International exercise recommendations in older adults (ICFSR): Expert consensus guidelines

Authors: IZQUIERDO, MIKEL - Public University Of Navarra; MERCHANT, R - National University Hospital Singapore; MORLEY, JOHN - St Louis University; ANKER, S - Charite' University Hospital Berlin; APRAHAMIAN, IVAN - Faculty Of Medicine Of Jundiai; ARAI, HIDENORI - National Center For Geriatrics And Gerontology; AUBERTIN-LEHEUDRE, MYLENE - University Of Quebec; BERNABEI, ROBERTO - Catholic University Of The Sacred Heart Italy; CADORE, E - Universidade Federal Do Rio Grande Do Norte (UFRN); CESARI, MATTEO - University Of Milan; CHEN, LIANG-KUNG - National Chaio Tung University; DE SOUTO, BARRETTO - University Hospital Center Of Toulouse; DUQUE, GUSTAVO - University Of Melbourne; FERRUCCI, LUIGI - National Institute On Aging (NIA, NIH); FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; GARCIA-HERMOSO, ANTONIO - Public University Of Navarra; GUTIERREZ-ROBLEDO, L. - National Institute Of Geriatrics; HARRIDGE, S., D. - King'S College; KIRK, B. - University Of Melbourne; KRITCHEVSKY, STEPHEN - Wake Forest School Of Medicine; LANDI, FRANCESCO - Catholic University Of The Sacred Heart Italy; LAZARUS, NORMAN - King'S College; MARTIN, F.C. - King'S College; MARZETTI, E. - Catholic University Of The Sacred Heart Italy; PAHOR, MARCO - University Of South Florida College Of Medicine; RAMIREZ-VELEZ, R. - Public University Of Navarra; RODRIGUEZ-MANAS, LEOCADIO - Instituto De Salud Carlos Iii; ROLLAND, YVES - University Of Toulouse; RUIZ, J. - University Of Miami; THEOU, O. - Dalhousie University; VILLAREAL, DENNIS - Baylor College Of Medicine; WATERS, D. - University Of Otago; WON WON, C. - Kyung Hee University; WOO, JEAN - The Chinese University Of Hong Kong (CUHK); VELLAS, BRUNO - University Of Toulouse; FIATRONE, SINGHMARIA - University Of Sydney

Submitted to: Journal of Nutrition Health and Aging
Publication Type: Other
Publication Acceptance Date: 7/23/2021
Publication Date: 7/30/2021
Citation: Izquierdo, M., Merchant, R.A., Morley, J.E., Anker, S.D., Aprahamian, I., Arai, H., Aubertin-Leheudre, M., Bernabei, R., Cadore, E.L., Cesari, M., Chen, L., De Souto, B.P., Duque, G., Ferrucci, L., Fielding, R.A., Garcia-Hermoso, A., Gutierrez-Robledo, L.M., Harridge, S., D.R., Kirk, B., Kritchevsky, S.B., Landi, F., Lazarus, N., Martin, F., Marzetti, E., Pahor, M., Ramirez-Velez, R., Rodriguez-Manas, L., Rolland, Y., Ruiz, J.G., Theou, O., Villareal, D.T., Waters, D.L., Won Won, C., Woo, J., Vellas, B., Fiatrone, S.A. 2021. International exercise recommendations in older adults (ICFSR): Expert consensus guidelines . Journal of Nutrition Health and Aging. 25(7):824-853. https://doi.org/10.1007/s12603-021-1665-8.
DOI: https://doi.org/10.1007/s12603-021-1665-8

Interpretive Summary:

Technical Abstract: The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.