expertise– Best available external clinical evidence from
systematic research and– Individual’s (Patient) values and expectations
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Total abstracts caught and searched by the committee:
Grand Sum: 89,804 Exercise and Fall Prevention: 11,713 Nutrition: 16,058
Osteoporosis Society of CanadaEvidence-Based Clinical Guidelines
Abstracts selected for formal review:– Grand Sum: 6941– Exercise and Fall Prevention: 1293
The scope
To this date, no review has ever been published that is more comprehensive
We have searched high and low for every possible citation
Evidence Based Danger
Systematic bias– A few therapies have much good evidence– Often can be reflective of funds to prove
effectiveness– May be at the expense of other areas without the
financial wherewithal
Danger of “without substantial evidence” to it being thought to be “without substantial value”
Physical Activity and Osteoporosis
Physical activity is not a standardized intervention
Variation in type, frequency and intensity and varies in site-specificity
Moreso that any other intervention compliance is a major issue
Potential for good and for harm
Physical Activity and Osteoporosis
As yet there is no clear insight into type, frequency or intensity is important for bone health
Or how this might change for different ages with different levels of bone mass
Some recent evidence that repetitious loading and unloading may work well
Goals
To prevent fractures:– a) Through improving bone mass– b) Through fall prevention
Effect of Exercise as Lifestyle
In children, exercise plus calcium (& Vit D) makes better bones
Lifelong exercisers have better bones then sedentary people (& fewer fractures)
Over-exercising can lead to bone loss in both men and women
Body weight changes might be important: weight gain above the waist is good, its loss is not good
Interim Expert Opinion
If you have been an exerciser all your life, stick with it
High activity level throughout adult life may be protective and lead to fewer fractures in old age
Interim Expert Opinion
In people with osteoporosis: If exercise has any role to play in reducing bone
loss it is secondary to pharmaceutical treatment Osteoporosis exercise programs are of value and
should be available to patients
Interim Expert Opinion
In Elderly Fallers: Strengthening and balance exercises, and where
relevant, multi-factorial interventions, based on individual assessment, will reduce falling risks
• Dr. Richard Crilly, Scientific Advisory Council. OSC
Implementation of Evidence Based Guidelines
Partnerships with allied organizations– College of Family Physicians– Other Health Charities– Corporate Health Sector– Other medical specialties
Web-site Nation wide forums with case study approach and
opportunity to dialogue with experts Translate into user friendly language Publish in Canadian Medical Association Journal
Implementation
New evidence often takes a long time to be implemented
Established practices persist even if they have been proven ineffective or harmful
Outcomes
Family physicians and non-specialists able to quickly establish the best, evidence-based care for a particular patient– Considering the patient’s individual characteristics
Guidelines for the prevention of osteoporosis– Policy changes for governments– Forms foundation for all Society public and
professional information– Credible source of osteoporosis information in
Canada i.e. media
Summary CommentsPlain Language Checklist
Use concrete examples to illustrate ideas or concepts
Present ideas with illustrations or diagrams Highlight main ideas and important information
with headings, point form and boldface type
Summary CommentsPlain Language Check List
Use familiar words, conversational personal tone Proceed logically, most important ideas first Use action verbs and active construction Favour short words and sentences Use short paragraphs
Promotion & Marketing Checklist
Research and consult guidelines about tailoring messages for older consumers
Focus-test your materials with older adults Recognize in your marketing plan that this is not
a single homogeneous group Test a marketing plan and materials with several
groups of older consumers (include a range of ages and literacy levels)
Promotion and Marketing Checklist
Use older persons or models in your promotional materials
Present positive images of people who are healthy, happy and representative of OA diversity of culture, language, health status, geographic location, income level, etc.
Active Living & Older AdultsNext Steps in Education
Continue increasing awareness & education about the benefits and importance of active living
Promote a consistent message Decrease fears about physical activity Advocacy efforts for policy changes Strengthen partnerships so that health
professionals and organizations at all levels promote the active living message
Active Living for Older AdultsNext steps in Programming
Create specialized programs for each stage of the older adult continuum
Incorporate a variety of programming Include all components of fitness Incorporate progression Include social components Address environmental and accessibility issues Develop community wide plans
Active Living for Older Adults Next steps in Research
Continue research into physical activity and older adults
Increase investigation of psychosocial aspects
Translate research into clear language
Active Living for Older AdultsNext steps in Empowerment
Older adults take responsibility for their own health and to take an active role in program planning and delivery
Encourage and support role models and leadership
Foster and promote a change in attitude
Active Living for Older AdultsNext steps in Empowerment
Older adults the fastest growing group on Internet users
Internet expands the world of seniors Powerful tool for maintaining health and well-
being New form of intergenerational communication Encourage older adults to get online Build senior friendly websites
This is a prime opportunity for governments, individuals and organizations to make a positive
impact on the health of all Canadians
Physical activity, especially for older adults, is overlooked as an effective and essential part of health promotion strategy
Active Living is a long-term, low-cost preventative approach
The Ultimate Goal
Prolong the independence of older Canadians and add life to years
When Physical Activity has a prominent place in the Cochrane Collaboration we will know we have been successful.
Thank you / Merci
For more information:
Physical Activity Guide: 1-888-334-9769– www.paguide.com
ALCOA: www.alcoa.ca 1-888-549-9799 Osteoporosis Society of Canada
– www.osteoporosis.ca