Introduction
As of 2000, the number of persons aged 65 and older was approximated to be at 35 million in the United States. This number represented approximately 13% of the general population. The number of older persons is projected to increase rapidly and to reach about 20% of the total population by 2030, according to the Federal Interagency Forum on Aging-Related Statistics (1). This trend does not only affect the United States but also other countries in the developed world such as Canada, European countries, Japan and China. Similar to this increase in the number of older persons is a projected increase in the total number of elderly persons suffering from chronic illnesses as well as some type of disability in carrying out activities of daily living (ADL). According to the Bureau of Epidemiology and Disease Control Statistics, chronic illnesses constrain close to 40% of those not in institutions in executing the ADLs, for instance, bathing, dressing, or moving from one place to another unsupported (2). At the moment, close to 7.3 million (72.5%) people aged 75 or older suffer from some sort of functional restraints.
In the United States, thirty percent more of persons aged 85 and older are in need of assistance with one or more ADLs than their counterparts aged between 65 and 85 (3, 4). More than 65% of older Americans suffer from some type of cardiovascular disease, and more than fifty percent of all men and sixty percent of all women in the aging population have arthritis (5). According to the most recent status report of Arizona, “Diabetes and Associated Complications in Arizona,” (6), 10.3 million individuals suffer from diabetes. The report also illustrates the economic costs that result from diabetes because diabetes is a cause of 3.5 million hospital admissions annually, about 14% of all hospitalizations. In older persons aged 65 and older, diabetes costs more than $5 billion dollars per year. The United States population surveys report that 33% to 39% of males aged 65 and older do not engage in any leisure-time activity. The participation in leisure activity of females in the same age bracket is significantly lower (7). Chronic diseases cause a heavy burden on individuals and the wider society because they lead to long-term illness and deteriorated quality of life. The total numbers of older persons in the next decades threaten to put great pressure on the existing resources (8).
Enhancement in the health of the aging population can only be beneficial if the “successful aging” approach is adopted (9, 10). The prospective for aging healthily can be improved most by a capability in the elderly to carry out activities of daily living independently and to remain actively occupied in life (11, 12). A healthy lifestyle is more powerful than genetic factors in helping older persons to evade the health decline and deterioration that are traditionally related to aging (13). Individuals who implement healthy behaviors especially through a healthy diet, engaging in physical activity, and avoiding tobacco use and excessive alcohol intake, have a lower risk of developing chronic illnesses and have a fifty percent lower rate of disability than those who do not. The majority of efficient approaches for minimizing the risk of developing chronic diseases and disabilities are broadly underutilized. Avoiding the development of diseases, minimizing disability, and enhancing the general quality of life for older persons through mutual community-based programs have proven effective in a number of settings (14). Indeed, many research studies have been conducted to examine the effect of diet and lifestyle on healthy aging. This paper will assess the work that has been done by the Center for Disease Control’s Healthy Aging Network in promoting healthy aging. It will also review the current literature that focuses on the role of lifestyle and diet and nutrition in healthy aging.
The Center for Disease Control: Healthy Aging Network
The Healthy Aging Network is a network of nine universities that carry out extensive research on healthy aging. The network also reviews the literature of other studies done on the same subject and evaluates their effectiveness and weaknesses. The network is based on a prevention research program to enhance the understanding of the factors that influence healthy aging among older persons; to recognize interventions that support healthy aging, and to put research results into action by initiating sustainable community-based programs in different regions of the nation. The researchers involved in the network identify the major health-enhancement skills and habits as well as the organ systems and conditions that can influence healthy aging. The network members work in collaboration with government officials who help them to create community-based programs that promote healthy aging. The network members and other stakeholders also conduct a review of the past studies that focus on healthy aging. The results from such studies and literature reviews are used as recommendations by the researchers in the network and the “Task Force on Community Preventive Services to establish a chapter for the Community Guide to Preventive Services on evidence-based interventions for enhancing the general health of older persons”, (15).
The Healthy Aging Network’s Core Projects
Center for Healthy Aging Community Outreach and Demonstration Project
This project is based in Allegheny County in western Pennsylvania which has the second-highest number of older persons aged 65 years and older, after Dade County, Florida. The network’s researchers recognize that older persons are vulnerable to illnesses such as heart disease and stroke, diabetes, flu, pneumonia, disability, emotional disorders, and other avoidable illnesses. They also recognize that those older adults that regularly engage in physical exercises, socially and mentally provoking activities, eat healthy foods, and go for regular health check-ups lead more active and healthier lives than their counterparts. Prior to this project, the network’s researchers created and tested a program named “Ten Keys to Healthy Aging”. This program sought to address 10 conditions that are necessary for maintaining health in older adults: “prevention of bone loss and muscle weakness, normal blood pressure, high levels of physical activity, control of blood sugar, non-smoking, having social support, engaging in cancer screening, obtaining regular immunizations, low cholesterol levels, and lack of depressive moods,” (16). Primary results showed that the majority of the participants had improved in a number of the 10 major conditions. Researchers worked together with community stakeholders to improve the program by including additional behavioral constituents to promote physical activity, enhance eating behaviors, and promote social support and mental acuteness (16).
In the Center for Healthy Aging Community Outreach and Demonstration Project, the network’s researchers executed and assessed two diverse intervention programs for approximately 1,000 participants: a healthy lifestyle intervention program and a brief education intervention program. “The participants first completed an initial 4-hour evaluation based on the ten key domains of healthy aging mentioned above, after which they were randomly assigned to either of the two intervention groups,” (16). Participants in the two groups met with a health counselor who explained the outcomes of their initial evaluation and provided recommendations. Participants then stated one or two goals for enhancing their health results and were referred to their physicians when required. Participants who were grouped into the brief education group were provided with a list of community health practitioners who could offer them the necessary assistance. The participants also got follow-up calls from the health counselor on a quarterly basis. However, participants who had poor health outcomes received follow-up calls every month.
Participants assigned to the healthy lifestyle intervention group took part in weekly walking activities and participated in group discussions to learn about healthy food alternatives for maintaining normal blood pressure and controlling diabetes, as well as physical activities to improve their potency, elasticity, and stamina. Additional social activities were offered which made it possible for the subjects to obtain support from their counterparts; adopt measures to improve their memory, and learn about the key determinants of chronic illnesses. “All participants were required to complete the evaluations again 6 and 12 months after the intervention, and subsequently every year for the next three-to-four years,” (16). This project is still ongoing but the results of the two groups of the project will be compared against each other and against individuals’ original evaluations to measure the effectiveness of the two intervention programs.
Physical Activity for Lifetime Success (PALS)
The PALS project is based on the Center for Disease Control’s 19 years of experience in assisting older persons (aged 65 years or older) in Seattle’s King County to become physically active. Physical activity minimizes the possibility of developing chronic illnesses. The project incorporates an intervention program to alter individuals’ physical activity levels and measures to modify the surroundings and policies to promote physical activities in a region which has a high number of ethnically diverse and low-income older persons. In the individual intervention program, the main physicians at two community-based healthcare centers work together with the local center for aged persons to enhance the engagement in physical activity of 200 older persons who were suffering from diabetes. Fifty percent of the project’s participants were classified into a comparison group that received the intervention one year after the other group (17).
The participants were counseled during clinic visits about the significance of the physical activity. The healthcare practitioners then gave each of the participants a customized written recommendation and a list of local resources that would be beneficial to them. The participants were also asked by the providers if they would prefer “a physical activity support program which was adopted from Active Choices, a telephone-assisted physical activity counseling program developed by Stanford University” (17). In order to participate in the physical activity support program, each of the participants was assigned to a peer who provides inspiration and support for enhancing their physical activity levels through phone calls for a period of 6- to 12-months. When suitable, the local center for older persons also referred participants to other programs, such as EnhanceFitness, a cost-effective exercise program provided in the majority of the senior and community centers. The complete information obtained from the clinic’s database will be used by the network’s researchers to make comparisons of the health status of individuals who took part in PALS with those who did not. To enhance the community’s capability, researchers will help to create a network of local service providers and other community stakeholders who can promote physical exercises (17).
Diabetes Prevention Program for Navajo Elders
In this project, researchers at the network established a program that would assist the Navajo elders (aged 55 years and more) in reducing the rate of diabetes among them. The program, known as Healthy Path, takes into consideration the culture and foods choices of the Navajo community, and it is meant to help the elders in making healthy choices regarding nutrition and physical exercise. The subjects of the program include “approximately 200 elders selected from ten centers of the elderly people located in the eastern part of the Navajo community,” (18). The program was implemented by the researchers in collaboration with widely acclaimed Native American partner organizations, tribal health educators, and community-based organizations. The results from the program “will be disseminated among the Eastern Navajo Health Board, the Eastern Area Council on Aging, and the Navajo Institutional Review Board,” (18).
EnhanceFitness (formerly Lifetime Fitness Program)
The EnhanceFitness program was initially referred to as the Lifetime Fitness Program. The development of this program began in 1993, through the collaboration of the network’s researchers with the Group Health Cooperative of Puget Sound and Senior Services of Seattle/King County. The main objective of the program is to create the most effective physical activity program for older persons aged 60 years and beyond. The program puts emphasis on activities that enhance perseverance, vigor, stability, and flexibility. Results from the pilot study indicated that physical activity had positive effects on participants’ physical and social performance as well as pain and depressive moods. The positive results from the pilot study encouraged the network to introduce it to other community sites in different states. In 2003, the EnhanceFitness program was voted one of the best 10 programs for enhancing the health of the aging population (19).
PEARLS (Program to Encourage Active, Rewarding Lives for Seniors)
Research shows that depression affects the majority of persons in the aging population. The risk for developing depressive moods is higher among older persons who are socially secluded or have poor health. Physicians and older patients alike may mistakenly think that depression is an inevitable outcome of aging; hence only about fifty percent of depressed older persons obtain medical assistance. Depression greatly affects the health and quality of life of older persons in addition to their ability to perform activities of daily living independently. The PEARLS program was developed based on this knowledge so as to minimize the risk of developing depressive moods among the aging population by teaching them depression management skills. The program was developed by the network in collaboration with the City of Seattle’s Aging and Disability Services and Senior Services of Seattle/King County. The program has eight in-home counseling sessions and six monthly phone calls. The counseling session covers three behavioral strategies for dealing with depression. The first strategy involves the definition of the problem the participants have so as to implement the most suitable solution. The second strategy involves engaging in the recommended social and physical activities through the use of community-based settings. The last strategy involves identifying and engaging in individualized pleasurable activities. The effectiveness of the program will be measured by participants’ depressive moods, general well-being, and utilization of healthcare services (20).
Promoting Health and Preventing Disease among Pittsburgh’s Older Adults
This project was implemented using a sample of approximately 500 seniors from Pittsburgh who were randomly classified into one of the two study groups. Participants who were assigned to the Lifestyle Plus Group worked in conjunction with health specialists and took part in healthy lifestyle programs created by the center. Participants who were assigned to the Education Group worked in conjunction with health specialists who provided them with access to important local resources. The main objective of the project is to identify the effectiveness of 10 key domains in promoting health and preventing illnesses among older adults. The ten domains are similar to the ones used in the Center for Healthy Aging Community Outreach and Demonstration Project. The network’s researchers will then compare the effectiveness of the interventions on the general well-being of the participants (21).
The Healthy Aging Network’s Special Interest projects
Identifying the Physical Activity Needs of Older Adults
The researchers of the Healthy Aging Network carried out a literature review on studies that were conducted between 1980 and 2000 and that dealt with the physical needs of the aging population. The main objective of the review was to find out the advantages of physical activity for older persons. The reviewers also recognized the kind, regularity, and intensity of physical activity that older persons need in order to maintain and enhance their general health, physical vigor, balance, and psychological welfare. The researchers worked together with a team of scholars in analyzing and reporting their findings. It was recommended that the results from the review be disseminated to “the National Institute on Aging, National Arthritis Association, National Diabetes Association, American College of Sports Medicine, managed care settings, physicians, other health professionals, and health care policymakers as well,” (22). The results will help these organizations and experts in establishing the most appropriate physical activity programs for the aging population.
Improving Self-Care among People with Epilepsy
This project involved the establishment of a 6-week intervention program to enhance the self-management skills and the quality of life of older persons suffering from epilepsy. The project was designed by the network’s researchers in collaboration with researchers from the University of Pittsburgh Epilepsy Center and the Veterans Affairs Pittsburgh Healthcare System. The intervention program tackles both the psychosomatic issues and the knowledge of the illness. The participants of the program learn how to establish and maintain their goals of managing epilepsy. The effectiveness, cost, and viability of the intervention program are currently being assessed to establish whether it can easily be reproduced in other community settings (23).
Defining the Public Health Role in Depression and Depressive Disorders for Older Adults
This project is based on current evidence and seeks to identify successful interventions for older persons (60 years of age or older) suffering from depressive moods. Five reviewers, with the assistance of a team of nine experts in health service interventions for depression, are creating a mechanism for carrying out a search of the scientific literature and identifying the standard for including the literature. The reviewers will then utilize a standardized instrument to collect the appropriate plan, intervention, and result information for each of the studies. The reviewers will also categorize the interventions in their order of ability to straightforwardly generate constructive outcomes and the ease of modifying them for different populations. The researchers will then concentrate on making out the interventions that are most appropriate for distribution to older persons through the public health and aging networks. Recommendations will then be made about how such distribution could be achieved—including the structural, procedural, and policy issues (24).
Prevention research to promote and protect brain health
A recent national survey shows that more than twice as many adults are afraid of losing their mental capability than their physical capability. Current improvements in scientific research on cognitive health provide significant hopes for enhancing the quality of life of the aging population. Factors that cause a reduced cognitive capability include high blood pressure, cholesterol, diabetes, overweight, obesity, smoking, and physical inactivity (The Healthy Aging Network). The research on cognitive ability will provide a roadmap for identifying the appropriate steps that can be taken to move the area of cognitive health into the public health domain. The Prevention Research Centers’ Healthy Aging Network will tackle one of the roadmap’s most important suggestions: to identify the opinions of different audiences on cognitive health and its relationship with lifestyle factors. The objective is to promote awareness among members of the general public and health care practitioners about improving cognitive health. The long-run objective is to encourage individuals to implement behaviors that promote cognitive health (25).
Researchers at the nine universities that constitute the Healthy Aging Network are evaluating the different manners that different populations of older persons, as well as the health care providers and caregivers, perceive brain health. The older persons will comprise persons from different racial and ethnic communities such as White, African Americans, and Hispanic Americans. Participants will assist the researchers in developing questions that can gauge the tendency in opinions about cognitive health. The significance of this project lies in its ability to educate health care providers and the general public about cognitive health and to identify the public’s views about the aging process, brain health, and the costs incurred as a result of cognitive decline.
Using Medical Data to Plan and Evaluate Interventions for Older Adults with Depression
This project is based on the fact that the majority (close to 80%) of older persons aged 65 years and beyond suffer from at least one chronic illness (for instance, arthritis, cardiovascular diseases, and diabetes), and have more chances than young adults of experiencing disability and social seclusion. These factors may lead to minor or clinical depression, which is typified by a lack of interest or delight in daily living activities, and feelings of unhappiness or despair. Depression in older persons often goes undiagnosed, untreated, or mal-treated. Primary care settings, which are accessible to the majority of older persons, may lack adequate resources for detecting or treating mental health. It is therefore important for communities to establish interventions provided in community settings that may provide the older persons with easy contact with programs that manage depression for their specific age bracket. In this project, the researchers will review medical and insurance records and will then identify approximately 350 older persons suffering from depression. A pilot study will then be conducted using this sample to assess a well-recognized, evidence-based intervention program namely: “the Stanford University School of Medicine Chronic Disease Self-Management Program,” (26).
In the course of the program’s six weekly sessions, the participants will be taught how to handle signs of chronic illness, cope with negative feelings and thoughts, interact regularly with health care providers, set personal objectives, and find solutions to their personal problems. The sessions of this program will be implemented in centers for senior citizens, religious centers, libraries, and hospitals. An assessment of the effectiveness of the program will be done eighteen months after its commencement. The assessment will be done using the medical and insurance records of both the participants and non-participants which will provide the subjects’ health and behavioral outcomes such as their frequency of visits to mental health practitioners and their length of stay in hospitals. The results of the project will enable the researchers to provide the most suitable recommendations on how to identify persons that require depression-related services, how to identify and distribute local resources for a community-based intervention program, and how to measure the outcomes of participants.
A Review of the Current Literature on Healthy Aging
The role of diet and nutrition in promoting healthy aging
Nutrition is one of the key determinants of successful aging and in the prevention of many illnesses. As people grow older, their intake of calories and other nutrients declines due to the deterioration of the body’s functioning (27). Nicolas, Faisant, Nourhashemi, Lanzmann-Petihory, and Villas (28) conducted a study to determine the differences in nutritional consumption among healthy older individuals and to examine if nutritional consumption affects morbidity and mortality. The researchers used a sample of 167 elderly individuals who were part of the Toulouse Aging Process Study which was initiated in 1991 and whose aim was to follow up an elderly population who were in perfect health condition at the commencement of the study. The sample included persons who were aged 55 and above and who had no known major illness at the beginning of the study. The researchers, Nicolas et al. (28) then made a comparison between the nutritional intake in 1993 of the participants who were still healthy in 1997 and the participants who had either become frail or ill or who had passed away.
The researchers found that out of the 167 participants: 123 were considered to be of good or excellent health in 1997; 27 were considered to be frail, some had difficulties performing the activities of daily living, while others had heart problems and other illnesses for which they were being treated; 11 were sick – 8 with malignancy, 2 with severe balance injuries and 1 with Alzheimer’s disease; 6 had died between 1994 and 1997 out of which 3 had died of malignancy, 1 had died from a fall and another from gastrointestinal bleeding. In examining the nutritional intake of these categories of the participants, a major observation was made: those subjects who were considered to be of good or excellent health had a higher energy intake than their counterparts. The intake of energy was much lower among the subjects who later died. The results of this study are consistent with previous studies carried out by other scholars (29, 30). The conclusion is that a decline in the intake of energy can cause frailty, illness, or even death. It is therefore important for healthcare professionals and nutritionists to evaluate the nutrition of the elderly and to detect any nutritional changes in the elderly so as to minimize the incidence of under-nutrition and health deterioration and enhance the quality of life of the elderly.
Haveman-Nies, De Groot, and Van Staveren (31) also investigated the effect of diet on healthy aging. The main objective of the study was to investigate the correlation between healthy lifestyle behaviors – physical activity, non-smoking, and a healthy diet – on changes in self-care ability and self-rated health of subjects. The researchers used a sample of participants from the Survey in Europe on Nutrition and the Elderly: a Concerted Action (SENECA) study. “The SENECA study was a longitudinal study that was conducted in three-time intervals: 1988/1989, 1993, and 1999. The participants in this study were selected from different European countries and were of both genders and born between 1913 and 1918. A total of 216 men and 264 women were able to provide complete information for the three sets of the survey,” (31). In this study, self-rated health was measured by the question, “How would you judge your present health in general?” (31). The responses to this question ranged from “very poor” to “very good”. Self-care ability was measured by using questions about the performance of daily living activities such as moving from one room to another, grooming, and feeding among others. The quality of diets and foods was measured using the modified Mediterranean Diet score which included items such as fat, alcohol, legumes, fruits and vegetables, meat and meat products, and dairy products (31).
The results of the study showed that the majority of the participants had similar health ratings (70%) and self-care ability (83%) at the start and at the end of the 10-year study. Only about 25% of the participants exhibited negative self-ratings of health at the beginning of the study and 3% were functionally reliant at that time. Unlike the previous studies, there was no association between diet and health status in this particular study. The overall self-rated health and self-care abilities of the participants declined steadily between 1988 and 1999 despite the differences in the quality of their diets. The researchers justify the results of their study by arguing that older participants are more likely than their younger peers to make their health judgments based on their attitude or behavior rather than on their actual health conditions, symptoms, or functioning (32). Despite this result, the role that diet and nutrition play in the aging process, particularly in the prevention and management of chronic illnesses, cannot be overlooked.
Countries that have a high number of aging populations are overwhelmed by an increase in the rate of chronic illnesses. These illnesses include cardiovascular diseases, osteoporosis, diabetes, age-related macular degeneration, and cognitive deterioration such as Alzheimer’s disease. Although the prevention of these illnesses requires different nutritional intakes, there are a number of measures that can be taken on a daily basis to minimize the development of such illnesses and to enhance the quality of life in later years. These measures include the provision of plenty of foods rich in starch and fiber, iron, folate, omega-3, vitamins, calcium, and potassium, and foods that have low salt intake. In addition, foods should be given in small quantities but regularly to enhance the intake of energy (33).
Nutrition is indeed one of the most important choices that individuals have to make as they grow older. However, with so much conflicting information about nutrition in the media, it is easy for one to become confused and overwhelmed (34). This is the reason why many nutritionists and healthcare professionals encourage individuals to adopt a holistic approach to nutrition with the argument that balance is important in peoples’ lives. A holistic approach is based on the assertion that good nutrition without a healthy lifestyle does not provide maximum benefits to individuals. The same can be said of a healthy lifestyle without a high-quality diet (35). Good nutrition and a healthy lifestyle should go hand in hand so as to minimize the imbalances that result from lack of adequate nutrition, inadequate rest, ineffective stress management, and a sedentary lifestyle. These factors can seriously undermine individuals’ health even when they consume healthy diets (36).
The role of lifestyle in healthy aging
Lifestyle is strongly linked with depressed mood among elderly people. A number of factors ranging from physical, psychological, social, and environmental factors lead to depressed mood (37). For instance, unhealthy lifestyles, such as smoking, excessive drinking, a sedentary lifestyle, and being overweight increase the risk of developing chronic illnesses or lead to deteriorated health status. Chronic illnesses and poor health are in turn associated with increased levels of depression which may, in turn, cause unhealthy lifestyles. The association between lifestyle and depression is therefore a downward spiral (38). Although many studies provide evidence that supports the lifestyle-depression link, none explains how the association develops over a long period of time. This literature gap is narrowed by the study conducted by Van Gool et al. (39). The main objective of Van Gool et al.’s study was “to determine if there is an association between healthy lifestyles and the absence of depression over time in the general population,” (39). The researchers used a sample of 1169 participants who were the subjects of the Maastricht Aging Study. A 6-year follow-up of the subjects was done to determine their engagement in several lifestyles such as smoking, alcohol consumption, and physical activities, as well as their body mass index and mood patterns. A longitudinal analysis was then done to establish the association between lifestyle and depressed mood.
Van Gool et al. (39) found that individuals who use excessive alcohol are more likely to develop depression later in life. They also found that individuals who engage in at least 30 minutes of regular physical activity exhibit the absence of depression. There was no association between smoking and depressed mood probably due to irregularities in questionnaire responses. The link between excessive alcohol consumption and depression supports other prior studies such as the one conducted by Aneshensel and Huba (38). Likewise, the link between physical activity and depressed mood supports the results of other studies such as the study by Strawbridge et al. (40) who found that individuals who engage in regular physical activity have a 44% lower risk of developing a depressed mood than individuals who are physically inactive. Besides minimizing depression, physical activity also helps in reducing the risk of developing chronic illnesses such as cardiovascular diseases.
Cardiovascular disease is one of the chronic illnesses that affect the elderly population. Apart from smoking which decreases as people grow older, other risk factors of cardiovascular diseases include increased cholesterol levels, high blood pressure, and physical inactivity all of which seem to increase as people age. According to several national surveys in the United Kingdom, the prevalence of hypertension is highest in the elderly population in both men and women while the levels of cholesterol increase steadily with age. This increase in the majority of the risk factors increases the vulnerability of the elderly population but also the opportunities for the prevention of chronic illnesses. One such opportunity is physical activity. According to the Department of Health (41) and other such studies (42), physical inactivity and lack of fitness are some of the key determinants of cardiovascular diseases. Some studies even propose that physical activity can reduce the risk of developing CHD by 30-50% (43).
The benefits of physical activity in the prevention of CHD are both primary and secondary. Indeed, such studies show that as little as 30 minutes of moderate-to-intense exercises performed daily are adequate enough to prevent the development of chronic illnesses. For instance, (43) showed that regular brisk walking and vigorous exercises done for three or more hours weekly reduce the risk of the development of CHD by 30-40%. The benefits of physical activity in promoting healthy aging lie in its ability to normalize body weight, to reduce insulin resistance, hypertension, dyslipidemia, and inflammation of body organs as well as to enhance insulin sensitivity, control of glycemia, and the functioning of fibrinolytic and endothelial organs. So far, no upper limit for the amount of exercise needed to minimize the risk for the development of CHD and other chronic illnesses has been identified through research (42). As a result, it is most likely that an increase in the daily activity level will provide additional benefits to individuals. However, the greatest benefits from physical activity are derived when individuals engage in moderate but regular activities. Stanner states that “intermittent episodes of activity accumulated over the course of a day may have cardio-respiratory fitness benefits comparable to one longer continuous episode as total energy expended is equivalent,” (44). Engaging in activities in shorter hours assists individuals to become more active in the long run. Because the majority of the diseases develop slowly over a long time, a life-course approach to the encouragement of physical activity (that is, encouraging physical activity from an early age and maintaining it throughout a lifetime) is necessary for individuals to reap utmost benefits (41).
The impact of physical activity on health is most significant for the elderly who are vulnerable to chronic illnesses and are often inactive (45). Research studies show that elderly people who engage in and maintain light or moderate physical exercises have lower mortality rates and develop lower incidences of heart attacks than their counterparts with or without existing heart conditions. Physical activity also minimizes the development of age-related weight gain and assists in shedding off unnecessary weight. Benefits of physical activities are also evident among elderly men who once adopted a sedentary lifestyle but later became physically active (46). This provides a backbone for encouraging older sedentary people to enhance their levels of activity and for active middle-aged individuals to progress with their activities even as they grow older.
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