People of all ages can improve their quality of life through a lifelong practice of moderate physical activity. This key takeaway from a watershed report of the US surgeon general on physical activity and health published in 1996 still holds true.
The report, an initiative of the US Department of Health and Human Services, Centres for Disease Control and Prevention (CDC), also underscored the importance of fitness in older adults, saying that “many of the diseases and disabling conditions associated with ageing can be prevented, postponed, or ameliorated with regular physical activity.”
Numerous other studies — encompassing everything from strength training to mall walking — that have dealt with the subject of physical activity in the ageing population have reinforced the importance of exercise on the quality of life.
Though the individual needs of people are varied, a report by the CDC points out that like adults, older adults also need 150 minutes of physical activity a week.
Happiest Health lists out a few activities and exercises for elderly that have, in some way or other, enriched the overall well-being of life in older adults.
“Tai chi is meditation in motion. It is a holistic practice,” says Christopher Fernandes, the founder of Sevangee, an institute in Mumbai that teaches the traditional form of tai chi chuan (Yang style) that combines movements with internal energy development exercises and meditation. “When I say holistic, it means total well-being pertaining to physical, mental, emotional and spiritual health.”
Tai chi is a non-competitive, self-paced system of gentle physical exercise and stretching. Each posture flows into the next without pause, ensuring that your body is in constant motion.
Fernandes is the first Indian to have trained at the Beijing Institute of Physical Education (now called Beijing University of Physical Education). He recalls that when he first started promoting tai chi in India, people were sceptical of the practice. But soon, senior citizens started seeing the results that tai chi had on their bodies. “When I first train an older adult, I analyse the posture of the person,” he says. “I see if he/she is standing on heels or toes. Each posture reflects one’s physiology. Physiology reflects the psychology and psychology reflects one’s philosophy in life.”
Fernandes says that in people over 60, tai chi immensely helps in posture alignment. “The way we stand, the posture we hold and the gait we take reflect the health, fitness and neuromuscular coordination of our body, mind and breath. Most people when they stand, stand on one leg or put their toes out. The best position is to keep your legs at shoulder distance, with toes slightly inward, heels out, knees outward and tailbone tucked in. This position builds up the kidney energy and strengthens the legs. Once people’s posture is right, then they can walk with confidence. And because of the confidence, they gain a new zest for life. It’s like a new birth in older adults,” he explains, also adding that tai chi has helped many people in their journey with Parkinson’s disease.
A meta-analysis of the efficacy and safety of tai chi for Parkinson’s disease, published in the journal Plos One, concluded that tai chi plus medication resulted in significantly greater benefit in terms of general motor symptoms, balance, mobility and stride length. The meta-analysis points out that one of the main manifestations of Parkinson’s disease is the rigidity which affects postural stability, balance and gait performance. These are symptoms that oftentimes do not respond well to traditional treatments and medicines. But the actions in tai chi could help with posture stability and balance.
Fernandes points out that if an older adult wants to try out tai chi for the first time, they should keep an open mind. “Don’t be caught up with old ideas,” he says. “Tension makes the muscles rigid, and that is not good. Tai chi might look fluid and easy. Still, it does take a toll on the mind. One has to be ready for all types of learning and at the end of the day, it will only benefit the person.”
On every full moon night, Shriram Vakade’s studio overbrims with sounds from Tibetan singing bowls, gongs and tuning forks. His Bengaluru studio is bursting with clients, most of whom are older adults.
“Sound meditation is a kind of meditation that uses sound to calm the body,” says Vakade, a sound mediation and sound therapy practitioner. “It benefits older adults particularly because it is the most effortless way to achieve relaxation. There is no need for the person to listen to instructions or even move from one place to another, but it is a practice that has profound effects on one’s physical and mental health. It is a practice that one can add to any fitness modality.” He says that sound meditation has been part of the Indian and Tibetan yogic systems for more than 4,000 years, but it has not received its due attention.
Sound meditation is an ancient exercise that has been practised in many cultures. Guided meditation uses Tibetan singing bowls, crystal singing bowls, gongs, bells, drums, didgeridoos and many other instruments that create vibrations that can reinforce one’s self-awareness, leading to self-realisation.
“Older people can particularly benefit from sound meditation and sound therapy because it addresses psychosomatic diseases, arthritis and postural problems,” says Vakade. He recalls a time when an older client of his had a frozen shoulder and after one hour of sound meditation, his shoulders relaxed.
Despite his belief that age is just a number, Vakade recognises the constraints that come with age, like muscle loss. “I believe that older adults can perform all kinds of movements as long as they know their limit,” he says. “But don’t push the body too much. Try to listen to it; be one with it. It would be ideal if people can do sound meditation thrice a week. On full moon nights, we particularly have very powerful sessions because of the effect the moon has on the body. The moon has proven to have effects on water bodies and the human body is made up of 70 per cent water.”
Srinivas Vupadrishta, a holistic health practitioner and sound healer based in Bengaluru, points out the difference between sound meditation and sound healing/therapy. “Sound meditation is a method to calm the mind,” he says. “Sound healing is what you do when you are dealing with specific issues like insomnia and anxiety in people.”
Vupadrishta says there is a lot of literature that talks about how sound meditation and sound therapy can help older people with arthritis. “But I wouldn’t say that people are cured only because of sound therapy,” he says. “It is a supplement to help you get better. And you don’t even have to be unwell to experience it. But yes, the sound vibrations are powerful. Sound works extremely differently in different people. I do not recommend sound therapy for people with heart conditions, especially people with stents because the vibrations can be powerful enough to move the stents. When it comes to older adults, I do not place the sound bowls directly on the body but around the body, because each bowl weighs about one to one-and-a-half kilograms.”
Vupadrishta works with both younger and older adults. According to him, apart from providing a path for destressing, sound meditation is also a way of engaging older people in something new and exciting.
Exercises for older people
Numerous studies have dealt with the physical and psychological effects of yoga in older adults. From reducing pain to boosting brain function and ensuring better sleep, practitioners consider yoga to be a holistic approach to health and wellness. “There is no age limit to yoga. The practice can be modified as per one’s comfort and ability. Best exercises for the elderly can be gentler and there can be more focus on meditation and gentle breathing exercises,” says Bhavna Yadav, a yoga practitioner and teacher, who trained at the Sivananda Yoga Vedanta Centre and Ashram in Kerala.
Yadav recalls a case study where she saw the positive result of yoga in an older adult. “One of my students (who was 75 years old) reported relief in back and neck pain, better energy levels and better sleep as a result of yoga practice.”
A cross-sectional study published in the Indian Journal of Psychiatry, the official publication of the Indian Psychiatric Society, analysing the effects of yoga intervention on sleep and quality of life in elderly, concludes that yoga improves the quality of life and sleep quality of elderly living in old age homes.
“Seniors benefit from neck, shoulder and joint exercises,” she says. “Depending on one’s level of practice and comfort, we modify the yoga asanas. Some of the asanas that older people can practice are tadasana (mountain pose), which is for stability and balance; trikonasana (triangle pose), which is good for the hips and gaining lateral strength; marjariasana (cat-cow stretch), a pose for releasing tension from the spine; pawanmuktasana, which helps with problems of flatulence, and baddha konasana (butterfly pose), which works on the hips and joints. Yoga can be practised every day for about 45 minutes to an hour, else at least three days a week.”
She says that older people who have difficulty sitting on the floor for long could even try chair yoga. “Sometimes an entire session can be done on a chair. In vrikshasana (tree pose), one can stand and even get the support of a chair,” she says.
A scoping review published in the journal OBM Geriatrics analysed 75 studies related to chair yoga. The results of the review support the use of chair/adapted yoga as an intervention for older adults; the majority of the studies had positive, if not significant results.
Yadav says that if older adults want to try yoga for the first time, they should practise under the guidance of a qualified teacher and respect the limitations of the body. They should also consult their doctor before starting their practice.
Exercises for older adults- Strength training
A research article in the American Journal of Preventive Medicine points out the impact of sarcopenia in older adults. Sarcopenia is the loss of muscle mass and strength as age increases. Strength training could be a way to slow down muscle atrophy (loss in muscle mass).
“People generally assume that strength training is only for bulking up,” says Bonney Paul, a strength and conditioning coach based in Bengaluru. “But that is not always the case. When I engage my older clients in strength-training activities, it is to maintain the muscle mass that they have, not to build it. Muscle atrophy happens after a certain age, and it is very important to slow that down. Strength training also increases the grip that the muscles have over the bones around the joints. As people age, they develop a lot of joint problems. Strength training thus helps them overcome issues related to the joints.”
A systematic review published in the journal Clinics in Geriatric Medicine — ‘Strength training in older adults: the benefits for osteoarthritis’ — underlines that strength training is beneficial to older people with osteoarthritis (a degenerative joint disease). The review also points out that there is currently no evidence that one type of strength-training programme is superior to another as long as the programme provides progressive overload and recommends clinicians to encourage participation in exercise training programs, even in the oldest old with osteoarthritis.
Debunking a common assumption, Paul says that older people should train with free weights and not machines. “Everyone’s range of motion is different,” he says. “So, free weights help one move the way their bodies are naturally meant to move, unlike the machine that might not be tuned to perfection. Another query I receive a lot is whether older people can lift heavy weights. My answer would be, yes. Progressive overload is important: start with lighter weights and graduate to heavier ones.”
Paul recommends three days of strength training a week and walking every day. “Still, don’t be so hard on your body as recovery takes time after the age of 60. But I believe that anyone can do anything if they just listen to the body.”
Grab some poles with Nordic walking
What began in Finland in the 1930s as training sessions among skiers during the offseason, when they practised walking long distances with poles, developed into a discipline, a lifestyle and a sport in the second half of the century. According to the International Nordic Walking Federation, the global governing body promoting the endeavour, “Nordic walking is a form of physical activity, where regular natural walking is enhanced by the addition of the active use of a pair of specially designed Nordic walking poles. Unlike regular walking, Nordic walking is not stressful on the body,” says Vijay Shivakumar, a certified national Nordic walking trainer based in Bengaluru. “When using poles, the stress spreads across the body. Both the upper and lower parts of the body are engaged in the process, and it leverages the entire body. Thus, it is a great activity for older people.”
Nordic walking trainers and practitioners believe that poles also protect older people from the possibility of tripping and falling. Most injuries in the elderly are the result of falls; fractures of the hip, forearm, humerus and pelvis usually result from the combined effect of falls and osteoporosis.
“Nordic walking has even proven to be beneficial for people with progressive movement and neurodegenerative disorders like Parkinson’s disease and Alzheimer’s,” says Shivakumar.
‘Effects of Nordic walking compared to conventional walking and band-based resistance exercise on fitness in older adults,’ a study published in the Journal of Sports and Science Medicine, highlights that Nordic walking can improve muscular strength and flexibility as well as aerobic endurance capacity. Though coupling aerobic activity and resistance training can have the same effect as Nordic walking, the latter takes less time if one were to perform the same amount of conventional walking and resistance training.
“Of course, the elderly and those in medical rehabilitation can benefit greatly from Nordic walking, but it is not only them. Anyone can benefit from Nordic walking,” says Cristina González Castro, a Nordic walker, a sports physiologist, an exercise specialist in cancer and a radiation therapist based in the Canary Islands. “The good thing about Nordic walking is that anyone able to walk can Nordic-walk. We also know that keeping adequate levels of exercise improves general mental and physical health and reduces all-cause mortality.” She also says that Nordic walking is a low-impact exercise, but people can practise it at high intensity if they wish, thus making it a very versatile discipline.
A study undertaken by the Tokyo Metropolitan Institute of Gerontology, titled ‘Effects of an unsupervised Nordic walking intervention on cognitive and physical function among older women engaging in volunteer activity’ and published in the Journal of Exercise Science and Fitness, analysed 47 women over the age of 70 for a three-month period. The researchers found that engaging in Nordic walking more than once a week enhanced handgrip strength, walking speed and cognitive function compared with simple walking.
Nevertheless, Shivakumar emphasises the importance of using a trainer if someone wants to try out Nordic walking for the first time. “People can develop injuries because of bad gait and posture,” he says. “So, it is important to start the session with someone who knows how to ease people into Nordic walking. Once they know how to do it the right way, they can move on, possibly to clubs and camps, as group dynamics will keep people committed to the activity.”
Head to the mall for a stroll
Mall walking is a preferred choice of activity for older adults in many countries. It can be either formal or informal, carried out solo or in groups, with the primary intention of overcoming the impediments (weather, fear of crime, fear of injury) that might exist if they were to walk on the roads.
A systematic review of the literature published in the CDC-sponsored public-health journal Preventing Chronic Disease concludes that individual benefits of mall walking programmes include improvements in physical, social, and emotional well-being. The review, however, points out the lack of availability of information on mall walking programmes in communities of colour, in areas of low socioeconomic status, or for people with disabilities or chronic conditions. Mall walking is also not an activity that is explored in many countries around the world.
The CDC has produced a programme resource guide for mall walking, listing out the considerations while putting into effect programmes, such as creating mile markers for calculating the distance walked, providing locked cabinets for storage and identifying routes that are secure and free of trip hazards.
Mile markers or not, if it is an informal walk one fancies, and if a mall happens to be around the corner, then possibilities still exist for some window-shopping and a saunter.