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In this month’s email, I report on more evidence relating to the benefits of exercise in older people.

There is evidence from high-quality studies to strongly support a positive association between increased levels of physical activity, exercise participation and improved health in older adults. In the elderly, worldwide, around 3.2 million deaths per year are attributed to inactivity.

Systematic reviews have highlighted that:

• Key factors in improving health are exercising at a moderate-to-vigorous level for at least 5 days per week and including both aerobic and strengthening exercises.
• Five leading risk factors for death are high blood pressure, smoking, high blood glucose, physical inactivity and obesity.
  • High blood pressure and glucose levels, as well as obesity, are connected with physical inactivity.
  • As well as the increasing incidence of these risk factors with ageing, there is a decline in many physiological systems, a loss of muscle mass, a decline in balance ability, a reduction in muscle strength and endurance, and a decline in cognitive performance, all of which have an impact on functional independence.

Thus, increasing physical activity levels is a really important intervention to improve health in elderly populations.

But how much exercise is necessary to show benefit? Well, not so much, the evidence would seem to say. It is not about going to the gym four times per week, say, and then swimming on the other days.

In a cohort of 45,176 female participants in the Nurses’ Health Study, sedentary behaviour was associated with reduced odds of healthy ageing, while light physical activity was associated with increased odds of healthy ageing. In this study, replacing television time with light physical activity, moderate-to-vigorous physical activity or sleep (in participants with inadequate sleep) was associated with better odds of healthy ageing.

What about strength training in older people? There is evidence of benefit, as when we age, we lose muscle (sarcopenia) and this has detrimental effects on mobility and muscle function and predisposes individuals to fall-related injuries. Resistance training helps to reduce these risks.

For more information relating to the exercise benefits that are possible in older people, see Primary Care Notebook.

Other highlights in this month’s email include information on aspirin in the prevention of colorectal cancer and domperidone in the management of insufficient production of breast milk in breastfeeding, as well as an update to the methadone section.

• Aspirin in the prevention of colorectal cancer: Is there evidence of benefit of high-dose aspirin or low-dose aspirin or both high and low doses in the prevention of colorectal cancer? Is there evidence of benefit of aspirin use in preventing the recurrence of colorectal cancer? How does the duration of aspirin use affect the risk of colorectal cancer?
• Domperidone in the management of insufficient production of breast milk in breastfeeding: What dose of domperidone is indicated in the management of an insufficient supply of breast milk? How long should domperidone be prescribed in this scenario before being reviewed? What about cardiac concerns with respect to the use of domperidone in the mother and infant?
• Exercise benefits in older people: This section has been updated.
• Methadone: This section has been updated.
• Respiratory syncytial virus vaccination programme: This has been summarised.
• Steroid injection for tennis elbow: This section has been updated.