COVID-19 poses a significant threat to the health and wellbeing of older people. The risks of serious illness requiring hospitalisation and dying both rise with age.

Moreover, measures to lessen the risk of COVID-19 infections before the advent of effective vaccines such as lockdowns and shielding have made it harder for older people to stay active. Physical activity is an important factor in staying healthy and is likely to play a role in COVID-19 resilience. Lockdowns can also have a detrimental effect on the mental health and wellbeing of older people.

The Physiological Society and Centre for Ageing Better are concerned about the long-term impact of the pandemic on physical activity levels among older people, particularly given people with lower levels of habitual physical activity were more severely affected by the disease. Regular physical activity is also vital to maintaining health and resilience. As COVID-19 restrictions began to ease from July 2021, The Physiological Society and Centre for Ageing Better have asked YouGov to again survey older people to give us an indication of what the long-term impact of COVID-19 restrictions on physical activity levels may be. While the Omicron variant may yet require additional restrictions to be reintroduced, it is more important than ever that we plan for a post-pandemic world and its consequences on physical activity.

It is clear from our new survey that the pandemic has had a detrimental impact on physical activity levels: despite restrictions now being lifted, over a quarter of over 50s told us they are less physically active than pre-pandemic.

Reductions in physical activity among all age groups will result in negative health implications, but this is particularly concerning for older and frail adults who are already at increased risk from low physical activity levels. Most COVID-19 related restrictions in the UK have been lifted for over five months and it is clear from the reported data that the UK will have an impending physical resilience crisis affecting many older adults, driven by a reduction in physical activity.

The top two reasons cited in our most recent data for a reduction in activity are a lack of motivation and that people are out of the habit of exercising or undertaking activities in person. We therefore need a big, bold programme to motivate and encourage older adults to get moving. This is also important as cases of ‘Long Covid’, where physical activity levels and resilience will be low, continue to grow.

Watch our launch event

Ahead of the lockdown over Christmas 2020, The Physiological Society and the Centre for Ageing Better brought together physiologists, nutritionists, geriatricians, physiotherapists and clinicians to discuss three critical areas where the impact of the pandemic and lockdown on older people required greater consideration.

What happens to an older person during lockdown or shielding?

Home confinement in older people may cause (i) cardiorespiratory and metabolic deconditioning, (ii) insulin resistance, (iii) muscle loss and (iv) increased fat mass. In addition, social isolation may be worsened.

How do COVID-19 risk factors relate to age?

COVID-19 disease severity rises with age and is also associated with comorbidities, such as obesity, diabetes and coronary vascular disease, that can accompany chronological age. Physical frailty is associated with poorer outcomes.

What are the physiological challenges to address as older people recover from COVID-19?

COVID-19 can cause or worsen frailty indirectly, e.g. deconditioning, or directly, e.g. lung disease, muscle wasting and neurological impacts. Mental health may also suffer, and needs for rehabilitation and mental health support may be quantitatively and qualitatively different from those of people who are younger.

A National COVID-19 Resilience Programme

In the absence of vaccines and treatments, physical activity (with tailored exercise or physical activity goals) represented the single most impactful way in which older people could reduce the risk of developing severe COVID-19, improve recovery, and limit deconditioning and frailty from home confinement.

We also recommended (i) clear guidance about the benefits and nature of a healthy, balanced diet containing sufficient levels of protein, with a balanced energy intake, and (ii) preventative and mitigative strategies to address mental health impacts. Older people will need to be supported to achieve these goals through clear advice and tools tailored to their needs.

At the launch of the report, Professor Paul Greenhaff, University of Nottingham, UK and Expert Panel Co-Chair said:

“Lockdowns, while important to reduce transmission of COVID-19, can have a detrimental effect on both the physical and mental health of older people. These changes happen rapidly: within 3 days of not using muscles, people can experience significant decreases in muscle mass and quality which might be the difference of an older people being able to get out of a chair by themselves or not.

Dr Alison Giles, Centre for Ageing Better, and Expert Panel Co-Chair said:

“As this report highlights, coronavirus lockdowns can be particularly challenging for older people as they can exacerbate a variety of health issues, such as cardiorespiratory deconditioning and weight gain, as well as increased loneliness and social isolation.

“A National COVID-19 Resilience Programme would give older people more control and offer guidance on how to take care of themselves as the pandemic continues. We must provide people with tools that will allow them to make their own informed decisions on their health, wellbeing and resilience.”

Who is involved?

The membership of the Expert Group for the project was as follows:

• Alison Giles, Centre for Ageing Better (Co-chair)
• Paul Greenhaff, University of Nottingham, UK (Co-chair)
• Clare Steves, Kings College London, UK and Guys & St Thomas’s
• Carolyn Greig, University of Birmingham, UK
• Zoe Saynor, University of Portsmouth, UK
• James Faulkner, University of Winchester, UK
• Danielle Lambrick, University of Southampton, UK
• Claire Stewart, Liverpool John Moores University, UK and The British Society for Research on Ageing (BRSA)
• Richard Siow, King’s College London, UK
• Steve Harridge, King’s College London, UK
• Charlotte Bolton, University of Nottingham, UK
• Sally Singh, University Hospitals of Leicester NHS Trust
• Susan Lanham-New, University of Surrey, UK
• Hugh Montgomery, University College London, UK and Whittington Health NHS Trust
• Dawn Skelton, Glasgow Caledonian University, UK
• Mike Tipton, University of Portsmouth, UK
• Julie Whitney, King’s College London, UK

We are also grateful to Michael Joyner from the Mayo Clinic in Rochester, MN, United States for a comparative international perspective.

The report was launched on 9 November 2020.