The effect of 6 months training on leg power, balance, and functional mobility of independently living adults over 70 years old

Where strength training has been used in conjunction with functional-task training in older people, not only have there been improvements in leg strength but also improved function has been measured (e.g., Skelton & McLaughlin, 1996). Many studies use participants from care homes rather than community dwellers. We investigated changes in leg power, balance, and functional mobility in community-dwelling sedentary men and women over 70 years of age (n = 6 for training group [TR]; n = 10 for control group [CN]). Progressive training took place over 24 weeks using seated and nonseated exercise. For TR, leg power increased 40%, from 108 +/- 40 to 141 +/- 53 W (p < .01); dynamic balance increased 48%, from 22.3 +/- 7.9 to 33.1 +/- 6.1 cm (p < .01; functional reach); and functional mobility increased 12%, from 7.46 +/- 1.32 to 6.54 +/- 1.41 s (p < .05; timed walk). CN showed no significant change. In conclusion, a community-based exercise program led to large improvements in leg-extensor power, dynamic balance, and functional mobility.     

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.     

Physical activity in the post-hip-fracture period

The purpose of this study was to characterize physical activity (PA) based on survey and ActiGraphy data from older adults at 2 mo post-hip fracture and consider the factors that influence PA among these individuals. The sample included participants from a current Baltimore hip study, the BHS-7. Measurement of PA was based on the Yale PA Survey (YPAS) and 48 hr of ActiGraphy. The sample included the first 200 individuals enrolled in the study, with analyses including 117 individuals (59%) who completed the YPAS and wore the ActiGraph for 48 hr. Half the participants were male, with an overall mean age of 81.3 yr (SD = 7.9). Findings indicate that at 2 mo post-hip fracture participants were engaged in very limited levels of PA. Age and comorbidities were the only variables to be significantly associated with PA outcomes.     

Motives for and barriers to physical activity among older adults with mobility limitations

The purpose of this study was to investigate what older adults with severe, moderate, or no mobility limitation consider motives for and barriers to engaging in physical exercise. Community-dwelling adults (N=645) age 75-81 years completed a questionnaire about their motives for and barriers to physical exercise and answered interview questions on mobility limitation. Those with severely limited mobility more often reported poor health, fear and negative experiences, lack of company, and an unsuitable environment as barriers to exercise than did those with no mobility limitation. They also accentuated disease management as a motive for exercise, whereas those with no or moderate mobility limitation emphasized health promotion and positive experiences related to exercise. Information about differences in motives for and barriers to exercise among people with and without mobility limitation helps tailor support systems that support engagement in physical activity among older adults.     

Effects of multicomponent training on functional fitness in older adults

The purpose of this study was to evaluate the effects of a 9-week supervised multicomponent exercise program on functional fitness and body composition in independent older adults. Forty-two adults age 60-86 years were randomly assigned to an exercise or a control group and were evaluated before and after training. The training program consisted of 3 sessions of walking, strengthening, and flexibility exercises per week. The multicomponent training program resulted in significant (p < .005) improvements on the chair stand, arm curl, 6-min walk, and up-and-go tests. The findings of this study indicate that a 9-week training program increased upper and lower body strength, aerobic endurance, and agility/dynamic balance in older adults. The most affected components of functional fitness were lower body strength and aerobic endurance. There was no effect of the 9-week training on body composition.     

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.     

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.     

Predicting habitual physical activity using coping strategies in older fallers engaged in falls-prevention exercise

One third of adults over 65 yr old fall each year. Wide-ranging consequences include fracture, reduced activity, and death. Research synthesis suggests that falls-prevention programs can be effective in reducing falls by about 20%. Strength and balance training is the most efficacious component, and the assumed method of effect is an improvement in these performance domains. There is some evidence for this, but the authors have previously proposed an alternative method, activity restriction, leading to a reduction in subsequent falls through a reduction in exposure. The aim of this study was to examine physical activity in older fallers, applying a theory of adaptation, to ascertain predictors of habitual physical activity. Referrals to hospital- and community-based exercise programs were assessed for (a) habitual walking steps and (b) coping strategies, falls self-efficacy, social support, and balance mobility. There was no average group change in physical activity. There was high interindividual variability. Two coping strategies, loss-based selection and optimization, best explained the change in physical activity between baseline and follow-up. Notwithstanding some limitations, this work suggests further use of adaptation theory in falls research. A potential application is the creation of a profiling tool to enable clinicians to better match treatment to patient.     

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.     

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.     

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.     

Cognitive impairment and effects on upper body strength of adults with dementia

The purpose of this investigation was to examine the association between cognitive ability and upper body muscle strength. Two sources of existing data were pooled for this examination. Thirty-eight older participants diagnosed with Alzheimer's disease or dementia (25 women, 13 men; age = 83.2 +/- 5.6 years, MMSE score = 16.75 +/- 7.04, M +/- SD) underwent an assessment of grip strength via handheld dynamometry. Multiple-regression analysis indicated that cognitive status was a significant predictor of strength and, when combined in a model with age and sex, explained 57% of the between-individuals variance in handgrip strength. The findings from this exploratory investigation suggest that dementia is associated with strength loss, a key contributor to functional disability; this further justifies efforts to investigate mechanisms responsible for this decay and to preserve muscle integrity by integrating physical activity interventions, notably, muscle strengthening, into the lifestyle of adults with dementia.     

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.     

Development of a lateral mobility task to identify individuals at risk for mobility disability and functional decline

Lateral mobility is integral to many activities of daily living involving transfer from one position to another. The objective of this study was to develop and evaluate the validity and test-retest reliability of a lateral-mobility (LATMOB) task for older adults. Measurements of lateral mobility, balance, and strength and self-reported and performance-based physical functioning were obtained in 63 women and 77 men > or = 50 years of age. The LATMOB task was significantly correlated with age, knee-extensor strength, grip strength, functional reach, and one-leg-stance time. Test-retest reliability of the task was excellent. The LATMOB task was highly correlated with the car task. Balance was significantly correlated with time to get into and out of a car and performance on the LATMOB task. The LATMOB task was significantly correlated with the Short Physical Performance Battery score. The LATMOB task is valid and reliable, but additional work is needed to assess its sensitivity to change and predictive validity.     

The effect of functional circuit training on physical frailty in frail older adults: a randomized controlled trial

The purpose of this study was to evaluate whether a 12-wk functional circuit-training program (FCT) could alter markers of physical frailty in a group of frail community-dwelling adults. Fifty-one individuals (31 women, 20 men), mean age (± SD) 84 (± 2.9) yr, met frailty criteria and were randomly assigned into groups (FCT = 26, control group [CG] = 25). FCT underwent a 12-wk exercise program. CG met once a week for health education meetings. Measures of physical frailty, function, strength, balance, and gait speed were assessed at Weeks 0, 12, and 36. Physical-frailty measures in FCT showed significant (p < .05) improvements relative to those in CG (Barthel Index at Weeks 0 and 36: 73.41 (± 2.35) and 77.0 (± 2.38) for the FCT and 70.79 (± 2.53) and 66.73 (± 2.73) for the CG. These data indicate that an FCT program is effective in improving measures of function and reducing physical frailty among frail older adults.     

Systematic review of functional training on muscle strength,physical functioning,and activities of daily living in older adults

Exercise programs are often recommended for preventing or delaying late-life disability. Programs that incorporate functional training, which uses movements similar to performing activities of daily living, may be suitable for such recommendation. The purpose of this systematic review was to examine the effects of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Studies in three electronic databases (MEDLINE, CINAHL, and SPORTDiscus) were searched, screened, and appraised. Thirteen studies were included in the review. These studies vary greatly in participant recruitment criteria, functional training content, and selection of comparison groups. Mobility exercises were the most common element in functional training across studies. Results show beneficial effects on muscle strength, balance, mobility, and activities of daily living, particularly when the training content was specific to that outcome. Functional training may be used to improve functional performance in older adults.     

Misconceptions about strength exercise among older adults

The purposes of this study were to determine current opinions of strength exercise among older adults and whether knowledge of recommended protocols differs between strength-exercise participants and nonparticipants. One hundred twenty-nine older adults (77.5 +/- 8.6 years) responded to questions about their opinions, experiences, and knowledge of strength-exercise recommendations. Some misconceptions were identified in the sample, with 48.4% of participants responding "no" to "strength training increases muscle mass," 45% responding "no" to "increasing weight is more important than number of repetitions for building strength," and 37% responding that walking is more effective than lifting weights at building muscle strength. The number of correct responses was related to the number of years in school (semipartial r(2)= .046). More education is needed about the benefits and recommendations to ensure proper use of current strength-exercise protocols among older adults.     

Rate of perceived exertion as a tool to monitor cycling exercise intensity in older adults

The purpose of this study was to determine the efficacy of rate of perceived exertion (RPE) to monitor exercise intensity in older adults. Middle-aged (46.9 +/- 7.0 years, n = 24) and older women (75.5 +/- 3.8 years, n = 29) performed a graded maximal exercise test on a cycle ergometer while RPE, oxygen uptake, heart rate, and blood lactate levels were measured. The Pearson's product moment correlation coefficient between RPE and oxygen uptake for each stage of the graded exercise test was calculated for each participant. The mean coefficient for the older group (r =.954) was similar to that of middle-aged group (r =.963). The autocorrelation coefficient was much lower (r =.411) in the older group than in the middle-aged group (r =.871). Variability in RPE through the graded exercise test was similar between the two groups. In conclusion, RPE was strongly associated with oxygen uptake in the older group. These results indicate that RPE is effective in monitoring exercise intensity in older adults.     

The effect of habitual exercise on respiratory- muscle function in older adults

Older adults' participation in habitual exercise might be affected by alterations to respiratory mechanics such as decreased respiratory-muscle strength. This reduction can cause a decrease in efficiency of the ventilatory pump, potentially compromising exercise participation. This research examined the role of habitual exercise in respiratory-muscle function and the associated implications for exercise performance. Seventy-two healthy older adults (36 men, 64.9 +/- 8.6 years, 177.2 +/- 8.4 cm, 82.5+/- 11.9 kg; 36 women, 64.9 +/- 9.5 years, 161.7+/- 6.4 cm, 61.6 +/- 9.2 kg) undertook respiratory-function and walking-performance tests. Active men and women achieved higher scores than their inactive counterparts for all tests except spirometry, where no differences were evident. The results indicate that a significant amount of the elevated fitness level might be accounted for by increased endurance capacity of the inspiratory muscles. Inactive older individuals might be at risk for inadequate respiratory-muscle strength, so interventions should be considered.