Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
The newspaper story about our research focused on the proportion of older people without sufficient leg strength to stand up unaided from sitting in a chair. At the time, it irritated me. We had just completed a major country wide health and activity survey with superb data on fitness at all ages....and they picked this one component. It was a huge piece of work. Our team had interviewed 1800 adults up to the age of 70 years old, measured VO2max together with ECGs on a treadmill, undertaken various strength tests in a mobile exercise laboratory that we transported to 14 different hospital sites, and taken fasting blood tests in peoples’ homes. My main interest in sport and exercise medicine was in promoting physical activity and - at the time - I thought I was a bit of an exercise guru. It wasn’t the headline I had hoped for and, furthermore, I was teased for weeks by friends and relatives. Everyone wanted to show me how they could all stand up unaided from sitting in their armchairs!
But, with a bit of hindsight, I can now say that perhaps the journalists were right. Functional fitness in older people may be just as important as population levels of physical activity. How one’s interest and priorities evolve! At a sports medicine conference some months later I spotted a talk on fitness in older people. I popped in to the session to see what it was about. By this time I knew of research published on strength training in people in their 80s and 90s and I expected something along those lines. But, this session didn’t emphasise gym work, walking or weight training...the first exercise they taught older people was how to get up off the floor.
Is there more we could do, and could we learn from sport? Gerontologists do prioritise independent living and it is now quite common to arrange hospital admission for intensive short stay rehabilitation. But I wonder if we could intervene earlier and, not necessarily using the medical model. Might we take a more global view of overall functional fitness and integrate lessons learned from sport and exercise physiology to improve the lives of older people? Is there a wider role for intensive training in active older people before they become disabled? Sports doctors and physiotherapists now talk about preventive training- “pre-hab” in athlete speak. We also know how effective performance enhancing drugs are in sport- could there be a role for anabolic steroids, growth hormone, EPO in routine elder care? Maintaining functional fitness should be seen as something entirely normal rather than waiting for medical necessity. After all, maintaining a normal life in one’s own home is usually restricted by mobility, practical limitations, ergonomics, nutrition and communication and not medicine. In this context, I was fascinated by a recent newspaper article describing a proposed new innovative centre in France. Urban Geronto Data is a research centre created to integrate all aspects of older people’s lives in the digital era with home based internet, cameras, sensors (e.g. for gas, fridge contents etc.) and physiological measures of blood pressure, temperature etc. The main aim is to change the focus to be home-centred rather than hospital-centred and they are currently building a 400 sq. metre living lab.
Like many aspects of health care, it may be time to look beyond our traditional perspectives and appreciate that the future may not be medical. Adapting the environment, improving functional fitness and monitoring people in their own homes may be much more effective.
We need to ensure that people can get out of a chair unaided.