Blueprint for an Active Australia

Action area 2: Older adults

Authors: Anne Tiedemann, Cathie Sherrington, David Scott, Tracy Kolbe-Alexander, Helen Macpherson, Venisa (Wing) Kwok, Heidi Gilchrist, Rik Dawson, Marina Pinheiro.

Strategic priorities

Key strategic priorities for impactful change in physical activity amongst older adults:

• Develop and fund a National Physical Activity Plan that has a dedicated focus for older adults using a triaged service model (universal promotion, targeted support, supervised programs).
• Develop, fund and disseminate a national evidence-based training program for health professionals and community providers to support all older adults, including those with mobility or cognitive limitations, to be more active.

Sustainable Development Goals

The United Nations Sustainable Development Goals1 that relate to physical activity in older adults include:

For more information see Appendix 1

Consider the case for change:

• There is extensive evidence of multiple benefits of physical activity for physical and mental health, independence and wellbeing in older adults across diverse health, function and independence levels.^2-4 Structured exercise targeting balance and strength helps to prevent falls among older people.⁵
• Increasing population level physical activity is particularly important in the context of our ageing population. In 2020, there were 4.2 million people aged 65 years and over in Australia, representing 16% of the population. In the coming decades with the anticipated continued rise in life expectancy the number of people aged over 65 years is predicted to more than double to 10.2 million – up to 23% of the population – by 2066.⁶
• Life expectancy at age 65 – the average number of additional years that a person at age 65 can be expected to live – is projected to continue to increase. In 2022–23, life expectancy at age 65 was 20 years for men and 23 years for women. This is expected to increase to 25 years for men and 26 years for women by 2062–63.7 Total government spending on aged care as a proportion of gross domestic product (GDP), currently 1.1%, is predicted to increase to 2.5% in the 2060s.⁸
• Health system disease management strategies often focus on survival but neglect function and independence.⁹ Current funding systems are primarily designed to fund evidence-based medicines,¹⁰ medical services,¹¹ and devices. Funding for non-pharmacological interventions, such as physical activity and exercise is harder to secure, even though these interventions can help maintain physical and mental function and have the potential to improve quality of life and life expectancy for older people.
• Older adults face more barriers to being active than people in other age groups.¹² For example, physical activity may be perceived by some older adults as daunting and unsafe,¹² with access further constrained by low income, low educational attainment, and lack of neighbourhood accessibility.^13-16 Additional social, behavioural and financial support may be required to promote consistent and regular physical activity.¹⁷
• There may have been a small increase in physical activity among older people in Australia from 2016 to 2021,^18,19 but it is difficult to link this improvement with any specific government and non-government initiatives. Additionally, data show that older adults with disabilities are less active than those without disability.¹³ Equity issues in participation remain, as many services that support older people to be active require participants to pay, with few funded for those who cannot afford to pay for services themselves.¹⁵

• Some state governments are investing in initiatives to promote physical activity amongst older adults. For example, the NSW Ministry of Health funds the Active and Healthy website,²⁰ which provides an up to date index of physical activity opportunities for people aged 50 and over across NSW that is searchable by postcode. They have supported exercise and falls prevention programs for older adults, and provides some funding to deliver programs such as Stepping On, which teaches a structured exercise program. Injury Matters, funded by the Western Australia Government, produces Stay on Your Feet ®, a toolkit of evidence-based resources for consumers and health and aged-care professionals to promote balance and strength exercises for falls prevention.
• The Exercise intervention outdoor project in the community (ENJOY) Seniors Exercise Park program, developed by the National Ageing Research Institute, involves partnerships with local government to create outdoor spaces for older adults to engage in physical activity.²¹ Seniors exercise parks consist of outdoor playground equipment specifically designed for older people to improve strength, balance, joint movements and overall mobility and function. More than 20 seniors exercise parks have been established across Victoria, New South Wales and Tasmania.
• Global resources have been developed to provide guidance for age-friendly cities and communities with consideration of socio-economic factors.^22-24 The ACTIVE toolkit developed by the World Health Organization provides evidence-based guidance on key approaches to promoting and enabling all older people to be physically active. The Canadian Choose to Move program is an example of a choice-based physical activity support program, with personalised guidance and community connection.²⁵
• Australian mass media campaigns offer examples of effective targeting of physical activity messages for older people in Australia.^24,26 They have used a variety of media channels, community newsletters and posters, in collaboration with local organisations, health services, and community groups, to reinforce campaign messages and foster a supportive environment for behaviour change.
• Community-driven strategies such as citizen science and participatory design can be powerful tools to identify local barriers, improve environments, and increase participation. A strong example is the Toowoomba Healthy Towns project, in which older residents collaborated with local stakeholders to advocate for improved neighbourhood walkability and active transport across the lifespan.^27,28

Policy, practice and leadership

• Ensure the National Physical Activity Plan (see Joining up action for an active Australia) embeds older adult physical activity goals in national and state-level public health and aged care strategies.
• Provide leadership that enables system integration through policy guidance, funding mechanisms and design standards for age-friendly environments.^22-24
• Use frameworks such as the ^{Global Age-Friendly Cities} initiative to guide planning and retrofitting of infrastructure.²⁹
• Expand funding for prevention-focused supports such as physical activity prescriptions, health coaching, supervised programs and telehealth-delivered exercise. This will enhance equitable access and strengthen the role of primary care and other services in promoting active ageing.³⁰ Funding could be provided through Medicare, Primary Health Networks, aged care services, and state and local governments.

Urban design and planning

Design and maintain local infrastructure that supports safe, accessible and engaging physical activity, including well-maintained and connected footpaths, seating, accessible toilets and good lighting.^31,32

Incorporate dementia-friendly and cognitive supportive design elements to enhance usability for older adults with cognitive impairment.^33-35

Prioritise safety and confidence for older adults by reviewing and adjusting local policies (e.g. shared paths, cycling regulations) to balance active transport with pedestrian safety.¹²

Organisation and service delivery

• Tailor physical activity approaches for people aged 65 and over (and Aboriginal and Torres Strait Islander people aged 50 and over) to their health status, frailty, cognitive function, level of disability and living situation.^2-4,13 The benefits of physical activity extend across diverse levels of health, function and independence,2-4 and older adults with disability are less active than those without.¹³
• Embed evidence-based physical activity interventions and promotion in routine health and aged care services to support older adults and strengthen prevention-focused care.^9,36
• Improve equity by increasing access to funded physical activity programs for those who cannot afford to pay.¹⁵
• Develop triaged service models which combine universal promotion with targeted support such as coaching and supervised programs for those with higher needs.⁴
• Integrate technology-enabled options, including telehealth, virtual exercise classes, active video games (exergaming) and digital tools, particularly for older adults in regional and remote areas and those comfortable using technology.^37-40

Workforce

• Fund statewide training and accreditation for health and community-based providers to deliver safe, evidence-based physical activity interventions for all older adults, including diverse groups and those with mobility or cognitive impairments.^41-43
• Improve pre- and in-service training to enable health professionals to prescribe and promote physical activity for older adults.^44-46

Community awareness and engagement

• Support co-design and delivery of programs by local communities, including Aboriginal and Torres Strait Islander communities, ensuring cultural safety and relevance. Participatory approaches such as the Toowoomba Healthy Towns project show how older residents can identify local barriers and improve their environments.^27,28
• Promote inclusive, community-based education and activation campaigns to increase awareness, motivation and confidence for lifelong activity.^24,26

Research, data and innovation

• A review of the evidence for this action area identified the following priorities for investment in research, data and innovation.
• Evaluate social and economic outcomes of physical activity interventions for older adults.⁴
• Support implementation of structured programs and strengthen broader initiatives to promote active societies, active environments and active systems for older people in line with the Global Action Plan for Physical Activity (GAPPA).⁴⁷
• Explore remote and digital interventions, social prescribing, equity-based incentive schemes, workplace promotion and peer support for physical activity in older adults.
• Investigate how technology could be used to enhance engagement with physical activity interventions, in order to improve health outcomes in older adults.⁴⁸
• Improve understanding of older adults’ preferences for receiving physical activity information and support.

Heart Foundation related information for older adults