International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines


The human ageing process is universal, ubiquitous, and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct types of ageing, shaped by patterns of living – experiences and behaviours, and by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially decreased.

Both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases such as:

  • Cardiovascular disease
  • Stroke
  • Diabetes
  • Osteoporosis
  • Obesity

Other benefits include improvement in mobility, mental health, and quality of life, and a reduction in mortality. An exercise intervention programme improves the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing.

The prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In these pathological conditions, exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. In line with other therapeutic agents, exercise shows a related effect and can be individualised using different modalities, volumes and/or intensities, as appropriate to the health state or medical condition.

Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome, as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment.

Inadequate PA/exercise and excess sedentary behaviours are big risk factors for all-purpose and cardiovascular mortality, stoutness, sarcopenia, delicacy, and inability, among other ongoing infections related with maturing. Being physically active and having a good dietary routine (combined with no smoking and moderate liquor utilization and the upkeep of proper weight) are essential to keeping up with wellbeing and prosperity at all ages. Exercise and PA offer clinical advantages across a wide scope of diseases and incapacities with no upper age limit.

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