Most of us would agree that quality of life in later years depends to a large degree on being able to do the things we want to do, without pain, for as long as possible. Because we are living longer, it is becoming increasingly important to pay attention to our physical condition. Ironically, the numerous technological advances in recent years have had mixed benefits for people relative to quantity and quality of life. Whereas medical technology has contributed to a longer life expectancy, computer technology and greater automation are contributing to increasingly sedentary lifestyles and to an increased risk for chronic health and mobility problems. Statistics suggest that in the United States, the health care cost associated with technology-induced inactivity approaches $1 trillion per year (Booth, Gordon, Carlson, & Hamilton, 2000). Very few jobs or household activities these days provide enough energy expenditure to meet people’s physical activity needs. Pushing a button to open the garage door, rolling a trash can out to the curb, or driving through an automated car wash, for example, contributes little to our physical strength, health, and functional mobility.
Several recent publications describing national and international physical activity guidelines (e.g., Canadian Physical Activity Guidelines, 2011; Physical Activity Guidelines for Americans, 2008; Start Active, Stay Active, published by the UK Department of Health, Physical Activity, Health Improvement and Protection, 2011; and the World Health Organization’s Global Recommendations on Physical Activity for Health, 2010) provide excellent overviews of the benefits of exercise for older adults as well as the relationship between sedentary lifestyles and the onset of a number of chronic conditions that can lead to frailty and disability in later years. Unfortunately, statistics suggest that most older adults do not get the amount of exercise they need and that 42 percent of those over 65 are experiencing functional limitation in common everyday activities, statistics that have not improved over the past decade (Federal Interagency Forum on Aging-Related Statistics, 2010). As a result, although average life expectancy continues to increase, so too does the possibility of living more years with physical limitations. Many older adults, often because of their sedentary lifestyles, are functioning dangerously close to their maximum ability during normal activities of daily living. Climbing stairs or getting out of a chair, for example, often requires near-maximal efforts for older people who are not very physically active. Any further decline or small physical setback could easily cause them to move from independent to disabled status in which assistance is needed for daily activities.
The good news, though, is that much of the usual age-related decline in physical fitness is preventable and even reversible through proper attention to our physical activity and exercise levels. Especially important is the early detection of physical weaknesses and appropriate changes in physical activity habits. The SFT, therefore, was developed specifically to evaluate and monitor the physical status of older adults so that evolving weaknesses might be identified and treated before resulting in overt functional limitations.
Rationale for Developing the SFT
With the rapid growth of the older population, finding ways to extend active life expectancy and reduce disability has become the goal of government agencies, gerontology researchers, and health practitioners throughout the world. Physical frailty in later years is costly both in terms of the resources spent on medical care and the diminished quality of life for these people.
Figures show that it costs the United States $54 billion a year to care for people who have lost their independence, and these figures are expected to increase drastically as the size of the older population continues to grow unless the proportion of those with disabilities is reduced (National Institutes of Health, 2012). The annual health care cost per person jumps drastically as an older adult progresses from independent to dependent status.
Although a number of conditions (e.g., mental confusion, visual loss) can rob people of their independence, problems with physical mobility rank at the top of the list (U.S. Department of Housing and Urban Development, 1999). Luckily, studies suggest that physical function is preserved at a much higher level for those who are active and physically fit, with improvements possible at any age, even for many of those with chronic health conditions (American College of Sports Medicine [ACSM], 2009; Physical Activity Guidelines Advisory Committee, 2008). Research clearly shows that it is never too late to improve one’s physical fitness and functional ability; even people in their 90s have experienced dramatic benefits from beginning a physical exercise program (Fiatarone Singh, 2002).
In earlier years, because of the lack of available fitness tests for older adults, health professionals were limited in their ability to evaluate clients and make recommendations based on objective data. Instead, program leaders generally had to rely on their own subjective judgment in evaluating older people’s physical condition and in planning exercise programs. The SFT was developed to address the need for improved ways of assessing fitness in older adults. Specifically, it was designed to assess the physical capacity of the large proportion of older adults who are still living independently within the community, but because of their declining fitness levels may soon be at risk for losing their functional independence.
As indicated in the physical function continuum presented in figure 1.1, approximately 65 percent of the older adult population fits into this independent but generally low-fit category. At the high end of the continuum are approximately 5 percent of older adults who are considered to be at a high-fit or elite level, such as those athletic older people who continue to engage in strenuous exercise or perhaps still participate in athletic competitions. At the lower end are those people (representing about 30 percent of the older population) who already have progressed into the physically frail and dependent categories and need assistance with common activities of daily living. Although the test items are suitable for use with most frail older adults at the low end of the continuum, they were primarily designed to evaluate fitness in the larger midsection of independent-living adults so that any evolving weaknesses could be detected and treated before causing loss of function and frailty. Cost savings in health care expenses and in diminished quality of life would be substantial if we could prevent, or at least delay, older adults’ progression from the independent to the frail and dependent category.