Physical activity, particularly engaging in the recommended 30 minutes a day of moderate-level physical activity, is critical for all older adults to prevent immobility and its complications and to optimize overall health and quality of life (American College of Sports Medicine and the American Heart Association, 2008).
There is now substantial evidence documenting the many health benefits associated with physical activity for adults of all ages (Netz et al., 2005; Palombaro et al., 2005; Prohaska et al., 2006). Physical activity improves health even for chronically ill or frail older adults for whom it is often falsely believed that physical activity will exacerbate versus ameliorate underlying health problems (Roddy et al., 2005; Roddy et al., 2005; Singh et al., 2005). Meta-analytic reviews have provided strong evidence that participation in either nonspecific physical activity or specific aerobic or resistive exercise is associated with a variety of health improvements such as decreased risk of coronary heart disease and stroke (Cornelissen & Fagard, 2005), decreased progression of degenerative joint disease (Roddy et al., 2005), improved cognitive function in sedentary older adults (Colcombe et. al., 2006), and a positive association with successful aging (Depp & Jeste, 2006).
The specific amount of exercise needed to achieve the desired benefit varies based on individual goals and capabilities. Combining recommendations from the American College of Sports Medicine (ACSM), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH), health care providers should recommend that older adults engage in 30 minutes of physical activity most days of the week, and this activity should incorporate aerobic activity (walking, dancing, swimming, biking), resistance training, and flexibility exercises (National Institute of Aging, 2009). Exercises can be done individually or in group settings depending on the individual’s preference, cognitive ability, and motivational level.
In light of the many benefits of physical activity and the relatively low risk of serious adverse events associated with low- and moderate-intensity physical activity, current guidelines from a consensus group from the American Heart Association and the American College of Cardiology no longer recommend routine stress testing for those initiating a physical activity program (United States Preventive Services Task Force, 2004). For sedentary older adults who are asymptomatic, low-intensity physical activity can be safely initiated regardless of whether or not they have had a recent medical evaluation.
Although low-intensity physical activity is quite safe for most older people (Cress et al., 2005), it is nonetheless important to weigh the potential risks and benefits associated with physical activity for each older person. A clear and open discussion of the risk-to-benefit ratio is especially important because many older adults may be unwilling to increase their physical activity due to largely unfounded fears that being more active may exacerbate underlying disease and cause trauma (Bruce et al., 2002; Wilcox et al., 2003). The absolute risk of sudden death or acute cardiac events with vigorous exercise is very low (Goldberger et al., 2008), and these events are not likely to occur at a moderate level of physical activity. Older adults and their health care providers, however, continue to be concerned that such things can happen. In reality, the greatest risk of harm associated with exercise is due to falls and generally minor musculoskeletal injuries rather than more serious cardiovascular incidents (Hootman et al., 2002; Sutton et al., 2001).
Although screening is not necessary prior to engaging in moderate-level physical activity, screening is preferred by many older adults. Screening helps to assure older individuals of the safety of exercise and to provide direction as to what type and amount of exercise will benefit them (Resnick et al., 2005). A new screening tool, Exercise/Physical Activity and Screening for You (the EASY), was developed to be used independently by older individuals or completed with their health care provider (Resnick et al., 2008). The tool is focused on helping individuals determine which physical activities will be safe and useful given their underlying medical problems.
To develop such a screening, an interdisciplinary group of health care providers, exercise trainers and physiologists, researchers, and experts in the field of public health worked together to review the literature and the thoughts and opinions of clinicians and older adults about current screening processes and their utility. We learned from that process that the current tools available, such as the PAR-Q, often resulted in inappropriate referrals for further costly, and potentially harmful, invasive testing (such as cardiac stress tests). In addition, we were told by older adults that screening gave them a sense of assurance that they were "safe" to engage in a regular physical activity (Resnick et al., 2005). Overall, the EASY development team concluded that a paradigm shift was needed in screening practices so that the focus changed from thinking of screening as a way in which to exclude individuals at risk for a sudden cardiac event to an emphasis on individually tailored programs geared toward optimal physical benefits without the risk of an adverse event.
The development team initiated a consensus process to develop a quick and easy-to-use screening tool that would: (1) facilitate the assessment of health problems that might put the individual at risk for injury; (2) provide initial strategies for tailoring an exercise program to an individual’s health conditions; and (3) provide a comprehensive listing of safety tips to minimize potential health risks. The product of this work was the development of the EASY.