Benefits of exercise for community-dwelling older adults

Urban built environment configuration and psychological distress in older men: results from the Caerphilly study

Background

Few studies have examined the impact of the built environment configuration upon mental health. The study examines the impact of objectively assessed land use and street network configuration upon psychological distress and whether this association is moderated by the natural environment and area-level deprivation.

Methods

In a community sample of 687 older men from the Caerphilly Prospective Study, built environment morphological metrics (morphometrics) were related to differences in psychological distress as measured by the General Health Questionnaire. Cross-sectional data were taken from the most recent (5th) phase. A multi-level analysis with individuals nested within census-defined neighbourhoods was conducted. Environmental measures comprised GIS-constructed land use and street network metrics, slope variability and a satellite derived measure of greenness.

Results

Reduced psychological distress was associated with residing in a terraced dwelling (OR = 0.48, p = 0.03), higher degrees of land-use mix (OR = 0.42, p = 0.03 for the high tertile) and having higher local-level street-network accessibility (‘movement potential’) (OR = 0.54, p = 0.03). Hillier topography with higher slope variability was associated with increased risks of psychological distress (OR = 1.38, p = 0.05).

Conclusions

The findings support our hypothesis that built environment configuration is independently associated with psychological distress. The study underscores the need for effective intervention in the planning and design of residential built environment to achieve the goal of health-sustaining communities.

Does neighborhood walkability moderate the effects of intrapersonal characteristics on amount of walking in post-menopausal women?

This study identifies factors associated with walking among postmenopausal women and tests whether neighborhood walkability moderates the influence of intrapersonal factors on walking. We used data from the Women's Health Initiative Seattle Center and linear regression models to estimate associations and interactions. Being white and healthy, having a high school education or beyond and greater non-walking exercise were significantly associated with more walking. Neighborhood walkability was not independently associated with greater walking, nor did it moderate influence of intrapersonal factors on walking. Specifying types of walking (e.g., for transportation) can elucidate the relationships among intrapersonal factors, the built environment, and walking.

Validity and reliability of the Chinese translation of the Physical Activity Scale for the Elderly (PASE)

PURPOSE

To translate and assess the reliability and validity of a Chinese version of the Physical Activity Scale for the Elderly (PASE).

METHODS

Participants included Chinese individuals >65 living in the community or assistive living facilities. At baseline, 73 subjects completed the translated PASE, and Chinese versions of three other scales to evaluate validity; the Timed-Up and Go (TUG), the Older American Resources Services Activities of Daily Living (OARS ADL), and the Activities Balance Confidence Scale (ABC). At follow-up, 66 subjects completed the PASE and a questionnaire to determine if there were any changes in health over the retest period.

RESULTS

The mean baseline PASE-C score was 76.0 (±49.1) at baseline and 78.33 (±50.27) at follow up. Correlations between the PASE-C and other variables were: age r = -0.51; TUG r = -0.52; OARS ADL r = 0.56 and ABC score r = 0.62. The retest reliability was ICC = 0.79 (95% confidence interval 0.68-0.86).

CONCLUSION

Our results indicate that the PASE-C has acceptable reliability and there is support for validity in the older Chinese population.

Pregnancy as a risk factor for ambulatory limitation in later life

OBJECTIVES

We investigated the relationship between the number of times a woman has been pregnant and walking difficulty in later life.

METHODS

With data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a representative population-based cohort of Mexican Americans aged 65 years and older residing in 5 Southwestern states, we measured walking difficulty using 2 items from the performance-oriented mobility assessments: the timed walk and seated chair rise.

RESULTS

We observed significantly higher rates of ambulatory limitation among women with 6 or more pregnancies than among women with 4 or fewer pregnancies: 44.9% and 27.0%, respectively, were unable to perform or performed poorly in the seated chair rise and timed walk. Ordinal logistic regression models show that gravidity predicts level of performance in both mobility tasks and that higher gravidity is associated with worse performance, even after adjustment for both age and chronic disease.

CONCLUSIONS

Gravidity is a risk factor for ambulatory limitation in old age. A life course approach to reproduction in public health research and practice is warranted.

The role of physical activity and diabetes status as a moderator: functional disability among older Mexican Americans

PURPOSE

we investigate the temporal association between the rate of change in physical function and the rate of change in disability across four comparison groups: Those with and without diabetes who report >30 min of physical activity per day, and those who report <30 min of physical activity per day.

METHODS

six waves of longitudinal data from the Hispanic Established Population for Epidemiologic Studies of the Elderly were utilised. At baseline, there were a total of 3,050 elder participants aged 65 years old or greater. The longitudinal rates of change in disability and physical function were compared by the diabetes status (ever versus none) and the physical activity status (less than or greater than or equal to 30 min per day).

RESULTS

disability and physical function data were analysed using a latent growth curve modelling approach adjusted for relevant demographic/health-related covariates. There were statistically significant longitudinal declines in physical function and disability (P < 0.001) in all groups. Most notable, the physical activity status was an important moderator. Those with >30 min of activity demonstrated better baseline function and less disability as well as better temporal trajectories than those reporting <30 min of physical activity per day. Comparisons between diabetes statuses within the same physical activity groups showed worse disability trajectories among those with diabetes.

CONCLUSIONS

a longitudinal decline in physical function and disability is moderated most notably by physical activity. The diabetes status further moderates decline in function and disability over time. Increased physical activity appears to be protective of disability in general and may lessen the influence of diabetes-related disability in older Mexican Americans, particularly at the end of life.

Impaired transcriptional activity of Nrf2 in age-related myocardial oxidative stress is reversible by moderate exercise training

Aging promotes accumulation of reactive oxygen/nitrogen species (ROS/RNS) in cardiomyocytes, which leads to contractile dysfunction and cardiac abnormalities. These changes may contribute to increased cardiovascular disease in the elderly. Inducible antioxidant pathways are regulated by nuclear erythroid 2 p45-related factor 2 (Nrf2) through antioxidant response cis-elements (AREs) and are impaired in the aging heart. Whereas acute exercise stress (AES) activates Nrf2 signaling and promotes myocardial antioxidant function in young mice (∼2 months), aging mouse (>23 months) hearts exhibit significant oxidative stress as compared to those of the young. The purpose of this study was to investigate age-dependent regulation of Nrf2-antioxidant mechanisms and redox homeostasis in mouse hearts and the impact of exercise. Old mice were highly susceptible to oxidative stress following high endurance exercise stress (EES), but demonstrated increased adaptive redox homeostasis after moderate exercise training (MET; 10m/min, for 45 min/day) for ∼6 weeks. Following EES, transcription and protein levels for most of the ARE-antioxidants were increased in young mice but their induction was blunted in aging mice. In contrast, 6-weeks of chronic MET promoted nuclear levels of Nrf2 along with its target antioxidants in the aging heart to near normal levels as seen in young mice. These observations suggest that enhancing Nrf2 function and endogenous cytoprotective mechanisms by MET, may combat age-induced ROS/RNS and protect the myocardium from oxidative stress diseases.

The Boston Rehabilitative Impairment Study of the Elderly: a description of methods

OBJECTIVES

To describe the methods of a longitudinal cohort study among older adults with preclinical disability. The study aims to address the lack of evidence guiding mobility rehabilitation for older adults by identifying those impairments and impairment combinations that are most responsible for mobility decline and disability progression over 2 years of follow-up.

DESIGN

Longitudinal cohort study.

SETTING

Metropolitan-based health care system.

PARTICIPANTS

Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks because of underlying health conditions.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Late Life Function and Disability Instrument (LLFDI) (primary outcome); Short Physical Performance Battery and 400-m walk test (secondary outcomes).

RESULTS

Among 7403 primary care patients identified as being potentially eligible for participation, 430 were enrolled. Participants have a mean age of 76.5 years, are 68% women, and have on average 4.2 chronic conditions. Mean LLFDI scores are 55.5 for Function and 68.9 and 52.3 for the Disability Limitation and Frequency domains, respectively.

CONCLUSIONS

Completion of our study aims will inform development of primary care-based rehabilitative strategies to prevent disability. Additionally, data generated in this investigation can also serve as a vital resource for ancillary studies addressing important questions in rehabilitative science relevant to geriatric care.

Resistance Training in Older Adults

Sarcopenia is associated with substantial health and economic consequences and is emerging as a major public health problem in the older population. The effects of sarcopenia may increase the risk for adverse health outcomes in older adults, and strategies need to be developed to maintain healthy aging. Although several intervention strategies have been proposed, resistance training (RT) has been suggested as the most effective stimulus for optimizing improvements in physical function and body composition with age. Although RT has been established as a safe and efficacious intervention for the prevention and treatment of sarcopenia, very few older adults regularly participate in RT programs. Community-based RT programs may be a feasible strategy because of their accessibility, cost-effectiveness, and lower-intensity training stimuli. However, the effects of these interventions on health outcomes in older adults have not been adequately reviewed. This report will describe the health effects associated with sarcopenia and summarize the major findings from community-based RT interventions on different health outcomes in older adults. Finally, it is suggested that all older adults who demonstrate the ability to safely participate in RT comply with the guidelines recommended by the American College of Sports Medicine.

Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: a randomised study

OBJECTIVE

Our main objective was to assess whether a home-based program supervised by home helpers (HH) during their normal working hours can prevent excessive sedentariness (mainly maximum walking time and distance) and preserve functional status in elderly people at risk for frailty or disability and using domestic services.

DESIGN

A four-month, open label, randomised trial with two groups called "prevention" and "control".

SETTING

In the homes of study participants.

PARTICIPANTS

The participants were all over 78 years old, lived independently at home, and received the visits of HHs at least once a week.

INTERVENTION

The intervention combined a self-administered exercise program, with 10 g amino-acid supplementation under the supervision of HHs.

MEASUREMENTS

Main outcome measures included physical activity (the PASE questionnaire), functional tests, nutritional and autonomy scores, and compliance (50% or more was considered satisfactory). Non-parametric methods were used for comparisons between the two groups. A linear regression model was fitted to assess the effect of the intervention on the relative variation of outcomes, adjusted for unbalanced baseline co-variables.

RESULTS

One hundred and two persons (prevention n=53, control n=49) with a median age of 85 years were included. Their median Activities of Daily Living and Instrumental Activities of Daily Living (IADL) scores were 6 and 7 respectively. Twenty-three (44%) were good compliers for both interventions. The maximum walking time remained stable while decreasing by 25% in the control group (p=0.0015); and fewer participants had a worsened IADL score in the prevention group (p=0.05). The baseline IADL Score was significantly associated with good compliance to the prevention program (p=0.0011). In good compliers, maximum walking distance and maximum walking time increased by 29.15% (0.0 to 66.7) and 33.3% (-20.0 to 50.0) respectively.

CONCLUSION

This study confirms the feasibility of a prevention program supervised by HHs, and some benefit from the intervention and identifies predictors for better compliance. It will help in the design of prevention trials for elderly people at risk for frailty.

Validity of an exercise test based on habitual gait speed in mobility-limited older adults

OBJECTIVE

To evaluate whether a customized exercise tolerance testing (ETT) protocol based on an individual's habitual gait speed (HGS) on level ground would be a valid mode of exercise testing older adults. Although ETT provides a useful means to risk-stratify adults, age-related declines in gait speed paradoxically limit the utility of standard ETT protocols for evaluating older adults. A customized ETT protocol may be a useful alternative to these standard methods, and this study hypothesized that this alternative approach would be valid.

DESIGN

We performed a cross-sectional analysis of baseline data from a randomized controlled trial of older adults with observed mobility problems. Screening was performed using a treadmill-based ETT protocol customized for each individual's HGS. We determined the content validity by assessing the results of the ETTs, and we evaluated the construct validity of treadmill time in relation to the Physical Activity Scale for the Elderly (PASE) and the Late Life Function and Disability Instrument (LLFDI).

SETTING

Outpatient rehabilitation center.

PARTICIPANTS

Community-dwelling, mobility-limited older adults (N=141).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Cardiac instability, ETT duration, peak heart rate, peak systolic blood pressure, PASE, and LLFDI.

RESULTS

Acute cardiac instability was identified in 4 of the participants who underwent ETT. The remaining participants (n=137, 68% female; mean age, 75.3 y) were included in the subsequent analyses. Mean exercise duration was 9.39 minutes, with no significant differences in durations being observed after evaluating among tertiles by HGS status. Mean peak heart rate and mean peak systolic blood pressure were 126.6 beats/min and 175.0 mmHg, respectively. Within separate multivariate models, ETT duration in each of the 3 gait speed groups was significantly associated (P<.05) with PASE and LLFDI.

CONCLUSIONS

Mobility-limited older adults can complete this customized ETT protocol, allowing for the identification of acute cardiac instability and the achievement of optimal exercise parameters.

Acute exercise stress activates Nrf2/ARE signaling and promotes antioxidant mechanisms in the myocardium

Oxidative stress has been implicated in the pathogenesis of cardiovascular diseases, including myocardial hypertrophy and infarction. Although impairment of antioxidant defense mechanisms has been thought to provoke oxidative stress-induced myocardial dysfunction, it has been difficult to clearly demonstrate. Nuclear erythroid 2 p45-related factor 2 (Nrf2) is a redox-sensitive, basic leucine zipper protein that regulates the transcription of several antioxidant genes. We previously reported that sustained activation of Nrf2 upregulates transcription of a number of endogenous antioxidants in the heart. Here, we show that acute exercise stress (AES) results in activation of Nrf2/ARE (antioxidant response element) signaling and subsequent enhancement of antioxidant defense pathways in wild-type (WT) mouse hearts, while oxidative stress, along with blunted defense mechanisms, was observed in Nrf2-/- mice. We also find that AES is associated with increased trans-activation of ARE-containing genes in exercised animals when compared to age-matched sedentary WT mice. However, enhanced oxidative stress in response to AES was observed in Nrf2-/- mice due to lower basal expression and marked attenuation of the transcriptional induction of several antioxidant genes. Thus, AES induces ROS and promotes Nrf2 function, but disruption of Nrf2 increases susceptibility of the myocardium to oxidative stress. Our findings suggest the basis for a nonpharmacological approach to activate Nrf2/ARE signaling, which might be a potential therapeutic target to protect the heart from oxidative stress-induced cardiovascular complications.

Occupational therapy intervention: effects on self-care, performance, satisfaction, self-esteem/self-efficacy, and role functioning of older Hispanic females with arthritis

ABSTRACT The purpose of this pilot study was to compare the effectiveness of occupation-based and enabling/preparatory interventions on self-care, perceived performance, satisfaction, self-efficacy, and role function among older Hispanic females with arthritis. A pre- and post-outcome measures design with semi-structured interview and questionnaire/rating scales was used with matched participants assigned to one of two intervention groups or a control, non-intervention group. For measures of task-specific functioning and self-efficacy, there were no statistically significant differences in average gain scores between the two interventions. Average gain scores were higher for the enabling/preparatory intervention than for the control group. For the occupational intervention, the scores were higher than for the control group for self-care/activities of daily living (ADL) functioning and self-esteem/self-efficacy. The results suggest that client-centered occupational therapy intervention provided within the home environment is beneficial for occupational performance, participation, role competence, and quality of life.

Performance-based versus patient-reported physical function: what are the underlying predictors?

BACKGROUND

Functional limitations have been operationally defined for studies of rehabilitation science through measures of physical performance and patient-reported function. Although conceived as representing similar concepts, differences between these 2 modes of measuring physical functioning have not been adequately characterized scientifically.

OBJECTIVE

The purpose of this study was to compare the Short Physical Performance Battery (SPPB) with the function component of the Late-Life Function and Disability Instrument (LLFDI) with respect to their association with physiologic factors and other psychosocial and health factors potentially influencing rehabilitative care.

DESIGN

This study was a cross-sectional analysis of baseline data from a sample of community-dwelling older adults (N=137) with mobility limitations enrolled in a randomized controlled trial of exercise.

METHODS

A performance-based measure of function (the SPPB) and a self-report measure of function (the LLFDI) served as functional outcomes. Physiologic factors included measures of leg strength, leg velocity, and exercise tolerance test (ETT) duration, which served as a surrogate measure of aerobic capacity. Psychosocial and health factors included age, sex, height, body mass index, number of chronic conditions, depression, and falls efficacy.

RESULTS

Separate multivariable regression models predicting SPPB and LLFDI scores described 33% and 42% of the variance in each outcome (R(2)), respectively. Leg velocity and ETT duration were positively associated with both performance-based and patient-reported functional measures. Leg strength and age were positively associated with SPPB scores, whereas number of chronic conditions, sex, and falls efficacy were associated with the LLFDI scores.

LIMITATIONS

This study included older adults with mobility limitations and may not generalize to other populations.

CONCLUSIONS

Performance-based and patient-reported measures of physical function appear to assess different aspects of an older person's functioning. The SPPB was associated with age and physiologic factors, whereas patient-reported function measured by the LLFDI was associated with these factors as well as with psychosocial and health factors.

Experiences of a high-intensity functional exercise programme among older people dependent in activities of daily living

The purpose of this qualitative study was to describe the experience of participating in a high-intensity functional exercise programme among older people dependent in activities of daily living (ADL) and living in residential care facilities. Interviews were conducted with nine older people, aged 73-91, and dependent in ADL who had participated in a high-intensity functional exercise programme. Qualitative content analysis was used in analysing the interviews. The findings show that the informants, despite extensive impairments, multiple diagnoses, and advanced age, displayed a belief in the positive effects of the programme, a strong desire to be active, and the will to strive to avoid further loss of capacity. They were struggling with failing bodies that constituted barriers to exercise. Support from the supervisors and belief in personal success facilitated performance of the exercises. The informants related physical and mental improvements that affected their daily life positively and that exercising in a group was stimulating and created a sense of togetherness. The effort was seen as worthwhile because participating in strenuous exercise could imply that they might overcome bodily limitations to achieve increased vitality and improved quality of life.

A randomized controlled trial to investigate the effects of water-based exercise to improve falls risk and physical function in older adults with lower-extremity osteoarthritis

OBJECTIVE

To investigate the efficacy of a water-based exercise program specifically targeting balance to reduce falls risk and improve measures of balance and physical function in older adults with osteoarthritis (OA).

DESIGN

Randomized controlled trial.

SETTING

Community.

PARTICIPANTS

Persons (N=39; mean±SD age, 74±6y; 26 women) with mild to moderate OA and at risk for falling met study criteria, were measured at baseline, and were randomly assigned to the intervention (n=23) and control groups (n=16).

INTERVENTIONS

Water-based program (12wk, twice weekly; intervention group) or a time-matched computer training program (control group).

MAIN OUTCOME MEASURE

The primary outcome was the short-form Physiological Profile Assessment (PPA). Secondary outcomes included the Step Test, Timed Up and Go Test, Western Ontario and McMaster Universities OA Index (Likert 3.0 version), Arthritis Impact Measurement Scales 2, and Activity-specific Balance Confidence Scale.

RESULTS

No statistically significant between-group differences were found for any outcome measured (n=35; 4 lost to follow-up). Within-group analysis indicated that Step Test results improved significantly in both groups (mean change: control group, left leg, 2.07; 95% confidence interval, 3.19-.95; P=.002; intervention group, 2.14; 95% confidence interval, 3.20-1.08; P=.000). Two PPA item scores (reaction time, contrast sensitivity) improved significantly (86.83; 95% confidence interval, 9.86-163.79; P=.03; 1.43; 95% confidence interval, 2.35-.50; P=.005, respectively) in the control group, resulting in a lower falls risk score.

CONCLUSIONS

Water-based exercise did not reduce falls risk in our sample compared with attending a computer skills training class. Our study is, to our knowledge, the first to compare water-based exercise in this population with a control group that attended a time-dose-equivalent seated community-based activity. Whether gaining computer skills and going out into the community twice weekly is adequate stimulus to reduce falls risk in people with OA requires further investigation.

Older patient-physician discussions about exercise

This cross-sectional observational study examined the frequency of older patient-physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician's being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.

Benefits of home-based rocking-chair exercise for physical performance in community-dwelling elderly women: a randomized controlled trial

BACKGROUND AND AIMS

Home-based exercise is a viable alternative for older adults with difficulties in exercise opportunities outside the home. The aim of this study was to investigate the benefits of home-based rocking-chair training, and its effects on the physical performance of elderly women.

METHODS

Community- dwelling women (n=51) aged 73-87 years were randomly assigned to the rocking-chair group (RCG, n=26) or control group (CG, n=25) by drawing lots. Baseline and outcome measurements were hand grip strength, maximal isometric knee extension, maximal walking speed over 10 meters, rising from a chair five times, and the Berg Balance Scale (BBS). The RCG carried out a six-week rocking-chair training program at home, involving ten sessions per week, twice a day for 15 minutes per session, and ten different movements. The CG continued their usual daily lives. After three months, the RCG responded to a mail questionnaire.

RESULTS

After the intervention, the RCG improved and the CG declined. The data showed significant interactions of group by time in the BBS score (p=0.001), maximal knee extension strength (p=0.006) and maximal walking speed (p=0.046), which indicates that the change between groups during the follow-up period was significant. Adherence to the training protocol was high (96%). After three months, the exercise program had become a regular home exercise habit for 88.5% of the subjects.

CONCLUSIONS

Results indicate that home-based elderly women benefit from this easily implemented rocking-chair exercise program. The subjects became motivated to participate in training and continued the exercises. This is a promising alternative exercise method for maintaining physical activity and leads to improvements in physical performance.

Design of an Ankle Rehabilitation Device Using Compliant Mechanisms

In this paper, we present the design, analysis, and testing of an ankle rehabilitation device (ARD), the purpose of which is to improve the efficacy of ankle joint complex (AJC) injury diagnosis and treatment. The ARD enables physicians to quantitatively measure the severity of an injury. This is done by measuring deficiencies in the joint’s range of motion, as well as force, torque, and power output. Evaluation of the relative degree of recovery over time can also reduce the error associated with current methodologies for rehabilitation, which rely on measurements based on the patient’s verbal response. A Wheatstone bridge circuit is used for the measurement of the various parameters as applied to the blades of complementary rotational flexures; the device is designed to measure motion about three axes of rotation in the ankle joint: pitch, roll, and yaw. A full bridge circuit is applied to each axis of rotation, and the use of multiple axes increases anatomically accurate measurement, enabling characterization of coupled motions. The device has flexibility and a range of motion such that it can be adjusted to take measurements of multiple different degrees of plantar or dorsiflexion of the AJC. The ARD is able to measure both range of motion, force, and torque output simultaneously. Experimental results show that there is significant coupled motion among the ankle joint rotations but that it is highly dependent on a subject’s own physical development.

Adverse events reported in progressive resistance strength training trials in older adults: 2 sides of a coin

OBJECTIVES

To summarize adverse events reported in randomized controlled trials that applied progressive resistance strength training in older adults and to examine factors that might be associated with these events.

DESIGN

After systematic searches of databases, 2 reviewers independently screened and extracted adverse event-related information from identified trials.

SETTING

Not applicable.

PARTICIPANTS

Older adults 60 years of age and above (N = 6700).

INTERVENTION

Muscle strength training exercise that increases load gradually.

MAIN OUTCOME MEASURES

Adverse events and reasons for dropout. Adverse events include any undesirable outcomes that may be directly related or unrelated to the intervention.

RESULTS

Among 121 trials identified, 53 trials provided no comments about adverse events, 25 trials reported no adverse events occurred, and 43 trials reported some types of adverse events. Most adverse events reported were musculoskeletal problems such as muscle strain or joint pain. Adverse events were reported more often in trials that recruited participants with certain health conditions, functional limitations, or sedentary lifestyle; in trials that applied high intensity; and in trials that were published after the 2001 Consolidated Standards of Reporting Trials statement had been published. Reasons reported for dropout in 58 trials might be related to adverse events. The most frequent reasons for dropout were illness or medical problems.

CONCLUSIONS

Adverse events may be underreported because there is no consensus on the definition. Reporting adverse events associated with progressive resistance strength training in older adults is informative for practitioners to translate clinical research to clinical practice by knowing both the benefits and risks. Future trials should clearly define adverse events and report them in the published article.

An investigation into the personal financial costs associated with stuttering

Stuttering has been found to deteriorate quality of life in psychological, emotional and social functioning domains. It is reasonable to assume then that stuttering would also be associated with economic consequences that may also challenge quality of life. Remarkably, the personal financial costs associated with stuttering in adults has rarely if ever been explored or investigated in the fluency disorders field. This study involved an assessment of the personal costs of stuttering and an investigation into determinants that may influence spending. Two hundred adults who stutter participated in this study. Findings indicated that the average total cost was around $5,500 (median cost $4,165) in 2007/08 Australian dollars over a 5-year period. Major financial items included costs of direct and indirect treatments for stuttering, self-help, stuttering related conferences, and technology. Financial costs were not significantly influenced by the sex of the person, annual income, or by how severe the person stuttered. However, those individuals younger than 60 years old spent significantly more on treatment related costs, while those with elevated levels of social anxiety spent significantly less than those with lower levels of social anxiety. Quality of life implications associated with stuttering are discussed.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) describe the method for assessing the direct financial costs of stuttering over a 5-year period; (b) describe the financial personal cost of stuttering for adults who stutter; (c) describe the relationship between factors like sex, age, severity of stuttering and financial costs; and (d) describe the relationship between social anxiety and the financial cost of stuttering.

The impact of self-reported arthritis and diabetes on response to a home-based physical activity counselling intervention

OBJECTIVES

Physical activity (PA) has the potential to improve outcomes in both arthritis and diabetes, but these conditions are rarely examined together. Our objective was to explore whether persons with arthritis alone or those with both arthritis and diabetes could improve amounts of PA with a home-based counselling intervention.

METHODS

As part of the Veterans LIFE (Learning to Improve Fitness and Function in Elders) Study, veterans aged 70-92 were randomized to usual care or a 12-month PA counselling programme. Arthritis and diabetes were assessed by self-report. Mixed models were used to compare trajectories for minutes of endurance and strength training PA for persons with no arthritis (n = 85), arthritis (n = 178), and arthritis plus diabetes (n = 84).

RESULTS

Recipients of PA counselling increased minutes of PA per week independent of disease status (treatment arm by time interaction p < 0.05 for both; endurance training time p = 0.0006 and strength training time p < 0.0001). Although PA was lower at each wave among persons with arthritis, and even more so among persons with arthritis plus diabetes, the presence of these conditions did not significantly influence response to the intervention (arthritis/diabetes group x time interactions p > 0.05 for both outcomes) as each group experienced a nearly twofold or greater increase in PA.

CONCLUSIONS

A home-based PA intervention was effective in increasing minutes of weekly moderate intensity endurance and strength training PA in older veterans, even among those with arthritis or arthritis plus diabetes. This programme may serve as a useful model to improve outcomes in older persons with these pervasive diseases.

Similarity of joint kinematics and muscle demands between elliptical training and walking: implications for practice

BACKGROUND

People with physical disabilities often face barriers to regaining walking ability and fitness after discharge from rehabilitation. Physical therapists are uniquely positioned to teach clients the knowledge and skills needed to exercise on functionally relevant equipment available in the community, such as elliptical trainers. However, therapeutic use is hindered by a lack of empirical information.

OBJECTIVE

The purpose of this study was to examine joint kinematics and muscle activation recorded during walking and elliptical training to provide evidence-based data to guide clinical decision making.

DESIGN

This was a prospective, controlled laboratory study using a repeated-measures design.

METHODS

Twenty adults free from impairments that might hinder gait participated. After familiarization procedures, subjects walked and trained on 4 elliptical devices while kinematic, electromyographic (EMG), and stride characteristic data were recorded.

RESULTS

Movement similarities between elliptical training and walking were supported by the documentation of relatively high coefficients of multiple correlation for the hip (.85-.89), thigh (.92-.94), knee (.87-.89) and, to a lesser extent, the ankle (.57-.71). Significantly greater flexion was documented at the trunk, pelvis, hip, and knee during elliptical training than during walking. One of the elliptical trainers most closely simulated sagittal-plane walking kinematics, as determined from an assessment of key variables. During elliptical training, gluteus maximus and vastus lateralis muscle activation were increased; medial hamstring, gastrocnemius, soleus, and tibialis anterior muscle activation were decreased; and gluteus medius and lateral hamstring muscle activation were relatively unchanged compared with muscle activation of those muscles in walking. On the basis of EMG findings, no elliptical trainer clearly emerged as the best for simulating gait.

LIMITATIONS

To date, only 4 elliptical trainers have been studied, and the contributions of the upper extremities to movement have not been quantified.

CONCLUSIONS

Although one of the elliptical trainers best simulated sagittal-plane walking kinematics, EMG analysis failed to identify one clearly superior device. This research provides evidence-based data to help guide clinical decision making related to the use of elliptical trainers across the health care continuum and into the community.

Trunk muscle attributes are associated with balance and mobility in older adults: a pilot study

OBJECTIVE

To determine whether trunk muscle attributes are associated with balance and mobility performance among mobility-limited older adults.

DESIGN

Cross-sectional analysis of data from a randomized clinical trial.

SETTING

Outpatient rehabilitation research center.

PARTICIPANTS

Community-dwelling older adults (N = 70; mean age 75.9 years) with mobility limitations as defined by the Short Physical Performance Battery (SPPB).

METHODS

Independent variables included physiologic measures of trunk extension strength, trunk flexion strength, trunk extension endurance, trunk extension endurance, and leg press strength. All measures were well tolerated by the study subjects without the occurrence of any associated injuries or adverse events. The association of each physiologic measure with each outcome was examined by the use of separate multivariate models to calculate the partial variance (R(2)) of each trunk and extremity measure.

MAIN OUTCOME MEASUREMENTS

Balance measured by the Berg Balance Scale and Unipedal Stance Test and mobility performance as measured by the SPPB.

RESULTS

Trunk extension endurance (partial R(2) = .14, P = .02), and leg press strength (partial R(2) = .14, P = .003) accounted for the greatest amount of the variance in SPPB performance. Trunk extension endurance (partial R(2) = .17, P = .007), accounted for the greatest amount of the variance in BBS performance. Trunk extension strength (R(2) = .09, P = .03), accounted for the greatest amount of the variance in UST performance. The variance explained by trunk extension endurance equaled or exceeded the variance explained by limb strength across all three performance outcomes.

CONCLUSIONS

Trunk endurance and strength can be safely measured in mobility-limited older adults and are associated with both balance and mobility performance. Trunk endurance and trunk strength are physiologic attributes worthy of targeting in the rehabilitative care of mobility-limited older adults.

Physical activity and cognitive health

BACKGROUND

The industrialized nations are experiencing a demographic revolution due to the continuing increase in longevity and the rapid rise in the percentage of the population over 65 years old. Interventions that promote healthy aging will continue to gain significance as efforts to delay disability and loss of function intensify.

METHODS

Since physical activity has been implicated in promoting healthy aging, here we review a large body of research that examines physical activity and cognitive health. Specifically, we focus on the associations of physical activity with cognitive function and dementia, including prevention, delay or slowing down of disease progression. Thus, we have prepared a descriptive review of the literature including various types of publications, prospective cohort, case-control, clinical trial and meta-analysis papers, published since 1999 in peer-reviewed journals.

RESULTS

Based on currently available data, we conclude that the relative risk of cognitive decline with aging may diminish in individuals who are physically active; however, this has not been definitively demonstrated thus far.

CONCLUSIONS

Further research is needed to determine conclusively the effects of physical activity on cognitive function and dementia and to elucidate the basis for this linkage.

Focus groups to explore the perceptions of older adults on a pedometer-based intervention

Focus group methodology was used to explore in depth the perceptions of older adults who had participated in a 12-week pedometer-based intervention. Nineteen women and 8 men, ages 55-86 years, volunteered to take part in the focus groups following participation in the intervention. Four focus groups of six to eight participants were scheduled at primary sites in the southern Maine area. Analysis of the data revealed four specific topical areas: (a) factors that led to increases in daily step count, (b) factors that hindered increases in daily step count, (c) benefits of pedometer intervention program, and (d) recommendations on how to improve older adults' physical activity. Overall, focus group participants found this intervention to be beneficial and recommended its expansion to other groups.

Predictors of long-term exercise adherence in a community-based sample of older women

BACKGROUND

Few studies have examined long-term exercise adherence in older women. The purpose of this study was to assess predictors of adherence to an intervention involving walking and balance exercises.

METHODS

This was a randomized controlled trial with 2-year follow-up. Sedentary women (n = 137) aged > or =70 randomized to the exercise intervention were evaluated in their homes. The exercise prescription included walking 30 minutes per day 5 days per week and completing 11 balance exercises twice per week. The main outcome measure was exercise adherence of the intervention group only.

RESULTS

The average number of minutes walked per week was 95.2 (SD 68.8); 17% walked the recommended 150 minutes or greater. The average number of times the balance exercises were done was 1.5 (SD 1.6) per week. Results of regression analysis for walking adherence showed clinical variables accounted for the greatest variance (17%) of all the blocks, and cognitive variables were second highest (12%). The final model explained 19% of the variance in predicting adherence to walking. Results of regression analysis for adherence to balance exercises showed health-related quality of life (HRQOL) variables accounted for the greatest variance (14%), followed by cognitive variables (12%). The final model explained 24% of the variance in predicting adherence to balance exercises.

CONCLUSIONS

Adherence to exercise was below recommended goals, although this study demonstrated that sedentary women can adopt and continue regular exercise long term. Predictors of adherence varied with different forms of exercise. Individually tailored exercise interventions may be most amenable to older women.

Exercise activates redox-sensitive transcription factors and restores renal D1 receptor function in old rats

We have previously reported that age-associated oxidative stress via protein kinase C (PKC) increases D1 receptor (D1R) phosphorylation and causes D1R-G protein uncoupling in renal proximal tubules (RPTs) of old Fischer 344 rats. This results in reduced ability of D1R agonist SKF-38393 to inhibit Na+-K+-ATPase in RPTs of old rats. Here, we studied the effect of treadmill exercise on markers of oxidative stress, PKC, D1R phosphorylation, D1R-G protein coupling, and Na+-K+-ATPase activity in RPTs of adult and old rats. We found increased levels of malondialdehyde, a marker of oxidative stress, in RPTs of old rats, which decreased during exercise. Nuclear levels of nuclear erythroid-related factor (Nrf)-2 and nuclear factor (NF)-kappaB in RPTs, transcription factors involved in antioxidant enzyme gene transcription, increased in exercised old rats. This was accompanied by an increase in the activity and expression of antioxidant enzymes, superoxide dismutase and heme oxygenase-1. Age-related decrease in the levels of D1R mRNAs and proteins was attenuated during exercise. Furthermore, exercise in old rats decreased PKC activity and D1R phosphorylation and increased SKF-38393-mediated [35S]guanosine 5'-O-(3-thiotriphosphate) binding (an index of D1R-G protein coupling). SKF-38393 also caused inhibition of Na+-K+-ATPase in these animals. Also, exercise caused a decrease in proteinuria and increase in phosphaturia in old rats. These results suggest beneficial effects of exercise in terms of increasing antioxidant defenses, decreasing oxidative stress, and improving kidney function in general and D1R function in particular in aging. Both Nrf-2 and NF-kappaB seem to play key role in this phenomenon.

Feasibility and Effectiveness of a Walking Program for Community-Dwelling Older Adults with Mild Cognitive Impairment

This study examined the feasibility and effect on aerobic fitness of a 1-yr, twice-weekly, group-based moderate-intensity walking program (MI-WP,n= 77) compared with a low-intensity activity program (LI-AP,n= 75) for community-dwelling older adults with mild cognitive impairment (MCI). Thirty participants did not start a program; median attendance in the other 122 participants was 71%. Small but significant associations were observed between attendance and memory in the MI-WP and general cognition in the LI-AP. Associations were no longer significant when both groups were analyzed together. Intensity, assessed using percentage of heart-rate reserve and the Borg scale, equaled intended intensity for both programs. Aerobic fitness improved significantly in participants in the MI-WP. In conclusion, cognition was not clearly associated with attendance in the 62 participants starting the MI-WP, and average attendance was good. The intensity was feasible for participants who continued the MI-WP. The findings support the proposal that regular moderate-intensity walking improves aerobic fitness in adults with MCI.

A framework for managing wandering and preventing elopement

PURPOSE OF THE STUDY

A framework aids choice of interventions to manage wandering and prevent elopement in consideration of associated risks and mobility needs of wanderers.

DESIGN AND METHODS

A literature review, together with research results, published wandering tools, clinical reports, author clinical experience, and consensus-based judgments was used to build a decision-making framework.

RESULTS

Referencing a published definition of wandering and originating a clinical description of problematic wandering, authors introduce a framework comprising (1) wandering and related behaviors; (2) goals of wandering-specific care, (3) interpersonally, technologically, and policy-mediated wandering interventions, and (4) estimates of relative frequencies of wandering behaviors, magnitudes of elopement risk, and restrictiveness of strategies.

IMPLICATIONS

Safeguarding wanderers from elopement risk is rendered person-centered and humane when goals of care guide intervention choice. Despite limitations, a reasoned, systematized approach to wandering management provides a basis for tailoring a specialized program of care. The need for framework refinement and related research is emphasized.

Are rural older Icelanders less physically active than those living in urban areas? A population-based study

BACKGROUND

Older people in rural areas have been labelled as physically inactive on the basis of leisure-time physical activity research. However, more research is needed to understand the total physical activity pattern in older adults, considering all domains of physical activity, including leisure, work, and domestic life.

AIMS

We hypothesised that: (a) total physical activity would be the same for older people in urban and rural areas; and (b) urban and rural residency, along with gender and age, would be associated with differences in domain-specific physical activities.

METHODS

Cross-sectional data were collected in Icelandic rural and urban communities from June through to September 2004. Participants were randomly selected, community-dwelling, 65-88 years old, and comprised 68 rural (40% females) and 118 urban (53% females) adults. The Physical Activity Scale for the Elderly (PASE) was used to obtain a total physical activity score and subscores in leisure, during domestic life, and at work.

RESULTS

The total PASE score was not associated with rural vs. urban residency, but males were, in total, more physically active than females, and the 65-74-year-olds were more active than the 75-88-year-olds. In the leisure domain, rural people had lower physical activity scores than urban people. Rural males were, however, most likely of all to be physically active in the work domain. In both urban and rural areas, the majority of the physical activity behaviour occurred in relation to housework, with the rural females receiving the highest scores.

CONCLUSIONS

Older Icelanders in rural areas should not be labelled as less physically active than those who live in urban areas. Urban vs. rural living may, however, influence the physical activity patterns among older people, even within a fairly socioeconomically and culturally homogeneous country such as Iceland. This reinforces the need to pay closer attention to the living environment when studying and developing strategies to promote physical activity.

Wearable systems for monitoring mobility-related activities in older people: a systematic review

OBJECTIVE

The use of wearable motion-sensing technology offers important advantages over conventional methods for obtaining measures of physical activity and/or physical functioning in aged individuals. This review aims to identify the actual state of applying wearable systems for monitoring mobility-related activity in older populations. In this review we focus on technologies and applications, research designs, feasibility and adherence aspects, and clinical relevance of wearable motion-sensing technology.

DATA SOURCES

PubMed (MEDLINE since 1990), Ovid (BIOSIS, CINAHL), and Cochrane (Central) and reference lists of all relevant articles were searched.

REVIEW METHODS

Two authors independently reviewed randomized and non-randomized trials on people above 65 years systematically. Quality of selected articles was scored and study results were summarised and discussed.

RESULTS

Two hundred and twenty-seven abstracts were considered. After application of inclusion criteria and full text reading, 42 articles were taken into account in a full text review. Twenty of these papers evaluated walking with step counters, other papers used varying accelerometry approaches for obtaining overall activity measures (n = 16), or for monitoring changes in body postures and activity patterns (n = 17). Seven studies explicitly mentioned feasibility and/or adherence aspects. Eight studies presented outcome evaluations of interventions. Eight articles were representing descriptive research designs, three articles were using mixed descriptive and exploratory research designs, 23 articles used exploratory research-type designs, and eight articles used experimental research designs.

CONCLUSION

Although feasible methods for monitoring human mobility are available, evidence-based clinical applications of these methods in older populations are in need of further development.

Interventions to prevent disability in frail community-dwelling elderly: a systematic review

Background

There is an interest for intervention studies aiming at the prevention of disability in community-dwelling physically frail older persons, though an overview on their content, methodological quality and effectiveness is lacking.

Methods

A search for clinical trials involved databases PubMed, CINAHL and Cochrane Central Register of Controlled Trials and manually hand searching. Trials that included community-dwelling frail older persons based on physical frailty indicators and used disability measures for outcome evaluation were included. The selection of papers and data-extraction was performed by two independent reviewers. Out of 4602 titles, 10 papers remained that met the inclusion criteria. Of these, 9 were of sufficient methodological quality and concerned 2 nutritional interventions and 8 physical exercise interventions.

Results

No evidence was found for the effect of nutritional interventions on disability measures. The physical exercise interventions involved 2 single-component programs focusing on lower extremity strength and 6 multi-component programs addressing a variety of physical parameters. Out of 8 physical exercise interventions, three reported positive outcomes for disability. There was no evidence for the effect of single lower extremity strength training on disability. Differences between the multi-component interventions in e.g. individualization, duration, intensity and setting hamper the interpretation of the elements that consistently produced successful outcomes.

Conclusion

There is an indication that relatively long-lasting and high-intensive multicomponent exercise programs have a positive effect on ADL and IADL disability for community-living moderate physically frail older persons. Future research into disability prevention in physical frail older persons could be directed to more individualized and comprehensive programs.

Leg strength or velocity of movement: which is more influential on the balance of mobility limited elders?

OBJECTIVE

To determine which component of leg power (maximal limb strength or limb velocity) is more influential on balance performance in mobility limited elders.

DESIGN

In this cross-sectional analysis we evaluated 138 community-dwelling older adults with mobility limitation. Balance was measured using the Unipedal Stance Test, the Berg Balance Test (BERG), the Dynamic Gait Index, and the performance-oriented mobility assessment. We measured one repetition maximum strength and power at 40% one repetition maximum strength, from which velocity was calculated. The associations between maximal estimated leg strength and velocity with balance performance were examined using separate multivariate logistic regression models.

RESULTS

Strength was found to be associated [odds ratio of 1.06 (95% confidence interval, 1.01-1.11)] with performance on the Unipedal Stance Test, whereas velocity showed no statistically significant association. In contrast, velocity was consistently associated with performance on all composite measures of balance (BERG 14.23 [1.84-109.72], performance-oriented mobility assessment 33.92 [3.69-312.03], and Dynamic Gait Index 35.80 [4.77-268.71]). Strength was only associated with the BERG 1.08 (1.01-1.14).

CONCLUSIONS

Higher leg press velocity is associated with better performance on the BERG, performance-oriented mobility assessment, and Dynamic Gait Index, whereas greater leg strength is associated with better performance on the Unipedal Stance Test and the BERG. These findings are likely related to the intrinsic qualities of each test and emphasize the relevance of limb velocity.

Which impairments are most associated with high mobility performance in older adults? Implications for a rehabilitation prescription

OBJECTIVE

To test which rehabilitative impairments are associated with higher mobility performance among community-dwelling, mobility-limited older adults.

DESIGN

Cross-sectional analysis of baseline data from participants within a randomized controlled trial.

SETTING

Outpatient rehabilitation research center.

PARTICIPANTS

Community-dwelling older adults (N=138; mean age, 75.4 y) with mobility limitations as defined by the Short Physical Performance Battery (SPPB).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Balance measured via the Berg Balance Scale, leg strength, leg velocity, submaximal aerobic capacity, body mass index (BMI), and mobility performance as measured by the SPPB.

RESULTS

Each of the 5 physiologic attributes (unipedal balance, leg strength, leg velocity, submaximal aerobic capacity, BMI) was categorized into tertiles by using lower values as reference for impairment status. Within an adjusted model, measures associated with higher SPPB performance (>9) included a BBS score greater than or equal to 54 (odds ratio [OR]=4.54; 95% confidence interval [CI], 1.11-18.60), leg strength greater than or equal to 21.5 N/kg (OR=30.35; 95% CI, 5.48-168.09), leg velocity .0101 to .0129 m.s(-1).kg(-1) (OR=5.31; 95% CI, 1.25-22.57), and leg velocity greater than or equal to .0130 m.s(-1).kg(-1) (OR=22.86; 95% CI, 3.88-134.75).

CONCLUSIONS

Our investigation highlights the importance of rehabilitative impairments in leg strength, leg velocity, and balance as being associated with mobility status as measured by the SPPB. In our sample of participants within an exercise trial, submaximal aerobic capacity and BMI status were not associated with mobility performance. These findings suggest that the augmentation of not only leg strength and balance but also leg velocity may be important in the rehabilitative care of mobility-limited older adults.

Cardiovascular aging and exercise in healthy older adults

OBJECTIVE

Physical inactivity in an aging population is a major contributing factor to the rising numbers of older persons with chronic illnesses and disabilities. The purpose of this article is to review the relationship between physical inactivity and age-associated changes to the cardiovascular system, and provide guidance on prescribing exercise to healthy older persons in order to mitigate the adverse effects of cardiovascular aging.

DESIGN

Interpretive review of the literature.

RESULTS

A number of structural and functional changes occur in the cardiovascular system with advancing age, many of which are mediated by changes in vascular stiffness. These changes lead not only to cardiovascular events and strokes, but also to frailty, functional decline, and cognitive impairment. A substantial proportion of the decline in aerobic capacity with age may result from physical inactivity. Guidelines for the prescription of aerobic, resistance, and balance training for otherwise healthy older persons are provided.

CONCLUSIONS

Lack of physical activity is a major risk factor for the epidemic of chronic disease and disability facing an aging population. Many age-associated changes in cardiovascular function result from physical inactivity. The benefits of regular exercise include prevention of cardiovascular events, disability, and cognitive impairment. Age is not a contraindication to exercise, which can usually be initiated safely in older persons.

Physical function, physical activity and recent falls. Results from the "Invecchiamento e Longevità nel Sirente (ilSIRENTE)" Study

BACKGROUND AND AIMS

A fall is a common and traumatic event in the life of older persons. This study aims: 1) to explore the relationship between recent falls and measures of physical function in elders, and 2) to examine the role played by habitual physical activity in the relationship between recent falls and physical function.

METHODS

We used baseline data from 361 community-dwelling persons aged > or = 80 years (mean age 85.9 yrs) enrolled in the "Invecchiamento e Longevità nel Sirente (ilSIRENTE)" study. Physical performance was assessed using the Short Physical Performance Battery (SPPB) and usual gait speed. Muscle strength was measured by hand grip strength. Functional status was assessed by the Basic (ADL) and Instrumental Activities of Daily Living (IADL) scales. Self-reported recent falls over the previous three months were recorded. Analyses of covariance were performed to evaluate the relationship between recent fall events and physical function measures.

RESULTS

Fifty participants (13.9%) reported at least one recent fall. Physically active participants had fewer falls and significantly higher physical function compared with sedentary subjects, regardless of recent falls. Significant interactions for physical activity were found in the relationships of usual gait speed and SPPB with recent fall history (p for interaction terms <0.01). A difference in usual gait speed and SPPB according to history of recent falls was found only in physically active subjects.

CONCLUSIONS

Physical performance measures are negatively associated with recent falls in physically active, but not sedentary, participants. Physical activity is associated with better physical function, independently of recent fall history.

Regular vigorous physical activity and disability development in healthy overweight and normal-weight seniors: a 13-year study

OBJECTIVES

We examined the relationship of regular exercise and body weight to disability among healthy seniors.

METHODS

We assessed body mass index (BMI) and vigorous exercise yearly (1989-2002) in 805 participants aged 50 to 72 years at enrollment. We studied 4 groups: normal-weight active (BMI< 25 kg/m(2); exercise> 60 min/wk); normal-weight inactive (exercise<or= 60 min/wk); overweight active (BMI>or= 25 kg/m(2)); and overweight inactive. Disability was measured with the Health Assessment Questionnaire (0-3; 0= no difficulty, 3= unable to do). We used multivariable analysis of covariance to determine group differences in disability scores after adjustment for determinants of disability.

RESULTS

The cohort was 72% men and 96% White, with a mean age of 65.2 years. After 13 years, overweight active participants had significantly less disability than did overweight inactive (0.14 vs 0.19; P= .001) and normal-weight inactive (0.22; P= .03) participants. Similar differences were found between normal-weight active (0.11) and normal-weight inactive participants (P< .001).

CONCLUSIONS

Being physically active mitigated development of disability in these seniors, largely independent of BMI. Public health efforts that promote physically active lifestyles among seniors may be more successful than those that emphasize body weight in the prevention of functional decline.

Exercise, aging, and cancer

Cancer is a common disease that affects over 150 000 Canadians every year. About 78% of all cancers are diagnosed in adults aged 60 years and older. Improved survival rates for cancer survivors have brought lifestyle and quality of life issues to the forefront. In other chronic disease populations, exercise is considered a foundational health behavior; however, the benefits of exercise in cancer survivors are only beginning to be described. Moreover, what little is known about exercise in cancer survivors has been derived largely from research on middle-aged survivors. In the present article, we review the literature on exercise, aging, and cancer. Our review shows that very few studies have examined exercise in older cancer survivors or have approached the topic from an aging perspective. The limited research that is available suggests that, compared with middle-aged cancer survivors, older cancer survivors: (i) derive similar benefits from exercise, (ii) have lower exercise participation rates, (iii) have more difficulty adhering to an exercise program, and (iv) have different determinants of exercise motivation and behavior. We end by offering some future research directions that may help generate important new exercise knowledge in this underserved cancer survivor population.

Physical activity and the elderly

Functional ageing processes are characterized by a loss of performance capabilities regarding coordination, flexibility, strength, speed, and endurance. The effects of ageing processes on the cardiovascular system and skeletal muscle are the foci of attention. After age 30, the maximum aerobic dynamic performance capacity decreases by an average of 8% per decade. The causes are mainly a reduction in the maximum cardiac output and decreases in capillarization and in the skeletal muscle mass. An improvement in the maximum oxygen uptake by 18% and in the aerobic-anaerobic threshold by 22% was achieved in untrained men aged 55-70 years, in a 12-week-long bicycle ergometer-training programme. The strength of the skeletal muscle decreases particularly after 50-60 years of age. The main cause is the reduction in the number of motor units and muscle fibres. Further, modifications of the endothelial function and the development of sarcopenia are of particular importance in ageing processes. General aerobic dynamic training can improve the endothelial function in old age and thus help prevent cardiovascular diseases. Strength training is most appropriate for the prevention of sarcopenia. Imaging techniques over the last 20 years have provided new findings on the influence and the significance of physical activity on the brain. We call this new interdisciplinary area 'Exercise Neuroscience'. Demands on coordination and aerobic dynamic endurance are suitable in counteracting age-related neuronal cellular loss, synapsis hypotrophy, and in improving neurogenesis and capillarization. Adjusted physical activity is thus capable of counteracting age-related changes and performance loss not only in the cardiovascular system but also in the brain.