For general health and well-being, a well-rounded physical activity program should include endurance, strength, balance, and flexibility (Table 2). Most sedentary individuals will prefer and should be encouraged to begin with low-intensity physical activity. These activities should be tailored to the individual’s specific needs and interests to ensure maximal enjoyment and optimize adherence to the physical activity regimen. Long-term adherence can be enhanced by making physical activity a part of one’s lifestyle . For those wanting to become more active, a group-based physical activity is an excellent way to start a physical activity program . It provides several advantages, including enhanced adherence through social interaction with others and mutual commitment to physical activity among friends, opportunities for instruction in proper technique, and qualified supervision.
Endurance-related physical activity refers to continuous movement that involves large muscle groups and is sustained for a minimum of 10 min . Examples of endurance activity include biking, swimming, walking, and lifestyle activities that incorporate large muscle groups. Some examples of lifestyle activities that build endurance when performed for at least 10 min without rest intervals are household chores such as washing windows, vacuuming, sweeping, and mopping, and gardening activities such as lawn mowing, raking, or pruning. Endurance activities provide the greatest protection against the deleterious effects of chronic diseases associated with aging. While some benefits listed in Table 1 accrue from low-intensity activities , progression from low to moderate intensity is important for optimizing the benefits of physical activity.
As new participants become more accustomed to the physical activity, and possibly improve their health, the workload will usually have to be increased to keep the activity at a moderate intensity level. The Borg Rate of Perceived Exertion scale  provides an inexpensive and convenient method of measuring physical activity intensity (Table 3). A guide for administering the scale is detailed in the ACSM exercise guidelines book . The talk test is another tool used to evaluate the intensity of aerobic activity and is particularly effective in detecting workloads that rise above moderate intensity. The talk test refers to the ability to engage in conversation while walking or cycling, which is an indication that there is adequate oxygen supply to meet the demands of the respiratory system and the muscle. If the physical activity intensity rises above moderate, talking will become difficult and provide an immediate reminder to reduce the intensity . Evaluating intensity as a percentage of a measure of estimated maximal heart rate (220-age) is the optimal method of tracking exercise intensity. This method is detailed in the ACSM fitness book  and several other resources listed in Table 4.
Strength-related activity refers to increasing muscle strength by moving or lifting some type of resistance, such as weights or elastic bands, at a level that requires some physical effort. Strength development is safe for older adults, and injuries are rarely reported. Instruction in proper lifting technique assists in minimizing injury. Exercise: a guide from the National Institute on Aging provides written and pictorial examples of good form and instruction on proper breathing and lifting techniques . The amount of resistance and number of repetitions will vary for each individual and muscle group. In general, one to three sets of 10 to 12 repetitions are regarded as the optimal amount for increasing muscle strength . As strength increases, the amount of resistance should also increase. Experts do not recommend that strength training be performed on consecutive days to give the muscles time to recover between sessions. While both upper- and lower-body muscles should be included in a strengthening regimen, muscles of the lower body (ankles, hips, leg extensors, and flexors) are particularly important for mobility and independence .
Flexibility-related activity facilitates greater range of motion around the joint. Flexibility activities increase the length of the muscle beyond that which is customarily used in normal activity. These exercises should be performed a minimum of 2 days a week. In addition to a formal physical activity program, flexibility activities can be conveniently incorporated into the office routine while sitting at a computer or in an airplane. They may be done as a session alone or by inclusion in the cool-down portion of a strength or endurance program . Stretching should include appropriate static and dynamic techniques. In dynamic stretching, the muscle is moved through the full range of motion of a joint, for example, arm circles. A static stretch is when the muscle is lengthened across the joint and held for a period of 10 to 30 s .
Balance is the ability to maintain control of the body over the base of support so as to avoid falling. While improvements in muscular strength and endurance can lead to improvements in balance, specific balance activities can have additional benefits . There are two types of balance: static balance and dynamic balance. Static balance, as the name indicates, is the ability to maintain balance without moving, while dynamic balance is the ability to move without losing balance or falling. Static balance can be improved by challenging the ability to maintain standing balance through decreasing the base of support. Exercises for static balance can progress from feet apart to feet together and then progress to a single-leg stance without holding on. At first, the person may need to rely on a solid object such as a kitchen counter for support; over time, the reliance on the support will gradually decrease. To challenge balance even further, the above progression can be repeated with eyes closed. The ability to balance with eyes closed is important in daily activities (e.g., standing in a shower while shampooing hair). Dynamic balance can be improved by decreasing the base of support while walking. For example, a way to challenge dynamic balance is to progress from the normal walking pattern to walking on a straight line and then walking heel-to-toe.
Some available resources
Although providing detailed exercise techniques and protocols is beyond the scope of this report, many books are available, several of which focus specifically on issues relating to older adults. The National Institute on Aging provides an exercise guide without charge to those contacting the NIA Public Information Office at 1-800-222-2225 or at the website http://nihseniorhealth.gov/exercise/toc.html. Information provided in Table 4 lists available resources to help plan a physical activity regimen that includes lifestyle activities, age-appropriate exercise, and techniques for leading group exercise.