Physical Activity Rx Boosts Healthspan, Lifespan, Function

Physical activity reduces chronic disease risks, improves function, and extends lifespan, thus supporting clinicians’ use of exercise prescriptions as a health intervention, new research suggests.

A review of the effects of physical activity for older adults documented specific benefits, such as preventing or reducing the risks for > 30 chronic conditions including coronary artery disease, heart failure, type 2 diabetes, chronic obstructive pulmonary disease, osteoporosis, depression, dementia, and cancer.

“Beyond physical health, physical activity helps with social and mental health as well,” study author Jane Thornton, MD, PhD, associate professor of family medicine and epidemiology and biostatistics at Western University in London, Ontario, Canada, and director of Health, Medicine, and Science at the International Olympic Committee, told Medscape Medical News.

“As we say in the article,” she added, “‘Age, frailty, or existing functional impairments should not be viewed as an absolute contraindication to physical activity but, considering the benefits of physical activity interventions for older adults, a key reason to prescribe exercise.’”

The study was published on January 27 in the Canadian Medical Association Journal.

Key Benefits

The researchers assessed the evidence published from 2002 to 2024 related to the health benefits of physical activity in older adults and presented strategies for talking to patients about getting active, as well as tools to make exercise prescription useful. Two reviewers screened the search results and selected only meta-analyses and systematic reviews for inclusion in the review.

The review presents the following benefits of physical activity, along with examples of the evidence that supports them:

Longevity: A 2023 meta-analysis of large prospective studies found that physical activity levels equivalent to the recommended 150 min/wk of moderate physical activity reduced all-cause mortality by 31% compared with no physical activity.

Functional independence: This benefit involves the ability to perform activities of daily living and encompasses cognition, social belonging, and quality of life. A 2012 meta-analysis involving frail older adults found that physical activity can lead to improvements in the ability to perform activities of daily living and in gait speed and balance.

Fall prevention: A 2016 systematic review and meta-analysis showed that exercise interventions and physical activity among older adults reduced falls by 21%. A 2021 meta-analysis of randomized controlled trials found that integrated exercise programs in which patients participated more than five times per week for more than 32 weeks were most effective in reducing fall risk.

Bone and joint health: A 2018 review of osteoarthritis data found that although very high levels of physical activity may increase the risk of developing osteoarthritis, moderate levels of physical activity do not. Regular exercise also can reduce pain and, as noted earlier, improve physical function.

Cognitive health: A 2021 analysis of longitudinal studies of aging found that higher levels of physical activity in older age were associated with a reduced risk of developing mild cognitive impairment and for the progression of mild dementia to severe dementia. It also found increased rates of returning from severe to mild cognitive impairment compared with low levels of physical activity.

Mental health: A 2022 systematic review found that exergaming (ie, technology-driven physical activity such as virtual reality and Wii Sports) is associated with an improvement in depressive symptoms.

Quality of life: Two 2021 meta-analyses underscored the effects of outdoor exercise parks and aquatic exercise on improved quality of life, mood, anxiety, and other neuropsychological outcomes among older adults.

“Physical activity is underused as a health intervention both in the community and in the delivery of healthcare for older adults,” the authors wrote. “Older adults who become more physically active can potentially add years to their lives as well as higher quality of life to those years.”

How to Prescribe

Clinicians can prescribe exercise for patients by following “two preferred initial steps,” Thornton said. One step, which can be taken by primary care physicians as well as specialists, is to track patients’ physical activity levels. “This signals to both patient and provider that physical activity is important and can prompt further discussion when levels are out of range or changing.” 

The second step is for the clinician to incorporate physical activity counseling into the treatment plan as they would for a medication or other intervention, she said. “This [step] can take the form of a written prescription or a discussion of the guidelines and [referral] to community resources.”

“In some cases, such as for risk factor or symptom assessment (eg, recent cardiac event, high risk for falls, or signs/symptoms of uncontrolled chronic disease), further tests can be ordered, and supervision by an exercise specialist may be necessary in the initial stages,” Thornton noted.

Although referrals to exercise specialists may be helpful, if such visits are not covered by insurance or only take place in specialized gyms, they may present a barrier to exercise, she cautioned. “Most individuals can start to be physically active gradually without specialist supervision, and it is important for clinicians to follow-up and check in.”

Lucas J. Carr, PhD, director of the Behavioral Medicine Lab and of the Community Health Collaborative at the University of Iowa in Iowa City, Iowa, commented on the study for Medscape Medical News. Carr, who was not involved in the current study but led a recent study on screening patients for inactivity, noted that such screening could be a helpful initial step and can be done in a timely manner.

“The Physical Activity Vital Sign questionnaire is a three-question survey that patients can complete on their own in

The study authors suggested using the World Health Organization’s Five-step framework (called the “5As”) as a road map to promote activity in their patients. They also suggested entering physical activity into patient records as a vital sign to be followed over time.

Overcoming Challenges

Not all clinicians are willing or able to prescribe physical activity for patients, Thornton acknowledged. “I usually break the challenges down into the clinician’s lack of the three T’s: Time, training, and trust,” she said. “Lack of time is a major issue in physical activity prescription, as clinic visits are often 5-15 minutes long, and other issues often end up being more pressing,” she said.

“Fundamental training in physical activity prescription is still lacking in many medical schools, even though the demand is there from medical students and patients,” she continued. “Finally, some physicians don’t trust that their patients will engage in physical activity, even if counseled to do so, so they don’t engage.”

These points “are sound, but not insurmountable,” Thornton said. Her team’s approach is to increase physician competence and comfort in physical activity prescription and address the three barriers. The team also has worked on national and international strategies to increase physical activity training in the medical curricula, so that training is more readily available.

“Time and money are major barriers” from Carr’s perspective. Even screening patients for physical inactivity can be a challenge, he said, “given the number of clinical preventive services and conversations that are already recommended for older adults.” Moreover, screening for inactivity is not directly reimbursable in the US health system.

For clinicians who are thinking of referring patients to a health coach or personal trainer, Carr recommends exploring the professional’s credentials before entering an agreement to avoid referring to individuals with less-than-credible certifications.

“There is a major need for the integration of physical activity into our healthcare system,” he said. “We need to address the barriers preventing this integration, which include a lack of billing options and limited time to counsel patients. We need a place for exercise counseling specialists who have the time, knowledge, and ability to bill for these types of services.”

Even where additional resources and training may still be needed, said Thornton, “Physical activity prescription is effective, cost-effective, and valued by patients. So if you’re not incorporating this into your practice on a regular basis, please do!”

No funding for the data review was reported. Thornton is Tier two Canada Research Chair in Injury Prevention and Physical Activity for Health and director of Health, Medicine, and Science at the International Olympic Committee. Carr declared having no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.