It is a reality that life expectancy is increasing. And although it is clear that we are not going to live forever, it is true that more and more people will reach the age of 100 or more.
This represents, a priori, a success in the history of humanity, probably explained by scientific advances, public health policies, and social and economic advances that have managed to limit premature deaths, eliminate many diseases and, in many cases, , “tame” certain pathologies that have become chronic. However, it is also a challenge for society, which already has to face demographic changes that affect social and health systems like never before.
Currently, people over 65 represent increasingly large percentages. But “over 65” is not the same as “older”. In fact, chronological age is probably not the best way to characterize “older people”. Due to the functional diversity of the population, perhaps it would be wiser to start evaluating other alternative measures to describe what we call the “older population”, such as physical and cognitive capacity.
For example, in Spain, one of the oldest countries in Europe, it is estimated that in 2068 there could be more than 14 million older people, which would mean around 30% of the country’s population. Probably the most worrying fact in this evolution is that the 80+ age group is growing the fastest. In fact, it is expected that in Europe we will go from 12.5 million in 2019 to almost 27 million in 2050.
Unfortunately, additional years of life are not always accompanied by an acceptable level of quality of life. Living longer is not always synonymous with living better. After all, aging is a time-dependent phenomenon associated with the gradual accumulation of molecular and cellular damage that ultimately leads to health problems.
The reality is that, although life expectancy increases, the age of onset of disease and disability remains constant. This implies that the quality of life is compromised for more years, and with it the sustainability of the system. Certain forms of physical exercise can help improve the situation.
Frailty and the challenge of active aging
In this situation in which we live longer but with many diseases and disabilities, the World Health Organization (WHO) in its report on aging and health proposes a new model. According to this model, the fundamental axis is the functional capacity of the elderly, and not so much the individual treatment of diseases that accumulate with age and that explain very little disability.
Currently, the WHO defines healthy aging as the process of promoting and maintaining the functional capacity that allows well-being in old age. This goes beyond the more classic health concept of the absence of disease, giving greater prominence to care and self-care.
Now, the vision is more functional, aimed at building and maintaining the ability of older people to be and do what adds value to their lives. It is thus opposed to frailty, understood as the progressive deterioration, related to age, of the physiological systems that generate greater vulnerability and greater risk of health problems.
Specifically, frailty is a multifactorial syndrome that can negatively affect mobility, balance, muscle strength, aerobic endurance or functional capacity. In addition, it is also associated with cognitive impairment, urinary incontinence and sleep problems. All of them can lead to falls, dependence, hospitalization or, ultimately, death.
Unfortunately, among people over 65 years of age, there are many who present frailty: between 7 and 16%, and it can reach up to 44% if the previous stage of pre-frailty is considered. However, its negative consequences can be prevented – even reversed – if the appropriate strategies are applied in the previous or initial stages. Hence, its early detection is essential.
The characteristics of physical exercise for the elderly
We tend to use the concepts of physical activity and exercise as synonyms, but they are not. And scientific advances explain why.
By physical activity we understand any movement that produces energy expenditure, whose beneficial effect on health has already been widely demonstrated. As for physical exercise, it is a subtype of planned, structured and repetitive physical activity, generally aimed at improving some component of physical condition or health.
A step that goes beyond the WHO physical activity recommendations, with their unquestionable benefits, is to use physical exercise in a more precise and individualized way. It responds to a double strategy, preventive and therapeutic, which curbs frailty and improves quality of life. And there is a recent expert consensus around exercise recommendations for seniors.
Unlike general physical activity, exercise must have individualization characteristics in relation to the person, their characteristics and needs, which will determine the type, frequency, intensity, duration and progression of that exercise. That is why it is essential, for greater efficiency and to avoid risks, that it is planned and supervised by highly qualified professionals. These receive different names depending on each country: kinesiologists, exercise physiologists or sports physical educators.
Multicomponent training, the pill of youth
There are many forms and types of exercise that can be applied aimed at improving some specific component of our fitness. For example, resistance training focuses on improving cardiorespiratory fitness, while strength training focuses on the muscular component. In both cases, we know that the benefits go much further, because they improve the metabolic pathways that regulate glucose and fatty acids, while helping to prevent multiple health problems and regulate body composition.
For this reason, the elderly population, especially understood in terms of function and not so much of age, should combine different types of training, which also contain adaptation to daily tasks and more recently to dual tasks that include cognitive aspects.
In response to this reality, training programs that mainly combine aerobic work, walking, strength and power, balance and functional training are called multicomponent training.
The skill of sports physical educator in the analysis of the person, the adjusted design of the training program and follow-up will be key to achieving the greatest benefits with the least risks. This strategy aims to restore function and improve the person’s health. Ultimately, she will be able to be and do what is important to her, optimizing her quality of life.