Dr Samuel Nyman, Department of Medical Sciences and Public Health, Bournemouth University – Written evidence (INQ0030)

A multidisciplinary approach to promote physical activity and exercise among older people

Dr Samuel Nyman is a leading researcher on preventing falls and promoting physical activity among older people. With a background in health psychology, his interests include the use of behaviour change techniques to promote exercise among older people and people with dementia. Dr Nyman was consulted for his expertise by Haringey Council in October 2016, for his input into the council’s Physical Activity for Older People Scrutiny Review. This directly led to recommendations that were agreed by the council.

This evidence is submitted in response to the government’s call, so that policy makers are aware of the need for a multidisciplinary perspective for promoting physical activity and preventing falls. This will include the use of psychological knowledge on behaviour change but also the expertise of others including urban planners to make environments more conducive for physical activity among older people.

Question 11: How feasible is the Government’s aim to provide five more years of health and independence in old age by 2035?”

Specifically question a. What strategies will be needed to achieve the Government’s aim?.

1. We’ve known, since the 1950s, that physical activity is a key factor in promoting the physical and mental health of people of all ages, including older people[1]. Leisure time physical activity is associated with a reduction in risk of 13 types of cancer, regardless of body size or smoking history[2]. However, people do not do enough physical activity to reap the health benefits, particularly at older age. The older people get, the less likely they are to be physically active[3],[4] resulting in a decrease in health and wellbeing directly due to physical inactivity; an estimated 9% of worldwide premature mortality is caused by lack of physical activity[5].

2. A strategy to promote physical activity and exercise in later life would directly address the government’s agenda of increasing the population’s health span. This will include people with dementia, and help maintain psychological wellbeing in later life[6]. It is also a key strategy for preventing falls among older people. Falls are recognised globally as a public health issue among older people[7], and exercise is the single most effective intervention for reducing the risk of falls including injurious falls[8].

3. To promote physical activity and exercise among older people, there is a need to use an ecological approach, i.e. an interdisciplinary strategy. For this, what is needed is a multi-layered perspective that moves beyond motivating individuals, to ensuring that there is also the capability and opportunity for them to exercise and be physically active[9]. This requires a broad range of disciplines including physiology, psychology, implementation science, landscape and built environment architecture, and sociology[10] .

4. For example, from a sociological perspective, by creating opportunities that allow men to express their masculinity, we can engage rural dwelling older men with dementia to engage with gaming technology to increase social wellbeing[11]. Such an approach could easily be expanded to include physical activities or exercise with the use of game technology, known as ‘exergaming’.

5. From a psychological approach, we know that some behaviour change techniques are more successful with some individuals than others in increasing physical activity[12], [13] . Hence, approaches that coach and facilitate older people to be active in their decision-making to promote health and prevent falls has been successful[14].

6. Behaviour change techniques also show promise for their use in promoting physical activity among older people with dementia[15].

7. By way of an example, my Tai Chi research, which is currently under peer review and not yet published, provided older people with dementia and their family carers with the opportunity to learn Tai Chi from a qualified instructor. Classes were provided weekly and carers facilitated home practise on the other days of the week. This provided an opportunity for people with dementia and their carers to enjoy an activity together and to do more exercise. The classes were designed for people with dementia, and so the social environment was very welcoming. We also provided Tai Chi classes, as Tai Chi lends itself for people of all ages and abilities given its slow, gentle, calming, and repetitive nature. We also used behaviour change techniques to facilitate class attendance and motivation to continue with home practice[16], [17].

Additional Reference

Sherrington, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z., Howard, K., . . . Lamb, S. (2019). Exercise for preventing falls in older people living in the community (Review). Cochrane Database of Systematic Reviews, 1, Art. No.: CD012424-DOI: 012410.011002/14651858.CD14012424.pub14651852.

19 September 2019