Plenary Keynotes

Life expectancy in developed nations is increasing by 5 hours a day, and in many developing countries even faster as they catch up, presenting globally a profound challenge for the organization of society. Whereas the increase was originally driven by success in reducing deaths in the early and middle years of life, recent decades have seen the emergence of an entirely new phenomenon – the declining death rates of people who are old already. Evidence from many lines of research confirms that ageing is more malleable than was previously thought, since it arises not from a strict genetic programme but from the gradual accumulation of damage in cells and tissues of the body, which can be modulated in turn by many factors including nutrition, lifestyle and environment.

Exercise is emerging as one of the most potent factors influencing health in old age. In some ways this is paradoxical, because exercise stresses the body, potentially causing more rather than less damage. However the potency of exercise as a beneficial factor arises from the multiple ways in which it stimulates the cellular maintenance systems to function at a higher level. Exercise works, but there is much yet to learn about its full potential.

Tom Kirkwood is Associate Dean for Ageing at Newcastle University, having been Director of the Institute for Ageing and Health from 2004-2011. His research is on the science of ageing and on understanding how genes as well as non-genetic factors, such as nutrition and exercise, influence longevity and health in old age. He led the 2007/8 Foresight project on ‘Mental Capital Through Life’, was Specialist Adviser to the House of Lords Science & Technology Select Committee inquiry into ‘Ageing: Scientific Aspects’ and served on the Councils of the Biotechnology and Biological Sciences Research Council and Academy of Medical Sciences. He has published more than 300 scientific papers and won several international prizes for his research. His books include the award-winning ‘Time of Our Lives: The Science of Human Ageing’, ‘Chance, Development and Ageing’ (with Caleb Finch) and ‘The End of Age’ based on his BBC Reith Lectures in 2001.

Since the 7th World Congress on Aging and Physical Activity in 2008, the World Health Organization and several countries have issued new or updated physical activity guidelines. These guidelines provide more specific recommendations on the types and amounts of activity that reduce risk of chronic disease and provide other health benefits in older people. The objectives of this presentation are: (1) to provide a brief history of physical activity guidelines; (2) to review health benefits of physical activity that are particularly important to older adults, such as prevention of dementia; (3) to discuss key physical activity guidelines for older people and how they differ from previous guidelines; and (4) to comment on gaps in knowledge and future directions for physical activity guidelines. Issues discussed include: how new guidelines reflect research on the dose-response relationship between physical activity and health; guidelines for physical activity and fall prevention; guidelines for muscle-strengthening activity; and guidelines for prevention of activityrelated injuries.

David M. Buchner, M.D., M.P.H. is a Shahid and Ann Carlson Khan Professor in Applied Health Sciences, in the Department of Kinesiology and Community Health, at the University of Illinois at Urbana-Champaign. He has published extensively in the area of physical activity and public health, with an emphasis on promotion of physical activity and prevention of fall injuries in older adults. Prior to joining the faculty at the University of Illinois, Dr. Buchner was a Professor in the School of Public Health at the University of Washington from 1984-1999. From 1999 to 2008, Dr. Buchner was Chief of the Physical Activity and Health Branch at the U.S. Centers for Disease Control and Prevention. In this role, he was chairman of the writing group for the 2008 Physical Activity Guidelines for Americans and he participated in numerous national initiatives involving physical activity and public health.

From birth to death physical activity pervades every aspect of our lives, from influencing the way we think, learn, love, express ourselves, choose our mates and friends, interact with our children, carry out our jobs, and recover from life-changing accidents and disease, to the way we accept the challenges of aging and ultimately, death. In early life physical activity comes easily, changes result in increased abilities, and enhanced well-being. Adult age-related physical changes require adaptation, both physically and mentally. Historically the focus and hypotheses of researchers that physical activity increases life span and decreases the effects of diseases that impair function and locomotion have been confirmed. For most individuals, however, quantity without quality of life would be tortuous. Within the last decade investigators have confirmed that physical activity can lead to increases in self-esteem, self-efficacy, and quality of life in general. Whether physical activity enriches our lives and feelings of well-being about our family, friends, work, play, and spiritual status, or whether a poverty of physical activity becomes a constraint that adds additional challenges to advanced aging is partially under our control. Frequent physical activity is beneficial for everyone at every age, the healthy, those with disabilities and disease, and even the frail elderly. No excuses! Opportunities to participate in physical activity are abundant if people just look for them.

Waneen Spirduso is the Mauzy Regents Professor Emeritus of the Department of Kinesiology and Health Education at The University of Texas, Austin. She is an author or co=author of Physical Dimensions of Aging, Research Proposals that Work, and Reading and Understanding Research. Since 1975 she has published over 75 research articles related to aging; received the Distinguished Alumni Award from the University of North Carolina, Greensboro. She is a frequent national and international lecturer on the relationship of health and fitness to physical and cognitive function in old adults. Her research has been funded by five of the National Institutes of Health, and several local foundations. She served as president of the National Academy of Kinesiology, and the North American Society for the Psychology of Sport and Physical Activity.

By 2030, the global prevalence of Alzheimer’s disease is predicted to reach 65.7 million. Despite worldwide research efforts, a cure for Alzheimer’s disease has not been identified. Thus, it is important to identify preventive strategies that reduce the risk of or delay the onset. Physical activity has been shown to have potential in this regard. In cognitively normal older adults, randomized controlled trials provide evidence that regular participation in physical activity benefits cognitive performance.

Additionally, there is evidence from prospective studies indicating that individuals who are more physically active have a reduced risk of dementia. Importantly, evidence also suggests that physical activity is more beneficial for individuals at greatest genetic risk for Alzheimer’s disease because of their apolipoprotein E (APOE) genotype. With regards to mechanisms, recent studies suggest that changes in cerebral structure and increases in growth factors such as brain-derived neurotrophic factor (BDNF) and vascular-endothelial growth factor (VEGF) may explain the cognitive benefits of physical activity. This is an important direction for future research designed to understand how to prescribe exercise to benefit cognitive function and to identify multi-modal interventions that include physical activity and other treatments such as diet and cognitive engagement to maximize these benefits.

Jennifer Etnier, Ph.D., is a Professor of Sport and Exercise Psychology and Director of Graduate Studies in the Department of Kinesiology at the University of North Carolina at Greensboro. Her research focuses on the effects of physical activity on cognition in older adults and in children. Her work has been published in journals such as Research Quarterly for Exercise and Sport, Chest, the Journal of Sport and Exercise Psychology, Medicine & Science in Sports and Exercise, and the Journal of Aging and Physical Activity. She is a fellow of the American College of Sports Medicine and Editor-in-Chief of the Journal of Aging and Physical Activity. She is a recipient of the Center for Women’s Health Research Award for Excellence. Recent research has focused on ApoE-4 genotype as a moderator and brain-derived neurotrophic factor (BDNF) as a mediator of the effects of physical activity on cognitive performance.

Epidemiological evidence suggests that, compared with a sedentary lifestyle, over three hours targeted exercise each week can halve the risk of osteoporosis, falls-related injuries and hip fracture. People spending less than 4 hours a day on their feet also have a greater risk of osteoporosis. To maintain healthy bone mass, three 20-30 minutes sessions of weight-bearing exercise each week are recommended. To reduce falls, weight bearing balance exercise is also recommended, but with the caviat of a 50 hour dose. But we know some forms of exercise, in certain groups of older people, can actually increase the risk of a fall or fracture. Brisk walking,, although has many endurance benefits, is often unsafe in those with poor balance and strength. There have been literally hundreds of studies that have looked at different types of exercise, different durations or intensities, different progressions and different frequencies per week. Do we have to exercise three times a week and are the effects better when we exercise in groups or alone? Once we are a faller or have osteoporosis, do the exercises change and does it matter who delivers them? How are we to make sense of the array of evidence and guidelines? Although this lecture cannot answer all of these, there will be some common-sense thoughts on research so far and where we can go in the future.

Dawn is Professor of Ageing and Health at the School of Health and Life Sciences at Glasgow Caledonian University. She was the foundation recipient of the Research into Ageing Queen Mother Research Fellowship. She undertook her fellowship at St Mary’s Hospital, Paddington and specialised in exercise interventions to reduce falls. She then moved into practice by becoming a Falls Researcher in the NHS at Merton, Sutton and Wandsworth Health Authority. She is a commissioned author for the World Health Organisation’s Health Evidence Network and the UK’s Department of Health; and is the Scientific Advisor for the Society for Physical Activity, the Prevention of Osteoporosis, Falls and Fractures (IsPAPOFF), and the British Heart Foundation National Centre for Physical Activity; and was Scientific Co-ordinator of the EC funded ProFaNE (Prevention of Falls Network Europe) project at the University of Manchester. She sits on the Research Grants Board for the National Osteoporosis Society. She also co-runs a not-for-profit training company to deliver courses to ensure evidence based translation into practice with allied health professionals and fitness instructors. She has won a number of NHS and Research Council grants and a number of research and educational practice awards.

Most governments, healthcare systems and corporations remain ill-prepared for population aging. Significant gaps exist in all areas that need to be filled—gaps that provide challenges and opportunities for society. One such gap is the health and well-being of older adults. One opportunity to fill these gaps is the promotion and marketing of physical activity to the older population. However, research shows that relatively few marketers focus on the older adult demographic, and most of those who do get a failing grade. How can this change? By attending this forward thinking session, you will journey into the mind of the older adult to learn about their core needs, and to better understand why current sales and marketing efforts fail to address them. In addition, you will learn how to transform your marketing efforts to capture this group’s hearts and minds and learn more about what it takes to make your marketing relevant to their lifestyles, capabilities, needs, dreams, aspirations and expectations, while achieving a response.

Colin Milner is a leading authority on the health and well-being of the older adult. For the past 4 years The World Economic Forum has invited Milner to serve on its Network of Global Agenda Councils, recognizing him as one of “the most innovative and influential minds” in the world on aging-related topics. An award-winning writer, Milner has authored over 250 articles on aging-related issues. He has also delivered speeches to thousands of business and governmental leaders, industry professionals, and older adults throughout the world. Some of the agencies that have sought his advice include: The European Commission; The World Economic Forum’s Global Agenda Council on Aging Society; The Shanghai Forum; US Department of Health and Human Services; US Administration on Aging; National Institute on Aging; Canadian Special Senate Committee on Aging; 2010 Vancouver Olympic Committee; British Columbia Ministry of Health and the White House Conference on Aging 2005.

Over the past few decades there has been a wealth of published scientific evidence for the physical, cognitive and social health-related benefits of exercise and increasing physical activity, especially in older adults. Strength, mobility, aerobic capacity, energy, anxiety, depression and reduction in fall risk in older populations have been shown to improve following increased physical activity interventions. While numerous studies have demonstrated the health-related benefits of physical activity, adherence to these programs is often disappointing. Barriers to adherence may include lack of interest in the program, low outcomes expectation, the weather or even a fear of falling during exercise. In our group at Neuroscience Research Australia we are examining how videogame technology can be used to increase compliance with exercise. In particular we are assessing the effects of exercise-based videogames to reduce the risk of falling, a major barrier to continued independence.

Stuart completed a PhD in Experimental Psychology at Macquarie University in 2000 followed by a postdoctoral fellowship at NASA’s Ames Research Center (2000-2002). Following academic positions at Trinity College Dublin and University College Dublin (2002-2007), Stuart returned to Australia in 2007 to undertake further research on the development and evaluation of telehealth technologies, with particular emphasis on the issue of postural instability and falls in older people. He is currently a Senior Research Officer at Neuroscience Research Australia and his research is funded by an NHMRC Career Development Award-industry, NHMRC Project and Partnership grants, an EU FP7 grant and a Parkinson’s NSW seed grant.

Neurological impairments are a major contributor to problems of gait and balance in older people, Whether due to well characterized conditions such as stroke or Parkinsons disease, or to more recently recognized conditions such as leukoencephalopthy or age related dopamine deficiency, there are numerous emerging opportunities to promote improved function through physical activity. The key to successful interventions may be to go beyond traditional exercise that focuses on endurance and strength, to exercise that incorporates principles of motor learning.

Dr Stephanie Studenski is a geriatrician and rheumatologist whose practice, teaching and research focus on mobility, balance disorders and falls in older adults. Through her research, she strives to understand balance and mobility problems that occur with obvious conditions such as stroke, as well as those of more insidious onset that may be related to subclinical losses in multiple organ systems. She has been continuously funded by NIH, VA and other sources for over 25 years and has published over 200 articles and book chapters. Dr Studenski is currently the principal investigator of the Claude D Pepper Older Americans Independence Center at the University of Pittsburgh, whose thematic focus area is gait and balance in the aged. She is Associate Editor of “Hazzard’s Textbook of Geriatrics and Clinical Gerontology”, co-author of the Geriatrics chapter in Harrison’s Internal Medicine Textbook and the lead author of the chapter on geriatrics research in the Textbook on Clinical and Translational Science. She currently serves on the NIA Council of Advisors.

In the past two decades, the mortality rate from cardiovascular disease (CVD) in many Westernised countries has been halved. Yet the number of people living with the burden of CVD has not changed and is showing signs of increasing. With increased survival rates, coupled with an ageing population, the management of CVD needs to be delivered in a manner to prevent unnecessary costly hospital re-admissions both for acute coronary events and heart-failure. In addition to exercise helping to reduce or manage bio-medical risk, it is increasingly playing a vital role in sustaining quality of life and prevention of co-morbid disability that often transpires either coincidently or as a result of acute cardiovascular events. This presentation aims to highlight the vital role that physical activity and exercise play in the physical, social and psychological elements of chronic CVD management that is increasingly prevalent in the Western World’s ageing population.

John’s career in sport and exercise science health (exercise physiologist) has spanned over 30 years. It includes having set up his own exercise, fitness and physiotherapy business in Shrewsbury and managing it with his physiotherapy partners for 21 years. In parallel to this, since 1989 he has held part-time teaching and research posts initially in the School of Physiotherapy at Keele University (1989-2006), and since 2006, moving to the University of Chester. Since 1999, he has been the Exercise Physiologist at the national McArdle Disease Clinic, which is now based at the MRC Neuromuscular Centre, University College Hospital London. He is the immediate past-President of the British Association for Cardiovascular Prevention and Rehabilitation, and Chaired the BASES Division of Physical Activity for Health for 4 years. He has written books and published widely in the area of exercise testing and prescription in internationally recognised journals of sports medicine and exercise science.

As people age, most become physically less active. Health promotion initiatives generally focus on moderate-to-vigorous physical activity or specific forms of exercising for health. However, older people can also spend a great deal of their time sitting. New evidence points to too much sitting as a distinct health risk, which is additional to the more well-known deleterious consequences of too little physical activity. This presentation will provide an overview of what is known about how too much sitting can be bad for health; what is known about how much sitting older people do; why prolonged sitting is so common; and, the feasibility and likely benefits of reducing and breaking up prolonged sitting time. Findings from recent research in Australia will be highlighted, with suggestions about the type of beneficial changes that older adults might make to their patterns of time spent sitting and being physically active. However, changing sitting time is not simply a matter of discretionary individual choice and personal initiative. Serious consideration also needs to be given to the environmental and policy initiatives that are most relevant for older adults and to the advocacy strategies that are needed.

Neville is Head of the Behavioural Epidemiology Laboratory at the Baker IDI Heart and Diabetes Institute in Melbourne and a National Health and Medical Research Council of Australia Senior Principal Research Fellow. His research relates to the primary prevention of cancer, diabetes and heart disease, and deals with the environmental, social and personal-level determinants of behavioral risk factors - primarily sedentary behaviors (television viewing, sitting in automobiles, desk- and screen-bound work) and lack of physical activity. He has published some 350 peer-reviewed papers, the book Physical Activity and Behavioral Medicine with James F Sallis and has been a contributing author to a number of national and international prevention-policy documents.