Frailty – are we doing enough?

Last time I told you about the current recommendations for how much exercise we should take to  reduce the risk of becoming frail in later life. This time I am questioning how well we are doing in meeting those recommendations.

Perception versus reality

There is a well known difference between how we think we behave and how we actually behave. This is known as “social desirability bias”. A good example is cigarette smoking. When I was a medical student we were taught how to work out how many cigarettes a person was smoking: Ask the individual the number of fags per day and double it. Ask the spouse and halve it. Add the two together and divide by two for a moderately accurate estimate!

This works for a number of different habits including eating, physical fitness  – and exercise. The bottom line is that we eat much more grub than we think, or declare, that we do, we are much less fit than we think  – and we take much less exercise.

The importance of this distinction is in working out the reliability of data from studies of the effects of exercise based on how the amount of exercise has been measured – either from exercise questionnaires or from real-life observation. Assessing activity levels from questionnaires is relatively cheap and easy. Actual measurement of activity is difficult, expensive and time consuming. You guessed it – most studies of the effects of exercise are based on questionnaires and that biases the results.

This was neatly demonstrated by the 2008 Health Survey for England (HSE). This study involved a large representative cohort of adults aged 16 to 75 who completed a questionnaire on their current exercise habit. 39% of men and 29% of women reached the targets for exercise then recommended by the DoH. However  the survey also added a measurement of exercise taken using accelerometers – sophisticated pedometers –  which the participants wore for one week. According to these measured activity levels, just 6% of men and 4% of women met the DoH recommendations – about a seventh of the number suggested by the questionnaires. Oh dear!

What about age-related activity?

In 2011 the DoH modified its targets so the figures look a bit better now but remain very disappointing. Taking just the aerobic activities, a graph of the effect of age on exercise has been produced and is this week’s illustration. Peak activity is reached in the 20s and then declines fairly steadily, but not precipitately, until the age of about 65. Thereafter the decline falls off a precipice

This is the age when we retire and have more time to get active. It is also the age at which the important health benefits of exercise become much more significant – through the effects on physical fitness on the risk of the degenerative diseases of later life and on functional capacity.

It does not matter much if, at the age of say 40, we are 30% less fit than we could be – but in old age it might make the difference between being able to be self-caring or needing help with the activities of daily living.

Why the decline?

It is definitely not lack of time. Perhaps the most important reason is that the effects of ageing make taking exercise more of an effort. Aches and pains and increasing intolerance of the side effects of exercise – breathlessness, joint pain, relatively easy muscle and joint injuries – all contribute. Minor strains and sprains are more easily provoked and take longer to recover. And the culture of old age discourages too much physical activity – maybe because if may appear undignified? Older people in Lycra can be the butt of inappropriate humour.
Finally, exercise is seldom encouraged or even prescribed by the medical profession, either as prevention or treatment of degenerative diseases – though in many cases exercise is more effective than medication.

What to do about it?

It will take a combined approach by politicians and the medical profession to have an effect. It is not on the agenda of either. Politicians are focused on increasing the provision of care facilities and doctors are obsessed with investigating the symptoms of later life and, egged on by the pharmaceutical industry,  prescribing ever more drugs of doubtful benefit to the taker. If just one tenth of the expense of these approaches could be diverted to increasing the physical activity of middle aged and older people we could see a real benefit to the health of the population

Next time

What you can do to help yourself.