Engaging the elderly with exercise to prevent age-related disease

Professor Isabelle J. Dionne from the Université de Sherbrooke investigates how regular physical activity (PA) can promote ‘successful ageing’. In particular, her team at the Research Centre on Ageing explores how specific exercise programmes can reduce the risk of certain age-related disorders such as cardiovascular disease, type 2 diabetes and sarcopenia. However, these exercise regimes may be difficult to implement due to a lack of motivation and confidence in older individuals. Professor Dionne aims to address this problem by developing innovative ways to encourage the elderly to exercise.

The world’s population is ageing at an unprecedented rate. According to the World Health Organization, between 2015 and 2050 the number of individuals aged 60 years and over will increase from 12% to 22%. Although an increased lifespan potentially brings new opportunities for the elderly, studies have shown that their quality of life is adversely impaired by a decline in health. The risk of developing diseases such as kidney failure, type 2 diabetes and cancer increases rapidly as ageing bodies physiologically deteriorate. This causes emotional distress for the sufferer and their family, and increases pressure on already strained health services.

Many research groups have focussed their efforts on developing novel therapies for treating these devastating diseases. However, Professor Dionne and her team are investigating a more preventative solution in the form of regular physical activity (PA). PA has been shown to promote ‘successful ageing’, defined as ‘a low probability of disease and disability and high cognitive and physical capacity and active engagement with life’.

Currently, the Canadian Society for Exercise Physiology guidelines encourage adults aged 65 and over to participate in a minimum of 150 minutes of vigorous aerobic exercise per week. The guidelines also encourage individuals to perform muscle and bone strengthening activities two days per week.

However, these recommendations are generalised and do not target specific health conditions. Different types of PA including aerobics and resistance at different modalities and intensities, can positively affect individual physiological functions. Professor Dionne therefore aims to improve the guidelines by designing different exercise plans that focus on reducing the risk of developing certain diseases in older ‘at risk’ individuals.

Only 15% of Canadian adults reach the weekly recommended minimum 150 minutes of physical activity

Resistance exercise and sarcopenia
Sarcopenia is a muscle degenerative disorder associated with ageing. A reduction in muscle mass can result in falls, fractures and physical incapacity, greatly impairing an individual’s quality of life. Studies have shown that resistance exercise (using weights to strengthen muscles) stimulates protein synthesis, increasing muscle mass. However, research conducted by Professor Dionne and her team showed that resistance training alone may be insufficient to counteract the effects of sarcopenia in older cohorts. This is because older individuals often have insufficient quantities of essential amino acids (EAA) from feeding, the building blocks of proteins. Studies have shown that EAA powder ingestion, following resistance training, is effective in promoting muscle mass. However, this is not a viable option for use by the wider elderly population as EAA supplements are expensive, difficult to digest and reduce appetite. Therefore, Professor Dionne and her colleagues performed a four-month in-depth study to determine whether consumption of dietary proteins from milk following resistance training can combat the effects of sarcopenia in elderly men. Results indicated that muscle mass does indeed significantly increase in the elderly following training and subsequent ingestion of 20g of milk protein.

Lifetime Physical Activity
The benefits of exercise are undeniable. From a young age we are taught the importance of regular PA in order to maintain a healthy, balanced lifestyle. However, despite this knowledge, only 15% of Canadian adults reach the weekly recommended minimum 150 minutes of PA. In order to understand this relationship, the team conducted an in-depth study that described participation in four different forms of PA (occupational, commuting, household and leisure time) across life. Results confirmed regular PA is associated with health benefits. Interestingly, current leisure time PA strongly predicted waist-to-hip ratio and fat mass in both sexes, regardless of their exercise history.

Professor Dionne discovered that individuals significantly reduce their PA participation after the age of 65 years

However, Professor Dionne discovered that individuals of both sexes significantly reduce their PA participation after the age of 65 years. This seems to be a large-scale issue as other studies have shown that only 8.5% of older American adults meet the activity levels required for benefitting health. A survey conducted by Professor Dionne revealed that elderly people often feel vulnerable and consider themselves to be too frail and at risk of injury. Many individuals feel that they are simply too old to exercise and that activity will not have a significant positive impact on their health.

Engaging the elderly – green exercise?
In order to address these concerns, Professor Dionne focussed her efforts on developing creative and novel exercise regimes to engage the elderly with exercise. For example, during ‘green exercise’, individuals are encouraged to conduct PA outside, rather than indoors. The team conducted a study on 23 older post-menopausal women, comparing the health benefits of indoor vs outdoor exercise.

Interestingly, the results indicated that the different environments offer unique physical health benefits. Indoor training is associated with a maintenance in performance intensity and significant improvements in body composition and VO₂ max. On the other hand, although training in a natural environment reduces maximum workout intensity over time, resting blood pressure and upper body maximal strength significantly improved. Furthermore, outdoor training increases adherence in the elderly (97% vs 91% for indoor training) and even reduces depression symptoms.

These exciting findings suggest that ‘green exercise’ may be a long-term solution to the lack of PA engagement in the elderly.

Future Research
Overall, the research of Professor Dionne and her team has highlighted the importance of regular PA as a preventative measure against age-related diseases. Different forms of exercise can positively impact different physiological functions which, in turn, can target specific ailments. Furthermore, the team have addressed a major obstacle – limited adherence in the elderly. Training in natural environments inspires and motivates older individuals, encouraging them to persevere with regular exercise, promoting successful ageing. The team has shown that even at the age of 75 years, the best predictor of good health is current physical activity; it is never too late to begin exercising!

How can specific forms of exercise target particular age-related disorders?
Research on exercise performance has long shown that different types of exercise produce different physiological adaptations. For instance, everyone knows that if athletes needs to improve their speed at running (i.e. 100m sprinter), the kind of exercise training will be specific to this performance and very much different to that of marathon runners who seeks to improve their efficiency over the long run. This applies to exercise and health. Specific health problems are characterised by impairments in specific systems (heart, skeletal muscles, specific hormones, etc.), and will be addressed by exercise regimens that provoke desirable physiological adaptations.

Why is there a reduction in regular exercise in the elderly?
Several reasons may explain this fact. First, those who were performing active transport to go to work lose this means of PA. The same takes place with others who had a more physical professional activity. For those who were regularly active, there may be some declines in performance that discourage them. Others also feel that it is not as useful to be active now that they are “old”, or that “sport” is not safe anymore. Of course, some health problems, even if they are minor, may occur that impair practising physical activity. And the less you do, the less you feel compelled to do. Unfortunately, this is the start of a downward spiral of deconditioning.

We need a better understanding of what makes healthy older adults refrain from being physically active

How can older individuals be encouraged to partake in regular physical activity?
Mostly, older adults report the same barriers as younger individuals: lack of time, lack of motivation, too expensive. One additional barrier appears to be a feeling of incompetence. In other words, older adults, especially if they do not have a history of practising physical exercise, do not feel skilled enough. Kinesiologists (exercise specialists in Canada) should be involved in educating and promoting the implementation of physical exercise programmes to assure safety but also to make older adults feel more competent and make the exercise enjoyable.

What are your future research goals?
We need a better understanding of what makes healthy older adults refrain from being physically active. On the other hand, for those who have developed health problems, we need to develop personalised exercise programmes that are specific to their condition. While research has long shown how specific exercise can help for type 2 diabetes, cardiovascular diseases, frailty and, more recently, cancer or cognitive decline, we still have a lot to learn regarding other health conditions such as kidney failure and Parkinson’s disease. My goal is thus to collaborate with specialists in these health conditions to advance research and provide efficient exercise strategies that contribute to improved health and quality of life for these patients.

Research Objectives
Dr Dionne’s work focuses on the impact and challenges of exercise for ageing adults.

Funding

• Research Centre on Aging
• Université de Sherbrooke
• Canada Research Chair
• Canadian Institutes of Health Research
• Diabète Québec

Collaborators

• All graduate students, past and present
• Dr Éléonor Riesco, Faculté des sciences de l’activité physique, Université de Sherbrooke
• Dr Martin Brochu, Faculté des sciences de l’activité physique, Université de Sherbrooke
• Dr Stephen Cunnane, Faculty of medicine and health sciences, Université de Sherbrooke

Bio
Dr Isabelle J. Dionne, PhD, is professor and currently Dean at the Faculty of physical activity sciences at Université de Sherbrooke. She runs the Laboratory of Body Composition and Metabolism located at the Research Centre on Aging of Sherbrooke. She holds the Canada Research Chair in Exercise Recommendations for Healthy Aging.

Contact
Isabelle J. Dionne
Tenured Professor Dean
Faculty of physical Activity Sciences
Université de Sherbrooke
2500 Boul de l’Université
Sherbrooke
Qc Canada, J1K 2R1

E: [email protected]
T: +1 819 821 8000 poste 63721
W: www.usherbrooke.ca/fasap/personnel/professeurs/dionne/

Engaging the elderly with exercise to prevent age-related disease