to evaluate the functional status of individuals and to identify and treat those at risk for mobility problems and frailty. In the periodic and field-based simplified approaches, the handgrip strength measurement has been widely used in clinical practice for the assessment of muscle size or strength
Ka-Chun Siu, Shireen S. Rajaram and Carolina Padilla
Increasing evidence underscores the health benefits of Tai Chi (TC), although there is limited evidence of benefits among racial and ethnic minorities. This study investigated the impact of psychosocial status on balance among 23 Latino seniors after a twice-a-week, 12-week TC exercise program. Functional status was measured at baseline, immediately after, and three months following the TC exercise program, using the Timed Up and Go Test and Tinetti Falls Efficacy Scale. Psychosocial status was measured at baseline by the Center for Epidemiologic Studies Depression Scale and Norbeck Social Support Questionnaire. Both measures of functional status improved and were sustained after three months of TC. Greater improvement was significantly related to a higher level of baseline social support. More depressed seniors reported less fear of falling after TC. Depression and social support are important moderators of functional improvement after TC among Latino seniors.
Katherine Beissner, Samantha J. Parker, Charles R. Henderson Jr., Anusmiriti Pal, Lynne Iannone and M. Cary Reid
This pilot study examined the feasibility and potential efficacy of a self-management program for seniors with chronic back pain and assessed for possible race/ ethnicity differences in program impact. Sixty-nine seniors (24 African Americans, 25 Hispanics, and 20 non-Hispanic Whites) enrolled in the 8-wk community-based program. Efficacy outcomes included pain-related disability as measured by the Roland Morris Disability Questionnaire (RMDQ), pain intensity, pain self-efficacy, depressive symptoms, social activity, and functional status. Eighty percent of enrollees completed the program. Clinically important decreases in RMDQ scores were found for non-Hispanic White (adjusted change score = –3.53), African American (–3.89), and Hispanic (–8.45) participants. Improvements in all other outcomes were observed, but only for Hispanic participants. Results confirm that implementation of the protocol in urban senior centers is feasible, and the program shows potential efficacy. The race/ethnicity differences observed in the current study merit further investigation.
Michael L. Voight and Gray Cook
Enhancing the ability to function within one's environment and to perform activities of daily living is a common goal in rehabilitation. The entire rehabilitation process should be focused on improving the patient's functional status. A functional progression for return to activity can be developed by breaking specific activities down into a hierarchy and then performing them in a sequence that allows for acquisition or reacquisition of skill. Rehabilitation following injury has focused upon restoring muscular strength, endurance, and joint flexibility without any consideration of the role of the neuromuscular mechanism. A common error in rehabilitation is assuming that clinical programs alone using traditional methods will safely return the athlete to function. Limiting athletic rehabilitation to these traditional programs often results in an incomplete restoration of athletic ability and quite possibly an increased risk of reinjury. Reactive neuromuscular training fills the gap left by traditional rehabilitation in order to return the athlete to activity.
Joanna S. Kostka, Jan W. Czernicki and Tomasz J. Kostka
We assessed the relative association of quadriceps muscle strength and power as well as optimal shortening velocity (υopt) to physical functioning in 28 women aged 50–87 years with chronic osteoarthritis participating in a three-week multimodal exercise program. Quadriceps muscle strength, power, υopt, and functional performance using the Activities of Daily Living (ADL) scale, Timed Up & Go (TUG) test, Tinetti test, and 6-Minute Walking Test (6-MWT) were assessed pre- and postrehabilitation. With rehabilitation, patients improved the values of strength, power, and the results of all functional tests. Both at baseline and postrehabilitation, functional status was more strongly related to power and υopt than to strength. Functional gains obtained with rehabilitation were not related to changes in power or υopt, and only very modestly related to changes in strength. Future studies should assess the benefits and feasibility of power- and velocity-oriented training in patients with osteoarthritis.
Silvia Varela, José M. Cancela, Manuel Seijo-Martinez and Carlos Ayán
This study aimed at identifying the effects of self-paced cycling on the cognitive and functional status and fall risk on institutionalized older adults without cognitive impairment. A total of 39 individuals were randomly assigned to an exercise group or to a control group. The exercise group participants cycled at their self-selected intensity at least for 15 min daily during 15 months. The control group participants performed recreational activities. The Mini-Mental State Examination, Fuld object memory evaluation, and symbol digit modality test were used for cognitive assessments. The Katz index, the timed “Up & Go” test, and the World Health Organization questionnaire were used to assess functional independence, mobility, and fall risk. Significant improvements were observed in the exercise group for global cognition and attention, visual scanning, and processing speed. Long-term self-paced cycling training seems to have a protective effect on cognitive status and attention, visual scanning, and processing speed in older institutionalized individuals.
Addie Middleton, Stacy L. Fritz and Michelle Lusardi
Walking speed (WS) is a valid, reliable, and sensitive measure appropriate for assessing and monitoring functional status and overall health in a wide range of populations. These capabilities have led to its designation as the “sixth vital sign”. By synthesizing the available evidence on WS, this scholarly review article provides clinicians with a reference tool regarding this robust measure. Recommendations on testing procedures for assessing WS, including optimal distance, inclusion of acceleration and deceleration phases, instructions, and instrumentation are given. After assessing an individual’s WS, clinicians need to know what this value represents. Therefore, WS cut-off values and the corresponding predicted outcomes, as well as minimal detectable change values for specific populations and settings are provided.
Kiyoji Tanaka, Ryosuke Shigematsu, Masaki Nakagaichi, Hunkyung Kim and Nobuo Takeshima
In Japan, 2 approaches have been adopted to assess health and functional status in older adults. One is a battery of physical-performance tasks. The other is estimation of physical vitality using biomedical risk factors. Previous research has examined strength and direction of the relationship between functional fitness and performance on activities of daily living. Vital-age tests have most often been used to assess risk for developing a variety of age-related diseases. The present study examined interrelationships among functional fitness and vital-age scores in Japanese women (N = 129, mean age = 71.9). The functional fitness test battery consisted of arm curls, walking around 2 cones, moving beans with chopsticks, and functional reach. The vital-age test battery consisted of 6 coronary heart disease risk factors (systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, triglycerides, abdominal girth, and hematocrit) and 5 physical-performance variables (oxygen uptake and heart rate at lactate threshold, side-to-side stepping, 1-leg balance with eyes closed, and forced expiratory volume).
Gerald Barber and Charles T. Heise
Although not well validated, physicians frequently use subjective estimates of exercise ability to assess clinical status and therapeutic results. This study employed a standardized questionnaire and cardiopulmonary exercise test to compare the results of subjective estimates by 211 patients (mean age 13.9 yrs) with objective measurements of exercise ability. Questionnaire data correlated with measured maximal oxygen consumption. Individuals thought to be below average had a maximal oxygen consumption of 21±6 ml/kg/min. Those thought to have average fitness had a maximal oxygen consumption of 26±8 ml/kg/min, and those thought to be above average had a maximal oxygen consumption of 30±7 ml/kg/min. There was a great degree of overlap and scatter of these data, however, such that questionnaire data significantly overestimated exercise ability in 67% and underestimated it in 3% of the subjects. In only 30% of the subjects did the subjective estimate of exercise ability correspond with objectively measured exercise ability. It was concluded that subjective estimates are unreliable and should not be used in assessing the functional status of an individual patient, but subjective estimates may give some idea of objective capabilities in large population studies.
Milan Chang, Suzanne Leveille, Jiska Cohen-Mansfield and Jack M. Guralnik
The Hebrew Home Study of Impairment and Exercise is a cross-sectional community-based study of nondisabled adults age 75–85 years that assessed attitude toward exercise by asking level of agreement with four statements evaluating participants’ perceptions of the health benefits and personal rewards of exercise. A physical-performance battery evaluated lower extremity function on a scale of 0 to 12. Attitude toward exercise was compared across 4 groups: non-vigorous exercisers with scores of 4–6 (n = 21), 7–9 (n = 90), or 10–12 (n = 113) and vigorous exercisers (n = 71). Vigorous exercisers had a significantly better attitude toward exercise than the reference group did, with odds ratios of 1.8-5.5 in all attitude statements. The lowest and moderate-performance groups had less positive attitudes toward exercise than the reference group did, with odds ratios of 0.27–0.62 for all statements. There was a highly significant gradient with better attitude toward exercise and higher functional-status level. Future work in improving older adults’ compliance with exercise should take into account the less positive attitude of those with functional limitations toward the benefits of exercise.