Exercise for aging with independence: what to do and how much

Why talk about independence, and not just years

Among the benefits of physical activity in people over 65, the WHO includes preventing falls and fall-related injuries, and slowing the loss of bone health and functional ability. When it reviewed the evidence it found, with high certainty, a relationship between the volume of aerobic activity and the risk of having physical limitations: the more activity, the lower the risk.¹

A systematic review of studies that followed older people living at home for years reached a similar conclusion: the most active had a lower risk of ending up with limitations or with difficulties in the activities of daily living. With moderate or high activity levels, the authors estimate a reduction of about half.⁵ These are observational studies: they show an association and can't fully rule out that the people in better health are precisely the ones who move the most.

To know whether activity causes that difference, trials are needed. In the LIFE study, 1,635 sedentary people aged 70 to 89, with some physical limitation but able to walk 400 meters (about a quarter mile), were randomly assigned to either a physical activity program or a health education program. The program combined walking, with the goal of reaching 150 minutes a week, with strength, balance and flexibility exercises: two sessions a week at a center and another three or four at home.⁴

After about two and a half years on average, 30.1% of the physical activity group and 35.5% of the health education group had lost the ability to walk 400 meters without help, about five percentage points fewer. Sustained loss, in two consecutive assessments, was also less common with the program: 14.7% compared with 19.8%.⁴

What the WHO and the Ministerio de Sanidad recommend

The WHO's 2020 guidelines are the international benchmark, and Spain's Ministerio de Sanidad adopts them in its recommendations for the public, updated in 2022.¹² For people aged 65 or older they're the same as for other adults, plus one more: varied activity that gives priority to balance and strength, at least three days a week.¹²

Three nuances from the WHO: minutes count even if they're done in short bouts, because it no longer asks for bouts of at least ten minutes; going beyond 300 moderate minutes brings additional benefits, although that recommendation is conditional; and there's benefit below the figures too.¹ What counts when your schedule won't stretch any further we review in healthy habits when you're short on time.

The Ministerio de Sanidad advises spreading activity across the week—for example, 30 minutes of moderate activity on five or more days—and, if you don't reach that, increasing it gradually, starting by building it into daily life.²

Aerobic activity: the base of the week

This is activity that moves large muscle groups rhythmically for several minutes or more: walking, running, swimming, cycling.² For the WHO, moderate intensity is what feels like a 5 or 6 on a personal scale of 0 to 10; the Ministerio describes it as the kind that speeds up your breathing but still lets you talk without running out of breath.¹² How to recognize it without a device, and how it differs from vigorous intensity, we explain in moderate and vigorous intensity.

Brisk walking, at more than 6 km/h (about 3.7 mph), is one of the two examples of moderate intensity the Ministerio gives; the other is leisurely cycling.² If you count steps, in how many steps a day we review what studies have found beyond the 10,000 figure, and in why your watch counts steps better than calories, how accurate that count is.

In the sports world, there's a lot of talk about “zone 2.” None of the three guidelines consulted uses that term: they talk about light, moderate and vigorous intensity.¹²³ What it means and why it isn't a figure that works for everyone we explain in what zone 2 is.

Strength: what keeps everyday life going

The WHO calls for muscle-strengthening activities of moderate or greater intensity, working all major muscle groups, on two or more days a week. It's a strong recommendation, with moderate-certainty evidence; on the other hand, it found no evidence that a greater volume of strength training brings more benefit.¹

You don't need a gym: pushing, pulling, carrying or lifting weight count too, including your own body weight, as when climbing stairs.² Why strength matters so much for independence and how much is enough to start is in strength and independence.

Balance and varied activity, especially from 65

The WHO calls activity that combines aerobic, strength and balance exercise in the same session, at home or in a group, “multicomponent.” Its examples: walking, lifting weights and, while working the arms, standing on one foot, or walking backward or sideways; dancing combines aerobic work and balance.¹ Since 2020 it has recommended it for all older adults, not only those with poor mobility.¹

One of the two reasons the WHO gives, along with functional ability, is falls. A Cochrane review of 108 trials, with 23,407 people living at home and an average age of 76, found with high certainty that exercise programs reduce the rate of falls—falls per person per year—by 23%, and those focused on balance and functional exercises, by 24%. Those combining several types, especially balance and strength, probably reduce them by 34% (moderate certainty), and tai chi may reduce them by 19% (low certainty).⁶

Less time sitting

The WHO recommends that all adults limit the time they spend sitting and replace it with activity of any intensity, including light activity. For people who sit for many hours, it also suggests trying to go beyond the figures for moderate or vigorous activity. What it doesn't set is a limit: the evidence isn't enough to put a number on it.¹

The Ministerio de Sanidad suggests walking part of your trips, taking the stairs, spending more time outdoors and taking active breaks.² What's known about those breaks we cover in getting up from your chair.

How to start with care

For people without contraindications, the WHO considers that a medical checkup generally isn't needed before starting light or moderate activity that demands no more than brisk walking or everyday life. People who already do moderate activity regularly can move on to vigorous activity gradually.¹ The Ministerio de Sanidad includes the first part in almost identical terms, among the WHO considerations it reproduces in its section on chronic conditions.²

The US guidelines sum up caution as “start low and go slow”: begin at low intensities and gradually increase frequency and duration, over weeks or months. They note that heart problems during exercise are rare, but that the risk is higher when an inactive person suddenly switches to vigorous effort.³ Older adults, the WHO adds, should adjust their effort to their fitness level and be as active as their functional ability allows.¹

It's a good idea to talk first with a health professional or a physical activity specialist in these cases:

• If you have a chronic condition or a disability, to adjust the type and amount of activity.¹³
• If you have symptoms, or new symptoms appear as you increase your activity.¹³
• If you're pregnant.³
• If you've been inactive for a while and plan to start straight away with vigorous exercise. The WHO's exemption refers to light or moderate activity; the US guidelines advise inactive people not to start with vigorous activity and note that, if you want to seek professional advice, it's especially appropriate to do so before vigorous activity, because its risks are greater than those of moderate activity.¹³

How much is enough to start

Doing something is better than doing nothing, and there are health benefits below the recommended figures too.¹ In the mortality data reported in the US guidelines, the biggest gain appears when going from no activity to about 60 minutes a week of moderate or vigorous intensity.³ It's an association with mortality, not a finding about independence, but it points in the same direction as the WHO's message.

As an example, those guidelines suggest that an inactive person start with five-minute walks several times a day, five or six days a week, and gradually lengthen them to ten minutes three times a day. For strength, start with one day a week at light or moderate effort and later move to two.³

The math that follows is ours, not the guidelines': ten minutes a day at a brisk pace makes 70 a week, a little more than those 60 and almost half of the 150 minimum. Thirty minutes on five days, the Ministerio's example, adds up to the full 150.²

To turn those first minutes into a routine, you can use the tools in the guide to sustainable habits: a small action, a fixed when and where, and a plan for getting back to it after a bad week.

What this guide doesn't cover

This guide summarizes public health recommendations for the general population; it isn't an exercise program and doesn't replace an individual assessment. The US guidelines deal separately with people who are frail or recovering from a hip fracture.³ In those cases, and if you have a chronic condition, the type and amount of exercise should be decided with a health professional.

The effects cited are averages from studies with specific populations. Neither exercise nor this guide guarantees that a particular person will stay independent; what the evidence allows us to say is that, in the groups studied, it reduces the risk of losing independence.