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Physical Activity Initiatives with Older Adults A Canadian Perspective Whistler, B. C. December 10, 2001
Our Challenges w “It is surely a great criticism of our profession that we have not organized a critical summary, by specialty of subspecialty, adapted periodically, of all relevant randomized controlled trials. ” • Archie Cochrane
Our Challenges w Clear Lake Agreement by Federal, Provincial, & Territorial Ministers responsible for fitness, active living, recreation set a joint target to reduce physical inactivity in Canadians by 10% from 1998 -2003
Active Old Age w Director General of the World Health Organization described gains in life expectancy as one of humanity’s greatest achievements w Living a full life to reach a healthy, happy and active old age is our aspiration
Not Aging but Saging … Wise Beyond Your Years w It might not affect you now, but it will. w Growing older is inevitable.
Dignity, Respect, Independence and Control w The importance of older people being able to maintain control and autonomy in their lives must not be lost
Definition of Older Adult w Self-defining (Active Living Coalition for Older Adults) w Varies depending upon initiative w 50 -55+ for many initiatives (Physical Activity Guide)
Aging Population - Facts w Being physically active reduces the risk of heart disease, fall and injuries, obesity, high blood pressure, adult-onset diabetes, osteoporosis, stroke, depression, colon cancer and premature death w One-third of older adults face an increased risk of loss of mobility and functional capacity, thereby decreasing their functional independence
Aging Population Facts w 1 in 10 Canadians is an older adult w This number will double by 2021 w The greatest health risk for older adults is sedentary living (WHO, 1997) w Among adults 55 + only 34% of men and 29% of women are physically active w Among adults 74+ only 29% of men and 19% of women are physically active
The Older Adult Audience w 50% of seniors report physical activity of 15 min. or more at least 12/month w Almost 2/3 of those aged 80+report needing no help with daily tasks w Only 16% of older adults use the Internet w Once online Canadian seniors use the Internet on average 12 hours weekly
The Older Adult Audience w 1/3 of Canadian seniors live in rural areas and small towns, the rest in urban areas w 93% of seniors live in private households w 20% of Canadians 65+ have post-secondary diploma or degree w 60% did not finish high school w Considerable number have difficulty with reading
By 2041…. w 46% have a disability but for most part continue to enjoy and active lifestyle in their communities w For those born in 1998 life expectancy increased to 92 for men and 100 for women w By 2041 number of Canadians over 80 will quadruple
Why Older Adults are not as Physically Active w w w Accessibility Safety Security Support Motivational issues – Must be addressed to encourage, support and ensure that opportunities exist that facilitate involvement in Active Living
Aging and Communication w w Visual acuity Hearing acuity Agility & Mobility Social/emotional changes
Barriers to Reaching Older Adults w Physical changes of aging w Stereotypes, outdated assumptions about older adults lifestyles, interests, capabilities w Communication materials and media not suited to audience
Initiatives w Physical Activity Guide for Older Adults – -individuals & leaders, practitioners w Moving through the Years – A Blueprint for Action for Active Living and Older Adults – Policy, decision makers w Evidence Based Clinical Guidelines for Osteoporosis – Physicians (Specialists/ GP, FP), Other Allied Health Professionals
Canada’s Physical Activity Guide for Older Adults w The Guide and the accompanying handbook are the Canadian standard for physical activity and older adults w Based on prototype of Physical Activity Guide for Canadians and Canada’s Food Guide w Bilingual (French & English)
Canada’s Physical Activity Guide for Older Adults w Developed over 3 years w Done in partnership with the Active Living Coalition for Older Adults (ALCOA), Canadian Society for Exercise Physiology and Health Canada w Launched in May 1999 w Multi-disciplinary national advisory committee which included older adults w Focus testing with both older adults and health professionals in urban and rural settings
Canada’s Physical Activity Guide for Older Adults w Guide and Handbook underwent numerous reviews by a group of scientific experts w Guide and handbook used by leaders, health providers and program delivers w Guide includes tips to getting started, how much activity is enough, health benefits, and examples of endurance, flexibility, strength and balance activities to choose from w Launched in conjunction with the “Blueprint for Action”
Canada’s Physical Activity Guide for Older Adults Challenges w Retain scientific validity w Retaining balance between consumer wants & needs and what science says w Marketing of message had to be simple, realistic, believeable, and inspiring w Attaining the outcomes & benefits while making goal attractive & attainable w Carry a message to audience that was clear and user friendly
Canada’s Physical Activity Guide for Older Adults Challenges w w w Simple Messages: Age is no barrier Be Active, Your Way, Every Day for Life Every little bit helps, but more is better Add it up principle Moderate physical activity most days for 30 -60 minutes w Choice of activities from each of three activity groups: – Endurance, Flexibility, Strength & Balance
Canada’s Physical Activity Guide for older adults w w w w Science based facts (benefits/risks) Why do this and what is in it for you Variety & Safety concerns (start where you can) Overcoming barriers Pull out Guide to put on refrigerator Sample calendar/planning sheet Stories/Real people (not cartoons) Next steps planner
Canada’s Physical Activity Guide for older adults - Barriers w I feel too tired to get started w I don’t want to exercise? I’ve worked hard all my life, not its time to relax w I have arthritis or stiff joints? w I have osteoporosis? w I have concerns about my heart? I’m afraid that physical activity will do more harm than good
Canada’s Physical Activity Guide for older adults - Barriers w I don’t have much time…so which activity is best? w I am unsteady on my feet? w I am afraid to go out in winter?
What’s Different w w w w Size of print Benefits right up front Real people Practical user friendly suggestions Talk about barriers (tell it like it is) Safety Refers individuals to their physician or health professional
What’s Different w w Lots of white space Bold headings Clear Language Stories of real people
Key Learning from the Guide w Senior friendliness is an attitude based on considering seniors’ needs and respecting seniors’ contributions w Physicians are credible influencers of individual’s health behaviours for older adults w Design communication with your clients not for them.
Canada’s Physical Activity Guide for Older Adults w An excellent example of how consensus statements and research can be translated into simple clear messaging for the target audience
Canada’s Physical Activity Guide for Older Adults w Outcomes – Over 50 National organizations endorsed the Guide – Over 2 million copies have been printed and distributed
College of Family Physicians Key Influencers w w w Adopted a Physical Activity and Health Strategy Developed a unique video on active ageing Physicians learn more about barriers to PA Describes new counseling & training tools New Practice-based Small Group Learning Module on PA & older adults w For info email [email protected] ca
Moving Through The Years: A Blueprint for Action Goal to update 1991 original Blueprint w Fondation en Adaptation Motrice, ALCOA and Health Canada conducted survey in 22 communities across Canada and over 20 NGO’s w Over 450 individuals consulted (over half of whom were older adults) w Launched in 1999 in International Year of Older Persons
Moving Through The Years: A Blueprint for Action w A national framework for plan of action w Provides a collective direction for current and future initiatives w A tool for planned change w ALCOA asked to serve as the keeper of the Blueprint to ensure its uptake w Serves as a base for ALCOA’s goals and objectives
Active Living Coalition for Older Adults w In 1993 three older adult national bodies came together (National Walking Campaign, Secretariat for Fitness for the Third Age, The Older Adult Active Living Association) w Became Active Living Coalition for Older Adults (ALCOA) w Mandate to bring together national organizations & researchers working with older Canadians in Active Living
Moving Through The Years: A Blueprint for Action w Nine Guiding Principles based on the vision of : w An active society where all older Canadians are leading active lifestyles thereby contributing to their physical and overall well-being.
Moving Through The Years: A Blueprint for Action w Principle 1 – It is recognized that active living is essential for daily living and a cornerstone of health and a quality of life.
Moving Through The Years: A Blueprint for Action w Principle 2: – There is a need for more positive attitudes toward aging, with realistic images that depict older adults as respected, valued, and physically active members of society.
Moving Through The Years: A Blueprint for Action w Principle 3: – Older adults should be encouraged to participate in decision-making and leadership positions, in all phases of program/service development and delivery.
Moving Through The Years: A Blueprint for Action w Principle 5: – Issues, needs and interests of older adults in their community need to be identified, and accessible, affordable active living activities and programs designed to meet these needs.
Moving Through The Years: A Blueprint for Action w Principle 6: – While it is recognized that both aging and learning are a life-long process, it is appreciated that for some, pre-retirement years may be a key time to re-focus on active living and well-being.
Moving Through The Years: A Blueprint for Action w Principle 7: – Canada is a society for all ages: Programs and services should be developed which accommodate older adults’ choice to be with others.
Moving Through The Years: A Blueprint for Action w Principle 8: – There is a need to identify, support, and share research priorities that apply to active living and aging.
Moving Through The Years: A Blueprint for Action w Principle 9: – There is a need for education and promotion of the health benefits of active living as a way of life for older adults
Areas of emphasis for active living and older adults w Increase public awareness about the benefits of active living w Develop competent leaders in active living who can meet the needs & interests of older adults w Ensure resources and social supports needed to be active are in place w Strengthen delivery systems and improve levels of cooperation, coordination, and communication among organizations
Areas of emphasis for active living and older adults w Encourage and enable older adults to advocate for the right to a quality of life that includes physical activity w Identify, support, and share research priorities and results on aging and active living w Continually monitor and evaluate programs, services and outcomes to ensure that active living needs, interests, and concerns of older adults are met
Blueprint Implementation Summit w In 1999 Blueprint implementation Summit held w Over 50 national and provincial organizations attended along with other stakeholders w Resulted in five priority areas: – – – Leadership Development Shared Research in Plain Language Marketing and Communications Influencing Policy Coordination and Capacity Building
Leadership Development w ALCOA providing strategic leadership w Develop a network of community presenters to conduct workshops with older adults w Develop strong delivery system at the community level through the members of ALCOA w Presenting to seniors groups and organizations to promote the Guide and the Blueprint and to highlight local opportunities in each community to be active
Communicating Research in Plain Language w ALCOA Research Update Launched May 2001 w Goal to interpret current leading edge research into user friendly, plan language format w Included in Research Update is a special Active Living Tips sheet for older adults w Copies available
Marketing & Communications w Includes ALCOA’s website, newsletter, electronic listserv, national spokesperson and a framework for affecting change w Provides an opportunity to share information, network, learn and reach older adults with consistent active living messages
Influencing Policy w ALCOA partners with key member groups and stakeholders w ALCOA to develop information to members of parliament/policy and decision makers to influence and promote the priority of active living opportunities for older adults
Capacity Building w Increase and strengthen ALCOA’s membership w Involve older adults in all planning & decision making w Bring together multidisciplinary professionals, volunteers and older adults to share information and resources w To foster a broader collaborative network w Holds national forums, Mark your calendars for Forum Regina Saskatchewan May 9 -12, 2002
Intended Outcomes of these Efforts by ALCOA w Results of these efforts is to increase the opportunities for and the possibility of healthy aging by all Canadians
Osteoporosis Society of Canada Definition of Osteoporosis w What is osteoporosis? – A disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risks. Thinning of bone that leads to higher risk of fracture.
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Prevalence of Osteoporosis – Major health problem in Canada and other industrialized countries – Affects up to 1 in 4 Canadian women over 50 – Affects 1 in 8 men over 50( and increasing) – As many as 2 million Canadians at risk over their lifetime
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Why should we be concerned about osteoporosis? – Hip fractures strongly related to osteoporosis • 20% lead to subsequent premature mortality – Vertebral fractures dramatically affect quality of life – Often decrease in personal freedom – Annual cost of treatment $1 billion in Canada – Canada’s population is aging – Frequency of osteoporosis will rise as well
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Our goal… – To prevent fracture through proven preventive measures and effective therapies
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Why do we need guidelines? w Distill a large body of medical knowledge into a convenient, readily useable format w Primary purpose is to educate and create awareness – Difficult for physicians to keep up with the latest advances
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Why Guidelines? w To keep up to date in Internal Medicine physicians need to read 17 articles a day, 365 days a year w They don’t w Nor does anyone else
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Why Guidelines? w Physicians need evidence about – The accuracy of diagnostic tests, – The power of prognostic markers, – The comparative efficacy and safety of interventions, etc w Need evidence about 5 times for every in-patient (and twice for every 3 out-patients) w Properly structured guidelines are an invaluable resource to the busy clinician
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w 1996 Guidelines Project were consensus-based guidelines – A narrative view – Scan through arbitrarily selected documents and pick out what seems to address questions – Quicker to create
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Consensus-based Guidelines – Very susceptible to bias – Subjective evaluation of literature, opinion – No criterion for inclusion of investigation or to the grading of quality – Often, exalted individuals keep up the least with current literature and advances – Experts are often less able to produce objective reviews of the literature in their area than nonexperts
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w What is evidence-based evidence? w It is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individuals (patients)
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Evidence-based medicine is the integration of: – Individual clinical expertise – Best available external clinical evidence from systematic research and – Individual’s (Patient) values and expectations
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Total abstracts caught and searched by the committee: w Grand Sum: 89, 804 w Exercise and Fall Prevention: 11, 713 w Nutrition: 16, 058
Osteoporosis Society of Canada Evidence-Based Clinical Guidelines w Abstracts selected formal review: – Grand Sum: 6941 – Exercise and Fall Prevention: 1293
The scope w To this date, no review has ever been published that is more comprehensive w We have searched high and low for every possible citation
Evidence Based Danger w Systematic bias – A few therapies have much good evidence – Often can be reflective of funds to prove effectiveness – May be at the expense of other areas without the financial wherewithal w Danger of “without substantial evidence” to it being thought to be “without substantial value”
Physical Activity and Osteoporosis w Physical activity is not a standardized intervention w Variation in type, frequency and intensity and varies in site-specificity w Moreso that any other intervention compliance is a major issue w Potential for good and for harm
Physical Activity and Osteoporosis w As yet there is no clear insight into type, frequency or intensity is important for bone health w Or how this might change for different ages with different levels of bone mass w Some recent evidence that repetitious loading and unloading may work well
Goals w To prevent fractures: – a) Through improving bone mass – b) Through fall prevention
Effect of Exercise as Lifestyle w In children, exercise plus calcium (& Vit D) makes better bones w Lifelong exercisers have better bones then sedentary people (& fewer fractures) w Over-exercising can lead to bone loss in both men and women w Body weight changes might be important: weight gain above the waist is good, its loss is not good
Interim Expert Opinion w If you have been an exerciser all your life, stick with it w High activity level throughout adult life may be protective and lead to fewer fractures in old age
Interim Expert Opinion w In people with osteoporosis: w If exercise has any role to play in reducing bone loss it is secondary to pharmaceutical treatment w Osteoporosis exercise programs are of value and should be available to patients
Interim Expert Opinion w In Elderly Fallers: w Strengthening and balance exercises, and where relevant, multi-factorial interventions, based on individual assessment, will reduce falling risks • Dr. Richard Crilly, Scientific Advisory Council. OSC
Implementation of Evidence Based Guidelines w Partnerships with allied organizations – – College of Family Physicians Other Health Charities Corporate Health Sector Other medical specialties w Web-site w Nation wide forums with case study approach and opportunity to dialogue with experts w Translate into user friendly language w Publish in Canadian Medical Association Journal
Implementation w New evidence often takes a long time to be implemented w Established practices persist even if they have been proven ineffective or harmful
Outcomes w Family physicians and non-specialists able to quickly establish the best, evidence-based care for a particular patient – Considering the patient’s individual characteristics w Guidelines for the prevention of osteoporosis – Policy changes for governments – Forms foundation for all Society public and professional information – Credible source of osteoporosis information in Canada i. e. media
Summary Comments Plain Language Checklist w Use concrete examples to illustrate ideas or concepts w Present ideas with illustrations or diagrams w Highlight main ideas and important information with headings, point form and boldface type
Summary Comments Plain Language Check List w w w Use familiar words, conversational personal tone Proceed logically, most important ideas first Use action verbs and active construction Favour short words and sentences Use short paragraphs
Promotion & Marketing Checklist w Research and consult guidelines about tailoring messages for older consumers w Focus-test your materials with older adults w Recognize in your marketing plan that this is not a single homogeneous group w Test a marketing plan and materials with several groups of older consumers (include a range of ages and literacy levels)
Promotion and Marketing Checklist w Use older persons or models in your promotional materials w Present positive images of people who are healthy, happy and representative of OA diversity of culture, language, health status, geographic location, income level, etc.
Active Living & Older Adults Next Steps in Education w Continue increasing awareness & education about the benefits and importance of active living w Promote a consistent message w Decrease fears about physical activity w Advocacy efforts for policy changes w Strengthen partnerships so that health professionals and organizations at all levels promote the active living message
Active Living for Older Adults Next steps in Programming w Create specialized programs for each stage of the older adult continuum w Incorporate a variety of programming w Include all components of fitness w Incorporate progression w Include social components w Address environmental and accessibility issues w Develop community wide plans
Active Living for Older Adults Next steps in Research w Continue research into physical activity and older adults w Increase investigation of psychosocial aspects w Translate research into clear language
Active Living for Older Adults Next steps in Empowerment w Older adults take responsibility for their own health and to take an active role in program planning and delivery w Encourage and support role models and leadership w Foster and promote a change in attitude
Active Living for Older Adults Next steps in Empowerment w Older adults the fastest growing group on Internet users w Internet expands the world of seniors w Powerful tool for maintaining health and wellbeing w New form of intergenerational communication w Encourage older adults to get online w Build senior friendly websites
This is a prime opportunity for governments, individuals and organizations to make a positive impact on the health of all Canadians w Physical activity, especially for older adults, is overlooked as an effective and essential part of health promotion strategy w Active Living is a long-term, low-cost preventative approach
The Ultimate Goal w Prolong the independence of older Canadians and add life to years w When Physical Activity has a prominent place in the Cochrane Collaboration we will know we have been successful.
Thank you / Merci w For more information: Physical Activity Guide: 1 -888 -334 -9769 – www. paguide. com w ALCOA: www. alcoa. ca 1 -888 -549 -9799 w Osteoporosis Society of Canada – www. osteoporosis. ca