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.
Katherine Beissner, Samantha J. Parker, Charles R. Henderson Jr., Anusmiriti Pal, Lynne Iannone and M. Cary Reid
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.
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.
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.
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.
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).
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.
Jacqueline M. Miotto, Wojtek J. Chodzko-Zajko, Jennifer L. Reich and Melissa M. Supler
A limiting factor in evaluating the functional status of older people is the lack of appropriate measurement tools for assessing functional mobility, muscle strength, aerobic endurance, agility, and flexibility. In this study, the reliability and validity of the seven-item Fullerton Functional Fitness Test (FFT) battery, designed for use with community-dwelling older adults, was examined. The test items were as follows: floor sit-and-reach, back scratch, 8-ft up-and-go, arm curl, 30-s chair stand. 2-min step, and 9-min walk. Seventy-nine participants (42 physically active, 37 sedentary) completed the FFT battery three times within a 2-week period. The test-retest reliability intraclass correlation coefficients were high. Construct validity analysis revealed that five of the seven FFT items discriminated between the physically active and sedentary groups. In conclusion, most of the evidence from the stability reliability and discriminant validity analyses supports the view that the Fullerton FFT battery is a reliable and valid test of functional fitness.
Addie Middleton, George D. Fulk, Michael W. Beets, Troy M. Herter and Stacy L. Fritz
Daily ambulatory activity is associated with health and functional status in older adults; however, assessment requires multiple days of activity monitoring. The objective of this study was to determine the relative capabilities of self-selected walking speed (SSWS), maximal walking speed (MWS), and walking speed reserve (WSR) to provide insight into daily ambulatory activity (steps per day) in community-dwelling older adults. Sixty-seven older adults completed testing and activity monitoring (age 80.39 [6.73] years). SSWS (R 2 = .51), MWS (R 2 = .35), and WSR calculated as a ratio (R 2 = .06) were significant predictors of daily ambulatory activity in unadjusted linear regression. Cutpoints for participants achieving < 8,000 steps/day were identified for SSWS (≤ 0.97 m/s, 44.2% sensitivity, 95.7% specificity, 10.28 +LR, 0.58 −LR) and MWS (≤ 1.39 m/s, 60.5% sensitivity, 78.3% specificity, 2.79 +LR, 0.50 −LR). SSWS may be a feasible proxy for assessing and monitoring daily ambulatory activity in older adults.
Roberta E. Rikli and C. Jessie Jones
The purpose of this study was to assess the reliability and validity of a 6-min walk test as a measure of physical endurance in older adults. Seventy-seven subjects, ages 60-87. performed three separate 6-min walk tests and a treadmill test and completed questionnaire items assessing physical activity level and functional status. The 6-min walk had good test-retest reliability (.88 <R < .94). particularly when a practice trial preceded the test trial. Convergent validity of the 6-min walk was demonstrated by its moderate correlation (.71 < r < .82) with treadmill performance. Construct validity was assessed by determining the ability of the test to detect differences between different age and activity level groups. As expected, walking scores decreased significantly across decades and were significantly lower for low-active subjects compared to high-active subjects. There was a moderate relationship between 6-min walk scores and self-reported functional ability. It was concluded that the 6-min walk can be used to obtain reasonably reliable and valid measures of physical endurance in older adults and that it moderately reflects overall physical functional performance.