Issue #1: The Inactivity Problem

Background

Before describing the new 2019 study, a brief background is helpful: More than a decade ago, a 2008 expert panel on physical activity and health reported that U.S. adults do not get enough exercise. The panel reported that about 30% of deaths in the U.S. (“all-cause mortality”) are linked to inactivity, or not enough activity. In other words, failure to be more active is killing us.

That 2008 report called for increased physical activity, specifically increased aerobic, strength building, and balance activity. The report set forth guidelines for how much and how often. See Lifesavers for specifics.

Fast forward to today

To see how much progress was achieved, a 2019 study by Du and his research team examined U.S. activity data every two years for a decade. They found that little had changed. The recommendations for increased activity had failed to change behavior.

About half of older adults then and now do not meet the standards for aerobic activity, using generous definitions that include all routine activities. In addition, we are sedentary about 6 hours each day (See Issue #2 of PreventFalls.net examining the topic of sedentary behavior and ways to reduce it.)

The Du research showed no improvement in aerobic activity over a decade. This 2019 finding is important for several reasons.

• First, this focus is a reminder that our lives depend on increasing physical activity. What could be more motivating than that! Sometimes we think, wrongly, that safety comes with being less active, staying home. For those with a history of falling, even without injuries, fear of future falls sometimes leads to reducing activity level.

More activity is good for everyone

The 2008 US Dept. of Health & Human Services report and a second edition published in 2018 paid special attention to those with chronic conditions and disabilities. Knowing that many older adults live with chronic conditions (e.g., cardiovascular disease, type 2 diabetes), the report emphasized the benefits for everyone meeting the guidelines. For those with specific limitations, a treating physician or activity specialist can help with adaptations that might be needed.

A call to action

The “all cause mortality” problem linked to inactivity has its counterpart in the national falls evidence (below) that shows fatalities due to falls are increasing.  Considering this evidence together with the report by Du and colleagues that U.S. adults have not improved activity levels over the past decade, the call to action gets louder.

• Second, the Du study is important because it looked at data over a ten year period for a national sample, that is 27,000 participants. It helps us to recognize that the common denominator for all the inactivity is being an adult in the U.S. (and also many other countries) in the 21st century.

The health problem of inactivity is linked to our national norms. Norms are the socially acceptable ways most of us typically behave. In general, for instance, we do not walk to a destination (aerobic activity), we drive/ride or take the train or bus. We do not play sports (often related to strength-building), we watch them on television.  We do not shop for the groceries, bring home the purchases, and prepare the meal (calling for balance skills and flexibility), we go through the drive-in – or, even less physically demanding, we use a delivery app. Such social conditions mean our efforts to be more active will be an uphill battle.

Some municipalities are working hard to be more health-friendly. They are adding, for instance, walking paths in parks, and benches along the way for those who could not proceed otherwise.

Moving from science to practice

• The third reason that the Du findings are important is because now we know. We did not know about this pattern of fatalities earlier, but we do know now.  It is apparent from Du’s results of “no improvement” that few were aware of the earlier report.

It is often said among researchers that it takes a generation to move from science to practice. I think that is changing these days, with more opportunities to move information out faster. PreventFalls.net is one effort to help get the information to the people who need it, to all of us wanting to live well longer.

The good news: Studies show that even small changes can make a health difference. For instance, programs emphasizing “small change” with people adding 2,000 steps rather than 10,000 or more continue to be successful in both short and long term results.

Below we use lifesavers from Aerobic Activities, Muscle Strengthening, and Balance/Flexibility lifesavers plus small-change goal setting.

What you can do right now

If you are currently or recently inactive, let’s say your goal is to increase activity gradually, working up to 10 minutes daily by one month from now.

1. Right now, think of the smallest possible step you could take toward being more active. Then make it smaller. Then do it. For instance, you could take a 10-minute walk every morning and evening. But make that step smaller. You can change 10-minutes to 5 minutes and instead of morning and evening, try it once a day for a week.
2. Next week, think of another small step you can take. You can do it instead of the first one, for variety.  Or, do it on alternating weeks. If you think you can do more, then keep the first and add in the second.
3. Keep doing steps one and two.

Log book

If you are thinking that steps 1-3 above will be a good approach for you, get a notepad and pencil right now. Studies show that keeping a log of what you do, and what you think about it can make a difference in achieving your goals.

Write down your plan for doing step 1. Be detailed in what you record. For instance, “walk at 5 p.m. down the street to the stop sign and back (estimated time 5 minutes).”

After your walk, ask yourself, and record your answers:

How did it go? Can you do it again tomorrow? If you need to change it, for instance, go half that distance to stay within the 5 minutes, make the changes in your written plan now. For instance, “Walk at 5 p.m. past 5 houses and back (est. 5 min.).”

Repeat daily for a week and then make a similar detailed plan for step 2.

If you are already somewhat active, consider that you can increase duration and, perhaps, intensity.

1. Consider your current routine. If you walk for 30 minutes, twice a week, can you add frequency such as one more day a week of walking, beginning slowly, with 10-15 minutes? Can you add duration such as going from 30 minutes to 35 minutes on your two established walk days?
2. Do you routinely do strength-building exercises? If so, is there one new exercise you can add to that routine?
3. It can be helpful to increase variety. Whether or not you plan to do an additional exercise, can you try an alternative to avoid potential boredom?
4. Same as above, for balance exercises.
5. For more exercise options, see the National Institute on Aging’s and the National Council on Aging’s websites for physical activities for older adult falls prevention.

Consider which one or more of the above you will add so that you are more active. Write down your plan in detail. See the log book notes above. This is your plan. It is a great step to improved health, and, thereby, reduced falls risk.

Watch out

There are two typical ways to block progress with making the changes above. 

1. Your enthusiasm may tempt you to do too much, too soon. One quick leap can lead to another and soon to being overwhelmed. Slow and steady wins this race to living well longer. 

2. Your anticipation of change may keep you from starting. This is another good reason to start any change with small steps. If you have been inactive, appreciate that adding a small step is an increase of 100% over your prior routine.  If you have been somewhat active, acknowledge that change can feel disruptive but you will soon have a new and improved baseline.

Congratulations!

For everyone undertaking change, be very proud of yourself!