Why is it important to stay active when ageing?
When an older adult goes into hospital walking independently and returns home struggling to stand or walk, families are often surprised by how quickly decline occurs. Physiologically, however, this change is predictable. The ageing body is highly responsive to activity levels, and inactivity triggers rapid deconditioning.
Ageing is associated with sarcopenia the progressive loss of skeletal muscle mass and strength. After the age of 50, adults lose approximately 1–2% of muscle mass per year and up to 3% of strength (Cruz-Jentoft et al., 2019). During bed rest, this process accelerates dramatically. Kortebein et al. (2007) demonstrated that just 10 days of bed rest in healthy older adults resulted in significant reductions in leg strength and functional capacity. Notably, strength loss often exceeds muscle mass loss, reflecting both muscular atrophy and reduced neural activation.
Walking is a complex neuromuscular task requiring integration of proprioceptive, vestibular and visual systems. Reduced stimulation during hospitalisation impairs balance and gait efficiency. Brown et al. (2009) found that low mobility during hospital stays was strongly associated with loss of independence at discharge. In addition, cardiovascular deconditioning occurs rapidly; bed rest reduces plasma volume and orthostatic tolerance, contributing to dizziness and fatigue on standing (Convertino, 1997).
Acute illness further compounds this process. Inflammatory responses increase muscle protein breakdown and suppress appetite, accelerating weakness in older adults (Tieland et al., 2018). Recovery takes longer than decline because rebuilding muscle and retraining neural pathways require progressive loading, adequate protein intake and repeated functional practice.
Early mobilisation in hospital and structured rehabilitation after discharge significantly improve outcomes. Even in advanced age, muscle and neural systems retain the capacity to adapt. The body responds to inactivity but it also responds to movement.
References
Brown, C. J., Redden, D. T., Flood, K. L., & Allman, R. M. (2009). The underrecognized epidemic of low mobility during hospitalization of older adults. Journal of the American Geriatrics Society, 57(9), 1660–1665. https://doi.org/10.1111/j.1532-5415.2009.02393.x
Convertino, V. A. (1997). Cardiovascular consequences of bed rest: Effect on maximal oxygen uptake. Medicine & Science in Sports & Exercise, 29(2), 191–196. https://doi.org/10.1097/00005768-199702000-00004
Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyère, O., Cederholm, T., … Zamboni, M. (2019). Sarcopenia: Revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16–31. https://doi.org/10.1093/ageing/afy169
Kortebein, P., Symons, T. B., Ferrando, A., Paddon-Jones, D., Ronsen, O., Protas, E., … Evans, W. J. (2007). Functional impact of 10 days of bed rest in healthy older adults. JAMA, 297(16), 1772–1774. https://doi.org/10.1001/jama.297.16.1772
Tieland, M., Trouwborst, I., & Clark, B. C. (2018). Skeletal muscle performance and ageing. Current Opinion in Clinical Nutrition & Metabolic Care, 21(1), 38–44. https://doi.org/10.1097/MCO.0000000000000434
