Promoting physical activity in older women to maximize health

Augustine Chavez; Robert Scales; Juliana M. Kling

doi:10.3949/ccjm.88a.20170

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TABLE 1

Physical activity and exercise: Definitions and durations

Physical activity	Bodily movement from skeletal muscle contraction resulting in energy expenditure above baseline.
Exercise	Planned, structured, repetitive physical activity performed to improve health or fitness.
MET (metabolic equivalent of task)	A measure of energy expenditure for an activity with a reference of 1 MET being rest.

Intensity	Low intensity: Nonsedentary activity ≤ 3 METs	Leisurely walking (≤ 2 mph) Light household chores
	Moderate intensity: 3–5.9 METs	Golfing (walking, carrying bag) Dance Pickleball Brisk walk (2.5–4 mph) Gardening Playing with grandchildren
	Vigorous intensity: ≥ 6 METs	Hiking Swimming Water aerobics Fast walk (≥ 4.5 mph) Stationary cycling Strenuous fitness classes
Activity level	Inactive: No moderate to vigorous physical activity
	Low: Almost completely inactive
	Moderate: Some physical activity >4 hr/wk or about 12 MET hr/week or more	Brisk walk 4 hr/wk Pickleball 2.5 hr/wk Golfing (walking, with bag) 3 hr/wk
	High: Vigorous activity >3 hr/week or about 18 MET hr/wk or more	Hiking 3 hr/wk Swimming 2.5 hr/wk Strenuous fitness class 2.5 hr/wk
Types of exercise	Aerobic: Rhythmic movement of large muscles for sustained periods of time	Walking Swimming Stationary cycling
	Resistance: Activity that increases skeletal muscle strength, power, endurance and mass	Lifting weights Using resistance bands Body movement underwater
	Combined: Activity with aerobic and resistance components	Fitness classes with weights Circuit training

Adapted from reference 2.

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TABLE 2

Benefits of exercise for common causes of morbidity and death in women^{^a}

CONDITION	INTERVENTION	END POINT	COMPARATOR GROUP	EFFECT SIZE (95% CI)
CVD	7.5–14.9 MET hr/wk LTPA⁷	All-cause mortality	No LTPA	HR 0.68 (0.66–0.69)
	150 min/wk MVPA⁸	CHD incidence	No LTPA	RR 0.86 (0.77–0.96)
Stroke	High PA³	Stroke incidence	Low level PA	RR 0.76 (0.64–0.89)
HTN	High PA⁴	HTN incidence	Low level PA	RR 0.81 (0.76–0.85)
	Moderate PA⁴	HTN incidence	Low level PA	RR 0.89 (0.85–0.94)
	Any exercise (exercise in general)¹⁴	SBP reduction	Control	−8.96 mm Hg (−10.27 to −7.64)
Diabetes	150 min/week MVPA⁵	Type 2 DM incidence	Inactivity	RR 0.74 (0.69–0.80)
	Supervised aerobic exercise⁹	HbA1c reduction	No exercise	−0.30 (−0.60 to −0.45)
	Supervised resistance exercise⁹	HbA1c reduction	No exercise	−0.30 (−0.38 to −0.15)
	Combined exercise⁹	HbA1c reduction	No exercise	−0.53 (−0.68 to −0.45)
Breast cancer	High-level MVPA¹⁰	Breast cancer incidence	Low level PA	HR 0.90 (0.87–0.93)
Cancer^{^b}	Supervised exercise¹¹	Health-related QOL	Control	SMD 0.48 (0.16–0.81)
Cognitive decline	Physical activity¹⁵	Alzheimer disease incidence	Inactivity	RR 0.61 (0.52–0.73)
	Moderate to high-intensity aerobic exercise¹⁶	Global cognition	Control	SMD 0.60 (0.21–0.98)
COPD	Pulmonary rehabilitation¹⁷	Dyspnea	Usual care	MD 0.79 (0.56–1.03)
Depression	Moderate to high intensity combined exercise¹⁸	Depression severity^{^c}	Control	SMD −0.34 (−0.52 to −0.17)
Hip OA	Land-based exercise¹²	Pain (3–6 mo)	No exercise	SMD −0.38 (−0.58 to −0.18)
	Land-based exercise¹²	Physical function	No exercise	SMD −0.37 (−0.57 to −0.16)
Knee OA	Land-based exercise¹³	Pain	No exercise	SMD −0.49 (−0.39 to −0.59)
	Land-based exercise¹³	Physical function	No exercise	SMD −0.52 (−0.39 to −0.64)
Falls	Exercise¹⁹	Number of fallers	Control	RR 0.85 (0.81–0.89)
	Exercise¹⁹	Falls	Control	RaR 0.77 (0.71–0.83)
Osteoporosis	Combined exercise²¹	Lumbar spine bone density	Usual care	SMD 0.349 (0.064–0.634)
	Exercise²⁰	Overall fracture	No exercise	RR 0.49 (0.31–0.76)

↵a Most studies cited here included both men and women.
↵b Breast, colorectal, head and neck, lymphoma, others.
↵c Severity determined by self-report on depression scales.
CHD = congestive heart disease; COPD = chronic obstructive pulmonary disease; CVD = cardiovascular disease; DM = diabetes mellitus; HbA1c = hemoglobin A1c; HR = hazard ratio; HTN = hypertension; LTPA = leisure-time physical activity; MD = mean difference; MET = metabolic equivalent of task; MVPA = moderate to vigorous physical activity; OA = osteoarthritis; PA = physical activity; QOL = quality of life; RaR = rate ratio; RR = relative risk; SBP = systolic blood pressure; SMD = standard mean difference