Feasibility and Impact of High-Intensity Walking Training in Frail Older Adults

in Journal of Aging and Physical Activity
Margaret K. Danilovich, David E. Conroy and T. George Hornby
View More View Less
DOI:
https://doi.org/10.1123/japa.2016-0305
Keywords:
frailty; high-intensity training; assisted living residents
In Print:
Volume 25: Issue 4
Pages:
533–538
Restricted access

Purchase article

USD  $24.95

Student 1 year online subscription

USD  $77.00

1 year online subscription

USD  $103.00

Student 2 year online subscription

USD  $147.00

2 year online subscription

USD  $196.00
Subscribe to this Journal

  • Purchase article

    USD  $24.95

  • Student 1 year online subscription

    USD  $77.00

  • 1 year online subscription

    USD  $103.00

  • Student 2 year online subscription

    USD  $147.00

  • 2 year online subscription

    USD  $196.00

To investigate the impact of high-intensity walking training (HIWT) on prefrail and frail older adults, five assisted living residents underwent a supervised 12-session intervention. The intervention consisted of 30 min of HIWT at 70–80% of heart rate reserve or ratings of 15 to 17 (hard to very hard) on the Borg Rating of Perceived Exertion scale. Training included walking at fast speeds, multi-directions, stairs, and outdoor surfaces with and without an assistive device. Training significantly reduced frailty using the SHARE-FI (p = .008), increased fast gait speed (p = .01), improved 6-min walk test distance (p = .03), and enhanced Berg Balance Scale scores (p = .03). There were no adverse events and all participants reached target training intensity in all 12 sessions. Participants viewed the walking intervention as highly satisfactory (9.6/10 on a Likert scale) and 100% recommended that the assisted living facility should offer HIWT as part of routine programming.

Danilovich is with the Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL. Conroy is with the Department of Kinesiology and Human Development & Family Studies, College of Health and Human Development, Penn State University, State College, PA. Hornby is with Rehabilitation Institute of Chicago, Chicago, IL; the Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL; and the Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN.

Address author correspondence to Margaret Danilovich at Margaret-wente@northwestern.edu.

Journal of Aging and Physical Activity

Cover Journal of Aging and Physical Activity

  • Berg, K.O., Wood-Dauphinee, S.L., Williams, J.I., & Maki, B. (1992). Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health, 83(Suppl 2), 7–11. PubMed

    • Search Google Scholar
    • Export Citation

  • Blodgett, J., Theou, O., Kirkland, S., Andreou, P., & Rockwood, K. (2015). The association between sedentary behaviour, moderate-vigorous physical activity and frailty in NHANES cohorts. Maturitas, 80(2), 187–191. PubMed doi:10.1016/j.maturitas.2014.11.010

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bock, J.O., Konig, H.H., Brenner, H., Haefeli, W.E., Quinzler, R., Matschinger, H., … Heider, D. (2016). Associations of frailty with health care costs--results of the ESTHER cohort study. BMC Health Services Research, 16, 128. PubMed doi:10.1186/s12913-016-1360-3

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bohannon, R.W. (1995). Sit-to-stand test for measuring performance of lower extremity muscles. Perceptual and Motor Skills, 80(1), 163–166. PubMed doi:10.2466/pms.1995.80.1.163

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Bowen, D.J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., … Fernandez, M. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457. PubMed doi:10.1016/j.amepre.2009.02.002

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Boyd, C.M., Xue, Q.L., Simpson, C.F., Guralnik, J.M., & Fried, L.P. (2005). Frailty, hospitalization, and progression of disability in a cohort of disabled older women. The American Journal of Medicine, 118(11), 1225–1231. PubMed doi:10.1016/j.amjmed.2005.01.062

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Brach, J.S., Francois, S.J., VanSwearingen, J.M., Gilmore, S., Perera, S., & Studenski, S.A. (2016). Translation of a motor learning walking rehabilitation program into a group-based exercise program for community-dwelling older adults. PM&R, 8(6), 520–528. PubMed doi:10.1016/j.pmrj.2015.10.004

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Cadore, E.L., Casas-Herrero, A., Zambom-Ferraresi, F., Idoate, F., Millor, N., Gomez, M., … Izquierdo, M. (2014). Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians. Age (Dordrecht), 36(2), 773–785. PubMed doi:10.1007/s11357-013-9586-z

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Cesari, M., Vellas, B., Hsu, F.C., Newman, A.B., Doss, H., King, A.C., … LIFE Study Group. (2015). A physical activity intervention to treat the frailty syndrome in older persons - results from the LIFE-P study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 70(2), 216–222. PubMed doi:10.1093/gerona/glu099

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Chamberlain, A.M., Finney Rutten, L.J., Manemann, S.M., Yawn, B.P., Jacobson, D.J., Fan, C., … St Sauver, J.L. (2016). Frailty trajectories in an elderly population-based cohort. Journal of the American Geriatrics Society, 64(2), 285–292. PubMed doi:10.1111/jgs.13944

    • Crossref
    • Search Google Scholar
    • Export Citation

  • De Labra, C., Gulmaraes-Pinheiro, C., Maseda, A., Lorenzo, T., & Millan-Calenti, J.C. (2015). Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatrics, 15(15), 154. PubMed doi:10.1186/s12877-015-0155-4

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Deley, G., Kervio, G., Van Hoecke, J., Verges, B., Grassi, B., & Casillas, J.M. (2007). Effects of a one-year exercise training program in adults over 70 years old: a study with a control group. Aging Clinical and Experimental Research, 19(4), 310–315. PubMed doi:10.1007/BF03324707

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Donat, H., & Ozcan, A. (2007). Comparison of the effectiveness of two programmes on older adults at risk for falling: unsupervised home exercise and supervised group exercise. Clinical Rehabilitation, 21(3), 273–283. PubMed doi:10.1177/0269215506069486

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Donoghue, D., & Stokes, E.K. (2009). How much change is true change? The minimum detectable change of the Berg balance scale in elderly people. Journal of Rehabilitation Medicine, 41(5), 343–346. PubMed doi:10.2340/16501977-0337

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Dwyer, T., Pezic, A., Sun, C., Cochrane, J., Venn, A., Srikanth, V., … Ponsonby, A.L. (2015). Objectively measured daily steps and subsequent long term all-cause mortality: the tasped prospective cohort study. PLoS One, 10(11), e0141274. PubMed doi:10.1371/journal.pone.0141274

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Enright, P.L. (2003). The six-minute walk test. Respiratory Care, 48(8), 783–785. PubMed

  • Faber, M.J., Bosscher, R.J., Chin, A.P.M.J., & van Wieringen, P.C. (2006). Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 87(7), 885–896. PubMed doi:10.1016/j.apmr.2006.04.005

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Fried, L.P., Tangen, C.M., Walston, J., Newman, A.B., Hirsch, C., Gottdiener, J., … McBurnie, M.A. (2001). Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 56(3), M146–M157. PubMed doi:10.1093/gerona/56.3.M146

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Frost, R., Belk, C., Jovicic, A., Ricciardi, F., Kharicha, K., Gardner, B., … Walters, K. (2017). Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis. BMC Geriatrics,  17(1), 157.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Guadalupe-Grau, A., Aznar-Lain, S., Manas, A., Castellanos, J., Alcazar, J., Ara, I., … Garcia-Garcia, F.J. (2016). Short and long term effects of concurrent strength and HIIT training in octogenarian COPDs. Journal of Aging and Physical Activity, 25(1), 105–115. PubMed doi:10.1123/japa.2015-0307

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hays, R.D., Bjorner, J.B., Revicki, D.A., Spritzer, K.L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), 873–880. PubMed doi:10.1007/s11136-009-9496-9

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Hornby, T.G., Holleran, C.L., Hennessy, P.W., Leddy, A.L., Connolly, M., Camardo, J., … Roth, E.J. (2016). Variable Intensive Early Walking Poststroke (VIEWS): a randomized controlled trial. Neurorehabilitation and Neural Repair, 30(5), 30, 440–450. PubMed doi:10.1177/1545968315604396

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Jansen, F.M., Prins, R.G., Etman, A., van der Ploeg, H.P., de Vries, S.I., van Lenthe, F.J., & Pierik, F.H. (2015). Physical activity in non-frail and frail older adults. PLoS One, 10(4), e0123168. PubMed doi:10.1371/journal.pone.0123168

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Keetch, K.M., Lee, T.D., & Schmidt, R.A. (2008). Especial skills: specificity embedded within generality. Journal of Sport and Exercise Psychology, 30(6), 723–736. PubMed doi:10.1123/jsep.30.6.723

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Kleim, J.A., & Jones, T.A. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51(1), S225–S239. PubMed doi:10.1044/1092-4388(2008/018)

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Kojima, G. (2016a). Frailty as a predictor of hospitalisation among community-dwelling older people: a systematic review and meta-analysis. Journal of Epidemiology and Community Health, 70(7), 722–729. PubMed doi:10.1136/jech-2015-206978

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Kojima, G. (2016b). Frailty as a predictor of nursing home placement among community-dwelling older adults: a systematic review and meta-analysis. Journal of Geriatric Physical Therapy. [Epub ahead of print]. doi:10.1519/jpt.0000000000000097

    • Search Google Scholar
    • Export Citation

  • Landi, F., Abbatecola, A.M., Provinciali, M., Corsonello, A., Bustacchini, S., Manigrasso, L., … Lattanzio, F. (2010). Moving against frailty: does physical activity matter? Biogerontology, 11(5), 537–545. PubMed doi:10.1007/s10522-010-9296-1

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Latham, N.K., Anderson, C.S., Lee, A., Bennett, D.A., Moseley, A., & Cameron, I.D. (2003). A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the Frailty Interventions Trial in Elderly Subjects (FITNESS). Journal of the American Geriatrics Society, 51(3), 291–299. PubMed doi:10.1046/j.1532-5415.2003.51101.x

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Lees, F.D., Clarkr, P.G., Nigg, C.R., & Newman, P. (2005). Barriers to exercise behavior among older adults: a focus-group study. Journal of Aging and Physical Activity, 13(1), 23–33. PubMed doi:10.1123/japa.13.1.23

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Leech, K.A., Kinnaird, C.R., Holleran, C.L., Kahn, J., & Hornby, T.G. (2016). Effects of locomotor exercise intensity on gait performance in individuals with incomplete spinal cord injury. Physical Therapy, 96(12), 1919–1929. PubMed doi:10.2522/ptj.20150646

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Middleton, A., Fritz, S.L., & Lusardi, M. (2015). Walking speed: the functional vital sign. Journal of Aging and Physical Activity, 23(2), 314–322. PubMed doi:10.1123/japa.2013-0236

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Perera, S., Mody, S.H., Woodman, R.C., & Studenski, S.A. (2006). Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society, 54(5), 743–749. PubMed doi:10.1111/j.1532-5415.2006.00701.x

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Resnick, B., Ory, M.G., Hora, K., Rogers, M.E., Page, P., Bolin, J.N., … Bazzarre, T.L. (2008). A proposal for a new screening paradigm and tool called Exercise Assessment and Screening for You (EASY). Journal of Aging and Physical Activity, 16(2), 215–233. PubMed doi:10.1123/japa.16.2.215

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Romero-Ortuno, R. (2013). The SHARE operationalized frailty phenotype: a comparison of two approaches. European Geriatric Medicine, 4(4), 255–259). PubMed doi:10.1016/j.eurger.2013.04.003

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Romero-Ortuno, R., & Soraghan, C. (2014). A frailty instrument for primary care for those aged 75 years or more: findings from the survey of health, ageing and retirement in Europe, a longitudinal population-based cohort study (SHARE-FI75+). BMJ Open, 4(12), e006645. PubMed doi:10.1136/bmjopen-2014-006645

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Serra, A.J., de Carvalho Pde, T., Lanza, F., de Amorim Flandes, C., Silva, S.C., Suzuki, F.S., … Silva, J.A., Jr. (2015). Correlation of six-minute walking performance with quality of life is domain- and gender-specific in healthy older adults. PLoS ONE,  10(2), e0117359.

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Straube, D.D., Holleran, C.L., Kinnaird, C.R., Leddy, A.L., Hennessy, P.W., & Hornby, T.G. (2014). Effects of dynamic stepping training on nonlocomotor tasks in individuals poststroke. Physical Therapy, 94(7), 921–933. PubMed doi:10.2522/ptj.20130544

    • Crossref
    • Search Google Scholar
    • Export Citation

  • Tanaka, H., Monahan, K.D., & Seals, D.R. (2001). Age-predicted maximal heart rate revisited. Journal of the American College of Cardiology, 37(1), 153–156. PubMed doi:10.1016/S0735-1097(00)01054-8

    • Crossref
    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 556 358 35
Full Text Views 31 19 1
PDF Downloads 19 9 0