Intended for healthcare professionals

Analysis

Recommendations for physical activity in older adults

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h100 (Published 21 January 2015) Cite this as: BMJ 2015;350:h100

Why would you move?

The paper on recommendations for physical activity in older adults by Sparling et al. emphasizes the great importance of physical activity and reducing sedentary behaviour in older adults. We totally agree on the importance of even small increases in physical activity in the large population of sedentary older adults. Sparling et al suggest to give older adults the advice to sit less and to move more. Brief interventions using goal setting and self monitoring are introduced as being effective. However, Sparling and colleagues stayed on the point how much older people should move to influence their health condition.

Unfortunately, they did not move to the crucial point of how we should get older sedentary people on the move. Self-management is crucial to reduce sedentary behaviour and increase physical activity in daily life. This means that we should ask the question what kind of health counselling will be needed.

Therefore, we should start with answering the question WHY older adults should move and answering the next question HOW they should realize this. Simon Sinek (1) rightly states in his very successful book, that to follow leaders and enter new activities, more than anything else, we rely on an inspiring, clear and appealing answer to the question WHY?

Like anyone else older adults do not only need information on what they need to do but also how to realize it with increasing challenges due to changing physical and social circumstances often leading to fear of falling and avoidance of activities (2). Ambivalence to physical activities in the elderly is resistant to traditional counselling methods such as patient education and advice. Moreover, older adults need guidance how they can choose activities that are safe and inspiring (3). The component lacking in most physical activity interventions is truly personalized goal setting, taking into account the seniors’ preferences, habits, social circumstances, motivation and passion. Next, we should also stimulate self-management of personal and environmental limitations and facilitators. Activity is not a goal in itself, it is a lifestyle necessary to stay healthy and even more importantly, socially active.

We claim that physical activity in older adults can only be improved with a patient-centred approach using targeted messages (4): We literally need to ask older adults: why would you move? And how are you going to realize this? Together with older adults and professionals we recently developed the Coach2Move strategy to guide frail older adults with mobility problems to stay or become more physically active (5). Key elements are:
1) Motivational interviewing techniques to answer the personal question: why would you start to move?
2) Explore the barriers in relation to physical and social activity;
3) Set priorities based on physical examination and clinical reasoning;
4) Decide together on meaningful goals;
5) Coach on self- management and self-efficacy to increase long term results;
6) Accept help from family, friends and/or professionals;
7) Stratify the intensity based on (expected) recovery.

We are convinced that a patient-centered focus on self-management and coaching is the key to achieving adequate physical activity levels for older adults. Investing in patient-centered care should have priority before downgrading of the current physical activity recommendations.

References
1. Sinek S. Start with why. 2nd ed. London: Penguin Publisher Group, 2011.
2. Stubbs B, Patchay S, Soundy A, Schofield P. The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study. Pain medicine (Malden, Mass.) 2014;15(11):1861-71.
3. Letourneau K, Goodman JH. A patient - centered approach to addressing physical activity in older adults: motivational interviewing. Journal of gerontological nursing 2014;40(11):26-33; quiz 34-5.
4. Ostrander RE, Thompson HJ, Demiris G. Using targeted messaging to increase physical activity in older adults: a review. Journal of gerontological nursing 2014;40(9):36-48.
5. de Vries NM, van Ravensberg CD, Hobbelen JS, van der Wees PJ, Olde Rikkert MG, Staal JB, et al. The Coach2Move Approach: Development and Acceptability of an Individually Tailored Physical Therapy Strategy to Increase Activity Levels in Older Adults With Mobility Problems. Journal of geriatric physical therapy (2001) 2015.

Competing interests: No competing interests

08 March 2015
Nienke M de Vries
Researcher
Maria W.G. Nijhuis-van der Sanden, Marcel G.M. Olde Rikkert
Radboud University Medical Center
P.O. Box 9101 HB, Nijmegen, The Netherlands