Comment
ENERGETIC ELDERS Introduction THERE is now evidence to confirm a common impression that the population of the United Kingdom is depressingly inactive.! Levels of habitual physical activity in the general population are so low that merely walking at a normal pace may, for many people, produce excessive physiological demands after a very short time. Information from the Canada Fitness Survey indicate that walking uphill at three miles per hour involves severe exertion for the average male over 35 years of age? Those who are sedentary are generally unaware of just how low their capacity is for sustained physical activity. When sedentary people do make brief efforts to exert themselves, they do so by drawing predominantly on their anaerobic energy stores, and do not realise that their endurance for such activity is severely limited. Such disheartening statistics pose a formidable challenge to the health educationalists, as there can be few young or middle aged people who are unaware that "exercise is good for you". However, one substantial and expanding subgroup of the population has been largely ignored in health promotion campaigns, namely the elderly. Old people are often assured by well-meaning carers and health professionals that it is "already too late" to enjoy and benefit from physical activity. Some old people wishing to embark on an exercise programme are subjected to such dire warnings and extensive screening procedures that all motivation is rapidly extinguished. Even those who have continued sporting activity into later life are advised to "hang up their boots". What is the balance between the risk and the benefits of exercise in old age?
Inactivity, ageing and fitness The age-related loss of stamina and fitness is an everyday observation for those working with elderly people. The precise age at which this decline begins and the rate of decline vary from one individual to another. Part of the deterioration is due to the intrinsic process of ageing which is not amenable to intervention. However, it is now accepted that many age-related changes that were once assumed to be solely the result of the ageing process are the result of disuse, and therefore potentially reversible. Inactivity and disuse are not normal accompaniments of ageing. Prevailing cultural expectations decree that habitual activity should decline with ageing. Pensioners are advised to "slow down". Those approaching retirement are moved to less physically demanding jobs. Well-intentioned relatives assume shopping and cleaning chores, and the provision of inappropriate social services promotes dependency. There is a reduction of muscle mass of 10-15 % between 35 and 45 and 65-75 years'' and the result of this decrease is that each unit of muscle tissue is responsible for the support and movement of a greater proportion of the total body mass. Thus
muscles must exert a greater force, working closer to their maximum, and the onset of fatigue is hastened. The term "fitness" is often misused and misunderstood. It is usually assessed by measuring the maximum oxygen uptake (V02max), for which the exercising subject has to attain a plateau of oxygen consumption such that increasing the level ofexercise produces no further increase in V02max. In practical terms in the context of old age, it means that the fitter the person, the less the body is disturbed by work and the more quickly will the body return to the resting state when the work is finished. For a young person, loss of fitness will be apparent if he is required to perform strenuous exercise, to play rugby for example. He will, however, have ample reserves to cope with the demands of everyday life, climbing stairs, cutting the grass or walking to the shops. His loss of fitness does not impinge on his everyday activities of his quality of life. In contrast, the old person is usually precariously close to the point where a small decline in fitness may render some everyday activities impossible, or at least requiring such a near-maximal effort as to be unpleasant to perform. Some of these activities may be crucial for an independent lifestyle, others for its quality. Thus the temporary loss of fitness occurring in association with, for example, an intercurrent illness may render even a previously healthy 80 year old immobile and dependent.
Potential benefits of exercise in old age The risk of cardiovascular disease increases progressively with age, and even in the elderly, regular exercise can reduce cardiovascular risk," Body mass and body fat content are reduced, resting blood pressure is decreased and the lipid profile is improved. 5 ,6,7 Regardless of age, appropriate physical activity will result in both hypertrophy of muscle tissue and in increased neuromuscular function. The improvements in strength and endurance which an elderly person can expect are proportionately similar to those experienced by younger adults. The relationship between falls in the elderly and postural sway is well established, and the morbidity and mortality associated with falls is well recognised," Several studies have examined the effect of exercise on postural sway, some of which noted a favourable effect,9 but others have found no improvement from participation in an exercise
programme.' 0,11 The mechanical stresses of weight-bearing stimulate osteoblast function, so load-bearing is an important mechanical stimulus to the skeleton, and physical fitness is related to bone density in both the spine and femoral neck l 2 Several trials of exercise interventions in postmenopausal women have increased bone density, reversing the normal postmenopausal loss seen in control groups.l" One hour of walking twice a week for eight months led to a 3.5% increase in the mineral content of the lumbar spine compared with a 165
Comment
decrease of 2.7% in controls. This is about half the effect reported with oestrogens.i" Further studies are required in elderly women to determine precisely which types of exercise are of most benefit to the skeleton. Flexibility and range of joint movement is improved by regular physical activity, even in the very elderly (85 years+), and is often the first sign of benefit noted by elderly participants in exercise. IS The psychological effects of exercise should not be underestimated. Most people take part in exercise because it makes them "feel good". This experience also occurs in elderly people. 11 There is also evidence that regular exercise may improve the mood, lessen anxiety and enhance sleep efficiency. Some work has suggested that cognitive function is improved by exercise, but this has not been replicated.i'' Safety aspects In adults aged 40-49 years unaccustomed vigorous exercise increases the immediate risk of sudden death by a factor of 5 to 10, although the prognosis for the entire day is improved. I? Curiously, the relative risk of sudden death in the 50-69 year old age group is less than that of younger adults. I S Warning symptoms include severe breathlessness, dizziness or chest pain. Older people tend to be less ambitious exercisers than their younger counterparts, and therefore less vulnerable to soft tissue injuries. Factors associated with injury in the elderly include: failure to take an adequate warm-up; violent exercises, especially twisting and excessive stretching; too rapid progression of training, with exercise continuing when the subject is more than pleasantly fatigued; exercise on a hard or uneven surface, and use of shoes with poor ankle support.i" Sustained isometric exercise, particularly straining against a closed glottis (Valsalva manoeuvre) should be avoided, because of the associated rise in blood pressure. However, the most hazardous forms of isometric exercise are unlikely to be encountered in leisure activities in old age, and more likely to occur in daily life - for example pushing the car on a cold morning. If exercise is not provoking symptoms, it is unlikely to be doing harm, and old people should not be discouraged from taking part in exercise that they enjoy. In the midst of all this guarded advice it is easy to lose sight of the fact that exercise is natural, health-enhancing behaviour. The medical profession is guilty of being more conservative than their old patients in their advice about exercise, resulting in little motivation for the elderly to comply. For those old people who have been sedentary and wish to embark on an exercise regimen, the intensity and frequency of activity should be gradually increased, and eachsession should have a warm-up and a cool-down element. Many old people overestimate the intensity of activity required to produce a training effect. Training is actually facilitated by a low initial fitness level, and although the rate of progression may be
166
slower in old age, the ultimate conditioning response is not diminished?O Exercise classes Group activities offer many opportunities for social interaction, although it is important that the social gains are not made at the expense of functional improvements, or vice versa. The pioneering Dundee University Over 60s Exercise Class, led by Miss Dorothy Dobson is an impressive example of all that is best in group exercise for older people. It attracts a large and faithful following of local pensioners, and is one of the few established exercise interventions to have been evaluated in a randomised controlled trial. l l There are daunting methodological problems to be overcome in the evaluation of exercise interventions. The term "exercise" covers a multitude of activities of variable intensity, duration, and frequency. Although "exercise" potentiall y offers a host of benefits, not all interventions are capable of producing all benefits. For example, swimming is beneficial to the cardiorespiratory system, but has little effect on bone density. It is valuable therefore to have information on precisely what type of exercise, performed at what frequency produces what physical and psychological effects. The Dundee Over 60s Health and Fitness Project recruited 87 healthy volunteers (aged 60-81) from the local community. They were allocated at random to one of two groups: exercise class (n=43), or health education (n=44). The exercise class group attended the Dundee University Over 60s Exercise Class three times per week, with each session lasting for 45 minutes. The health education group attended a series of informal health education sessions held at the University. One of the most conspicious results of the project was that 81/87 (93%) completed the eight month project. Other exercise interventions have found that as man6. as 50% of participants may defect over the first six months? The average attendance at the exercise sessions was 83% and at the health education sessions 71%. This emphasises the acceptability of both interventions. At eight months, the exercise group was significantly improved in comparison to the health education group in terms of spine flexion, life satisfaction, and perceived health status. There were no adverse events. Of the 81 subjects completing the study, 78% enrolled to continue taking part in exercise classes.
Conclusion The ideal exercise programme for old people has not been described, and will vary from person to person. The Dundee Over 60s Exercise Class possesses all of the key elements of safety, effectiveness and compliance. Group exercise will not appeal to everyone, but the intrinsic social benefits make it an attractive option to counter the isolation suffered by many old people. The exercise class approach can be translated successfully into the residential home setting. Even this frailer and
Comment
older subgroup of the elderly population can benefit from increasing their activity levels. Indeed significant evidence of functional improvement after participation in a seven month programme of exercise creates a powerful argument for such classes to be available in all local authority homes. 15 Clearly there are advantages for old people to be physically active. If more old people are to have this opportunity, changes in attitude are required from the caring professions. Too much of the care provided at present over protects and underestimates the elderly person. It is too often the case that the old person struggling with an aspect of self-care is simply provided with a home help, instead of receiving an assessment and efforts being made to help regain the lost skill. Inactivity is reinforced by some care staff because the staff member enjoys the gratitude that results from performing the task for the old person. Low staffing levels also create dependence, as the old person soon learns that improvements in functional ability lead to p. reduction in the number of contacts with staff. The beliefs of older people must also be challenged. Some old people believe that rest is therapeutic and that it is pointless trying to prevent disabilities which are the inevitable accompaniment of "old age". Others think it is their entitlement to be waited upon, as a reward for years of toil, a view particularly prevalent amongst old people who arepaying for private care. Health educators must provide specific advice for old people regarding the intensity, frequency and duration of exercise which is necessary to improve their fitness. Vague exhortations to "take more exercise" are not enough. Information on the availability oflocalleisure facilities should be provided, with the offer of assistance to those unable to reach their facilities due to limited mobility. Different approaches are necessary for the diverse needs of three main subgroups, namely the active elderly, the housebound elderly and the institutionalised elderly. The medical profession must take a leading role in encouraging and motivating older people to enjoy exercise. If it is presented as a means of postponing dependency, keeping fit - and having fun more old people will have the chance to add life to their years?1
M.E.T. McMurdo Section of Ageing and Health, Department of Medicine, University of Dundee Ninewells Hospital and Medical School Dundee DDl 9SY
OVER 60'S EXERCISE CLASSES IN DUNDEE UNIVERSITY
about regular, supervised exercise to music.
"When you are getting on in years When you are letting little fears Grow out ofall proportion in your mind Inface ofthis adversity Come join the University It's better to be cruel than to be kind."
SO SAYS an original piece of verse recently published in a book of poems written by members of Dundee University Over 60's Exercise Class, expressing their thoughts and feelings
FOOlNOTE Atraining course and symposium to teach people about exercise in older people with both atheoretical and practical element isrun annually by the University ofDundee. Further details from the author. REFERENCES 1 Brodie D, Roberts K, Lamb K. Citysport challenge. Cambridge: Burlington Press 1991. 2 Stephens T,Craig CL, Ferris BF. Adult physical fitness inCanada: findings from the Canada Fitness Survey Can JPublic Health 1986; 77: 285-290 3 Young A, Stokes M, Crowe M. The size and strength of the quadriceps muscles ofold and young men. Clin Physiology 1985; 38: 673-677. 4 Pekkanen J, Marti B, Nissenen A. Reduction of premature mortality by physical activity. Lancet 1987; i: 1473-1477. 5 Sidney KH, Shephard RI, Harrison J.Endurance training and body composition ofthe elderly. Am J Clin Nutr 1977; 30: 326-330. 6 Tipton CH. Exercise, training and hypertension. Exerc Sport Sci Rev 1984; 12: 245-306. 7 Yano K, Reed DM, Curb JD, etal. Biological and dietary correlates ofplasma lipids and lipoproteins among elderly Japanese men in Hawaii. Arteriosclerosis 1986; 6: 422-433. 8 Overstall PW, Exton-Smith AN, Imms FJ, Johnson AL. Falls in the elderly related to postural imbalance. Br Med J 1977; 1: 261-264. 9 Johansson G, JamIo GB. Balance training in70year old women. Physiother Prac 1991; 7: 121-125. 10 Crilly ¢, Willems DA, Trenholm KJ, Delaquerriere-Richardson LF. Effect ofexercise on postural sway inthe elderly. Gerontology 1989; 35: 137-143. 11 McMurdo MET, Burnett L. Arandornised controlled trial ofexercise in the elderly. Gerontology (in press). 12 Pocock NA, Eisman JA, Yeates MG, Sambrook PN, Erbels S. Physicalfitness isamajordeterminant offemoral neckfracture and lumberspine bone density. J Clin Invest 1986; 78: 618-621. 13 Chow A, Harrison IE, Notarius C. Effect oftwo randornised exercise programs on bone mass ofhealthy postmenopausal women. Br Med J 1987; 63: 780-787. 14 Munk-Jensen N, Nielsen SP, Obel EB, Eriksen PB. Reversal ofpostmenopausal osteoporosis by oestrogen and progestogen: a double blind placebo controlled study. Br Med J 1988; 296: 1150-1152. 15 McMurdo MET, Rennie L. Acontrolled trial ofexercise inresidents ofold peoples' homes. Age Ageing (in press) 16 Molloy DW, Richardson LD, CrillyRG. The effects ofathree-month exercise programme on neuropsychological function in elderly institutionalised women: arandornised controlled trial. Age Ageing 1988; 17: 303-310. 17 Siscock D, LaPorte R, Newman G. The disease specific benefits and risks of physical activity and exercise. Public Health Rep 1985; 100: 180-188. 18 Vuori I,Suurnakki L, Suumakki T. Risk ofsudden cardiovascular death in exercise. Med Sci Sports 1982; 14: 114-115. 19 Shephard RI. Physical activity and aging. London: Croom Helm 1987. 20 Shephard RI. Intensity, duration and frequency ofexercise as determinants of the response toatraining regime. Int J Agnew PhysioI1968; 28: 38-48. 21 Shephard RI. Motivation the key tocompliance. Phys Sportsmed 1986; 13: 88-101
The writer refers, when saying "Join the University" to Over 60' s Exercise Classes which have been run by the Department of Physical Education and the University of Dundee for 13 years. (I can only imagine that the word "cruel" refers to the thought of coming to a class rather than what happens at one - and the word "kind" refers to the fact that it may be a more pleasant idea to sit at home in one's chair!) I hope so. One thousand three hundred senior citizens enrol weekly for five classes which we offer. The classes have only ever been advertised once - at the beginning to let people know what we intended to do - and we have never fallen below the 167
ENERGETIC ELDERS Introduction THERE is now evidence to confirm a common impression that the population of the United Kingdom is depressingly inactive.! Levels of habitual physical activity in the general population are so low that merely walking at a normal pace may, for many people, produce excessive physiological demands after a very short time. Information from the Canada Fitness Survey indicate that walking uphill at three miles per hour involves severe exertion for the average male over 35 years of age? Those who are sedentary are generally unaware of just how low their capacity is for sustained physical activity. When sedentary people do make brief efforts to exert themselves, they do so by drawing predominantly on their anaerobic energy stores, and do not realise that their endurance for such activity is severely limited. Such disheartening statistics pose a formidable challenge to the health educationalists, as there can be few young or middle aged people who are unaware that "exercise is good for you". However, one substantial and expanding subgroup of the population has been largely ignored in health promotion campaigns, namely the elderly. Old people are often assured by well-meaning carers and health professionals that it is "already too late" to enjoy and benefit from physical activity. Some old people wishing to embark on an exercise programme are subjected to such dire warnings and extensive screening procedures that all motivation is rapidly extinguished. Even those who have continued sporting activity into later life are advised to "hang up their boots". What is the balance between the risk and the benefits of exercise in old age?
Inactivity, ageing and fitness The age-related loss of stamina and fitness is an everyday observation for those working with elderly people. The precise age at which this decline begins and the rate of decline vary from one individual to another. Part of the deterioration is due to the intrinsic process of ageing which is not amenable to intervention. However, it is now accepted that many age-related changes that were once assumed to be solely the result of the ageing process are the result of disuse, and therefore potentially reversible. Inactivity and disuse are not normal accompaniments of ageing. Prevailing cultural expectations decree that habitual activity should decline with ageing. Pensioners are advised to "slow down". Those approaching retirement are moved to less physically demanding jobs. Well-intentioned relatives assume shopping and cleaning chores, and the provision of inappropriate social services promotes dependency. There is a reduction of muscle mass of 10-15 % between 35 and 45 and 65-75 years'' and the result of this decrease is that each unit of muscle tissue is responsible for the support and movement of a greater proportion of the total body mass. Thus
muscles must exert a greater force, working closer to their maximum, and the onset of fatigue is hastened. The term "fitness" is often misused and misunderstood. It is usually assessed by measuring the maximum oxygen uptake (V02max), for which the exercising subject has to attain a plateau of oxygen consumption such that increasing the level ofexercise produces no further increase in V02max. In practical terms in the context of old age, it means that the fitter the person, the less the body is disturbed by work and the more quickly will the body return to the resting state when the work is finished. For a young person, loss of fitness will be apparent if he is required to perform strenuous exercise, to play rugby for example. He will, however, have ample reserves to cope with the demands of everyday life, climbing stairs, cutting the grass or walking to the shops. His loss of fitness does not impinge on his everyday activities of his quality of life. In contrast, the old person is usually precariously close to the point where a small decline in fitness may render some everyday activities impossible, or at least requiring such a near-maximal effort as to be unpleasant to perform. Some of these activities may be crucial for an independent lifestyle, others for its quality. Thus the temporary loss of fitness occurring in association with, for example, an intercurrent illness may render even a previously healthy 80 year old immobile and dependent.
Potential benefits of exercise in old age The risk of cardiovascular disease increases progressively with age, and even in the elderly, regular exercise can reduce cardiovascular risk," Body mass and body fat content are reduced, resting blood pressure is decreased and the lipid profile is improved. 5 ,6,7 Regardless of age, appropriate physical activity will result in both hypertrophy of muscle tissue and in increased neuromuscular function. The improvements in strength and endurance which an elderly person can expect are proportionately similar to those experienced by younger adults. The relationship between falls in the elderly and postural sway is well established, and the morbidity and mortality associated with falls is well recognised," Several studies have examined the effect of exercise on postural sway, some of which noted a favourable effect,9 but others have found no improvement from participation in an exercise
programme.' 0,11 The mechanical stresses of weight-bearing stimulate osteoblast function, so load-bearing is an important mechanical stimulus to the skeleton, and physical fitness is related to bone density in both the spine and femoral neck l 2 Several trials of exercise interventions in postmenopausal women have increased bone density, reversing the normal postmenopausal loss seen in control groups.l" One hour of walking twice a week for eight months led to a 3.5% increase in the mineral content of the lumbar spine compared with a 165
Comment
decrease of 2.7% in controls. This is about half the effect reported with oestrogens.i" Further studies are required in elderly women to determine precisely which types of exercise are of most benefit to the skeleton. Flexibility and range of joint movement is improved by regular physical activity, even in the very elderly (85 years+), and is often the first sign of benefit noted by elderly participants in exercise. IS The psychological effects of exercise should not be underestimated. Most people take part in exercise because it makes them "feel good". This experience also occurs in elderly people. 11 There is also evidence that regular exercise may improve the mood, lessen anxiety and enhance sleep efficiency. Some work has suggested that cognitive function is improved by exercise, but this has not been replicated.i'' Safety aspects In adults aged 40-49 years unaccustomed vigorous exercise increases the immediate risk of sudden death by a factor of 5 to 10, although the prognosis for the entire day is improved. I? Curiously, the relative risk of sudden death in the 50-69 year old age group is less than that of younger adults. I S Warning symptoms include severe breathlessness, dizziness or chest pain. Older people tend to be less ambitious exercisers than their younger counterparts, and therefore less vulnerable to soft tissue injuries. Factors associated with injury in the elderly include: failure to take an adequate warm-up; violent exercises, especially twisting and excessive stretching; too rapid progression of training, with exercise continuing when the subject is more than pleasantly fatigued; exercise on a hard or uneven surface, and use of shoes with poor ankle support.i" Sustained isometric exercise, particularly straining against a closed glottis (Valsalva manoeuvre) should be avoided, because of the associated rise in blood pressure. However, the most hazardous forms of isometric exercise are unlikely to be encountered in leisure activities in old age, and more likely to occur in daily life - for example pushing the car on a cold morning. If exercise is not provoking symptoms, it is unlikely to be doing harm, and old people should not be discouraged from taking part in exercise that they enjoy. In the midst of all this guarded advice it is easy to lose sight of the fact that exercise is natural, health-enhancing behaviour. The medical profession is guilty of being more conservative than their old patients in their advice about exercise, resulting in little motivation for the elderly to comply. For those old people who have been sedentary and wish to embark on an exercise regimen, the intensity and frequency of activity should be gradually increased, and eachsession should have a warm-up and a cool-down element. Many old people overestimate the intensity of activity required to produce a training effect. Training is actually facilitated by a low initial fitness level, and although the rate of progression may be
166
slower in old age, the ultimate conditioning response is not diminished?O Exercise classes Group activities offer many opportunities for social interaction, although it is important that the social gains are not made at the expense of functional improvements, or vice versa. The pioneering Dundee University Over 60s Exercise Class, led by Miss Dorothy Dobson is an impressive example of all that is best in group exercise for older people. It attracts a large and faithful following of local pensioners, and is one of the few established exercise interventions to have been evaluated in a randomised controlled trial. l l There are daunting methodological problems to be overcome in the evaluation of exercise interventions. The term "exercise" covers a multitude of activities of variable intensity, duration, and frequency. Although "exercise" potentiall y offers a host of benefits, not all interventions are capable of producing all benefits. For example, swimming is beneficial to the cardiorespiratory system, but has little effect on bone density. It is valuable therefore to have information on precisely what type of exercise, performed at what frequency produces what physical and psychological effects. The Dundee Over 60s Health and Fitness Project recruited 87 healthy volunteers (aged 60-81) from the local community. They were allocated at random to one of two groups: exercise class (n=43), or health education (n=44). The exercise class group attended the Dundee University Over 60s Exercise Class three times per week, with each session lasting for 45 minutes. The health education group attended a series of informal health education sessions held at the University. One of the most conspicious results of the project was that 81/87 (93%) completed the eight month project. Other exercise interventions have found that as man6. as 50% of participants may defect over the first six months? The average attendance at the exercise sessions was 83% and at the health education sessions 71%. This emphasises the acceptability of both interventions. At eight months, the exercise group was significantly improved in comparison to the health education group in terms of spine flexion, life satisfaction, and perceived health status. There were no adverse events. Of the 81 subjects completing the study, 78% enrolled to continue taking part in exercise classes.
Conclusion The ideal exercise programme for old people has not been described, and will vary from person to person. The Dundee Over 60s Exercise Class possesses all of the key elements of safety, effectiveness and compliance. Group exercise will not appeal to everyone, but the intrinsic social benefits make it an attractive option to counter the isolation suffered by many old people. The exercise class approach can be translated successfully into the residential home setting. Even this frailer and
Comment
older subgroup of the elderly population can benefit from increasing their activity levels. Indeed significant evidence of functional improvement after participation in a seven month programme of exercise creates a powerful argument for such classes to be available in all local authority homes. 15 Clearly there are advantages for old people to be physically active. If more old people are to have this opportunity, changes in attitude are required from the caring professions. Too much of the care provided at present over protects and underestimates the elderly person. It is too often the case that the old person struggling with an aspect of self-care is simply provided with a home help, instead of receiving an assessment and efforts being made to help regain the lost skill. Inactivity is reinforced by some care staff because the staff member enjoys the gratitude that results from performing the task for the old person. Low staffing levels also create dependence, as the old person soon learns that improvements in functional ability lead to p. reduction in the number of contacts with staff. The beliefs of older people must also be challenged. Some old people believe that rest is therapeutic and that it is pointless trying to prevent disabilities which are the inevitable accompaniment of "old age". Others think it is their entitlement to be waited upon, as a reward for years of toil, a view particularly prevalent amongst old people who arepaying for private care. Health educators must provide specific advice for old people regarding the intensity, frequency and duration of exercise which is necessary to improve their fitness. Vague exhortations to "take more exercise" are not enough. Information on the availability oflocalleisure facilities should be provided, with the offer of assistance to those unable to reach their facilities due to limited mobility. Different approaches are necessary for the diverse needs of three main subgroups, namely the active elderly, the housebound elderly and the institutionalised elderly. The medical profession must take a leading role in encouraging and motivating older people to enjoy exercise. If it is presented as a means of postponing dependency, keeping fit - and having fun more old people will have the chance to add life to their years?1
M.E.T. McMurdo Section of Ageing and Health, Department of Medicine, University of Dundee Ninewells Hospital and Medical School Dundee DDl 9SY
OVER 60'S EXERCISE CLASSES IN DUNDEE UNIVERSITY
about regular, supervised exercise to music.
"When you are getting on in years When you are letting little fears Grow out ofall proportion in your mind Inface ofthis adversity Come join the University It's better to be cruel than to be kind."
SO SAYS an original piece of verse recently published in a book of poems written by members of Dundee University Over 60's Exercise Class, expressing their thoughts and feelings
FOOlNOTE Atraining course and symposium to teach people about exercise in older people with both atheoretical and practical element isrun annually by the University ofDundee. Further details from the author. REFERENCES 1 Brodie D, Roberts K, Lamb K. Citysport challenge. Cambridge: Burlington Press 1991. 2 Stephens T,Craig CL, Ferris BF. Adult physical fitness inCanada: findings from the Canada Fitness Survey Can JPublic Health 1986; 77: 285-290 3 Young A, Stokes M, Crowe M. The size and strength of the quadriceps muscles ofold and young men. Clin Physiology 1985; 38: 673-677. 4 Pekkanen J, Marti B, Nissenen A. Reduction of premature mortality by physical activity. Lancet 1987; i: 1473-1477. 5 Sidney KH, Shephard RI, Harrison J.Endurance training and body composition ofthe elderly. Am J Clin Nutr 1977; 30: 326-330. 6 Tipton CH. Exercise, training and hypertension. Exerc Sport Sci Rev 1984; 12: 245-306. 7 Yano K, Reed DM, Curb JD, etal. Biological and dietary correlates ofplasma lipids and lipoproteins among elderly Japanese men in Hawaii. Arteriosclerosis 1986; 6: 422-433. 8 Overstall PW, Exton-Smith AN, Imms FJ, Johnson AL. Falls in the elderly related to postural imbalance. Br Med J 1977; 1: 261-264. 9 Johansson G, JamIo GB. Balance training in70year old women. Physiother Prac 1991; 7: 121-125. 10 Crilly ¢, Willems DA, Trenholm KJ, Delaquerriere-Richardson LF. Effect ofexercise on postural sway inthe elderly. Gerontology 1989; 35: 137-143. 11 McMurdo MET, Burnett L. Arandornised controlled trial ofexercise in the elderly. Gerontology (in press). 12 Pocock NA, Eisman JA, Yeates MG, Sambrook PN, Erbels S. Physicalfitness isamajordeterminant offemoral neckfracture and lumberspine bone density. J Clin Invest 1986; 78: 618-621. 13 Chow A, Harrison IE, Notarius C. Effect oftwo randornised exercise programs on bone mass ofhealthy postmenopausal women. Br Med J 1987; 63: 780-787. 14 Munk-Jensen N, Nielsen SP, Obel EB, Eriksen PB. Reversal ofpostmenopausal osteoporosis by oestrogen and progestogen: a double blind placebo controlled study. Br Med J 1988; 296: 1150-1152. 15 McMurdo MET, Rennie L. Acontrolled trial ofexercise inresidents ofold peoples' homes. Age Ageing (in press) 16 Molloy DW, Richardson LD, CrillyRG. The effects ofathree-month exercise programme on neuropsychological function in elderly institutionalised women: arandornised controlled trial. Age Ageing 1988; 17: 303-310. 17 Siscock D, LaPorte R, Newman G. The disease specific benefits and risks of physical activity and exercise. Public Health Rep 1985; 100: 180-188. 18 Vuori I,Suurnakki L, Suumakki T. Risk ofsudden cardiovascular death in exercise. Med Sci Sports 1982; 14: 114-115. 19 Shephard RI. Physical activity and aging. London: Croom Helm 1987. 20 Shephard RI. Intensity, duration and frequency ofexercise as determinants of the response toatraining regime. Int J Agnew PhysioI1968; 28: 38-48. 21 Shephard RI. Motivation the key tocompliance. Phys Sportsmed 1986; 13: 88-101
The writer refers, when saying "Join the University" to Over 60' s Exercise Classes which have been run by the Department of Physical Education and the University of Dundee for 13 years. (I can only imagine that the word "cruel" refers to the thought of coming to a class rather than what happens at one - and the word "kind" refers to the fact that it may be a more pleasant idea to sit at home in one's chair!) I hope so. One thousand three hundred senior citizens enrol weekly for five classes which we offer. The classes have only ever been advertised once - at the beginning to let people know what we intended to do - and we have never fallen below the 167
