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Matthew P. Ford, Laurie A. Malone, Harrison C. Walker, Ildiko Nyikos, Rama Yelisetty and C. Scott Bickel

Background:

UPDRS and PDQ-39 are reliable and valid assessments of quality of life and physical function in persons with Parkinson’s disease (PD). However, these measures were not designed to track day-to-day or week-to-week changes in community activity in persons with PD.

Methods:

Twelve individuals with PD (stage 1 to 3, Hoehn and Yahr) who were active members of a health and wellness facility were recruited for this study. Investigators collected health history information, asked questions about the amount and frequency of weekly exercise, and assessed motor symptoms and ADL skills using the UPDRS, and provided participants with Step Activity Monitor (SAM). SAM data were collected for a continuous 7-day period.

Results:

Participants averaged 8996 steps/day, had an average of 322 minutes of step activity per day, but were inactive (minIA) 77% of their time per day. On the days that participants visited the health and wellness facility they took an average of 802 more steps with 12 minutes more activity per day.

Conclusions:

A SAM can be used to capture activity levels in persons with PD. These pilot data indicate that persons with mild to moderate PD can achieve step activity levels similar to healthy older adults.

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Nancy Margaret Salbach, Jo-Anne Howe, Karen Brunton, Kathryn Salisbury and Lorene Bodiam

Background:

The purpose of this article is to describe the development and evaluation of a task-oriented group exercise program, delivered through a municipal recreation program, for community-dwelling people with neurological conditions.

Methods:

Physical therapists (PTs) at a rehabilitation hospital partnered with a municipal recreation provider to develop and evaluate a 12-week exercise program for people with stroke, acquired brain injury, and multiple sclerosis at 2 community centers. Fitness instructors who were trained and supported by PTs taught 1-hour exercise classes twice a week. In a program evaluation of the safety, feasibility and effects of the program, standardized measures of physical function were administered before and after the program.

Results:

Fourteen individuals (mean age: 63 years) participated and attended 92% of exercise classes, on average. Two minor adverse events occurred during 293 attendances. Improvement in mean score on all measures was observed. In people with stroke, a statistically significant improvement in mean Berg Balance Scale (mean ± SD change = 3 ± 2 points, P = .016, n = 7) and 6-minute walk test scores (change = 26 ± 26 m, P = .017, n = 9) was observed.

Conclusions:

This model of exercise delivery provides people with neurological conditions with access to a safe, feasible and potentially beneficial exercise program in the community.

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William R. Sukala, Rachel Page, Chris Lonsdale, Isabelle Lys, David Rowlands, Jeremy Krebs, Murray Leikis and Birinder Singh Cheema

Background:

To evaluate the differential effect of 2, group-based exercise modalities on quality of life (QoL) in indigenous Polynesian peoples with type 2 diabetes (T2DM) and visceral obesity.

Methods:

Participants were randomized to resistance training or aerobic training performed 3 times per for 16 weeks. The Short-Form 36 was administered at baseline and post intervention to assess 8 domains and physical and mental component scales (PCS and MCS) of QoL.

Results:

With the exception of Mental Health and MCS, all scores were lower at baseline than general population norms. Significant improvements were documented in several QoL scores in each group post intervention. No group × time interactions were noted. Pooled analyses of the total cohort indicated significantly improved Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Role-Emotional, PCS and MCS. Adaptation ranged from 5%−22%, and demonstrated a moderate-to-large effect (Cohen’s d = 0.64−1.29). All measures of QoL increased to near equivalent, or greater than general norms.

Conclusion:

Exercise, regardless of specific modality, can improve many aspects of QoL in this population. Robust trials are required to investigate factors mediating improvements in QoL, and create greater advocacy for exercise as a QoL intervention in this and other indigenous populations with T2DM.

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Thomas M. Maden-Wilkinson, Jamie S. McPhee, David A. Jones and Hans Degens

To investigate reasons for the age-related reduction in physical function, we determined the relationships between muscle size, strength, and power with 6-min walk distance (6MWD) and timed up-and-go performance in 49 young (23 ± 3.1 years) and 66 healthy, mobile older adults (72 ± 5 years). While muscle mass, determined by DXA and MRI, did not correlate with performance in the older adults, power per body mass, determined from a countermovement jump, did correlate. The 40% lower jumping power observed in older adults (p < .05) was due to a lower take-off velocity, which explained 34% and 42% of the variance in 6MWD in older women and men, respectively (p < .01). The lower velocity was partly attributable to the higher body mass to maximal force ratio, but most was due to a lower intrinsic muscle speed. While changes in muscle function explain part of the age-related reduction in functional performance, ~60% of the deficit remains to be explained.

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Takashi Kamijo and Masami Murakami

Background:

Lifestyle-related diseases among middle-age and elderly people have become serious problems. Underlying causes might be related to the changes in the lifestyle including the absence of regular physical exercise.

Methods:

To clarify the significance of regular physical exercise to prevent lifestyle-related diseases, we studied motor functions and blood chemistry examinations in middle-age and elderly women (over 40 years old) who performed regular physical exercise for 2 years (exercise group) and those who initially did not (control group).

Results:

In study 1, VO2max significantly increased in the exercise group compared with the control group in the under 60 years old groups. In the over 60 years old groups, VO2max, foot balance, and HDL-cholesterol significantly increased. Plasma glucose at 120 minutes after the 75 g oral glucose tolerance test, fasting insulin, homeostasis model assessment (HOMA-R), and high sensitivity C-reactive protein (hsCRP) significantly decreased in the exercise group compared with the control group. In study 2, a 1-year exercise program significantly improved physical functions and biochemical markers in the control group.

Conclusion:

These results suggest that regular physical exercise might help to maintain sound motor functions and decrease insulin resistance and a risk for arteriosclerosis.

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Katherine S. Hall and Edward McAuley

Background:

Few studies have examined physical activity behavior and its associated outcomes in older adults living in retirement communities. Guided by the disablement model and social cognitive theory, we tested a cross-sectional model in which physical activity was hypothesized to influence disability indirectly through self-efficacy, functional performance, and functional limitations.

Methods:

One hundred six older men and women residing in independent-living (ILF) assisted-living (ALF) facilities completed self-report measures of self-efficacy, function, and disability. Objective assessments of physical activity and functional performance were conducted using waist-mounted accelerometers and the short physical performance battery (SPPB), respectively. Path analysis was used to examine the proposed associations among constructs.

Results:

Older adults who were more active were also more efficacious and had better physical function and fewer functional limitations. Only higher levels of self-efficacy were associated with less disability. The effects of individual-level covariates were also examined.

Conclusions:

This cross-sectional study is among the first to examine the associations between physical activity, function, and disability among older adults residing in ILFs and ALFs. Future research addressing the physical and psychological needs of this growing population is warranted.

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Kimberlee A. Gretebeck, Kaitlyn Radius, David R. Black, Randall J. Gretebeck, Rosemary Ziemba and Lawrence T. Glickman

Background:

Regular walking improves overall health and functional ability of older adults, yet most are sedentary. Dog ownership/pet responsibility may increase walking in older adults. Goals of this study were to identify factors that influence older adult walking and compare physical activity, functional ability and psychosocial characteristics by dog ownership status.

Methods:

In this cross-sectional study, older adults (65−95 years of age, n = 1091) completed and returned questionnaires via postal mail. Measures included: Physical Activity Scale for the Elderly, Physical Functioning Questionnaire and Theory of Planned Behavior Questionnaire.

Results:

Dog owner/dog walkers (n = 77) reported significantly (P < .05) more total walking, walking frequency, leisure and total physical activity and higher total functional ability than dog owner/nondog walkers (n = 83) and nondog owners (n = 931). Dog owner/nondog walkers reported lower intention and perceived behavioral control and a less positive attitude than dog owner/dog walkers (P < .05).

Conclusions:

Dog owner/dog walkers were significantly different than the nondog walker groups in nearly every study variable. Many dog owners (48.1%) reported walking their dogs regularly and the dog owner/dog walkers participated in nearly 50% more total walking than the 2 nondog walking groups, suggesting that pet obligation may provide a purposeful activity that motivates some older dog owners to walk.

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Silvia Aranda-García, Albert Busquets, Antoni Planas, Joan A. Prat-Subirana and Rosa M. Angulo-Barroso

Purpose:

Gait speed is related to physical function in older adults. This cross-sectional study examined the best predictors of maximal gait speed (MGS) among physical abilities, and general factors in healthy, rural community-dwelling older adults.

Methods:

MGS, muscle strength, and postural sway were measured in 55 community-dwelling participants (age, 72.1 ± 6.8, range 61–87 years; 72.7% women). Two stepwise regressions were used to find MGS predictors in two models: physical abilities and global.

Results:

Strength of knee extensors with 60° of knee flexion (KStrength60°) and maximal distance in the anterior-posterior direction with eyes closed explained 50.2% of MGS variance (p < .05) in the physical abilities model. KStrength60°, age, and level of physical activity explained 63.9% of MGS variance (p < .05) in the global model.

Conclusions:

Regardless of the model, KStrength60° was the best predictor of MGS in rural female older adults. Future research should examine the generalization of these findings to rural male older adults.

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Anners Lerdal, Elin Hannevig Celius and Gunn Pedersen

Background:

Participants who completed a 3-month prescribed individualized exercise program in groups were followed-up prospectively. The aims were to describe the characteristics of the participants, their health-related quality of life (HRQoL) and physical fitness at baseline, at completion and at 12-month follow-up, and to identify predictors of HRQoL and physical fitness at completion and at 12-month follow-up.

Methods:

A 1-group follow-up design was used. Data were collected from records of 163 attendees at a municipality-sponsored health center in Norway. HRQoL was measured by self-report using the COOP/WONCA questionnaire. Physical fitness was estimated from the results of a 2-km walk test.

Results:

Of the 163 participants referred to the clinic, 130 (79.8%) were women and 33 were (20.2%) men. Participants who completed were older than those who dropped out. The participants showed clinical improvement in physical fitness and all health-related quality life domains (d > 0.53) at the completion of the program and in physical functioning, mental health, performance of daily activities, overall health, and perceived improved health after 12 months (d > 0.36).

Conclusions:

Participation in group-based prescribed exercise program for 3 months may improve physical fitness and HRQoL significantly in short and long terms.

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Fuzhong Li, Peter Harmer, K. John Fisher, Junheng Xu, Kathleen Fitzgerald and Naruepon Vongjaturapat

The primary objective of this study was to provide preliminary evaluation of the feasibility, safety, and efficacy of a newly developed Tai Chi-based exercise program for older adults with Parkinson’s disease (PD). Using a one-group pretest-posttest design, 17 community-dwelling adults (mean age 71.51 years) with mild to moderate idiopathic PD (Stage I, II, or III on the Hoehn and Yahr scale) and stable medication use completed a 5-day, 90-min/day Tai Chi exercise-evaluation program. Outcome measures included face-to-face exit interviews on appropriateness and safety and physical performance (i.e., 50-ft speed walk, up-and-go, functional reach). At the end of this brief intervention, exercise adherence was 100% and the program was shown to be safe. Exit interviews indicated that the program was well received by all participants with respect to program appropriateness, participant satisfaction and enjoyment, and intentions to continue. Furthermore, a significant pretest-to-posttest change was observed at the end of the 5-day program in all three physical-performance measures (p < .05). The results of this pilot evaluation suggest that Tai Chi is an appropriate physical activity for older adults with PD and might also be useful as a therapeutic exercise modality for improving and maintaining physical function. These preliminary findings warrant further investigation.