Community-based rehabilitative exercise programs might be an effective means to improve functional outcomes for hip-fracture patients. The purpose of this study was to evaluate the effectiveness of a community exercise program (CEP) for older adults recovering from hip fracture. Twenty-five older adults (mean age 80.0 ± 6.0 years; 24 women; 71 ± 23 days post–hip fracture) participated in this pilot study (17 exercise, 8 control). The CEP involved functional stepping and lower extremity–strengthening exercises. Control participants received only standard outpatient therapy. Measures of functional mobility, balance confidence, falls efficacy, lower extremity strength, and daily physical activity were evaluated at baseline and at 16 weeks. Improvements for self-reported physical activity, mobility, balance, and knee-extensor strength were observed for the CEP group. This study demonstrated that a CEP is beneficial for community-dwelling older adults post–hip fracture.
Gareth R. Jones, Jennifer M. Jakobi, Albert W. Taylor, Rob J. Petrella and Anthony A. Vandervoort
L. Jerome Brandon, Lisa W. Boyette, Adreinne Lloyd and Deborah A. Gaasch
The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults. A repeated-measures experimental research design was employed as a sample of 55 apparently healthy, older, community-dwelling volunteers (30 exercisers—25 women and 5 men; 25 comparisons—16 women and 9 men) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function. Strength and function were evaluated at 6-month intervals. The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention. Furthermore, a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence.
Kristin Taraldsen, Beatrix Vereijken, Pernille Thingstad, Olav Sletvold and Jorunn L. Helbostad
The aim of the study was to investigate the precision of estimated upright time during one week in community-dwelling older adults after hip fracture when monitoring activity for different numbers of consecutive days. Information about upright time was collected by thigh-worn accelerometers during 7 consecutive days in 31 older adults (mean age 81.8 years ± 5.3) 3 months after hip-fracture surgery. Mean time in upright position, including both standing and walking, was 260.9 (±151.2) min/day. A cutoff value of half an hour was used to provide recommendations about number of recording days. Large variability between participants between days, as well as a nonconstant within-participant variability between days indicates that at least 4 consecutive days of recording should be used to obtain a reliable estimate of upright time for individual persons. However, at a group level, one day of recording is sufficient.
Minna Rasinaho, Mirja Hirvensalo, Raija Leinonen, Taru Lintunen and Taina Rantanen
The purpose of this study was to investigate what older adults with severe, moderate, or no mobility limitation consider motives for and barriers to engaging in physical exercise. Community-dwelling adults (N = 645) age 75–81 years completed a questionnaire about their motives for and barriers to physical exercise and answered interview questions on mobility limitation. Those with severely limited mobility more often reported poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise than did those with no mobility limitation. They also accentuated disease management as a motive for exercise, whereas those with no or moderate mobility limitation emphasized health promotion and positive experiences related to exercise. Information about differences in motives for and barriers to exercise among people with and without mobility limitation helps tailor support systems that support engagement in physical activity among older adults.
David E. Vance, Virginia G. Wadley, Karlene K. Ball, Daniel L. Roenker and Matthew Rizzo
Physical activity has been shown to be positively associated with cognitive health, but the mechanisms underlying the benefits of physical activity on cognitive health are unclear. The present study simultaneously examined two hypotheses using structural equation modeling (SEM). The depression-reduction hypothesis states that depression suppresses cognitive ability and that physical activity alleviates dysphoric mood and thereby improves cognitive ability. The social-stimulation hypothesis posits that social contact, which is often facilitated by socially laden physical activities, improves cognitive functioning by stimulating the nervous system. Sedentary behavior in the absence of physical activity is expected to exert an inverse relationship on cognitive health through each of these hypotheses. Community-dwelling elders (N = 158) were administered a variety of measures of cognition, depression, social support, and physical activity. SEM techniques provided partial support for the social-stimulation hypothesis and depression-reduction hypothesis. Implications for treating depression and improving cognitive functioning are discussed.
Kristiann C. Heesch, Jannique van Uffelen and Wendy J. Brown
The aim of this study was to examine older adults’ understanding and interpretation of a validated questionnaire for physical activity surveillance, the Active Australia Survey (AAS). To address this aim, cognitive interviewing techniques were used during face-to-face semistructured interviews with 44 adults age 65–89 years. Qualitative data analysis revealed that participants were confused with questionnaire phrasing, misunderstood the scope of activities to include in answers, and misunderstood the time frame of activities to report. They also struggled to accurately estimate the frequency and duration of their activities. Our findings suggest that AAS questions may be interpreted differently by older adults than intended by survey developers. Findings also suggest that older adults use a range of methods for calculating PA frequency and duration. The issues revealed in this study may be useful for adapting AAS for use in older community-dwelling adults.
Maria Giné-Garriga, Míriam Guerra, Esther Pagès, Todd M. Manini, Rosario Jiménez and Viswanath B. Unnithan
The purpose of this study was to evaluate whether a 12-wk functional circuit-training program (FCT) could alter markers of physical frailty in a group of frail community-dwelling adults. Fifty-one individuals (31 women, 20 men), mean age (± SD) 84 (± 2.9) yr, met frailty criteria and were randomly assigned into groups (FCT = 26, control group [CG] = 25). FCT underwent a 12-wk exercise program. CG met once a week for health education meetings. Measures of physical frailty, function, strength, balance, and gait speed were assessed at Weeks 0, 12, and 36. Physical-frailty measures in FCT showed significant (p < .05) improvements relative to those in CG (Barthel Index at Weeks 0 and 36: 73.41 (± 2.35) and 77.0 (± 2.38) for the FCT and 70.79 (± 2.53) and 66.73 (± 2.73) for the CG. These data indicate that an FCT program is effective in improving measures of function and reducing physical frailty among frail older adults.
Johanne Desrosiers, François Prince, Annie Rochette and Michel Raîche
The objectives of this study were to standardize measurement procedures and study the test-retest and interrater reliability of the belt-resisted method for measuring the lower extremity isometric strength of three muscle groups. The strength of 33 healthy, elderly, community-dwelling subjects was evaluated with a hand-held dynamometer using the belt-resisted method. Isometric strength testing of three muscle groups (hip flexors, knee extensors, and ankle dorsiflexors) was performed on two separate occasions, I week apart, by the same tester to determine test-retest reliability. The test results of two different examiners testing on different days were used to determine interrater reliability. Test-retest reliability was higher than interrater reliability. Test-retest reliability coefficients of the three muscle groups were high (J9-.95). For interrater reliability, intraclass correlation coefficients varied from .64 to .92. depending on the muscle group and side. For the two kinds of reliability, intraclass correlation coefficients increased from proximal to distal. The method for the hip muscle group should be modified to increase reliability of the measure.
Wendy C. Stephen and Ian Janssen
Little is known about the effects of physical activity on weight loss in older adults.
Participants included 4512 community-dwelling older (≥65 yr) men and women from the Cardiovascular Health Study. Physical activity (PA) was determined from a questionnaire at baseline and subjects were divided into sex-specific PA quartiles. Weight was measured at baseline and annually over the 8 years of follow-up. The influence of PA on longitudinal changes in body weight was examined using mixed models while adjusting for lifestyle variables, sociodemographic characteristics, and disease status.
Body weight declined in a curvilinear manner over time with accelerated weight loss occurring in the final years. Over the 8 yr follow-up period, the least active PA quartile lost 2.72 kg. Weight loss was attenuated by 0.55 kg (20%, P = .057), 0.80 kg (29%, P = .05), and 0.69 kg (25%, P = .016) within the second through fourth PA quartiles. The effects of PA did not differ by gender, but increased with advancing age.
Participation in modest amounts of PA attenuated age-related weight loss by approximately 25% with little additional benefit observed at higher PA levels. This finding adds to the growing number of health outcomes that are positively affected by PA.
George J. Salem, Sean P. Flanagan, Man-Ying Wang, Joo-Eun Song, Stanley P. Azen and Gail A. Greendale
Stepping activities when wearing a weighted vest may enhance physical function in older persons. Using 3 weighted-vest resistance dosages, this study characterized the lower-extremity joint biomechanics associated with stepping activities in elders. Twenty healthy community-dwelling older adults, ages 74.5 ± 4.5 yrs, performed 3 trials of forward step-up and lateral step-up exercises while wearing a weighted vest which added 0% body weight (BW), 5% BW, or 10% BW. They performed these activities on a force platform while instrumented for biomechanical analysis. Repeated-measures ANOVA was used to evaluate the differences in ankle, knee, and hip maximum joint angles, peak net joint moments, joint powers, and impulses among both steping activities and the 3 loading conditions. Findings indicated that the 5% BW vest increased the kinetic output associated with the exercise activities at all three lower-extremity joints. These increases ranged from 5.9% for peak hip power to 12.5% for knee extensor impulse. The application of an additional 5% BW resistance did not affect peak joint moments or powers, but it did increase the joint impulses by 4–11%. Comparisons between exercise activities, across the 3 loading conditions, indicated that forward stepping preferentially targeted the hip extensors while lateral stepping targeted the plantar flexors; both activities equally targeted the knee extensors. Weighted-vest loads of 5% and 10% BW substantially increased the mechanical demand on the knee extensors, hip extensors (forward stepping), and ankle plantar flexors (lateral stepping).