Regular aerobic exercise has an inverse dose-dependent relationship with the prevalence of major chronic diseases of ageing including: coronary heart disease, osteoarthritis, type 2 diabetes, depression, some cancers, dementia, disability, falls, and loss of function.

Regular aerobic exercise is beneficial to older adults because it increases cardiorespiratory fitness which itself is an independent risk factor for morbidity and mortality.

Regular strength training is especially important in older adults as it is essential for the maintenance or improvement in muscle mass, muscle quality, mobility, and bone mineral density.

Combined exercise modalities are likely more beneficial to older adults and individualized prescriptions are best.

Stretching or low intensity exercise (Tai Chi or Medical Qigong) are unproven alone, but may contribute to improve flexibility and balance.

Balance training should be recommended as part of an exercise intervention to prevent falls.

Increasing physical activity in middle and older age may reduce the risk of cognitive decline in older adults.

Despite the evidence, exercise recommendations have been poorly adopted—particularly in older age.

Behavioural inertia is greater than for primary prevention. For example, patients with diabetes are less likely to be active or adopt healthy exercise habits than non-diabetics.

Clinical inertia may be due to an incorrect belief that physical exertion is associated with an increased risk for cardiac events. Evidence now supports clinical guidelines that recommend moderate exercise for the treatment and management of established chronic diseases (including coronary heart disease, hypertension, peripheral vascular disease, type 2 diabetes, obesity, dyslipidaemia, stroke, osteoporosis, osteoarthritis, claudication, and COPD effectively reduces secondary risk.

Older patients starting exercise training as secondary prevention should be referred to a facility experienced in exercise for older adults. They may require clinical assessment including, when appropriate, exercise stress testing. This may identify previously undiagnosed heart disease and/or help determine an appropriate exercise training prescription.

Older adults should participate in moderate-intensity aerobic activity for a total of 150min/week, or in vigorous-intensity activity for a total of 90min/week.

Moderate- and vigorous-intensity activities are defined as approximately 50% and 60-70% of maximal aerobic capacity, respectively.

Intensity can be determined from either submaximal or maximal exercise testing. Screening exercise stress testing should be considered in those patients who are new to exercise training or quite deconditioned, have known cardiovascular risk factors, a positive family history, or based on clinical presentation in consultation with the patient.

There are some risks, but it is important to avoid discourageing older people from being active.

Older adults should undertake resistance exercises on at least 2 days/week.

Resistance exercise should involve the major muscle groups of the body (including the upper and lower extremities and core), and should consist of 8-12 repetitions at > 60% of 1 RM.

Formal equipment is not required. Initial supervision is advised to ensure appropriate technique and safety.

Flexibility/balance at least 2-4 times a week (as warm-up/cool-down to resistance exercise sessions) but preferably daily.

Multimodal exercise including Tai Chi, or Medical Qigong have been shown to be effective in reducing the risk falls.