Abstract

Abstract Baby Boomers want to hike, bike, and surf their way into retirement. Edward S. Potkanowicz, PhD, ACSM HFS Paula Hartman-Stein, PhD Jeanette S. Biermann, PhD, MBA, MA Contact-hour credits are available for this article. On October 15 th , 2007, Kathleen Casey-Kirschling became the first Baby Boomer to ride the "silver tsunami" by applying for her social security benefits. Riding a wave is an appropriate analogy for Baby Boomers given the expectations they have for their later years. Now, just as it was in the original 2003 Behavioral Determinants article, the answer to the question, "Can this generation of Americans expect to achieve a satisfying, high-quality life as older adults?" is still a resounding yes. But now, there is greater clarity and more specific detail as to exactly what the Baby Boomer generation should, and can, be doing to insure that they have the quality of life as older adults that they have become accustomed to in their younger years. To that end, this article will examine the updated recommendations for physical activity and psychological elements associated with healthy aging. Citation: Potkanowicz, E., Hartman-Stein, P., Biermann J., DOI: 10.3912/OJIN.Vol14No03PPT01 Keywords: age-related cognitive decline, Alzheimer's disease, authentic happiness in late life healthy aging, cardiovascular fitness, cognitive functioning, flexibility training, late life vitality, life-span psychology view of aging, older adult quality of life, prevention of cognitive impairment, primary prevention of geriatric depression, reducing risk of resistance training, successful aging, wellness On October 15 th , 2007, Kathleen Casey-Kirschling became the first of the Baby Boomer generation to ride the "silver tsunami" (a term coined by Mary Finn Maples in 2002 to represent the rising swell of Baby Boomers moving towards older adulthood) by applying for her social security benefits. Having been born at one second past midnight on January 1, 1946, Ms. Casey-Kirschling has the unique distinction of being regarded as Baby Boomer #1. The "wave" is not only a figurative symbol for the Baby Boomers. The wave is also this group's literal expectation for continuing an active and fulfilling lifestyle into their later years. In other words, Baby Boomers want to hike, bike, and surf their way into retirement. In the original Behavioral Determinants article , we spoke of the leading edge of the Baby Boomer generation moving steadily towards their older adult years. Those born between 1946 and 1964 will start to reach the age of 65 by 2011; and estimates now suggest that by 2030 the number of adults 65 years of age and over will be 71 million, or, 20% of the United States (U.S.) population (Centers for Disease Control and Prevention [CDC], 2007). The wave is a big one. Like the steady march of this Baby Boomer generation, the recommendations for healthy aging have continued to move forward and change as well. As such, an update to the original The Key to Remaining Physically Fit Physical fitness includes both health-related fitness and skill-related fitness. In this section the authors will define physical fitness, discuss the role of physical activity in fitness, offer guidance for pre-exercise screening, and review the updated recommendations for aerobic activity, muscle strengthening, and flexibility and balance. They will conclude by considering how much physical activity is enough. What Physical Fitness Really Is For the sake of clarity, physical fitness is defined by the American College of Sports Medicine (ACSM) as: ...a set of attributes or characteristics that people have or achieve that relates to the ability to perform physical activity. These characteristics are usually separated into either health-related or skill-related components (2009, p. 2). Although many people aspire to possess the skill-related components associated with physical fitness, e.g., agility, balance, coordination, speed, power, and reaction time, we benefit more on a day-to-day basis, and certainly in the long term, from the health-related components of physical fitness. That is not to say that skill-related attributes cannot be attained or achieved by the older adult; but rather that the general population of older adults benefits more significantly from possessing the health-related attributes. As defined by the ACSM (2006, p. 3), health-related physical fitness: …is associated with the ability to perform daily activities with vigor, and the possession of traits and capacities that are associated with a low risk of premature development of hypokinetic diseases (e.g. those associated with physical inactivity, like obesity, diabetes, and hypertension). The combination of high levels of both health-related fitness, and its associated traits and capacities, such as cardiovascular endurance, muscular fitness, flexibility, body composition, and physiologic fitness (fitness that relates to the status of metabolic systems, body compositional factors, and bone mineral density) can increase a Baby Boomer's chances of enjoying a life filled with satisfying personal experiences, a life of good quality, and a life of pursuits not hindered by physiological setbacks... The Role of Physical Activity in Fitness Fitness and healthcare professionals have made great strides in improving the public's recognition of the importance of regular physical activity. Through the work of organizations, such as the American College of Sports Medicine (ACSM), The American Heart Association (AHA), and The National Institutes of Health (NIH), as well as through initiatives like Healthy People 2010, the public's recognition of the importance of regular physical activity has improved appreciably. However, there are those who suggest that the What makes the topic of exercise recommendations particularly problematic and troublesome is that this lack of specific information can potentially lead to inactivity and/or indifference. According to the CDC (2007), physical inactivity is one of the three behaviors (along with smoking and poor diet) that contributed to almost 35% of all deaths in the US in the year 2000, as these behaviors often contributed to the development of diseases. Sadly, the older adult population is the least active of all age groups (CDC, 2003). In 2002, 32% of adults age 65 and older died from heart disease, 22% died from cancer, and 8% died from a stroke. In total, these three conditions represented 61% of all deaths among this age group (CDC, 2007). Perhaps the most disturbing recognition is that the eventual deaths associated with these conditions were largely preventable. Baby Boomers today stand a very good chance of dramatically reducing their risk for developing a chronic disease as long as they include regular physical activities in their daily lives and receive appropriate direction regarding these activities. Pre-Exercise Screening In the original 2003 article, the recommendations offered for physical activity were prefaced by the recommendations that (a) before beginning any exercise program, the individual should consult with a physician to insure that he or she is healthy enough to begin an exercise program, and (b) the individual should seek the advice and guidance of an exercise professional certified through a recognized certifying body, such as the ACSM or National Strength and Conditioning Association. Both of these recommendations still stand and are strongly encouraged. However, the screening process is changing today. While not a substitute for direct contact with an exercise or medical professional, older adults can now begin the screening process and initiate a self-directed physical activity program through the use of a new screening tool called the EASY tool, which is an acronym for Exercise Assessment and Screening for You. The EASY tool, according to the authors (Resnick et al., 2008, p. 215): …is a tool developed to help older individuals, their health care providers, and exercise professionals identify different types of exercise and physical activity regimens that can be tailored to meet the existing health conditions, illnesses, or disabilities of older adults. The authors go on to say that the EASY tool can be completed either independently by the older adult or with the assistance of a healthcare or exercise professional. The authors contend that pre-exercise screening should not keep people from being physically active (and many screening tools do so), but rather should set people on their way to being physically active, given that physical activity in all age groups is good. The EASY tool is available online at the EASY website <www.easyforyou.info/>. Updated Recommendations for Aerobic Activity When one considers the number of activities in any given day that require aerobic activity, commonly called endurance, and the important role of endurance in independent living, the importance of sufficient aerobic capacity becomes apparent. Older adults need sufficient aerobic capacity to get through their day and to retain their independent lifestyle. Spirdusso, ). Research has demonstrated that aerobic capacity changes as one ages. Estimates place the age-related decline in aerobic capacity at approximately 1% per year, for each year after the age of 25 (Spirdusso et al.2005). Furthermore, the rate of decline is thought to increase between the ages of 65 and 75 and then again between the ages of 75 and 85. Sufficient aerobic capacity not only helps to maintain an independent lifestyle, it also contributes to the prevention of multiple chronic disease processes. Being physically active is an important tool in promoting healthy aging. Before examining the updated recommendations for aerobic activity, it is important to operationally define some aerobic-related terms. With respect to aerobic activity, and relative to one's fitness level, moderate-intensity aerobic activity is defined as a rating of 5-6 on a 10-point scale, where 0 is sitting, 10 is an all out effort, and 5-6 involves a noticeable increases in heart rate and breathing The new recommendations from the ACSM and the AHA Updated Recommendations for Muscle Strengthening Within the context of activities of daily living, there are a number of activities that require moderate levels of strength and power (e.g., carrying groceries, lifting grandchildren, and getting into and out of a car) (Spirdusso, Francis, & MacRae, 2005). More complex activities, too, require more than minimal levels of muscular strength. A muscular strength training regimen is necessary to have the lifestyle outcomes desired by the Baby Boomers. The importance of muscular strength training cannot be understated. Before examining the recommendations for muscular strength, it is again appropriate to operationally define some terms with respect to level of effort. With respect to muscle-strengthening activities, a moderate-intensity effort is defined as a rating of 5-6 on a 10-point scale, where 0 is no movement and 10 is a maximal effort for the muscle group According to the new recommendations Updated Recommendations for Flexibility and Balance The recommendations for flexibility have remained relatively unchanged, except for recommendations regarding frequency and duration. Older adults are still encouraged to participate in some form of flexibility training; however, they are now encouraged to do so on at least two days of each week for at least 10 minutes each time. As we stated in the original article , "When we take the time to consider just how important freedom of movement and flexibility are in everyday living, it becomes easier to see the significant role that flexibility training can play in maintaining one's quality of life." An element not directly addressed in the 2003 article is the current recommendation that older adults should intentionally pursue and participate in exercises and training that improve balance and reduce the risk of falls. In the past, balance training was considered a passive component of some other training mechanism or regimen. The current recommendations suggest that as a way to prevent falls in those individuals with a known risk for falls; for example, older adults with mobility problems or those who fall frequently, the older adult should perform exercises that will contribute to the maintenance and improvement of balance Some is Good, More is Better The preceding recommendations represent the minimum levels of involvement with respect to aerobic activity and muscle strengthening. Being minimum recommendations, the older adult can expect to experience the minimum in the way of outcomes. While this amount of improvement is not necessarily a bad thing, Perhaps most encouraging for the older adult are studies showing that the older adult possesses a capacity for change, both aerobically and muscularly, that is similar to the young adult The Key to a Sharp Mind In the original 2003 article, we noted, "cognitive decline, especially memory deficit associated with aging, is a concern of many Baby Boomers in regard to their parents as well as themselves." We also reviewed the topics of maintaining cognitive abilities, emotional health, and the relationship between religion and physical and mental health. While the latter two areas remain important elements of healthy aging, maintaining cognitive ability and slowing age-related cognitive decline have become hot topics for researchers and the general public. Many new resources related to cognitive abilities are available for the general public. In the last few years, however, the media has been abuzz with hopeful news that we may be able to keep our brain fit just as we keep our body fit, and thereby age successfully. In this section we will examine recent findings addressing the preservation of the older adult's cognitive capacity as we discuss theoretical perspectives related to cognitive functioning, such as cognitive reserve and neurogenesis; interventions to enhance cognitive functioning, for example, enriched environments and cognitive activities; the relationships between and among physical activities, cognition, and social functioning; and commercial brain fitness products. Cognitive Reserve Until relatively recently, the dominant view of cognitive aging has been that of pervasive, progressive, and irreversible decline. However, current theoretical underpinnings of enhancing cognitive fitness later in life, i.e., at age 65 and older, are based on the concepts of cognitive reserve and neural plasticity. Both constructs are exciting and hopeful because they imply that the older adult can actively help to preserve his/her intellectual capacity. Cognitive reserve theory explains why some individuals are more resilient or adaptive to brain pathology and can function well in everyday life despite neuronal damage. It implies that people have more cognitive capacity than needed for survival, and that we can draw from an extra "reserve" when needed Neurogenesis Similarly encouraging is the theory of neurogenesis. For most of the twentieth century, scientists believed that brain cells, unlike hair cells, skin cells and other cells in the body, could not reproduce; i.e., a human would have no more neurons at death than he or she had at birth -and would probably have significantly fewer. Then, near the end of the last century, researchers discovered that two brain structures, the hippocampus (a structure involved in memory and learning) and the olfactory bulb (the brain structure involved in the perception of odor) could generate new cells. Even adults beyond the age of 65 had the capacity for neurogenesis in these two structures Along the lines of neurogenesis, there is evidence to suggest that there can also be growth in the connections between neurons. Vigorous physical activity appears to enhance neuronal growth, while learning, which involves using the cells, appears to promote new connections Improving Cognitive Capacity through Enriched Environments In 2006 the community of scientists on the cutting edge of research regarding the role of physical and cognitive exercise in promoting cognitive vitality made the following recommendation: The concept of the "enriched environment" currently employed in animal studies to promote physical activity, socialization, and problem solving, needs to be explored in human studies Having an "enriched environment" seems to be the key to improving cognitive capacity. Such an environment comprises increased opportunities for physical activity, learning, and social interaction. In their experiments using animal models, Cognitive Activities Cognitive scientists study cognition in terms of specific functions, such as attention, recall, expressive and receptive language, motor coordination, and executive functions that include planning and problem solving as well as stress management and emotional modulation. Many researchers, as well as the general public, believe that these skills inevitably decline with age. Hence, there have been quite a few attempts over the past decades to train people in these specific functions as a defense against time. In general, results of empirically supported studies using healthy older adults suggest that specific skills can be improved when targeted by an intervention A few studies have found evidence of generalized benefit from cognitive training programs. For example, the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study One emerging and promising area of research is the design and evaluation of interventions that offer ecologically valid activities in "real life" environments, because of their increased likelihood for acceptance and adherence by older adults. One example is the Experience Corps (EC) project that has forged a partnership between older adults and the public schools . In this project, teams of older adults worked in elementary school classrooms where they participated in teaching literacy and math skills as well as conflict resolution. Older adults deemed at the greatest risk for cognitive impairment who participated in this project showed improvement in executive functioning and memory skills . Another innovative program is the first intergenerational Charter School in Cleveland, Ohio. In this program, children aged six to twelve learn in the company of older adults, some of whom have been diagnosed as having Alzheimer's Disease Physical Activities and Cognition Physical fitness training, specifically aerobic training, has been found to have robust benefits for cognition. In the original 2003 article, the work of More recently, new evidence has surfaced that has further validated the role of aerobic conditioning in the preservation of cognition. Cognitive, Physical, and Social Functioning Cognitive training alone and physical training alone each have benefits for cognitive function. However, when an individual engages in both types of training, there appears to be a multiplier effect in which each enhances the impact of the other. Newson and Kemps (2006), too, found that the combination of physically and cognitively stimulating activities was related to better cognitive performance. In their study, participants recorded their engagement (time and effort) in such physical activities as running, swimming, and jogging; and cognitive activities, such as reading a book and completing crossword puzzles. They were then tested on a visual imagery task which made demands on cognitive function. By choosing this task for their test, Newson and Kemps claimed that the results of their study are indicative of a broad range of cognitive demands people face. The data analysis suggested that cognitive activities promoted performance on complex cognitive tasks better than the physical activity, but both physical and cognitive activity promoted general cognitive function. The authors concluded that both physical and cognitive stimulation offer protection against cognitive decline with age, but likely take different paths in doing so. Meaningful activities are those that require skill, concentration, feedback, deep involvement, and also a sense of flow, i.e, loss of awareness of the passage of time due to focused concentration . Professionally conducted, community-based cultural programs are examples of such activities. In a study of 166 healthy older adults, participants were assigned to a singing chorale intervention or comparison group of usual activities and were followed for 12 months Additionally,