Exercise intervention designed to improve strength and dynamic balance among community-dwelling older adults

Loss of balance and falling are critical concerns for older adults. Physical activity can improve balance and decrease the risk of falling. The purpose of this study was to evaluate a simple, low-cost exercise program for community-dwelling older adults. Sixteen senior adults were evaluated using the Senior Fitness Test for measures of functional strength, aerobic endurance, dynamic balance and agility, and flexibility. In addition, measures of height, weight, resting blood pressure, blood lipids, and cognitive function were obtained. Participants then attended a 10-week exercise class including stretching, strengthening, and balance-training exercises. At the completion of the program, significant improvements were observed in tests measuring dynamic balance and agility, lower and upper extremity strength, and upper extremity flexibility. The results indicate that exercise programs such as this are an effective, low-cost solution to improving health and factors that affect falling risk among older adults.     

Effect of age and physical activity level on functional fitness in older adults

It is difficult to distinguish between the effects of age and physical activity level in the functional fitness level of older adults. The objective of this study was to determine the effects of age and physical activity level on some functional fitness parameters in community-dwelling older adults.Two hundred twenty-nine elderly (111 female; 118 male) aged between 65–87 years living in the Balçova municipality region were divided into two groups: the young elderly (65–69 years old) and the elderly (70 years old or over). The “seven-day physical activity recall questionnaire” was used to estimate physical activity level (PAL). The functional fitness evaluation included the body mass index (BMI), the lower body strength (LBS), the dynamic balance, and the aerobic endurance. The young elderly were significantly worse with regard to BMI and significantly better with regard to LBS, dynamic balance, and aerobic endurance than the elderly; in contrast, PAL did not affect any of the functional fitness parameters. The young elderly showed worse BMI than the elderly when the age groups were less active. The young elderly showed better LBS and dynamic balance than the elderly when the age groups were more active. The young elderly showed significantly better aerobic endurance than the elderly in both the less and more active age groups. This study confirms that age affects functional fitness, whereas PAL generally does not. However, being more active is advantageous for the young elderly with regard to BMI, LBS, and dynamic balance.     

Best practices for physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The article identifies key practices for promoting physical activity in older adults, with a focus on those with chronic disease or low fitness and those with low levels of physical activity. Key practices identified: (a) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; (b) principles of behavior change including social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; (c) manage risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk:benefit ratio and should be the goal for older adults; (d) an emergency procedure plan is prudent for community-based programs; and (e) monitoring aerobic intensity is important for progression and motivation. Selected content review of physical activity programming from major organizations and institutions is provided.     

Effects of an 8-week multimodal exercise program on strength, flexibility, and golf performance in 55- to 79-year-old men

Substantial research has indicated the beneficial effect of physical activity on physical fitness and activities of daily living in older adults, but none have investigated the effects on performance of recreational activities. This investigation studied the effect of an exercise program on fitness and golf-clubhead speed in older men. Thirty-one golfers (mean age 65.1 +/- 6.2 years) were randomly assigned to a treatment (n = 19) or control (n = 12) group. The treatment group completed an 8-week strength and flexibility program. Assessments included 10-RM muscle strength; selected range-of-motion (ROM) measurements; and golf-clubhead speed (CHS). ANCOVA revealed significant differences between groups (p <.005) for all strength measurements and several ROM measurements. CHS was significantly different (p <.05) between groups after the intervention. Mean CHS improved from 85.0 to 87.1 miles/hr (136.8 to 140.2 km/hr). These results indicate that a strength and flexibility program can improve golf performance in older adults.     

Community exercise program for older adults recovering from hip fracture: a pilot study

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.     

Best practices for physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The purpose of this paper is to identify key practices for promoting physical activity in older adults, with a focus on older adults with chronic disease or low fitness and those with low levels of physical activity. Key practices identified in promotion activity in older adults include: (1) a multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; (2) principles of behavior change, including social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement, enhance adherence; (3) management of risk by beginning at low intensity but gradually increasing to moderate physical activity which has a better risk/benefit ratio should be the goal for older adults; (4) an emergency procedure plan is prudent for community-based programs; and (5) monitoring aerobic intensity is important for progression and for motivation. Selected content reviews of physical activity programming from major organizations and institutions are provided. Regular participation in physical activity is one of the most effective ways for older adults, including those with disabilities, to help prevent chronic disease, promote independence, and increase quality of life in old age.Publication Note All National Blueprint Publications are in the public domain and can be freely reproduced without copyright. This article has been previously published in Medicine Science and Sports and Exercise and the Journal of Aging and Physical Activity. Individuals or organizations who wish to publish National Blueprint articles should contact the National Blueprint Office for permission.     

The effect of a novel ADL-based training program on performance of activities of daily living and physical fitness

The purpose of this study was to determine the degree to which a novel training program based on activities of daily living (ADL) would affect performance of ADLs, as well as the fitness of older adults. Fourteen individuals (mean age 82 years) took part in a 10-week control period followed by a 10-week ADL-based training program. Pre- and posttests included the Physical Performance Test (PPT), the Physical Functional Performance-10 (PFP-10), and the Senior Fitness Test (SFT). After the training period, improvements ranging from 7% to 33% (p<.05) were seen on the PPT and PFP-10 and on three items of the SFT. After conversion to standard scores, the magnitude of change in the PPT and the PFP10 was significantly greater (p<.05) than the magnitude of change in the SFT. These data support the idea that this novel ADL-based training program was able to facilitate improved performance of ADLs, as well as select measures of fitness among older adults.     

Does yoga engender fitness in older adults? A critical review

Interest in yoga is growing, especially among older adults. This review critically summarizes the current literature to investigate whether physical fitness and function benefits are engendered through the practice of yoga in older adults. A comprehensive search yielded 507 studies; 10 studies with 544 participants (69.6 ± 6.3 yr, 71% female) were included. Large variability in yoga styles and measurement outcomes make it challenging to interpret results across studies. Studies reported moderate improvements for gait (ES = 0.54, 0.80), balance (ES = 0.25-1.61), upper/lower body flexibility (ES = 0.25, 0.70), lower body strength (ES = 0.51), and weight loss (ES = 0.73, 0.99).Yoga may engender improvements in some components of fitness in older adults. However, more evidence is needed to determine its effectiveness as an alternative exercise to promote fitness in older adults. Further investigation into yoga as an exercise activity for older adults is warranted.     

Effects of Pilates method in physical fitness on older adults. A systematic review

Pilates method is employed for physical and mental conditioning. Elderly people could be benefited from a patterned and regulated conditioning work based on Pilates method. We performed a systematic review to assess the evidence on the effects of Pilates method in physical fitness on older adults. Our search included the following databases: MEDLINE-PubMed, Scopus and CINAHL Plus with Full Text via EBSCO and SPORTDiscus databases (up to April 2014). A summary of the results was performed using a best evidence synthesis and was reported according to the systematic review method proposed by Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodology quality of selected studies. Seventeen experimental studies were included in this review. Fourteen were randomized controlled trials (RCT) and three clinical controlled trials (CCT). Quality scores according to PEDro indicate low quality of the included studies (range 1–6, mean 3.8?±?1.2). The most studied components related to physical fitness were neuromotor fitness (n?=?11), muscle strength (n?=?8), cardiorespiratory endurance (n?=?4), body composition (n?=?4) and flexibility (n?=?4). Results indicate that Pilates method seems to present positive effects in neuromotor fitness, especially in static and dynamic balance. Related to the other components of physical fitness (cardiorespiratory endurance, muscle strength, body composition and flexibility), contradictory results were observed. The Pilates method indicates to be an appropriate exercise modality in order to improve balance on older adults. Nevertheless, more intervention research is needed to build a solid knowledge base about the health benefits of Pilates method on older people, especially regarding the other components of physical fitness.     

Resistive training and long-term function in older adults

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.     

The effects of high- and moderate-resistance training on muscle function in the elderly

The purpose of this study was to investigate the effects of a 12-week resistance-training program on muscle strength and mass in older adults. Thirty-three inactive participants (60-74 years old) were assigned to 1 of 3 groups: high-resistance training (HT), moderate-resistance training (MT), and control. After the training period, both HT and MT significantly increased 1-RM body strength, the peak torque of knee extensors and flexors, and the midthigh cross-sectional area of the total muscle. In addition, both HT and MT significantly decreased the abdominal circumference. HT was more effective in increasing 1-RM strength, muscle mass, and peak knee-flexor torque than was MT. These data suggest that muscle strength and mass can be improved in the elderly with both high- and moderate-intensity resistance training, but high-resistance training can lead to greater strength gains and hypertrophy than can moderate-resistance training.     

The effect of three different exercise training modalities on cognitive and physical function in a healthy older population

Background

Older adults are encouraged to participate in regular physical activity to counter the age-related declines in physical and cognitive health. Literature on the effect of different exercise training modalities (aerobic vs resistance) on these health-related outcomes is not only sparse, but results are inconsistent. In general, it is believed that exercise has a positive effect on executive cognitive function, possibly because of the physiological adaptations through increases in fitness. Indications are that high-intensity interval training is a potent stimulus to improve cardiovascular fitness, even in older adults; however, its effect on cognitive function has not been studied before.Therefore, the purpose of this study was to compare the effects of resistance training, high-intensity aerobic interval training and moderate continuous aerobic training on the cognitive and physical functioning of healthy older adults.

Methods

Sixty-seven inactive individuals (55 to 75 years) were randomly assigned to a resistance training (RT) group (n = 22), high-intensity aerobic interval training (HIIT) group (n = 13), moderate continuous aerobic training (MCT) group (n = 13) and a control (CON) group (n = 19) for a period of 16 weeks. Cognitive function was assessed with a Stroop task and physical function with the Timed-Up-and-Go (TUG) and submaximal Bruce treadmill tests.

Results

No significant GROUP x TIME interaction was found for Stroop reaction time (P > .05). The HIIT group showed the greatest practical significant improvement in reaction time on the information processing task, i.e. Stroop Neutral (ES = 1.11). MCT group participants had very large practical significant improvements in reaction time on the executive cognitive tasks, i.e. Stroop Incongruent and Interference (ES = 1.28 and 1.31, respectively). The HIIT group showed the largest practically significant increase in measures of physical function, i.e. walking endurance (ES = 0.91) and functional mobility (ES = 0.36).

Conclusions

MCT and RT proved to be superior to HIIT for the enhancement of older individuals’ executive cognitive function; whereas HIIT were most beneficial for improvement in information processing speed. HIIT also induced the largest gains in physical function.

     

Nutrition of the elderly: Interactions with physical activity

Elderly subjects have a lower energy requirement compared to young adults as a result of lower physical activity and a lower basal metabolic rate. A lower energy intake in the elderly could lead to undesirable low intakes of essential nutrients. The reduction of the energy turnover is caused by, or a consequence of, a decrease in active cell mass. Thus, the effect of exercise training on habitual activity across age ranges, and age-related changes in body composition in relation to habitual activity level, are investigated here. The focus is on data on physical activity and body composition obtained with doubly labelled water. The results suggest that exercise training does not affect energy requirement in the elderly and the age-related decrease in fat-free mass is not delayed in subjects with a relatively high habitual activity level. Beneficial effects of exercise training in the elderly are endurance, flexibility, range of motion and balance control, all contributing to a delay in the age-induced impairment of personal mobility. Energy intake will inevitably go down as a result of a reduction of the energy requirement. Thus, the nutrition of elderly subjects needs more attention with regard to the essential nutrients than the nutrition of younger adults.     

Physical training as a substance abuse prevention intervention for youth

Program evaluation data from school and community applications of a physical fitness drug prevention program is presented. A train-the-trainer methodology was applied to install the program in twenty-two settings within the state of Illinois. The physical training program consisted of exercise and educational modules delivered over a twelve-week time period that focused on learning values and life skills through exercise. Complete pre-post data were obtained on 329 participating youth at six school and community based sites. Significant increases were demonstrated in physical activity and physical fitness (cardiovascular endurance, strength, and flexibility). Youth self-report data indicated significant decreases in risk factors such as low self-concept, poor school attendance, anxiety, depression, and number of friends who use alcohol and drugs. There were significant reductions in the percentage of youth who used cigarettes, smokeless tobacco, and alcohol. It was concluded that a strong relationship was demonstrated for increased fitness leading to lowered risk factors and usage patterns. Likewise, the train-the-trainer model was shown to be an effective installation approach to expand fitness programming within prevention settings.     

Type of activity and fitness benefits as moderators of the effect of physical activity on affect in advanced age: a review

This study aimed to review studies exploring the effect of physical activity on affect in advanced age with a special focus on the moderating role of fitness improvement and mode of exercise and to examine those studies in relation to the potential mechanisms for explaining the physical activity–affect relationship. Studies were assembled through a computer search of online psychological, medical, and exercise science databases. Randomized controlled studies having as their purpose the examination of physical activity effects on affect, with a mean sample population age of at least 50 years, were included. Thirty-nine studies were collated and divided into three groups: those applying aerobic activity, those applying strength training, and those applying non-specific physical activity. The main finding was that aerobic exercise and aerobic fitness do not moderate the effect of physical activity on affect. While fewer than 50% of the aerobic studies reporting fitness improvement also reported improvement in affect, over 50% of the strength training studies and of the non-specific exercise studies reported improvement in affect. Theories with a physiological orientation claiming that aerobic fitness is the mediator between physical activity and affect are not supported, whereas theories with a psychological orientation maintaining that alterations in affect are not dependent on physiological alterations do receive support. It is argued that the differentiation between physiologically and psychologically oriented theories is arbitrary. It is recommended that the relationship between physical activity and affect be explored further, embracing a psychophysiological perspective in which the psychological and physiological perspectives are complementary.     

The beneficial effects of different types of exercise interventions on motor and cognitive functions in older age: a systematic review

The decline in cognitive and motor functions with age affects the performance of the aging healthy population in many daily life activities. Physical activity appears to mitigate this decline or even improve motor and cognitive abilities in older adults. The current systematic review will focus mainly on behavioral studies that look into the dual effects of different types of physical training (e.g., balance training, aerobic training, strength training, group sports, etc.) on cognitive and motor tasks in older adults with no known cognitive or motor disabilities or disease. Our search retrieved a total of 1095 likely relevant articles, of which 41 were considered for full-text reading and 19 were included in the review after the full-text reading. Overall, observations from the 19 included studies conclude that improvements on both motor and cognitive functions were found, mainly in interventions that adopt physical-cognitive training or combined exercise training. While this finding advocates the use of multimodal exercise training paradigms or interventions to improve cognitive-motor abilities in older adults, the sizeable inconsistency among training protocols and endpoint measures complicates the generalization of this finding.     

Exercise and health in frail elderly people: a review of randomized controlled trials

Frailty is a physiological syndrome that increases the risk of poor health. Although some research has been conducted to study the benefits of physical exercise in frail elderly populations, different operational definitions of frailty have been used, and this makes the studies difficult to compare. The present review was aimed at examining the influence of exercise on health in frail older adults. Studies using randomized controlled trials that administered an exercise program to a frail elderly population and that had an operational definition of frailty were selected from publications between January 2000 and October 2008. Information about the study population, frailty criteria, exercise program, principles of exercise training, randomization procedures, main and secondary outcome measures, study follow-up, and control group characteristics was taken from these studies, and the results from a final sample of 28 articles are discussed. Exercise training seems to be a safe and effective tool for promoting and maintaining optimal health levels in a wide variety of vulnerable older adults. However, the lack of studies on a well-defined frail older adult sample with selection procedures based on current knowledge in this field does not allow us, at the present time, to conclude that exercise influences health in this population. Further research is needed to confirm the benefits of exercise on health in frail older adults. The study population must be selected based on current knowledge in the area of frailty, and the design of the exercise program must be based on principles of training.     

Endurance training for cancer patients during and shortly after completion of the anti-cancer treatment

Cardiorespiratory fitness is one of the most important indicators of health and improves length of life. The attention and acceptance for endurance training in patients with several cancer diagnoses increased during the last decade. This review highlight’s the effect of endurance training in cancer patients by summarizing exemplary randomized clinical trials and systematic reviews both within the acute hospital treatment context, as in a rehabilitation setting. To date, most studies focus on endurance training in patient groups with moderate to good prognosis. The studies within these patient groups evaluate the endurance training in cancer patients using a moderate training intensity between 50 and 75 % of the VO₂ peak with an exercise time varying from 20 min (five times per week) in hospital up to 45 min (two to three times per week) in an ambulatory setting. Recently, the American College of Sports Medicine indicated that cancer survivors should follow the Physical Activity Guidelines for Americans, which represents ≥150 min per week of moderate intensity, ≥75 min per week of vigorous intensity aerobic exercise, or an equivalent combination of moderate and vigorous intensity aerobic exercises. To date, fewer studies evaluate the effects of endurance training in a palliative setting to maintain physical function of the patient. Future studies should investigate the effect of endurance training by evaluating different types of intensity training (moderate vs. high intensity training), the use of high-tech devices to improve physical activity, and to evaluate the effect of endurance training in patients with a palliative intention.