The article describes the design and preliminary evaluation of a 17-week, twice-weekly, comprehensive, progressive exercise program for frail elderly adults. The main objective was to maintain or improve mobility and performance of daily activities essential for independent functioning. Strength, speed, endurance, flexibility, and coordination were trained by walking, kneeling, and chair stands, performed in the context of motor behavior such as games and daily activities. The acceptability of the exercise program was evaluated in a population of community-dwelling, frail older adults (mean age 77.6 ± 5.4 years). Eighty-one percent completed the program. Program appreciation and attendance were high. Seventy-three percent reported wanting to continue participating if possible—although most only once a week. At follow-up (1–1.5 years afterward) 30% were still participating in an exercise program. The exercise program was enjoyed and accepted by a population of frail, previously sedentary elderly adults. Widespread implementation of this program could increase physical activity among frail older adults.
Marijke J.M. Chin A Paw, Nynke de Jong, Martin Stevens, Petrus Bult and Evert G. Schouten
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.
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).
Masamitsu Kamada, Jun Kitayuguchi, Kuninori Shiwaku, Shigeru Inoue, Shimpei Okada and Yoshiteru Mutoh
Physical activity contributes to maintaining functional ability later in life. Specific relationships between walking for particular purposes (eg, recreation or transport) and functional ability are not clear. It is useful for planning health promotion strategies to clarify whether walking time for recreation, or walking time for transport has the stronger relationship with maximum walking speed (MWS), a determinant of functional ability later in life in the elderly.
A cross-sectional survey was conducted in 2007 using a sample of 372 community-dwelling elderly people aged 60 to 87 years in Mitoya Town, Unnan City, rural Japan. Associations with MWS were examined for self-reported weekly times of walking for recreation and for transport using multiple linear regression analyses.
Both in men and women, walking time for recreation was significantly associated with MWS after controlling for age, height, weight, hip and knee pain, and a number of chronic diseases (men: β = 0.18, P = .024; women: β = 0.17, P < .01). However, walking time for transport was not significantly associated with MWS (men: β = −0.094, P = .24; women: β = −0.040, P = .50).
Walking for recreation may contribute to maintaining functional abilities such as MWS in the elderly.
Ellen F. Binder, Marybeth Brown, Suzanne Craft, Kenneth B. Schechtman and Stanley J. Birge
Fifteen community dwelling older adults, ages 66 to 97 years, with at least one risk factor for recurrent falls, attended a thrice weekly group exercise class for 8 weeks. In post- versus preexercise comparisons, knee extensor torque at 0°/sec increased by 16.5% (p = 0.055); time to perform the stand-up test once, and five times consecutively, improved by 29.4 and 27.4%, respectively (p = 0.05, p = 0.01); gait speed for 24 feet increased by 16.5% (p < 0.001); and performance of the progressive Romberg test of balance improved with a mean increase of 1.1 ± 0.9 positions (p = 0.001). Participants reported a significant increase in the mean number of times per week that they went out of their apartment/home independent of exercising, and a significant increase in the mean number of city blocks they could walk. Performance data for nine exercise participants at 1-yr postintervention are presented. A low- to moderate-intensity groups exercise program can effect improvements in lower extremity strength, gait speed, balance, and self-reported mobility function in frail older adults.
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.
Liza Stathokostas and Gareth R. Jones
A convenience sample of 176 healthy, community-dwelling, inactive older adults (mean age 70 ± 5 years; 62 males, 114 females) were tracked for one year. The purpose was to describe the exercise modality choices older adults make one year following participation in an exercise and education intervention. Telephone follow-up contacted 137 participants (78%, men = 50, women = 87) and 62% of the men and 69% of the women reported to be “currently exercising.” Exercising independently was the most common type of exercise reported by 81% and 64% of men and women, respectively. Walking was the most commonly reported modality by both genders. The setting of exercise was most often reported to be at home or outside for both men and women. The main reason for continued participation at 12 months was for overall health (50% of men and 40% of women). Little variation was observed for exercise modality choice. Future interventions should consider a variety of exercise and physical activity opportunities for older adults.
Scott J. Strath, Ann M. Swartz and Susan E. Cashin
This study examined objectively determined walking profiles of older adults across a wide range of sociocultural backgrounds. All individuals (N = 415; 131 men age 70.5 ± 9.2 yr and 284 women age 71.5 ± 9.0 yr) underwent physiological measurements, completed pen-and-paper surveys, and wore a pedometer for 7 consecutive days. The total sample accumulated a mean of 3,987 ± 2,680 steps/day. Age (r = –.485, p < .001) and body-mass index (BMI; r = –.353, p < .001) were negatively associated with steps per day. Multivariate analysis revealed that race/ethnic category (F = 3.15, df = 3), gender (F = 2.46, df = 1), BMI (F = 6.23, df = 2), income (F = 9.86, df = 1), education (F = 43.3, df = 1), and retirement status (F = 52.3, df = 1) were significantly associated with steps per day. Collectively these categories accounted for 56% of the variance in walking activity in this independently living, community-dwelling older adult sample. Sedentary characteristics highlighted within, and step-per-day values specific to, older adults have implications for planning targeted physical activity interventions related to walking activity in this population.
John Cooper, Barbara Stetson, Jason Bonner, Sean Spille, Sathya Krishnasamy and Sri Prakash Mokshagundam
This study assessed physical activity (PA) in community dwelling adults with Type 2 diabetes, using multiple instruments reflecting internationally normed PA and diabetes-specific self-care behaviors.
Two hundred and fifty-three Black (44.8%) and White (55.2%) Americans [mean age = 57.93; 39.5% male] recruited at low-income clinic and community health settings. Participants completed validated PA self-report measures developed for international comparisons (International Physical Activity Questionnaire Short Form), characterization of diabetes self-care (Summary of Diabetes Self-Care Activities Measure; SDSCA) and exercise-related domains including provider recommendations and PA behaviors and barriers (Personal Diabetes Questionnaire; PDQ).
Self-reported PA and PA correlates differed by instrument. BMI was negatively correlated with PA level assessed by the PDQ in both genders, and assessed with SDSCA activity items in females. PA levels were low, comparable to previous research with community and diabetes samples. Pain was the most frequently reported barrier; females reported more frequent PA barriers overall.
When using self-report PA measures for PA evaluation of adults with diabetes in clinical settings, it is critical to consider population and setting in selecting appropriate tools. PA barriers may be an important consideration when interpreting PA levels and developing interventions. Recommendations for incorporating these measures in clinical and research settings are discussed.
Johanna Eronen, Mikaela von Bonsdorff, Merja Rantakokko, Erja Portegijs, Anne Viljanen and Taina Rantanen
Life-space mobility describes the extent of community mobility of older persons. The aim of this cross-sectional study was to examine the relationship between socioeconomic status (SES) and life-space mobility and to investigate whether associations might be explained by SES-related disparities in health and functioning. The participants (n = 848) were community-dwelling adults aged 75–90. Education and occupation were used to indicate SES. Life-space assessment (range 0–120) was used to indicate distance and frequency of moving and assistance needed in moving. People with low education had lower life-space mobility scores than those with intermediate or high education: marginal means 63.5, 64.8, and 70.0 (p = .003), respectively. SES-related health disparities, i.e., higher body mass index, poorer cognitive capacity, and poorer physical performance explained the association, rendering it nonsignificant (marginal means 65.2, 65.3, and 67.5, p = .390). Low SES and restricted life-space mobility often coexist with overweight, reduced cognition, and poorer physical performance.