Enabling the promise of healthy longevity through regular physical activity: Navigating the challenges and unlocking the opportunities

The health and quality of life benefits of regular physical activity, both through daily movement and as part of structured exercise, are pervasive, supported by decades of evidence across virtually every system of the body, from cellular pathways through biobehavioral mechanisms. These health benefits occur across the life course and can be particularly beneficial in older age, irrespective of levels of function. The accompanying economic benefits of a physically active lifestyle, both at the individual and population levels, make physical activity a “best buy” in the health care landscape.

So, given the tremendous evidence base coupled with continuing societal messages emphasizing the benefits of a physically active lifestyle, why does a significant proportion of the world’s population, especially in middle and older age groups, remain insufficiently active to receive many of these benefits?

This global consensus document on optimal physical activity recommendations for enhancing healthy longevity in older adults makes a persuasive case for the importance of personalized medicine in being able to best meet the needs of the tremendously heterogeneous older adult population [1]. One important means discussed is through effectively translating the large evidence base into achievable clinical practices through guidance tools that are integrated directly into electronic health record systems and similar health care management practices. The accelerating wave of artificial intelligence (AI) tools being developed for health care provides one potentially promising avenue for developing person-centric algorithms that can support greater provider-initiated activities and patient participation in this area [2]. Additionally, as described in the Consensus document, putting into practice feasible methods that integrate physical activity and exercise into the nutritional and pharmacotherapy management of patients, potentially through AI-driven “real-time” information, provides an avenue for catalyzing positive benefits for each patient. While such AI tools hold tremendous promise for increasing relevant personalization and integration of health care decisions for the older patient, It is critical that the databases upon which AI algorithms are based are representative of the full spectrum of the older adult population [3]. The physical activity research and service community can play an important role in supporting activities that increase the heterogeneity of such databases for historically marginalized groups of older adults, including lower-income and other minoritized populations.

1. Addressing the “how” of increasing regular physical activity among older adults

The Consensus document does an outstandingly thorough and comprehensive job of answering the “why” question related to including specific exercise prescriptions into every patient’s treatment plan. The question remains, how can we get health care providers and health care systems more generally to prioritize the inclusion of regular physical activity and exercise in their treatment plans? In addition to seeking out, as noted earlier, complementary patient care services (i.e., nutrition and pharmacotherapy) into which physical activity programs can be more fully integrated, an avenue for incenting health care systems to more actively integrate physical activity interventions into health care is through the economic arguments described at the end of the document. Continuing research on the cost effectiveness and related economic benefits of physical activity interventions across the geriatric medicine field is strongly indicated, along with clearer determinations of the most effective ways of making the economic argument for physical activity which will stimulate positive movement among health care system leadership.

2. Recognizing the broader context beyond the patient role

A third important pathway focused on the “how” of increasing regular physical activity across diverse older patient populations is to more fully recognize the larger context in which patients live. The role of “patient” is for many but one facet among a myriad of roles that individuals are regularly required to play which can interfere with clinical directives and prescriptions. In addition, assuming that the principal drivers of behavior, including physical activity, lie primarily at the individual level of “choice” ignores the extensive evidence base demonstrating the critical importance of the surrounding physical, social, and policy environments shaping all aspects of human behavior, including physical activity [4]. Such behaviors are embedded in a broader contextual landscape impacting people’s lives, as reflected in the socioecological framework shown in Fig. 1 [5]. Notably, while the clinical setting sits within the community level of the socioecological framework, it traditionally has been isolated from other important aspects of people’s lives that directly impact their ability to execute clinical prescriptions and instructions, including increasing and maintaining physical activity.

Fig. 1.

A Socioecological Framework & examples of relevant factors.

3. Clinic-engaged citizen science aimed at building bridges between clinical and community contexts

One potential pathway for connecting health care clinics to the fuller contexts of patients’ lives is through clinic- and patient-engaged citizen science. An evidence-supported citizen science method, called Our Voice, provides one example of how this can be done. Based on a four-step method [6], this type of citizen science can bring the lived experiences and perspectives of patients and their family members into the clinic through capturing, using an easy-to-use multi-lingual mobile application (the Discovery Tool), those features of patients’ daily lives that make it easier or harder for them to adhere to a clinical prescription. The multi-component data they collect, including geo-tagged photos, narratives, and simple ratings relating to barriers to adherence, can provide accessible information that patients can bring or send to the clinical setting to provide further insights and help in identifying feasible solutions for such barriers. This type of mobile app has been used successfully by community members ages 8 to 95+ years, including socioeconomically and culturally diverse older adults spanning six continents [6]. The Our Voice method also has been used effectively by patients and health care staff in helping to identify positive as well as more challenging features of the clinic environment itself for different patient populations. For example, older patients in a medical rehabilitation unit in Brisbane, Australia used the Discovery Tool to identify positive clinic features (e.g., a garden at the rehab unit; windows providing views of greenery and the sky) as well as challenging features (e.g., hard-to-reach cupboards, drab décor). Sharing this information with clinic staff and administrators led to demonstrable positive changes in the clinic setting [6]. This method also has been used to better identify the healthcare needs and perspectives of adults with intellectual and developmental disabilities (IDD) [7]. That information is being used to optimize the health care environment for IDD patients.

4. Conclusion

The Consensus Report provides a robust foundation upon which to build strategies aimed directly at increasing personalized and actionable physical activity prescriptions across the geriatric patient continuum. The field is ready to make substantive progress in implementing the wide range of interventions that it will take to make demonstrable headway in achieving the goal of more active living for all geriatric patients.

Funding/Support

Dr. King received partial support through US Public Health Services grants 1R01 AG071490 (King) and 1R44AG071211 (Fauci) from the National Institute on Aging, and a Stanford Institute for Human-Centered Artificial Intelligence Seed Grant (award WOBAU).

Declaration of competing interest

The author declares that she has no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.