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Physical Activity and Public Health in Older Adults: Recommendation From the
American College of Sports Medicine and the American Heart Association

Miriam E. Nelson; W. Jack Rejeski; Steven N. Blair; Pamela W. Duncan; James
O. Judge; Abby C. King; Carol A. Macera; Carmen Castaneda-Sceppa
Med Sci Sports Exerc. 2007;39(8):1435-1445. ©2007 American College of
Sports Medicine
Posted 08/24/2007

Abstract and Introduction

Abstract

Objective: To issue a recommendation on the types and amounts of physical
activity needed to improve and maintain health in older adults.
Participants: A panel of scientists with expertise in public health,
behavioral science, epidemiology, exercise science, medicine, and
gerontology.
Evidence: The expert panel reviewed existing consensus statements and
relevant evidence from primary research articles and reviews of the
literature.
Process: After drafting a recommendation for the older adult population and
reviewing drafts of the Updated Recommendation from the American College of
Sports Medicine (ACSM) and the American Heart Association (AHA) for Adults,
the panel issued a final recommendation on physical activity for older
adults.
Summary: The recommendation for older adults is similar to the updated
ACSM/AHA recommendation for adults, but has several important differences
including: the recommended intensity of aerobic activity takes into account
the older adult's aerobic fitness; activities that maintain or increase
flexibility are recommended; and balance exercises are recommended for older
adults at risk of falls. In addition, older adults should have an activity
plan for achieving recommended physical activity that integrates preventive
and therapeutic recommendations. The promotion of physical activity in older
adults should emphasize moderate-intensity aerobic activity,
muscle-strengthening activity, reducing sedentary behavior, and risk
management.

Introduction

In 1995 the Centers for Disease Control and Prevention (CDC) and the
American College of Sports Medicine (ACSM) published a preventive
recommendation that "Every US adult should accumulate 30 minutes or more of
moderate-intensity physical activity on most, preferably all, days of the
week".[46] Subsequently, ACSM and the American Heart Association (AHA), in a
companion paper[25] to the present article, provide an update to this
recommendation. The update is more inclusive and provides recommendations
for moderate-intensity aerobic activity, vigorous-intensity aerobic
activity, and muscle-strengthening activity. It states explicitly that many
adults should exceed the minimum recommended amount of activity.

In considering an update of the 1995 recommendation, ACSM deemed it
appropriate to issue a separate recommendation for older adults (men and
women age „ 65 yr and adults age 50 to 64 yr with clinically significant
chronic conditions and/or functional limitations). Issues naturally arise
about how to apply a recommendation intended mainly for the generally
healthy adult population to older adults, who commonly have chronic medical
conditions, low fitness levels, and/or functional limitations. In addition,
the amount of scientific information on physical activity in older adults
has grown rapidly. For example, a recent meta-analysis located 66 randomized
trials of resistance exercise as the sole form of exercise for older
adults.[35] Older Americans are the least physically active of any age
group[13] and generate the highest expenditures for medical care. Older
Americans have been the most rapidly growing age group, yet more rapid
growth in this group will occur in the next 20-30 yr when millions of baby
boomers turn 65. The feasibility of attaining higher levels of physical
activity in the population of older adults is encouraging in that recent
trends, albeit modest, are on the upswing.[14] It is possible that
increasing levels of activity could reduce medical expenditures in this
group within a year or so of the onset of behavior change.[41]

The objectives of this article are to 1) provide a preventive recommendation
on physical activity for older adults that consists of the updated ACSM/AHA
recommendation for adults with additions and modifications appropriate for
older adults; 2) explain and clarify the additions and modifications; and 3)
discuss the promotion of physical activity in older adults so as to provide
guidance about appropriate types and amounts of physical activity.

Expert Panel Process

In 1999, an expert panel was convened with the assistance and support of the
International Life Sciences Institute (http://www.ilsi.org). The panel had
expertise in public health, behavioral science, epidemiology, exercise
science, medicine, and gerontology. The panel was initially charged with
issuing a comprehensive preventive recommendation on physical activity for
older adults that addressed aerobic, muscle-strengthening, flexibility, and
balance activities, as well as the promotion of physical activity. The panel
was instructed to base its recommendation on a review of primary research
articles, literature reviews, existing preventive recommendations, and
therapeutic recommendations. (Selected therapeutic recommendations are shown
in Table 1 .)

Panel members wrote background papers addressing components of the proposed
recommendation, using their judgment to develop a strategy for locating and
analyzing relevant evidence. The panelists relied as appropriate on earlier
reviews of evidence, without repeating them. The panel did not undertake a
full review of the evidence of the benefits of aerobic activity in the older
population, because previous evidence-based recommendations for aerobic
activity applied to all adults.[61] But the panel considered whether
modifications or clarifications were needed when applying these
recommendations to older adults who commonly have chronic diseases, low
fitness levels and/or functional limitations. Recommendations for
muscle-strengthening exercises, which applied to older adults, had also been
issued by the 1990s.[61] In 2001, a consensus statement dealt with the role
of balance exercise in preventing falls among older adults.[7] In that same
year, an extensive evidence summary and consensus statement was published
from a CDC/Health Canada Expert Panel meeting entitled "Dose-Response
Aspects of Physical Activity and Health".[30] Three years earlier, ACSM had
published positions stands for older adults[39] and for healthy adults,[5]
and ACSM regularly updated its guidelines for exercise prescription.[20]
Late in the process, the panel had access to draft conclusions of an expert
panel convened by the University of Illinois at Chicago that had reviewed
the evidence on the health effects of physical activity in older adults.

The background papers developed by the expert panel were discussed and
critiqued by all members of the panel. In 2001, following regular
discussions, the panel completed a draft of a preventive recommendation.
Shortly thereafter, ACSM/AHA agreed to update the 1995 CDC/ACSM
recommendation for adults. Issuing a separate older adult recommendation had
the risk of causing confusion, if it was not consistent with the updated
adult recommendation. Hence, the panel was given a revised charge of issuing
an older adult recommendation, which was consistent with the updated
recommendation for adults. Both recommendations would be issued
simultaneously.

Given drafts of an update to the 1995 recommendation for adults, in 2004 the
panel on older adults synthesized a companion recommendation. Manuscripts
describing both recommendations were circulated for comments, revised, and
edited for consistency, prior to review and approval by ACSM and AHA.

In its recommendation for older adults, the panel used terms as they are
defined conventionally.[20,62] With the exception that only exercise is
recommended to improve balance, the recommendation uses "physical activity"
to indicate that exercise programs are not the only way to meet the
recommendation. Additionally, because of its focus on older adults, the text
uses the terms impairments, functional limitations, and disability.[50]
Impairments refer to abnormalities at the level of tissues, organs, and body
systems, whereas functional limitations are deficits in the ability to
perform discrete tasks such as climbing stairs. Disability on the other hand
is a functional limitation expressed in a social context such as the
inability to clean one's home or to shop independently.

Recommendation Statement

The following recommendation for older adults describes the amounts and
types of physical activity that promote health and prevent disease. The
recommendation applies to all adults aged 65+ years, and to adults aged
50-64 with clinically significant chronic conditions or functional
limitations that affect movement ability, fitness, or physical activity. For
the purposes of this recommendation, a chronic condition is "clinically
significant" if a person receives (or should receive) regular medical care
and treatment for it. A functional limitation is "clinically significant" if
it impairs the ability to engage in physical activity. Thus, adults age
50-64 with chronic conditions that do not affect their ability to be active
(e.g., controlled hypertension) would follow the adult recommendation.[25]
The parts of the recommendation below that are not italicized repeat the
recommendation for adults, meaning these parts apply to all adults; the
italicized parts are specific for older adults. Classification of
recommendations and level of evidence are expressed in American College of
Cardiology/American Heart Association (ACC/AHA) format as defined in Table 2
and the Methodology Manual for ACC/AHA Guideline Writing Committees.[3]

Regular physical activity, including aerobic activity and
muscle-strengthening activity, is essential for healthy aging. This
preventive recommendation specifies how older adults, by engaging in each
recommended type of physical activity, can reduce the risk of chronic
disease, premature mortality, functional limitations, and disability.

Aerobic Activity

To promote and maintain health, older adults need moderate-intensity aerobic
physical activity for a minimum of 30 min on five days each week or
vigorous-intensity aerobic activity for a minimum of 20 min on three days
each week. [I (A)] Also, combinations of moderate- and vigorous-intensity
activity can be performed to meet this recommendation. [IIa (B)]
Moderate-intensity aerobic activity involves a moderate level of effort
relative to an individual's aerobic fitness. On a 10-point scale, where
sitting is 0 and all-out effort is 10, moderate-intensity activity is a 5 or
6 and produces noticeable increases in heart rate and breathing. On the same
scale, vigorous-intensity activity is a 7 or 8 and produces large increases
in heart rate and breathing. For example, given the heterogeneity of fitness
levels in older adults, for some older adults a moderate-intensity walk is a
slow walk, and for others it is a brisk walk. This recommended amount of
aerobic activity is in addition to routine activities of daily living of
light-intensity (e.g., self care, cooking, casual walking or shopping) or
moderate-intensity activities lasting less than 10 min in duration (e.g.,
walking around home or office, walking from the parking lot).

Muscle-strengthening Activity

To promote and maintain health and physical independence, older adults will
benefit from performing activities that maintain or increase muscular
strength and endurance for a minimum of two days each week. [IIa (A)] It is
recommended that 8-10 exercises be performed on two or more nonconsecutive
days per week using the major muscle groups. To maximize strength
development, a resistance (weight) should be used that allows 10-15
repetitions for each exercise. The level of effort for muscle-strengthening
activities should be moderate to high. On a 10-point scale, where no
movement is 0, and maximal effort of a muscle group is 10,
moderate-intensity effort is a 5 or 6 and high-intensity effort is a 7 or 8.
Muscle-strengthening activities include a progressive-weight training
program, weight bearing calisthenics, and similar resistance exercises that
use the major muscle groups.

Benefits of Greater Amounts of Activity

Participation in aerobic and muscle-strengthening activities above minimum
recommended amounts provides additional health benefits and results in
higher levels of physical fitness. [I (A)] Older adults should exceed the
minimum recommended amounts of physical activity if they have no conditions
that preclude higher amounts of physical activity, and they wish to do one
or more of the following; (a) improve their personal fitness, (b) improve
management of an existing disease where it is known that higher levels of
physical activity have greater therapeutic benefits for the disease, and/or
(c) further reduce their risk for premature chronic health conditions and
mortality related to physical inactivity. In addition, to further promote
and maintain skeletal health, older adults should engage in extra muscle
strengthening activity and higher-impact weight-bearing activities, as
tolerated. [IIa (B)] To help prevent unhealthy weight gain, some older
adults may need to exceed minimum recommended amounts of physical activity
to a point that is individually effective in achieving energy balance, while
considering diet and other factors that affect body weight. [IIa (B)]

Flexibility Activity

To maintain the flexibility necessary for regular physical activity and
daily life, older adults should perform activities that maintain or increase
flexibility on at least two days each week for at least 10 min each day.
[IIb (B)]

Balance Exercise

To reduce risk of injury from falls, community-dwelling older adults with
substantial risk of falls (e.g., with frequent falls or mobility problems)
should perform exercises that maintain or improve balance. [IIa (A)]

Integration of Preventive and Therapeutic Recommendations

Older adults with one or more medical conditions for which physical activity
is therapeutic should perform physical activity in the manner that
effectively and safely treats the condition(s). [IIa (A)] So as to prevent
other conditions from developing, older adults should also perform physical
activity in the manner recommended for prevention as described herein. When
chronic conditions preclude activity at minimum recommended levels for
prevention, older adults should engage in regular physical activity
according to their abilities and conditions so as to avoid sedentary
behavior.

Activity Plan

Older adults should have a plan for obtaining sufficient physical activity
that addresses each recommended type of activity. [IIa (C)] In addition, to
specifying each type of activity, care should be taken to identify, how,
when, and where each activity will be performed. Those with chronic
conditions for which activity is therapeutic should have a single plan that
integrates prevention and treatment. For older adults who are not active at
recommended levels, plans should include a gradual (or stepwise) approach to
increase physical activity over time using multiple bouts of physical
activity („10 min) as opposed to continuous bouts when appropriate. Many
months of activity at less than recommended levels is appropriate for some
older adults (e.g., those with low fitness) as they increase activity in a
stepwise manner. Older adults should also be encouraged to self-monitor
their physical activity on a regular basis and to re-evaluate plans as their
abilities improve or as their health status changes.

Benefits of Regular Physical Activity in Older Adults

The benefits of regular physical activity in older adults are extensive. As
noted in the adult recommendation,[25] regular physical activity reduces
risk of cardiovascular disease, thromboembolic stroke, hypertension, type 2
diabetes mellitus, osteoporosis, obesity, colon cancer, breast cancer,
anxiety, and depression. Of particular importance to older adults, there is
substantial evidence that physical activity reduces risk of falls and
injuries from falls,[7] prevents or mitigates functional
limitations,[30,31,37,44] and is effective therapy for many chronic
diseases. Clinical practice guidelines identify a substantial therapeutic
role for physical activity in coronary heart disease,[19,49,59]
hypertension,[6,15,59] peripheral vascular disease,[42] type 2 diabetes,[54]
obesity,[66] elevated cholesterol,[21,59] osteoporosis,[22,64]
osteoarthritis,[4,8] claudication,[57] and chronic obstructive pulmonary
disease.[47] Clinical practice guidelines identify a role for physical
activity in the management of depression and anxiety disorders,[11]
dementia,[17] pain,[2] congestive heart failure,[51] syncope,[10]
stroke,[23] prophylaxis of venous thromboembolism,[53] back pain,[24] and
constipation.[38] There is some evidence that physical activity prevents or
delays cognitive impairment[1,34,67] and disability,[31,48,55,60] and
improves sleep.[32,56]

The 2001 consensus statement on the dose-response relationship between
physical activity and health applies to all adults (though the statement
notes that the effect of age on dose-response relationships has not been
carefully studied).[30] As an example of studies providing evidence of a
dose-response relationship in older adults, at least 33 of 44 papers that
provided data on the dose-response relationship between physical activity
and all cause mortality either recruited adults age 65 and over, or followed
cohorts of adults over time until a substantial percentage were age 65 and
over at the end of follow-up.[28,36]

The recommendation for older adults states that greater volumes of aerobic
activity help prevent unhealthy weight gain. The dose-response consensus
panel found evidence that increased levels of physical activity are
associated with prevention of weight gain, but the nature of the
dose-response relationship was unclear, and in general there was
insufficient information on whether age modified dose-response
relationships.[30] The recommendation in the 2005 Dietary Guidelines that
additional physical activity helps prevent unhealthy weight gain applies to
older adults.[65]

Differences Between the Older Adult and Adult Recommendations

Definition of Aerobic Intensity

The adult recommendation defines aerobic intensity in absolute terms, e.g.,
moderate intensity comprises 3.0 to 6.0 MET activities. A different
definition of aerobic intensity is appropriate for older adults, because
fitness levels can be low. For example, performing 3.0 to 6.0 MET activities
either requires relatively vigorous effort or is impossible for older adults
with low fitness. The older adult recommendation defines aerobic intensity
as relative to fitness, in the manner of an exercise prescription. For
aerobic exercise, ACSM recommends a target intensity of 50-85% of oxygen
uptake reserve-a range that includes both moderate and vigorous
exercise.[20] If oxygen reserve is measured on a 10 point scale, then
moderate intensity begins at around "5" (50%), and the range of vigorous
intensity does not quite reach "9" (90%). Simply telling older adults that
their perceived effort during activity should be 5-6 (or 7-8) on a 10-point
scale may not achieve the desired level of effort. Subjective perception of
effort is related to objectively measured level of effort, but not
linearly.[9] When there is concern an adult will not engage in activity at
the desired intensity, a period of supervised exercise can help the adult
learn the desired level of effort.

Muscle-strengthening Activities

The recommendation specifies the intensity (level of effort) of activities
that maintain and increase muscle strength. For adults generally, ACSM
recommends resistance training of moderate intensity.[20] High intensity
training is an option for older adults, preferably in supervised settings or
in adults with sufficient fitness, experience, and knowledge of resistance
exercise. Historically, people have increased and maintained their strength
through purposeful physical activity, such as manual labor on a farm. Today,
older adults will commonly elect to meet the muscle-strengthening
recommendation through exercise programs involving such activities as weight
bearing calisthenics or progressive weight training. For resistance
exercise, ACSM recommends performing at least one set of repetitions for
8-10 exercises that train the major muscle groups, and recommends exercise
for each muscle group occur on two or three nonconsecutive days each
week.[20] Experts recommend 10 to 15 (as opposed to 8-12) repetitions per
set for older adults.[20]

Flexibility Activities

Flexibility activity is recommended to maintain the range of motion
necessary for daily activities and physical activity. Unlike aerobic and
muscle strengthening activities, specific health benefits of flexibility
activities are unclear. For example, it is not known if flexibility
activities reduce risk of exercise-related injury[58]. In addition, few
studies have documented the age-related loss of range of motion in healthy
older adults. However, flexibility exercises have been shown to be
beneficial in at least one randomized trial and are recommended in the
management of several common diseases in older adults ( Table 1 ).[33] At
least 10 min of flexibility activities is recommended based upon the time
required for a general stretching routine involving major muscle and tendon
groups with 10-30 s for a static stretch and 3-4 repetitions for each
stretch.[20] Preferably, flexibility activities are performed on all days
that aerobic or muscle-strengthening activity is performed.

Balance Exercise

The recommendation for balance exercise is consistent with a clinical
practice guideline published in 2001.[7] In community-living older adults at
risk for falls (e.g., with frequent falls or mobility problems),
multi-component interventions that include regular physical activity are
effective in preventing falls.[7] Physical activity, by itself, may reduce
falls and fall injuries as much as 35-45%.[52] Because research has focused
on balance exercise rather than balance activity (e.g., dancing), only
exercise is currently recommended.[7] The preferred types, frequency, and
duration of balance training are unclear and not specified in the clinical
guideline.[7] Balance exercise three times each week is one option, as this
approach was effective in a series of four fall prevention studies.[52] The
recommendation applies only to community-dwelling older adults because of
insufficient data in long-term care settings and hospital settings. The
guideline for prevention of falls does not specify an age cutoff,[7] but
there are few data on the effects of physical activity on falls in adults
less than age 65.

Integration of Preventive and Therapeutic Recommendations

Older adults should perform physical activity in the manner recommended for
prevention as described herein. Older adults also commonly have chronic
conditions ( Table 3 ) for which physical activity is therapeutic. Hence,
many older adults require an activity plan that integrates preventive and
therapeutic recommendations. Integration is facilitated by the fact
preventive recommendations are similar to therapeutic recommendations for
many common diseases, including coronary artery disease, hypertension, type
2 diabetes, stroke, high cholesterol, osteoporosis, and/or osteoarthritis (
Table 1 ). In adults with no activity limitations, the activity plan
specifies aerobic, muscle-strengthening, and flexibility activities (and
possibly balance exercise), with types and amounts that meet both preventive
and therapeutic recommendations. To illustrate combining recommendations, an
activity recommendation for a person with osteoporosis would start with the
preventive recommendation for aerobic, muscle strengthening, and balance
activities, but emphasize weight bearing activities, and add high impact
activities like jumping for those who tolerate them.[64] Adjustments in the
activity plan for a person with arthritis of moderate severity could involve
in combination with strength training tailoring the number of aerobic
activity days to 3-5 as tolerated every other day.[8]

It is more challenging for a person with activity limitations to develop a
physical activity plan, which combines preventive and therapeutic
recommendations. In 1999, 20% of Medicare enrollees had impairment in IADLs
(instrumental activities of daily living) or ADLs (activities of daily
living) or were institutionalized.[18] Inability to walk 2-3 blocks was
reported by 14% of men and 23% of women.[18] Clearly, a target level of
physical activity below that of the typical preventive and therapeutic
recommendations in Table 1 is appropriate for a subgroup of older adults. An
assessment of the nature of the activity limitation and of the capability
and preferences of the person will determine the target activity level and
other details of the activity plan. Often the plan will rely on health care
and community resources designed for people with activity limitations, such
as cardiac rehabilitation and pulmonary rehabilitation centers, and exercise
classes specifically designed for adults with arthritis.

Need for an Activity Plan

An activity plan identifies recommended levels of physical activity for a
specific person and describes how the person intends to meet them. It is
recommended that older adults with chronic conditions develop an activity
plan in consultation with a health care provider so that the plan adequately
takes into account therapeutic and risk management issues related to chronic
conditions. The plan should be tailored according to chronic conditions and
activity limitations, risk for falls, individual abilities and fitness,
strategies for minimizing risks of activity, strategies for increasing
activity gradually over time (if the person is not active at recommended
levels), behavioral strategies for adhering to regular physical activity,
and individual preferences. Healthy, asymptomatic older adults without
chronic conditions should also develop an activity plan, preferably in
consultation with a health care provider or fitness professional, so as to
take advantage of expertise and resources on physical activity and injury
prevention. This recommendation reframes the common advice to consult a
health care provider before starting to increase physical activity. Health
provider consultation regarding physical activity should occur regardless of
whether an adult currently plans to increase physical activity, as it is
part of the ongoing process of promoting physical activity that should occur
in geriatric medicine. This recommendation is consistent with a recently
developed quality of care measure for older adults that measures whether
older adults discuss physical activity with a health care provider at least
once a year.[43]

Areas of Emphasis in Promoting Physical Activity in Older Adults

With sufficient skill, experience, fitness, and training, older adults can
achieve high levels of physical activity. The promotion of physical activity
in older adults should avoid ageism that discourages older adults from
reaching their potential. At the same time, it is difficult or impossible
for some older adults to attain high levels of activity. Several areas
should be emphasized in promoting physical activity in older adults as
described below.

Reducing Sedentary Behavior

There is substantial evidence that older adults who do less activity than
recommended still achieve some health benefits. Such evidence is consistent
with the scientific consensus for a continuous dose-response relationship
between physical activity and health benefits.[30] For example, lower risks
of cardiovascular disease have been observed with just 45-75 min of walking
per week.[40]

Increasing Moderate Activity and Giving Less Emphasis to Attaining High
Levels of Activity

Realistic goals for aerobic activity will commonly be in the range of 30-60
min of moderate-intensity activity a day, as illustrated by the Health
Canada recommendation for older adults[26] ( Table 1 ). Vigorous activity
has higher risk of injury and lower adherence.[20] Age-related loss of
fitness, chronic diseases, and functional limitations act as barriers to
attaining high levels of activity. Vigorous activity and/or high levels of
activity are appropriate for selected older adults with sufficient fitness,
experience, and motivation.

Taking a Gradual or Stepwise Approach

The standard advice to increase physical activity gradually over time is
highly appropriate and particularly important for older adults. This advice
minimizes risk of overuse injury, makes increasing activity more pleasant,
and allows positive reinforcement for small steps that lead to attainment of
intermediate goals. It can be appropriate for older adults to spend a long
time at one step (e.g., attending exercise classes two or three days a week)
so as to gain experience, fitness, and self-confidence. Very deconditioned
older adults may need to exercise initially at less effort than a "5" on a
10-point scale and may need to perform activity in multiple bouts („10 min)
rather than in a single continuous bout.[20] In addition, activity plans
need to be reevaluated when there are changes in health status.

Performing Muscle-strengthening Activity and Engaging in All Recommended
Types of Activity

Muscle-strengthening activity is particularly important in older adults,
given its role in preventing age-related loss of muscle mass,[60] bone,[44]
and its beneficial effects on functional limitations.[30,31,35,55,60]
Currently, only about 12% of older adults perform muscle-strengthening
activities at least twice a week.[63]

Sustaining Emphasis on Individual-level and Community-level Approaches

As with younger adults, promotion of physical activity in older adults
relies upon both individual and community approaches that are evidence-based
and reflect theory and research on behavior change. For example, the Task
Force on Community Preventive Services has recommended or strongly
recommended several community-level interventions as effective in promoting
physical activity, such as interventions to increase access to places of
physical activity combined with informational outreach.[29]

Using Risk Management Strategies to Prevent Injury

Chronic conditions increase risk of activity-related adverse events, e.g.,
heart disease increases risk of sudden death and osteoporosis increases risk
of activity-related fractures. Activity-related musculoskeletal injuries act
as a major barrier to regular physical activity.[27] While these
considerations lead to more emphasis on risk management, there is
insufficient research on effective strategies to prevent injuries. Risk
management strategies mainly reflect clinical experience, expert opinion,
and legal liability concerns. Evidence that risk management strategies can
be effective comes from the observation that published exercise studies
routinely implement risk management and serious adverse events in these
studies are rare.[12,45] However, research studies presumably exclude adults
at high risk of injury.

Conclusion

Virtually all older adults should be physically active. See Table 4 . An
older adult with a medical condition for which activity is therapeutic
should perform physical activity in a manner that treats the condition. In
addition, an older adult with medical conditions should engage in physical
activity in the manner that reduces risk of developing other chronic
diseases as described above. Given the breadth and strength of the evidence,
physical activity should be one of the highest priorities for preventing and
treating disease and disablement in older adults. Effective interventions to
promote physical activity in older adults deserve wide implementation.

What else is published in Medicine & Science in Sports & Exercise®? Visit
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Table 1. Summary of Selected Preventive or Therapeutic Recommendations for
Aerobic Activity, Muscle-strengthening Activity, and Flexibility Activity




Table 2. ACC/AHA Approach to Assigning the Classification of Recommendations
and Level of Evidence




Table 3. Percent of Older Adults With Selected Chronic Conditions in 1995
and 2001-2002




Table 4. Summary of Physical Activity Recommendations for Older Adults -
2007






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Acknowledgements
The authors thank David M. Buchner, M.D., M.P.H., at the Division of
Nutrition and Physical Activity, Centers for Disease Control and Prevention,
Atlanta, GA, for his technical assistance with the development of these
recommendations. In addition, the authors acknowledge Debra Kibbe and the
International Life Sciences Institute (ILSI) Research Foundation (formerly
ILSI Center for Health Promotion) for assistance provided to the expert
panel.

Reprint Address
Miriam E. Nelson, Ph.D., FACSM, Director, John Hancock Center for Physical
Activity and Nutrition, Friedman School of Nutrition Science and Policy, 150
Harrison Avenue, room 249, Tufts University, Boston, MA 02111; E-mail:
miriam.nelson@...


Miriam E. Nelson,1,2 W. Jack Rejeski,3 Steven N. Blair,4 Pamela W. Duncan,5
James O. Judge,6,7 Abby C. King,8 Carol A. Macera,9 and Carmen
Castaneda-Sceppa2,10

1John Hancock Center for Physical Activity and Nutrition, Tufts University,
Boston, MA;
2Friedman School of Nutrition Science and Policy, Tufts University, Boston,
MA;
3Department of Health and Exercise Science, Wake Forest University,
Winston-Salem, NC;
4Department of Exercise Science and Department of Epidemiology and
Biostatistics, University of South Carolina, Columbia, SC;
5Division of Physical Therapy, Department of Community and Family Medicine,
Duke University, Durham, NC;
6Evercare, Hartford, CT;
7Center on Aging, University of Connecticut School of Medicine, Farmington,
CT;
8Departments of Health Research & Policy and Medicine, Stanford University,
Stanford, CA;
9Graduate School of Public Health, San Diego State University, San Diego,
CA; and
10Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts
University, Boston, MA

The first two authors were co-chairs of the expert panel; the other
coauthors were members of the expert panel and are listed alphabetically.