Exercise Comes of Age: Rationale and Recommendations for a Geriatric Exercise Prescription

Abstract

THERE has been a gradually growing awareness among policy makers and health care professionals during the past several decades of the importance of appropriate exercise habits to major public health outcomes, resulting in numerous position stands and policy recommendations that include physical activity prescriptions ^{(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)}. However, there is still skepticism among some clinicians and investigators as to the actual potency of exercise for disease and/or disability prevention and treatment, particularly in already frail or near frail adults ⁽¹³⁾. It is likely that some of the discrepancies among research findings, clinical practice, and policy recommendations result from a lack of appreciation of the heterogeneity of the terms “exercise” and “physical activity” as they are used in the literature. Posing the question “Does exercise prevent or treat disease in older persons?” is analogous to asking “Does medication prevent or treat disease in older persons?” The answer only makes sense when exercise is described in terms of its modality, dose (frequency and intensity), duration of exposure, and compliance with the prescription, and in relation to a specific disease, syndrome, or biological change of aging. In addition, it does not necessarily follow that the same type or dose of exercise is needed for treatment of overt or advanced disease as that which would be required for prevention. Such observations are obvious to clinicians when thinking about surgical, pharmacological, or nutritional management of disease, but lack of explicit training in exercise physiology for most physicians has often obscured this point in discussions of the value of exercise for geriatric health care problems.