Promoting resilience in the face of ageing and disease: The central role of exercise and physical activity

It is your doctor's responsibility to get you recovered enough to do all these exercises

Promoting resilience in the face of ageing and disease: The central role of exercise and physical activity

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Abstract

Exercise and physical activity offer clinical benefits across a wide range of both physical and neuropsychological diseases and disabilities in older adults, including syndromes for which pharmacological treatment is either absent or hazardous. However, exercise is vastly under-utilised and rarely fully integrated into aged care and geriatric medicine practice. It is still absent from the core training of most geriatricians and other healthcare professionals, and myths about risks of robust exercise abound. Insufficient physical activity and sedentariness are in fact the lethal conditions. Frailty is not a barrier to exercise, but rather one of the most important reasons to prescribe it. Like any other medical treatment, to prescribe exercise as a drug will require a full understanding of its benefits, dose-response characteristics, modality-specific adaptations, potential risks, and interactions with other treatments. Additionally, exercise prescription should be a mandatory component of training for all healthcare professionals in geriatric medicine and gerontology. This personal view asserts the importance of medication management closely integrated with physical exercise prescription, as well as nutritional support as cornerstone of a coherent and holistic approach to treating both fit and frail older adults. This includes identification and management of drug-exercise interactions, in the same way that we seek out and manage drug-drug interactions and drug-nutrient interactions. Our oldest patients deserve the dignity of our urgent resolve to remember the mission of medicine: the assertion and the assurance of the human potential. Exercise medicine is core to this mission.

Section snippets

Building resilience for optimal ageing the crucial role of physical activity and healthy behaviors

Insufficient physical activity (PA) and/or structured exercise as well as excessive sedentary behavior are potent risk factors for all-cause and cardiovascular mortality, obesity, sarcopenia, frailty, neuropsychological declines, and disability, among other conditions associated with ageing (Izquierdo et al., 2021a). Disuse and biological ageing have long been recognised to share many pathophysiological features (Bortz, 1982), making a separation of the two critical to the promotion of optimal

How does one promote such resilience if it is indeed core to healthy ageing?

Being physically active, socially engaged, cognitively stimulated, and having a healthy diet (coupled with no hazardous substance use or other toxic environmental exposures, low-moderate alcohol consumption and the maintenance of healthful body composition) are integral to maintaining health and well-being at all ages. Physical activity operates as both preventive medicine to attenuate age-related changes in physiology and risk factors for disease, as well as direct treatment of both physical

Indications for exercise and physical activity as a treatment in medicine

Both structured exercise and incidental PA offer clinical benefits across a wide range of diseases and disabilities with no upper age limit (Izquierdo et al., 2020). The role of exercise in the prevention of disease and the management of many age-related diseases and conditions is increasingly evident, including syndromes for which the benefit of pharmacological treatment is controversial. There is strong evidence for PA and exercise as both preventive and therapeutic strategies for

Specificity, dose-response and interindividual variability

Although many questions remain unanswered about the optimal exercise modalities and dose, a synthesis of the literature indicates multiple positive effects of participation in PA on the ageing process and mortality, with dose-response curves showing that health benefits are linked to both the intensity and volume of exercise (Ekelund et al., 2019). However, using the evidence-based modality of exercise is perhaps the most important consideration when prescribing exercise in older adults. For

The relationship of exercise to medication optimisation

The rapidly growing literature on the hazards of polypharmacy and PIMS in older adults has thus far largely ignored the issues related to exercise prescription. An overview of the major issues that should ideally be considered in a holistic drug review that links all assessment components together is shown in Table 1. In some cases, the review will indicate that certain drugs (particularly psychotropic and anticholinergic medications) are impairing exercise engagement via their effects on

Shortcomings in training and implementation

An overview of the major recommended changes to policy and practice to integrate exercise into health care is shown in Table 2. Despite the well-known benefits outlined above, exercise is rarely fully integrated into aged care and geriatric medicine practice. It is still absent from the core training of most geriatricians and other healthcare professionals (Izquierdo et al., 2020, Izquierdo et al., 2021b). Full integration of exercise into medicine has been stalled in part by concerns amongst

Conclusions

Long-term physical exercise is safe and effective in older adults, and its benefits are demonstrable irrespective of the individuals’ age, co-morbidities, place of residence, physical function or cognitive status at baseline (García-Hermoso et al., 2020). Frailty is not a contraindication to robust exercise prescription, but rather one of the most important reasons to prescribe it. Considering the accumulated evidence of the benefits and safety of exercise in frail older adults over many