There are three main components of health related fitness: aerobic fitness, musculoskeletal strength and endurance, and flexibility. While the link between aerobic and musculoskeletal fitness with health and independence is clear and consistent, there is limited evidence to show any relationship between flexibility and long term functional health outcomes.
So, is flexibility important? It is important to note that I am not asking if stretching is important. Of course, at the end of a long run or strenuous workout, one should stretch as there is evidence to suggest that this prevents injury and maintains flexibility. But does it matter if I am a flexible person? Do measures of flexibility actually determine whether I will be healthy and remain independent when I am older? A recent review published in the Journal of Aging Research attempted to answer just this question. In a paper entitled “Flexibility Training and Functional Ability in Older Adults: A Systematic Review” Dr. Stathokostas and her colleagues reviewed 22 research studies and found that flexibility training (i.e. stretching of the appropriate intensity, frequency and duration) leads to an increase in range of motion of a joint, but does not necessarily lead to an increase in functional abilities. The average age of participants in the papers reviewed was 74 years. The main outcomes assessed were range of motion about a joint (flexibility), assessments of gait and walking speed as well as a variety of functional tests such as how long one takes to stand from a chair and walk 8 meters. According to the results of the review, gait and walking speed were positively affected by flexibility training, but this was not consistent. Further, many studies did not demonstrated a significant improvement in functionality with flexibility training. In a subgroup of older old participants (aged 80 and older) results were a bit more promising, but still not consistent.
The flexibility training used in the studies ranged in intensity, type, duration and frequency. Some studies used whole body training i.e. joints all over the body were trained while others only used lower body/lower back stretches. The studies ranged in duration from 4 weeks to one year and the frequency was approximately 4 sessions per week. Stretches were held anywhere from 30-85 seconds. Despite scientifically devised flexibility training sessions, the review showed that there is not much benefit on overall functional ability. So, why is there such an emphasis on stretching? Well, as I mentioned above, for those of us who are active we need to stretch to ensure we prevent injury and to ensure we are able to maximize our athletic performance. Also, for those who have sedentary jobs, stretching can help ease muscle tension. Of course, an inflexible lower back leads to significant problems as well. It seems then that maintaining “normal” flexibility is important, but increasing flexibility may offer no additional health benefit.
Take Home Message: Maintaining “normal” flexibility is important for general health however, it is apparent from this review that flexibility training is not strongly associated with functional ability, particularly among older adults. Thus, while we should spend some time stretching after a workout or a long day at the office, there may be no point in spending additional time stretching. I would suggest that you use that extra stretching time to do some aerobic activity (eg. walking) as aerobic fitness is STRONGLY associated with health and wellness. Whatever you do, stay active so that you can maintain your HALF!
There is no doubt in the exercise science and health world that strength training (a.k.a. weight training or resistance training) is beneficial for older adults. In addition to increasing overall strength, it prevents bone and muscle wasting as you age. This is particularly important for older women. Women are at a higher risk of developing conditions such as sarcopenia (low muscle mass that increases risk of becoming dependent) and osteoporosis (low bone mineral density that increases risk of fractures) than men. In other words, they are more likely to require assistance to conduct activities of daily living such as cleaning, cooking and washing themselves, than are men. This is one of the reasons we see more women living in assisted living facilities (nursing homes) than men. Luckily, women can prevent this loss of independence if they routinely participate in strength training. While there are guidelines available on what you should do, there is some debate over “how much” you need to do to reap these health and fitness gains.
A recent study conducted by Farinatti et al. in the Journal of Strength and Conditioning Research set out to determine the difference in benefits from training once a week compared to training twice or even three times per week. Women over the age of 60 participated in 16 weeks of strength training and completed fitness assessments both before and after this training program. The training program consisted of 8-12 repetitions of 10 exercises conducted at an intensity of 60-80% of maximum measured strength. Only one set of these exercises was conducted at each session and weight (loads) was increased by 5% when the participant was able to perform more than 12 repetitions. Thus overall, participants who were in the group that exercised once per week conducted 8-12 repetitions of each of the 10 exercises at a weight that caused their muscles to fatigue completely. Those in twice weekly and three times weekly groups did this same exercise routine on one or two other days of the week. The authors found that generally, more was better. When looking at gains in strength, those who exercised three times per week had the greatest gains. Furthermore, those in the group who exercised three times per week also had the greatest gains in functional fitness. However, it should be noted that ALL GROUPS had significant improvements in strength and functional fitness i.e. just one set of high intensity strength training per week led to significant gains in strength and thus health!
TAKE HOME MESSAGE: As we age we lose muscle mass and increase our risk of becoming dependent on others. In order to maintain our independence it is essential to include strength training in our weekly exercise program. Research indicates that one set of 8-12 repetitions of high intensity strength training is sufficient to improve strength and functional fitness, but that doing this on 2 or even 3 days of the week will lead to greater benefit. So, if you are crunched for time be sure to include at least one set of high intensity strength training to your weekly routine. If muscle loss is of concern to you, do your strength training exercises 3 days/week. Remember, strength training is essential in ensuring your HALF!
Successful aging is a term used to define the success or health of an individual as they age. It specifically refers to success in aging within the area of physical health, psychological health and social health. Physical health refers to whether one has a chronic condition such as heart disease, high blood pressure or diabetes and whether one has functional impairments such that they require assistance in basic activities (eg. a cane or a walker). Psychological health refers to depression, cognitive function (mental sharpness) and emotional vitality (happy and interested in life). Finally, social health refers to items such as engagement with life, social support and spirituality.
Research has shown that people who are physically active are more likely to age successfully. But the influence of sedentary behaviour i.e. the amount of time one spends in sitting activities, on successful aging is not known. In a recent paper entitled “Sedentary Behavior and Physical Activity are Independent Predictors of Successful Aging in Middle-Aged and Older Adults” published in the Journal of Aging Research (link), a colleague and I set out to understand the influence of sedentary behaviour in this relationship. Using a large sample of middle-aged and older adults from Canada we determined that sedentary behaviour influenced the chances of aging successfully (overall, physically, psychologically and socially) regardless of how physically active one was. Specifically, compared to sedentary older adults, moderately sedentary and least sedentary older adults were 38% and 43% more likely to be aging successfully overall, respectively. In other words, despite being physically active, someone who spends a great deal of time sedentary (for example, sitting at a desk or on a couch) is less likely age successfully in all three domains!
I must acknowledge, as with any research, this paper comes with some limitations. But, it is the first in what will hopefully be a growing field of research to indicate that being active isn’t enough, we must cut down on the amount of time we spend in sedentary activities in order improve our health or to maintain good health. Some people may say that this is impossible, that it is difficult enough to find 30 minutes to exercise. But there are simple strategies one can use to decrease sedentary time or to break up sedentary time. For great information and tips on this, please visit: http://www.sedentarybehaviour.org/ or http://blogs.plos.org/obesitypanacea/
TAKE HOME MESSAGE: Regardless of your age, you should make an effort to decrease the amount of time you spend in sedentary activities. This may be of particular importance to middle-aged and older adults, as these ages are considered “high risk” for the development of chronic diseases such as heart disease or cancer and are generally associated with higher rates of depression and loneliness. To ensure that you or your parents and loved ones age successfully, be sure to incorporate as much activity into your day, whether it be walking or gardening or cooking/cleaning or simply standing at your desk or sitting on a stability ball to watch TV. Anything you can do to break up sedentary time will help, so get moving and keep up with your HALF!