Older age - opportunity and challenge

Dr John Searle

Chief Medical Officer

Fitness Industry Association (UK)

Who are we talking about?

• Transition: 50 - 64

• Older: 65 - 75

• Oldest: > 75

How many are we talking about?

• In the UK:

2009:

over 65: 9.6m

over 85: 1.4m

2015:

Over 65: 12.7m

Over 85: 1.8m

EU: ageing population

65+• 2008: 84.6m• 2060: 151.5m

80+• 2008: 21.8m• 2060: 61.4m

Health of older people in UK

• 65 to 74: 60% have a chronic illness

• 75+ 64% have a chronic illness

• 1:4 men and 1:3 women over 65 have a fall each year

Physiology of ageing

Decrease in:• aerobic capacity• cardiac output• lung function• renal function• muscle bulk and strength• cognitive function• motor skills

Diseases in older age

• Heart disease

• Strokes

• Cancer

• Arthritis

• Depression

• Dementia

• Falls - fractures

Falls

• 30% of 65+ have a fall

• 50% they are recurrent

Fractured neck of femur

• annual UK: 70,000• Hospital death rate:

4-11%• deaths at 1 year: 30%• 45% need community

support• 14% go to falls

prevention clinic

Dementia

• 820,000 cases of dementia

• 1:3 >65 will suffer from some form of dementia

• Annual cost of care is £23 billion

Outcome

• failing health

• decreased mobility

• loss of family and social interaction

• increasing dependence

• increasing demands on health care and social services

What is the answer?EXERCISE!

Exercise in older people: general advantages

• maintains independence

• increases social interaction

• maintains cognitive function

Exercise in older people: specific advantages

Decreases the risk of:• depression• dementia• diabetes• heart attack & stroke• bowel cancer• falls

Exercise in older people: specific advantages

Improves:• CV fitness• muscle strength &

endurance• motor function• sense of well being

Exercise in diseases in older age

• Heart disease

• Strokes

• Cancer

• Arthritis

• Depression

• Dementia

• Falls - fractures

Exercise in older people

• Maintains health and independence

• Plays a vital part in the treatment of long-term disease

• Keeps people out of hospital

• Speeds recovery

• Reduces NHS and social service expenditure

3 case histories

• Long standing rheumatoid arthritis

• 84 and trained at home

• 73 year old psychiatrist

Exercise in rheumatoid arthritis

Improves:• aerobic fitness• joint range of movement• muscle strength and endurance• and therefore:

function

activity

independence

What have you got in the house?

After cancer

• Surgery x 2 + chemotherapy x 2 over 18 months

• tired• depressed• lethargic

After cancer - what did we do?

• Walking

• Increasing ADL’s

• Gently in the gym- all the component of fitness

• Increasing volume of exercise (duration x intensity) over 6 months

ACSM / BASES

Recommendations (2008 / 2010)• 150 minutes/week of moderate intensity

aerobic exercise or 75 minutes of vigorous exercise

• 2-3 strength training sessions per week• motor function exercises• stretching

Recommendations

How can these be achieved?

Increase in ADL and activity - ‘think outside the box’

Planned, structured, supervised, monitored exercise

Recommendations

The opportunity: older people

• An ageing population presents the fitness industry with a massive opportunity!

What does the fitness sector need to do?

• skilled trainers

• good customer service

• appropriate facilities

• provide social interaction

• work with doctors and health professionals

Key questions

• Will we grab the commercial opportunity which also provides a public service?

• Do we want to?