The purpose of this study was to determine whether a walking program supplemented by tasks designed to challenge balance and mobility (WALK+) could improve physical function more than a traditional walking program (WALK) in older adults at risk for mobility disability. 31 community-dwelling older adults (M ± SD age = 76 ± 5 yr; Short Physical Performance Battery [SPPB] score = 8.4 ± 1.7) were randomized to treatment. Both interventions were 18 sessions (1 hr, 3×/wk) and progressive in intensity and duration. Physical function was assessed using the SPPB and the 400-m-walk time. A subset of participants in the WALK group who had relatively lower baseline function showed only small improvement in their SPPB scores after the intervention (0.3 ± 0.5), whereas a subset of participants in the WALK+ group with low baseline function showed substantial improvement in their SPPB scores (2.2 ± 0.7). These preliminary data underscore the potential importance of tailoring interventions for older adults based on baseline levels of physical function.
Anthony P. Marsh, Elizabeth A. Chmelo, Jeffrey A. Katula, Shannon L. Mihalko and W. Jack Rejeski
Javier T. Gonzalez, Martin J. Barwood, Stuart Goodall, Kevin Thomas and Glyn Howatson
Unaccustomed eccentric exercise using large muscle groups elicits soreness, decrements in physical function and impairs markers of whole-body insulin sensitivity; although these effects are attenuated with a repeated exposure. Eccentric exercise of a small muscle group (elbow flexors) displays similar soreness and damage profiles in response to repeated exposure. However, it is unknown whether damage to small muscle groups impacts upon whole-body insulin sensitivity. This pilot investigation aimed to characterize whole-body insulin sensitivity in response to repeated bouts of eccentric exercise of the elbow flexors. Nine healthy males completed two bouts of eccentric exercise separated by 2 weeks. Insulin resistance (updated homeostasis model of insulin resistance, HOMA2-IR) and muscle damage profiles (soreness and physical function) were assessed before, and 48 h after exercise. Matsuda insulin sensitivity indices (ISIMatsuda) were also determined in 6 participants at the same time points as HOMA2-IR. Soreness was elevated, and physical function impaired, by both bouts of exercise (both p < .05) but to a lesser extent following bout 2 (time x bout interaction, p < .05). Eccentric exercise decreased ISIMatsuda after the first but not the second bout of eccentric exercise (time x bout interaction p < .05). Eccentric exercise performed with an isolated upper limb impairs whole-body insulin sensitivity after the first, but not the second, bout.
David E. Vance, Karlene K. Ball, Daniel L. Roenker, Virginia G. Wadley, Jerri D. Edwards and Gayla M. Cissell
Falls can impair health and reduce quality of life among older adults. Although many factors are related to falling, few analyses examine causal models of this behavior. In this study, factors associated with falling were explored simultaneously using structural-equation modeling. A variety of cognitive, physical-performance, and health measures were administered to 694 older adult drivers from the state of Maryland. The observed and latent variables of age, cognitive ability, physical functioning, health, and falling behavior were used to create a causal model. The model revealed that being older was associated with declines in cognition, and such cognitive declines predicted increased falling. Similarly, poorer health was related to poorer physical functioning, which, in turn, also predicted increased falling. This model indicates that in addition to existing fall-prevention interventions aimed at improving physical functioning, interventions to improve cognition and health might also be effective. It is speculated that fear of falling, which often results in reduced mobility among older adults, might account for the lack of a direct relationship between age and falling. This hypothesis should be examined in further research.
Keith P. Gennuso, Kathryn Zalewski, Susan E. Cashin and Scott J. Strath
To examine the effectiveness of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) resistance training (RT) guidelines to improve physical function and functional classification in older adults with reduced physical abilities.
Twenty-five at-risk older adults were randomized to a control (CON = 13) or 8-week resistance training intervention arm (RT = 12). Progressive RT included 8 exercises for 1 set of 10 repetitions at a perceived exertion of 5–6 performed twice a week. Individuals were assessed for physical function and functional classification change (low, moderate or high) by the short physical performance battery (SPPB) and muscle strength measures.
Postintervention, significant differences were found between groups for SPPB—Chair Stand [F(1,22) = 9.14, P < .01, η = .29] and SPPB—Total Score [F(1,22) = 7.40, P < .05, η = .25]. Functional classification was improved as a result of the intervention with 83% of participants in the RT group improving from low to moderate functioning or moderate to high functioning. Strength significantly improved on all exercises in the RT compared with the CON group.
A RT program congruent with the current ASCM and AHA guidelines is effective to improve overall physical function, functional classification, and muscle strength for older adults with reduced physical abilities.
James H. Rimmer
During the last 15 years a growing number of persons with mental retardation (MR) have been relocated from large congregate facilities to residences in the community. With this trend comes the realization that exercise specialists employed in community based fitness centers will have to address the needs of a growing number of adults with MR who are beginning to access these facilities. Since adults with MR present themselves as a unique group in terms of their cognitive and physical function, this paper will address specific exercise guidelines that must be considered when developing cardiovascular fitness programs for this population.
Linda C. Campanelli
Functional mobility is generally considered a major contributor to maintaining quality of life at any age. There are several overviews of physiological aging relative to physical functioning and/or mobility in the recent literature. This paper reiterates the need for continued exercise (at all levels) throughout one’s lifetime, specifically to enhance quality of life and functional independence. Implications for professionals and program development are included. Tailored exercises for both ambulatory and nonambulatory older adults to maintain flexibility, gait, and bed mobility are described.
Danielle M. Thiel, Fatima Al Sayah, Jeff Vallance, Steven T. Johnson and Jeffrey A. Johnson
The objective was to investigate the longitudinal relationship between physical activity and health-related quality of life (HRQL) in adults with type 2 diabetes.
Data were from a prospective cohort of adults with type 2 diabetes. Weekly moderate-to-vigorous physical activity (MVPA) was reported using the Godin Leisure-Time Physical Activity Questionnaire, and HRQL was reported using the SF-12 and 5-level EQ-5D. Participants were categorized based on current weekly MVPA recommendations. Multivariable linear regression was used to explore associations between MVPA and HRQL, and multinomial logistic regression was used to assess the direction of change in HRQL after 1 year.
Mean age of participants (N = 1948) was 64.5 ± 10.8 years and 45% were female. Participants reported a mean of 84.1 ± 172.4 min of MVPA/week, and 21% (n = 416) met weekly MVPA recommendations. MVPA was associated with differences in the physical functioning (b = 5.42; P < .001), general health (b = 2.45; P = .037), and vitality (b = 2.83; P = .016) SF-12 dimensions. Participants who met recommendations were less likely to report a decline (vs. no change) in EQ-5D index score (OR = 0.75; 95% CI [0.57, 0.99]), and SF-12 physical component summary (OR = 0.67; 95% CI [0.50, 0.90]), compared with participants not meeting recommendations.
Participants who met weekly MVPA recommendations reported better physical functioning and were more likely to maintain their physical and overall HRQL over time.
Clara Suemi da Costa Rosa, Danilo Yuzo Nishimoto, Ismael Forte Freitas Júnior, Emmanuel Gomes Ciolac and Henrique Luiz Monteiro
Patients on hemodialysis (HD) report lower physical activity (PA) levels. We analyzed factors associated with low levels of PA in patients with chronic kidney disease (CKD) and compared PA on HD day and non-HD.
79 patients wore an accelerometer and were classified according to time spent on moderate-to-vigorous PA (MVPA). Demographic data, BMI, comorbidities, clinical status, and health-related quality of life (HRQoL) were checked for association with PA. In addition, PA level was compared between days of HD and non-HD.
Accelerometer compliance was 78.5% [33 men and 29 women (53.96 ± 15.71 yrs) were included in analysis]. 35.5% of sample achieved ≥150min/week on MVPA. Lower MVPA was associated with older age (OR = 5.80, 95% CI = 1.11 to 30.19, P = .04), and lower score of physical function HRQoL (OR = 4.33, 95% CI = 1.23 to 15.23, P = .02). In addition, patients spent 9.73% more time on sedentary behavior, 38.9% less on light PA and 74.9% less on MVPA on HD day versus non-HD day.
Age and physical function HRQoL were the main factors associated to lower PA levels. In addition, lower time spent on PA during HD day suggest that strategies for increasing physical activity levels during HD day such exercising during HD session could help CKD patients to reach current PA recommendations.
Ikuyo Imayama, Catherine M. Alfano, Caitlin E. Mason, Chiachi Wang, Liren Xiao, Catherine Duggan, Kristin L. Campbell, Karen E. Foster-Schubert, Ching-Yun Wang and Anne McTiernan
Regular exercise increases exercise self-efficacy and health-related quality of life (HRQOL); however, the mechanisms are unknown. We examined the associations of exercise adherence and physiological improvements with changes in exercise self-efficacy and HRQOL.
Middle-aged adults (N = 202) were randomized to 12 months aerobic exercise (360 minutes/week) or control. Weight, waist circumference, percent body fat, cardiopulmonary fitness, HRQOL (SF-36), and exercise self-efficacy were assessed at baseline and 12 months. Adherence was measured in minutes/day from activity logs.
Exercise adherence was associated with reduced bodily pain, improved general health and vitality, and reduced role-emotional scores (P trend ≤ 0.05). Increased fitness was associated with improved physical functioning, bodily pain and general health scores (P trend ≤ 0.04). Reduced weight and percent body fat were associated with improved physical functioning, general health, and bodily pain scores (P trend < 0.05). Decreased waist circumference was associated with improved bodily pain and general health but with reduced role-emotional scores (Ptrend ≤ 0.05). High exercise adherence, increased cardiopulmonary fitness and reduced weight, waist circumference and percent body fat were associated with increased exercise self-efficacy (P trend < 0.02).
Monitoring adherence and tailoring exercise programs to induce changes in cardiopulmonary fitness and body composition may lead to greater improvements in HRQOL and self-efficacy that could promote exercise maintenance.
Philipe de Souto Barreto, Anne-Marie Ferrandez and Bérengère Saliba-Serre
Participation bias in exercise studies is poorly understood among older adults. This study was aimed at looking into whether older persons who volunteer to participate in an exercise study differ from nonvolunteers.
A self-reported questionnaire on physical activity and general health was mailed out to 1000 persons, aged 60 or over, who were covered by the medical insurance of the French National Education System. Among them, 535 answered it and sent it back. Two hundred and thirty-three persons (age 69.7 ±7.6, 65.7% women) said they would volunteer to participate in an exercise study and 270 (age 71.7 ±8.8, 62.2% women) did not.
Volunteers were younger and more educated than nonvolunteers, but they did not differ in sex. They had less physical function decline and higher volumes of physical activity than nonvolunteers. Compared with volunteers, nonvolunteers had a worse self-reported health and suffered more frequently from chronic pain. Multiple logistic regressions showed that good self-reported health, absence of chronic pain, and lower levels of physical function decline were associated with volunteering to participate in an exercise study.
Volunteers were fitter and healthier than nonvolunteers. Therefore, caution must be taken when generalizing the results of exercise intervention studies.