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93

Review article             UDC: 796.012:613.98
received: 2017-07-04

PHYSICAL ACTIVITY AND EXERCISE AS A KEY FACTOR 
IN SUCCESSFUL AGING

Eleonora CAPATTI, Edoardo DALLA NORA, Angelina PASSARO

University of Ferrara, Department of Medical Sciences, Section of Internal Medicine and 
Cardio-Respiratory, Via Aldo Moro n°8, Cona 44121 Ferrara, Italy

Corresponding Author: 
Angelina PASSARO, MD, PhD. 

University of Ferrara, Department of Medical Sciences, Section of Internal Medicine and 
Cardio-Respiratory, Via Aldo Moro n°8, Cona 44121 Ferrara, Italy

Tel +039 0532 239012 
e-mail: psn@unife.it

ABSTRACT

Aging is associated with several changes in body composition and metabolism, in-
cluding sarcopenia, sarcopenic obesity and decrease in bone mass; aerobic capacity, 
muscle mass and strength tend to decline progressively. These changes have consider-
able impact on the ability to perform daily activities, especially when associated with 
chronic diseases, such as type 2 diabetes, cardio-vascular disease and dyslipidemia, 
as well as geriatric syndromes, like mobility impairment, falls and frailty. Scientific 
research has shown that physical activity and exercise can slow the physiological ag-
ing clock. Particularly, active elderly people seem to age “successfully” compared to 
sedentary ones. The aim of our work is to review evidence-based recommendations 
for physical activity, exercise and diet that would help to preserve muscle mass and 
strength, and to reduce the gain of fat mass in older adults. Increasing levels of physi-
cal activity, in particular resistance training mixed with aerobic exercise, and adequate 
protein nutrition intake should be an integral component in the prevention and treat-
ment of sarcopenia, sarcopenic obesity and metabolic syndrome in elderly subjects.

Key words: sarcopenia, physical activity, body composition, energy consumption, 
nutrition, aging.

mailto:psn@unife.it


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GIBALNA AKTIVNOST IN VADBA KOT KLJUČNA FAKTORJA PRI 
USPEŠNEM STARANJU 

IZVLEČEK

Staranje je povezano s številnimi spremembami v telesni zgradbi in metabolizmu kot 
so npr. sarkopenija, sarkopenična debelost in zmanjševanje kostne gostote. Posledično 
se progresivno zmanjšujejo aerobna kapaciteta ter mišična masa in moč. Te spre-
membe odločilno vplivajo na sposobnost opravljanja vsakdanjih aktivnosti, še zlasti 
v povezavi z morebitnimi kroničnimi boleznimi kot so npr. sladkorna bolezen tipa 2, 
kardio-vaskularne bolezni in dislipidemija pa tudi raznimi geriatričnimi sindromi kot 
so motnje v gibanju, padci in krhkost. Znanstvene raziskave so pokazale, da gibalna 
aktivnost in vadba lahko upočasnita fiziološko uro staranja. Predvsem se zdi, da se 
aktivni starostniki starajo »bolj uspešno«, kot pa sedentarni. Namen članka je pregled 
priporočil, pridobljenih na osnovi raziskav in dokazov, za gibalno aktivnost, vadbo in 
prehrano, ki bi pomagali starejšim odraslim ohraniti mišično moč in maso ter hkrati 
zmanjševati maščobno maso. Povečevanje stopnje gibalne aktivnosti, predvsem vadbe 
za moč v povezavi z aerobno vadbo, ter ustrezna prehrana bogata s proteini, bi mo-
rale biti integralne komponente pri preprečevanju in obravnavi primerov sarkopenije, 
sarkopenične debelosti ter metaboličnih sindromov pri starejših osebah.

Ključne besede: sarkopenija, gibalna aktivnost, telesna zgradba, poraba energije, 
prehrana, staranje

INTRODUCTION

Aging is associated with major changes in body composition, including an increase 
and redistribution of adipose tissue and a decrease in skeletal muscle mass (sarcopenia) 
and bone mass, events that begin generally around the fourth decade of life (Fiatarone 
Singh, 2002). 

Recent population trends (Swinburn et al., 2011) indicate an alarming rise in the 
prevalence of obesity among older adults, potentially adding a complementary condi-
tion that compounds the risk of poor health outcomes. The interplay between sarco-
penia and rising trends in obesity in aging population emerged more than 20 years 
ago as an important public health concern in geriatrics (Evans & Campbell, 1993). 
The prevalence of sarcopenia and sarcopenic obesity increases with age, thus, muscle 
mass and strength lead to a progressive decline (Zamboni, Mazzali, Fantin, Rossi, & Di 
Francesco, 2008). These changes have considerable impact on the ability of perform-
ing daily activities (Batsis, Mackenzie, Lopez-Jimenez, & Bartels, 2015; Baumgartner 
et al., 2004) and have also significant consequences in health and functioning of the 



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individual, because of their association with chronic disease’s expression and severity, 
as well as with mobility impairment, risk of falls and frailty. 

Changes in muscle, fat and bone surely relate to an excess / incorrect energy con-
sumption, decreased energy expenditure in physical activity, or both factors in combi-
nation. However, in elderly subjects, other mechanisms are involved, such as changes 
in hormones regulating metabolism, like growth and sex hormones (Sakuma & Yama-
guchi, 2012). 

This declining need for energy due to a reduction in the amount of lean body mass 
and a more sedentary lifestyle, together with an inappropriate dietary intake, is the first 
step in the development of malnutrition in the elderly. 

The main age-related changes in body composition and physiologic function which 
appear to influence nutrient requirements in older adults are listed in Table 1 (Blum-
berg, 1997). Dietary intervention has to be considered a key part of the demographic 
challenge of an aging population and should be a fundamental part of the public health 
policy necessary to reduce chronic diseases and compress morbidity (Bendich & Deck-

Table 1. Examples of Age-Related Changes in Body Composition and Physiologic 
Function that Influence Nutrient Requirements (modified from Blumberg, 1997).

Changes in body composition or 
physiological function Impact on nutrient requirements

Decreased muscle mass Decreased need for energy

Decreased bone density Increased need for calcium and vitamin D

Decreased immune function Increased need for vitamin B6, vitamin E and 
zinc

Increased gastric pH and decreased gastric 
motility 

Increased need for vitamin B6, folic acid, 
calcium, iron, zinc, fiber and water

Decreased skin capacity for cholecalciferol 
synthesis Increased need for vitamin D

Increased wintertime parathyroid hormone 
production Increased need for vitamin D

Decrease calcium bioavailability Increased need for calcium and vitamin D

Decreased efficiency in metabolic use of 
vitamin B6 Increased need for vitamin B

Increased oxidative stress and homocysteine 
levels

Increased need for beta-carotene, vitamin C, 
vitamin E, folate, vitamin B12 and B6

Decreased vitamin absorption Increased need for food choices with high 
nutrient density



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ANNALES KINESIOLOGIAE • 8 • 2017 • 2

elbaum, 2015), as well as physical activity and exercise, capable of slowing down the 
physiological aging clock (Taylor et al., 2004).

METHODS

Relevant medical literature was identified from searches of PubMed and references 
cited in appropriate articles identified. Search terms used included sarcopenia, aging, 
physical activity, elderly, exercise, body composition, aging metabolism, nutrition. 
More detailed search terms were used following the identification of relevant mecha-
nisms and to identify epidemiological studies. Selection of articles was based on peer 
review, journal and relevance.

AGE-RELATED CHANGES IN BODY COMPOSITION AND BODY 
METABOLISM

Sarcopenia, commonly associated with fat infiltration into muscles (sarcopenic obe-
sity), is very common, with a prevalence of ∼5 % in persons aged 65 years and as high 
as 50 % over the age of 80 (Janssen, 2010). It leads to a decline in muscle strength and 
power, supported also by altered muscle energetics, changes in tendon insertion, altered 
muscle coordination and decreased blood flow in the capillary bed of the muscle. Fat 
infiltration into muscle (myosteatosis) is associated with decreased strength and an in-
crease in the prevalence of disability (Rolland et al., 2009).

As an adequate nutrient intake is essential to maintain muscle mass, the decline 
in food intake with aging plays a role in the development of sarcopenia. In particular, 
maintenance of muscle mass requires adequate protein intake; it is postulated that older 
persons require at least 1.2 g / kg of protein a day (Morley et al., 2010).

From a metabolic point of view, the most important consequence of sarcopenia 
is the decrease in energy expenditure (in particular for physical activity) and basal 
metabolic decline; moreover, the ability to increase or decrease energy expenditure to 
counterbalance overeating or undereating is impaired with an increased susceptibility 
to energy imbalance (both positive and negative) (Roberts & Rosenberg, 2006). A de-
cline in basal metabolic rate (BMR) with aging is well recognized (Poehlman, 1992), 
associated to a loss of fat free mass (FFM) and a gain of fat (FM), a less metabolically 
active tissue. 

A longitudinal study by Keys, Taylor, and Grande (1973) documented a decline 
in BMR with age of 1 – 2 % per decade. Other studies examining the role of aging 
on resting metabolic rate (RMR) and substrate oxidation (Frisard et al., 2007; Krems, 
Lührmann, Straßburg, Hartmann, & Neuhäuser-Berthold, 2005) indicate a reduction in 
RMR with age greater than what would be predicted from the observed modification 
of FM and FFM, suggesting that the lower RMR of older adults may be due in part to 
slowed organ metabolic rates (St-Onge & Gallagher, 2010). 



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The lowering of FFM and the increase of FM, in particular of visceral adipose tis-
sue (VAT), is related to an increased risk of cardiovascular disease, type 2 diabetes, 
hyperlipidemia, hypertension and malignancy (Donohoe, Doyle, & Reynolds, 2011).

The association of central adiposity to poor health is related to VAT accumulation 
and associated with hyperinsulinemia and insulin resistance. VAT secretes a number 
of adipokines and inflammatory cytokines (TNF- α, IL-6, IL-1β) that can up-regulate 
nuclear factor-κB (NFκB), which leads to an increase in nitric oxide (NO), a substrate 
for reactive oxygen species (ROS) (Sonnenberg, Krakower, & Kissebah, 2004). 

Moreover, excess adiposity is associated with a state of low-grade chronic inflam-
mation, which interfere with adipose cell differentiation and adipokines pattern secre-
tion, resulting in dysfunctional adipose tissue (Paniagua, 2016). Increased VAT is as-
sociated with elevated free fatty acids, impaired hepatic insulin clearance, resulting in 
hyperinsulinemia, increased gluconeogenesis, and elevation of very-low-density lipo-
protein secretion (Matsuzawa et al., 1995). 

In this state the subject presents a pro-inflammatory, pro-coagulant and insulin re-
sistant state typical of the metabolic syndrome (Despres & Lemieux, 2006).

PHYSICAL ACTIVITY AND AEROBIC / ANAEROBIC EXERCISE

Regular physical activity is one of the most important protective factors against the 
development of chronic diseases (Harridge & Lazarus, 2017): sedentary individuals 
show an higher incidence of cardiovascular disease, diabetes mellitus, obesity as well 
as different malignancy. On the contrary, physical activity is inversely related to all-
cause mortality in older adults (Brown et al., 2012).

Besides being active or un-active, also the total amount and intensity of physical ac-
tivity is important. The physiologic adaptations to aerobic and resistance exercise are 
different: aerobic exercise improves cardiovascular function, that increase peak oxygen 
consumption without significantly changing strength, whereas resistance exercise im-
proves neuromuscular adaptations, leading to an increase in strength, without significant-
ly changing peak oxygen consumption. Despite lower baseline values, the available data 
suggest that older individuals have the same relative improvement in maximal strength 
and maximal aerobic capacity to resistance training and aerobic training regimens, re-
spectively (Lambert & Evans, 2005). These physiologic adaptations may integrate with 
each other when the two types of training are performed together (Wilson et al., 2012). 
In a recent clinical trial (Villareal et al., 2017), the effectiveness of aerobic exercise has 
been compared with resistance exercise and combined exercise in reversing frailty and 
preserving muscle and bone mass, during weight loss in obese older adults. The authors 
show that combined aerobic and resistance training seems to provide the greatest benefits 
with respect to physical function (PF) and relative preservation of lean mass. In particular, 
the most effective exercise protocol for frail older adults seem to be a multi-component 
training, performed three times per week, with shorter-duration sessions (30 – 45 min), in 
order to prevent adverse health consequences (Theou et al., 2011).



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PHYSICAL EXERCISE AND CHANGES IN BODY COMPOSITION

Human body is composed of water, protein, minerals, and fat. The total amount of 
body fat consists of essential fat (detectable in bone marrow, heart, lungs, liver, spleen, 
kidneys, muscles, and central nervous system) and storage fat, that accumulates in adi-
pose tissue. Lean body mass (LBM), comprehensive of muscles, bones, ligaments, ten-
dons, and internal organs, differences from FFM for the content of a small percentage 
of essential fat (bone marrow and organs). 

Regular physical activity has an overall positive effect on body composition, modi-
fying both FFM and FM, muscle volume, muscle strength, and physical mobility in 
older people, including overweight and obese individuals (Liao et al., 2017). Many 
studies describe a non-significant change, reliable to exercise, in FFM (Toth, Beckett, 
& Poehlman, 1999), even if exercise leads to an increase in skeletal muscle mass, espe-
cially if anaerobic one, with a related increase in strength.

According to different studies on elderly people, an aerobic exercise of moderate 
intensity (VO2max> 60 %), is generally associated to a lowering in total body fat (FM), 
even in the absence of changes in dietary regime, proportional to the amount of train-
ing sessions. In particular, aerobic exercise can induce significant results on the loss of 
adipose tissue in the abdominal region (VAT) (Kay & Fiatarone Singh, 2006). 

In order to estimate VO2max and fitness index, a two-km walking test was developed 
by the UKK Institute in Finland (Laukkanen, Oja, Ojala, Pasanen, & Vuori, 1992). This 
test, relatively simple to administer, is a feasible and accurate alternative for determina-
tion of cardio-respiratory fitness in adults with both normal body weight as well as in 
overweight individuals. In Ferrara’s population of PANGeA study (a mass population 
study we conducted with Slovenian colleagues, aiming at identifying the main elements 
involved in successful aging), applying the UKK-test, we found that fitness index is 
inversely correlated to waist circumference. In this population, applying a linear regres-
sion model, fitness index, independently of gender and age, predicts waist circumfer-
ence, explaining the 32 % of its variability (R2 square 0,322, standardized β-coefficient 
-0,477, p < 0,001) (Figure 1, data not published). 

PHYSICAL EXERCISE AND CHANGES IN BODY METABOLISM

Even if not associated with a specific dietary regime, aerobic exercise and resistance 
training may be responsible for different and positive changes in body metabolism:

 – improvement in glycemic control (Sigal et al., 2007), due to increases in muscle 
GLUT4 number and function (Holten et al., 2004),

 –  improvements in insulin sensitivity (Winnick et al., 2008),
 –  stimulation of lipid oxidation,
 –  improvement in lipid profile with increased clearance of atherogenic lipids, 

specially triglycerides (Katsanos, 2006), reduced levels of total cholesterol and 
apolipoprotein B (Holme, Høstmark, & Anderssen, 2007), changes in LDL par-



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ticle size (more than lower levels) and higher HDL concentration (Kraus et al., 
2002),

 –  decrease of VAT in relation to an increased sympathetic tonus and consequential 
increased lipolysis (Ismail, Keating, Baker, & Johnson, 2012),

 –   decrease of VAT and pro-inflammatory state may contribute to improve glucose 
uptake (Fisher et al., 2011),

 –  decrease in biomarkers of inflammation like C-reactive protein (CRP) (Strasser, 
Arvandi, & Siebert, 2012),

 –  improvement in adiponectin and leptin profile (Simpson & Singh, 2008).
The impact of aerobic exercise on body metabolism is better and more significant if 

it is characterized by high intensity; strength training can provide up to a 15 % increase 
in metabolic rate, which is very helpful in terms of weight loss and long-term weight 
control. 

A review published by Strasser provides strong support for the recommendation 
that physical activity, in particular resistance training mixed with aerobic exercise, 
should be an integral component in the prevention and treatment of obesity and meta-
bolic syndrome risk factors (Strasser, 2013). Resistance training is an effective way to 
increase energy requirements, decrease body FM, and maintain metabolically active 

Figure 1. Pearson correlation between fitness index and waist circumference (PAN-
GeA’s Ferrara population): Men r=-0,62, p<0.001; Women r=-0,401, p=0,001.



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tissue mass. A consequent improvement in insulin sensitivity and in the lipid profile 
could reduce the risk of metabolic syndrome and type 2 diabetes and attenuate the de-
velopment of cardiovascular disease in an elderly population (Ferrara, Goldberg, Ort-
meyer, & Ryan, 2006). 

PHYSICAL ACTIVITY AND RELATED BENEFITS

It is well established that with increasing age, individuals are more likely to experi-
ence functional declines, mobility limitations, and physical disability (Holmes, Powell-
Griner, Lethbridge-Cejku, & Heyman, 2009). A large body of literature has supported 
the interrelationships among various factors affecting physical function (PF) in older 
adults (Villareal et al., 2011), like physical activity, body composition (fat mass and 
skeletal muscle mass), muscle capacity (leg strength and leg power), and muscle qual-
ity, whose aging-related changes tend to promote a decline in maximal aerobic power 
and skeletal muscle force production. Although the likelihood of physical limitations 
and disability increases with age, multiple studies have demonstrated that exercise is 
an effective intervention strategy for improving PF in older adults (Brady, Straight, & 
Evans, 2014). 

Several intervention trials have reported improvements in PF after a resistance 
training program in relatively healthy older (Avila, Gutierres, Sheehy, Lofgren, & Del-
monico, 2010; Henwood & Taaffe, 2005), as well as older adults with chronic health 
conditions (Yang, Wang, Lin, Chu, & Chan, 2006). In addition, aerobic training, often 
a cornerstone of an exercise program, has also been found to be beneficial at improving 
PF in older adults (Davidson et al., 2009).

The evidence suggests how the pillars of an effective exercise program should be 
both aerobic and resistance exercise (Chodzko-Zajko et al., 2009) and it is well known 
that both endurance exercise and resistance training can substantially improve physical 
fitness and health-related factors in older individuals (Conceição et al., 2014). This helps 
to maintain and increase skeletal muscle mass and respiratory fitness, with increase in 
resting metabolic rate and enhanced capacity for lipid oxidation during rest and exer-
cise. Endurance training in particular is purported to be more effective for decreasing 
FM, resting heart rate and blood pressure, while resistance training has been shown to 
be more effective for increasing basal metabolism, bone mineral density (BMD) and 
muscle strength and power (Romero-Arenas, Martínez-Pascual, et al. 2013). 

Regular physical activity can have a positive effect on disorders and diseases that 
affect muscles and bones (such as osteoarthritis, back pain and osteoporosis). Walking 
provides a modest increase in the loads on the skeleton above gravity and, therefore, 
this type of exercise has proved to be less effective in osteoporosis prevention. Strength 
exercises instead, seems to be a powerful stimulus to improve and maintain bone mass 
during the aging process (Gomez-Cabello, Ara, González-Agüero, Casajús, & Vicente-
Rodríguez, 2012).



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Many evidences show that physical activity programs aimed at strengthening mus-
cles help the elderly to maintain balance, which decrease the likelihood and severity of 
falls and fractures, one of major health concerns for many older adults (Howe, Roches-
ter, Neil, Skelton, & Ballinger, 2011).

Compared to sedentary people, older athletes enjoy a wide range of physiological 
benefits on health:

 –  a better profile in body composition including a lower accumulation of total and 
especially abdominal fat; greater volume muscle mass in upper and lower limbs,

 –  higher bone mineral density (BMD), especially in case of strength training with 
high-load low repetitions (Romero-Arenas, Blazevich, et al., 2013),

 –  articulation muscle more resistant to oxidative processes and fatigue,
 –  a better cardiac output during maximum exercise and improved cardiovascular 

fitness (Gibala, Little, MacDonald, & Hawley, 2012),
 –  less cardiovascular and metabolic stress during sub-maximal exercise (Lanza et 

al., 2008),
 –  significantly reduced coronary risk profile in relation to lowering of blood pres-

sure (Whelton, Chin, Xin, & He, 2002), improvement in endothelium function 
(Maiorana, O’Driscoll, Taylor, & Green, 2003); low systemic inflammatory in-
dex; improved insulin sensitivity and glucose homeostasis; better lipid profile 
and lower waist circumference,

 –  slowed development of disability in old age.
Twenty to forty minutes a day of aerobic training leads to a lower probability to 

develop metabolic and cardiovascular diseases. Moreover, several studies have shown 
the beneficial effects of circuit weight training in individuals with CHD. Volaklis et 
al. combined resistance circuit and aerobic exercise program in patients with coronary 
artery disease. Subjects improved cardiovascular fitness (VO2 peak 15.4 %) and mus-
cular strength significantly in all exercises by an average of 28 % (Volaklis, Douda, 
Kokkinos, & Tokmakidis, 2006).

A Cochrane review of 121 randomized controlled trials of progressive resistance 
training (PRT) in older people showed that doing PRT 2–3 times per week improved 
physical function, gait speed, timed get-up-and-go, climbing stairs, and balance, and, 
more importantly, had a significant effect on muscle strength, especially in the high-
intensity training groups (Crocker et al., 2013). 

In order to optimize body composition, muscle strength gains and to develop car-
diovascular function, Romero-Arenas, Martínez-Pascual, et al. (2013) recommended 
a circuit weight training with a minimum frequency of 2 sessions per week (with a 
volume ranging from 30 to 50 minutes) that could be implemented with endurance 
training. 



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DIET COMBINED WITH PHYSICAL ACTIVITY AND BODY 
COMPOSITION

Aging is related with the loss of skeletal muscle and bone mass along with progres-
sive increase of adipose tissue. Recent investigations have attempted to modify these 
processes with various combinations of dietary and exercise intervention (Iglay, Thy-
fault, Apolzan, & Campbell, 2007; Kukuljan, Nowson, Sanders, & Daly, 2009).

Increasing the quantity and quality (essential amino acids, specifically leucine) 
of dietary protein stimulates muscle protein synthesis in the elderly (Børsheim et al., 
2008), while protein supplementation at twice the Recommended Dietary Allowance 
(RDA) does not improve skeletal muscle function or increase muscle mass in healthy 
elderly weight lifters compared to those on a normal diet (Campbell & Leidy, 2007). 
Therefore, regular resistance exercises and the habitual ingestion of adequate amounts 
of dietary protein from high-quality sources are two important ways to slow the pro-
gression and treat sarcopenia. Assuming three meals are consumed each day, a relative 
protein dose of 0.4 – 0.5 g / kg / meal is consistent with recent expert opinions con-
cerning the optimal daily protein intake (1.2 – 1.5 g / kg / day) for healthy older adults 
(Deutz et al., 2014).

This amount of protein markedly exceeds the RDA for protein (at present set at 0.8 
g / kg ideal body mass / day for healthy adults, regardless of sex and age), but it is sup-
ported by several larger-scale longitudinal studies (Bartali et al., 2012; Gray-Donald et 
al., 2014). Several studies have also reported a positive relationship between protein 
intake and peak bone mass in older adults (Hannan et al., 2000; Sahni et al., 2014). 

Increased intake of vitamin D stimulates gene expression and boosts muscle protein 
synthesis, facilitates neuromuscular function and enhances strength and balance (Muir 
& Montero-Odasso, 2011). In a recent clinical trial, Rondanelli et al. found a significant 
beneficial effect of supplementation with whey protein, essential amino acids, and vi-
tamin D compared with placebo in elderly sarcopenic adults participating in controlled 
resistance training, with a gain of 1.7 kg in FFM. Supplementation attenuated the in-
flammatory state, as seen by the significant drops in CRP concentrations and leads to 
a reduced prevalence of malnutrition, assessed with the Mini Nutritional Assessment 
(MNA) (Rondanelli et al., 2016).

In all individuals older than 70 years of age, vitamin D intakes of at least 600 IU per 
day (up to 1000 IU / day) are recommended, in addition to the calcium requirement of 
1200 mg per day (American Geriatrics Society Workgroup on Vitamin D Supplementa-
tion for Older Adults, 2014). For those individuals in whom there is inadequate calcium 
and vitamin D intake from diet, supplements and/or multivitamins can be used. 

A recent review suggests that calcium and vitamin D supplementation, with or with-
out osteoporosis therapy, may decrease the risk of fractures (Tricco et al., 2017). Any-
way, the U.S. Preventive Services Task Force (USPSTF) concluded that the current 
evidence is insufficient to assess the balance of benefits and harms of combined vitamin 
D and calcium supplementation to prevent bone fractures in premenopausal women or 
in men (Moyer & U.S. Preventive Services Task Force*, 2013).



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CONCLUSIONS

An inevitable consequence of advancing age is the gradual loss of muscle mass and 
strength, termed sarcopenia, frequently associated with a parallel increase in fat mass. 
This geriatric condition has known negative impacts on metabolic health, and in later 
life, the ability to perform everyday activities (Witard, McGlory, Hamilton, & Phillips, 
2016).

This review highlights the major benefits of physical activity in the elderly in terms 
of body composition and metabolism. Active elderly subjects show a slower “aging 
clock” and a lighter burden of chronic morbidity. Aerobic exercises help to raise heart 
and lung efficiency and to increase cardiovascular fitness and endurance, while resis-
tance training promotes an increase in muscle mass and bone density. Achieving these 
goals represents the first step of a realistic strategy for maintaining functional status 
and independence. 

International guideline recommendations suggest that older people should perform 
at least 150 minutes of moderate physical activity per week and should be less seden-
tary in order to achieve health benefits (World Health Organization, 2010). Active el-
derly in particular, seems to develop a “successful aging” compared to sedentary ones.

Developing simple lifestyle interventions and safe, effective and sustainable ways 
to promote physical activity, aimed to preserve muscle mass and strength with advanc-
ing age, is crucial for the care of patients in mid-life and beyond.

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Avila, J. J., Gutierres, J. A., Sheehy, M. E., Lofgren, I. E., & Delmonico, M. J. (2010). 
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